Global burden of diseases, injuries, and risk factors for young people's health during 1990-2013: a systematic analysis for the Global Burden of Disease Study 2013
Global burden of diseases, injuries, and risk factors for young people's health during 1990-2013: a systematic analysis for the Global Burden of Disease Study 2013
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DOI：
10.1016/s0140-6736(16)00648-6
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发表时间：
2016-06-11
期刊：
影响因子：
168.9
通讯作者：
Murray, Christopher J. L.
中科院分区：
文献类型：
--
作者：
Mokdad, Ali H.;Forouzanfar, Mohammad Hossein;Murray, Christopher J. L.
青年健康已成为全球发展中一个被忽视但又紧迫的问题。年轻人健康模式的变化有可能破坏未来的人口健康和全球经济发展，除非及时制定有效的战略。我们使用死亡率、残疾、伤害和健康风险因素的数据，报告了1990年至2013年10-24岁年轻人过去、现在和预期的疾病负担。方法2013年全球疾病负担研究（GBD 2013）包括对188个国家1990 - 2013年的年度评估，涵盖306种疾病和损伤、1233种后遗症和79种危险因素。我们使用比较风险评估方法来评估在给定年份报告的疾病负担中有多少可归因于过去暴露于某种风险。我们通过比较观察到的健康结果与过去发生替代或反事实暴露水平时本应观察到的健康结果来估计归因负担。我们将同样的方法应用于前几年，以便对1990年至2013年进行比较。我们将伤残调整生命年（DALYs）的分位数与1990年至2013年伤残调整生命年（DALYs）年增长的五分位数交叉制成表格，以显示负担的伤残调整生命年增长率。我们使用了GBD 2013的原因层次，将306种疾病和伤害分为四个级别。一级分为三大类：第一，传染性、孕产妇、新生儿和营养失调；第二，非传染性疾病；第三，伤病。第二级有21个相互排斥和共同详尽的类别，第三级有163个类别，第四级有254个类别。2013年10-14岁青少年的主要死亡原因是艾滋病毒/艾滋病、道路伤害和溺水（25.2%），而交通伤害是15-19岁（14.2%）和20-24岁（15.6%）青少年的主要死亡原因。2013年，孕产妇疾病是20-24岁年轻妇女死亡的最大原因（17.1%），是15-19岁女孩死亡的第四大原因（11.5%）。从1990年到2013年，不安全性行为作为残疾调整生命年的一个风险因素，在15-19岁的男女中从第13位上升到第二位。酒精滥用是20-24岁年轻人DALYs的最高危险因素（总体为7.0%，男性为10.5%，女性为2.7%），而吸毒占2.7%（男性为3.3%，女性为2.0%）。风险因素的作用在国家之间和国家内部各不相同。例如，在20-24岁年龄组中，卡塔尔的吸毒情况最高，占DALYs的4.9%，其次是阿拉伯联合酋长国的4.8%，而俄罗斯的饮酒情况最高，占21.4%，其次是白俄罗斯的21.0%。在墨西哥20-24岁的年轻人中，酒精占DALYs的9.0%（从香港的4.2%到山东的11.3%）和11.6%（从阿瓜斯卡伦特斯的10.1%到奇瓦瓦的14.9%）。从1990年至2013年，10-24岁人群的酒精和药物使用年变化率为1.0%，占残疾调整生命年的3.1%以上。我们的研究结果呼吁加大努力，改善年轻人的健康状况，减少疾病负担和疾病风险。此外，由于各国之间在风险和负担方面存在很大差异，除非考虑到每个国家的具体情况，否则在这一重要生命时期改善健康的全球办法将会失败。最后，我们的结果呼吁制定一项战略来克服财政和技术障碍，以便在卫生信息系统中充分捕捉年轻人的健康风险因素及其决定因素。
Background Young people's health has emerged as a neglected yet pressing issue in global development. Changing patterns of young people's health have the potential to undermine future population health as well as global economic development unless timely and effective strategies are put into place. We report the past, present, and anticipated burden of disease in young people aged 10-24 years from 1990 to 2013 using data on mortality, disability, injuries, and health risk factors.Methods The Global Burden of Disease Study 2013 (GBD 2013) includes annual assessments for 188 countries from 1990 to 2013, covering 306 diseases and injuries, 1233 sequelae, and 79 risk factors. We used the comparative risk assessment approach to assess how much of the burden of disease reported in a given year can be attributed to past exposure to a risk. We estimated attributable burden by comparing observed health outcomes with those that would have been observed if an alternative or counterfactual level of exposure had occurred in the past. We applied the same method to previous years to allow comparisons from 1990 to 2013. We cross-tabulated the quantiles of disability-adjusted life-years (DALYs) by quintiles of DALYs annual increase from 1990 to 2013 to show rates of DALYs increase by burden. We used the GBD 2013 hierarchy of causes that organises 306 diseases and injuries into four levels of classification. Level one distinguishes three broad categories: first, communicable, maternal, neonatal, and nutritional disorders; second, non-communicable diseases; and third, injuries. Level two has 21 mutually exclusive and collectively exhaustive categories, level three has 163 categories, and level four has 254 categories.Findings The leading causes of death in 2013 for young people aged 10-14 years were HIV/AIDS, road injuries, and drowning (25.2%), whereas transport injuries were the leading cause of death for ages 15-19 years (14.2%) and 20-24 years (15.6%). Maternal disorders were the highest cause of death for young women aged 20-24 years (17.1%) and the fourth highest for girls aged 15-19 years (11.5%) in 2013. Unsafe sex as a risk factor for DALYs increased from the 13th rank to the second for both sexes aged 15-19 years from 1990 to 2013. Alcohol misuse was the highest risk factor for DALYs (7.0% overall, 10.5% for males, and 2.7% for females) for young people aged 20-24 years, whereas drug use accounted for 2.7% (3.3% for males and 2.0% for females). The contribution of risk factors varied between and within countries. For example, for ages 20-24 years, drug use was highest in Qatar and accounted for 4.9% of DALYs, followed by 4.8% in the United Arab Emirates, whereas alcohol use was highest in Russia and accounted for 21.4%, followed by 21.0% in Belarus. Alcohol accounted for 9.0% (ranging from 4.2% in Hong Kong to 11.3% in Shandong) in China and 11.6% (ranging from 10.1% in Aguascalientes to 14.9% in Chihuahua) of DALYs in Mexico for young people aged 20-24 years. Alcohol and drug use in those aged 10-24 years had an annual rate of change of >1.0% from 1990 to 2013 and accounted for more than 3.1% of DALYs.Interpretation Our findings call for increased efforts to improve health and reduce the burden of disease and risks for diseases in later life in young people. Moreover, because of the large variations between countries in risks and burden, a global approach to improve health during this important period of life will fail unless the particularities of each country are taken into account. Finally, our results call for a strategy to overcome the financial and technical barriers to adequately capture young people's health risk factors and their determinants in health information systems.