Global, regional, and national age-sex specific mortality for 264 causes of death, 1980-2016: a systematic analysis for the Global Burden of Disease Study 2016.
Global, regional, and national age-sex specific mortality for 264 causes of death, 1980-2016: a systematic analysis for the Global Burden of Disease Study 2016.
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DOI：
10.1016/s0140-6736(17)32152-9
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发表时间：
2017-09-16
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通讯作者：
GBD 2016 Causes of Death Collaborators
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作者：
GBD 2016 Causes of Death Collaborators
监测过早死亡率的水平和趋势对于了解社会如何解决过早死亡的主要原因至关重要。2016年全球疾病负担研究（GBD 2016）对1980年至2016年期间195个地区的264种原因的特定原因死亡率进行了全面评估。该评估包括评估随着发展变化的预期流行病学转变以及当地模式偏离这些趋势的情况。我们按年龄、性别、地理和年份估计了死因特异性死亡和寿命损失年数（YLLs）。YLLs的计算方法是每次死亡的总和乘以每个年龄段的标准预期寿命。我们使用了GBD死因数据库，包括：针对登记不足和垃圾编码进行校正的生命登记（VR）数据;针对垃圾编码进行校正的国家和次国家死因推断（VA）研究;以及其他来源，包括针对特定原因（如孕产妇死亡率）的调查和监测系统。为了便于质量评估，我们报告了按地点和年份划分的GBD 1级或2级死因（主要垃圾代码）的死亡比例。基于完整性、垃圾编码、原因列表细节和所涵盖的时间段，我们为每个位置提供了整体数据质量评级，评分范围从0星（最差）到5星（最好）。我们使用了强大的统计方法，包括死因推断模型（CODEm），以生成每个地点、年份、年龄和性别的估计值。我们根据社会人口指数（SDI）评估了观察到的和预期的死因死亡水平和趋势，SDI是一个汇总指标，来自人均平均收入，教育程度和总生育率的测量，并根据SDI将地点分为五分之一。相对于GBD 2015，我们将GBD 2016的死因层级扩大了18个。现有数据的质量因地点而异。25个国家的数据质量被评为最高类别（5星），而48、30、21和44个国家被评为每个后续数据质量级别。27个国家没有生命登记或死因推断数据，因此数据质量被定为零。2016年，非传染性疾病（NCD）死亡占死亡人数的72.3%（95%不确定性区间[UI] 71.2 - 73.2），其中19.3%（18.5 - 20.4）的死亡发生在传染性、孕产妇、新生儿和营养（CMNN）疾病中，另有8.43%（8.00 - 8.67）的死亡发生在伤害中。尽管2006年至2016年期间全球非传染性疾病的年龄标准化死亡率有所下降，但这些死亡的总人数有所增加; 2006-16年十年期间CMNN原因的死亡人数和年龄标准化死亡率均有所下降-受伤死亡的年龄标准化死亡率有所下降，但总人数变化不大。2016年，全球5岁以下儿童死亡的三大主要原因是下呼吸道感染、新生儿早产并发症和出生窒息和创伤所致的新生儿脑病，共导致180万人死亡（95% UI 159万至189万）。在1990年至2016年期间，老年人死亡发生了深刻的转变，90-94岁的死亡人数增加了178%（95%UI 176-181），95岁以上的死亡人数增加了210%（208-212）。从2006年到2016年，按年龄标准化YLL率计算的十大主要原因显着下降（中位数年化变化率为2.89%）;在同一期间，所有其他原因的中位数年化变化率较低（下降1.59%）。在全球范围内，2016年导致YLL总数的五大主要原因是心血管疾病;腹泻，下呼吸道感染和其他常见传染病;肿瘤;新生儿疾病;以及艾滋病毒/艾滋病和结核病。在原因分组的更精细细分层面上，2016年总YLL的十大主要原因是缺血性心脏病，脑血管疾病，下呼吸道感染，呼吸道疾病，道路伤害，疟疾，新生儿早产并发症，艾滋病毒/艾滋病，慢性阻塞性肺疾病和新生儿脑病由于出生窒息和创伤。缺血性心脏病是113个国家男性和97个国家女性YLL总数的主要原因。将各国观察到的最低生活水平与仅根据空间数据基础预测的最低生活水平进行比较，突出了不同的区域模式，包括撒哈拉以南非洲疟疾和艾滋病毒/艾滋病造成的最低生活水平高于预期;糖尿病，特别是在大洋洲;人际暴力，特别是在拉丁美洲和加勒比;以及心肌病和心肌炎，特别是在东欧和中欧。在195个地点中的117个地点，缺血性心脏病的YLL水平低于预期。YLL明显低于预期的其他主要原因包括南亚和东南亚许多地区的新生儿早产并发症以及西欧的脑血管疾病。在过去37年中，所有五分之一的SDI中传染病、孕产妇、新生儿和营养性疾病的发病率都有所下降，许多地区相对于其SDI的增长速度快于预期。全球老龄死亡趋势的转变表明，在减少许多早死原因方面取得了成功。在全球范围内，因糖尿病或某些肿瘤等原因造成的YLL有所增加，在某些地方，因吸毒失调、冲突和恐怖主义等原因造成的YLL有所增加。YLL水平的增加可能反映了需要高水平护理但有效治疗仍然难以实现的条件的结果，可能会增加卫生系统的成本。比尔和梅林达·盖茨基金会。
Monitoring levels and trends in premature mortality is crucial to understanding how societies can address prominent sources of early death. The Global Burden of Disease 2016 Study (GBD 2016) provides a comprehensive assessment of cause-specific mortality for 264 causes in 195 locations from 1980 to 2016. This assessment includes evaluation of the expected epidemiological transition with changes in development and where local patterns deviate from these trends. We estimated cause-specific deaths and years of life lost (YLLs) by age, sex, geography, and year. YLLs were calculated from the sum of each death multiplied by the standard life expectancy at each age. We used the GBD cause of death database composed of: vital registration (VR) data corrected for under-registration and garbage coding; national and subnational verbal autopsy (VA) studies corrected for garbage coding; and other sources including surveys and surveillance systems for specific causes such as maternal mortality. To facilitate assessment of quality, we reported on the fraction of deaths assigned to GBD Level 1 or Level 2 causes that cannot be underlying causes of death (major garbage codes) by location and year. Based on completeness, garbage coding, cause list detail, and time periods covered, we provided an overall data quality rating for each location with scores ranging from 0 stars (worst) to 5 stars (best). We used robust statistical methods including the Cause of Death Ensemble model (CODEm) to generate estimates for each location, year, age, and sex. We assessed observed and expected levels and trends of cause-specific deaths in relation to the Socio-demographic Index (SDI), a summary indicator derived from measures of average income per capita, educational attainment, and total fertility, with locations grouped into quintiles by SDI. Relative to GBD 2015, we expanded the GBD cause hierarchy by 18 causes of death for GBD 2016. The quality of available data varied by location. Data quality in 25 countries rated in the highest category (5 stars), while 48, 30, 21, and 44 countries were rated at each of the succeeding data quality levels. Vital registration or verbal autopsy data were not available in 27 countries, resulting in the assignment of a zero value for data quality. Deaths from non-communicable diseases (NCDs) represented 72·3% (95% uncertainty interval [UI] 71·2–73·2) of deaths in 2016 with 19·3% (18·5–20·4) of deaths in that year occurring from communicable, maternal, neonatal, and nutritional (CMNN) diseases and a further 8·43% (8·00–8·67) from injuries. Although age-standardised rates of death from NCDs decreased globally between 2006 and 2016, total numbers of these deaths increased; both numbers and age-standardised rates of death from CMNN causes decreased in the decade 2006–16—age-standardised rates of deaths from injuries decreased but total numbers varied little. In 2016, the three leading global causes of death in children under-5 were lower respiratory infections, neonatal preterm birth complications, and neonatal encephalopathy due to birth asphyxia and trauma, combined resulting in 1·80 million deaths (95% UI 1·59 million to 1·89 million). Between 1990 and 2016, a profound shift toward deaths at older ages occurred with a 178% (95% UI 176–181) increase in deaths in ages 90–94 years and a 210% (208–212) increase in deaths older than age 95 years. The ten leading causes by rates of age-standardised YLL significantly decreased from 2006 to 2016 (median annualised rate of change was a decrease of 2·89%); the median annualised rate of change for all other causes was lower (a decrease of 1·59%) during the same interval. Globally, the five leading causes of total YLLs in 2016 were cardiovascular diseases; diarrhoea, lower respiratory infections, and other common infectious diseases; neoplasms; neonatal disorders; and HIV/AIDS and tuberculosis. At a finer level of disaggregation within cause groupings, the ten leading causes of total YLLs in 2016 were ischaemic heart disease, cerebrovascular disease, lower respiratory infections, diarrhoeal diseases, road injuries, malaria, neonatal preterm birth complications, HIV/AIDS, chronic obstructive pulmonary disease, and neonatal encephalopathy due to birth asphyxia and trauma. Ischaemic heart disease was the leading cause of total YLLs in 113 countries for men and 97 countries for women. Comparisons of observed levels of YLLs by countries, relative to the level of YLLs expected on the basis of SDI alone, highlighted distinct regional patterns including the greater than expected level of YLLs from malaria and from HIV/AIDS across sub-Saharan Africa; diabetes mellitus, especially in Oceania; interpersonal violence, notably within Latin America and the Caribbean; and cardiomyopathy and myocarditis, particularly in eastern and central Europe. The level of YLLs from ischaemic heart disease was less than expected in 117 of 195 locations. Other leading causes of YLLs for which YLLs were notably lower than expected included neonatal preterm birth complications in many locations in both south Asia and southeast Asia, and cerebrovascular disease in western Europe. The past 37 years have featured declining rates of communicable, maternal, neonatal, and nutritional diseases across all quintiles of SDI, with faster than expected gains for many locations relative to their SDI. A global shift towards deaths at older ages suggests success in reducing many causes of early death. YLLs have increased globally for causes such as diabetes mellitus or some neoplasms, and in some locations for causes such as drug use disorders, and conflict and terrorism. Increasing levels of YLLs might reflect outcomes from conditions that required high levels of care but for which effective treatments remain elusive, potentially increasing costs to health systems. Bill & Melinda Gates Foundation.