Global, regional, and national disability-adjusted life-years (DALYs) for 359 diseases and injuries and healthy life expectancy (HALE) for 195 countries and territories, 1990-2017: a systematic analysis for the Global Burden of Disease Study 2017.
Global, regional, and national disability-adjusted life-years (DALYs) for 359 diseases and injuries and healthy life expectancy (HALE) for 195 countries and territories, 1990-2017: a systematic analysis for the Global Burden of Disease Study 2017.
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DOI：
10.1016/s0140-6736(18)32335-3
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发表时间：
2018-11-10
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GBD 2017 DALYs and HALE Collaborators
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作者：
GBD 2017 DALYs and HALE Collaborators
一个人的寿命有多长，健康状况良好和不佳的寿命有多少年，人口的健康状况和残疾的主要原因如何随着时间的推移而变化，这些都对政策、规划和提供服务产生影响。我们比较评估了健康预期寿命（黑尔）的模式和趋势，它量化了预期健康生活的年数，以及残疾调整生命年（DALLS）的补充措施，这是一种综合衡量疾病负担的指标，既包括过早死亡率，也包括患病率和健康状况不佳的严重程度，在过去28年里，195个国家和地区的359种疾病和伤害。我们使用了2017年全球疾病、伤害和风险因素负担研究（GBD）中的特定年龄死亡率、过早死亡导致的寿命损失年数（YLL）和残疾寿命年数（YLD）数据，计算了1990年至2017年的黑尔和DALLS。我们使用每个地点、年龄、性别和年份的年龄别死亡率和人均YLD计算黑尔。我们计算了359个原因的DIFE，作为YLL和YLD的总和。我们评估了观察到的黑尔和DALLS在国家和性别方面与基于社会人口指数（SDI）的预期趋势之间的差异。我们还通过将1990年至2017年期间获得的寿命分解为健康状况良好和健康状况不佳的寿命，以及女性与男性相比的额外寿命来分析黑尔。从全球来看，1990年至2017年，出生时预期寿命增加了7.4岁（95%不确定性区间7.1 - 7.8），从1990年的65.6岁（65.3 - 65.8）增加到2017年的73.0岁（72.7 - 73.3）。寿命年数的增加从高SDI国家的5.1年（5.0 - 5.3）到低SDI国家的12.0年（11.3 - 12.8）不等。在出生时预期增加的寿命中，高SDI国家的26.3%（20.1 - 33.1）预计将在健康状况不佳的情况下度过，而中低SDI国家为11.7%（8.8 - 15.1）。出生时黑尔增加了6.3岁（5.9 - 6.7），从1990年的57.0岁（54.6 - 59.1）增加到2017年的63.3岁（60.5 - 65.7）。增加的时间从高SDI国家的3.8年（3.4 - 4.1）到低SDI国家的10.5年（9.8 - 11.2）不等。在各国之间观察到的黑尔差异甚至比这些更大，圣文森特和格林纳丁斯为1·0年（0·4-1·7）（1990年62·4年[59·9-64·7]至2017年63·5年[60·9-65·8]）至23·7年（21·9-25·6）在厄立特里亚（30·7年[28·9-32·2]在1990年至54·4年[51·5-57·1]在2017年）。在大多数国家，黑尔的增长小于总体预期寿命的增长，表明健康状况不佳的年数更多。2017年，在195个国家和地区中的180个国家和地区，女性的预期寿命将长于男性，阿尔及利亚的额外寿命为1.4年（0.6 - 2.3），乌克兰为11.9年（10.9 - 12.9）。在获得的额外年数中，健康状况不佳的比例在各国之间差异很大，波斯尼亚和黑塞哥维那、布隆迪和斯洛伐克的健康状况不佳的额外年数不到20%，而在巴林，所有额外年数都是健康状况不佳的。2017年，新加坡的女性（75.8岁[72.4 - 78.7]）和男性（72.6岁[69.8 - 75.0]）出生时黑尔估计值最高，中非共和国的估计值最低（女性47.0岁[43.7 - 50.2]，男性42.8岁[40.1 - 45.6]）。在全球范围内，2017年，导致糖尿病的五大原因是新生儿疾病、缺血性心脏病、中风、下呼吸道感染和慢性阻塞性肺病。在1990年至2017年期间，传染病的年龄标准化DALY率下降了41.3%（38.8 - 43.5），新生儿疾病下降了49.8%（47.9 - 51.6）。对于非传染性疾病，全球DALY增加了40.1%（36.8 - 43.0），尽管年龄标准化DALY率下降了18.1%（16.0 - 20.2）。随着大多数国家预期寿命的增加，增加的寿命是在健康状况良好还是健康状况不佳的情况下度过的问题越来越重要，因为这可能涉及政策问题，例如保健规定和延长退休年龄。在一些地方，这些额外的年数中有很大一部分是在健康状况不佳的情况下度过的。不同SDI五分位数的国家之间以及性别之间在健康和寿命延长以及疾病负担方面存在很大的不平等。致残疾病的负担对卫生系统规划和与卫生有关的支出产生了严重影响。尽管低SDI国家在减少传染病和新生儿疾病负担方面取得了进展，但通过扩大已证明有效的干预措施，可以加快这一进展的速度。非传染性疾病的全球趋势表明，需要做出更多努力，最大限度地提高黑尔，例如风险预防和关注健康的上游决定因素。比尔和梅林达·盖茨基金会。
How long one lives, how many years of life are spent in good and poor health, and how the population’s state of health and leading causes of disability change over time all have implications for policy, planning, and provision of services. We comparatively assessed the patterns and trends of healthy life expectancy (HALE), which quantifies the number of years of life expected to be lived in good health, and the complementary measure of disability-adjusted life-years (DALYs), a composite measure of disease burden capturing both premature mortality and prevalence and severity of ill health, for 359 diseases and injuries for 195 countries and territories over the past 28 years. We used data for age-specific mortality rates, years of life lost (YLLs) due to premature mortality, and years lived with disability (YLDs) from the Global Burden of Diseases, Injuries, and Risk Factors Study (GBD) 2017 to calculate HALE and DALYs from 1990 to 2017. We calculated HALE using age-specific mortality rates and YLDs per capita for each location, age, sex, and year. We calculated DALYs for 359 causes as the sum of YLLs and YLDs. We assessed how observed HALE and DALYs differed by country and sex from expected trends based on Socio-demographic Index (SDI). We also analysed HALE by decomposing years of life gained into years spent in good health and in poor health, between 1990 and 2017, and extra years lived by females compared with males. Globally, from 1990 to 2017, life expectancy at birth increased by 7·4 years (95% uncertainty interval 7·1–7·8), from 65·6 years (65·3–65·8) in 1990 to 73·0 years (72·7–73·3) in 2017. The increase in years of life varied from 5·1 years (5·0–5·3) in high SDI countries to 12·0 years (11·3–12·8) in low SDI countries. Of the additional years of life expected at birth, 26·3% (20·1–33·1) were expected to be spent in poor health in high SDI countries compared with 11·7% (8·8–15·1) in low-middle SDI countries. HALE at birth increased by 6·3 years (5·9–6·7), from 57·0 years (54·6–59·1) in 1990 to 63·3 years (60·5–65·7) in 2017. The increase varied from 3·8 years (3·4–4·1) in high SDI countries to 10·5 years (9·8–11·2) in low SDI countries. Even larger variations in HALE than these were observed between countries, ranging from 1·0 year (0·4–1·7) in Saint Vincent and the Grenadines (62·4 years [59·9–64·7] in 1990 to 63·5 years [60·9–65·8] in 2017) to 23·7 years (21·9–25·6) in Eritrea (30·7 years [28·9–32·2] in 1990 to 54·4 years [51·5–57·1] in 2017). In most countries, the increase in HALE was smaller than the increase in overall life expectancy, indicating more years lived in poor health. In 180 of 195 countries and territories, females were expected to live longer than males in 2017, with extra years lived varying from 1·4 years (0·6–2·3) in Algeria to 11·9 years (10·9–12·9) in Ukraine. Of the extra years gained, the proportion spent in poor health varied largely across countries, with less than 20% of additional years spent in poor health in Bosnia and Herzegovina, Burundi, and Slovakia, whereas in Bahrain all the extra years were spent in poor health. In 2017, the highest estimate of HALE at birth was in Singapore for both females (75·8 years [72·4–78·7]) and males (72·6 years [69·8–75·0]) and the lowest estimates were in Central African Republic (47·0 years [43·7–50·2] for females and 42·8 years [40·1–45·6] for males). Globally, in 2017, the five leading causes of DALYs were neonatal disorders, ischaemic heart disease, stroke, lower respiratory infections, and chronic obstructive pulmonary disease. Between 1990 and 2017, age-standardised DALY rates decreased by 41·3% (38·8–43·5) for communicable diseases and by 49·8% (47·9–51·6) for neonatal disorders. For non-communicable diseases, global DALYs increased by 40·1% (36·8–43·0), although age-standardised DALY rates decreased by 18·1% (16·0–20·2). With increasing life expectancy in most countries, the question of whether the additional years of life gained are spent in good health or poor health has been increasingly relevant because of the potential policy implications, such as health-care provisions and extending retirement ages. In some locations, a large proportion of those additional years are spent in poor health. Large inequalities in HALE and disease burden exist across countries in different SDI quintiles and between sexes. The burden of disabling conditions has serious implications for health system planning and health-related expenditures. Despite the progress made in reducing the burden of communicable diseases and neonatal disorders in low SDI countries, the speed of this progress could be increased by scaling up proven interventions. The global trends among non-communicable diseases indicate that more effort is needed to maximise HALE, such as risk prevention and attention to upstream determinants of health. Bill & Melinda Gates Foundation.