Cardiovascular disease, chronic kidney disease, and diabetes mortality burden of cardiometabolic risk factors from 1980 to 2010: a comparative risk assessment.
Cardiovascular disease, chronic kidney disease, and diabetes mortality burden of cardiometabolic risk factors from 1980 to 2010: a comparative risk assessment.
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DOI：
10.1016/s2213-8587(14)70102-0
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发表时间：
2014-08
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通讯作者：
Global Burden of Metabolic Risk Factors for Chronic Diseases Collaboration
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作者：
Global Burden of Metabolic Risk Factors for Chronic Diseases Collaboration
血压和血糖升高、血清胆固醇和体重指数（BMI）是心血管疾病（CVD）的风险因素;其中一些因素还增加了慢性肾脏疾病（CKD）和糖尿病的风险。我们估计了1980年至2010年期间所有国家和地区的CVD，CKD和糖尿病死亡率归因于这四种心脏代谢风险因素。我们使用了来自基于人群的健康调查汇总分析的国家、年龄组和性别的风险因素暴露数据。病因特异性死亡率的相对风险来自于大型前瞻性研究的汇总。我们计算了每个单独危险因素和所有危险因素组合的人群归因分数（PAF），解释了多因果关系和BMI对其他三种危险因素的影响。我们通过将病因特异性PAF乘以2010年全球疾病、伤害和风险因素负担研究中的疾病特异性死亡人数来计算可归因死亡。我们将所有输入的不确定性传播到最终估计中。2010年，高血压是每个地区死于心血管疾病、慢性肾脏病和糖尿病的主要危险因素，导致全球40%以上死于这些疾病;高BMI和高血糖分别导致约15%的死亡;胆固醇导致10%的死亡。在考虑多因性因素后，这些疾病的死亡中有63%（1080万人死亡; 95%置信区间10.1-11.5）可归因于这四种代谢危险因素的综合作用，而1980年为67%（710万人死亡; 6.6-7.6）。在1980年至2010年期间，高BMI和高血糖的死亡负担几乎翻了一番。在国家一级，白俄罗斯、蒙古和哈萨克斯坦的男性中，这四个风险因素导致的年龄标准化死亡率超过每10万人925人，但在日本、新加坡、韩国、法国、西班牙、荷兰、澳大利亚和加拿大等一些高收入国家，女性死亡率低于每10万人130人，男性死亡率低于200人。在21世纪世纪初，心脏代谢流行病的显著特征是高血压的巨大作用以及肥胖和糖尿病的日益增加的影响。死亡率负担已从高收入国家转移到低收入和中等收入国家。
Elevated blood pressure and glucose, serum cholesterol, and body mass index (BMI) are risk factors for cardiovascular diseases (CVDs); some of these factors also increase the risk of chronic kidney disease (CKD) and diabetes. We estimated CVD, CKD, and diabetes mortality attributable to these four cardio-metabolic risk factors for all countries and regions between 1980 and 2010. We used data on risk factor exposure by country, age group, and sex from pooled analysis of population-based health surveys. Relative risks for cause-specific mortality were obtained from pooling of large prospective studies. We calculated the population attributable fractions (PAF) for each risk factor alone, and for the combination of all risk factors, accounting for multi-causality and for mediation of the effects of BMI by the other three risks. We calculated attributable deaths by multiplying the cause-specific PAFs by the number of disease-specific deaths from the Global Burden of Diseases, Injuries, and Risk Factors 2010 Study. We propagated the uncertainties of all inputs to the final estimates. In 2010, high blood pressure was the leading risk factor for dying from CVDs, CKD, and diabetes in every region, causing over 40% of worldwide deaths from these diseases; high BMI and glucose were each responsible for about 15% of deaths; and cholesterol for 10%. After accounting for multi-causality, 63% (10.8 million deaths; 95% confidence interval 10.1–11.5) of deaths from these diseases were attributable to the combined effect of these four metabolic risk factors, compared with 67% (7.1 million deaths; 6.6–7.6) in 1980. The mortality burden of high BMI and glucose nearly doubled between 1980 and 2010. At the country level, age-standardised death rates attributable to these four risk factors surpassed 925 deaths per 100,000 among men in Belarus, Mongolia, and Kazakhstan, but were below 130 deaths per 100,000 for women and below 200 for men in some high-income countries like Japan, Singapore, South Korea, France, Spain, The Netherlands, Australia, and Canada. The salient features of the cardio-metabolic epidemic at the beginning of the twenty-first century are the large role of high blood pressure and an increasing impact of obesity and diabetes. There has been a shift in the mortality burden from high-income to low- and middle-income countries.