The state of health in Pakistan and its provinces and territories, 1990-2019: a systematic analysis for the Global Burden of Disease Study 2019.
The state of health in Pakistan and its provinces and territories, 1990-2019: a systematic analysis for the Global Burden of Disease Study 2019.
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DOI：
10.1016/s2214-109x(22)00497-1
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发表时间：
2023-02
影响因子：
34.3
通讯作者：
Mokdad, Ali H.
中科院分区：
文献类型：
--
作者：
Hafeez, Assad;Dangel, William James;Ostroff, Samuel M.;Kiani, Ayyaz Gul;Glenn, Scott D.;Abbas, Jaffar;Afzal, Muhammad Sohail;Afzal, Saira;Ahmad, Sajjad;Ahmed, Ali;Ahmed, Haroon;Ali, Liaqat;Ali, Muhammad;Ali, Zahid;Arshad, Muhammad;Ashraf, Tahira;Bhutta, Zulfiqar A.;Bibi, Sadia;Butt, Zahid A.;Das, Jai K.;Fadoo, Zehra;Hanif, Asif;Hayat, Khezar;Humayun, Ayesha;Iqbal, Khalid;Iqbal, Usman;Khalid, Nauman;Khan, Ejaz Ahmad;Khan, Muhammad Shahzeb;Malik, Ahmad Azam;Naveed, Muhammad;Naz, Shumaila;Niazi, Robina Khan;Piracha, Zahra Zahid;Saeed, Umar;Salman, Muhammad;Samad, Zainab;Saqib, Muhammad Arif Nadeem;Shah, Syed Mahboob;Shahid, Izza;Shaikh, Masood Ali;Shamshad, Hina;Shuja, Kanwar Hamza;Suleman, Muhammad;Ullah, Anayat;Ullah, Irfan;Ullah, Saif;Ullah, Sana;Waheed, Yasir;Waris, Abdul;Hay, Simon, I;Murray, Christopher J. L.;Mokdad, Ali H.
了解卫生趋势并估计国家和国家以下各级的疾病负担有助于政策制定者跟踪进展情况并找出总体卫生绩效方面的差距。2019年全球疾病、伤害和风险因素负担研究(GBD)提供了巴基斯坦的全面估计。自1990年以来健康指标的比较为巴基斯坦加强其医疗保健系统、减少不平等、改善妇女和儿童健康结果、实现全民健康覆盖以及实现联合国可持续发展目标的能力提供了宝贵的见解。我们根据GBD 2019年对巴基斯坦各省和地区从1990年到2019年的疾病、伤害和风险因素负担进行了估计，以改善该国的健康和健康结果。我们使用GBD 2019年的方法和数据输入来估计1990年至2019年巴基斯坦及其四省三区286例死因和369例非致命性健康损失原因的社会人口指数、总生育率、特定原因死亡、损失寿命、残疾寿命、残疾调整寿命、健康预期寿命以及风险因素。为了生成巴基斯坦在国家和国家以下各级的估计，我们使用68个位置年的数据来估计巴基斯坦特定的人口指标，316个位置年的巴基斯坦特定的死因数据，579个巴基斯坦特定的非致命结果的位置年数据，296个巴基斯坦特定风险因素的位置年数据，以及3089个巴基斯坦特定协变量的位置年数据。巴基斯坦全国男女的预期寿命从1990年的61·1岁(95%不确定区间[UI]60·0-62·1)增加到2019年的65·9(63·8-67·8)岁；然而，这些增长在各省和联邦领土上并不一致。从1990年到2019年，巴基斯坦男女之间的健康预期寿命差异缩小，因为女性的健康改善速度快于男性。在1990年至2019年间，女性的预期寿命增加了8.2%(95%UI 6·3-13.8)，而男性的预期寿命增加了7.6%(3.5-11.8)。新生儿疾病，其次是缺血性心脏病、中风、腹泻和下呼吸道感染是2019年所有年龄段过早死亡的主要原因。儿童和产妇营养不良、空气污染、高收缩压、饮食风险和烟草消费是2019年国家一级死亡和残疾调整寿命年的主要全年龄风险因素。五种非传染性疾病--缺血性心脏病、中风、先天缺陷、肝硬变和慢性肾脏疾病--是导致巴基斯坦人死亡的十大原因之一。负担因社会人口指数而异。值得注意的是，俾路支省和开伯尔-普赫图赫瓦的预期寿命增长最低。在1990年和2019年，膳食缺铁是导致男性和女性残疾的主要原因。低出生体重、短孕和颗粒物污染是1990年和2019年总体疾病负担的主要贡献者，尽管情况有所改善，在研究期间，年龄标化的DALY比率分别下降了23.5%(95%UI 3·8-39·2)和27·6%(14·3-38·6)。我们的研究表明，自1990年以来，巴基斯坦在减少疾病负担方面取得了进展，但地理、年龄和性别差异依然存在。需要对卫生系统进行公平投资，并确定高影响政策干预和方案的优先次序，以挽救生命和改善卫生结果。巴基斯坦正面临着几个国内外挑战--塔利班在阿富汗重新掌权、政治动荡、灾难性的洪灾、新冠肺炎疫情--这些挑战将决定巴基斯坦的健康和发展轨迹。巴基斯坦必须解决传染病的负担，并遏制非传染性疾病发病率的上升。优先考虑这三个领域将增强巴基斯坦实现全民健康覆盖、实现可持续发展目标和改善整体健康成果的能力。比尔和梅琳达·盖茨基金会。摘要的乌尔都语翻译见补充资料部分。
Understanding health trends and estimating the burden of disease at the national and subnational levels helps policy makers track progress and identify disparities in overall health performance. The Global Burden of Diseases, Injuries, and Risk Factors Study (GBD) 2019 provides comprehensive estimates for Pakistan. Comparison of health indicators since 1990 provides valuable insights about Pakistan's ability to strengthen its health-care system, reduce inequalities, improve female and child health outcomes, achieve universal health coverage, and meet the UN Sustainable Development Goals. We present estimates of the burden of disease, injuries, and risk factors for Pakistan provinces and territories from 1990 to 2019 based on GBD 2019 to improve health and health outcomes in the country. We used methods and data inputs from GBD 2019 to estimate socio-demographic index, total fertility rate, cause-specific deaths, years of life lost, years lived with disability, disability-adjusted life-years, healthy life expectancy, and risk factors for 286 causes of death and 369 causes of non-fatal health loss in Pakistan and its four provinces and three territories from 1990 to 2019. To generate estimates for Pakistan at the national and subnational levels, we used 68 location-years of data to estimate Pakistan-specific demographic indicators, 316 location-years of data for Pakistan-specific causes of death, 579 location-years of data for Pakistan-specific non-fatal outcomes, 296 location-years of data for Pakistan-specific risk factors, and 3089 location-years of data for Pakistan-specific covariates. Life expectancy for both sexes in Pakistan increased nationally from 61·1 (95% uncertainty interval [UI] 60·0–62·1) years in 1990 to 65·9 (63·8–67·8) years in 2019; however, these gains were not uniform across the provinces and federal territories. Pakistan saw a narrowing of the difference in healthy life expectancy between the sexes from 1990 to 2019, as health gains for women occurred at faster rates than for men. For women, life expectancy increased by 8·2% (95% UI 6·3–13·8) between 1990 and 2019, whereas the male life expectancy increased by 7·6% (3·5–11·8). Neonatal disorders, followed by ischaemic heart disease, stroke, diarrhoeal diseases, and lower respiratory infections were the leading causes of all-age premature mortality in 2019. Child and maternal malnutrition, air pollution, high systolic blood pressure, dietary risks, and tobacco consumption were the leading all-age risk factors for death and disability-adjusted life-years at the national level in 2019. Five non-communicable diseases—ischaemic heart disease, stroke, congenital defects, cirrhosis, and chronic kidney disease—were among the ten leading causes of years of life lost in Pakistan. Burden varied by socio-demographic index. Notably, Balochistan and Khyber Pakhtunkhwa had the lowest observed gains in life expectancy. Dietary iron deficiency was the leading cause of years lived with disability for both men and women in 1990 and 2019. Low birthweight and short gestation and particulate matter pollution were the leading contributors to overall disease burden in both 1990 and 2019 despite moderate improvements, with a 23·5% (95% UI 3·8–39·2) and 27·6% (14·3–38·6) reduction in age-standardised attributable DALY rates during the study period. Our study shows that progress has been made on reducing Pakistan's disease burden since 1990, but geographical, age, and sex disparities persist. Equitable investment in the health system, as well as the prioritisation of high-impact policy interventions and programmes, are needed to save lives and improve health outcomes. Pakistan is facing several domestic and foreign challenges—the Taliban's return to power in Afghanistan, political turmoil, catastrophic flooding, the COVID-19 pandemic—that will shape the trajectory of the country's health and development. Pakistan must address the burden of infectious disease and curb rising rates of non-communicable diseases. Prioritising these three areas will enhance Pakistan's ability to achieve universal health coverage, meet its Sustainable Development Goals, and improve the overall health outcomes. Bill & Melinda Gates Foundation. For the Urdu translation of the abstract see Supplementary Materials section.