Quality-adjusted life years and surgical waiting list:Systematic review of the literature

BACKGROUND The quality-adjusted life year(QALY)is a metric that is increasingly used today in the field of health economics to evaluate the value of different medical treatments and procedures.Surgical waiting lists(SWLs)represent a pressing problem in public healthcare.The QALY measure has rarely been used in the context of surgery.It would be interesting to know how many QALYs are lost by patients on SWLs.AIM To investigate the relationship between QALYs and SWLs in a systematic review of the scientific literature.METHODS The study was conducted in accordance with the Preferred Reporting Items for Systematic Reviews and Meta-Analyses Statement.An unlimited search was carried out in PubMed,updated on January 19,2024.Data on the following variables were investigated and analyzed:Specialty,country of study,procedure under study,scale used to measure QALYs,the use of a theoretical or real-life model,objectives of the study and items measured,the economic value assigned to the QALY in the country in question,and the results and conclusions published.RESULTS Forty-eight articles were selected for the study.No data were found regarding QALYs lost on SWLs.The specialties in which QALYs were studied the most in relation to the waiting list were urology and general surgery,with 15 articles each.The country in which the most studies of QALYs were carried out was the United States(n=21),followed by the United Kingdom(n=9)and Canada(n=7).The most studied procedure was organ transplantation(n=39),including 15 kidney,14 liver,5 heart,4 lung,and 1 intestinal.Arthroplasty(n=4),cataract surgery(n=2),bariatric surgery(n=1),mosaicplasty(n=1),and septoplasty(n=1)completed the surgical interventions included.Thirty-nine of the models used were theoretical(the most frequently applied being the Markov model,n=34),and nine were real-life.The survey used to measure quality of life in 11 articles was the European Quality of Life-5 dimensions,but in 32 articles the survey was not specified.The willingness-to-pay per QALY gained ranged from$100000 in the United States to€20000 in Spain.CONCLUSION The relationship between QALYs and SWLs has only rarely been studied in the literature.The rate of QALYs lost on SWLs has not been determined.Future research is warranted to address this issue.

Reevaluating health metrics:Unraveling the limitations of disabilityadjusted life years as an indicator in disease burden assessment

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.

Disability-adjusted life years and the trends of the burden of colorectal cancer:a population-based study in Shanghai,China during 2002 to 2016

Background:Colorectal cancer(CRC)still ranks the top in morbidity and mortality of cancers worldwide,posing a huge threat and burden to the society.We aimed to determine the age-standardized incidence,mortality,and disability-adjusted life years(DALYs)of CRC and explore potential changes in the temporal trends of the CRC burden in Shanghai during 2002 to 2016.Methods:The cancer statistics and demographics were obtained from the Cancer Registry and the Statistics Bureau of Pudong New Area,respectively.Data from 2002 to 2016 were included and analyzed retrospectively.DALYs were calculated using DisMod and the age-standardized rates(ASRs)were obtained according to Segi world standard population.Joinpoint regression was used to measure the trends in CRC incidence and to estimate the annual percent change.Results:The increasing trend of CRC ASR incidence halted after 2014,coinciding with the introduction of the Shanghai CRC screening program.The ASRs of mortality and DALYs increased,at 0.42%(P<0.05)and 4.07%(P<0.001)per year,respectively,which were mainly driven by men and individuals aged above the CRC screening program target.Conclusions:The disease burden of CRC in Shanghai remains serious,especially among men,and individuals aged>74 years.The benefits of the screening program have been partially proven by the ASRs of CRC incidence,providing important insights into better and wider application of screening programs.

Burden of road traffic accidents in Nepal by calculating disability-adjusted life years

Objective:To calculate the burden of road traffic accidents in Kathmandu Valley and then extrapolate this to the national level.Methods:A prospective study was performed to compute the burden of road traffic accidents by quantification of disability-adjusted life years(DALYs)using the Global Burden of Disease Study method on the basis of 1-year data from nine hospitals in Nepal and the Department of Foren-sic Medicine and cross-checked with the Nepal Traffic Directorate.Multiple methods were applied to the extrapolated population metrics of the burden of road traffic accidents in Nepal.Results:The total number of years of life lived in disability,years of life lost,and DALYs in Nepal were 38,848±194,119,935±1464,and 158,783±1658(95% confidence interval)re-spectively.The number of years lost because of morbidity and death was similar in Kathmandu Valley.Most(75%)of the DALYs resulted from years of life lost in Nepal.Males accounted for 73% of DALYs.Almost half(44%)of the DALYs were contributed by the group aged 15-29 years.Conclusion:This study is the first to calculate the burden of road traffic accidents in Nepal using Nepal’s own data.Nepal needs to develop and enhance its own system to identify significant public health issues so as to set national priorities for prevention of road traffic accidents.

Analysis of the Global Burden of Disease study highlights the trends in death and disability-adjusted life years of leukemia from 1990 to 2017

Background:The patterns of leukemia burden have dramatically changed in recent years.This study aimed to estimate the global trends of leukemiarelated death and disability-adjusted life-years(DALYs)from 1990 to 2017.Methods:The data was acquired from the latest version of the Global Burden of Disease(GBD)study.Estimated annual percentage changes(EAPCs)were calculated to estimate the trend of age-standardized rate(ASR)of death and DALYs due to leukemia and its main subtypes from 1990 to 2017.Results:Globally,the numbers of death and DALYs due to leukemia were 347.58×10^(3)(95%uncertainty interval[UI]=317.26×10^(3)-364.88×10^(3))and 11975.35×10^(3)(95%UI=10749.15×10^(3)-12793.58×10^(3))in 2017,with a 31.22% and 0.03% increase in absolute numbers from 1990 to 2017,respectively.Both of their ASR showed decreasing trends from 1990 to 2017 with the EAPCs being−1.04(95%confidence interval[CI]=(−1.10-−0.99)and−1.52(95%CI=−1.59-−1.44),respectively.Globally,the most pronounced decreasing trend of death and DALYs occurred in chronic myeloid leukemia with EAPCs of−2.76(95%CI=−2.88-−2.64)and−2.84(95%CI=−2.97-−2.70),respectively,while the trend increased in acute myeloid leukemia.The death and DALYs of leukemia decreased in most areas and countries with high socio-demographic index(SDI)including Bahrain,Finland,and Australia.Conclusions:The disease burden of death and DALYs due to leukemia decreased globally,and for most regions and countries from 1990 to 2017.However,the leukemia burden is still a substantial challenge globally and required adequate and affordable medical resources to improve the survival and quality of life of leukemia patients.

Racial disparity in years of potential life lost to induced abortions

The magnitude of the overall prevalence and racial disparity in induced abortion suggests that it is a major influence on the demographic and socioeconomic composition of the population of the United States (US). However, the years of potential lives averted by induced abortion have not been systematically studied. We applied race-specific intra-uterine death estimates to the induced abortions occurring to non-Hispanic (NH) white and non-Hispanic (NH) black women in the US state of North Carolina in 2008. The resultant estimate of births averted by induced abortion was used to project years of potential life lost. All-cause detailed mortality data were used to compare induced abortion with other contributing causes of years of potential life lost before age 75 (YPLL 75). For NH whites, induced abortions in 2008 contributed 59% of total YPLL 75, and 1.5 times the total YPLL 75 from all other causes combined. For NH blacks, induced abortions in 2008 contributed 76% of total YPLL 75 and 3.2 times the total YPLL 75 from all other causes combined. Induced abortion is the overwhelmingly predominant contributing cause of preventable potential lives lost in the North Carolina population, and NH blacks are disproportionately affected.

Maternal Death and Potential Years of Life Lost(PYLL)in Santa Catarina,Brazil,in 2000 and 2014

Introduction: Indicators of maternal health are often used to evaluate the social development and overall health of a population, as well as the accessibility of health services. Among these indicators, the Potential Years of Life Lost, which is associated with maternal deaths, is useful for the definition of priorities, monitoring, evaluation, and intervention, identifying the highest risk groups. Objective: To analyze the Potential Years of Life Lost by maternal death in Santa Catarina in 2000 and 2014. Method: An Ecological study with exploratory spatial analysis was conducted with data obtained from the Information System on Mortality and Live Births. Results: In the Information System, 35 maternal deaths in the year 2000 were identified and 24 in 2014. The total estimated years of life lost were 845 years in 2000 and 780 years in 2014, dominated by direct obstetric causes. In 2000, women who died lost, on average, 39.8 years of life;and 41.5 years in 2014. Conclusion: The spatial pattern observed in 2000 highlights areas of high risk in different regions of Santa Catarina. The greatest loss of years occurred in younger women, confirming the need to prevent and control maternal mortality and review strategies for compliance with public policies in the State.

I Do Biotech Dental Implants: Prospective Multicentric Study after 5 Years of Functional Loading

Introduction: I Do Biotech’s implants were developed starting in 2014. Since then, they obtained GMP and KFDA licenses for distribution in 2015. The main objective of this paper is to determine the survival rate of I Do Biotech implants five years after the first surgery. Material and Methods: 1000 implants were used on 480 prostheses across 10 clinics on 320 healthy, non-smoker and non-diabetic patients, chosen at random, of which 160 are male and 160 female, all in the age range of 30 to 50 years old. The failure rate was studied related to the patient’s gender, the length and diameter of the implant, anatomical location, the percentage of peri-implantitis, prosthodontic failures and the patient’s quality of life. Discussion: The results obtained are similar to those of Van Steenberghe D. Dieter-Busenlechner, E. Serrano Catauria and far superior to those of Sáenz Guzmán. Failure rates vary greatly from study to study due to the heterogeneity of the samples in the other research papers. Conclusion: The overall implant failure rate at 5 years is 1.7%. The factors affecting significantly the survival rate are: the implant diameter, its length and the anatomic area. Failure ratios increase significantly when the diameter or the length of the implant decreases, and when they are placed in the posterior maxilla (up to 4.3%). The rate of peri-implantitis is 5.1%. The prosthodontic failure rate is 2.91%. The improvement in quality of life and satisfaction increases with the years.

BRAIN TUMORS OF THE FIRST YEAR OF LIFE:CLINICAL AND SURGICAL MANAGEMENT

Brain tumors incidence in pediatric age hasbeen estimated between 1.3 to 5% with a relativeincidence of 1.4 to 11% during the first year oflife; the improvement in instrumental deviceshas lead to a relative increase in precocious diag-nosis. The choice to study brain tumors of the firstyear of life as a separate topic from pediatric ageones depends on the observation that these le-sions have peculiar clinical, topographic and tis-sular characteristics. The survival rate of thesepatients is very poor if compared with that found

1990-2019年中国成年人归因于糖尿病的心血管疾病负担研究

背景在全球老龄化不断深化的背景下,慢性病患者不断增加,多病共存现象愈加严重。在普遍认知中,心血管疾病与2型糖尿病大多属于老年病,但随着居民生活节奏与饮食等行为方式的改变,很多疾病呈现年轻化趋势。现也有研究表明,与一般人群相比,年轻时患糖尿病的患者的心血管疾病风险及死亡率会相对增加。目的探究1990—2019年中国成年人归因于糖尿病的心血管疾病负担情况,为共病预防提供依据。方法基于2019年全球疾病负担研究(GBD)数据,主要采用死亡率、伤残调整寿命年(DALY)率和计算获取的年估计变化百分比(EAPC)等指标评估我国心血管疾病(包括缺血性心脏病、脑卒中和外周动脉疾病3类)归因于糖尿病的疾病负担情况,并对年龄段(25~49岁、50~69岁、≥70岁)及性别进行分层分析,最后对疾病负担的时间趋势进行分析。结果中国25岁及以上人群归因于糖尿病的心血管疾病死亡数从1990年的29.805万例上升到2019年的70.034万例。男性归因于糖尿病的心血管疾病标化死亡率较1990年升高,而女性标化死亡率有所降低,且男性标化死亡率始终高于女性。2019年归因于糖尿病的心血管疾病DALY为1358.585万人年,按年龄划分的死亡率和DALY率随年龄增长而增加。女性标化DALY率下降趋势较男性明显(女性:EAPC=-0.32%,95%CI=-0.49%~-0.11%;男性:EAPC=-0.01%,95%CI=-0.26%~0.29%)。2019年归因于糖尿病的缺血性心脏病、外周动脉疾病患者3个年龄段的死亡率和DALY率较1990年大部分上升,而2019年归因于糖尿病的脑卒中患者3个年龄段的死亡率较1990年下降。1990—2019年心血管疾病中3类心血管疾病归因于糖尿病的标化DALY率占比呈波动性变化,但在2019年归因于糖尿病的3类心血管疾病标化DALY率占比均高于1990年。结论1990—2019年我国成年人归因于糖尿病的心血管疾病的死亡率和DALY率总体呈现上升趋势,人群糖尿病及心血管疾病共病风险较大,应注重在糖尿病患者中筛查心血管疾病或患心血管疾病风险高的个体,重点关注男性、高龄人群以及不良生活习惯较多的年轻人,对其进行早期的健康干预,减少共病疾病负担。

Esophageal cancer global burden profiles, trends, and contributors

Objective:This study aimed to provide a comprehensive overview of the global burden of esophageal cancer(EC)and determine the temporal trends and factors influencing changes in the global burden.Methods:The latest incidence and mortality data for EC worldwide were obtained from GLOBALCAN 2022.The mortality and disability-adjusted life years(DALYs)rates for EC from 1990±2019 were sourced from the 2019 Global Burden of Diseases.Trends in EC mortality and DALYs attributable to 11 risk factors or clusters of risk were analyzed using the joinpoint regression model.The trends in age-related EC burden were assessed using a decomposition approach.Results:An estimated 511,054 new cases of EC were diagnosed in 2022 with 445,391 deaths worldwide.Approximately 75%of cases and deaths occurred in Asia.Nearly 50%of global EC deaths and DALYs were attributed to tobacco use in men in 2019,while 20%were attributed to high body mass index(BMI)in women.From 1990±2019,EC deaths and DALYs attributable to almost all risk factors had declining trends,while EC deaths and DALYs attributed to high BMI in men had upward trends.The age-related EC burden exhibited an upward trend driven by population growth and aging,which contributed to 307.4 thousand deaths and 7.2 million DALYs due to EC.Conclusions:The EC burden remains substantial worldwide.Effective tobacco and obesity control measures are critical for addressing the risk-attributable burden of EC.Population growth and aging pose challenges for EC prevention and control efforts.

Colorectal cancer’s burden attributable to a diet high in processed meat in the Belt and Road Initiative countries

BACKGROUND Colorectal cancer(CRC)plays a significant role in morbidity,mortality,and economic cost in the Belt and Road Initiative(“B and R”)countries.In addition,these countries have a substantial consumption of processed meat.However,the burden and trend of CRC in relation to the consumption of a diet high in processed meat(DHPM-CRC)in these“B and R”countries remain unknown.AIM To analyze the burden and trend of DHPM-CRC in the“B and R”countries from 1990 to 2019.METHODS We used the 2019 Global Burden of Disease Study to collate information regarding the burden of DHPM-CRC.Numbers and age-standardized rates(ASRs)of deaths along with the disability-adjusted life years(DALYs)were determined among the“B and R”countries in 1990 and 2019.Using joinpoint regression analysis,the average annual percent change(AAPC)was used to analyze the temporal trends of age-standardized DALYs rate(ASDALR)from 1990 to 2019 and in the final decade(2010–2019).RESULTS We found geographical differences in the burden of DHPM-CRC among“B and R”countries,with the three highest-ranking countries being the Russian Federation,China,and Ukraine in 1990,and China,the Russian Federation,and Poland in 2019.The burden of DHPM-CRC generally increased in most member countries from 1990 to 2019(all P<0.05).The absolute number of deaths and DALYs in DHPM-CRC were 3151.15[95%uncertainty interval(UI)665.74-5696.64]and 83249.31(95%UI 15628.64-151956.31)in China in 2019.However,the number of deaths(2627.57-2528.51)and DALYs(65867.39-55378.65)for DHPM-CRC in the Russian Federation has declined.The fastest increase in ASDALR for DHPM-CRC was observed in Vietnam,Southeast Asia,with an AAPC value of 3.90%[95%confidence interval(CI):3.63%-4.16%],whereas the fastest decline was observed in Kyrgyzstan,Central Asia,with an AAPC value of-2.05%(95%CI:-2.37%to-1.73%).A substantial upward trend in ASR of mortality,years lived with disability,years of life lost,and DALYs from DHPM-CRC changes in 1990-2019 and the final decade(2010-2019)for most Maritime Silk Route members in East Asia,South Asia,Southeast Asia,North Africa,and the Middle East,as well as Central Europe,while those of the most Land Silk Route members in Central Asia and Eastern Europe have decreased markedly(all P<0.05).The ASDALR for DHPM-CRC increased more in males than in females(all P<0.05).For those aged 50-74 years,the ASDALR for DHPM-CRC in 40 members exhibited an increasing trend,except for 20 members,including 7 members in Central Asia,Maldives,and 12 high or high-middle social development index(SDI)members in other regions(all P<0.05).CONCLUSION The burden of DHPM-CRC varies substantially across“B and R”countries and threatens public health.Relevant evidence-based policies and interventions tailored to the different trends of countries in SDIs or Silk Routes should be adopted to reduce the future burden of CRC in“B and R”countries via extensive collaboration.

宁波市热浪对寿命损失年影响的总效应及附加效应

目的评估宁波市热浪对寿命损失年(YLL)影响的总效应及附加效应。方法收集2013—2019年宁波市死亡、人口、气象和空气质量监测资料,计算得到每日YLL率;根据日最高气温的百分位数和持续时间定义15种热浪类型,利用时间序列方法结合分布滞后非线性模型评估热浪对人群YLL率影响的总效应及附加效应,并按照性别和年龄(<65岁、≥65岁)进行分层分析。结果研究期间宁波市人群总YLL率为(19.74±3.14)人年/10万,热浪期的总YLL率均高于非热浪期(P<0.05)。随着热浪强度增加和持续时间延长,热浪的总效应均呈上升趋势。当热浪定义为日最高气温≥P97.5(37.2℃)且持续时间≥2d时,热浪累积10 d(Lag0-10 d)的总效应最大,总YLL率增加3.77(95%CI:2.25,5.29)人年/10万。热浪对男性和老年人影响的总效应高于女性和低年龄人群。仅部分热浪类型对男性和老年人YLL率影响的附加效应有统计学意义(P<0.05)。结论热浪导致宁波市人群YLL率增加,且对男性和老年人的影响更大;热浪的附加效应可能仅在男性和老年人等敏感人群中出现。

1990—2021年中国中老年人群2型糖尿病疾病负担趋势分析

目的分析1990—2021年我国中老年人群2型糖尿病(type 2 diabetes mellitus,T2DM)的变化趋势,评价近年来T2DM预防策略,为中老年人T2DM的防控措施改进提供理论依据。方法对全球疾病负担研究2021数据库中我国55岁及以上人群T2DM发病率、患病率、死亡率以及伤残调整寿命年(disability adjusted life years,DALYs)数据进行标准化,线图描述各指标的变化趋势,Joinpoint回归模型定量分析变化情况,以年度变化百分比(annual percent change,APC)和平均年度变化百分比(average annual percent change,AAPC)作为观察指标。结果1990—2021年我国55岁及以上人群T2DM的疾病负担仍然较重,发病率、患病率和DALYs率保持上升趋势(AAPC分别为0.39、1.08和0.39,P<0.001),死亡率整体下降(AAPC=-0.16,P<0.001)。女性以及55~74岁人群的发病率较高,随年龄增长中老年人T2DM死亡率升高。结论应加强对中老年人群T2DM健康管理和健康教育,倡导积极健康的生活方式,个人、家庭、社会、政府多方联动,降低我国中老年人群T2DM的疾病负担。

基于LCA的不同设计寿命沥青路面能耗排放分析

为研究不同设计寿命沥青路面的能耗排放特征,建立生命周期评价体系,量化分析柔性基层沥青路面、典型半刚性基层沥青路面、高掺量胶粉沥青路面的能耗排放。通过灵敏度分析确定主要能耗排放环节,并分析水泥类型、温拌技术、再生技术及运输效率对三种沥青路面能耗排放的影响规律。结果表明,典型半刚性基层沥青路面的能耗强度分别比柔性基层沥青路面及高掺量胶粉沥青路面能耗强度高25.29%、153.03%,全球变暖潜值总量比两种长寿命沥青路面分别高106.97%、107.99%;水泥生产、沥青生产、加热及运输环节为主要能耗排放环节;适用于水稳基层的通用水泥中,矿渣硅酸盐水泥能耗排放最低,替换掉普通硅酸盐水泥后典型半刚性基层沥青路面及高掺量胶粉沥青路面碳排放量分别下降了13.17%、12.43%;采用温拌技术后,柔性基层沥青路面碳排放量下降幅度最大,降低了2.41%,高掺量胶粉沥青路面能耗强度下降幅度最大,降低了3.71%;当RAP掺量达到30%时,三类沥青路面能耗强度分别下降20.64%、18.56%、15.26%,碳排放量分别下降6.92%、3.92%、4.39%;运输效率提升幅度与沥青路面的能耗排放减少率呈正相关,运输效率每提升10%,三类沥青路面能耗强度分别下降1.55%、1.63%、2.10%,碳排放量分别下降4.03%、3.26%、3.07%。

1990—2019年亚洲主要国家与全球宫颈癌疾病负担变化趋势分析

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。

1990-2019年中国慢性阻塞性肺疾病的疾病负担分析及未来10年发病预测

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。

1990~2019年全球和中国归因于家庭空气污染的心血管疾病负担及其变化趋势

目的:探讨1990~2019年全球和中国归因于家庭空气污染的心血管疾病负担及其变化趋势。方法:利用2019年全球疾病负担(GDB)研究数据,通过死亡率及伤残调整寿命年(DALY)绝对数及其年龄标化率、估计年度变化百分比(EAPC)来分析1990~2019年全球和中国归因于家庭空气污染的心血管疾病负担及其变化趋势。结果:1990~2019年,全球归因于家庭空气污染的心血管疾病年龄标化死亡率(ASDR)(EAPC=-3.65,95%CI:-3.86~-3.44)和年龄标化DALY率(EAPC=-3.60,95%CI:-3.78~-3.41)及中国相应的ASDR(EAPC=-5.78,95%CI:-6.17~-5.38)和年龄标化DALY率(EAPC=-5.97,95%CI:-6.32~-5.62)均呈下降趋势。男性归因于家庭空气污染的心血管疾病负担略高于女性,75~89岁时达到峰值。菲律宾相应的ASDR和年龄标化DALY率增幅最大[EAPC(95%CI)分别为0.87(0.21~1.54)和1.32(0.60~2.03)],沙特阿拉伯降幅最大[EAPC(95%CI)分别为-18.48(-18.63~-18.32)和-18.25(-18.38~-18.12)]。2019年,低社会人口指数(SDI)地区每10万人中归因于家庭空气污染的心血管疾病ASDR[56.67,95%不确定性区间(UI):42.08~73.07]和年龄标化DALY率(1318.63,95%UI:997.40~1672.29)显著高于其他SDI地区。2019年,全球范围内每10万人中归因于家庭空气污染的心血管疾病负担最高的地区和国家分别为大洋洲和所罗门群岛,中国相应的ASDR为12.52(95%UI:6.35~21.29),年龄标化DALY率为262.65(95%UI:133.90~447.50)。结论:1990~2019年全球和中国归因于家庭空气污染的心血管疾病负担呈一致下降趋势,男性略高于女性,75~89岁时达到高峰。中国的相关疾病负担虽有一定程度的下降,但仍较高,仍需采取强有力的干预措施。

1990-2019年中国心血管疾病流行现状、疾病负担及发病预测分析

背景心血管疾病是严重危害人类健康的重大慢病,且仍是我国乃至全球一个亟待解决的公共卫生问题。目的探讨1990—2019年中国心血管疾病流行特征和疾病负担情况,预测2020—2050年中国心血管疾病发病情况,为心血管疾病相关防治策略的制订提供参考。方法检索2019年全球疾病负担研究(GBD 2019)数据库,提取1990—2019年中国及全球心血管疾病负担及危险因素的相关数据并进行分析,使用基于GBD 2019数据库可公开的发病率、患病率、死亡率以及对应的年龄标准化(简称标化)率来量化心血管疾病的疾病流行情况,使用伤残损失寿命年(YLD)、早死损失寿命年(YLL)、伤残调整寿命年(DALY)量化疾病负担情况,构建ARIMA模型预测2020—2050年中国心血管疾病的发病情况。结果1990—2019年中国心血管疾病的发病率、患病率及死亡率呈逐年上升趋势,其中发病率、患病率及死亡率分别增长了93.75%、99.75%、57.39%。女性的标化发病率、标化患病率均高于男性,标化死亡率低于男性(P<0.05)。从2019年数据上看,中国心血管疾病总体发病率随着年龄升高呈上升趋势,在95岁及以上年龄组达到最高值。男性和女性的发病率趋势与总体趋势相似,但略有差异。总体患病率随着年龄升高呈上升趋势,女性高于男性。在45岁以后心血管疾病的死亡率呈现上升趋势,男性的死亡率在各个年龄段均高于女性。1990—2019年男性YLL率、YLD率、DALY率增长了36.99%、102.42%、40.78%,女性增长了2.79%、107.13%、11.50%。从2019年数据来看,中国总人群心血管疾病的YLL率、YLD率、DALY率总体随着年龄的增加呈上升趋势,尚无拐点出现。男性YLL率、DALY率随人口老龄化进展逐渐升高并远高过女性,女性YLD率在55~59岁年龄组后逐渐升高并远高过男性。1990—2019年,全球心血管疾病的标化发病率、标化患病率及标化死亡率呈逐年下降趋势,而中国的标化发病率和标化患病率仍有所增加,标化死亡率虽有所降低,但仍高于全球范围。从全球整体水平上看,中国心血管疾病的标化YLL率、标化DALY率虽同全球一样呈下降趋势,但2000年以后中国心血管疾病的疾病负担高于全球整体水平,且标化YLD率逐年增加。与心血管疾病死亡相关的危险因素主要是吸烟、吸二手烟、饮酒、体力活动少、高空腹血糖、高收缩压、高BMI、高低密度脂蛋白胆固醇以及肾功能不全。从中国及全球相关数据来看,高收缩压(高血压)依然是造成心血管疾病死亡的首要危险因素,且死亡人数逐年增加。高低密度脂蛋白胆固醇(高脂血症)是全球及近年来中国心血管疾病死亡的第二因素。2020—2050年中国心血管疾病标化发病率仍呈上升趋势,预计到2050年心血管疾病的标化发病率将达到663.618/10万。结论1990—2019年我国心血管疾病的发病率、患病率及死亡率呈逐年上升趋势,因心血管疾病导致的疾病负担较重,在未来50年尚无拐点出现,疾病流行及负担情况均高于全球范围。预计到2050年心血管疾病的标化发病率将达到663.618/10万。