Burden of non-communicable diseases in sub-Saharan Africa, 1990-2017: results from the Global Burden of Disease Study 2017
Burden of non-communicable diseases in sub-Saharan Africa, 1990-2017: results from the Global Burden of Disease Study 2017
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DOI：
10.1016/s2214-109x(19)30374-2
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发表时间：
2019-10-01
影响因子：
34.3
通讯作者：
Whiteford, Harvey
中科院分区：
文献类型：
--
作者：
Gouda, Hebe N.;Charlson, Fiona;Whiteford, Harvey
尽管撒哈拉以南非洲的疾病负担仍然以传染病为主，但该地区各国正在经历人口结构转型，导致非传染性疾病（NCD）的流行率不断上升。为了告知卫生系统对这些不断变化的疾病模式的反应，我们旨在评估1990年至2017年撒哈拉以南非洲地区非传染性疾病负担的变化。2017年非传染性疾病和风险因素研究（GBD），以残疾调整生命年（DSDs）的形式分析撒哈拉以南非洲地区的非传染性疾病负担-粗计数以及每10万人口的所有年龄和年龄标准化率-95%不确定区间（UI）。我们研究了1990年至2017年期间的负担变化，以及年龄，性别和地区之间的差异。我们还比较了观察到的非传染性疾病的负担在各国与预期值的基础上，一个国家的社会人口指数。（9060万[95% UI 81.0-101.9]）和2017年（1.513亿[133.4-171.8]），反映出非传染性疾病占总负担的比例增加（从18.6% [95% UI 17.1 - 20.4]增至29.8% [27.6-32.0]）。虽然这一增长的大部分可以用人口增长和老龄化来解释，2017年非传染性疾病（每10万人）（21757.7 DALLS [95%UI 19 377.1-24380.7]）几乎与传染性、孕产妇、新生儿、和营养性疾病（26 491.6丹麦克朗[25 165.2-28 129.8]）。心血管疾病是2017年非传染性疾病负担的第二大原因，导致2290万（21.5-24.3）丹麦克朗（占非传染性疾病总负担的15.1%），仅次于被归类为其他非传染性疾病的疾病组（2880万[25.1 -33.0]丹麦克朗，19.1%）。其次是肿瘤、精神障碍和消化系统疾病。尽管撒哈拉以南非洲地区所有非传染性疾病的粗DALY率略有下降，但一些国家的年龄标准化率却在上升（特别是撒哈拉以南非洲南部的国家）和一些非传染性疾病撒哈拉以南非洲的非传染性疾病对卫生系统构成越来越大的挑战，迄今为止，这些方案主要侧重于解决传染病和孕产妇、新生儿和儿童死亡问题。为了有效应对这些不断变化的需求，撒哈拉以南非洲国家需要关于非传染性疾病的详细流行病学数据。版权所有（C）2019作者。爱思唯尔有限公司出版
Background Although the burden of disease in sub-Saharan Africa continues to be dominated by infectious diseases, countries in this region are undergoing a demographic transition leading to increasing prevalence of non-communicable diseases (NCDs). To inform health system responses to these changing patterns of disease, we aimed to assess changes in the burden of NCDs in sub-Saharan Africa from 1990 to 2017.Methods We used data from the Global Burden of Diseases, Injuries, and Risk Factors Study (GBD) 2017 to analyse the burden of NCDs in sub-Saharan Africa in terms of disability-adjusted life-years (DALYs)-with crude counts as well as all-age and age-standardised rates per 100 000 population-with 95% uncertainty intervals (UIs). We examined changes in burden between 1990 and 2017, and differences across age, sex, and regions. We also compared the observed NCD burden across countries with the expected values based on a country's Socio-demographic Index.Findings All-age total DALYs due to NCDs increased by 67.0% between 1990 (90.6 million [95% UI 81.0-101.9]) and 2017 (151.3 million [133.4-171.8]), reflecting an increase in the proportion of total DALYs attributable to NCDs (from 18.6% [95% UI 17 .1-20 .4] to 29.8% [27.6-32.0] of the total burden). Although most of this increase can be explained by population growth and ageing, the age-standardised DALY rate (per 100 000 population) due to NCDs in 2017 (21757.7 DALYs [95% UI 19 377.1-24380.7]) was almost equivalent to that of communicable, maternal, neonatal, and nutritional diseases (26 491.6 DALYs [25 165.2-28 129.8]). Cardiovascular diseases were the second leading cause of NCD burden in 2017, resulting in 22.9 million (21.5-24.3) DALYs (15.1% of the total NCD burden), after the group of disorders categorised as other NCDs (28.8 million [25 .1-33.0] DALYs, 19.1%). These categories were followed by neoplasms, mental disorders, and digestive diseases. Although crude DALY rates for all NCDs have decreased slightly across sub-Saharan Africa, age-standardised rates are on the rise in some countries (particularly those in southern sub-Saharan Africa) and for some NCDs (such as diabetes and some cancers, including breast and prostate cancer).Interpretation NCDs in sub-Saharan Africa are posing an increasing challenge for health systems, which have to date largely focused on tackling infectious diseases and maternal, neonatal, and child deaths. To effectively address these changing needs, countries in sub-Saharan Africa require detailed epidemiological data on NCDs. Copyright (C) 2019 The Author(s). Published by Elsevier Ltd.