Global, regional, and national incidence, prevalence, and years lived with disability for 310 diseases and injuries, 1990-2015: a systematic analysis for the Global Burden of Disease Study 2015.
Global, regional, and national incidence, prevalence, and years lived with disability for 310 diseases and injuries, 1990-2015: a systematic analysis for the Global Burden of Disease Study 2015.
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DOI：
10.1016/s0140-6736(16)31678-6
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发表时间：
2016-10-08
期刊：
影响因子：
168.9
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中科院分区：
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--
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疾病和伤害的非致命后果日益削弱世界人口充分健康生活的能力，这一趋势主要是由于许多国家的流行病从影响儿童的原因转变为成年人更常见的非传染性疾病。在2015年全球疾病、伤害和风险因素负担研究（GBD 2015）中，我们估计了1990年至2015年期间全球、区域和国家范围内疾病和伤害的发病率、患病率和残疾年数。我们采用广泛的更新和标准化分析程序，按年龄、性别、病因、年份和地理位置估计了发病率和患病率。GBD 2013的改进包括增加新的数据源，更新85个原因的文献综述，以及识别和纳入截至2015年11月发表的其他研究，以将用于估计非致死性结局的数据库扩展到60900个独特的数据源。 使用DisMod-MR 2.1（首次为GBD 2010和GBD 2013开发的DisMod-MR贝叶斯元回归工具的改进版）确定病因和后遗症的患病率和发生率。对于某些原因，我们使用了替代建模策略，其中疾病的复杂性不适合DisMod-MR 2.1或需要从其他数据确定发病率和患病率。对于GBD 2015，我们创建了一个汇总指标，该指标结合了人均收入，教育程度和生育率（社会人口指数[SDI]），并将其用于将观察到的健康损失模式与具有类似SDI得分的国家或地区的预期模式进行比较。我们根据患病率、发生率和YLD的各种组合，按年龄、性别、地理位置和年份对病因、后遗症和损伤进行了93亿次估计。2015年，有两个原因的急性发病率超过10亿：上呼吸道感染（172亿，95%不确定性区间[UI] 15.4 - 19.2亿）和呼吸道疾病（23.9亿，2.3 - 2.5亿）。2015年，8种慢性疾病和损伤的原因分别影响了世界10%以上的人口：永久性龋齿、紧张型头痛、缺铁性贫血、年龄相关性和其他听力损失、偏头痛、生殖器疱疹、屈光和调节障碍以及蛔虫病。2015年影响人数最多的缺陷是贫血，有23.6亿（23.5 - 23.7亿）人受到影响。按受影响人数计算，第二和第三大损害分别是听力损失和视力损失。在2005年至2015年期间，全球范围内残疾生活年（YLD）的主要原因几乎没有变化。在全球范围内，非传染性疾病占年龄标准化YLD的20个主要原因中的18个。在死亡率下降的情况下，对于我们分析中包括的几乎每一种原因，YLD的下降速度都慢于寿命损失年数（YLLs）。在低SDI地区，第1组原因通常占残疾总数的20-30%，主要是营养不良、疟疾、被忽视的热带疾病、艾滋病毒/艾滋病和结核病。下背部和颈部疼痛是2015年全球大多数国家残疾的主要原因。主要原因是亚洲和非洲22个国家和拉丁美洲中部一个国家的感觉器官紊乱;大洋洲四个国家的糖尿病;撒哈拉以南非洲三个南部国家的艾滋病毒/艾滋病;两个北非和中东国家的集体暴力和法律的干预;索马里和委内瑞拉的缺铁性贫血;乌干达的抑郁症;利比里亚的盘尾丝虫病;和其他被忽视的热带疾病。世界人口的老龄化正在使越来越多的人生活在疾病和伤害的后遗症中。社会经济变化导致的流行病学概况的变化也导致残疾年数持续增加，残疾年数的增长率也在上升。尽管数据可用性的差距和可用数据的可变质量带来了限制，但GBD研究的标准化和全面的方法提供了机会来研究广泛的趋势，比较国家或国家以下地区之间的趋势，以处于类似发展阶段的地点为基准，并衡量现有估计的优势或劣势。比尔和梅林达·盖茨基金会。
Non-fatal outcomes of disease and injury increasingly detract from the ability of the world's population to live in full health, a trend largely attributable to an epidemiological transition in many countries from causes affecting children, to non-communicable diseases (NCDs) more common in adults. For the Global Burden of Diseases, Injuries, and Risk Factors Study 2015 (GBD 2015), we estimated the incidence, prevalence, and years lived with disability for diseases and injuries at the global, regional, and national scale over the period of 1990 to 2015. We estimated incidence and prevalence by age, sex, cause, year, and geography with a wide range of updated and standardised analytical procedures. Improvements from GBD 2013 included the addition of new data sources, updates to literature reviews for 85 causes, and the identification and inclusion of additional studies published up to November, 2015, to expand the database used for estimation of non-fatal outcomes to 60 900 unique data sources. Prevalence and incidence by cause and sequelae were determined with DisMod-MR 2.1, an improved version of the DisMod-MR Bayesian meta-regression tool first developed for GBD 2010 and GBD 2013. For some causes, we used alternative modelling strategies where the complexity of the disease was not suited to DisMod-MR 2.1 or where incidence and prevalence needed to be determined from other data. For GBD 2015 we created a summary indicator that combines measures of income per capita, educational attainment, and fertility (the Socio-demographic Index [SDI]) and used it to compare observed patterns of health loss to the expected pattern for countries or locations with similar SDI scores. We generated 9·3 billion estimates from the various combinations of prevalence, incidence, and YLDs for causes, sequelae, and impairments by age, sex, geography, and year. In 2015, two causes had acute incidences in excess of 1 billion: upper respiratory infections (17·2 billion, 95% uncertainty interval [UI] 15·4–19·2 billion) and diarrhoeal diseases (2·39 billion, 2·30–2·50 billion). Eight causes of chronic disease and injury each affected more than 10% of the world's population in 2015: permanent caries, tension-type headache, iron-deficiency anaemia, age-related and other hearing loss, migraine, genital herpes, refraction and accommodation disorders, and ascariasis. The impairment that affected the greatest number of people in 2015 was anaemia, with 2·36 billion (2·35–2·37 billion) individuals affected. The second and third leading impairments by number of individuals affected were hearing loss and vision loss, respectively. Between 2005 and 2015, there was little change in the leading causes of years lived with disability (YLDs) on a global basis. NCDs accounted for 18 of the leading 20 causes of age-standardised YLDs on a global scale. Where rates were decreasing, the rate of decrease for YLDs was slower than that of years of life lost (YLLs) for nearly every cause included in our analysis. For low SDI geographies, Group 1 causes typically accounted for 20–30% of total disability, largely attributable to nutritional deficiencies, malaria, neglected tropical diseases, HIV/AIDS, and tuberculosis. Lower back and neck pain was the leading global cause of disability in 2015 in most countries. The leading cause was sense organ disorders in 22 countries in Asia and Africa and one in central Latin America; diabetes in four countries in Oceania; HIV/AIDS in three southern sub-Saharan African countries; collective violence and legal intervention in two north African and Middle Eastern countries; iron-deficiency anaemia in Somalia and Venezuela; depression in Uganda; onchoceriasis in Liberia; and other neglected tropical diseases in the Democratic Republic of the Congo. Ageing of the world's population is increasing the number of people living with sequelae of diseases and injuries. Shifts in the epidemiological profile driven by socioeconomic change also contribute to the continued increase in years lived with disability (YLDs) as well as the rate of increase in YLDs. Despite limitations imposed by gaps in data availability and the variable quality of the data available, the standardised and comprehensive approach of the GBD study provides opportunities to examine broad trends, compare those trends between countries or subnational geographies, benchmark against locations at similar stages of development, and gauge the strength or weakness of the estimates available. Bill & Melinda Gates Foundation.