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作者：SCI天天读
SCI
30 April 2024
Global incidence, prevalence, years lived with disability (YLDs), disability-adjusted life-years (DALYs), and healthy life expectancy (HALE) for 371 diseases and injuries in 204 countries and territories and 811 subnational locations, 1990–2021: a systematic analysis for the Global Burden of Disease Study 2021
(LANCET, IF: 168.9)
GBD 2021 Diseases and Injuries Collaborators*
CORRESPONDENCE TO: sihay@uw.edu
Background 背景
Detailed, comprehensive, and timely reporting on population health by underlying causes of disability and premature death is crucial to understanding and responding to complex patterns of disease and injury burden over time and across age groups, sexes, and locations. The availability of disease burden estimates can promote evidence-based interventions that enable public health researchers, policy makers, and other professionals to implement strategies that can mitigate diseases. It can also facilitate more rigorous monitoring of progress towards national and international health targets, such as the Sustainable Development Goals. For three decades, the Global Burden of Diseases, Injuries, and Risk Factors Study (GBD) has filled that need. A global network of collaborators contributed to the production of GBD 2021 by providing, reviewing, and analysing all available data. GBD estimates are updated routinely with additional data and refined analytical methods. GBD 2021 presents, for the first time, estimates of health loss due to the COVID-19 pandemic.
详尽、全面且及时的关于人群健康的报告，着眼于疾病和早死的根本原因，对于理解和应对长期以来、不同年龄组、性别和地点的疾病和伤害负担的复杂模式至关重要。预估疾病负担可以促进基于证据的干预措施，使公共卫生研究人员、政策制定者和其他专业人士能够实施减轻疾病的策略。这也有助于更严格地监测向国家和国际健康目标（如可持续发展目标）的发展。全球疾病、伤害和风险因素研究（GBD）在近三十年满足了这一需求。全球合作网络为GBD 2021的出版贡献了力量，提供审查和分析所有可用数据。GBD预测报告会定期使用额外数据和改进的分析方法更新。GBD 2021首次提供了由COVID-19大流行引起的健康损失估计。
Methods 方法
The GBD 2021 disease and injury burden analysis estimated years lived with disability (YLDs), years of life lost (YLLs), disability-adjusted life-years (DALYs), and healthy life expectancy (HALE) for 371 diseases and injuries using 100 983 data sources. Data were extracted from vital registration systems, verbal autopsies, censuses, household surveys, disease-specific registries, health service contact data, and other sources. YLDs were calculated by multiplying cause-age-sex-location-year-specific prevalence of sequelae by their respective disability weights, for each disease and injury. YLLs were calculated by multiplying cause-age-sex-location-year-specific deaths by the standard life expectancy at the age that death occurred. DALYs were calculated by summing YLDs and YLLs. HALE estimates were produced using YLDs per capita and age-specific mortality rates by location, age, sex, year, and cause. 95% uncertainty intervals (UIs) were generated for all final estimates as the 2·5th and 97·5th percentiles values of 500 draws. Uncertainty was propagated at each step of the estimation process. Counts and age-standardised rates were calculated globally, for seven super-regions, 21 regions, 204 countries and territories (including 21 countries with subnational locations), and 811 subnational locations, from 1990 to 2021. Here we report data for 2010 to 2021 to highlight trends in disease burden over the past decade and through the first 2 years of the COVID-19 pandemic.
GBD 2021的疾病和伤害负担分析估计了371种疾病和伤害的残疾调整寿命年（DALYs）、健康寿命（HALE）以及使用100,983个数据来源的伤残生活年（YLDs）和生命损失年（YLLs）。数据从生命登记系统、死因推断、人口普查、家庭调查、特定疾病登记、健康服务接触数据和其他来源提取。YLDs通过将特定因果、年龄、性别、地点和年份的后遗症流行病学与之相应的残疾权重相乘来计算，每种疾病和伤害均是如此。YLLs通过将特定因果、年龄、性别、地点和年份的死亡数乘以该年龄发生死亡时的标准预期寿命来计算。DALYs通过累加YLDs和YLLs来计算。使用每人YLDs和按地点、年龄、性别、年份和原因特定的年龄特定死亡率估计HALE数据。由500次抽样的第2.5和第97.5百分位数的值生成了95%不确定性区间（UIs）。在估计过程的每一步中都预估了传播不确定性。从1990年到2021年，在全球范围、七个超区域、21个区域、204个国家和地区（包括21个亚地区的国家）以及811个亚地区都计算了计数和年龄标准化率。在这里我们报告2010年到2021年的数据，以突出过去十年的疾病负担趋势和COVID-19大流行头两年的疾病负担趋势。
Findings 研究发现
Global DALYs increased from 2·63 billion (95% UI 2·44–2·85) in 2010 to 2·88 billion (2·64–3·15) in 2021 for all causes combined. Much of this increase in the number of DALYs was due to population growth and ageing, as indicated by a decrease in global age-standardised all-cause DALY rates of 14·2% (95% UI 10·7–17·3) between 2010 and 2019. Notably, however, this decrease in rates reversed during the first 2 years of the COVID-19 pandemic, with increases in global age-standardised all-cause DALY rates since 2019 of 4·1% (1·8–6·3) in 2020 and 7·2% (4·7–10·0) in 2021. In 2021, COVID-19 was the leading cause of DALYs globally (212·0 million [198·0–234·5] DALYs), followed by ischaemic heart disease (188·3 million [176·7–198·3]), neonatal disorders (186·3 million [162·3–214·9]), and stroke (160·4 million [148·0–171·7]). However, notable health gains were seen among other leading communicable, maternal, neonatal, and nutritional (CMNN) diseases. Globally between 2010 and 2021, the age-standardised DALY rates for HIV/AIDS decreased by 47·8% (43·3–51·7) and for diarrhoeal diseases decreased by 47·0% (39·9–52·9). Noncommunicable diseases contributed 1·73 billion (95% UI 1·54–1·94) DALYs in 2021, with a decrease in age-standardised DALY rates since 2010 of 6·4% (95% UI 3·5–9·5). Between 2010 and 2021, among the 25 leading Level 3 causes, age standardised DALY rates increased most substantially for anxiety disorders (16·7% [14·0–19·8]), depressive disorders (16·4% [11·9–21·3]), and diabetes (14·0% [10·0–17·4]). Age-standardised DALY rates due to injuries decreased globally by 24·0% (20·7–27·2) between 2010 and 2021, although improvements were not uniform across locations, ages, and sexes. Globally, HALE at birth improved slightly, from 61·3 years (58·6–63·6) in 2010 to 62·2 years (59·4–64·7) in 2021. However, despite this overall increase, HALE decreased by 2·2% (1·6–2·9) between 2019 and 2021.
全球DALYs（残疾调整生命年）从2010年的26.3亿（95% UI：2.44-2.85亿）增加到2021年的28.8亿（2.64-3.15亿）。DALYs的大部分增加是由于人口增长和老龄化，从2010年至2019年全球年龄标准化的全因DALY率下降14.2%（95% UI：10.7-17.3%）。然而，值得注意的是，这种下降趋势在COVID-19大流行的前两年发生逆转，自2019年以来，全球年龄标准化的全因DALY率在2020年增加了4.1%（1.8-6.3%），2021年增加了7.2%（4.7-10.0%）。在2021年，COVID-19是全球DALYs的主要原因（2.12亿[1.98-2.345亿] DALYs），其次是缺血性心脏病（1.883亿[1.767-1.983亿]）、新生儿疾病（1.863亿[1.623-2.149亿]）和中风（1.604亿[1.480-1.717亿]）。然而，其他主要的传染病、母婴、新生儿及营养性（CMNN）疾病中也见到显著的健康获益。全球范围内，2010年至2021年间，HIV/AIDS的年龄标准化DALY率下降了47.8%（43.3-51.7%），腹泻病的DALY率下降了47.0%（39.9-52.9%）。非传染性疾病在2021年贡献了17.3亿（95% 不确定区间1.54-1.94亿）DALYs，自2010年以来年龄标准化DALY率下降了6.4%（95% 不确定区间3.5-9.5%）。在2010年至2021年间，在25种主要三级病因中，焦虑症（16.7% [14.0-19.8%]）、抑郁症（16.4% [11.9-21.3%]）和糖尿病（14.0% [10.0-17.4%]）的年龄标准化DALY率增长最为显著。尽管并不是在所有地区、年龄和性别中均匀发生了改善，在2010年至2021年间，全球因伤害导致的年龄标准化DALY率下降了24.0%（20.7-27.2%）。全球从出生开始的健康寿命（HALE）从2010年的61.3年（58.6-63.6年）轻微增加到2021年的62.2年（59.4-64.7年）。然而，尽管总体有所增加，HALE在2019年至2021年间下降了2.2%（1.6-2.9%）。
Interpretation 解读
Putting the COVID-19 pandemic in the context of a mutually exclusive and collectively exhaustive list of causes of health loss is crucial to understanding its impact and ensuring that health funding and policy address needs at both local and global levels through cost-effective and evidence-based interventions. A global epidemiological transition remains underway. Our findings suggest that prioritising non-communicable disease prevention and treatment policies, as well as strengthening health systems, continues to be crucially important. The progress on reducing the burden of CMNN diseases must not stall; although global trends are improving, the burden of CMNN diseases remains unacceptably high. Evidence-based interventions will help save the lives of young children and mothers and improve the overall health and economic conditions of societies across the world. Governments and multilateral organisations should prioritise pandemic preparedness planning alongside efforts to reduce the burden of diseases and injuries that will strain resources in the coming decades.
将COVID-19大流行放在一个互斥且全面的健康损失原因列表中，对于理解其影响并确保卫生资金和政策通过成本效益和基于证据的干预措施，能够满足地方和全球的需求至关重要。全球流行病学转型正在进行中。我们的发现表明，优先考虑非传染性病症的预防和治疗政策以及加强卫生系统的重要性依然至关重要。减轻CMNN疾病负担的进展不能停滞；尽管全球趋势在改善，但CMNN疾病的负担仍然高得令人无法接受。基于证据的干预将有助于挽救年幼儿童和母亲的生命，并改善全球各地社会的整体健康和经济状况。政府和多边组织应当将大流行准备规划与减轻未来几十年可能耗尽资源的疾病和伤害负担的努力并列优先。
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