Nations within a nation: variations in epidemiological transition across the states of India, 1990-2016 in the Global Burden of Disease Study.
Nations within a nation: variations in epidemiological transition across the states of India, 1990-2016 in the Global Burden of Disease Study.
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DOI：
10.1016/s0140-6736(17)32804-0
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发表时间：
2017-12-02
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通讯作者：
India State-Level Disease Burden Initiative Collaborators
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作者：
India State-Level Disease Burden Initiative Collaborators
世界人口的18%生活在印度，印度许多邦的人口与大国相似。有效改善印度人口健康的行动需要获得可靠和全面的国家一级长期疾病负担和风险因素估计数。到目前为止，还没有对所有主要疾病和风险因素进行这种全面的估计。因此，我们的目标是估计印度每个邦的疾病负担和风险因素，作为2016年全球疾病负担（GBD）研究的一部分。使用所有可用的数据来源，印度国家级疾病负担计划估计了1990年至2016年印度每个州333种疾病和伤害以及84种风险因素的负担（指标为死亡，残疾调整生命年[DIBs]，患病率，发病率和预期寿命），作为GBD 2016的一部分。我们根据2016年传染病、孕产妇、新生儿和营养性疾病（CMNND）与非传染性疾病（NCD）和伤害的比例，将印度各邦分为四个流行病学过渡水平（ETL）组。我们评估了ETL州组之间和各州之间疾病负担和风险因素的变化，以了解各州和整个印度更具体的卫生系统应对措施。2003年，印度因非传染性疾病和伤害而死亡的人数超过了因CMNND而死亡的人数，但这一转变对四个ETL州组来说有24年的时间。从1990年到2016年，印度的年龄标准化DALY率下降了36.2%。在1990年至2016年期间，所有ETL组中大多数CMNND的DALY和DALY率大幅下降，但CMNND的下降速度在低ETL状态组中最慢。相比之下，在所有ETL州组中，非传染性疾病的DADs数量大幅增加，并且在所有ETL州组中，除了最高的伤害，伤害的DADs数量显著增加。从1990年到2016年，印度大多数主要非传染性疾病的所有年龄段患病率大幅增加，年龄标准化的非传染性疾病DALY率略有下降。非传染性疾病的主要风险因素，包括高收缩压，高空腹血糖，高总胆固醇和高体重指数，从1990年到2016年增加，在高ETL状态下通常水平更高;环境空气污染也增加，并且在低ETL组中最高。从1990年到2016年，受伤的主要原因的发生率也有所增加。2016年印度糖尿病的五个主要原因是缺血性心脏病，慢性阻塞性肺疾病，呼吸道疾病，下呼吸道感染和脑血管疾病; 2016年糖尿病的五个主要风险因素是儿童和孕产妇营养不良，空气污染，饮食风险，高收缩压和高空腹血糖。在这些广泛的趋势背后，ETL状态组之间以及ETL组内的状态之间存在许多变化。在2016年印度疾病负担的十大主要原因中，有五个原因的最高和最低国家特定DALY率之间至少有五倍的差异。在过去26年中，以残疾调整生命年率衡量的人均疾病负担在印度下降了约三分之一。然而，疾病负担的程度和原因以及风险因素在各州之间差异很大。非传染性疾病和伤害对CMNND的主导地位的变化在四个ETL州群体中发生了大约四分之一个世纪的时间。然而，一些主要CMNND的负担仍然很高，特别是在ETL最低的州。这种对印度各邦疾病负担不平等及其原因的全面测绘可以成为印度政府首要智库国家转变印度研究所和2017年国家卫生政策所设想的每个邦更具体的卫生规划的关键投入。比尔及梅林达·盖茨基金会、印度政府卫生和家庭福利部卫生研究司印度医学研究理事会和世界银行
18% of the world's population lives in India, and many states of India have populations similar to those of large countries. Action to effectively improve population health in India requires availability of reliable and comprehensive state-level estimates of disease burden and risk factors over time. Such comprehensive estimates have not been available so far for all major diseases and risk factors. Thus, we aimed to estimate the disease burden and risk factors in every state of India as part of the Global Burden of Disease (GBD) Study 2016. Using all available data sources, the India State-level Disease Burden Initiative estimated burden (metrics were deaths, disability-adjusted life-years [DALYs], prevalence, incidence, and life expectancy) from 333 disease conditions and injuries and 84 risk factors for each state of India from 1990 to 2016 as part of GBD 2016. We divided the states of India into four epidemiological transition level (ETL) groups on the basis of the ratio of DALYs from communicable, maternal, neonatal, and nutritional diseases (CMNNDs) to those from non-communicable diseases (NCDs) and injuries combined in 2016. We assessed variations in the burden of diseases and risk factors between ETL state groups and between states to inform a more specific health-system response in the states and for India as a whole. DALYs due to NCDs and injuries exceeded those due to CMNNDs in 2003 for India, but this transition had a range of 24 years for the four ETL state groups. The age-standardised DALY rate dropped by 36·2% in India from 1990 to 2016. The numbers of DALYs and DALY rates dropped substantially for most CMNNDs between 1990 and 2016 across all ETL groups, but rates of reduction for CMNNDs were slowest in the low ETL state group. By contrast, numbers of DALYs increased substantially for NCDs in all ETL state groups, and increased significantly for injuries in all ETL state groups except the highest. The all-age prevalence of most leading NCDs increased substantially in India from 1990 to 2016, and a modest decrease was recorded in the age-standardised NCD DALY rates. The major risk factors for NCDs, including high systolic blood pressure, high fasting plasma glucose, high total cholesterol, and high body-mass index, increased from 1990 to 2016, with generally higher levels in higher ETL states; ambient air pollution also increased and was highest in the low ETL group. The incidence rate of the leading causes of injuries also increased from 1990 to 2016. The five leading individual causes of DALYs in India in 2016 were ischaemic heart disease, chronic obstructive pulmonary disease, diarrhoeal diseases, lower respiratory infections, and cerebrovascular disease; and the five leading risk factors for DALYs in 2016 were child and maternal malnutrition, air pollution, dietary risks, high systolic blood pressure, and high fasting plasma glucose. Behind these broad trends many variations existed between the ETL state groups and between states within the ETL groups. Of the ten leading causes of disease burden in India in 2016, five causes had at least a five-times difference between the highest and lowest state-specific DALY rates for individual causes. Per capita disease burden measured as DALY rate has dropped by about a third in India over the past 26 years. However, the magnitude and causes of disease burden and the risk factors vary greatly between the states. The change to dominance of NCDs and injuries over CMNNDs occurred about a quarter century apart in the four ETL state groups. Nevertheless, the burden of some of the leading CMNNDs continues to be very high, especially in the lowest ETL states. This comprehensive mapping of inequalities in disease burden and its causes across the states of India can be a crucial input for more specific health planning for each state as is envisioned by the Government of India's premier think tank, the National Institution for Transforming India, and the National Health Policy 2017. Bill & Melinda Gates Foundation; Indian Council of Medical Research, Department of Health Research, Ministry of Health and Family Welfare, Government of India; and World Bank