On the comparable quantification of health risks: Lessons from the Global Burden of Disease Study
On the comparable quantification of health risks: Lessons from the Global Burden of Disease Study
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DOI：
10.1097/00001648-199909000-00029
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发表时间：
1999-09-01
期刊：
影响因子：
5.4
通讯作者：
Lopez, AD
中科院分区：
文献类型：
--
作者：
Murray, CJL;Lopez, AD
对全球疾病负担研究结果的广泛讨论和评论表明，需要更仔细地检查比较不同健康风险程度的基础。可归因的负担可以定义为当前观察到的负担与在替代人群暴露分布下观察到的负担之间的差异。暴露的人群分布可以在许多不同的暴露水平和强度上定义（例如连续尺度的收缩压或舒张压），并且暴露的比较分布不必为零。可避免的负担被定义为，如果当前暴露于危险因素的水平降低到暴露的反事实分布所指定的水平，则未来疾病负担的减少。选择变量的替代人口分布，即暴露的反事实分布，是制定更普遍和标准化的可比较、可归因或可避免负担概念的关键步骤。我们已经确定了四种可用作反事实分布的风险分布：理论最小风险、合理最小风险、可行最小风险和成本效益最小风险。以烟草和酒精为例，我们探讨了使用这些不同类型的反事实分布来定义可归因和可避免的负担的含义。全球疾病负担研究中包含的十个风险因素评估反映了一系列方法和反事实分布。我们建议未来的评估应侧重于基于合理的最小风险反事实暴露分布的可避免和可归因的负担。
Extensive discussion and comments on the Global Burden of Disease Study findings have suggested the need to examine more carefully the basis for comparing the magnitude of different health risks. Attributable burden can be defined as the difference between burden currently observed and burden that would have been observed under an alternative population distribution of exposure. Population distributions of exposure may be defined over many different levels and intensities of exposure (such as systolic or diastolic blood pressure on a continuous scale), and the comparison distribution of exposure need not be zero. Avoidable burden is defined as the reduction in the future burden of disease if the current levels of exposure to a risk factor were reduced to those specified by the counterfactual distribution of exposure. Choosing the alternative population distribution for a variable, the counterfactual distribution of exposure, is the critical step in developing a more general and standardized concept of comparable, attributable, or avoidable burden. We have identified four types of distributions of exposure that could be used as the counterfactual distributions: theoretical minimum risk, plausible minimum risk, feasible minimum risk, and cost-effective minimum risk. Using tobacco and alcohol as examples, we explore the implications of using these different types of counterfactual distributions to define attributable and avoidable burden. The ten risk factor assessments included in the Global Burden of Disease Study reflect a range of methods and counterfactual distributions. We recommend that future assessments should focus on avoidable and attributable burden based on the plausible minimum risk counterfactual distribution of exposure.