Rapid health transition in China, 1990-2010: findings from the Global Burden of Disease Study 2010.
Rapid health transition in China, 1990-2010: findings from the Global Burden of Disease Study 2010.
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DOI：
10.1016/s0140-6736(13)61097-1
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发表时间：
2013-06-08
期刊：
影响因子：
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通讯作者：
Murray CJ
中科院分区：
文献类型：
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作者：
Yang G;Wang Y;Zeng Y;Gao GF;Liang X;Zhou M;Wan X;Yu S;Jiang Y;Naghavi M;Vos T;Wang H;Lopez AD;Murray CJ
在过去几十年中，中国经历了人口和流行病的快速变化，包括生育率和儿童死亡率的显著下降以及出生时预期寿命的增加。公众对卫生系统的不满导致了重大改革。为了帮助这些改革提供信息，我们对中国的疾病负担进行了全面评估，评估了1990年至2010年间的变化，以及中国的健康负担与其他国家的比较。我们使用2010年全球疾病、伤害和风险因素负担研究（GBD 2010）的结果，对中国和其他18个G20国家的1990年和2010年的死亡率、死亡原因、寿命损失年（YLLs）、残疾生存年（YLDs）、残疾调整寿命年（DALs）和健康预期寿命（黑尔）进行了评估。我们目前的结果为231种疾病和伤害和67个危险因素或危险因素集群相关的中国。我们使用年龄标准化比率和95%的不确定性区间评估了中国与G20国家的相对表现（显著优于、劣于或无法与G20平均值区分）。2010年，中国的主要死因是卒中（170万例死亡，95% UI 150 - 180万）、缺血性心脏病（948700例死亡，774500 - 1024600）和慢性阻塞性肺疾病（934000例死亡，846600 - 1032300）。 2010年，中国的非标准化YLL低于G20中的所有新兴经济体，仅略高于美国。2010年，中国是G20中年龄标准化YLD率最低的国家。中国在黑尔方面排名第十（95% UI第八至第十），在预期寿命方面排名第十二（第十一至第十三）。1990年至2010年期间，新生儿、传染病和儿童受伤造成的YLL大幅下降。精神和行为障碍、物质使用障碍和肌肉骨骼疾病几乎占所有YLD的一半。来自YLD的DIFE的比例从1990年的28.1%（95%UI 24.2 - 32.5）上升到2010年的39.4%（34.9 - 43.8）。2010年，导致糖尿病的主要原因是心血管疾病（中风和缺血性心脏病）、癌症（肺癌和肝癌）、腰痛和抑郁症。膳食危险因素、高血压和烟草暴露是构成中国归因性糖尿病人数最多的危险因素。在2010年按年龄标准化的DALY率方面，环境空气污染排名第四（第三至第五;在20国集团中排名第二），家庭空气污染排名第五（第四至第六;在20国集团中排名第三高）。城市化、收入增加和老龄化导致的非传染性疾病的迅速增加，以及慢性残疾的转变，对中国的卫生系统构成了重大挑战。减少不良饮食、高血压、烟草使用、胆固醇和空腹血糖对人群的暴露是中国公共政策的优先事项，控制环境和家庭空气污染也是如此。这些变化将需要政府采取综合对策，改善初级保健，并采取必要的多部门行动应对主要风险。疾病负担的分析为指导中国应对不断变化的疾病谱提供了一个有用的框架。比尔和梅林达·盖茨基金会。
China has undergone rapid demographic and epidemiological changes in the past few decades, including striking declines in fertility and child mortality and increases in life expectancy at birth. Popular discontent with the health system has led to major reforms. To help inform these reforms, we did a comprehensive assessment of disease burden in China, how it changed between 1990 and 2010, and how China's health burden compares with other nations. We used results of the Global Burden of Diseases, Injuries, and Risk Factors Study 2010 (GBD 2010) for 1990 and 2010 for China and 18 other countries in the G20 to assess rates and trends in mortality, causes of death, years of life lost (YLLs), years lived with disability (YLDs), disability-adjusted life-years (DALYs), and healthy life expectancy (HALE). We present results for 231 diseases and injuries and for 67 risk factors or clusters of risk factors relevant to China. We assessed relative performance of China against G20 countries (significantly better, worse, or indistinguishable from the G20 mean) with age-standardised rates and 95% uncertainty intervals. The leading causes of death in China in 2010 were stroke (1·7 million deaths, 95% UI 1·5–1·8 million), ischaemic heart disease (948 700 deaths, 774 500–1 024 600), and chronic obstructive pulmonary disease (934 000 deaths, 846 600–1 032 300). Age-standardised YLLs in China were lower in 2010 than all emerging economies in the G20, and only slightly higher than noted in the USA. China had the lowest age-standardised YLD rate in the G20 in 2010. China also ranked tenth (95% UI eighth to tenth) for HALE and 12th (11th to 13th) for life expectancy. YLLs from neonatal causes, infectious diseases, and injuries in children declined substantially between 1990 and 2010. Mental and behavioural disorders, substance use disorders, and musculoskeletal disorders were responsible for almost half of all YLDs. The fraction of DALYs from YLDs rose from 28·1% (95% UI 24·2–32·5) in 1990 to 39·4% (34·9–43·8) in 2010. Leading causes of DALYs in 2010 were cardiovascular diseases (stroke and ischaemic heart disease), cancers (lung and liver cancer), low back pain, and depression. Dietary risk factors, high blood pressure, and tobacco exposure are the risk factors that constituted the largest number of attributable DALYs in China. Ambient air pollution ranked fourth (third to fifth; the second highest in the G20) and household air pollution ranked fifth (fourth to sixth; the third highest in the G20) in terms of the age-standardised DALY rate in 2010. The rapid rise of non-communicable diseases driven by urbanisation, rising incomes, and ageing poses major challenges for China's health system, as does a shift to chronic disability. Reduction of population exposures from poor diet, high blood pressure, tobacco use, cholesterol, and fasting blood glucose are public policy priorities for China, as are the control of ambient and household air pollution. These changes will require an integrated government response to improve primary care and undertake required multisectoral action to tackle key risks. Analyses of disease burden provide a useful framework to guide policy responses to the changing disease spectrum in China. Bill & Melinda Gates Foundation.