Global, regional, and national burden of meningitis, 1990-2016: a systematic analysis for the Global Burden of Disease Study 2016.
Global, regional, and national burden of meningitis, 1990-2016: a systematic analysis for the Global Burden of Disease Study 2016.
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DOI：
10.1016/s1474-4422(18)30387-9
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发表时间：
2018-12
期刊：
影响因子：
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通讯作者：
GBD 2016 Meningitis Collaborators
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作者：
GBD 2016 Meningitis Collaborators
急性脑膜炎的病死率很高，幸存者可能会有严重的终身残疾。我们的目标是对全球脑膜炎负担的水平和趋势进行全面评估，以帮助指导疫苗和治疗方案的引进、继续和持续发展。2016年全球疾病、伤害和风险因素负担(GBD)研究估计了四种原因之一造成的脑膜炎负担：肺炎双球菌、脑膜炎双球菌、b型流感嗜血杆菌和其他原因的残留类别。具体死因死亡率的估计是通过对生命登记和口头尸检数据进行整体建模而产生的，这些数据受到标准化数据处理算法的影响。死亡人数乘以GBD死亡年龄标准预期寿命，以估计损失寿命年，即残疾调整寿命年(DALY)的死亡率部分。对相关出版物以及医院和索赔数据的系统分析被用来通过贝叶斯元回归工具估计脑膜炎发病率。脑膜炎死亡和病例被分成不同的病因，分别与死亡率和发病率的病因比例进行Meta回归。脑膜炎引起的长期损害的概率被应用于幸存者，并用来估计残疾寿命(YLD)。我们评估了负担指标和社会人口指数(SDI)之间的关系，SDI是一种基于生育率、收入和教育的综合发展衡量标准。从1990年到2016年，全球脑膜炎死亡人数下降了21.0%，从403 012(95%不确定性区间[UI]319 426-458 514)降至318 400(265 218-408 705)。全球事件案例从1990年的250万(95%UI 2.19-2.91)增加到2016年的282万(2.46-3.31)。脑膜炎病死率和发病率与SDI密切相关。死亡率和发病率最高的是构成非洲脑膜炎带的萨赫勒周边国家，病例和死亡人数最多的10个国家中有6个位于该区域。1990年，b型流感嗜血杆菌是导致脑膜炎的最常见原因，全球为780 070例(95%UI613 585-978 219)，但在2016年下降最多(-49.1%)，成为最不常见的原因，为397例 297例(291 076-533 662)。脑膜炎球菌是1990年脑膜炎死亡的主要原因(全球192例 833死亡[95%UI153 358-221 503])，而其他脑膜炎是2016年死亡(136 423[112 682-178 022])和病例(125万[1.06-1.49])的首要原因。肺炎球菌导致的YLD数量在2016年最多(634 458[444 787-839 749])，因为它对幸存者的长期影响更严重。2016年，全球有148万(1.04-1.96)年因脑膜炎死亡，相比之下，2187万(18.20-28.28)年死亡人数为2187万，这表明死亡率对脑膜炎负担的贡献远远大于致残结果的贡献。脑膜炎负担仍然很高，进展大大落后于其他疫苗可预防的疾病。应特别注意开发针对脑膜炎病因的覆盖面更广的疫苗，使受影响最严重的国家负担得起这些疫苗，提高疫苗接种率，改善获得低成本诊断和治疗的机会，并改善对残疾幸存者的支持。脑膜炎的致病原因和危险因素仍然存在很大的不确定性。对脑膜炎的持续、积极的特定原因监测对于继续和改进对全世界脑膜炎负担和趋势的监测至关重要。比尔和梅琳达·盖茨基金会。
Acute meningitis has a high case-fatality rate and survivors can have severe lifelong disability. We aimed to provide a comprehensive assessment of the levels and trends of global meningitis burden that could help to guide introduction, continuation, and ongoing development of vaccines and treatment programmes. The Global Burden of Diseases, Injuries, and Risk Factors (GBD) 2016 study estimated meningitis burden due to one of four types of cause: pneumococcal, meningococcal, Haemophilus influenzae type b, and a residual category of other causes. Cause-specific mortality estimates were generated via cause of death ensemble modelling of vital registration and verbal autopsy data that were subject to standardised data processing algorithms. Deaths were multiplied by the GBD standard life expectancy at age of death to estimate years of life lost, the mortality component of disability-adjusted life-years (DALYs). A systematic analysis of relevant publications and hospital and claims data was used to estimate meningitis incidence via a Bayesian meta-regression tool. Meningitis deaths and cases were split between causes with meta-regressions of aetiological proportions of mortality and incidence, respectively. Probabilities of long-term impairment by cause of meningitis were applied to survivors and used to estimate years of life lived with disability (YLDs). We assessed the relationship between burden metrics and Socio-demographic Index (SDI), a composite measure of development based on fertility, income, and education. Global meningitis deaths decreased by 21·0% from 1990 to 2016, from 403 012 (95% uncertainty interval [UI] 319 426–458 514) to 318 400 (265 218–408 705). Incident cases globally increased from 2·50 million (95% UI 2·19–2·91) in 1990 to 2·82 million (2·46–3·31) in 2016. Meningitis mortality and incidence were closely related to SDI. The highest mortality rates and incidence rates were found in the peri-Sahelian countries that comprise the African meningitis belt, with six of the ten countries with the largest number of cases and deaths being located within this region. Haemophilus influenzae type b was the most common cause of incident meningitis in 1990, at 780 070 cases (95% UI 613 585–978 219) globally, but decreased the most (–49·1%) to become the least common cause in 2016, with 397 297 cases (291 076–533 662). Meningococcus was the leading cause of meningitis mortality in 1990 (192 833 deaths [95% UI 153 358–221 503] globally), whereas other meningitis was the leading cause for both deaths (136 423 [112 682–178 022]) and incident cases (1·25 million [1·06–1·49]) in 2016. Pneumococcus caused the largest number of YLDs (634 458 [444 787–839 749]) in 2016, owing to its more severe long-term effects on survivors. Globally in 2016, 1·48 million (1·04—1·96) YLDs were due to meningitis compared with 21·87 million (18·20—28·28) DALYs, indicating that the contribution of mortality to meningitis burden is far greater than the contribution of disabling outcomes. Meningitis burden remains high and progress lags substantially behind that of other vaccine-preventable diseases. Particular attention should be given to developing vaccines with broader coverage against the causes of meningitis, making these vaccines affordable in the most affected countries, improving vaccine uptake, improving access to low-cost diagnostics and therapeutics, and improving support for disabled survivors. Substantial uncertainty remains around pathogenic causes and risk factors for meningitis. Ongoing, active cause-specific surveillance of meningitis is crucial to continue and to improve monitoring of meningitis burdens and trends throughout the world. Bill & Melinda Gates Foundation.