Endemic Cardiovascular Diseases of the Poorest Billion
Endemic Cardiovascular Diseases of the Poorest Billion
复制标题
DOI：
10.1161/circulationaha.116.008731
复制
发表时间：
2016-06-14
期刊：
影响因子：
37.8
通讯作者：
Bukhman, Gene
中科院分区：
文献类型：
--
作者：
Kwan, Gene F.;Mayosi, Bongani M.;Bukhman, Gene
最贫穷的10亿人分布在世界各地，尽管大多数集中在撒哈拉以南非洲和南亚的农村地区。在城市中心以外的低收入和中等收入国家，心血管疾病(CVD)数据可能很稀少。尽管存在这种城市偏见，但来自最贫穷国家的心血管疾病登记长期以来一直显示，非动脉粥样硬化性中风、高血压性心脏病、非缺血性和查加斯心肌病、风湿性心脏病和先天性心脏病等疾病占主导地位。缺血性心脏病相对较少见。在这里，我们总结了关于世界上最贫穷的人群中心血管疾病流行病学的已知情况，并评估了全球心血管疾病控制目标在这一人群中的相关性。我们评估了两个主要数据来源，2013年全球疾病负担研究模拟了世界上最贫穷的16个国家的估计，这些国家62%的人口属于最贫穷的10亿人。我们发现，在最贫穷的国家，缺血性心脏病仅占心血管疾病和先天性心脏畸形残疾调整寿命年(DALY)的12%，而在高收入国家，这一比例为51%。我们发现，在最贫穷的国家(如尼日尔，在最贫穷的10亿人中，82%的人口是由行为或代谢风险因素造成的)，心血管疾病和先天性心脏异常的综合负担(1629/3049 DALY/10万)只有53%，而在高收入国家，心血管疾病和先天性心脏异常的综合负担(4439/5199 DALY)的85%被归因于行为或代谢风险因素。此外，在心血管疾病和先天性心脏畸形的综合负担中，在最贫穷的国家，34%的人在30岁以下，而在高收入国家，只有3%的人在30岁以下。我们得出结论，尽管目前针对非传染性疾病和心血管疾病控制的全球目标将有助于减少最贫穷人口中心血管疾病的过早死亡，但这些目标是不够的。具体地说，目前的框架(1)排除了人的死亡。
The poorest billion people are distributed throughout the world, though most are concentrated in rural sub-Saharan Africa and South Asia. Cardiovascular disease (CVD) data can be sparse in low-and middle-income countries beyond urban centers. Despite this urban bias, CVD registries from the poorest countries have long revealed a predominance of nonatherosclerotic stroke, hypertensive heart disease, nonischemic and Chagas cardiomyopathies, rheumatic heart disease, and congenital heart anomalies, among others. Ischemic heart disease has been relatively uncommon. Here, we summarize what is known about the epidemiology of CVDs among the world's poorest people and evaluate the relevance of global targets for CVD control in this population. We assessed both primary data sources, and the 2013 Global Burden of Disease Study modeled estimates in the world's 16 poorest countries where 62% of the population are among the poorest billion. We found that ischemic heart disease accounted for only 12% of the combined CVD and congenital heart anomaly disability-adjusted life years (DALYs) in the poorest countries, compared with 51% of DALYs in high-income countries. We found that as little as 53% of the combined CVD and congenital heart anomaly burden (1629/3049 DALYs per 100 000) was attributed to behavioral or metabolic risk factors in the poorest countries (eg, in Niger, 82% of the population among the poorest billion) compared with 85% of the combined CVD and congenital heart anomaly burden (4439/5199 DALYs) in high-income countries. Further, of the combined CVD and congenital heart anomaly burden, 34% was accrued in people under age 30 years in the poorest countries, while only 3% is accrued under age 30 years in high-income countries. We conclude although the current global targets for noncommunicable disease and CVD control will help diminish premature CVD death in the poorest populations, they are not sufficient. Specifically, the current framework (1) excludes deaths of people