Global, regional, and national age-sex-specific mortality for 282 causes of death in 195 countries and territories, 1980-2017: a systematic analysis for the Global Burden of Disease Study 2017.
Global, regional, and national age-sex-specific mortality for 282 causes of death in 195 countries and territories, 1980-2017: a systematic analysis for the Global Burden of Disease Study 2017.
复制标题
DOI：
10.1016/s0140-6736(18)32203-7
复制
发表时间：
2018-11-10
期刊：
影响因子：
--
通讯作者：
GBD 2017 Causes of Death Collaborators
中科院分区：
文献类型：
--
作者：
GBD 2017 Causes of Death Collaborators
全球发展目标越来越多地依赖针对具体国家的估计数来衡量一个国家的进展情况。为了满足这一需求，2016年全球疾病、伤害和风险因素负担研究（GBD）估计了1980年开始的全球、区域、国家和国家以下地区的特定原因死亡率。在这里，我们报告了该研究的更新，利用新的可用数据和改进的方法。GBD 2017对1980年至2017年期间195个国家和地区的282种死因进行了全面评估。死因数据库由生命登记（VR）、死因推断（VA）、登记、调查、警方和监测数据组成。GBD 2017增加了10项VA研究，127个国家-年的VR数据，502个癌症登记国家-年和一个额外的监测国家-年。GBD死因层级的扩展导致GBD 2017年估计增加了18个原因。新获得的数据导致了另外五个国家的国家以下一级的估计-埃塞俄比亚，伊朗，新西兰，挪威和俄罗斯。通过纳入不确定性估计的再分配算法，将国际疾病分类（ICD）编码为非特异性、不可信或中间死亡原因的死亡重新分配为潜在原因。我们使用了为GBD开发的统计建模工具，包括死因推断模型（CODEm），以生成每个地点、年份、年龄和性别的死因分数和死因特异性死亡率。GBD 2017没有像以前的版本那样使用联合国的估计，而是独立地估计了所有地点的人口规模和生育率。然后计算寿命损失年数（YLLs），即每次死亡的总和乘以每个年龄的标准预期寿命。这里报告的所有比率都是年龄标准化的。在最广泛的死亡原因分组（1级）中，非传染性疾病（NCD）占死亡人数的最大比例，占73.4%（95%不确定区间[UI] 72.5 - 74.1），而传染性、孕产妇、新生儿和营养（CMNN）原因占18.6%（17.9 ~ 19.6），损伤8.0%（7.7 ~ 8.2）。从2007年到2017年，非传染性疾病导致的死亡总数增加了22.7%（21.5 - 23.9），这意味着2017年估计的死亡人数比2007年增加了761万（7.20 - 8.01）。全球非传染性疾病死亡率下降了7.9%（7.0 - 8.8）。CMNN原因死亡人数下降22.2%（20.0 - 24.0），死亡率下降31.8%（30.1 - 33.3）。2007年至2017年，伤害死亡总数增加了2.3%（0.5 - 4.0），伤害死亡率下降了13.7%（12.2 - 15.1），2017年每10万人中有57.9人死亡（55.9 - 59.2）。 物质使用障碍的死亡人数也有所增加，从2007年的284000人（268000 - 289000人）上升到2017年的352000人（334000 - 363000人）。 2007年至2017年，冲突和恐怖主义造成的总死亡人数增加了118.0%（88.8 - 148.6）。在某些CMNN原因中，5岁以下儿童的总死亡人数和死亡率的下降幅度大于老年人，例如，5岁以下儿童下呼吸道感染死亡人数减少36.4%（32.2 - 40.6），而70岁以上成人的死亡人数增加33.6%（31.2 - 36.1）。在全球范围内，2017年大多数年龄段的男性死亡人数都高于女性，但85岁以上的年龄段除外。全球YLL的趋势反映了流行病学的转变，1990年至2017年期间，肠道感染，呼吸道感染和结核病以及孕产妇和新生儿疾病的YLL总量下降;这些在社会人口指数（SDI）的最低水平上通常更大。与此同时，肿瘤和心血管疾病的YLL大幅增加。在所有SDI五分位数中，五个主要二级原因的YLL率都有所下降。1990年YLL的主要原因-新生儿疾病，下呼吸道感染和肠道疾病-在2017年排名第二，第四和第五。与此同时，缺血性心脏病（2017年排名第一）和中风（排名第三）的估计YLL增加，尽管YLL率下降。2007年至2017年期间，人口增长导致20个主要二级死亡原因的总死亡人数增加。死因死亡率的下降减少了人口增长对所有原因的影响，但有三个原因除外：物质使用障碍、神经系统疾病以及皮肤和皮下组织疾病。全球健康状况的改善在人口中分布不均。伤害、药物使用障碍、武装冲突和恐怖主义、肿瘤和心血管疾病造成的死亡正在扩大对全球健康的威胁。在下呼吸道和肠道感染等死亡原因方面，儿童的进展速度比老年人快，各年龄组按性别分列的死亡率继续存在差异。一些常见疾病死亡率的下降本身正在放缓或已经停止，主要是非传染性疾病，过去十年中，某些原因的死亡率有所上升。比尔和梅林达·盖茨基金会。
Global development goals increasingly rely on country-specific estimates for benchmarking a nation's progress. To meet this need, the Global Burden of Diseases, Injuries, and Risk Factors Study (GBD) 2016 estimated global, regional, national, and, for selected locations, subnational cause-specific mortality beginning in the year 1980. Here we report an update to that study, making use of newly available data and improved methods. GBD 2017 provides a comprehensive assessment of cause-specific mortality for 282 causes in 195 countries and territories from 1980 to 2017. The causes of death database is composed of vital registration (VR), verbal autopsy (VA), registry, survey, police, and surveillance data. GBD 2017 added ten VA studies, 127 country-years of VR data, 502 cancer-registry country-years, and an additional surveillance country-year. Expansions of the GBD cause of death hierarchy resulted in 18 additional causes estimated for GBD 2017. Newly available data led to subnational estimates for five additional countries—Ethiopia, Iran, New Zealand, Norway, and Russia. Deaths assigned International Classification of Diseases (ICD) codes for non-specific, implausible, or intermediate causes of death were reassigned to underlying causes by redistribution algorithms that were incorporated into uncertainty estimation. We used statistical modelling tools developed for GBD, including the Cause of Death Ensemble model (CODEm), to generate cause fractions and cause-specific death rates for each location, year, age, and sex. Instead of using UN estimates as in previous versions, GBD 2017 independently estimated population size and fertility rate for all locations. Years of life lost (YLLs) were then calculated as the sum of each death multiplied by the standard life expectancy at each age. All rates reported here are age-standardised. At the broadest grouping of causes of death (Level 1), non-communicable diseases (NCDs) comprised the greatest fraction of deaths, contributing to 73·4% (95% uncertainty interval [UI] 72·5–74·1) of total deaths in 2017, while communicable, maternal, neonatal, and nutritional (CMNN) causes accounted for 18·6% (17·9–19·6), and injuries 8·0% (7·7–8·2). Total numbers of deaths from NCD causes increased from 2007 to 2017 by 22·7% (21·5–23·9), representing an additional 7·61 million (7·20–8·01) deaths estimated in 2017 versus 2007. The death rate from NCDs decreased globally by 7·9% (7·0–8·8). The number of deaths for CMNN causes decreased by 22·2% (20·0–24·0) and the death rate by 31·8% (30·1–33·3). Total deaths from injuries increased by 2·3% (0·5–4·0) between 2007 and 2017, and the death rate from injuries decreased by 13·7% (12·2–15·1) to 57·9 deaths (55·9–59·2) per 100 000 in 2017. Deaths from substance use disorders also increased, rising from 284 000 deaths (268 000–289 000) globally in 2007 to 352 000 (334 000–363 000) in 2017. Between 2007 and 2017, total deaths from conflict and terrorism increased by 118·0% (88·8–148·6). A greater reduction in total deaths and death rates was observed for some CMNN causes among children younger than 5 years than for older adults, such as a 36·4% (32·2–40·6) reduction in deaths from lower respiratory infections for children younger than 5 years compared with a 33·6% (31·2–36·1) increase in adults older than 70 years. Globally, the number of deaths was greater for men than for women at most ages in 2017, except at ages older than 85 years. Trends in global YLLs reflect an epidemiological transition, with decreases in total YLLs from enteric infections, respiratory infections and tuberculosis, and maternal and neonatal disorders between 1990 and 2017; these were generally greater in magnitude at the lowest levels of the Socio-demographic Index (SDI). At the same time, there were large increases in YLLs from neoplasms and cardiovascular diseases. YLL rates decreased across the five leading Level 2 causes in all SDI quintiles. The leading causes of YLLs in 1990—neonatal disorders, lower respiratory infections, and diarrhoeal diseases—were ranked second, fourth, and fifth, in 2017. Meanwhile, estimated YLLs increased for ischaemic heart disease (ranked first in 2017) and stroke (ranked third), even though YLL rates decreased. Population growth contributed to increased total deaths across the 20 leading Level 2 causes of mortality between 2007 and 2017. Decreases in the cause-specific mortality rate reduced the effect of population growth for all but three causes: substance use disorders, neurological disorders, and skin and subcutaneous diseases. Improvements in global health have been unevenly distributed among populations. Deaths due to injuries, substance use disorders, armed conflict and terrorism, neoplasms, and cardiovascular disease are expanding threats to global health. For causes of death such as lower respiratory and enteric infections, more rapid progress occurred for children than for the oldest adults, and there is continuing disparity in mortality rates by sex across age groups. Reductions in the death rate of some common diseases are themselves slowing or have ceased, primarily for NCDs, and the death rate for selected causes has increased in the past decade. Bill & Melinda Gates Foundation.