The evolution of the Global Burden of Disease framework for disease, injury and risk factor quantification: developing the evidence base for national, regional and global public health action
The evolution of the Global Burden of Disease framework for disease, injury and risk factor quantification: developing the evidence base for national, regional and global public health action
复制标题
DOI：
10.1186/1744-8603-1-5
复制
发表时间：
2005-01-01
影响因子：
10.8
通讯作者：
Lopez, Alan D.
中科院分区：
文献类型：
--
作者：
Lopez, Alan D.
关于人口中疾病和伤害的主要原因以及这些原因如何变化的可靠、可比较的信息，是关于卫生部门优先事项的辩论的一个关键投入。关于疾病、伤害和风险因素的描述性流行病学的传统信息来源一般不完整、不完整，可靠性和可比性不确定。由于缺乏标准化的衡量框架，无法对各种疾病和伤害以及风险因素进行比较，而且未能系统地评价数据质量，因此无法对各种疾病和风险因素的真正公共卫生重要性进行比较分析。因此，人们对重大条件和危害对人口健康的影响认识不足，往往导致公共卫生投资不足。1990年代初，随着第一次全球疾病负担研究的完成，全球疾病和风险因素的量化有了显著改善。这是第一次，可以使用一个共同的衡量标准（残疾调整寿命年）来评估100多种疾病和伤害以及10个主要风险因素对全球和区域健康状况的相对重要性，该标准同时考虑到过早死亡率以及疾病和伤害的非致命后果的流行率、持续时间和严重程度。因此，精神健康状况和伤害被确定为全世界疾病/伤害负担的主要原因之一，非致命性后果对这些状况和伤害具有特别重要的意义，这对政策，特别是预防政策具有明显的影响。这项研究的一项主要成就是完整的全球描述性流行病学，包括按年龄、性别和区域分列的100多种疾病和伤害的发病率、流行率和死亡率。各国的应用、进一步的方法研究和数据供应的增加，导致2000年国家、区域和全球估计数的改进，但包括艾滋病毒在内的主要疾病造成的疾病负担仍然存在很大的不确定性。如果要更有效地了解促进健康的全球公共政策，在发展中国家迅速实施具有成本效益的数据收集系统是一个关键的优先事项。
Reliable, comparable information about the main causes of disease and injury in populations, and how these are changing, is a critical input for debates about priorities in the health sector. Traditional sources of information about the descriptive epidemiology of diseases, injuries and risk factors are generally incomplete, fragmented and of uncertain reliability and comparability. Lack of a standardized measurement framework to permit comparisons across diseases and injuries, as well as risk factors, and failure to systematically evaluate data quality have impeded comparative analyses of the true public health importance of various conditions and risk factors. As a consequence the impact of major conditions and hazards on population health has been poorly appreciated, often leading to a lack of public health investment. Global disease and risk factor quantification improved dramatically in the early 1990s with the completion of the first Global Burden of Disease Study. For the first time, the comparative importance of over 100 diseases and injuries, and ten major risk factors, for global and regional health status could be assessed using a common metric (Disability-Adjusted Life Years) which simultaneously accounted for both premature mortality and the prevalence, duration and severity of the non-fatal consequences of disease and injury. As a consequence, mental health conditions and injuries, for which non-fatal outcomes are of particular significance, were identified as being among the leading causes of disease/injury burden worldwide, with clear implications for policy, particularly prevention. A major achievement of the Study was the complete global descriptive epidemiology, including incidence, prevalence and mortality, by age, sex and Region, of over 100 diseases and injuries. National applications, further methodological research and an increase in data availability have led to improved national, regional and global estimates for 2000, but substantial uncertainty around the disease burden caused by major conditions, including, HIV, remains. The rapid implementation of cost-effective data collection systems in developing countries is a key priority if global public policy to promote health is to be more effectively informed.