Changes in health in the countries of the UK and 150 English Local Authority areas 1990-2016: a systematic analysis for the Global Burden of Disease Study 2016.
Changes in health in the countries of the UK and 150 English Local Authority areas 1990-2016: a systematic analysis for the Global Burden of Disease Study 2016.
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DOI：
10.1016/s0140-6736(18)32207-4
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发表时间：
2018-11-03
期刊：
影响因子：
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通讯作者：
Murray CJL
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文献类型：
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作者：
Steel N;Ford JA;Newton JN;Davis ACJ;Vos T;Naghavi M;Glenn S;Hughes A;Dalton AM;Stockton D;Humphreys C;Dallat M;Schmidt J;Flowers J;Fox S;Abubakar I;Aldridge RW;Baker A;Brayne C;Brugha T;Capewell S;Car J;Cooper C;Ezzati M;Fitzpatrick J;Greaves F;Hay R;Hay S;Kee F;Larson HJ;Lyons RA;Majeed A;McKee M;Rawaf S;Rutter H;Saxena S;Sheikh A;Smeeth L;Viner RM;Vollset SE;Williams HC;Wolfe C;Woolf A;Murray CJL
之前的研究报告了英国国家和地区的全球疾病负担（GBD）估计。由于英国境内健康状况存在巨大差异，改善健康状况的行动需要对国家和地方层面的疾病负担和风险进行可比较的估计。预期寿命改善速度的放缓需要进一步调查。我们使用 GBD 2016 年关于死亡率、死因和残疾的数据，按剥夺五分位数分析英国各国和英格兰地方当局的疾病负担。我们从 GBD 2016 中提取数据来估计 1990 年至 2016 年英格兰、苏格兰、威尔士、北爱尔兰、英国和 150 个英国上层地方当局的生命损失年数 (YLL)、残疾寿命 (YLD)、残疾调整生命年 (DALY) 和可归因风险。我们根据死因、病情、年份和性别估算了疾病负担。我们使用多重剥夺指数分析了疾病负担与社会经济剥夺之间的关联。我们提供了所有 264 种 GBD 死亡原因和主要 20 个特定原因的结果，以及所有 84 种 GBD 风险或风险群的组合和 17 个特定风险或风险群的结果。 2016年英国所有国家经年龄调整的YLL的主要原因是缺血性心脏病、肺癌、脑血管疾病和慢性阻塞性肺病。根据社会经济剥夺程度，英格兰各地区各种原因的年龄标准化 YLL 率相差两倍（从布莱克浦的每 100000 人 14 274 [95% 不确定性区间 12 791–15 875] 到沃金厄姆的 6888 [6145–7739]）。一些上层地方政府，尤其是伦敦的地方政府，其贫困程度的表现好于预期。考虑到年龄结构的差异，贫困程度较高的上层地方政府对于 GBD 中大多数主要风险因素的可归因 YLL 较高。各个主要风险因素的全因 YLL 的人口归因分数在各个上层地方政府中各不相同。与 1990-2010 年相比，自 2010 年以来英国所有国家的预期寿命和 YLL 的改善速度更为缓慢。在 150 个上层地方当局中，有 9 个的 YLL 在 2010 年之后有所增加。对于可归因的 YLL，心血管疾病、乳腺癌、结直肠癌和肺癌的改善速度大幅放缓，而阿尔茨海默病和其他痴呆症的改善速度几乎没有变化。与死亡率相比，发病率对英国总体负担的影响越来越大。英国腰痛和颈部疼痛的年龄标准化 DALY 率 (1795 [1258–2356]) 高于缺血性心脏病 (1200 [1155–1246]) 或肺癌 (660 [642–679])。 2016 年英国健康状况不佳（通过 YLD 衡量）的主要原因是腰背和颈部疼痛、皮肤和皮下疾病、偏头痛、抑郁症和感觉器官疾病。年龄标准化的 YLD 率变化远小于英国各地的同等 YLL 率，这反映出当地有关健康状况不佳原因的数据相对匮乏。这些地方、区域和国家层面的估计将使政策制定者能够将资源和优先事项与负担和风险因素的水平相匹配。 2010年之后，YLL和预期寿命的改善明显放缓，特别是在心血管疾病和癌症方面，如果要恢复改善速度，就需要采取有针对性的行动。还需要采取有针对性的政策应对措施，以解决肌肉骨骼问题和抑郁症等发病率日益增加的负担。提高有关这些原因的可用数据的质量和完整性是这一应对措施的重要组成部分。比尔及梅琳达·盖茨基金会和英格兰公共卫生。
Previous studies have reported national and regional Global Burden of Disease (GBD) estimates for the UK. Because of substantial variation in health within the UK, action to improve it requires comparable estimates of disease burden and risks at country and local levels. The slowdown in the rate of improvement in life expectancy requires further investigation. We use GBD 2016 data on mortality, causes of death, and disability to analyse the burden of disease in the countries of the UK and within local authorities in England by deprivation quintile. We extracted data from the GBD 2016 to estimate years of life lost (YLLs), years lived with disability (YLDs), disability-adjusted life-years (DALYs), and attributable risks from 1990 to 2016 for England, Scotland, Wales, Northern Ireland, the UK, and 150 English Upper-Tier Local Authorities. We estimated the burden of disease by cause of death, condition, year, and sex. We analysed the association between burden of disease and socioeconomic deprivation using the Index of Multiple Deprivation. We present results for all 264 GBD causes of death combined and the leading 20 specific causes, and all 84 GBD risks or risk clusters combined and 17 specific risks or risk clusters. The leading causes of age-adjusted YLLs in all UK countries in 2016 were ischaemic heart disease, lung cancers, cerebrovascular disease, and chronic obstructive pulmonary disease. Age-standardised rates of YLLs for all causes varied by two times between local areas in England according to levels of socioeconomic deprivation (from 14 274 per 100 000 population [95% uncertainty interval 12 791–15 875] in Blackpool to 6888 [6145–7739] in Wokingham). Some Upper-Tier Local Authorities, particularly those in London, did better than expected for their level of deprivation. Allowing for differences in age structure, more deprived Upper-Tier Local Authorities had higher attributable YLLs for most major risk factors in the GBD. The population attributable fractions for all-cause YLLs for individual major risk factors varied across Upper-Tier Local Authorities. Life expectancy and YLLs have improved more slowly since 2010 in all UK countries compared with 1990–2010. In nine of 150 Upper-Tier Local Authorities, YLLs increased after 2010. For attributable YLLs, the rate of improvement slowed most substantially for cardiovascular disease and breast, colorectal, and lung cancers, and showed little change for Alzheimer's disease and other dementias. Morbidity makes an increasing contribution to overall burden in the UK compared with mortality. The age-standardised UK DALY rate for low back and neck pain (1795 [1258–2356]) was higher than for ischaemic heart disease (1200 [1155–1246]) or lung cancer (660 [642–679]). The leading causes of ill health (measured through YLDs) in the UK in 2016 were low back and neck pain, skin and subcutaneous diseases, migraine, depressive disorders, and sense organ disease. Age-standardised YLD rates varied much less than equivalent YLL rates across the UK, which reflects the relative scarcity of local data on causes of ill health. These estimates at local, regional, and national level will allow policy makers to match resources and priorities to levels of burden and risk factors. Improvement in YLLs and life expectancy slowed notably after 2010, particularly in cardiovascular disease and cancer, and targeted actions are needed if the rate of improvement is to recover. A targeted policy response is also required to address the increasing proportion of burden due to morbidity, such as musculoskeletal problems and depression. Improving the quality and completeness of available data on these causes is an essential component of this response. Bill & Melinda Gates Foundation and Public Health England.