1990—2016年不同发展水平国家≥70岁人群疾病负担趋势分析
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摘要
目的:分析1990—2016年全球不同发展水平国家≥70岁老年人口的疾病负担差异及变化趋势。方法:采用全球疾病负担(global burden of disease,GBD)研究中社会人口学指数将全球195个国家分为高、偏高、中等、偏低和低5个发展水平。利用2016年GBD研究课题组估算数据,评价不同发展水平国家间≥70岁人口在伤残调整寿命年(disability-adjusted life years,DALY)上的差异及变化趋势,估算DALY排名居前十位的疾病及危险因素造成的健康损失比重。结果:1990—2016年间,5类发展水平国家≥70岁人口的标化DALY率总体均呈下降趋势,高、偏高、中等、偏低和低5类发展水平国家DALY/10万人下降幅度分别为23.9%,21.3%,23.4%,18.8%和16.3%。1990年,低和较低发展水平国家≥70岁年龄标化DALY率分别为高发展水平国家的1.67倍和1.49倍,2016年分别为1.83倍和1.59倍,差距扩大。标化DALY率下降主要来自于过早死亡寿命损失年的降低。2016年,低和较低发展水平国家≥70岁人口面临着传染性疾病和慢性非传染性疾病均高发的疾病模式;环境污染和不良卫生条件相关的危险因素在低和较低发展水平国家中造成严重的疾病负担。结论:1990—2016年间,尽管5类发展水平国家的疾病负担均有所下降,但发展水平较低国家的下降幅度低于发展水平偏高的国家,加剧了高发展水平国家和低发展水平国家之间的老年人健康差距。国际组织及各国政府应根据当前面临的主要疾病和危险因素采取措施,缩小不同发展水平国家之间老年人的健康差距。
Objective: To examine differences in burden of disease among people aged ≥70 years old in countries with different developmental levels from 1990 to 2016.Methods: The sociodemographic index(SDI) of global burden of disease(GBD) was used to divide 195 countries into five developmental levels: high, high middle, middle, low middle and low. The results of the Global Burden of Diseases Study 2016(GBD 2016) were extracted to examine disability-adjusted life years(DALY) and the health loss from the top 10 diseases and risk factors among the people aged ≥70 years old in countries with different SDIs. Results: Between 1990 and 2016, the age-standardized DALY rate among people aged ≥70 years old in countries with different SDIs all showed a downward trend. Different decreases in DALY rate in over-seventy old people were observed across countries with different SDI levels: –23.9% in high SDI, –21.3% in high-middle SDI, –23.4% in middle SDI, –18.8% in low-middle SDI and –16.3% in low SDI. In 1990, the age-standardized DALY rate among people aged ≥70 years old in low and low middle SDI countries was 1.67 and 1.49 times of th at in high SDI countries; and the gaps rose to 1.83 and 1.59 times in 2016. The DALY rate of the aged people remained remarkably higher in low middle and low SDI countries in 2016, and the gap widened compared with that in 1990. The reduction of age-standardized DALY rate was mainly due to the decrease of years of life lost(YLL). In 2016, low SDI and low-middle SDI countries suffered much higher burden of disease from infectious diseases and chronic non-communicable diseases. Analysis of leading causes and risk factors of DALY showed significant disparities across different SDI countries; burden of disease caused by environmental pollution and adverse health conditions was much higher in the low SDI and lower-middle SDI countries th an th at in the other countries.Conclusion: During 1990—2016, the burden of disease in countries of all 5 SDI levels declined. But the reductions in the developing countries were less th an those in the developed countries, widening health disparities for the elderly between low and high SDI countries. International organizations and individual governments should take measures to narrow health gaps among old adults across countries with different developmental levels.
Objective: To examine differences in burden of disease among people aged ≥70 years old in countries with different developmental levels from 1990 to 2016.Methods: The sociodemographic index(SDI) of global burden of disease(GBD) was used to divide 195 countries into five developmental levels: high, high middle, middle, low middle and low. The results of the Global Burden of Diseases Study 2016(GBD 2016) were extracted to examine disability-adjusted life years(DALY) and the health loss from the top 10 diseases and risk factors among the people aged ≥70 years old in countries with different SDIs. Results: Between 1990 and 2016, the age-standardized DALY rate among people aged ≥70 years old in countries with different SDIs all showed a downward trend. Different decreases in DALY rate in over-seventy old people were observed across countries with different SDI levels: –23.9% in high SDI, –21.3% in high-middle SDI, –23.4% in middle SDI, –18.8% in low-middle SDI and –16.3% in low SDI. In 1990, the age-standardized DALY rate among people aged ≥70 years old in low and low middle SDI countries was 1.67 and 1.49 times of th at in high SDI countries; and the gaps rose to 1.83 and 1.59 times in 2016. The DALY rate of the aged people remained remarkably higher in low middle and low SDI countries in 2016, and the gap widened compared with that in 1990. The reduction of age-standardized DALY rate was mainly due to the decrease of years of life lost(YLL). In 2016, low SDI and low-middle SDI countries suffered much higher burden of disease from infectious diseases and chronic non-communicable diseases. Analysis of leading causes and risk factors of DALY showed significant disparities across different SDI countries; burden of disease caused by environmental pollution and adverse health conditions was much higher in the low SDI and lower-middle SDI countries th an th at in the other countries.Conclusion: During 1990—2016, the burden of disease in countries of all 5 SDI levels declined. But the reductions in the developing countries were less th an those in the developed countries, widening health disparities for the elderly between low and high SDI countries. International organizations and individual governments should take measures to narrow health gaps among old adults across countries with different developmental levels.
引文
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[4]Prince MJ,Wu F,Guo Y,et al.The burden of disease in older people and implications for health policy and practice[J].Lancet,2015,385(9967):549-562.
[5]Jagger C,Gillies C,Moscone F,et al.Inequalities in health y life years in the 25 countries of the European Union in 2005:a cross-national meta-regression analysis[J].Lancet,2008,372(9656):2124-2131.
[6]Chatterji S,Byles J,Cutler D,et al.Health ,functioning,and disability in older adults-present status and future implications[J].Lancet,2015,385(9967):563-375.
[7]United Nations.Political declaration and Madrid international plan of action on ageing[EB/OL].(2018-03-01).http://www.un.org/en/events/pastevents/pdfs/Madrid_plan.pdf.
[8]World Health Organization.Active ageing:a policy framework[EB/OL].(2018-03-01).http://whqlibdoc.who.int/hq/2002/who_nmh_nph_02.8.pdf.
[9]Hosseinpoor AR,Bergen N,Magar V,et al.Monitoring inequality:an emerging priority for health post-2015[J].Bull World Health Organ,2015,93(9):591.
[10]Frank JW,Cohen R,Yen I,et al.Socioeconomic gradients in health status over 29 years of follow-up after midlife:the Alameda county study[J].Soc Sci Med,2003,57(12):2305-2323.
[11]Abajobir AA,Abate KH,Abbafati C,et al.Global,regional,and national disability-adjusted life-years(DALYs)for 333 diseases and injuries and health y life expectancy(HALE)for 195 countries and territories,1990-2016:a systematic analysis for the Global Burden of Disease Study 2016[J].Lancet,2017,390(10100):1260-1344.
[12]Abajobir AA,Abate KH,Abbafati C,et al.Global,regional,and national incidence,prevalence,and years lived with disability for 328diseases and injuries for 195 countries,1990-2016:a systematic analysis for the Global Burden of Disease Study 2016[J].Lancet,2017,390(10100):1211-1259.
[13]Murray CJ,Salomon JA,Mathers CD,et al.Summary measures of population health .Concepts,eth ics,measurement and Applications[M].Geneva:World Health Organization,2002.
[14]Patterson L.Making our health and care systems fit for an ageing population:David Oliver,Catherine Foot,Richard Humphries.King’s Fund March 2014[J].Age Ageing,2014,43(5):731.
[15]Global healthestimates 2013:death s by cause,age,sex and regional grouping,2000-2012[M]//World Health Organization.Global healthestimates.Geneva:World Health Organization,2015.
[16]Goeppel C,Frenz P,Tinnemann P,et al.Universal health coverage for elderly people with non-communicable diseases in low-income and middle-income countries:a cross-sectional analysis[J].Lancet,2014,384:S6.
[17]Forouzanfar MH,Afshin A,Alexander LT,et al.Global,regional,and national comparative risk assessment of 79 behavioural,environmental and occupational,and metabolic risks or clusters of risks,1990-2015:a systematic analysis for the Global Burden of Disease Study 2015[J].Lancet,2016,388(10053):1659-1724.
[18]李镒冲,刘世炜,王丽敏,等.1990年与2010年中国慢性病主要行为危险因素的归因疾病负担研究[J].中华预防医学杂志,2015,49(4):333-338.LI Yichong,LIU Shiwei,WANG Limin,et al.Burden of disease attributable to main behavioral risk factor of chronic disease inactivity in China,1990 and 2010[J].Chinese Journal of Preventive Medicine,2015,49(4):333-338.
[19]Michel JP,Newton JL,Kirkwood TB.Medical challenges of improving the quality of a longer life[J].JAMA,2008,299(6):688-690.