Disability-adjusted life years (DALYs) for 291 diseases and injuries in 21 regions, 1990-2010: a systematic analysis for the Global Burden of Disease Study 2010
Disability-adjusted life years (DALYs) for 291 diseases and injuries in 21 regions, 1990-2010: a systematic analysis for the Global Burden of Disease Study 2010
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DOI：
10.1016/s0140-6736(12)61689-4
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发表时间：
2012-12-15
期刊：
影响因子：
168.9
通讯作者：
Lopez, Alan D.
中科院分区：
文献类型：
--
作者：
Murray, Christopher J. L.;Vos, Theo;Lopez, Alan D.
测量人群中的疾病和伤害负担需要一个综合指标，该指标既能反映过早死亡率，也能反映健康状况不佳的患病率和严重程度。1990年的全球疾病负担研究提出了残疾调整生命年（DIFs）来衡量疾病负担。自1990年研究以来，没有对世界范围内的疾病负担进行全面更新，其中包括对疾病和伤害特定流行病学的系统性重新评估。我们的目的是计算全球范围内的疾病负担和21个地区的1990年，2005年和2010年的方法，使有意义的比较随着时间的推移。方法我们计算DFDs的总和的寿命损失年（YLLs）和年生活残疾（YLDs）。计算了187个国家的291种病因、20个年龄组和男女的疾病负担，并采用严格可比的定义和方法，将其汇总为三个时间点的区域和全球疾病负担估计数。YLLs是根据年龄-性别-国家-时间-特定原因的死亡率估计值计算的，每个年龄的死亡率是标准化预期寿命损失。YLD计算为1160例致残后遗症的患病率，按年龄、性别和原因，并按每种健康状态的新残疾权重进行加权。YLL和YLD都没有年龄加权或贴现。围绕病因特异性DALTS的不确定性计算纳入全因死亡率，病因特异性死亡率，患病率和残疾welfingers.Findings水平的不确定性全球DALTS保持稳定，从1990年（25.03亿）到2010年（24.90亿）。每1000人的粗第纳尔下降了23%（每1000人472人下降到每1000人361人）。残疾调整生命年的构成发生了重大变化，儿童（5岁以下）死亡和残疾所占全球残疾人口的比例从1990年的41%下降到2010年的25%。在较发达地区（高收入亚太地区、西欧、高收入北美和澳大拉西亚），弱势群体通常占疾病负担的一半左右，在撒哈拉以南非洲，这一比例上升到80%以上。1990年，全球47%的残疾人是由于传染性疾病、孕产妇疾病、新生儿疾病和营养失调，43%是由于非传染性疾病，10%是由于受伤。到2010年，这一比例分别变为35%、54%和11%。缺血性心脏病是2010年全球糖尿病的主要原因（从1990年的第四位上升到29%），其次是下呼吸道感染（1990年排名第一;残疾人下降44%），（1990年第五，增加19%）、肠道疾病（1990年第二，减少51%）和艾滋病毒/艾滋病（1990年第33，增加351%）。重度抑郁症从第15位上升到第11位（上升37%），道路伤害从第12位上升到第10位（上升34%）。解释全球疾病负担继续从传染性疾病转向非传染性疾病，从过早死亡转向残疾年数。然而，在撒哈拉以南非洲，许多传染性疾病、孕产妇疾病、新生儿疾病和营养失调仍然是疾病负担的主要原因。精神和行为障碍、肌肉骨骼疾病和糖尿病造成的日益沉重的负担将给卫生系统带来新的挑战。区域差异突出表明，必须了解当地的疾病负担，并在考虑到这些模式的情况下制定2015年后议程的目标和具体目标。由于定义、方法和数据的改进，1990年和2010年的这些结果取代了所有先前发表的全球疾病负担结果。
Background Measuring disease and injury burden in populations requires a composite metric that captures both premature mortality and the prevalence and severity of ill-health. The 1990 Global Burden of Disease study proposed disability-adjusted life years (DALYs) to measure disease burden. No comprehensive update of disease burden worldwide incorporating a systematic reassessment of disease and injury-specific epidemiology has been done since the 1990 study. We aimed to calculate disease burden worldwide and for 21 regions for 1990, 2005, and 2010 with methods to enable meaningful comparisons over time.Methods We calculated DALYs as the sum of years of life lost (YLLs) and years lived with disability (YLDs). DALYs were calculated for 291 causes, 20 age groups, both sexes, and for 187 countries, and aggregated to regional and global estimates of disease burden for three points in time with strictly comparable definitions and methods. YLLs were calculated from age-sex-country-time-specific estimates of mortality by cause, with death by standardised lost life expectancy at each age. YLDs were calculated as prevalence of 1160 disabling sequelae, by age, sex, and cause, and weighted by new disability weights for each health state. Neither YLLs nor YLDs were age-weighted or discounted. Uncertainty around cause-specific DALYs was calculated incorporating uncertainty in levels of all-cause mortality, cause-specific mortality, prevalence, and disability weights.Findings Global DALYs remained stable from 1990 (2.503 billion) to 2010 (2.490 billion). Crude DALYs per 1000 decreased by 23% (472 per 1000 to 361 per 1000). An important shift has occurred in DALY composition with the contribution of deaths and disability among children (younger than 5 years of age) declining from 41% of global DALYs in 1990 to 25% in 2010. YLLs typically account for about half of disease burden in more developed regions (high-income Asia Pacific, western Europe, high-income North America, and Australasia), rising to over 80% of DALYs in sub-Saharan Africa. In 1990, 47% of DALYs worldwide were from communicable, maternal, neonatal, and nutritional disorders, 43% from non-communicable diseases, and 10% from injuries. By 2010, this had shifted to 35%, 54%, and 11%, respectively. Ischaemic heart disease was the leading cause of DALYs worldwide in 2010 (up from fourth rank in 1990, increasing by 29%), followed by lower respiratory infections (top rank in 1990; 44% decline in DALYs), stroke (fifth in 1990; 19% increase), diarrhoeal diseases (second in 1990; 51% decrease), and HIV/AIDS (33rd in 1990; 351% increase). Major depressive disorder increased from 15th to 11th rank (37% increase) and road injury from 12th to 10th rank (34% increase). Substantial heterogeneity exists in rankings of leading causes of disease burden among regions.Interpretation Global disease burden has continued to shift away from communicable to non-communicable diseases and from premature death to years lived with disability. In sub-Saharan Africa, however, many communicable, maternal, neonatal, and nutritional disorders remain the dominant causes of disease burden. The rising burden from mental and behavioural disorders, musculoskeletal disorders, and diabetes will impose new challenges on health systems. Regional heterogeneity highlights the importance of understanding local burden of disease and setting goals and targets for the post-2015 agenda taking such patterns into account. Because of improved definitions, methods, and data, these results for 1990 and 2010 supersede all previously published Global Burden of Disease results.