Trends in premature avertable mortality from non-communicable diseases for 195 countries and territories, 1990-2017: a population-based study
Trends in premature avertable mortality from non-communicable diseases for 195 countries and territories, 1990-2017: a population-based study
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DOI：
10.1016/s2214-109x(20)30035-8
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发表时间：
2020-04-01
影响因子：
34.3
通讯作者：
McKee, Martin
中科院分区：
文献类型：
--
作者：
Martinez, Ramon;Lloyd-Sherlock, Peter;McKee, Martin
到2030年将非传染性疾病（NCD）过早死亡率降低三分之一是可持续发展目标（SDG）3.4的宏伟目标。然而，该指标的定义很窄，只包括四种主要的非传染性疾病（心血管疾病、癌症、糖尿病和慢性呼吸道疾病），而且只针对30-70岁的人。本研究的重点是非传染性疾病造成的可避免的过早死亡率-非传染性疾病造成的过早死亡，可以通过有效的公共政策和卫生干预措施加以预防，或者可以通过高质量的卫生保健加以预防-以评估全球、区域和国家各级的趋势，和风险因素研究（GBD）2017年。方法我们回顾了现有的NCD死亡原因列表，这些死亡原因可以通过公共卫生政策和干预措施预防，也可以通过医疗保健来预防，以创建一个可避免的NCD死亡原因列表，这被映射到GBD原因列表。我们按性别、地点和年份估计了每10万人因NCD过早可避免死亡、可避免的NCD原因集群和不可避免的NCD原因而损失的年龄标准化寿命年数（YLL），并报告了其95%不确定区间（UI）。我们检查了可避免和不可避免的非传染性疾病导致的年龄标准化YLL趋势，评估了可避免的非传染性疾病过早死亡率在实现可持续发展目标3.4方面的进展，并探讨了可能对过早死亡率总体趋势做出重大贡献的特定可避免的非传染性疾病原因集群。男女非传染性疾病的可避免过早死亡率合计下降了-1.3%（95% UI -1.4至-1.2），从1990年的12855岁（11809至14051）增加到2017年的9008岁（8329至9756）。然而，可避免的非传染性疾病死亡的绝对数量从1990年的2310万（22.0-24.1）例死亡增加了49.3%（95% UI 47.3至52.2），到2017年增加了3450万（33.4至35.6）例。1990年至2017年期间，世卫组织每个区域以及大多数国家和地区的可避免的非传染性疾病过早死亡率均有所下降。尽管有这些减少，但只有西太平洋和欧洲区域以及25个国家（其中大多数是高收入国家）有望实现可持续发展目标3.4。自2017年以来，全球可避免的非传染性疾病过早死亡率下降速度放缓。2017年，非传染性疾病的可避免过早死亡率高集中在低收入和中等收入国家，主要集中在东南亚地区、东地中海地区和非洲地区。在1990年至2017年期间，此类死亡率每年大幅下降的大多数国家到2017年实现了非传染性疾病过早可避免死亡率的低水平。一些国家，人口最多的国家是阿富汗、中非共和国、乌兹别克斯坦、海地、蒙古、土库曼斯坦、巴基斯坦、乌克兰、老挝和埃及，报告说非传染性疾病造成的可避免过早死亡率呈上升趋势，而且很高。心血管疾病、癌症和慢性呼吸道疾病一直是全球和区域非传染性疾病导致的可避免的过早死亡率下降的主要驱动因素，而物质使用障碍、慢性肾脏疾病和急性肾小球肾炎以及糖尿病导致的过早死亡率一直在上升。但各群体的进展并不均衡。各国目前的水平和趋势存在很大差异，因此，它们在实现可持续发展目标3.4的轨道上的程度也存在很大差异。通过计算可避免过早死亡率，同时避免任意的年龄截止值，非传染性疾病可避免过早死亡率是量化和监测全球和国家非传染性疾病预防和控制进展的一个强有力、全面和可操作的指标。版权所有（c）2020泛美卫生组织。由Elsevier Ltd.发布，这是CC BY 4.0许可下的开放获取文章。
Background The reduction by a third of premature non-communicable disease (NCD) mortality by 2030 is the ambitious target of Sustainable Development Goal (SDG) 3.4. However, the indicator is narrowly defined, including only four major NCDs (cardiovascular diseases, cancer, diabetes, and chronic respiratory diseases) and only for people aged 30-70 years. This study focuses on premature avertable mortality from NCDs-premature deaths caused by NCDs that could be prevented through effective public policies and health interventions or amenable to high-quality health care-to assess trends at global, regional, and national levels using estimates from the Global Burden of Disease, Injuries, and Risk Factors Study (GBD) 2017.Methods We reviewed existing lists of NCD causes of death that are either preventable through public health policies and interventions or amenable to health care to create a list of avertable NCD causes of death, which was mapped to the GBD cause list. We estimated age-standardised years of life lost (YLL) per 100 000 population due to premature avertable mortality from NCDs, avertable NCD cause clusters, and non-avertable NCD causes by sex, location, and year and reported their 95% uncertainty intervals (UIs). We examined trends in age-standardised YLL due to avertable and non-avertable NCDs, assessed the progress of premature avertable mortality from NCDs in achieving SDG 3.4, and explored specific avertable NCD cause clusters that could make a substantial contribution to overall trends in premature mortality.Findings Globally, premature avertable mortality from NCDs for both sexes combined declined -1.3% (95% UI -1.4 to -1.2) per year, from 12 855 years (11 809 to 14 051) in 1990 to 9008 years (8329 to 9756) in 2017. However, the absolute number of avertable NCD deaths increased 49.3% (95% UI 47.3 to 52.2) from 23.1 million (22.0-24.1) deaths in 1990 to 34.5 million (33.4 to 35.6) in 2017. Premature avertable mortality from NCDs reduced in every WHO region and in most countries and territories between 1990 and 2017. Despite these reductions, only the Western Pacific and European regions and 25 countries (most of which are high-income countries) are on track to achieve SDG target 3.4. Since 2017, there has been a global slowdown in the reduction of premature avertable mortality from NCDs. In 2017, high premature avertable mortality from NCDs was clustered in low-income and middle-income countries, mainly in the South-East Asia region, Eastern Mediterranean region, and African region. Most countries with large annual reductions in such mortality between 1990 and 2017 had achieved low levels of premature avertable mortality from NCDs by 2017. Some countries, the most populous examples being Afghanistan, the Central African Republic, Uzbekistan, Haiti, Mongolia, Turkmenistan, Pakistan, Ukraine, Laos, and Egypt, reported both an upward trend and high levels of premature avertable mortality from NCDs. Cardiovascular diseases, cancers, and chronic respiratory diseases have been the main drivers of the global and regional reduction in premature avertable mortality from NCDs, whereas premature mortality from substance use disorders, chronic kidney disease and acute glomerulonephritis, and diabetes have been increasing.Interpretation Worldwide, there has been a substantial reduction in premature avertable mortality from NCDs, but progress has been uneven across populations. Countries vary substantially in current levels and trends and, hence, the extent to which they are on track to achieve SDG 3.4. By accounting for premature avertable mortality while avoiding arbitrary age cutoffs, premature avertable mortality from NCDs is a robust, comprehensive, and actionable indicator for quantifying and monitoring global and national progress towards NCD prevention and control. Copyright (c) 2020 Pan American Health Organization. Published by Elsevier Ltd. This is an Open Access article under the CC BY 4.0 license.