Estimation of potential global pandemic influenza mortality on the basis of vital registry data from the 1918-20 pandemic: a quantitative analysis
Estimation of potential global pandemic influenza mortality on the basis of vital registry data from the 1918-20 pandemic: a quantitative analysis
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DOI：
10.1016/s0140-6736(06)69895-4
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发表时间：
2006-12-23
期刊：
影响因子：
168.9
通讯作者：
Hill, Kenneth H.
中科院分区：
文献类型：
--
作者：
Murray, Christopher J. L.;Lopez, Alan D.;Hill, Kenneth H.
背景禽流感大流行的威胁正在引起公众的广泛关注和卫生政策的反应，特别是在高收入国家。我们的目标是使用1918-20年大流行期间收集的高质量重要登记数据来估计如果今天发生这样的大流行，全球死亡率。方法我们确定了所有拥有1918-20年大流行高质量重要登记数据的国家，并使用这些数据来计算超额死亡率。我们建立了普通的最小二乘回归模型，将超额死亡率与人均收入和绝对纬度联系起来，并使用这些模型来估计2004年流感大流行时的死亡率。发现超额死亡率数据表明，即使在1918-20年，人口死亡率在不同国家之间的差异超过30倍。人均收入在很大程度上解释了死亡率的变化。对1918-20年全球人口2004年死亡率的外推表明，估计有6200万人(10%至90%百分位数范围为5100万-8100万)将死于类似的流感大流行；其中96%(95%可信区间95-98)将发生在发展中国家。如果这一死亡率集中在一年，全球死亡率将增加114%。对1918-20年大流行的经验记录的分析提供了大流行死亡率的合理上限。大多数死亡将发生在贫穷国家，即其稀缺的卫生资源已经因现有的卫生优先事项而捉襟见肘的社会。
Background The threat of an avian influenza pandemic is causing widespread public concern and health policy response, especially in high-income countries. Our aim was to use high-quality vital registration data gathered during the 1918-20 pandemic to estimate global mortality should such a pandemic occur today.Methods We identified all countries with high-quality vital registration data for the 1918-20 pandemic and used these data to calculate excess mortality. We developed ordinary least squares regression models that related excess mortality to per-head income and absolute latitude and used these models to estimate mortality had there been an influenza pandemic in 2004.Findings Excess mortality data show that, even in 1918-20, population mortality varied over 30-fold across countries. Per-head income explained a large fraction of this variation in mortality. Extrapolation of 1918-20 mortality rates to the worldwide population of 2004 indicates that an estimated 62 million people (10th-90th percentile range 51 million-81 million) would be killed by a similar influenza pandemic; 96% (95% CI 95-98) of these deaths would occur in the developing world. if this mortality were concentrated in a single year, it would increase global mortality by 114%.Interpretation This analysis of the empirical record of the 1918-20 pandemic provides a plausible upper bound on pandemic mortality. Most deaths will occur in poor countries-ie, in societies whose scarce health resources are already stretched by existing health priorities.