Global mortality, disability, and the contribution of risk factors: Global Burden of Disease Study
Global mortality, disability, and the contribution of risk factors: Global Burden of Disease Study
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DOI：
10.1016/s0140-6736(96)07495-8
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发表时间：
1997-05-17
期刊：
影响因子：
168.9
通讯作者：
Lopez, AD
中科院分区：
文献类型：
--
作者：
Murray, CJL;Lopez, AD
背景：预防和控制疾病和伤害需要有关疾病的主要医学原因和暴露或风险因素的信息，由于缺乏调查全球总体负担的共同方法，对这些因素的公共卫生重要性的评估受到了阻碍。全球疾病负担研究（GBD）为流行病学评估提供了一种标准化的方法，并使用标准单位——残疾调整生命年（DALY）来帮助进行比较。方法根据病因、发病率、平均发病年龄、持续时间和残疾严重程度的死亡率估计，计算每个GBD地区每个年龄-性别组107种疾病的DALYs。对不同区域因营养不良、供水不良、环境卫生和个人及家庭卫生、不安全的性行为、吸烟、饮酒、职业、高血压、缺乏运动、使用非法药物和空气污染造成的疾病的负担和流行程度进行了估计。发达地区占全球所有死亡和残疾原因造成的负担的11.6%，占全球卫生支出的90.2%。传染病、孕产妇、围产期和营养失调占43.9%；非传染性原因占40.9%；伤害15.1%;恶性肿瘤5.1%，神经精神疾病10.5%；心血管疾病占全球伤残调整生命年的9.7%。全球残疾调整生命年的十大主要具体原因依次为：下呼吸道感染、腹泻病、围产儿疾病、单极重度抑郁症、缺血性心脏病、脑血管病、结核病、麻疹、道路交通事故和先天性异常，全世界残疾调整生命年的15.9%可归因于儿童营养不良，6.8%归因于水、环境卫生和个人及家庭卫生条件差。造成疾病负担的三个主要因素是影响儿童的传染性疾病和围产期疾病。神经精神疾病和损伤的巨大负担未得到充分认识。在中国、拉丁美洲和加勒比、其他亚洲和岛屿以及中东新月地区，按伤残调整生命年计算的流行病学转变取得了重大进展。如果考虑到残疾和死亡的负担，我们的清单与其他主要死亡原因的清单有很大不同，DALYs提供了共同的指标，有助于对风险因素、疾病和伤害的负担进行有意义的比较。
Background Prevention and control of disease and injury require information about the leading medical causes of illness and exposures or risk factors, The assessment of the public-health importance of these has been hampered by the lack of common methods to investigate the overall, worldwide burden. The Global Burden of Disease Study (GBD) provides a standardised approach to epidemiological assessment and uses a standard unit, the disability-adjusted life year (DALY), to aid comparisons.Methods DALYs for each age-sex group in each GBD region for 107 disorders were calculated, based on the estimates of mortality by cause, incidence, average age of onset, duration, and disability severity. Estimates of the burden and prevalence of exposure in different regions of disorders attributable to malnutrition, poor water supply, sanitation and personal and domestic hygiene, unsafe sex, tobacco use, alcohol, occupation, hypertension, physical inactivity, use of illicit drugs, and air pollution were developed.Findings Developed regions account for 11.6% of the worldwide burden from all causes of death and disability, and account for 90.2% of health expenditure worldwide. Communicable, maternal, perinatal, and nutritional disorders explain 43.9%; noncommunicable causes 40.9%; injuries 15.1%; malignant neoplasms 5.1%: neuropsychiatric conditions 10.5%; and cardiovascular conditions 9.7% of DALYs worldwide. The ten leading specific causes of global DALYs are, in descending order, lower respiratory infections, diarrhoeal diseases, perinatal disorders, unipolar major depression, ischaemic heart disease, cerebrovascular disease, tuberculosis, measles, road-traffic accidents, and congenital anomalies, 15.9% of DALYs worldwide are attributable to childhood malnutrition and 6.8% to poor water, and sanitation and personal and domestic hygiene.Interpretation The three leading contributors to the burden of disease are communicable and perinatal disorders affecting children. The substantial burdens of neuropsychiatric disorders and injuries are under-recognised. The epidemiological transition in terms of DALYs has progressed substantially in China, Latin America and the Caribbean, other Asia and islands, and the middle eastern crescent. If the burdens of disability and death are taken into account, our list differs substantially from other lists of the leading causes of death, DALYs provide common metric to aid meaningful comparison of the burden of risk factors, diseases, and injuries.