Worldwide trends in diabetes since 1980: a pooled analysis of 751 population-based studies with 4.4 million participants.
Worldwide trends in diabetes since 1980: a pooled analysis of 751 population-based studies with 4.4 million participants.
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自1980年以来，糖尿病的全球趋势：对751个基于人群的研究的共同分析，有440万参与者。
DOI：
10.1016/s0140-6736(16)00618-8
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发表时间：
2016-04-09
期刊：
影响因子：
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通讯作者：
NCD Risk Factor Collaboration (NCD-RisC)
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文献类型：
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作者：
NCD Risk Factor Collaboration (NCD-RisC)
非传染性疾病的全球目标之一是到2025年，将年龄标准化的成人糖尿病患病率降至2010年的水平。我们的目标是估计糖尿病的全球趋势，各国实现全球目标的可能性，以及患病率的变化以及人口增长和老龄化如何影响糖尿病成年人的数量。我们汇总了来自基于人群的研究的数据，这些研究通过测量其生物标志物收集了糖尿病数据。我们使用贝叶斯分层模型来估计1980年至2014年期间21个地区的200个国家和地区的糖尿病患病率趋势，定义为空腹血糖≥ 7·0 mmol/L，或糖尿病诊断史，或使用胰岛素或口服降糖药物。我们还计算了如果2000年后的趋势继续下去，实现全球糖尿病目标的后验概率。我们使用了来自751项研究的数据，其中包括来自200个国家中146个国家的4372000名成年人。 全球年龄标准化糖尿病患病率从1980年的4.3%（95%可信区间2.4 - 7.0）增加到2014年的9.0%（7.2 - 11.1），女性从5.0%（2.9 - 7.9）增加到7.9%（6.4 - 9.7）。全球成年糖尿病患者人数从1980年的1.08亿增加到2014年的4.22亿（28.5%是由于患病率上升，39.7%是由于人口增长和老龄化，31.8%是由于这两个因素的相互作用）。2014年，欧洲西北部的成人糖尿病患病率最低，波利尼西亚和密克罗尼西亚最高，接近25%，其次是美拉尼西亚、中东和北非。1980年至2014年期间，西欧大陆成年女性的年龄标准化糖尿病患病率几乎没有变化，尽管由于人口老龄化，粗患病率上升。相比之下，波利尼西亚和密克罗尼西亚男女的年龄标准化成人流行率上升了15个百分点。2014年，美属萨摩亚是全国糖尿病患病率最高的国家（男女均超过30%），波利尼西亚和密克罗尼西亚的一些其他岛屿的年龄标准化成人患病率也高于25%。如果2000年后的趋势继续下去，实现到2025年将全球糖尿病患病率控制在2010年水平的全球目标的可能性，男性低于1%，女性为1%。只有9个国家的男性和29个国家的女性，主要是在西欧，有50%或更高的概率达到全球目标。自1980年以来，在每个国家，成年人的年龄标准化糖尿病患病率都有所增加，或者充其量保持不变。再加上人口增长和老龄化，这一增长导致全世界成年糖尿病患者人数几乎翻了两番。就患病率和受影响的成年人人数而言，低收入和中等收入国家的糖尿病负担比高收入国家增加得更快。Wellcome Trust.
One of the global targets for non-communicable diseases is to halt, by 2025, the rise in the age-standardised adult prevalence of diabetes at its 2010 levels. We aimed to estimate worldwide trends in diabetes, how likely it is for countries to achieve the global target, and how changes in prevalence, together with population growth and ageing, are affecting the number of adults with diabetes. We pooled data from population-based studies that had collected data on diabetes through measurement of its biomarkers. We used a Bayesian hierarchical model to estimate trends in diabetes prevalence—defined as fasting plasma glucose of 7·0 mmol/L or higher, or history of diagnosis with diabetes, or use of insulin or oral hypoglycaemic drugs—in 200 countries and territories in 21 regions, by sex and from 1980 to 2014. We also calculated the posterior probability of meeting the global diabetes target if post-2000 trends continue. We used data from 751 studies including 4 372 000 adults from 146 of the 200 countries we make estimates for. Global age-standardised diabetes prevalence increased from 4·3% (95% credible interval 2·4–7·0) in 1980 to 9·0% (7·2–11·1) in 2014 in men, and from 5·0% (2·9–7·9) to 7·9% (6·4–9·7) in women. The number of adults with diabetes in the world increased from 108 million in 1980 to 422 million in 2014 (28·5% due to the rise in prevalence, 39·7% due to population growth and ageing, and 31·8% due to interaction of these two factors). Age-standardised adult diabetes prevalence in 2014 was lowest in northwestern Europe, and highest in Polynesia and Micronesia, at nearly 25%, followed by Melanesia and the Middle East and north Africa. Between 1980 and 2014 there was little change in age-standardised diabetes prevalence in adult women in continental western Europe, although crude prevalence rose because of ageing of the population. By contrast, age-standardised adult prevalence rose by 15 percentage points in men and women in Polynesia and Micronesia. In 2014, American Samoa had the highest national prevalence of diabetes (>30% in both sexes), with age-standardised adult prevalence also higher than 25% in some other islands in Polynesia and Micronesia. If post-2000 trends continue, the probability of meeting the global target of halting the rise in the prevalence of diabetes by 2025 at the 2010 level worldwide is lower than 1% for men and is 1% for women. Only nine countries for men and 29 countries for women, mostly in western Europe, have a 50% or higher probability of meeting the global target. Since 1980, age-standardised diabetes prevalence in adults has increased, or at best remained unchanged, in every country. Together with population growth and ageing, this rise has led to a near quadrupling of the number of adults with diabetes worldwide. The burden of diabetes, both in terms of prevalence and number of adults affected, has increased faster in low-income and middle-income countries than in high-income countries. Wellcome Trust.