Demographic and epidemiologic drivers of global cardiovascular mortality.
Demographic and epidemiologic drivers of global cardiovascular mortality.
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全球心血管死亡率的人口统计学和流行病学驱动因素。
DOI：
10.1056/nejmoa1406656
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发表时间：
2015-04-02
期刊：
影响因子：
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通讯作者：
Murray CJ
中科院分区：
文献类型：
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作者：
Roth GA;Forouzanfar MH;Moran AE;Barber R;Nguyen G;Feigin VL;Naghavi M;Mensah GA;Murray CJ
由于人口增长、人口老龄化和疾病的流行病学变化，全球心血管疾病死亡人数正在增加。解开这三个驱动因素对死亡率趋势的影响，对于规划医疗保健系统的未来和衡量减少心血管疾病的进展非常重要。我们使用了2013年全球疾病负担研究的死亡率数据，其中包括分为21个世界地区的188个国家的数据。我们开发了三种反事实情景来代表1990年至2013年心血管死亡变化的主要驱动因素（仅人口增长，人口增长和老龄化以及疾病的流行病学变化）。审查了长期趋势和与国民收入变化的相互关系。1990年至2013年间，尽管特定年龄死亡率下降了39%，但全球心血管疾病死亡人数仍增加了41%;这一增长是由人口老龄化导致的死亡率增加55%和人口增长导致的死亡率增加25%推动的。增长。这些驱动因素的相对贡献因区域而异;只有在中欧和西欧，每年死于心血管疾病的人数实际上有所下降。只有在中上收入国家，人均国内生产总值的变化与年龄别死亡率的变化相关，而且这种相关性很弱;在其他地方没有显著的相关性。人口老龄化和增长导致1990年至2013年间全球心血管疾病死亡人数增加，尽管大多数地区的年龄别死亡率有所下降。只有中欧和西欧在心血管健康方面取得的进展足以抵消这些人口因素。（由比尔及梅琳达·盖茨基金会等资助。）
Global deaths from cardiovascular disease are increasing as a result of population growth, the aging of populations, and epidemiologic changes in disease. Disentangling the effects of these three drivers on trends in mortality is important for planning the future of the health care system and benchmarking progress toward the reduction of cardiovascular disease. We used mortality data from the Global Burden of Disease Study 2013, which includes data on 188 countries grouped into 21 world regions. We developed three counterfactual scenarios to represent the principal drivers of change in cardiovascular deaths (population growth alone, population growth and aging, and epidemiologic changes in disease) from 1990 to 2013. Secular trends and correlations with changes in national income were examined. Global deaths from cardiovascular disease increased by 41% between 1990 and 2013 despite a 39% decrease in age-specific death rates; this increase was driven by a 55% increase in mortality due to the aging of populations and a 25% increase due to population growth. The relative contributions of these drivers varied by region; only in Central Europe and Western Europe did the annual number of deaths from cardiovascular disease actually decline. Change in gross domestic product per capita was correlated with change in age-specific death rates only among upper-middle income countries, and this correlation was weak; there was no significant correlation elsewhere. The aging and growth of the population resulted in an increase in global cardiovascular deaths between 1990 and 2013, despite a decrease in age-specific death rates in most regions. Only Central and Western Europe had gains in cardiovascular health that were sufficient to offset these demographic forces. (Funded by the Bill and Melinda Gates Foundation and others.)