城市居民对疾病负担归因的主要危险因素感知研究

目的了解我国人群对于WHO发布的东亚国家疾病负担归因的主要危险因素的主观感知。方法采用单纯随机抽样方法获取140名济南城市居民样本并进行入户调查,调查数据使用描述性统计分析与相关性分析方法,得出研究人群对各危险因素的感知水平;同时对比基于研究人群主观感知的危险因素排序与基于疾病负担评估得出的危险因素排序,考察二者一致性。结果人群对同一危险因素不同维度的感知水平存在较大差异,尤其对环境健康类危险因素的关注和了解较少。人群对东亚国家疾病负担贡献较大的危险因素的认知程度与这些危险因素客观的风险水平并不完全一致。结论本研究提示对不同危险因素应当采取针对性的风险交流与干预策略,提示了关注人群感知的切实意义与加强健康风险交流的必要性。     

内科住院病人跌倒危险因素分析

目的探讨老年病人发生跌倒的原因,分析内科疾病住院病人跌倒的状况及其影响因素。方法通过访谈法调查291例病人的跌倒状况及相关的危险因素,采取美国Morse跌倒评估量表进行入院评估分析跌倒发生的相关因素。结果有52例属于高度危险,86例属于中度危险,153例属于低度危险。病人跌倒是生理和心理状况、疾病、药物和生活环境等诸多因素交互作用的结果。结论年龄、居住状况、长期服药和患病时间对内科住院病人跌倒的发生有影响。     

个体失能调整损失年的建立和探讨

以研究发病或死亡为基础的前瞻性研究通常是以探索疾病危险因素或评价干预措施效果为目的，常缺乏对疾病负担的综合评估，不利于指导宏观卫生决策。失能调整生命年(disability adjusted life year，DALY)是将发病和死亡所致失能结合在一起反映疾病负担的一个综合指标，20世纪90年代以     

2030年中国慢性阻塞性肺疾病的疾病负担预测与危险因素控制效果模拟

目的基于统计模型预测2030年中国慢性阻塞性肺疾病(COPD)的疾病负担,评估控制危险因素对降低疾病负担的效果。方法基于死亡风险与危险因素暴露的相关性和比较风险评估理论,利用2015年全球疾病负担研究的中国数据,筛选危险因素,采用比例变化模型估计2030年不同场景下COPD死亡情况,模拟控制危险因素对2030年COPD的疾病负担的影响。结果如危险因素暴露按1990-2015年的变化趋势发展,2030年中国COPD的死亡例数为105.54万例、死亡率为73.85/10万,相比2015年将分别上升15.81%和10.69%,标化死亡率和过早死亡概率将降低38.88%和52.73%。如吸烟或PM2.5污染控制达标,到2030年相比于自然趋势发展可分别减少34.07万和27.34万死亡例数,过早死亡概率将降至0.59%和0.52%。如所有危险因素控制达标,到2030年我国可避免52.59万例死亡,过早死亡概率将降至0.44%。结论自然趋势下,2030年COPD死亡数和死亡率预计将比2015年高,但标化死亡率与过早死亡概率将下降。如所有危险因素控制达标,可进一步降低COPD的负担,提示应加强控烟与大气污染治理等举措来降低COPD的疾病负担。     

2030年中国慢性阻塞性肺疾病的疾病负担预测与危险因素控制效果模拟

目的基于统计模型预测2030年中国慢性阻塞性肺疾病(COPD)的疾病负担,评估控制危险因素对降低疾病负担的效果。方法基于死亡风险与危险因素暴露的相关性和比较风险评估理论,利用2015年全球疾病负担研究的中国数据,筛选危险因素,采用比例变化模型估计2030年不同场景下COPD死亡情况,模拟控制危险因素对2030年COPD的疾病负担的影响。结果如危险因素暴露按1990-2015年的变化趋势发展,2030年中国COPD的死亡例数为105.54万例、死亡率为73.85/10万,相比2015年将分别上升15.81%和10.69%,标化死亡率和过早死亡概率将降低38.88%和52.73%。如吸烟或PM2.5污染控制达标,到2030年相比于自然趋势发展可分别减少34.07万和27.34万死亡例数,过早死亡概率将降至0.59%和0.52%。如所有危险因素控制达标,到2030年我国可避免52.59万例死亡,过早死亡概率将降至0.44%。结论自然趋势下,2030年COPD死亡数和死亡率预计将比2015年高,但标化死亡率与过早死亡概率将下降。如所有危险因素控制达标,可进一步降低COPD的负担,提示应加强控烟与大气污染治理等举措来降低COPD的疾病负担。     

1990—2019年中国白血病归因于各类危险因素的疾病负担分析与模型预测

目的 分析1990—2019年中国白血病归因于各类危险因素的疾病负担变化趋势和预测,为白血病的预防提供参考。方法 利用2019年全球疾病负担数据库数据,研究1990—2019年各种危险因素导致的白血病,探寻不同性别的该病疾病负担DALYs率的变化趋势,比较1990和2019年两个年龄段人群的主要危险因素及其变化速率,通过时间序列模型预测未来10年中国白血病归因于各类危险因素的疾病负担情况。结果 1990—2019年中国白血病归因于危险因素的伤残调整寿命年粗率整体呈上升趋势,但是标化率小幅下降,男女差别不明显。中国白血病归因于各类危险因素的疾病负担随着年龄的增长呈上升趋势。1990和2019年吸烟均是白血病疾病负担的首要危险因素,30年间吸烟、职业致癌物、苯的职业接触、甲醛职业接触造成的疾病负担标化DALYs率都下降,下降率依次是23.34%、22.18%、21.14%和24.10%,但是高体重指数的标化DALYs率上升,变化率高达50.70%;未来10年,吸烟仍然是造成中国白血病疾病负担的首要危险因素。结论 由于预期寿命增加和人口老龄化,中国白血病归因于危险因素的DALYs率变化趋势,...     

流行病学与计算机应用 第二讲 伤残调整寿命年的计算机计算

研究疾病对人群健康的负担，需要一个综合的指标，既能表明由于疾病过早死亡造成的危害，又能表达发病后形成残疾对生命质量的影响。伤残调整寿命年（DALY）就是这样的指标，已在世界上广泛应用，并以此决策需要重点防治的疾病和危险因素，评估控制后的效果。本文介绍DALY计算方法和计算机程序以及在我国应用后的成绩。     

儿童对环境致癌物的易感性增加

WHO认为,全球疾病负担有1/3归因于环境危险因素,而＜5岁儿童只占世界人口的12%,却占环境相关疾病负担的40%以上.其他国际组织也得出与WHO相似的结论.第3届"环境与健康"欧洲部长级会议强调了保护儿童免受有害环境暴露危害的重要性,已认识到儿童独特的易感性,正着手制订政策并采取行动,以获得可以使儿童最大限度地健康成长的安全环境.     

生物学因子在化学因素中的混杂问题

为了研究环境与疾病的关系，对危险因素进行调查是一项重要工作。世界卫生组织于1983年制定了对环境物质的作用进行流行病学研究的目标：1．给予决策者及卫生保健工作者提供制定卫生标准与规划所必须的信息，以控制污染及环境健康危害；2．对人类为避免环境危险而采取的预防及控制措施的效果进行评估，改善生活质量；3．提高环境条件对健康影响的科学认识。除了世界卫生组织规定的以上目标外。环境流行病学家有责任给社会及以公众提供他们的研究结果的信息。但是，获得危险因素的评估数据，过程非常复杂，主要是对进行危险因素评估要处理很…     

气候变化相关疾病负担的评估方法

气候变化已经明显影响到人类的健康,造成疾病负担的加重,因此,开展气候变化对人群疾病负担影响的研究显得尤为重要。目前气候变化疾病负担的评估主要应用了环境疾病负担(EBD)的评估方法,主要为伤残调整寿命年(DALY)的计算和风险评估模型(CRA)的应用。该文综述了国内外气候变化疾病负担评估的基本方法,通过计算基准年的DALY值、应用CRA模型来计算归因分值(PAF)、总的疾病负担与归因分值的乘积等一系列步骤,最终得出归因于气候变化的疾病负担。     

How much disease burden can be prevented by environmental interventions?

There is very little systematically collected evidence on the overall contribution of environmental risk factors to the global burden of disease. The World Health Organization (WHO) recently completed a comprehensive, systematic, and transparent estimate of the disease burden attributable to the environment highlighting the full potential for environmental interventions to improve human health.This report is the result of a systematic literature review on environmental risks completed by a survey of expert opinion using a variant of the Delphi method. More than 100 experts provided quantitative estimates on the fractions of 85 diseases attributable to the environment. They were asked to consider only the contributions of the "reasonably modifiable environment"-that is, the part of environment that can plausibly be changed by existing interventions.The report estimates that 24% of the global burden of disease was due to environmental risk factors. Environmental factors were judged to play a role in 85 of the 102 diseases taken into account. Major diseases were, for example, diarrheal diseases with fractions attributable to the environment of 94%, lower respiratory infections with 41%, malaria with 42%, and unintentional injuries with 42%. The evidence shows that a large proportion of this "environmental disease burden" could be averted by existing cost-effective interventions such as clean water, clean air, and basic safety measures. In children, 34% of the disease burden is attributable to the environment, and much of this burden is in developing countries.     

Risk factors of chronic obstructive pulmonary disease

Many personal and environmental risk factors are associated to increased prevalence and severity of chronic obstructive pulmonary disease (COPD). In this review, we shortly describe most of these risk factors, aiming at defining each factor as causative or modifier of the natural history of the disease. It is clear that the environmental risk factors do have an outstanding relevance for both the initiation and the evolution of COPD. This review focuses on the crucial importance of prevention in order to decrease the public health burden of COPD in the western countries during the next decades.     

Environmental determinants of infectious disease: a framework for tracking causal links and guiding public health research

BACKGROUND: Discoveries that emerging and re-emerging pathogens have their origin in environmental change has created an urgent need to understand how these environmental changes impact disease burden. In this article we present a framework that provides a context from which to examine the relationship between environmental changes and disease transmission and a structure from which to unite disparate pieces of information from a variety of disciplines. METHODS: The framework integrates three interrelated characteristics of environment-disease relationships: a) Environmental change manifests in a complex web of ecologic and social factors that may ultimately impact disease; these factors are represented as those more distally related and those more proximally related to disease. b) Transmission dynamics of infectious pathogens mediate the effects that environmental changes have on disease. c) Disease burden is the outcome of the interplay between environmental change and the transmission cycle of a pathogen. RESULTS: To put this framework into operation, we present a matrix formulation as a means to define important elements of this system and to summarize what is known and unknown about the these elements and their relationships. The framework explicitly expresses the problem at a systems level that goes beyond the traditional risk factor analysis used in public health, and the matrix provides a means to explicitly express the coupling of different system components. CONCLUSION: This coupling of environmental and disease transmission processes provides a much-needed construct for furthering our understanding of both specific and general relationships between environmental change and infectious disease.     

Climate change, flooding, urbanisation and leptospirosis: fuelling the fire?

Flooding and heavy rainfall have been associated with numerous outbreaks of leptospirosis around the world. With global climate change, extreme weather events such as cyclones and floods are expected to occur with increasing frequency and greater intensity and may potentially result in an upsurge in the disease incidence as well as the magnitude of leptospirosis outbreaks. In this paper, we examine mechanisms by which climate change can affect various ecological factors that are likely to drive an increase in the overall incidence as well as the frequency of outbreaks of leptospirosis. We will discuss the geographical areas that are most likely to be at risk of an increase in leptospirosis disease burden owing to the coexistence of climate change hazard risk, environmental drivers of leptospirosis outbreaks, local socioeconomic circumstances, and social and demographic trends. To reduce this disease burden, enhanced surveillance and further research is required to understand the environmental drivers of infection, to build capacity in emergency response and to promote community adaptation to a changing climate.     

Dealing with uncertainties in environmental burden of disease assessment

Disability Adjusted Life Years (DALYs) combine the number of people affected by disease or mortality in a population and the duration and severity of their condition into one number. The environmental burden of disease is the number of DALYs that can be attributed to environmental factors. Environmental burden of disease estimates enable policy makers to evaluate, compare and prioritize dissimilar environmental health problems or interventions. These estimates often have various uncertainties and assumptions which are not always made explicit. Besides statistical uncertainty in input data and parameters – which is commonly addressed – a variety of other types of uncertainties may substantially influence the results of the assessment. We have reviewed how different types of uncertainties affect environmental burden of disease assessments, and we give suggestions as to how researchers could address these uncertainties. We propose the use of an uncertainty typology to identify and characterize uncertainties. Finally, we argue that uncertainties need to be identified, assessed, reported and interpreted in order for assessment results to adequately support decision making.     

The search for cancer risk factors: when can we stop looking?

In recent decades, countless cohort, case-control, and ecologic studies have been conducted in the search for cancer risk factors. On the basis of knowledge gained from these studies, various influential commentaries have endeavored to classify the extent to which the total cancer burden is attributable to general categories of risk, such as diet, tobacco, sun exposure, and others. These commentaries have led to the conventional wisdom that most of the cancer burden is caused by environmental factors and relatively little is directly attributable to genetic susceptibility. In the face of the apparent knowledge that the cancer burden is essentially fully "explainable" on the basis of known environmental risks, this article addresses the conceptual and empirical basis of the continued search for new risk factors. It proposes that the extent of the aggregation of cancer within individuals in the population--that is, the occurrence of second primary cancers--is a crucial statistic in this context. A study of the incidence of second primary melanoma suggests that the bulk of the risk variation in this disease cannot be explained by known risk factors. The implications of these ideas for research strategy and for public health policy are discussed.     

Burden of Disease from Toxic Waste Sites in India,Indonesia, and the Philippines in 2010

Background: Prior calculations of the burden of disease from toxic exposures have not included estimates of the burden from toxic waste sites due to the absence of exposure data.Objective: We developed a disability-adjusted life year (DALY)-based estimate of the disease burden attributable to toxic waste sites. We focused on three low- and middle-income countries (LMICs): India, Indonesia, and the Philippines.Methods: Sites were identified through the Blacksmith Institute’s Toxic Sites Identification Program, a global effort to identify waste sites in LMICs. At least one of eight toxic chemicals was sampled in environmental media at each site, and the population at risk estimated. By combining estimates of disease incidence from these exposures with population data, we calculated the DALYs attributable to exposures at each site.Results: We estimated that in 2010, 8,629,750 persons were at risk of exposure to industrial pollutants at 373 toxic waste sites in the three countries, and that these exposures resulted in 828,722 DALYs, with a range of 814,934–1,557,121 DALYs, depending on the weighting factor used. This disease burden is comparable to estimated burdens for outdoor air pollution (1,448,612 DALYs) and malaria (725,000 DALYs) in these countries. Lead and hexavalent chromium collectively accounted for 99.2% of the total DALYs for the chemicals evaluated.Conclusions: Toxic waste sites are responsible for a significant burden of disease in LMICs. Although some factors, such as unidentified and unscreened sites, may cause our estimate to be an underestimate of the actual burden of disease, other factors, such as extrapolation of environmental sampling to the entire exposed population, may result in an overestimate of the burden of disease attributable to these sites. Toxic waste sites are a major, and heretofore underrecognized, global health problem.     

The environmental burden of disease in Canada: respiratory disease, cardiovascular disease, cancer, and congenital affliction

BACKGROUND: Exposure to environmental hazards contributes to many chronic diseases, yet the magnitude of their contribution to the total disease burden in Canada is not well understood. OBJECTIVES: To estimate the environmental burden of disease (EBD) in Canada for respiratory disease, cardiovascular disease, cancer, and congenital affliction. Quantifying the contribution of environmental exposures to the overall burden of disease could play an important role in shaping public health and environmental policy priorities. METHODS: The World Health Organization (WHO) recently estimated the environmental burden of disease globally by using a combination of comparative risk assessment data and expert judgment to develop environmentally attributable fractions (EAFs) of mortality and morbidity for 85 categories of disease. We use the EAFs developed by the WHO, EAFs developed by other researchers, and data from Canadian public health institutions to provide an initial estimate of the environmental burden of disease in Canada for four major categories of disease. RESULTS: Our results indicate that: 10,000-25,000 deaths; 78,000-194,000 hospitalizations; 600,000-1.5 million days spent in hospital; 1.1 million-1.8 million restricted activity days for asthma sufferers; 8000-24,000 new cases of cancer; 500-2500 low birth weight babies; and between $3.6 billion and $9.1 billion in costs occur in Canada each year due to respiratory disease, cardiovascular illness, cancer, and congenital affliction associated with adverse environmental exposures. CONCLUSIONS: The burden of illness in Canada resulting from adverse environmental exposures is significant. Stronger efforts to prevent adverse environmental exposures are warranted, including research, education, and regulation.     

Environmental risks to public health in the United Arab Emirates: a quantitative assessment and strategic plan

Background: Environmental risks to health in the United Arab Emirates (UAE) have shifted rapidly from infectious to noninfectious diseases as the nation has developed at an unprecedented rate. In response to public concerns over newly emerging environmental risks, the Environment Agency–Abu Dhabi commissioned a multidisciplinary environmental health strategic planning project.Objectives: In order to develop the environmental health strategic plan, we sought to quantify the illnesses and premature deaths in the UAE attributable to 14 environmental pollutant categories, prioritize these 14 risk factors, and identify interventions.Methods: We estimated the disease burden imposed by each risk factor using an attributable fraction approach, and we prioritized the risks using an empirically tested stakeholder engagement process. We then engaged government personnel, scientists, and other stakeholders to identify interventions.Results: The UAE’s environmental disease burden is low by global standards. Ambient air pollution is the leading contributor to premature mortality [~ 650 annual deaths; 95% confidence interval (CI): 140, 1,400]. Risk factors leading to > 10,000 annual health care facility visits included occupational exposures, indoor air pollution, drinking water contamination, seafood contamination, and ambient air pollution. Among the 14 risks considered, on average, outdoor air pollution was ranked by the stakeholders as the highest priority (mean rank, 1.4; interquartile range, 1–2) and indoor air pollution as the second-highest priority (mean rank 3.3; interquartile range, 2–4). The resulting strategic plan identified 216 potential interventions for reducing environmental risks to health.Conclusions: The strategic planning exercise described here provides a framework for systematically deciding how to invest public funds to maximize expected returns in environmental health, where returns are measured in terms of reductions in a population’s environmental burden of disease.