Global and regional mortality from 235 causes of death for 20 age groups in 1990 and 2010: a systematic analysis for the Global Burden of Disease Study 2010
Global and regional mortality from 235 causes of death for 20 age groups in 1990 and 2010: a systematic analysis for the Global Burden of Disease Study 2010
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DOI：
10.1016/s0140-6736(12)61728-0
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发表时间：
2012-12-15
期刊：
影响因子：
168.9
通讯作者：
Murray, Christopher J. L.
中科院分区：
文献类型：
--
作者：
Lozano, Rafael;Naghavi, Mohsen;Murray, Christopher J. L.
背景 关于人口主要死亡原因及其变化的可靠和及时的信息是卫生政策辩论的重要投入。在 2010 年全球疾病、伤害和风险因素负担研究 (GBD 2010) 中，我们的目的是估计 1980 年至 2010 年间世界和 21 个地区每年因 235 种原因造成的死亡人数，并按年龄和性别分别确定不确定区间 (UI)。 方法 我们试图从 1980 年至 2010 年期间通过人口动态登记、口头登记、口头登记等方式确定 187 个国家的所有可用死因数据。尸检、死亡率监测、 人口普查、调查、医院、警察记录和太平间。我们评估了数据质量的完整性、诊断准确性、缺失数据、随机变化和可能的死亡原因。我们应用六种不同的建模策略来根据数据的强度来估计特定原因的死亡率趋势。对于 133 个原因和三个特殊聚合，我们使用了死亡原因集成模型 (CODEm) 方法，该方法使用四个统计模型系列，使用不同的协变量排列来测试大量不同的模型。模型集成是从这些组件模型开发出来的。我们通过严格的样本外预测误差测试和 95% UI 的有效性来评估模型性能。对于观察到的死亡人数较低的 13 种原因，我们开发了具有合理协变量的负二项式模型。对于死亡罕见的 27 种原因，我们对 GBD 2010 的原因层次结构中的较高级别原因进行了建模，然后根据数据库中的所有可用数据估计，按比例将死亡分配给各个组成原因。对于选定的病因（非洲锥虫病、先天性梅毒、百日咳、麻疹、伤寒和甲状旁腺、利什曼病、急性戊型肝炎和艾滋病毒/艾滋病），我们使用基于发病率、患病率和病死率信息的自然史模型。我们分别估计了腹泻、下呼吸道感染和脑膜炎的病因分数，以及慢性肾病、孕产妇疾病、肝硬化和肝癌的亚原因分类。对于集体暴力和自然灾害造成的死亡，我们使用了死亡率冲击回归。对于每种原因，我们估计 95% 的 UI 都捕获了参数估计不确定性和由于使用 CODEm 的模型规范而导致的不确定性。我们根据不确定性分布，限制每个年龄-性别组内的特定原因分数，以求总死亡率之和。调查结果 2010 年，全球有 5280 万人死亡。从总体来看，2010 年全球死亡人数中，传染性、孕产妇、新生儿和营养原因占 24.9%，低于 1990 年的 1590 万人（34.1%）和 4650 万人。这一下降主要是由于腹泻病（从 2.5 万人减少到 140 万人）、下呼吸道感染（从 3.4 万人减少到 280 万人）、新生儿疾病死亡率的下降。 （从 3.1 到 220 万）、麻疹（从 0.63 到 13 万）和破伤风（从 0.27 到 06 万）。艾滋病毒/艾滋病死亡人数从 1990 年的 30 万人增加到 2010 年的 150 万人，并于 2006 年达到峰值 170 万人。自 1990 年以来，疟疾死亡率估计也上升了 19.9%，2010 年死亡人数为 117 万人。2010 年，结核病导致 120 万人死亡。非传染性疾病死亡人数增加了近 800 万人。 1990 年至 2010 年间，占全球死亡人数的三分之二（3,450 万人） 到2010年。2010年有800万人死于癌症，比二十年前增加了38%；其中，150万（19%）来自气管、支气管和肺癌。 2010 年，缺血性心脏病和中风总共导致 1,290 万人死亡，占全球死亡人数的四分之一，而 1990 年这一比例为五分之一； 130 万人死于糖尿病，是 1990 年的两倍。2010 年全球因伤害死亡的比例（510 万人）略高于 20 年前（8.8%）（9.6%）。这是由于全球道路交通事故死亡人数增加了 46%（2010 年为 130 万人）以及跌倒死亡人数增加。缺血性心脏病、中风、慢性阻塞性肺病 (COPD)、下呼吸道感染、肺癌和艾滋病毒/艾滋病是 2010 年死亡的主要原因。缺血性心脏病、下呼吸道感染、中风、腹泻病、疟疾和艾滋病毒/艾滋病是 2010 年因过早死亡 (YLL) 导致寿命损失的主要原因，与 1990 年的估计类似， 艾滋病毒/艾滋病和早产并发症除外。自 1990 年以来，下呼吸道感染和腹泻导致的 YLL 下降了 45-54%；缺血性心脏病和中风的 YLL 增加了 17-28%。主要死亡原因的地区差异很大。 2010年，传染性、孕产妇、新生儿和营养原因仍然占撒哈拉以南非洲地区过早死亡的76%。一些关键疾病（艾滋病毒/艾滋病、阿尔茨海默病、糖尿病，尤其是慢性肾病）的年龄标准化死亡率上升，但大多数疾病的死亡率在过去二十年有所下降；包括主要血管疾病、慢性阻塞性肺病、大多数癌症、肝硬化和孕产妇疾病。对于其他疾病，特别是疟疾、前列腺癌和损伤，几乎没有变化。 解释 人口增长、世界人口平均年龄的增加以及特定年龄、特定性别和特定原因死亡率的大幅下降，共同推动了从传染性、孕产妇、新生儿和营养原因向非传染性疾病的广泛转变。尽管如此，传染性、孕产妇、新生儿和营养原因仍然是撒哈拉以南非洲地区 YLL 的主要原因。叠加在流行病学转变的总体模式上，许多原因都存在显着的区域差异，例如人际暴力、自杀、肝癌、糖尿病、肝硬化、恰加斯病、非洲锥虫病、黑色素瘤等。区域异质性凸显了定期对死因进行合理流行病学评估的重要性。
Background Reliable and timely information on the leading causes of death in populations, and how these are changing, is a crucial input into health policy debates. In the Global Burden of Diseases, Injuries, and Risk Factors Study 2010 (GBD 2010), we aimed to estimate annual deaths for the world and 21 regions between 1980 and 2010 for 235 causes, with uncertainty intervals (UIs), separately by age and sex.Methods We attempted to identify all available data on causes of death for 187 countries from 1980 to 2010 from vital registration, verbal autopsy, mortality surveillance, censuses, surveys, hospitals, police records, and mortuaries. We assessed data quality for completeness, diagnostic accuracy, missing data, stochastic variations, and probable causes of death. We applied six different modelling strategies to estimate cause-specific mortality trends depending on the strength of the data. For 133 causes and three special aggregates we used the Cause of Death Ensemble model (CODEm) approach, which uses four families of statistical models testing a large set of different models using different permutations of covariates. Model ensembles were developed from these component models. We assessed model performance with rigorous out-of-sample testing of prediction error and the validity of 95% UIs. For 13 causes with low observed numbers of deaths, we developed negative binomial models with plausible covariates. For 27 causes for which death is rare, we modelled the higher level cause in the cause hierarchy of the GBD 2010 and then allocated deaths across component causes proportionately, estimated from all available data in the database. For selected causes (African trypanosomiasis, congenital syphilis, whooping cough, measles, typhoid and parathyroid, leishmaniasis, acute hepatitis E, and HIV/AIDS), we used natural history models based on information on incidence, prevalence, and case-fatality. We separately estimated cause fractions by aetiology for diarrhoea, lower respiratory infections, and meningitis, as well as disaggregations by subcause for chronic kidney disease, maternal disorders, cirrhosis, and liver cancer. For deaths due to collective violence and natural disasters, we used mortality shock regressions. For every cause, we estimated 95% UIs that captured both parameter estimation uncertainty and uncertainty due to model specification where CODEm was used. We constrained cause-specific fractions within every age-sex group to sum to total mortality based on draws from the uncertainty distributions.Findings In 2010, there were 52.8 million deaths globally. At the most aggregate level, communicable, maternal, neonatal, and nutritional causes were 24.9% of deaths worldwide in 2010, down from 15.9 million (34.1%) of 46.5 million in 1990. This decrease was largely due to decreases in mortality from diarrhoeal disease (from 2.5 to 1.4 million), lower respiratory infections (from 3.4 to 2.8 million), neonatal disorders (from 3.1 to 2.2 million), measles (from 0.63 to 0.13 million), and tetanus (from 0.27 to 0.06 million). Deaths from HIV/AIDS increased from 0.30 million in 1990 to 1.5 million in 2010, reaching a peak of 1.7 million in 2006. Malaria mortality also rose by an estimated 19.9% since 1990 to 1.17 million deaths in 2010. Tuberculosis killed 1.2 million people in 2010. Deaths from non-communicable diseases rose by just under 8 million between 1990 and 2010, accounting for two of every three deaths (34.5 million) worldwide by 2010. 8 million people died from cancer in 2010, 38% more than two decades ago; of these, 1.5 million (19%) were from trachea, bronchus, and lung cancer. Ischaemic heart disease and stroke collectively killed 12.9 million people in 2010, or one in four deaths worldwide, compared with one in five in 1990; 1.3 million deaths were due to diabetes, twice as many as in 1990. The fraction of global deaths due to injuries (5.1 million deaths) was marginally higher in 2010 (9.6%) compared with two decades earlier (8.8%). This was driven by a 46% rise in deaths worldwide due to road traffic accidents (1.3 million in 2010) and a rise in deaths from falls. Ischaemic heart disease, stroke, chronic obstructive pulmonary disease (COPD), lower respiratory infections, lung cancer, and HIV/AIDS were the leading causes of death in 2010. Ischaemic heart disease, lower respiratory infections, stroke, diarrhoeal disease, malaria, and HIV/AIDS were the leading causes of years of life lost due to premature mortality (YLLs) in 2010, similar to what was estimated for 1990, except for HIV/AIDS and preterm birth complications. YLLs from lower respiratory infections and diarrhoea decreased by 45-54% since 1990; ischaemic heart disease and stroke YLLs increased by 17-28%. Regional variations in leading causes of death were substantial. Communicable, maternal, neonatal, and nutritional causes still accounted for 76% of premature mortality in sub-Saharan Africa in 2010. Age standardised death rates from some key disorders rose (HIV/AIDS, Alzheimer's disease, diabetes mellitus, and chronic kidney disease in particular), but for most diseases, death rates fell in the past two decades; including major vascular diseases, COPD, most forms of cancer, liver cirrhosis, and maternal disorders. For other conditions, notably malaria, prostate cancer, and injuries, little change was noted.Interpretation Population growth, increased average age of the world's population, and largely decreasing age-specific, sex-specific, and cause-specific death rates combine to drive a broad shift from communicable, maternal, neonatal, and nutritional causes towards non-communicable diseases. Nevertheless, communicable, maternal, neonatal, and nutritional causes remain the dominant causes of YLLs in sub-Saharan Africa. Overlaid on this general pattern of the epidemiological transition, marked regional variation exists in many causes, such as interpersonal violence, suicide, liver cancer, diabetes, cirrhosis, Chagas disease, African trypanosomiasis, melanoma, and others. Regional heterogeneity highlights the importance of sound epidemiological assessments of the causes of death on a regular basis.