Premature mortality projections in the USA through 2030: a modelling study
Premature mortality projections in the USA through 2030: a modelling study
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DOI：
10.1016/s2468-2667(18)30114-2
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发表时间：
2018-08-01
影响因子：
50
通讯作者：
Shiels, Meredith S.
中科院分区：
文献类型：
--
作者：
Best, Ana F.;Haozous, Emily A.;Shiels, Meredith S.
尽管预计高收入国家的预期寿命将增加，但美国的预期寿命增幅预计是最小的，2014年至2015年，美国总体死亡率实际上有所增加，具体美国人口有所不同。因此，预测未来的过早死亡率对于临床和公共卫生服务规划、遏制迅速增加的死亡原因和维持在减少死亡原因方面的进展至关重要。我们旨在预测过早死亡率（此处定义为25-64岁的个人死亡）的趋势，并估计预计死亡总数、预计因过早死亡而损失的潜在寿命年数，以及每年减少2%的预计意外死亡率的效果。方法我们获得了美国25岁以下人群的死亡证明数据，1990年至2015年的64年来自美国疾病控制和预防中心（CDC）国家卫生统计中心。我们从CDC WONDER获得了2016年美国非美洲印第安人或阿拉斯加原住民群体的死亡率数据; 2016年的数据不适用于美洲印第安人或阿拉斯加原住民。我们的分析集中在白色人、黑人、西班牙裔、亚洲人或太平洋岛民以及美洲印第安人或阿拉斯加原住民男性和女性中的全因过早死亡和最常见的过早死亡原因（癌症、心脏病、事故、自杀和慢性肝病或肝硬化）。我们通过使用年龄阶段队列预测模型，按性别和种族或民族估计了2017-30年的年龄标准化过早死亡率和相应的年度百分比变化。我们还做了一个敏感性分析，预测未来的死亡率从横截面死亡率和（日志）周期率比曲线的JoinPoint。我们使用相应的特定年龄和特定年份的美国人口普查人口预测计算了绝对死亡人数，并估计了潜在寿命损失的年数。结果在2017-30年期间，预计白色妇女和美洲印第安人或阿拉斯加原住民的全因死亡人数将增加，导致239 700人过早死亡，相对于2017年的死亡率（增加10%）。白色男性和黑人、西班牙裔以及亚洲或太平洋岛民男性和女性的死亡率下降将导致死亡人数减少945900人（减少14%）。预计白色、黑人、西班牙裔和亚洲或太平洋岛民的癌症死亡率将下降，黑人妇女的下降幅度最大（年龄标准化过早死亡率，2016年：每10万女性年104.5例死亡; 2030年：每10万女性年77.1例死亡）和男性（2016年：116.8/100 000人年; 2030年：81.6/100 000人年）。预计美国印第安人或阿拉斯加原住民男性的心脏病死亡率将增加（2015年：150.9例/100 000人年; 2030年：175.9例/100 000人年），其他组下降，尽管白色仅略有下降（2016年：每10万妇女年35.6例; 2030年：每10万妇女年31.1例）和美洲印第安人或阿拉斯加土著妇女（2015年：每10万妇女年64.4例; 2030年：每10万妇女年62.8例）。意外死亡率预计将增加在所有美国人口除了亚洲或太平洋岛民妇女，并将增加最快的白色妇女（2030年：每100 000名妇女-年60.5人）和男子（2030年：每100 000人年101.9人）和美洲印第安人或阿拉斯加土著妇女（2030年：每100 000人年97.5人）和男子（2030年：每100 000人年298.7人）。预计所有群体的自杀率都将增加，慢性肝病和肝硬化死亡率预计将增加，除了黑人男性。预计意外死亡每年减少2%将在2017- 2030年期间减少约178700例死亡。解释为了减少未来的过早死亡率，需要采取有效的干预措施来解决由于事故、自杀、慢性肝病和肝硬化导致的死亡率迅速上升的问题。版权所有（C）2018作者。爱思唯尔有限公司出版
Background Although life expectancy has been projected to increase across high-income countries, gains for the USA are anticipated to be among the smallest, and overall US death rates actually increased from 2014 to 2015, with divergence for specific US populations. Therefore, projecting future premature mortality is essential for clinical and public health service planning, curbing rapidly increasing causes of death, and sustaining progress in declining causes of death. We aimed to project premature mortality (here defined as deaths of individuals aged 25-64 years) trends through 2030, and to estimate the total number of projected deaths, the projected number of potential years of life lost due to premature mortality, and the effect of reducing projected accidental death rates by 2% per year.Methods We obtained death certificate data for the US population aged 25-64 years for 1990-2015 from the US Centers for Disease Control and Prevention (CDC) National Center for Health Statistics. We obtained US mortality data for 2016 for non-American Indian or Alaska native groups from CDC WONDER; data for 2016 were not available for American Indians or Alaska natives. Our analysis focused on all-cause premature mortality and the commonest causes of premature death (cancer, heart disease, accidents, suicide, and chronic liver disease or cirrhosis) among white, black, Hispanic, Asian or Pacific islanders, and American Indian or Alaska native men and women. We estimated age-standardised premature mortality and corresponding annual percentage changes for 2017-30 by sex and race or ethnic origin by use of age-period-cohort forecasting models. We also did a sensitivity analysis projecting future mortality from cross-sectional mortality and a JoinPoint of the (log) period rate ratio curve. We calculated absolute death counts by use of corresponding age-specific and year-specific US census population projections, and estimated years of potential life lost.Findings During 2017-30, all-cause deaths are projected to increase among white women and American Indians or Alaska natives, resulting in 239 700 excess premature deaths relative to 2017 rates (a 10% increase). Mortality declines in white men and black, Hispanic, and Asian or Pacific islander men and women will result in 945 900 fewer deaths (a 14% reduction). Cancer mortality rates are projected to decline among white, black, Hispanic, and Asian or Pacific islander women and men, with the largest declines among black women (age-standardised premature mortality rate 2016: 104.5 deaths per 100 000 woman-years; 2030: 77.1 per 100 000 woman-years) and men (2016: 116.8 per 100 000 man-years; 2030: 81.6 per 100 000 man-years). Heart disease death rates are projected to increase in American Indian or Alaska native men (2015: 150.9 per 100 000 man-years; 2030: 175.9 per 100 000 man-years) and decline in other groups, albeit only slightly in white (2016: 35.6 per 100 000 woman-years; 2030: 31.1 per 100 000 woman-years) and American Indian or Alaska native women (2015: 64.4 per 100 000 woman-years; 2030: 62.8 per 100 000 womanyears). Accidental death rates are projected to increase in all US populations except Asian or Pacific islander women, and will increase most rapidly among white women (2030: 60.5 per 100 000 woman-years) and men (2030: 101.9 per 100 000 man-years) and American Indian or Alaska native women (2030: 97.5 per 100 000 woman-years) and men (2030: 298.7 per 100 000 man-years). Suicide rates are projected to increase for all groups, and chronic liver disease and cirrhosis deaths are projected to increase for all groups except black men. A 2% per year reduction in projected accidental deaths would eliminate an estimated 178 700 deaths during 2017-30.Interpretation To reduce future premature mortality, effective interventions are needed to address rapidly rising mortality rates due to accidents, suicides, and chronic liver disease and cirrhosis. Copyright (C) 2018 The Author(s). Published by Elsevier Ltd.