Cardiovascular Diseases in Pakistan: Imagining a Postpandemic, Postconflict Future.
Cardiovascular Diseases in Pakistan: Imagining a Postpandemic, Postconflict Future.
复制标题
巴基斯坦的心血管疾病：想象大流行后、冲突后的未来。
DOI：
10.1161/circulationaha.122.059122
复制
发表时间：
2023
期刊：
影响因子：
37.8
通讯作者：
Hanif,Bashir
中科院分区：
文献类型：
--
作者：
Samad,Zainab;Hanif,Bashir
巴基斯坦巴基斯坦位于中亚、中东和南亚的十字路口，是世界上第五大人口大国。在过去30年中，我国的经济和工业取得了增长，但地区冲突、自然灾害和政府对卫生的投资有限阻碍了卫生指标的进步。与我们的东部邻国相比，巴基斯坦人的平均寿命较低（男性67岁，女性69岁），由于传染病仍然是地方病，我们资源匮乏的卫生系统现在正在努力应对非传染性疾病，特别是心血管疾病的发病率不断上升和昂贵的负担。根据2019年全球疾病负担研究，巴基斯坦CVD的年龄标准化发病率估计为每10万人918.18例（全球，每10万人684.33例），年龄标准化死亡率为每10万人357.88例（全球，每10万人239.85例）。1在全国社会经济登记调查中，包括巴基斯坦3400万家庭的人口统计，社会经济，教育，健康和资产概况，18.9%的参与者自我报告心血管疾病。在可预见的未来，这种上升趋势将继续下去，因为心血管疾病的危险因素非常普遍：年龄调整的糖尿病比较患病率为30.8%，而37%的成年人患有高血压，25%的成年男性吸烟。此外，高近亲比率（58%与第一或第二堂表兄弟结婚）可能有助于遗传风险的聚集。总之，这些因素将推动心血管疾病负担的大幅上升，因为主要是年轻人口进入中年。这将构成重大挑战，因为卫生支出仍然很低（每人43美元;政府卫生支出占国内生产总值的1.2%），而且在全球范围内，巴基斯坦在全民健康覆盖有效性方面福尔斯最低的十分位。2，3巴基斯坦特有的心血管疾病特征包括风湿性心脏病和早发性冠状动脉疾病的高负担。
Pakistan. Situated at the crossroads of Central Asia, the Middle East, and South Asia, Pakistan is the fifth most populous country in the world. In the past 30 years, our country has seen economic and industrial growth, but regional conflicts, natural disasters, and limited government investment in health have stunted progress in health indicators. Compared with our neighbors to the east, Pakistanis have a lower average lifespan (men, 67 years; women, 69 years), and because infectious diseases remain endemic, our poorly resourced health systems now grapple with the continuously rising incidence—and costly burden—of noncommunicable diseases, particularly CVDs. According to the 2019 Global Burden of Disease study, the estimated agestandardized incidence of CVD in Pakistan was 918.18 per 100 000 (global, 684.33 per 100 000) and the age-standardized death rate was 357.88 per 100 000 (global, 239.85 per 100 000). 1 In the National Socioeconomic Registry Survey, which includes demographic, socioeconomic, education, health, and asset profiling of 34 million households across Pakistan, CVDs were selfreported by 18.9% of participants. For the foreseeable future, this rising trend will continue because CVD risk factors are highly prevalent: ageadjusted comparative prevalence of diabetes is 30.8%, whereas 37% of adults have hypertension and≈ 25% of adult men smoke. In addition, the high consanguinity rate (58% married to first or second cousins) likely contributes to clustering of genetic risk. Together, these factors will fuel a large rise in CVD burden as a predominantly young population enters middle age. This will pose major challenges as health spending remains low ($43 per person; government health expenditure, 1.2% of gross domestic product), and globally, Pakistan falls in the lowest decile of universal health coverage effectiveness. 2, 3 Features of CVD specific to Pakistan include a high burden of rheumatic heart disease and early-onset coronary artery disease.