In 1993,the World Bank released a global report on the efficacy of health promotion,introducing the disability-adjusted life years(DALY)as a novel indicator.The DALY,a composite metric incorporating temporal and quali...In 1993,the World Bank released a global report on the efficacy of health promotion,introducing the disability-adjusted life years(DALY)as a novel indicator.The DALY,a composite metric incorporating temporal and qualitative data,is grounded in preferences regarding disability status.This review delineates the algorithm used to calculate the value of the proposed DALY synthetic indicator and elucidates key methodological challenges associated with its application.In contrast to the quality-adjusted life years approach,derived from multi-attribute utility theory,the DALY stands as an independent synthetic indicator that adopts the assumptions of the Time Trade Off utility technique to define Disability Weights.Claiming to rely on no mathematical or economic theory,DALY users appear to have exempted themselves from verifying whether this indicator meets the classical properties required of all indicators,notably content validity,reliability,specificity,and sensitivity.The DALY concept emerged primarily to facilitate comparisons of the health impacts of various diseases globally within the framework of the Global Burden of Disease initiative,leading to numerous publications in international literature.Despite widespread adoption,the DALY synthetic indicator has prompted significant methodological concerns since its inception,manifesting in inconsistent and non-reproducible results.Given the substantial diffusion of the DALY indicator and its critical role in health impact assessments,a reassessment is warranted.This reconsideration is imperative for enhancing the robustness and reliability of public health decisionmaking processes.展开更多
Introduction: Hematological malignancies (HM) are relatively frequent nosological entities within the structure of morbidity by malignant tumors, exhibiting a severe evolution, restrained prognosis and negative socio-...Introduction: Hematological malignancies (HM) are relatively frequent nosological entities within the structure of morbidity by malignant tumors, exhibiting a severe evolution, restrained prognosis and negative socio-economic impact in the advanced stages and phases. Objective: The objective of the study was to identify the epidemiological patterns, and to evaluate the epidemiological trends and disease burden issues of HM in the Republic of Moldova and worldwide. Materials and Methods: The following research methods were used: epidemiological, descriptive statistics, clinico-analytic. The diagnosis was proved in all cases by histopathological, cytological, cytogenetic, molecular and immunophenotyping examinations. The qualitative type researches were performed and enriched by the narrative synthesis of the data. From the specialized international bibliographic sources and official statistics concerning HM. The narrative review of the reference sources was fulfilled in the form of a synthesis. Results: The number of newly diagnosed and followed-up patients with HM at the Institute of Oncology in 2016, 2017, 2018, 2019, 2020 and 2021 amounted respectively to 725, 802, 613, 628, 536 and 528, the incidence (new cases per 100,000 population) being 17.6, 19.5, 14.9, 17.7, 15.1 and 20.3. In 2021 HM constituted 6.2% of all newly-diagnosed cases with malignant tumors in the Republic of Moldova. In the same year Hodgkin lymphoma was diagnosed in 10.04% of cases, non-Hodgkin’s lymphomas—in 31.63%, multiple myeloma and plasma cells neoplasms—in 7.77%, lymphoid leukemias—in 17.42%, myeloid leukemias—in 12.31%, monocytic leukemias—in 0.95%, and other leukemias—in 16.29%. In 2019 the male rate was 51.5%, and the female rate—48.5%. Within 2 years males were 266 (50.4%), females—262 (49.6%). The age of 50 - 79 years prevailed in both genders (males—65%, females—72.5%). The children constituted 4.0% of the newly diagnosed cases, 4.8% of those under the follow-up at the end of the year 2019 and 6.4% of the newly diagnosed cases in 2021. The disease span from the onset to diagnosis ranged between 1 - 24 months and constituted on average 5.63 months, without a significant difference as compared to 2019 (5.76 months). The incidence of HM in Western countries is 14 - 19 new cases per 100,000 population (4% of all cases with malignant tumors). The incidence of non-Hodgkin’s lymphomas increased by 45% between 2006 and 2016, from 319,078 to 461,000 cases. Between 2006 and 2016, the incidence of leukemias increased by 26%, from 37,000,000 to 467,000 cases. Conclusions: The epidemiological study revealed slightly lower morbidity by HM in the Republic of Moldova as compared to the West European countries mainly due to the migration of a workable population. The patients with malignant lymphomas, male gender and age categories of 50 - 79 years proved to be commonly registered epidemiological patterns. The narrative analysis of the literature revealed that patients with HM may experience a considerable disease burden with a negative impact on their employment status, working productivity and annual household income.展开更多
目的分析1990—2019亚洲主要国家及全球宫颈癌疾病负担,为制定宫颈癌防控策略提供科学依据。方法收集1990—2019年全球疾病负担研究(global burden of disease,GBD)数据,利用发病、死亡、伤残调整寿命年(disability-adjusted life years...目的分析1990—2019亚洲主要国家及全球宫颈癌疾病负担,为制定宫颈癌防控策略提供科学依据。方法收集1990—2019年全球疾病负担研究(global burden of disease,GBD)数据,利用发病、死亡、伤残调整寿命年(disability-adjusted life years,DALY)等指标定量评估宫颈癌的疾病负担情况,采用估计百分百变化(estimated annual percent change,EAPC)分析疾病负担时间变化趋势。结果1990—2019年,全球宫颈癌标化发病率从7.64/10万下降至6.81/10万,标化死亡率从4.46/10万降低至3.40/10万,标化DALY率从139.98/10万下降至107.20/10万,年平均降低分别为0.39%、0.96%、0.94%(EAPC<0,P<0.05)。亚洲主要国家中,中国的标化发病率从4.20/10万上升至5.53/10万,平均每年增长1.63%(EAPC>0,P>0.05)。中国宫颈癌的死亡数从2.64万增加到5.34万,相对增长1.02倍,全球及亚洲主要国家标化死亡率、标化DALY率均呈逐年下降趋势,而中国未出现下降趋势。相关分析显示,发病率与社会人口指数(socio-demographic index,SDI)无明显相关性(ρ=-0.13,P=0.11),死亡率与SDI呈负相关(ρ=-0.74,P<0.001),DALY与SDI也呈负相关(ρ=-0.77,P<0.001)。结论中国宫颈癌的标化发病率、死亡率逐年增加,疾病负担呈上升趋势,应积极采取科学有效的防控措施,降低宫颈癌疾病负担。展开更多
目的了解1990-2019年中国慢性阻塞性肺疾病发病、患病、死亡情况及疾病负担情况,预测2020-2030年中国慢性阻塞性肺疾病发病情况,为评估和制定慢性阻塞性肺疾病相关预防治疗政策和措施提供数据支持。方法利用2019年全球疾病负担研究数据...目的了解1990-2019年中国慢性阻塞性肺疾病发病、患病、死亡情况及疾病负担情况,预测2020-2030年中国慢性阻塞性肺疾病发病情况,为评估和制定慢性阻塞性肺疾病相关预防治疗政策和措施提供数据支持。方法利用2019年全球疾病负担研究数据库(Global burden of disease study,GBD),研究分析1990-2019年中国慢性阻塞性肺疾病的发病、患病、死亡、伤残调整寿命年(DALY)、早死寿命损失年(YLL)、伤残寿命损失年(YLD)等情况。采用贝叶斯-时期-队列分析(BAPC)方法,预测2020-2030年中国慢性阻塞性肺疾病发病率。结果相对于1990年,2019年中国慢性阻塞性肺疾病粗患病率增长35.44%,标化患病率减少27.16%,粗发病率增长38.31%,标化发病率减少28.52%,粗死亡率减少30.59%,标化死亡率减少70.08%。1990-2019年中国人群因慢性阻塞性肺疾病导致的YLL率由3281.48/10万降至862.37/10万,YLD率由330.33/10万降至240.40/10万,DALY率由3611.81/10万降至1102.77/10万。2019年男性慢性阻塞性肺疾病DALY率相比于1990年降低66.56%,女性DALY率相比于1990年降低71.87%。2020-2030年中国慢性阻塞性肺疾病标化发病率预计呈下降趋势,2030年男性标化发病率预计比2020年降低31.97%,女性标化发病率预计比2020年降低27.69%。结论1990-2019年,慢性阻塞性肺疾病对中国人口造成的疾病负担总体呈下降趋势。但从患病情况和死亡情况来看,发病及死亡人数较多,中国慢性阻塞性肺疾病的疾病负担仍处于较高水平。同时预测结果显示,未来10年中国慢性阻塞性肺疾病标化发病率在下降,但是仍处于较高水平,因此进行早筛查、早预防和早治疗,及广泛开展慢阻肺相关知识普及,对于做好COPD疾病管理具有重要意义。展开更多
目的研究1990—2019年由社会经济发展水平差异所致的全球口腔癌疾病负担不平等情况,为制定有效的预防和控制政策提供科学依据。方法本研究的疾病负担数据来源于2019年全球疾病负担研究,人类发展指数(human development index,HDI)来自于...目的研究1990—2019年由社会经济发展水平差异所致的全球口腔癌疾病负担不平等情况,为制定有效的预防和控制政策提供科学依据。方法本研究的疾病负担数据来源于2019年全球疾病负担研究,人类发展指数(human development index,HDI)来自于《2020年人类发展报告》,采用线性回归分析年龄标化的伤残调整寿命年(disability-adjusted life yeas,DALY)率与HDI的相关性,使用不平等斜率指数(slope index of inequality,SII)和集中指数(concentration index,CI)评价1990—2019年全球口腔癌疾病负担的不公平情况及发展趋势。结果本研究共纳入189个国家和地区,2019年口腔癌DALY率为46.61[IQR(30.70,64.97)],线性回归结果显示口腔癌DALY率与HDI水平呈显著负相关(ρ=-0.06,P<0.001)。口腔癌DALY负担在189个国家和地区间表现出显著的不平等性,2019年SII值为-107.16[95%CI(-127.60,-90.69)],1990—2019年SII值<0且绝对值呈上升趋势;2019年口腔癌CI值为-1.35[95%CI(-2.88,-1.01)],1990—2015年CI值>0且呈下降趋势,而2016—2019年CI值<0且绝对值呈上升趋势。结论1990—2019年全球口腔癌疾病负担存在明显的社会不公平现象,口腔癌疾病负担更集中在低社会经济发展水平国家,且随着时间变化呈现出加重趋势。因此,未来应注重发展中国家的医疗资源分配问题,采取更有针对性的措施,有效控制口腔癌疾病负担的不平等现状。展开更多
目的:分析海南省1990至2019年肝癌疾病负担的变化趋势及其危险因素归因情况。方法:根据2019年全球疾病负担(Global Burden of Disease,GBD)研究的海南省数据,利用Joinpoint回归模型分析1990至2019年海南省肝癌发病、死亡、伤残调整寿命...目的:分析海南省1990至2019年肝癌疾病负担的变化趋势及其危险因素归因情况。方法:根据2019年全球疾病负担(Global Burden of Disease,GBD)研究的海南省数据,利用Joinpoint回归模型分析1990至2019年海南省肝癌发病、死亡、伤残调整寿命年(disability-adjusted life year,DALY)的变化趋势,平均年度变化百分比(average annual percentage change,AAPC)用于描述年平均变化趋势,年度变化百分比(annual percentage change,APC)用于描述不同阶段时间变化趋势,归因DALY率用于描述危险因素归因情况。结果:1990至2019年海南省肝癌年龄标化发病率、年龄标化死亡率及年龄标化DALY率均呈下降趋势,分别下降了59.30%、61.21%和64.03%(P<0.001)。1990至2019年海南省40岁以下人群肝癌的年龄标化DALY率均较低,1990年的年龄标化DALY率的峰值出现在55~59岁年龄组,2019年后移至75~79岁年龄组。在1990至2019年期间,吸烟一直是海南省肝癌归因DALY率的主要危险因素,而在2019年,高BMI已经超越了药物使用因素,成为肝癌疾病负担的第三大危险因素。结论:海南省肝癌疾病负担总体呈下降趋势,峰值年龄段后移,吸烟、饮酒和高BMI仍是主要危险因素,应继续加强肝癌的早诊早治及危险因素干预等防控工作。展开更多
文摘In 1993,the World Bank released a global report on the efficacy of health promotion,introducing the disability-adjusted life years(DALY)as a novel indicator.The DALY,a composite metric incorporating temporal and qualitative data,is grounded in preferences regarding disability status.This review delineates the algorithm used to calculate the value of the proposed DALY synthetic indicator and elucidates key methodological challenges associated with its application.In contrast to the quality-adjusted life years approach,derived from multi-attribute utility theory,the DALY stands as an independent synthetic indicator that adopts the assumptions of the Time Trade Off utility technique to define Disability Weights.Claiming to rely on no mathematical or economic theory,DALY users appear to have exempted themselves from verifying whether this indicator meets the classical properties required of all indicators,notably content validity,reliability,specificity,and sensitivity.The DALY concept emerged primarily to facilitate comparisons of the health impacts of various diseases globally within the framework of the Global Burden of Disease initiative,leading to numerous publications in international literature.Despite widespread adoption,the DALY synthetic indicator has prompted significant methodological concerns since its inception,manifesting in inconsistent and non-reproducible results.Given the substantial diffusion of the DALY indicator and its critical role in health impact assessments,a reassessment is warranted.This reconsideration is imperative for enhancing the robustness and reliability of public health decisionmaking processes.
文摘Introduction: Hematological malignancies (HM) are relatively frequent nosological entities within the structure of morbidity by malignant tumors, exhibiting a severe evolution, restrained prognosis and negative socio-economic impact in the advanced stages and phases. Objective: The objective of the study was to identify the epidemiological patterns, and to evaluate the epidemiological trends and disease burden issues of HM in the Republic of Moldova and worldwide. Materials and Methods: The following research methods were used: epidemiological, descriptive statistics, clinico-analytic. The diagnosis was proved in all cases by histopathological, cytological, cytogenetic, molecular and immunophenotyping examinations. The qualitative type researches were performed and enriched by the narrative synthesis of the data. From the specialized international bibliographic sources and official statistics concerning HM. The narrative review of the reference sources was fulfilled in the form of a synthesis. Results: The number of newly diagnosed and followed-up patients with HM at the Institute of Oncology in 2016, 2017, 2018, 2019, 2020 and 2021 amounted respectively to 725, 802, 613, 628, 536 and 528, the incidence (new cases per 100,000 population) being 17.6, 19.5, 14.9, 17.7, 15.1 and 20.3. In 2021 HM constituted 6.2% of all newly-diagnosed cases with malignant tumors in the Republic of Moldova. In the same year Hodgkin lymphoma was diagnosed in 10.04% of cases, non-Hodgkin’s lymphomas—in 31.63%, multiple myeloma and plasma cells neoplasms—in 7.77%, lymphoid leukemias—in 17.42%, myeloid leukemias—in 12.31%, monocytic leukemias—in 0.95%, and other leukemias—in 16.29%. In 2019 the male rate was 51.5%, and the female rate—48.5%. Within 2 years males were 266 (50.4%), females—262 (49.6%). The age of 50 - 79 years prevailed in both genders (males—65%, females—72.5%). The children constituted 4.0% of the newly diagnosed cases, 4.8% of those under the follow-up at the end of the year 2019 and 6.4% of the newly diagnosed cases in 2021. The disease span from the onset to diagnosis ranged between 1 - 24 months and constituted on average 5.63 months, without a significant difference as compared to 2019 (5.76 months). The incidence of HM in Western countries is 14 - 19 new cases per 100,000 population (4% of all cases with malignant tumors). The incidence of non-Hodgkin’s lymphomas increased by 45% between 2006 and 2016, from 319,078 to 461,000 cases. Between 2006 and 2016, the incidence of leukemias increased by 26%, from 37,000,000 to 467,000 cases. Conclusions: The epidemiological study revealed slightly lower morbidity by HM in the Republic of Moldova as compared to the West European countries mainly due to the migration of a workable population. The patients with malignant lymphomas, male gender and age categories of 50 - 79 years proved to be commonly registered epidemiological patterns. The narrative analysis of the literature revealed that patients with HM may experience a considerable disease burden with a negative impact on their employment status, working productivity and annual household income.
文摘目的分析1990—2019亚洲主要国家及全球宫颈癌疾病负担,为制定宫颈癌防控策略提供科学依据。方法收集1990—2019年全球疾病负担研究(global burden of disease,GBD)数据,利用发病、死亡、伤残调整寿命年(disability-adjusted life years,DALY)等指标定量评估宫颈癌的疾病负担情况,采用估计百分百变化(estimated annual percent change,EAPC)分析疾病负担时间变化趋势。结果1990—2019年,全球宫颈癌标化发病率从7.64/10万下降至6.81/10万,标化死亡率从4.46/10万降低至3.40/10万,标化DALY率从139.98/10万下降至107.20/10万,年平均降低分别为0.39%、0.96%、0.94%(EAPC<0,P<0.05)。亚洲主要国家中,中国的标化发病率从4.20/10万上升至5.53/10万,平均每年增长1.63%(EAPC>0,P>0.05)。中国宫颈癌的死亡数从2.64万增加到5.34万,相对增长1.02倍,全球及亚洲主要国家标化死亡率、标化DALY率均呈逐年下降趋势,而中国未出现下降趋势。相关分析显示,发病率与社会人口指数(socio-demographic index,SDI)无明显相关性(ρ=-0.13,P=0.11),死亡率与SDI呈负相关(ρ=-0.74,P<0.001),DALY与SDI也呈负相关(ρ=-0.77,P<0.001)。结论中国宫颈癌的标化发病率、死亡率逐年增加,疾病负担呈上升趋势,应积极采取科学有效的防控措施,降低宫颈癌疾病负担。
文摘目的了解1990-2019年中国慢性阻塞性肺疾病发病、患病、死亡情况及疾病负担情况,预测2020-2030年中国慢性阻塞性肺疾病发病情况,为评估和制定慢性阻塞性肺疾病相关预防治疗政策和措施提供数据支持。方法利用2019年全球疾病负担研究数据库(Global burden of disease study,GBD),研究分析1990-2019年中国慢性阻塞性肺疾病的发病、患病、死亡、伤残调整寿命年(DALY)、早死寿命损失年(YLL)、伤残寿命损失年(YLD)等情况。采用贝叶斯-时期-队列分析(BAPC)方法,预测2020-2030年中国慢性阻塞性肺疾病发病率。结果相对于1990年,2019年中国慢性阻塞性肺疾病粗患病率增长35.44%,标化患病率减少27.16%,粗发病率增长38.31%,标化发病率减少28.52%,粗死亡率减少30.59%,标化死亡率减少70.08%。1990-2019年中国人群因慢性阻塞性肺疾病导致的YLL率由3281.48/10万降至862.37/10万,YLD率由330.33/10万降至240.40/10万,DALY率由3611.81/10万降至1102.77/10万。2019年男性慢性阻塞性肺疾病DALY率相比于1990年降低66.56%,女性DALY率相比于1990年降低71.87%。2020-2030年中国慢性阻塞性肺疾病标化发病率预计呈下降趋势,2030年男性标化发病率预计比2020年降低31.97%,女性标化发病率预计比2020年降低27.69%。结论1990-2019年,慢性阻塞性肺疾病对中国人口造成的疾病负担总体呈下降趋势。但从患病情况和死亡情况来看,发病及死亡人数较多,中国慢性阻塞性肺疾病的疾病负担仍处于较高水平。同时预测结果显示,未来10年中国慢性阻塞性肺疾病标化发病率在下降,但是仍处于较高水平,因此进行早筛查、早预防和早治疗,及广泛开展慢阻肺相关知识普及,对于做好COPD疾病管理具有重要意义。
文摘目的研究1990—2019年由社会经济发展水平差异所致的全球口腔癌疾病负担不平等情况,为制定有效的预防和控制政策提供科学依据。方法本研究的疾病负担数据来源于2019年全球疾病负担研究,人类发展指数(human development index,HDI)来自于《2020年人类发展报告》,采用线性回归分析年龄标化的伤残调整寿命年(disability-adjusted life yeas,DALY)率与HDI的相关性,使用不平等斜率指数(slope index of inequality,SII)和集中指数(concentration index,CI)评价1990—2019年全球口腔癌疾病负担的不公平情况及发展趋势。结果本研究共纳入189个国家和地区,2019年口腔癌DALY率为46.61[IQR(30.70,64.97)],线性回归结果显示口腔癌DALY率与HDI水平呈显著负相关(ρ=-0.06,P<0.001)。口腔癌DALY负担在189个国家和地区间表现出显著的不平等性,2019年SII值为-107.16[95%CI(-127.60,-90.69)],1990—2019年SII值<0且绝对值呈上升趋势;2019年口腔癌CI值为-1.35[95%CI(-2.88,-1.01)],1990—2015年CI值>0且呈下降趋势,而2016—2019年CI值<0且绝对值呈上升趋势。结论1990—2019年全球口腔癌疾病负担存在明显的社会不公平现象,口腔癌疾病负担更集中在低社会经济发展水平国家,且随着时间变化呈现出加重趋势。因此,未来应注重发展中国家的医疗资源分配问题,采取更有针对性的措施,有效控制口腔癌疾病负担的不平等现状。
