Estimates of the global, regional, and national morbidity, mortality, and aetiologies of lower respiratory infections in 195 countries, 1990-2016: a systematic analysis for the Global Burden of Disease Study 2016.
Estimates of the global, regional, and national morbidity, mortality, and aetiologies of lower respiratory infections in 195 countries, 1990-2016: a systematic analysis for the Global Burden of Disease Study 2016.
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DOI：
10.1016/s1473-3099(18)30310-4
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发表时间：
2018-11
期刊：
影响因子：
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通讯作者：
GBD 2016 Lower Respiratory Infections Collaborators
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作者：
GBD 2016 Lower Respiratory Infections Collaborators
下呼吸道感染是世界各地发病率和死亡率的主要原因。《2016年全球疾病、损伤和风险因素负担（GBD）研究》提供了195个国家下呼吸道感染负担的最新分析。本研究评估了过去26年的病例、死亡和病因，并显示了各年龄段人群下呼吸道感染负担的变化情况。我们在GBD 2016中使用了三种独立的下呼吸道感染建模策略：贝叶斯分层集成建模平台（死因集成模型），它使用生命登记、尸检数据和监测系统数据来预测下呼吸道感染导致的死亡率；部门元回归工具（DisMod-MR），它使用科学文献、人口代表性调查和卫生保健数据来预测发病率、患病率和死亡率；以及对肺炎链球菌、b型流感嗜血杆菌、流感和呼吸道合胞病毒引起的下呼吸道感染发作的人口归因比例的反事实估计建模。我们计算了每个年龄、性别、年份和地点的模型估计值。我们使用DisMod-MR和时空高斯过程回归对人群中特定危险因素的暴露水平进行建模，并评估针对5岁以下儿童中每个危险因素的针对性干预措施的有效性。我们还使用2016年GBD中与LRI相关的危险因素对2000-16年LRI死亡的变化进行了分解分析。2016年，全球5岁以下儿童（5岁以下）因下呼吸道感染死亡655272人（95%不确定区间[UI] 586 475 - 720612）， 70岁以上成人因下呼吸道感染死亡1080958人（943 749-1 170 638），各年龄段人群因下呼吸道感染死亡2377697人（2 145 584-2 512 809）。肺炎链球菌是全球下呼吸道感染发病率和死亡率的主要原因，2016年造成的死亡人数超过所有其他病因的总和（1 189 937人死亡，95% UI 690 445-1 770 660）。儿童期消瘦仍然是5岁以下儿童下呼吸道感染死亡的主要危险因素，占2016年下呼吸道感染死亡的61.4%（95%死亡率为45.7 - 69.6）。改善浪费、家庭空气污染、环境颗粒物污染和扩大抗生素使用的干预措施，可在下呼吸道感染负担最重的国家中，每4000名接受治疗的儿童中避免1名5岁以下儿童死于下呼吸道感染。我们的研究结果显示，在减少下呼吸道感染负担方面取得了实质性进展，但这一进展在不同地区并不相同，这是由几个主要危险因素的减少所驱动的，可能需要在老年人中付出更多努力。通过强调负担最重的区域和人群以及可能产生最大影响的风险因素，资助者、决策者和规划执行者可以更有效地减少世界上最易感人群中的下呼吸道感染。比尔和梅林达·盖茨基金会。
Lower respiratory infections are a leading cause of morbidity and mortality around the world. The Global Burden of Diseases, Injuries, and Risk Factors (GBD) Study 2016, provides an up-to-date analysis of the burden of lower respiratory infections in 195 countries. This study assesses cases, deaths, and aetiologies spanning the past 26 years and shows how the burden of lower respiratory infection has changed in people of all ages. We used three separate modelling strategies for lower respiratory infections in GBD 2016: a Bayesian hierarchical ensemble modelling platform (Cause of Death Ensemble model), which uses vital registration, verbal autopsy data, and surveillance system data to predict mortality due to lower respiratory infections; a compartmental meta-regression tool (DisMod-MR), which uses scientific literature, population representative surveys, and health-care data to predict incidence, prevalence, and mortality; and modelling of counterfactual estimates of the population attributable fraction of lower respiratory infection episodes due to Streptococcus pneumoniae, Haemophilus influenzae type b, influenza, and respiratory syncytial virus. We calculated each modelled estimate for each age, sex, year, and location. We modelled the exposure level in a population for a given risk factor using DisMod-MR and a spatio-temporal Gaussian process regression, and assessed the effectiveness of targeted interventions for each risk factor in children younger than 5 years. We also did a decomposition analysis of the change in LRI deaths from 2000–16 using the risk factors associated with LRI in GBD 2016. In 2016, lower respiratory infections caused 652 572 deaths (95% uncertainty interval [UI] 586 475–720 612) in children younger than 5 years (under-5s), 1 080 958 deaths (943 749–1 170 638) in adults older than 70 years, and 2 377 697 deaths (2 145 584–2 512 809) in people of all ages, worldwide. Streptococcus pneumoniae was the leading cause of lower respiratory infection morbidity and mortality globally, contributing to more deaths than all other aetiologies combined in 2016 (1 189 937 deaths, 95% UI 690 445–1 770 660). Childhood wasting remains the leading risk factor for lower respiratory infection mortality among children younger than 5 years, responsible for 61·4% of lower respiratory infection deaths in 2016 (95% UI 45·7–69·6). Interventions to improve wasting, household air pollution, ambient particulate matter pollution, and expanded antibiotic use could avert one under-5 death due to lower respiratory infection for every 4000 children treated in the countries with the highest lower respiratory infection burden. Our findings show substantial progress in the reduction of lower respiratory infection burden, but this progress has not been equal across locations, has been driven by decreases in several primary risk factors, and might require more effort among elderly adults. By highlighting regions and populations with the highest burden, and the risk factors that could have the greatest effect, funders, policy makers, and programme implementers can more effectively reduce lower respiratory infections among the world's most susceptible populations. Bill & Melinda Gates Foundation.