第五讲 疾病负担的研究方法与应用

疾病负担(burden of disease)是指疾病造成的健康、经济、资源的损失与产生的生物、心理和对社会的危害,以及对疾病结局如死亡、失能和康复等所带来的后果和影响。疾病负担不仅包括疾病不同转归所带来的负担,也包括疾病对社会带来的负担及资源的消耗。该研究方法的应用,在疾病防制、医疗实践和卫生管理工作中不可缺少。一、疾病负担的特点和意义1. 疾病负担的特点:不同性别,不同年龄组的人群疾病谱不同,疾病负担也有较大差异。如婴儿早死对年轻组人群的预期寿命可造成严重影响,但对劳动生产率没有影响,疾病的经济负担不大。而25～64岁的青壮…     

2002年北京市居民心脑血管疾病的疾病负担分析

目的:计算5种心脑血管疾病的疾病负担,以评价心脑血管疾病对社会及人群所致危害程度的大小。方法:根据2002年北京市居民营养与健康状况调查中有关居民患病数据和北京市疾病预防控制中心统计信息中心死因统计数据资料,采用综合描述死亡与伤残负担的定量指标——伤残调整生命年(disability adhysted life year,DALY)作为反映疾病负担的量化指标。结果:2002年北京市居民心脑血管疾病的疾病负担中脑血管疾病造成的DALY损失最严重,平均每千人口造成15.77个DALY损失;男性脑血管病和心肌梗死的疾病负担高于女性;65岁以上老年人的心脑血管疾病负担高于中青年和青少年。结论:影响北京市居民健康的重点心脑血管疾病是脑血管病、急性心肌梗死、其他冠心病;重点人群是中老年人群。     

GBD数据库的数据提取方法与流程

疾病对人群健康的危害始终是人们普遍关注的问题,疾病负担是指疾病、伤残以及早逝对生命健康、社会经济方面的损失和影响,准确掌握全球疾病负担的现状和发展,对促进人类健康和经济社会发展具有重要意义。GBD数据库是了解全球疾病负担最重要的数据库,它涵盖了最全面的疾病、风险、死亡及与疾病相关的伤残对健康造成的负担,因此掌握GBD数据库的使用方法非常必要。该数据库是一个开放的状态,感兴趣的研究者可以申请其中的数据进行相关研究,本文旨在对该数据库的申请方式以及数据的提取方法进行介绍。     

老年人流行性感冒的特殊考量

流行性感冒(流感)是一种人群普遍易感的常见疾病, 对人群造成多方面的影响。老年人一旦罹患流感, 容易出现并发症, 导致重症, 甚至死亡。流感对老年人的健康造成严重影响, 如何识别和防治老年人的流感至关重要。本文就老年人罹患流感的特殊性进行综述。     

秋冬季节老年糖尿病患者流感疫苗接种的中国专家建议

正流感是流感病毒引起的具有高度传染性和致病性的急性呼吸道传染病,是全人群易感性传染病,每年均在全球范围内带来沉重的疾病负担。流感是诸多病毒性呼吸道传染性疾病中唯一可利用疫苗,短期快速建立有效免疫屏障的可防可控疾病。接种流感疫苗是预防流感的最有效手段,可减少相关疾病带来的危害及对医疗资源的占用。今年全球新冠疫情严重流行态势仍将持续,若流感防控不充分,疫情防控将面临新冠病毒与流感病毒叠加双流行的威胁,一方面,众多病患可能无法得到及时救治导致重症病例增加,特别是在老年人和慢病患者中救治难度增大;另一方面,医疗资源集中消耗,医务人员人力耗损和健康威胁,都将对医疗资源配置、常规疾病诊疗和整体疫情防控形成挑战。由于受到老龄和疾病的双重影响,老年糖尿病患者流感感染后极易造成严重不良临床预后,需引起各界的特殊关注。WHO将老年和慢病患者流感疫苗接种率目标设定为75%,     

肿瘤疾病负担研究进展

疾病负担(Burden of Diseue,BOD)是指疾病所造成的对健康、经济、资源的损失与产生的生物、心理和对社会的危害,以及对疾病结局如死亡、失能和康复所带来的后果和影响.文章对国内外疾病负担以及和肿瘤疾病负担的研究进展进行了综述.     

流行性感冒早期诊断的重要性

流行性感冒 (流感 )是由流感病毒引起的急性呼吸道传染性疾病 ,人群具有广泛易感性 ,世界范围内每年都有流感流行 ,年发病率达 10 %～ 3 0 %。历史上曾有 4次大流行 ,对人类健康带来严重威胁 ,对社会经济造成巨大损失。流感病毒疫苗接种对预防流感流行有一定作用。随着近年来抗病毒药物神经氨酸酶抑制剂的应用 ,流感的治疗亦取得很大进展 ,使病程缩短 ,并发症减少 ,并且对减少流感传播亦起一定作用。关键在于早期诊断 ,因为药物治疗只有在早期 (起病1～ 2天内 )使用 ,才能发挥应有效果。流感的临床表现缺乏特异性 ,往往容易与其它急性上呼吸…     

流行病学方法——第五讲 疾病负担的研究方法与应用

疾病负担(burden of disease)是指疾病造成的健康、经济、资源的损失与产生的生物、心理和对社会的危害，以及对疾病结局如死亡、失能和康复等所带来的后果和影响。疾病负担不仅包括疾病不同转归所带来的负担，也包括疾病对社会带来的负担及资源的消耗。该研究方法的应用，在疾病防制、医疗实践和卫生管理工作中不可缺少。     

卒中的疾病负担

卒中是一类发病率、致残率和死亡率均很高的神经系统疾病,已成为全球性公共卫生问题.目前,世界各国的卒中疾病负担均呈上升趋势.文章综述了卒中造成的人群健康危害程度以及疾病经济负担的评价.     

美国的肝脏疾病负担

疾病负担是指疾病对人群健康多方面的影响 ,其中包括 :(1)疾病的发生率 ,通常用发病率及患病率来衡量 ;(2 )疾病对寿命的影响 ,如患者病死率及未成年死亡患者损失的生存年数 ;(3 )疾病造成的伤残包括健康状态及生活质量的恶化 ;(4 )疾病带来的经济负担 ,包括直接的健康费用及早     

Southern Hemisphere Influenza and Vaccine Effectiveness Research and Surveillance

The 2009 influenza A(H1N1)pdm09 pandemic highlighted the need for improved scientific knowledge to support better pandemic preparedness and seasonal influenza control. The Southern Hemisphere Influenza and Vaccine Effectiveness Research and Surveillance (SHIVERS) project, a 5‐year (2012–2016) multiagency and multidisciplinary collaboration, aimed to measure disease burden, epidemiology, aetiology, risk factors, immunology, effectiveness of vaccination and other prevention strategies for influenza and other respiratory infectious diseases of public health importance. Two active, prospective, population‐based surveillance systems were established for monitoring influenza and other respiratory pathogens among those hospitalized patients with acute respiratory illness and those enrolled patients seeking consultations at sentinel general practices. In 2015, a sero‐epidemiological study will use a sample of patients from the same practices. These data will provide a full picture of the disease burden and risk factors from asymptomatic infections to severe hospitalized disease and deaths and related economic burden. The results during the first 2 years (2012–2013) provided scientific evidence to (a) support a change to NZ's vaccination policy for young children due to high influenza hospitalizations in these children; (b) contribute to the revision of the World Health Organization's case definition for severe acute respiratory illness for global influenza surveillance; and (c) contribute in part to vaccine strain selection using vaccine effectiveness assessment in the prevention of influenza‐related consultations and hospitalizations. In summary, SHIVERS provides valuable international platforms for supporting seasonal influenza control and pandemic preparedness, and responding to other emerging/endemic respiratory‐related infections.     

The burden of influenza in East and South‐East Asia: a review of the English language literature

Abstract While human infections with avian influenza A (H5NI) viruses in Asia have prompted concerns about an influenza pandemic, the burden of human influenza in East and Southeast Asia has received far less attention. We conducted a review of English language articles on influenza in 18 countries in East and Southeast Asia published from 1980 to 2006 that were indexed on PubMed. Articles that described human influenza‐associated illnesses among outpatients or hospitalized patients, influenza‐associated deaths, or influenza‐associated socioeconomic costs were reviewed. We found 35 articles from 9 countries that met criteria for inclusion in the review. The quality of articles varied substantially. Significant heterogeneity was noted in case definitions, sampling schemes and laboratory methods. Early studies relied on cell culture, had difficulties with specimen collection and handling, and reported a low burden of disease. The recent addition of PCR testing has greatly improved the proportion of respiratory illnesses diagnosed with influenza. These more recent studies reported that 11–26% of outpatient febrile illness and 6‐14% of hospitalized pneumonia cases had laboratory‐confirmed influenza infection. The influenza disease burden literature from East and Southeast Asia is limited but expanding. Recent studies using improved laboratory testing methods and indirect statistical approaches report a substantial burden of disease, similar to that of Europe and North America. Current increased international focus on influenza, coupled with unprecedented funding for surveillance and research, provide a unique opportunity to more comprehensively describe the burden of human influenza in the region.     

Universal influenza vaccination in the United States: are we ready? Report of a meeting

Universal influenza vaccination has been proposed as one strategy to improve vaccination coverage and disease prevention. In October 2005, influenza and vaccination experts, public health practitioners, representatives from medical professional societies, influenza vaccine manufacturers, and managed care organizations met to assess whether current data were sufficient to support an expansion of universal influenza vaccination and to define information gaps and potential barriers to implementation. Presenters at the meeting documented the substantial burden of influenza disease among all age groups, the major role of children in transmission, and the effectiveness of vaccine, especially in healthy children and adults. Observational studies and a mathematical model suggested that indirect protection, or "herd immunity," resulting from vaccination of school-age children would substantially reduce the incidence of disease in other age groups. Economic analyses generally showed that vaccination of healthy children and adults is cost-effective and is sensitive to vaccine cost, population group, and season. Influenza vaccination received annually over several years is safe and effective, but data on long-term use are limited. Challenges to expanded recommendations include maintenance of the vaccine supply, implementation of a feasible and effective strategy for vaccine delivery, the burden on the public health infrastructure, public acceptability, and financing. Overall, meeting attendees favored incremental expansion of recommendations, potentially toward universal influenza vaccination. They preferred to expand recommendations among children first, because children have a higher risk of illness, compared with healthy adults; because there is greater feasibility of implementation of the recommendations among children; and because of the potential for herd immunity decreasing morbidity and mortality among adults.     

Influenza surveillance and immunisation in New Zealand, 1997–2006

Background The national influenza surveillance in New Zealand is an essential public health component for assessing and implementing strategies to control influenza. Objective The aim of this study is to report the national influenza surveillance data collected during 1997–2006 in terms of the community disease burden, circulating viral strains, hospitalisations, mortality, and immunisation coverage. Methods The national influenza surveillance system includes sentinel general practice surveillance, laboratory‐based surveillance, and hospital admission and mortality surveillance and immunisation coverage. The results obtained during 1997–2006 were analysed. Results When the last 10 years were compared to the previous years, sentinel general practice surveillance recorded a decreasing trend of influenza‐like illness rates in the community. Sentinel surveillance also showed that children aged 0–4 years were the most affected. Influenza‐related hospitalisation surveillance reported an increasing trend of hospital admissions particularly in children aged 0–19 years. Introduction of routine influenza vaccination among the New Zealand elderly was associated with a significant decrease of influenza‐related mortality. Conclusions This report demonstrates that an integrated virological and epidemiological surveillance system for influenza is essential for monitoring the disease burden, identifying circulating strains, guiding effective vaccination and planning for a potential pandemic.     

Knowledge and beliefs about influenza,pneumococcal disease,and immunizations among older people

OBJECTIVES: Despite the burden of disease caused by influenza and pneumococcus, immunization rates are moderate and have not reached national goals set for 2010. This study's objective was to identify patient knowledge, attitudes, and beliefs that serve as facilitators of and barriers to influenza and pneumococcal vaccination. DESIGN: A survey conducted in 2000 by computer-assisted telephone interviewing. SETTING: To encounter a broad spectrum of patients and healthcare systems, we sampled patients at inner-city health centers, Department of Veterans Affairs outpatient clinics, and rural and suburban practices. PARTICIPANTS: Inclusion criteria were patients aged 66 and older and an office visit after September 30, 1998. MEASUREMENTS: Responses to questionnaire. RESULTS: Overall, 1,007 (82%) interviews were completed among 1,234 people contacted by phone. Vaccination against pneumococcal disease was significantly related to being able to accurately describe one or more classic symptoms of pneumonia (P =.05). Vaccination against influenza and pneumococcal disease was significantly related to belief that vaccination was the best way to prevent these diseases (P <.001). The unvaccinated reported that they felt they were not likely to contract influenza and that they did not know they needed the pneumococcal vaccine. Access was not related to vaccination status. CONCLUSIONS: Educational campaigns to increase vaccination rates among older adults should focus on symptoms of, risk for, and severity of influenza and pneumococcal diseases and encouraging physicians to recommend the vaccines to their patients.     

Influenza: the virus and prophylaxis with inactivated influenza vaccine in ��at risk�� groups, including COPD patients

Influenza is a major respiratory pathogen, which exerts a huge human and economic toll on society. Influenza is a vaccine preventable disease, however, the vaccine strains must be annually updated due to the continuous antigenic changes in the virus. Inactivated influenza vaccines have been used for over 50 years and have an excellent safety record. Annual vaccination is therefore recommended for all individuals with serious medical conditions, like COPD, and protects the vaccinee against influenza illness and also against hospitalization and death. In COPD patients, influenza infection can lead to exacerbations resulting in reduced quality of life, hospitalization and death in the most severe cases. Although there is only limited literature on the use of influenza vaccination solely in COPD patients, there is clearly enough evidence to recommend annual vaccination in this group. This review will focus on influenza virus and prophylaxis with inactivated influenza vaccines in COPD patients and other “at risk” groups to reduce morbidity, save lives, and reduce health care costs.     

Estimating influenza outpatients' and inpatients' incidences from 2009 to 2011 in a tropical urban setting in the Philippines

Objectives

Although the public health significance of influenza in regions with a temperate climate has been widely recognized, information on influenza burden in tropical countries, including the Philippines, remains limited. We aimed to estimate influenza incidence rates for both outpatients and inpatients then characterized their demographic features.

Design

An enhanced surveillance was performed from January 2009 to December 2011 in an urbanized highland city. The influenza-like illness (ILI) surveillance involved all city health centers and an outpatient department of a tertiary government hospital. The severe acute respiratory infection (sARI) surveillance was also conducted with one government and four private hospitals since April 2009. Nasal and/or oropharyngeal swabs were collected and tested for influenza A, influenza B, and respiratory syncytial virus.

Results and Conclusions

We obtained 5915 specimens from 13 002 ILI cases and 2656 specimens from 10 726 sARI cases throughout the study period. We observed year-round influenza activity with two possible peaks each year. The overall influenza detection rate was 23% in the ILI surveillance and 9% in the sARI surveillance. The mean annual outpatient incidence rate of influenza was 5·4 per 1000 individuals [95% confidence interval (CI), 1·83–12·7], and the mean annual incidence of influenza-associated sARI was 1·0 per 1000 individuals (95% CI, 0·03–5·57). The highest incidence rates were observed among children aged <5 years, particularly those aged 6–23 months. Influenza posed a certain disease burden among inpatients and outpatients, particularly children aged <5 years, in an urbanized tropical city of the Philippines.     

Health care costs of diarrheal disease and estimates of the cost-effectiveness of rotavirus vaccination in Vietnam

BACKGROUND: Rotavirus disease causes a significant health and economic burden worldwide. Several rotavirus vaccines may soon be available for use. A country's decision to introduce these vaccines will depend on its rotavirus disease burden, on the cost of the vaccine, and on the results of an economic assessment of the cost and effectiveness of a rotavirus vaccination program. METHODS: Data on medical and nonmedical direct costs and indirect costs were established in Khanh Hoa Province, Vietnam, and extrapolated to national estimates on the basis of the birth cohort in 2004. The main outcome measures were economic burden and cost-effectiveness ratio (United States dollars per disability-adjusted life-year averted and dollars per life saved) of vaccination. RESULTS: The disease burden is equivalent to an economic burden of an estimated 3.1 million US dollars in medical direct costs, 685,000 US dollars in nonmedical direct costs, and 1.5 million US dollars in indirect costs. From a societal perspective, treatment of rotavirus disease costs an estimated 5.3 million US dollars per year. From the health care system perspective, universal vaccination of infants at a cost of < or = 7.26 US dollars/vaccine dose would be a cost-effective public health intervention, according to the World Bank cost-effectiveness standard for low-income countries (140 US dollars/disability-adjusted life-year). CONCLUSIONS: Vaccination can effectively reduce the disease burden and health care costs of rotavirus-specific diarrhea in Vietnam.     

WHO guide on the economic evaluation of influenza vaccination

Influenza is responsible for substantial morbidity and mortality across the globe, with a large share of the total disease burden occurring in low‐ and middle‐income countries (LMICs). There have been relatively few economic evaluations assessing the value of seasonal influenza vaccination in LMICs. The purpose of this guide is to outline the key theoretical concepts and best practice in methodologies and to provide guidance on the economic evaluation of influenza vaccination in LMICs. It outlines many of the influenza vaccine‐specific challenges and should help to provide a framework for future evaluations in the area to build upon.     

江苏省晚期血吸虫病患者疾病经济负担调查

目的 了解江苏省晚期血吸虫病（晚血）患者的经济负担。方法 2015年分层抽取苏南、苏北和苏中地区450例登记在册的晚血患者作为调查对象,自行设计疾病经济负担问卷,对其进行调查。采用描述性分析方法分析晚血患者的经济负担,采用多重线性回归分析探索其影响因素。结果 共发放问卷450份,回收有效问卷434份,问卷回收率为96.44%。2015年江苏省晚血患者人均疾病经济负担为10 217元,其中直接经济负担为7 221元,间接经济负担为2 996元。晚血患者的劳动力损失平均为140 d,家庭成员劳动力损失平均为23 d。多因素分析表明,婚姻状况、是否住院、自身健康状况是晚血疾病经济负担的影响因素。 结论 江苏省晚血患者的疾病经济负担较重。