Burden of non-communicable diseases from infectious causes in 2017: a modelling study.
Burden of non-communicable diseases from infectious causes in 2017: a modelling study.
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DOI：
10.1016/s2214-109x(20)30358-2
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发表时间：
2020-12
期刊：
影响因子：
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通讯作者：
Bukhman G
中科院分区：
文献类型：
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作者：
Coates MM;Kintu A;Gupta N;Wroe EB;Adler AJ;Kwan GF;Park PH;Rajbhandari R;Byrne AL;Casey DC;Bukhman G
非传染性疾病在全球造成巨大的疾病负担。一些传染病会增加罹患特定非传染性疾病的风险。尽管一些传染性原因造成的NCD负担已经量化，但在本研究中，我们旨在更全面地量化传染性原因造成的NCD全球负担。在这项建模研究中，我们确定了具有既定传染性风险因素的非传染性疾病和具有长期非传染性后遗症的传染病，并在2018年4月11日至2020年6月10日期间进行了叙述性审查，以从量化传染性原因对非传染性疾病的贡献的研究中获得相对风险（RR）或人群归因分数（PAF）。为了确定2017年的感染可归因负担，我们将PAF的估计值应用于2017年全球疾病负担研究（GBD）对感染原因和非传染性疾病的疾病负担估计值，或直接使用GBD 2017的可归因负担估计值。根据GBD定义的地理区域，使用年龄标准化残疾调整生命年（DIFs）率总结这些疾病的发病率和死亡率负担。将传染性原因引起的NCD负担估计值与2017年GBD中PAF最高的风险因素组的可归因负担进行比较。在全球范围内，我们量化了1.3亿例可归因于感染的非传染性疾病，占所有非传染性疾病的8.4%。感染-非传染性疾病对最大的负担是胃癌由于幽门螺杆菌（1460万丹麦克朗）、肝硬化和其他慢性肝病由于B型肝炎病毒（1220万）和丙型肝炎病毒（10.4万），因B型肝炎病毒而导致的肝癌（940万），链球菌感染引起的风湿性心脏病（940万），HPV引起的宫颈癌（800万）。大洋洲（每10万人口中有3564丹麦人）和撒哈拉以南非洲中部（每10万人口中有2988丹麦人）的非传染性疾病标准化感染率最高，其次是其他撒哈拉以南非洲地区，澳大利亚和新西兰（每10万人口中有803丹麦人）最低，其次是其他高收入地区。在撒哈拉以南非洲地区，传染性原因造成的非传染性疾病粗负担比例为11.7%，高于几种常见非传染性疾病风险因素（烟草、酒精使用、高收缩压、饮食风险、高空腹血糖、空气污染和高LDL胆固醇）造成的负担比例。在其他广泛地区，传染病原因在所比较的九种风险中的粗归因比例排名在第五到第八之间。在撒哈拉以南非洲地区，年龄标准化的感染风险归因比例仍然最高，但年龄标准化导致感染风险低于饮食风险，高收缩压和空腹血糖在该地区的排名归因比例。感染性疾病造成了巨大的非传染性疾病负担，并存在明显的区域差异，随着可用于量化的证据的增加，对这一负担的估计可能会增加。为了全面避免非传染性疾病的负担，特别是在低收入和中等收入国家，需要加强针对主要传染病的具有成本效益的干预措施的可用性、覆盖面和质量。促进全民健康覆盖的努力必须解决导致非传染性疾病的传染风险，特别是在这些传染病发病率高的人群中，以减少非传染性疾病负担率的现有区域差异。利昂娜M和哈里B赫尔姆斯利慈善信托基金。
Non-communicable diseases (NCDs) cause a large burden of disease globally. Some infectious diseases cause an increased risk of developing specific NCDs. Although the NCD burden from some infectious causes has been quantified, in this study, we aimed to more comprehensively quantify the global burden of NCDs from infectious causes. In this modelling study, we identified NCDs with established infectious risk factors and infectious diseases with long-term non-communicable sequelae, and did narrative reviews between April 11, 2018, and June 10, 2020, to obtain relative risks (RRs) or population attributable fractions (PAFs) from studies quantifying the contribution of infectious causes to NCDs. To determine infection-attributable burden for the year 2017, we applied estimates of PAFs to estimates of disease burden from the Global Burden of Disease Study (GBD) 2017 for pairs of infectious causes and NCDs, or used estimates of attributable burden directly from GBD 2017. Morbidity and mortality burden from these conditions was summarised with age-standardised rates of disability-adjusted life-years (DALYs), for geographical regions as defined by the GBD. Estimates of NCD burden attributable to infectious causes were compared with attributable burden for the groups of risk factors with the highest PAFs from GBD 2017. Globally, we quantified 130 million DALYs from NCDs attributable to infection, comprising 8·4% of all NCD DALYs. The infection–NCD pairs with the largest burden were gastric cancer due to H pylori (14·6 million DALYs), cirrhosis and other chronic liver diseases due to hepatitis B virus (12·2 million) and hepatitis C virus (10·4 million), liver cancer due to hepatitis B virus (9·4 million), rheumatic heart disease due to streptococcal infection (9·4 million), and cervical cancer due to HPV (8·0 million). Age-standardised rates of infection-attributable NCD burden were highest in Oceania (3564 DALYs per 100 000 of the population) and central sub-Saharan Africa (2988 DALYs per 100 000) followed by the other sub-Saharan African regions, and lowest in Australia and New Zealand (803 DALYs per 100 000) followed by other high-income regions. In sub-Saharan Africa, the proportion of crude NCD burden attributable to infectious causes was 11·7%, which was higher than the proportion of burden attributable to each of several common risk factors of NCDs (tobacco, alcohol use, high systolic blood pressure, dietary risks, high fasting plasma glucose, air pollution, and high LDL cholesterol). In other broad regions, infectious causes ranked between fifth and eighth in terms of crude attributable proportions among the nine risks compared. The age-standardised attributable proportion for infectious risks remained highest in sub-Saharan Africa of the broad regions, but age-standardisation caused infectious risks to fall below dietary risks, high systolic blood pressure, and fasting plasma glucose in ranked attributable proportions within the region. Infectious conditions cause substantial NCD burden with clear regional variation, and estimates of this burden are likely to increase as evidence that can be used for quantification expands. To comprehensively avert NCD burden, particularly in low-income and middle-income countries, the availability, coverage, and quality of cost-effective interventions for key infectious conditions need to be strengthened. Efforts to promote universal health coverage must address infectious risks leading to NCDs, particularly in populations with high rates of these infectious conditions, to reduce existing regional disparities in rates of NCD burden. Leona M and Harry B Helmsley Charitable Trust.