Mortality, morbidity, and risk factors in China and its provinces, 1990-2017: a systematic analysis for the Global Burden of Disease Study 2017
Mortality, morbidity, and risk factors in China and its provinces, 1990-2017: a systematic analysis for the Global Burden of Disease Study 2017
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DOI：
10.1016/s0140-6736(19)30427-1
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发表时间：
2019-09-28
期刊：
影响因子：
168.9
通讯作者：
Liang, Xiaofeng
中科院分区：
文献类型：
--
作者：
Zhou, Maigeng;Wang, Haidong;Liang, Xiaofeng
公共卫生是中国政府的工作重点。在拥有全球五分之一人口的中国，以证据为基础的省级卫生决策至关重要。该分析使用了2017年全球疾病、伤害和风险因素负担研究（GBD）的数据，以帮助为省一级的决策提供信息并监测卫生进展。方法采用GBD 2017中的方法，分析1990 - 2017年中国34个省级行政单位的健康模式。我们估计了全因死亡率和特定原因死亡率、生命损失年数（YLLs）、残疾生活年数（YLDs）、残疾调整生命年数（DALYs）、总暴露值（sev）和归因风险。我们将观察结果与基于社会人口指数（SDI）估计的期望值进行了比较。结果2017年中国全国范围内，脑卒中和缺血性心脏病是导致死亡和伤残调整寿命的主要原因。从1990年到2017年，每10万人口中，中风的年龄标准化DALYs下降了33.1%(95%不确定区间[UI] 29.8至37.4)，缺血性心脏病的年龄标准化DALYs增加了4.6%（-3.3至10.7）。2017年，年龄标准化中风、缺血性心脏病、肺癌、慢性阻塞性肺疾病和肝癌是导致yls的五大原因。2017年，肌肉骨骼疾病、精神健康障碍和感觉器官疾病是导致YLDs的三大主要原因，而高收缩压、吸烟、高钠饮食和环境颗粒物污染是导致死亡和DALYs的四大主要危险因素。所有省份每10万人肝癌DALYs均高于预期，观察到的与预期的比率在2.04至6.88之间。2017年，所有省份每10万人口的全因年龄标准化DALYs低于预期，前20个三级原因中缺血性心脏病、阿尔茨海默病、头痛疾病和腰痛低于预期。在全国范围内，年龄标准化sev在十大主要危险因素中的变化百分比最大的是高体重指数（185%,95% UI 113.1 ~ 247.7），其次是环境颗粒物污染（88.5%,66.4 ~ 116.4）。中国在减轻许多疾病和残疾负担方面取得了实质性进展。在不断扩大的中国卫生保健系统中，应优先考虑针对慢性病，特别是老年人的战略。版权所有(C) 2019作者。Elsevier Ltd.出版。
Background Public health is a priority for the Chinese Government. Evidence-based decision making for health at the province level in China, which is home to a fifth of the global population, is of paramount importance. This analysis uses data from the Global Burden of Diseases, Injuries, and Risk Factors Study (GBD) 2017 to help inform decision making and monitor progress on health at the province level.Methods We used the methods in GBD 2017 to analyse health patterns in the 34 province-level administrative units in China from 1990 to 2017. We estimated all-cause and cause-specific mortality, years of life lost (YLLs), years lived with disability (YLDs), disability-adjusted life-years (DALYs), summary exposure values (SEVs), and attributable risk. We compared the observed results with expected values estimated based on the Socio-demographic Index (SDI).Findings Stroke and ischaemic heart disease were the leading causes of death and DALYs at the national level in China in 2017. Age-standardised DALYs per 100 000 population decreased by 33.1% (95% uncertainty interval [UI] 29.8 to 37.4) for stroke and increased by 4.6% (-3.3 to 10.7) for ischaemic heart disease from 1990 to 2017. Age-standardised stroke, ischaemic heart disease, lung cancer, chronic obstructive pulmonary disease, and liver cancer were the five leading causes of YLLs in 2017. Musculoskeletal disorders, mental health disorders, and sense organ diseases were the three leading causes of YLDs in 2017, and high systolic blood pressure, smoking, high-sodium diet, and ambient particulate matter pollution were among the leading four risk factors contributing to deaths and DALYs. All provinces had higher than expected DALYs per 100 000 population for liver cancer, with the observed to expected ratio ranging from 2.04 to 6.88. The all-cause age-standardised DALYs per 100 000 population were lower than expected in all provinces in 2017, and among the top 20 level 3 causes were lower than expected for ischaemic heart disease, Alzheimer's disease, headache disorder, and low back pain. The largest percentage change at the national level in age-standardised SEVs among the top ten leading risk factors was in high body-mass index (185%, 95% UI 113.1 to 247.7]), followed by ambient particulate matter pollution (88.5%, 66.4 to 116.4).Interpretation China has made substantial progress in reducing the burden of many diseases and disabilities. Strategies targeting chronic diseases, particularly in the elderly, should be prioritised in the expanding Chinese health-care system. Copyright (C) 2019 The Author(s). Published by Elsevier Ltd.