DALY和DALE:两种健康衡量指标内在关系探索

伤残调整的生命年(DALY)和伤残调整的预期寿命(DALE)是世界组织和世界银行在对全球疾病负担的研究中,使用的两个综合性衡量人口健康状况的指标。其中,DALY用于表示人口健康状况的有效指标。两个指标都是通过分析疾病、残疾等对健康寿命造成的损失,来衡量各类疾病对人口健康的影响,因而可作为政府在权衡、分配卫生资源时的依据。

利用DALY对哈尔滨市人群健康问题的研究

目的 研究哈尔滨市的疾病负担 ,提出哈尔滨市人群主要健康问题。方法 利用残疾调整生命年(DALY)为疾病负担测量单位。结果 1999年哈尔滨市疾病谱前四位主要疾病是心血管疾病、神经精神疾病、呼吸道疾病、恶性赘生物。其中 4 5岁以上人群承担比重最大。在性别方面分布也不同 ,男性大于女性。哈尔滨市疾病负担强度 (每千人DALY值 )为 14 1.72 ,即每千人 1999年因疾病损失为 14 1.72个人年 ,说明哈尔滨市居民的健康状况在全国居于领先地位。结论 哈尔滨市疾病负担以慢性病为主 ,卫生防治工作重点应继续加强对慢性病的预防。

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.

1990-2019年中国白内障患病率和伤残调整寿命年的趋势分析

目的:评估1990-2019年以来中国白内障疾病的负担变化趋势。方法:中国白内障相关疾病负担数据来源于大型公共数据库—2019年全球疾病负担研究(GBD 2019)。利用GBD 2019的公开数据,提取中国白内障疾病负担的有关信息。根据GBD 2019的研究结果,对中国白内障患病率和伤残调整寿命年(DALYs)进行分析。同时,进一步探讨中国及其邻国年龄标准化患病率(ASPR)和年龄标准化伤残调整寿命年(ASDR)的变量特征。结果:1990年至2019年间,我国因白内障致盲和视力丧失患病人数增加223.54%,相应DALYs增加了142.14%。与男性群体相比,女性在过去30年中表现出更高的ASPR和DALYs。同时,65岁至84岁年龄段的人群比其他人更容易患白内障。与周边国家相比,中国ASPR排名从1990年的第9位867.09(95%UI:761.36-975.42)/10万,上升到2019年的第11位991.56(95%UI:861.52-1131.04)/10万;同时ASDR从1990年的第9位65.85(95%UI:46.39-89.41)/10万,上升到2019年的第10位59.16(95%UI:41.70-80.15)/10万。然而,从全球范围来看,2019年中国白内障ASDR和ASPR仍保持较低水平。结论:从1990年到2019年,中国因白内障而导致失明和视力丧失的总人群患病率和DALYs呈总体上升趋势,需要加强早期白内障筛查,尤其是针对老年人和女性群体。

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.

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.

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.

施工扬尘扩散模拟与工人健康损害定量评估研究

为准确掌握现场不同工作条件下的生产工人受施工扬尘损害情况,利用计算流体力学(Computational Fluid Dynamics,CFD)技术,对土方运输阶段不同工况下的扬尘扩散进行模拟,获取场地内各区域扬尘扩散情况与扬尘质量浓度。根据模拟结果,采用伤残调整生存年法(Disability-Adjusted Life Year,DALY),建立土方运输阶段的工人健康损害量化评估方法,定量分析施工扬尘引起的工人健康损害及抑尘措施的阻损效果。结果表明:不同工作区域内建筑工人的健康损害程度不同,且对场地地面清洁度的变化较为敏感,采取措施降低地面积尘负荷后健康损害减轻度较大;土方运输工人长期工作暴露下,两种不同质量浓度的施工扬尘对其健康的减损高达0.51 a和0.18 a。研究可为管理者准确区分工人健康损害情况以设计科学施工扬尘管理体系、加强劳动保障提供依据。

Global burden of cirrhosis and other chronic liver diseases due to nonalcoholic fatty liver disease,1990-2019

BACKGROUND Nonalcoholic fatty liver disease(NAFLD)has become the leading cause of cirrhosis and other chronic liver diseases(COCLDs).AIM To conduct a comprehensive and comparable updated analysis of the global,regional,and national burden of COCLDs due to NAFLD in 204 countries and territories from 1990 and 2019 by age,sex,and sociodemographic index.METHODS Data on COCLDs due to NAFLD were collected from the Global Burden of Diseases,Injuries,and Risk Factors Study 2019.Numbers and age-standardized prevalence,death,and disability-adjusted life years(DALYs)were estimated through a systematic analysis of modelled data from the Global Burden of Diseases,Injuries,and Risk Factors Study 2019.The estimated annual percentage change was used to determine the burden trend.RESULTS In 2019,the global age-standardized prevalence rate of COCLDs due to NAFLD was 15022.90 per 100000 population[95%uncertainty interval(UI):13493.19-16764.24],which increased by 24.51%(22.63%to 26.08%)from 1990,with an estimated annual percentage change of 0.78(95%confidence interval:0.74-0.82).In the same year,however,the age-standardized death rate and age-standardized DALYs per 100000 population were 1.66(95%UI:1.20-2.17)and 43.69(95%UI:31.28-58.38),respectively.North Africa and the Middle East had the highest prevalence rates of COCLDs due to NAFLD.The death rate increased with age up to the 95+age group for both sexes.Males had higher numbers of prevalence,death rate,and DALYs than females across all age groups before the 65-69 age group.The sociodemographic index was negatively correlated with the age-standardized DALYs.CONCLUSION Globally,the age-standardized prevalence rate has increased during the past three decades.However,the agestandardized death rate and age-standardized DALYs decreased.There is geographical variation in the burden of COCLDs due to NAFLD.It is strongly recommended to improve the data quality of COCLDs due to NAFLD across all countries and regions to facilitate better monitoring of the burden of COCLDs due to NAFLD.

广东省2005-2014年梅毒流行趋势和疾病负担

【目的】分析广东省2005-2014年梅毒流行趋势和疾病负担,为全面认识梅毒的危害性、合理制定卫生政策提供参考。【方法】利用广东省2005-2014年梅毒病例报告数据和广东省人口数据,分别以发病率和伤残调整寿命年（DALY）为分析指标,对广东省不同年份、不同性别、不同年龄组的梅毒疫情和疾病负担进行分析比较。【结果】梅毒报告发病率从2005年的21.08/10万,增长到2014年的52.55/10万,梅毒疾病负担强度从2005年的2.00 DALYs/10万,增长到2014年的3.16DALYs/10万。一期和二期梅毒在全部梅毒病例所占的构成比不断减少,而隐性梅毒的构成比不断增加。虽然三期和胎传梅毒的发病率很低,但其所致疾病负担却远远高于其他分期梅毒。隐性梅毒女性发病率高于男性,但各分期梅毒所致疾病负担均是男性高于女性。一期和二期梅毒的发病高峰为20~35岁,隐性梅毒有两个发病高峰,一个是20~35岁,另一个是60岁及以上年龄人群。【结论】广东省梅毒疫情形势严峻,梅毒疾病谱已经发生改变,隐性梅毒病例占大多数,三期和胎传梅毒发病率处于较低水平,但其所致疾病负担巨大。本研究提示要把各分期梅毒的防控工作放在同等重要的位置上。

应用伤残调整寿命年分析中国脑卒中疾病负担与危险因素

目的分析我国脑卒中疾病负担与危险因素的现状及趋势。方法采用2013年全球疾病负担研究(GBD 2013)数据,利用伤残调整寿命年(disability adjusted life years,DALY)反映我国不同年份、年龄、性别脑卒中疾病负担及危险因素,利用地理信息系统(GIS)制作统计地图反映不同省份的分布情况。结果随着时间推移,我国脑卒中DALY率仍有上升,主要集中于老年人群,男性DALY率远高于女性,西藏、贵州等地高于浙江、上海等东南沿海地区;高血压、水果摄入不足、高盐饮食,吸烟以及室外PM_(2.5)是前五位脑卒中危险因素。结论我国脑卒中疾病负担及危险因素在年龄、性别、地域等方面存在明显差异,急需采取针对性的预防与控制措施,减小脑卒中对个人、家庭和社会造成的负担。

2010年新疆生产建设兵团肿瘤登记地区恶性肿瘤疾病负担研究

目的了解新疆生产建设兵团(简称兵团)肿瘤登记地区恶性肿瘤死亡情况及疾病负担,为肿瘤防治提供依据。方法收集2010年兵团肿瘤登记地区(第七师、第八师)恶性肿瘤发病资料和死亡资料,利用死亡率(mortality)、潜在减寿年(potential years of life lost,PYLL)、伤残调整生命年(disability adjusted life year,DALY)包括早死所致的健康寿命损失年(years of life lost,YLL)和残疾所致的健康寿命损失年(years lived with disability,Y L D)评价恶性肿瘤疾病负担。结果2010年肿瘤登记地区全部恶性肿瘤死亡率为113.36/10万,中标率、世标率分别为58.50/10万、79.05/10万。男性死亡率139.08/10万高于女性死亡率87.13/10万。全部肿瘤PYLL为11 603.5人年,PYLL率为10.05‰,高于兵团2008—2012年死因分析恶性肿瘤平均水平。全部肿瘤DALYs率为13.14/千人、YLDs和YLLs分别为0.83/千人和12.31/千人;男性YLLs为13.50/千人高于女性YLLs 10.88/千人。PYLL率与DALYs率随年龄增加而上升,其中PYLL和PYLL率在40岁之后达到高峰,DALYs率从40岁年龄组开始明显升高,在60~69岁年龄组达到最高,且从65岁开始男性高于女性。2010年女性DALYs/千人高于全国水平。结论兵团肿瘤登记地区肿瘤疾病负担较重,男性高于女性,中老年人肿瘤疾病负担最高,应加强肿瘤的早诊早治项目,减轻居民肿瘤疾病负担。

2001年哈尔滨市肺结核疾病负担研究

应用伤残调整生命年(DALY)对哈尔滨市2001年肺结核的疾病负担进行了测算,得出每千人口肺结核的疾病负担远低于我国所处的西太平洋地区的平均水平,与该地区低死亡率国家接近。还对防治该病可能给哈尔滨市所带来的经济效益进行了分析,指出如果到2015年该病全部DALY降为零,这将给哈尔滨市每年带来4522万元的经济效益,而其成本仅为20.7万元。建议我国实行疾病负担的测算,为政府制订卫生优先干预领域计划提供决策信息。

煤矿全生命周期粉尘健康损害评价方法

为减小煤矿粉尘给从业人员带来的健康损害和经济损失,以生命周期评价(LCA)理论为基础,结合环境卫生学、病理学的相关内容研究损害和损失评价方法。首先对煤矿生命周期进行单元分解,然后收集各阶段粉尘的清单数据。将粉尘健康损害归入呼吸系统疾病类型指标。采用伤残调整寿命年(DALY)作为量化指标,构建粉尘与量化指标之间的评价模型,进行货币化分析,最终提出综合量化值的评价方法。结果表明,LCA理论可用于煤矿全生命周期粉尘健康损害评价,实现对煤矿全生命周期粉尘造成的健康损害程度的定量分析,为煤矿职业健康管理提供决策依据。

农村艾滋病高发地区社会疾病经济负担分析

目的了解艾滋病高发省区农村的艾滋病社会疾病经济负担情况,为农村地区艾滋病防治提供基础数据资料。方法通过现场调查、死亡登记等资料,测算艾滋病社会直接经济负担、计算伤残(失能)调整生命年(DALYs)以反映艾滋病社会疾病负担和计算艾滋病社会间接经济负担,进而计算艾滋病社会经济负担。结果被调查省区当年DALYs合计43 602.69健康人年,平均每例DALYs 20.72健康人年,总DALYs达518 745.92健康人年;当年社会间接经济负担为41 291.75万元/年,艾滋病总的社会间接经济负担为596 248.85万元。该省区当年艾滋病社会疾病经济负担合计71 236.92万元/年,艾滋病社会疾病经济负担总计641 166.61万元。结论艾滋病的例均疾病社会经济负担较重;其社会疾病经济负担对宏观经济尚不造成较大影响,但对高发的县、乡、村影响较大;艾滋病疾病负担构成以间接经济负担为主。

重庆市糖尿病患病率、死亡率及伤残调整寿命年率分析

目的·分析重庆市糖尿病的患病率、死亡率及伤残调整寿命年(disability-adjusted life year,DALY),为开展糖尿病防治提供依据。方法·收集并整理中国死因登记报告信息系统中记录的2018年重庆市糖尿病死亡个案资料;根据《中国居民慢性病与营养监测工作方案(试行)》,获取2018年重庆市糖尿病患病率资料。采用SPSS 25.0软件计算重庆市糖尿病死亡率、标化死亡率、患病率、标化患病率、早死所致寿命损失年(years of life lost,YLL)率、伤残所致寿命损失年(years lived with disability,YLD)率、DALY率等指标。结果·2018年重庆市糖尿病死亡率与标化死亡率分别为16.20/10万、8.82/10万,女性的糖尿病死亡率高于男性(χ^2=3.99,P=0.045)。2018年重庆市15岁及以上居民的糖尿病患病率为17.90%,标化患病率为9.25%,男性的糖尿病患病率高于女性(χ^2=18.12,P=0.000)。2018年重庆市糖尿病YLL率、YLD率和DALY率分别为2.99‰、7.44‰与10.43‰,YLL率与YLD率占DALY率的比例分别为28.67%与71.33%。结论·重庆市糖尿病疾病负担较重,死亡率与患病率均较高,YLD率占DALY率超过70%。

健康寿命年——一个新的测量疾病负担的指标

介绍一种新的测量疾病负担的指标——健康寿命率（ＨｅａＬＹ）。我们用此指标对１９９０～１９９３年北京ＭＯＮＩＣＡ资料进行了重新估算和分析，并将其与几年前ＷＨＯ和世界银行提出的另一个测量疾病负担的指标ＤＡＬＹ进行了比较。

辽宁省城乡居民糖尿病及其并发症疾病负担研究

目的了解辽宁省城乡居民糖尿病及其并发症的疾病负担水平和特征。方法依据辽宁省糖尿病患病和死亡资料,采用全球疾病负担研究方法,计算辽宁省城乡居民糖尿病的伤残调整生命年(DisabilityAdjusted Life Years,DALY)。结果辽宁省糖尿病疾病负担(DALY)每10万人损失健康寿命299.4人.a,女性高于男性(351.1/10万:252.3/10万),城市高于农村(474.1/10万:215.8/10万),农村YLD/YLL比值(0.47)明显低于城市(0.96)。结论辽宁省糖尿病DALY是GBD2000对中国糖尿病及其并发症疾病负担估计值的2.0倍,城市居民糖尿病DALY已接近发达国家水平。

煤矿不同工种的粉尘健康风险定量评价

为评估粉尘排放对从事各工种的人员造成的健康风险,基于环境卫生学、病理学等相关内容,建立粉尘排放与工种健康损害定量评价关系。首先对煤矿各工种按工作区域进行分类,然后收集煤矿各区域的清单数据。在此基础上进行归宿分析、效应分析和损害分析,采用伤残调整年(DALY)作为量化指标,构建量化指标与粉尘之间的评价模型。最终,建立从职业健康风险因素到伤残调整年,再到具有经济含义的表征测量健康风险评价方法。结果表明:煤矿粉尘排放给各工种带来了严重的健康风险,平均生命损失年增加值为6.56 a;各作业区域工种按健康风险大小排序依次为回采、掘进工作面、胶带运输、锚喷作业点、煤仓口。

艾滋病健康生命年损失情况分析

目的计算艾滋病损失的健康生命年,确定艾滋病在中国的高危人群和高危地区,确定艾滋病防治工作重点,为卫生资源分配提供科学依据。方法将2005年艾滋病的发病、死亡情况按照地区、年龄、性别整理,计算艾滋病疾病负担指标中的残疾调整生命年(DALY),并对地区、性别和年龄间采用强度指标进行比较。结果2005年艾滋病的健康生命年损失以死亡生命损失年为主(85%);健康生命年损失集中在25～44岁年龄组;男性高于女性;黄河中游地区和西北地区最高,西南地区、华北地区最低。结论25～44岁年龄组为艾滋病的高危人群;男性高于女性;黄河中游地区和西北地区为艾滋病的高危地区。