柳叶刀2013-12-29 1:51 AM

A comparative risk assessment of burden of disease and injury attributable to 67 risk factors and risk factor clusters in 21 regions, 1990–2010: a systematic analysis for the Global Burden of Disease Study 2010 : The Lancet 21个地区,1990-2010年针对67个风险因素和风险因素集群的疾病和伤害负担比较风险评估:2010年全球疾病负担研究

Abstract
Background
Quantification of the disease burden caused by different risks informs prevention by providing an account of health loss different to that provided by a disease-by-disease analysis. No complete revision of global disease burden caused by risk factors has been done since a comparative risk assessment in 2000, and no previous analysis has assessed changes in burden attributable to risk factors over time. 背景 对不同风险造成的疾病负担的量化可以通过提供健康损失的报告而非提供按病例分析的报告的方式来提前(对疾病进行)预防。 除了2000年做的一项比较风险评估外,我们对致危因素导致的全球疾病负担尚未做任何完整的修订,对危险因素造成的负担随时间推移的变化先前也没有做任何鉴定分析。
Methods
We estimated deaths and disability-adjusted life years (DALYs; sum of years lived with disability [YLD] and years of life lost [YLL]) attributable to the independent effects of 67 risk factors and clusters of risk factors for 21 regions in 1990 and 2010. We estimated exposure distributions for each year, region, sex, and age group, and relative risks per unit of exposure by systematically reviewing and synthesising published and unpublished data. We used these estimates, together with estimates of cause-specific deaths and DALYs from the Global Burden of Disease Study 2010, to calculate the burden attributable to each risk factor exposure compared with the theoretical-minimum-risk exposure. We incorporated uncertainty in disease burden, relative risks, and exposures into our estimates of attributable burden. 方法 我们估计了1990年和2010年 21个地区中由67个危险因素独立影响和危险因素集群影响所造成的死亡和伤残调整生命年(残疾调整生命年;残疾年数[YLD]和寿命损失年数[YLL])。我们通过进行系统的检验和整合发表和未发表的数据估计了每年,地区,性别和年龄组的曝光分布以及每单位曝光的相关风险。我们使用了包含来自2010年疾病研究全球负担的病因特异性死亡及伤残调整生命年的估计在内的这些估计来计算相较于理论最小风险曝光的每一危险因素曝光导致的负担。我们将疾病负担,相对风险和暴露中的不确定性归并到了我们对可归于负担的估计中。
Findings
In 2010, the three leading risk factors for global disease burden were high blood pressure (7·0% [95% uncertainty interval 6·2—7·7] of global DALYs), tobacco smoking including second-hand smoke (6·3% [5·5—7·0]), and household air pollution from solid fuels (4·3% [3·4—5·3]). In 1990, the leading risks were childhood underweight (7·9% [6·8—9·4]), household air pollution from solid fuels (HAP; 6·8% [5·5—8·0]), and tobacco smoking including second-hand smoke (6·1% [5·4—6·8]). Dietary risk factors and physical inactivity collectively accounted for 10·0% (95% UI 9·2—10·8) of global DALYs in 2010, with the most prominent dietary risks being diets low in fruits and those high in sodium. Several risks that primarily affect childhood communicable diseases, including unimproved water and sanitation and childhood micronutrient deficiencies, fell in rank between 1990 and 2010, with unimproved water and sanitation accounting for 0·9% (0·4—1·6) of global DALYs in 2010. However, in most of sub-Saharan Africa childhood underweight, HAP, and non-exclusive and discontinued breastfeeding were the leading risks in 2010, while HAP was the leading risk in south Asia. The leading risk factor in Eastern Europe, Andean Latin America, and southern sub-Saharan Africa in 2010 was alcohol use; in most of Asia, most of Latin America, North Africa and Middle East, and central Europe it was high blood pressure. Despite declines, tobacco smoking including second-hand smoke remained the leading risk in high-income north America and western Europe. High body-mass index has increased globally and it is the leading risk in Australasia and southern Latin America, and also ranks high in other high-income regions, North Africa and Middle East, and Oceania. 发现 在2010年,全球疾病负担的三个主要危险因素包括高血压(全球残疾调整生命年的7.0%[95%的不确定性区间为6.2 -7.7]),包括二手烟在内的吸烟(6.3%[5.5 -7.0])以及固体燃料造成的家庭空气污染(4.3%[3.4 -5.3])。在1990年,主要的风险是儿童体重过低(7.9%[6.8 -9.4]),固体燃料污染造成的家庭空气污染(HAP; 6.8%[5.5 -8.0]),以及包括二手烟在内的吸烟(6.1%[5.4 -6.8])。以低水果量和高钠食物摄入的饮食为显著典型,在2010年饮食危险因素和缺乏身体锻炼共占全球残疾调整生命年的10.0%(95%的用户界为 9.2 -10.8)。包括未改善的水和卫生设施以及儿童微量营养素缺乏在内的一些主要影响小儿传染病的风险在1990年至2010年间排名下跌, 其中2010年未改良的水和卫生设施占全球残疾调整生命年的0.9%(0.4 -1.6)。然而在大多数撒哈拉以南非洲地区,儿童体重过低,家庭空气污染和不固定的间断的母乳喂养是2010年的主要风险,在南亚地区家庭空气污染则成为主要风险。东欧,安第斯拉丁美洲和撒哈拉以南非洲南部地区酗酒是2010年的主要危险因素;在亚洲及拉丁美洲大部分地区,北非,中东以及欧洲中部地区高血压是主要风险。尽管已有减少,包括二手烟在内的吸烟仍然是高收入的北美和西欧地区的主要风险。高体重指数在全球范围内攀升,它已经成为澳大利亚和拉丁美洲南部地区的主要风险,且在其他高收入地区,北非,中东和大洋洲,它也是排名居前的风险。
Interpretation
Worldwide, the contribution of different risk factors to disease burden has changed substantially, with a shift away from risks for communicable diseases in children towards those for non-communicable diseases in adults. These changes are related to the ageing population, decreased mortality among children younger than 5 years, changes in cause-of-death composition, and changes in risk factor exposures. New evidence has led to changes in the magnitude of key risks including unimproved water and sanitation, vitamin A and zinc deficiencies, and ambient particulate matter pollution. The extent to which the epidemiological shift has occurred and what the leading risks currently are varies greatly across regions. In much of sub-Saharan Africa, the leading risks are still those associated with poverty and those that affect children.

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