Global, regional, and national incidence, prevalence, and years lived with disability for 354 diseases and injuries for 195 countries and territories, 1990-2017: a systematic analysis for the Global Burden of Disease Study 2017.
Global, regional, and national incidence, prevalence, and years lived with disability for 354 diseases and injuries for 195 countries and territories, 1990-2017: a systematic analysis for the Global Burden of Disease Study 2017.
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DOI：
10.1016/s0140-6736(18)32279-7
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发表时间：
2018-11-10
期刊：
影响因子：
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通讯作者：
GBD 2017 Disease and Injury Incidence and Prevalence Collaborators
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文献类型：
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作者：
GBD 2017 Disease and Injury Incidence and Prevalence Collaborators
2017年全球疾病、伤害和风险因素负担研究（GBD 2017）包括对1990年至2017年195个国家和地区354种原因的发病率、患病率和残疾生活年数（YLD）的全面评估。GBD之前的研究表明，从1990年到2016年，死亡率的下降如何导致预期寿命的增加，全球人口老龄化以及非致命性疾病和伤害负担的扩大。这些研究还表明，世界上相当一部分人口经历了非致命性健康损失，在不同原因、地点、年龄和性别之间存在相当大的异质性。GBD研究的持续目标包括提高估计细节的水平，改进分析策略，以及增加高质量数据的数量。我们估计了354种疾病和损伤以及3484种后遗症的发病率和患病率。我们使用了更新和广泛的文献研究，调查数据，监测数据，住院记录，门诊就诊记录和健康保险索赔，并使用死因模型的结果来提供估计，总共使用了68781个数据源。 纳入了来自印度、伊朗、日本、约旦、尼泊尔、中国、巴西、挪威和意大利的新可用临床数据，以及来自美国的更新声明数据和来自中国台湾（中国省）和新加坡的新声明数据。我们使用DisMod-MR 2.1（贝叶斯元回归工具）作为主要估计方法，确保每种疾病的发病率、患病率、缓解率和死亡原因之间的一致性。YLD被估计为患病率估计值和每种互斥后遗症的健康状态的残疾权重的乘积，并对合并症进行了调整。我们更新了社会人口指数（SDI），这是人均收入、受教育年限和总和生育率的概括性发展指标。此外，我们计算了男性和女性YLD之间的差异，以确定不同性别之间的差异趋势。GBD 2017符合准确和透明的健康评估报告指南。在全球范围内，1990年和2017年，女性年龄标准化患病率最高的原因是口腔疾病、头痛疾病、血红蛋白病和溶血性贫血。对于男性，年龄标准化患病率最高的原因是口腔疾病，头痛疾病和结核病，包括1990年和2017年的潜伏性结核病感染。在YLD方面，腰痛，头痛疾病和膳食缺铁是1990年YLD计数的主要3级原因，而腰痛，头痛疾病和抑郁症是2017年男女合并的主要原因。从1990年到2017年，全因年龄标准化YLD率下降了3.9%（95%不确定性区间[UI] 3.1 - 4.6）;然而，全年龄YLD率增加了7.2%（6.0 - 8.4），而全球YLD总数从5.62亿（4.21 - 7.23）增加到8.53亿（6.42 -1100）。男性和女性的增幅相似，男性所有年龄段YLD率的增幅为7.9%（6.6 - 9.2），女性为6.5%（5.4 - 7.7）。我们发现，男性和女性之间的年龄标准化患病率估计多种原因的显着差异。2017年性别间相对差异最大的原因包括物质使用障碍（男性每10万人中有3018例[95% UI 2782-3252]，女性每10万人中有1400例[1279-1524]），运输伤害（3322 [3082-3583] vs 2336 [2154-2535]），自我伤害和人际暴力（3265 [2943-3630] vs 5643 [5057-6302]）。 全球全因年龄标准化YLD率在近30年的时间里仅略有改善。然而，非致命性疾病负担的规模在全球范围内扩大，越来越多的人患有各种各样的疾病。自1990年以来，一部分疾病在全球范围内仍然普遍存在，而其他疾病则显示出更动态的趋势，地球仪的不同年龄、性别和地理位置经历着不同的健康损失负担和趋势。这项研究强调了全球在特定条件下过早死亡率的改善如何导致老年人口患有复杂和潜在昂贵的疾病，但也突出了全球在某些疾病和损伤领域的成就。比尔和梅林达·盖茨基金会。
The Global Burden of Diseases, Injuries, and Risk Factors Study 2017 (GBD 2017) includes a comprehensive assessment of incidence, prevalence, and years lived with disability (YLDs) for 354 causes in 195 countries and territories from 1990 to 2017. Previous GBD studies have shown how the decline of mortality rates from 1990 to 2016 has led to an increase in life expectancy, an ageing global population, and an expansion of the non-fatal burden of disease and injury. These studies have also shown how a substantial portion of the world's population experiences non-fatal health loss with considerable heterogeneity among different causes, locations, ages, and sexes. Ongoing objectives of the GBD study include increasing the level of estimation detail, improving analytical strategies, and increasing the amount of high-quality data. We estimated incidence and prevalence for 354 diseases and injuries and 3484 sequelae. We used an updated and extensive body of literature studies, survey data, surveillance data, inpatient admission records, outpatient visit records, and health insurance claims, and additionally used results from cause of death models to inform estimates using a total of 68 781 data sources. Newly available clinical data from India, Iran, Japan, Jordan, Nepal, China, Brazil, Norway, and Italy were incorporated, as well as updated claims data from the USA and new claims data from Taiwan (province of China) and Singapore. We used DisMod-MR 2.1, a Bayesian meta-regression tool, as the main method of estimation, ensuring consistency between rates of incidence, prevalence, remission, and cause of death for each condition. YLDs were estimated as the product of a prevalence estimate and a disability weight for health states of each mutually exclusive sequela, adjusted for comorbidity. We updated the Socio-demographic Index (SDI), a summary development indicator of income per capita, years of schooling, and total fertility rate. Additionally, we calculated differences between male and female YLDs to identify divergent trends across sexes. GBD 2017 complies with the Guidelines for Accurate and Transparent Health Estimates Reporting. Globally, for females, the causes with the greatest age-standardised prevalence were oral disorders, headache disorders, and haemoglobinopathies and haemolytic anaemias in both 1990 and 2017. For males, the causes with the greatest age-standardised prevalence were oral disorders, headache disorders, and tuberculosis including latent tuberculosis infection in both 1990 and 2017. In terms of YLDs, low back pain, headache disorders, and dietary iron deficiency were the leading Level 3 causes of YLD counts in 1990, whereas low back pain, headache disorders, and depressive disorders were the leading causes in 2017 for both sexes combined. All-cause age-standardised YLD rates decreased by 3·9% (95% uncertainty interval [UI] 3·1–4·6) from 1990 to 2017; however, the all-age YLD rate increased by 7·2% (6·0–8·4) while the total sum of global YLDs increased from 562 million (421–723) to 853 million (642–1100). The increases for males and females were similar, with increases in all-age YLD rates of 7·9% (6·6–9·2) for males and 6·5% (5·4–7·7) for females. We found significant differences between males and females in terms of age-standardised prevalence estimates for multiple causes. The causes with the greatest relative differences between sexes in 2017 included substance use disorders (3018 cases [95% UI 2782–3252] per 100 000 in males vs s1400 [1279–1524] per 100 000 in females), transport injuries (3322 [3082–3583] vs 2336 [2154–2535]), and self-harm and interpersonal violence (3265 [2943–3630] vs 5643 [5057–6302]). Global all-cause age-standardised YLD rates have improved only slightly over a period spanning nearly three decades. However, the magnitude of the non-fatal disease burden has expanded globally, with increasing numbers of people who have a wide spectrum of conditions. A subset of conditions has remained globally pervasive since 1990, whereas other conditions have displayed more dynamic trends, with different ages, sexes, and geographies across the globe experiencing varying burdens and trends of health loss. This study emphasises how global improvements in premature mortality for select conditions have led to older populations with complex and potentially expensive diseases, yet also highlights global achievements in certain domains of disease and injury. Bill & Melinda Gates Foundation.