广东省佛山市疾病负担研究

[目的]在佛山市人群的健康研究中首次引入DALY指标体系,对佛山市的疾病负担进行综合性测量,确定主要卫生问题。[方法]以伤残调整生命年—DALY为疾病负担的测量单位,采用直接法计算死亡损失寿命年(YLL),采用间接法计算伤残损失寿命年(YLD),结合人力资本法计算疾病经济负担。[结果]从佛山市疾病分类看,恶性肿瘤、循环系统疾病、呼吸系统疾病居于疾病负担前3位;从具体疾病看,脑血管病、支气管肺癌、慢性下呼吸道疾病居于疾病负担前3位。2004年疾病直接、间接经济负担分别占GDP百分比为0.47%与7.08%,间接经济负担到2010年将上升为9.07%。年龄45岁以上人群是恶性肿瘤疾病负担主要年龄;15～45岁是交通事故疾病负担的主要年龄。[结论]佛山市的疾病模式类似欧美等发达国家,但有其特殊性。

Methodology for the Assessment of Burden of Smear-positive Pulmonary TB and Its Infectivity

Objective The study investigated the burden of smear-positive pulmonary TB and itsinfectivity using DALY(disability-adjusted life year) as an indicator. Methods An assumedcohort of 2 000 cases was set up based on the age-specific incidence of 794 newly registeredsmear-positive cases in Beijing in 1994. Prognostic trees and model diagrams of infectivityunder natural history and DOTS(directly observed treatment, short-course) strategy wereestablished according to the epidemiological evidence. Results The results showed that 29. 6%of DALYs would be neglected if the burden caused by the infectivity was not considered.Conclusion DOTS strategy may reduce 97.3% of the number of potential cases infected,92.9% of DALYs related to TB-patients themselves, and 99.9% of DALYs caused by TB’sinfectivity as well.

Economic Evaluation of Mobile Mental Health Units in Greece: The Case of Cyclades Islands

Background: In Greece, the provision of mental health services is limited to people residing in rural and remote areas. The operation of Mobile Mental Health Units (MMHUs) has been introduced in the Cyclades islands. It is an innovative policy intervention that has been shown to be effective and efficient internationally. Objective: The aim was to evaluate the operation of MMHUs in the Cyclades islands based on real-world evidence (RWE), from a societal perspective. Methods: A cost-effectiveness analysis was performed where outcomes and costs were elaborated and classified based on two comparators, 1) with MMHUs’ operation and 2) without MMHUs’ operation. Clinical primary outcomes were based on RWE data and were elaborated for the Disability-Adjusted Life Years (DALYs) values calculation, for a 12 months’ time horizon. Data descriptive statistics were performed with SPSS Statistics 22.0. Direct medical, non-medical and indirect costs were incorporated. Unit costs and monetary values were extracted from published data. Sensitivity analysis was undertaken to test the robustness of the results. Results: The operation of MMHUs in the Cyclades islands led to an incremental cost of €12,250.78 per DALY averted. A substantial higher increase is observed in the direct non-medical costs of the non-MMHUs’ operation where patients had to pay approximately €2,602 per capita annually for their transportation and accommodation due to hospitalization and outpatient care. Informal care expenses are 3 fold increasing in the non-MMHUs’ operation arm. Both direct non-medical and informal care costs correspond to high out of pocket payments totally covered by the patients. The sensitivity analyses demonstrated that the decision does not change when we varied the unit costs by ±10%. Conclusions: The operation of MMHUs appears to be a cost-effective option for treating patients with mental disorders in remote areas and islands in Greece. MMHUs appear to overcome the existing NHS structural inefficiencies by minimizing public expenditures and patients’ income losses by preventing and improving their mental health status.

Global and national burden of atherosclerosis from 1990 to 2019:trend analysis based on the Global Burden of Disease Study 2019

Background:Atherosclerosis-related diseases represent significant health issues among adults globally.Despite their widespread impact,comprehensive data concerning the global and national burden and trends of these diseases remain sparse.Our objective is to examine the trends in the burden of atherosclerosis among adults from 1990 to 2019 at both global and national levels.Methods:We reported the average annual percentage changes(AAPCs)in prevalence,incidence,mortality,and disabilityadjusted life years(DALYs)of atherosclerosis-related diseases(ischemic heart disease[IHD],ischemic stroke,and peripheral arterial disease[PAD])at the global and national levels among individuals based on a trend analysis of the Global Burden of Diseases Study(GBD)2019.We further analyzed these global trends as a function of age,gender,and the social development index.We also used joinpoint regression analysis to identify the year with the most substantial changes in global trends.Results:Globally,the AAPC of IHD incidence rose from 1990 to 2019(0.20;95%confidence interval[CI],0.12-0.28),with substantial surges in 1995,2001,2005,2010,and 2017.Conversely,AAPC of IHD mortality rates exhibited a different trend until a rise in 2014.The AAPC of incidence rates of ischemic stroke and PAD also escalated during the same period,with respective 0.43(95%CI,0.39-0.48)and 0.13(95%CI,0.06-0.21).For ischemic stroke,both incidence and mortality soared in 2014,while PAD incidence declined in 1994 and 1998,then sharply climbed in 2016.Nationally,the Northern Mariana Islands experienced the steepest increase in IHD and PAD incidence and mortality between 1990 and 2019.China saw a significant rise in ischemic stroke incidence,whereas the highest mortality rate increase occurred in Timor-Leste.By sociodemographic index(SDI)quintile,low-middle-,middle-,and high-middle-SDI countries all showed upward trends in IHD,ischemic stroke,and PAD incidence.Simultaneously,IHD and ischemic stroke mortality rates,as well as DALYs,dropped in the low-,high-middle-,and high-SDI nations.However,PAD mortality rates and DALYs saw an uptick across all SDI quintiles.Regarding age demographics,a global decrease in the AAPC IHD incidence as noted in individuals above 55 years old,in contrast to an increase in the 20-55 age group during this period.AAPC of mortality rates for IHD,ischemic stroke,and PAD decreased across all ages.The AAPC showed an increase in IHD incidence in both genders.Conversely,IHD’s DALYs saw a reduction in both males and females.Ischemic stroke patterns mirrored these trends,whereas all measures for PAD exhibited growth for both sexes.Conclusions:From 1990 to 2019,there was an overall increasing trend in the global incidence of all three clinical manifestations of atherosclerosis.Between 1990 and 2019,both the mortality rate and DALYs for IHD and ischemic stroke declined across all age groups.Overall,the burden of atherosclerosis-related diseases has not significantly decreased and even shows signs of trending upward.These findings strongly suggest that despite some progress made,efforts to control atherosclerosis diseases globally need to be intensified.