The state of US health, 1990-2010: burden of diseases, injuries, and risk factors.
The state of US health, 1990-2010: burden of diseases, injuries, and risk factors.
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DOI：
10.1001/jama.2013.13805
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发表时间：
2013-08-14
期刊：
影响因子：
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通讯作者：
U.S. Burden of Disease Collaborators
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作者：
Murray CJ;Atkinson C;Bhalla K;Birbeck G;Burstein R;Chou D;Dellavalle R;Danaei G;Ezzati M;Fahimi A;Flaxman D;Foreman;Gabriel S;Gakidou E;Kassebaum N;Khatibzadeh S;Lim S;Lipshultz SE;London S;Lopez;MacIntyre MF;Mokdad AH;Moran A;Moran AE;Mozaffarian D;Murphy T;Naghavi M;Pope C;Roberts T;Salomon J;Schwebel DC;Shahraz S;Sleet DA;Murray;Abraham J;Ali MK;Atkinson C;Bartels DH;Bhalla K;Birbeck G;Burstein R;Chen H;Criqui MH;Dahodwala;Jarlais;Ding EL;Dorsey ER;Ebel BE;Ezzati M;Fahami;Flaxman S;Flaxman AD;Gonzalez-Medina D;Grant B;Hagan H;Hoffman H;Kassebaum N;Khatibzadeh S;Leasher JL;Lin J;Lipshultz SE;Lozano R;Lu Y;Mallinger L;McDermott MM;Micha R;Miller TR;Mokdad AA;Mokdad AH;Mozaffarian D;Naghavi M;Narayan KM;Omer SB;Pelizzari PM;Phillips D;Ranganathan D;Rivara FP;Roberts T;Sampson U;Sanman E;Sapkota A;Schwebel DC;Sharaz S;Shivakoti R;Singh GM;Singh D;Tavakkoli M;Towbin JA;Wilkinson JD;Zabetian A;Murray;Abraham J;Ali MK;Alvardo M;Atkinson C;Baddour LM;Benjamin EJ;Bhalla K;Birbeck G;Bolliger I;Burstein R;Carnahan E;Chou D;Chugh SS;Cohen A;Colson KE;Cooper LT;Couser W;Criqui MH;Dabhadkar KC;Dellavalle RP;Jarlais;Dicker D;Dorsey ER;Duber H;Ebel BE;Engell RE;Ezzati M;Felson DT;Finucane MM;Flaxman S;Flaxman AD;Fleming T;Foreman;Forouzanfar MH;Freedman G;Freeman MK;Gakidou E;Gillum RF;Gonzalez-Medina D;Gosselin R;Gutierrez HR;Hagan H;Havmoeller R;Hoffman H;Jacobsen KH;James SL;Jasrasaria R;Jayarman S;Johns N;Kassebaum N;Khatibzadeh S;Lan Q;Leasher JL;Lim S;Lipshultz SE;London S;Lopez;Lozano R;Lu Y;Mallinger L;Meltzer M;Mensah GA;Michaud C;Miller TR;Mock C;Moffitt TE;Mokdad AA;Mokdad AH;Moran A;Naghavi M;Narayan KM;Nelson RG;Olives C;Omer SB;Ortblad K;Ostro B;Pelizzari PM;Phillips D;Raju M;Razavi H;Ritz B;Roberts T;Sacco RL;Salomon J;Sampson U;Schwebel DC;Shahraz S;Shibuya K;Silberberg D;Singh JA;Steenland K;Taylor JA;Thurston GD;Vavilala MS;Vos T;Wagner GR;Weinstock MA;Weisskopf MG;Wulf S;Murray;U.S. Burden of Disease Collaborators
了解美国的主要健康问题以及它们如何随着时间的推移而变化，对于制定国家卫生政策至关重要。测量1990年至2010年美国的疾病、伤害和主要风险因素的负担，并将这些测量结果与经济合作与发展组织（OECD）34个国家的测量结果进行比较。我们对291种疾病和伤害，1160种这些疾病和伤害的后遗症，1990年至2010年，为2010年全球疾病负担研究制定的187个国家的67个风险因素或风险因素群，以描述美国的健康状况，并将美国的健康结果与34个经合组织国家的健康结果进行比较。国家由于过早死亡而损失的寿命年数（YLLs）是通过将每个年龄的死亡人数乘以该年龄的参考预期寿命来计算的。残疾生活年数（YLD）的计算方法是将患病率（基于系统评价）乘以每种后遗症的残疾权重（基于基于人口调查）;本研究中的残疾是指任何短期或长期的健康损失。残疾调整生命年（DLDs）估计为YLDs和YLLs之和。与风险因素相关的死亡和伤残是基于对暴露数据和风险-结局对的相对风险的系统性综述和荟萃分析。健康预期寿命（黑尔）用于总结总体人口健康状况，包括不同年龄段的寿命和健康状况不佳的程度。美国男性和女性的预期寿命从1990年的75.2岁增加到2010年的78.2岁;同期，黑尔从65.8岁增加到68.1岁。2010年YLL人数最多的疾病和伤害是缺血性心脏病、肺癌、中风、慢性阻塞性肺疾病和道路伤害。阿尔茨海默病、药物使用障碍、慢性肾病、肾癌和福尔斯的标准化YLL率增加。2010年，YLD数量最多的疾病是腰痛、重度抑郁症、其他肌肉骨骼疾病、颈部疼痛和焦虑症。随着美国人口的老龄化，YLD在DALLS中所占的比例比YLL大。与糖尿病相关的主要危险因素是饮食风险、吸烟、高体重指数、高血压、高空腹血糖、缺乏身体活动和饮酒。在1990年至2010年的34个经合组织国家中，美国的年龄标准化死亡率排名从第18位变为第27位，年龄标准化YLL率从第23位变为第28位，年龄标准化YLD率从第5位变为第6位，出生时预期寿命从第20位变为第27位，黑尔从第14位变为第26位。从1990年到2010年，美国在改善健康方面取得了实质性进展。出生时预期寿命和黑尔增加，所有年龄段的全因死亡率下降，特定年龄段的残疾年率保持稳定。然而，发病率和慢性残疾现在占美国健康负担的近一半，美国人口健康的改善并没有跟上其他富裕国家人口健康的进步。
Understanding the major health problems in the United States and how they are changing over time is critical for informing national health policy. To measure the burden of diseases, injuries, and leading risk factors in the United States from 1990 to 2010 and to compare these measurements with those of the 34 countries in the Organisation for Economic Co-operation and Development (OECD) countries. We used the systematic analysis of descriptive epidemiology of 291 diseases and injuries, 1160 sequelae of these diseases and injuries, and 67 risk factors or clusters of risk factors from 1990 to 2010 for 187 countries developed for the Global Burden of Disease 2010 Study to describe the health status of the United States and to compare US health outcomes with those of 34 OECD countries. Years of life lost due to premature mortality (YLLs) were computed by multiplying the number of deaths at each age by a reference life expectancy at that age. Years lived with disability (YLDs) were calculated by multiplying prevalence (based on systematic reviews) by the disability weight (based on population-based surveys) for each sequela; disability in this study refers to any short- or long-term loss of health. Disability-adjusted life-years (DALYs) were estimated as the sum of YLDs and YLLs. Deaths and DALYs related to risk factors were based on systematic reviews and meta-analyses of exposure data and relative risks for risk-outcome pairs. Healthy life expectancy (HALE) was used to summarize overall population health, accounting for both length of life and levels of ill health experienced at different ages. US life expectancy for both sexes combined increased from 75.2 years in 1990 to 78.2 years in 2010; during the same period, HALE increased from 65.8 years to 68.1 years. The diseases and injuries with the largest number of YLLs in 2010 were ischemic heart disease, lung cancer, stroke, chronic obstructive pulmonary disease, and road injury. Age-standardized YLL rates increased for Alzheimer disease, drug use disorders, chronic kidney disease, kidney cancer, and falls. The diseases with the largest number of YLDs in 2010 were low back pain, major depressive disorder, other musculoskeletal disorders, neck pain, and anxiety disorders. As the US population has aged, YLDs have comprised a larger share of DALYs than have YLLs. The leading risk factors related to DALYs were dietary risks, tobacco smoking, high body mass index, high blood pressure, high fasting plasma glucose, physical inactivity, and alcohol use. Among 34 OECD countries between 1990 and 2010, the US rank for the age-standardized death rate changed from 18th to 27th, for the age-standardized YLL rate from 23rd to 28th, for the age-standardized YLD rate from 5th to 6th, for life expectancy at birth from 20th to 27th, and for HALE from 14th to 26th. From 1990 to 2010, the United States made substantial progress in improving health. Life expectancy at birth and HALE increased, all-cause death rates at all ages decreased, and age-specific rates of years lived with disability remained stable. However, morbidity and chronic disability now account for nearly half of the US health burden, and improvements in population health in the United States have not kept pace with advances in population health in other wealthy nations.