Global burden of disease attributable to illicit drug use and dependence: findings from the Global Burden of Disease Study 2010
Global burden of disease attributable to illicit drug use and dependence: findings from the Global Burden of Disease Study 2010
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DOI：
10.1016/s0140-6736(13)61530-5
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发表时间：
2013-11-09
期刊：
影响因子：
168.9
通讯作者：
Vos, Theo
中科院分区：
文献类型：
--
作者：
Degenhardt, Louisa;Whiteford, Harvey A.;Vos, Theo
背景没有系统的尝试来估计安非他明、大麻、可卡因和阿片类药物依赖的全球和区域流行率，并量化它们的负担。我们的目的是评估药物依赖的患病率和负担，以残疾生活年数(YLDs)、丧失寿命年数(YLLS)和残疾调整寿命年(DALYs)来衡量。方法我们对药物依赖的流行病学进行了系统的回顾，并用2010年全球疾病、伤害和风险因素负担研究(GBD 2010)的贝叶斯Meta回归技术(DismodMR)对药物依赖和使用的流行率进行了分析。GBD 2010年通过使用具有代表性的社区调查和基于互联网的调查计算了新的残疾权重。我们结合对依赖和残疾权重的估计来计算流行的YLD、YLL和DALY，并估计可归因于药物使用的YLD、YLL和DALY作为其他健康结果的风险因素。2010年，发现的非法药物依赖直接占2,000万DALY(95%UI 1530-2,540万)，占全球全因DALY的0.8%(0.6-1.0)。在世界范围内，依赖阿片类药物和苯丙胺的人比依赖其他药物的人多。阿片依赖是DALY直接负担的最大贡献者(920万，95%UI7.1-11.4)。在一些区域，因药物依赖而导致的全因生命周期减退的比例是其他区域的20倍，收入最高的国家负担的比例更高。注射吸毒作为HIV的危险因素的DALY为210万(95%UI1.1-360万)，作为丙型肝炎的危险因素的DALY为50.2万(28.6万-891000)。自杀是安非他命依赖的风险的854 000个DALY(291 000-1791 000)，阿片类药物依赖的风险671 000(329 000-1 730 000)，可卡因依赖的风险324 000(109 000-682 000)。负担最高的国家(每10万人650天)包括美国、英国、俄罗斯和澳大利亚。非法药物使用是全球疾病负担的重要因素。需要采取有效的战略来减少阿片依赖和注射吸毒造成的疾病负担，例如提供阿片类药物替代治疗以及针头和注射器方案，以在人口规模上减轻这一负担。
Background No systematic attempts have been made to estimate the global and regional prevalence of amphetamine, cannabis, cocaine, and opioid dependence, and quantify their burden. We aimed to assess the prevalence and burden of drug dependence, as measured in years of life lived with disability (YLDs), years of life lost (YLLs), and disabilityadjusted life years (DALYs).Methods We conducted systematic reviews of the epidemiology of drug dependence, and analysed results with Global Burden of Diseases, Injuries, and Risk Factors Study 2010 (GBD 2010) Bayesian meta-regression technique (DisModMR) to estimate population-level prevalence of dependence and use. GBD 2010 calculated new disability weights by use of representative community surveys and an internet-based survey. We combined estimates of dependence with disability weights to calculate prevalent YLDs, YLLs, and DALYs, and estimated YLDs, YLLs, and DALYs attributable to drug use as a risk factor for other health outcomes.Findings Illicit drug dependence directly accounted for 20.0 million DALYs (95% UI 15.3-25.4 million) in 2010, accounting for 0.8% (0.6-1.0) of global all-cause DALYs. Worldwide, more people were dependent on opioids and amphetamines than other drugs. Opioid dependence was the largest contributor to the direct burden of DALYs (9.2 million, 95% UI 7.1-11.4). The proportion of all-cause DALYs attributed to drug dependence was 20 times higher in some regions than others, with an increased proportion of burden in countries with the highest incomes. Injecting drug use as a risk factor for HIV accounted for 2.1 million DALYs (95% UI 1.1-3.6 million) and as a risk factor for hepatitis C accounted for 502 000 DALYs (286 000-891 000). Suicide as a risk of amphetamine dependence accounted for 854 000 DALYs (291 000-1 791 000), as a risk of opioid dependence for 671 000 DALYs (329 000-1 730 000), and as a risk of cocaine dependence for 324 000 DALYs (109 000-682 000). Countries with the highest rate of burden (> 650 DALYs per 100 000 population) included the USA, UK, Russia, and Australia.Interpretation Illicit drug use is an important contributor to the global burden of disease. Effi cient strategies to reduce disease burden of opioid dependence and injecting drug use, such as delivery of opioid substitution treatment and needle and syringe programmes, are needed to reduce this burden at a population scale.