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。     

1990-2017年中国艾滋病疾病负担分析

目的 分析1990-2017年中国艾滋病疾病负担变化.方法 利用全球疾病负担研究资料分析1990-2017年中国艾滋病疾病负担变化趋势;描述1990年和2017年死亡、伤残调整寿命年(DALY)、伤残损失健康寿命年(YLD)和过早死亡损失寿命年(YLL)的年龄、性别分布.结果 1990-2017年中国艾滋病年龄别标化死...     

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。     

亚洲地区的心血管病负担

据估计,1998年多于30%的全部死亡人数和大于10%的总疾病负担(以损失的伤残调整生命年DALYs计算)要归因于心血管病.因而心血管病(CVD)造成的高全球负担成为1999年世界卫生报告的重要内容.到1990年为止,包括中国、印度和其他亚洲地区在内的亚洲国家因CVD死亡的人数已占到全球因CVD死亡人数的44%,这些国家的CVD负担已超过全球CVD负担的50%.     

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     

吸烟对中老年人癌症和慢性阻塞性肺疾病的归因分析

目的通过定量计算吸烟导致中老年人癌症和慢性阻塞性肺疾病(COPD)的疾病负担来评估中国2007年吸烟导致的累积健康危害。方法采用间接法,依据当地流行病学证据和国家生命登记数据计算癌症和COPD归因于吸烟的伤残调整寿命年(DALYs)。结果中国2007年因吸烟导致的中老年癌症和COPD死亡数为203 922~234 415人,并造成242万~279万年寿命损失,其中中老年男性死亡占28.6%,女性占3.8%,城市和农村无差异。2007年中国中老年人中归因于吸烟的癌症和COPD死亡率为21.2%。结论吸烟导致的癌症和COPD负担在中国非常严峻,影响到人群期望寿命,其造成严重的累积危害预示吸烟导致的健康问题在中国非常突出,控烟措施势在必行。     

疾病负担（DALY）的评价与应用

1 前言 1.1 出现时间 广义而言，疾病（或伤害）、早死对患者、家庭、社会和国家所造成的任何健康和/或经济方面的损失或压力都可称为疾病负担，但公共卫生学家习惯从人群健康的角度、以时间为尺度对其加以测量和描述。20世纪80年代前，人们用病死人数和死因排序等来评价和比较不同疾病的危害程度，没有区分不同年龄病死的寿命损失；1982年，美国CDC采用潜在寿命年损失（YPLL）来衡量疾病负担，但未考虑疾病的非致死性结局的后果与影响；1988年，为明确世界面临的主要健康问题，世界银行和世界卫生组织与哈佛公共卫生学院合作，开始对全球疾病负担（the global burden of disease and injury， GBD）进行评价，首次采用伤残（失能）调整寿命年（disability adjusted life year，DALY）做为量化疾病负担的新方法。1993年，世界银行将DALY用于世界发展报告，公布了GBD1990的研究方法和成果，从此DALY就成为了疾病负担的代名词而被广泛应用并得以深入研究。     

失能调整生命年及其在寄生虫病研究中的应用

失能调整生命年 (DALYs)是定量计算各种疾病造成的早逝与残疾对健康生命年损失的综合指标。近几年来 ,DALYs指标在宏观地认识和控制疾病方面的研究进展迅速 ,主要应用于评价疾病负担 ,并被许多国家作为制定卫生政策与疾病预防措施的依据     

1990年和2016年北京市心脑血管疾病负担及其变化

目的调查1990年和2016年北京市心脑血管疾病负担及其变化情况。方法利用2016年全球疾病负担研究数据,分析1990年和2016年北京市心脑血管疾病死亡情况和疾病负担。主要指标包括死亡人数、过早死亡损失寿命年(YLL)、伤残损失寿命年(YLD)和伤残调整寿命年(DALY),同时使用2000—2025年世界人口的平均人口作为标准人口,计算标化死亡率、DALY率、YLL率和YLD率。结果2016年,北京市居民心脑血管病标化死亡率为209.24/10万;心脑血管病DALY、YLL和YLD分别为87.56、73.36和14.20万人年,较1990年分别增加了58.05%、44.24%和213.47%;标化DALY率和标化YLL率分别为3552.24/10万和2988.01/10万,较1990年分别下降47.90%和52.43%,标化YLD率为564.23/10万,较1990年增加5.10%。2016年,脑血管疾病和缺血性心脏病的死亡数分别为1.76万例和2.37万例;DALY分别为39.63和39.36万人年,较1990年(DALY分别为33.02和16.27万人年)分别增加20.02%和141.92%。结论北京市心脑血管疾病负担重,其中以脑血管疾病和缺血性心脏病最为显著;脑血管疾病的伤残负担严重,缺血性心脏病的疾病负担成倍增长。     

广东省居民健康、伤残、死亡三者间的量效关系研究

目的采用图谱法解析居民健康、伤残、死亡三者间的量效关系.方法以居民年龄别为横坐标,以年龄别期望寿命（LE）、健康期望寿命（DALE）、伤残调整寿命年（DALY）为纵坐标,分别绘制出健康、伤残、死亡三者关系的量效图谱.结果居民健康、伤残、死亡三者关系量效图谱中LE=A＋B,DALE=A＋f（B）,DALY=C＋g（B）.女性的心血管疾病负担明显高于男性,男性的损伤与中毒疾病负担则明显高于女性.男性在呼吸疾病、恶性肿瘤、脑血管疾病和糖尿病等4类疾病的疾病负担上也均较女性为重.结论f（B）、g（B）是一种量效关系函数,它根据居民伤残状态的严重性权重,将在这种伤残状态下生活的年数转化成相当于在完全健康状态下生活的年数与死亡状态下损失的年数,从而直观反映居民健康、伤残与死亡的量效关系.     

Burden of gastrointestinal and liver diseases in India, 1990–2016

There is no comprehensive report on the burden of gastrointestinal (GI) and liver diseases in India. In this study, we estimated the age-standardized prevalence, mortality, and disability adjusted life years (DALY) rates of GI and liver diseases in India from 1990 to 2016 using data from the Global Burden of Disease (GBD) Study, which systematically reviews literature and reports for international disease burden trends. Despite a decrease in the overall burden from GI infectious disorders since 1990, they still accounted for the majority of DALYs in 2016. Among noncommunicable disorders (NCDs), there were increases in the prevalence and mortality rates for pancreatitis, liver cancer, paralytic ileus and intestinal obstruction, gallbladder and biliary tract cancer, vascular intestinal disorders, colorectal cancer, and inflammatory bowel disease. Prevalence and mortality rates decreased for peptic ulcer disease, hernias, appendicitis, and stomach and esophageal cancer. For gastritis and duodenitis, cirrhosis and other chronic liver diseases, and gallbladder and biliary tract diseases, there was an increase in prevalence but a decrease in mortality while the opposite was true for pancreatic cancer (decreased prevalence, increased mortality). Indian gastroenterologists and hepatologists must continue to attend to the large majority of patients with infectious diseases while also managing the increasing number of GI and liver diseases, noncommunicable nonmalignant and malignant.     

Cost of colorectal cancer in France in 1999

AIM: Due to high incidence and disease severity, colorectal cancer is a major public health concern in western countries. Few studies have been devoted to estimating its cost in France. The aim of this study was to analyze the direct (medical) and indirect (short-term disability, long-term disability, premature death) costs of colorectal cancer in France. METHODS: This cost-of-illness study was based on data available for 1999. Two evaluation perspectives were considered: French social security system (medical care + daily allowances + disability allowances) and the society (medical care + production losses). Sources of data used in this analysis were: PMSI (hospital care), EPPM-IMS study (ambulatory care) and the GAZEL cohort (short-term disability). RESULTS: Direct costs of colorectal cancer in France amounted in 1999 to more than 469.7 million euros, of which 98% were induced by hospitalisation (on an outpatient or an inpatient basis). Indirect costs represented in 1999 for the French social security system an amount of 85.9 million, of which 71% were due to disability allowances. Taking into account the society's point of view, indirect costs corresponded to production losses of 528.1 million. Total costs of colorectal cancer amounted 555.5 million for the social security system and 997 million for the society. CONCLUSION: These results confirm the high economic burden of colorectal cancer for the French social security system and for the society in general.     

Burden of diabetes mellitus attributable to demographic levels in Qatar: An emerging public health problem

BackgroundDiabetes is one of the main contributors to ill health and premature mortality worldwide and its prevalence has been rising during the last decades.AimThe aim of the present study was to quantify the burden of disease in terms of deaths and loss of healthy life years (DALYs) attributed to diabetes by its demographic levels in the State of Qatar.Materials and methodsThe methods were largely based on the established Global Burden of Disease methodology and use the burden of disease in terms of disability adjusted life years (DALYs) and the years lost due to disability (YLD) as the outcome measure. We calculated years lost due to disability (YLD) and years life lost (YLL) attributable to diabetes. The study was conducted during the period from June 2013 to January 2014.ResultsThe study findings revealed that disability adjusted life years (DALYs) has been increasing across the years and reached to 4.35 in 2011 from 2.58 in 2007. DALYs for men was remarkably higher than women during the period (2007–2011). Diabetes mellitus was the 6th leading cause of disease burden in Qatar (3.8%). The YLD showed a sharp increase in men (2.52 in 2011 from 1.34 in 2007) and women (1.05 in 2011 from 0.33 in 2007) during the year 2011. YLL portion of women enlarged considerably in 2011 (0.10) compared to 2010 (0.04). YLL for men and women was fluctuating across the years with a decrease in 2011 (18%) from 2007 (35%). Men and women in the age group 30–44 years had the highest peak across the years.ConclusionThe study findings revealed that diabetes disease burden was considerably high in Qatar, particularly in the working age group. DALYs has been increasing across the years.     

Alcohol consumption and non-communicable diseases: epidemiology and policy implications

Aims This paper summarizes the relationships between different patterns of alcohol consumption and various on non‐communicable disease (NCD) outcomes and estimates the percentage of NCD burden that is attributable to alcohol. Methods A narrative review, based on published meta‐analyses of alcohol consumption‐disease relations, together with an examination of the Comparative Risk Assessment estimates applied to the latest available revision of Global Burden of Disease study. Results Alcohol is causally linked (to varying degrees) to eight different cancers, with the risk increasing with the volume consumed. Similarly, alcohol use is related detrimentally to many cardiovascular outcomes, including hypertension, haemorrhagic stroke and atrial fibrillation. For other cardiovascular outcomes the relationship is more complex. Alcohol is furthermore linked to various forms of liver disease (particularly with fatty liver, alcoholic hepatitis and cirrhosis) and pancreatitis. For diabetes the relationship is also complex. Conservatively, of the global NCD‐related burden of deaths, net years of life lost (YLL) and net disability adjusted life years (DALYs), 3.4%, 5.0% and 2.4%, respectively, can be attributed to alcohol consumption, with the burden being particularly high for cancer and liver cirrhosis. This burden is especially pronounced in countries of the former Soviet Union. Conclusions There is a strong link between alcohol and non‐communicable diseases, particularly cancer, cardiovascular disease, liver disease, pancreatitis and diabetes, and these findings support calls by the World Health Organization to implement evidence‐based strategies to reduce harmful use of alcohol.     

Estimating the burden of scleroderma disease in Spain

OBJECTIVE: Scleroderma (systemic sclerosis) is a rare disease that results in great suffering. We estimated the burden of disease posed by scleroderma and its relative importance in the health of the Spanish population. METHODS: We estimated scleroderma-based burden of disease following procedures developed for the Global Burden of Disease study to ensure comparability. RESULTS: Despite its low prevalence, scleroderma generated 1732 disability-adjusted life-years (DALY) in Spain in 2001, comprising 562 (32%) years of life lost and 1170 (68%) years lived with disability. Most scleroderma-related DALY (73%) occurred in the population aged 15-54 years. Estimated DALY accounted for 0.59% of other musculoskeletal disorder-related DALY in the European A subregion (countries with low mortality rate in both adults and children in the World Health Organization classification), a significant value in the overall burden of disease. CONCLUSION: The burden of scleroderma in Spain was high, with disability being the major contributing factor. Burden of disease is an important measure in rare diseases, and may be an important indicator to be considered as a health unit in developed countries.     

Occurrence of chronic diseases and their impact on physical disability over the whole spectrum of aging: from 65 to over 100 years of age

The aging of the Italian population is an emerging public health priority. In 2025 Italy is expected to have the highest world median age with nearly half of the population over 50 years old. To avoid an unbearable burden of disease and disability on future generations, we must identify areas for intensive disease and disability prevention programs. Preliminary results from the PRO.V.A study show that disability is associated with conditions that are potentially preventable as chronic diseases and falls or are treatable as chronic pains. Moreover, it is of extreme interest to identify and understand biological and environmental secrets of successful aging as the AKEA study tries to do and the ways of overcoming disabilities in the extreme limits of life more and more possible to reach.     

Smoking-related diseases: the importance of COPD.

SETTING: Smoking plays a major role in a variety of diseases. Despite a strong relationship between smoking and chronic obstructive pulmonary disease (COPD), cardiovascular disease and lung cancer attract greater attention. OBJECTIVE: To assess the burden of illness produced by smoking. DESIGN: Smoking-attributable risk (SAR) and smoking-attributable disease burden (mortality, morbidity, and cost) were estimated for four conditions: COPD, coronary heart disease (CHD), lung cancer, and stroke. RESULTS: Smoking-attributable deaths worldwide were: 1772 580 COPD, 1277 000 CHD, 822 150 lung cancer, and 788 580 stroke. Smoking-attributable disability adjusted life years (DALYs) were: 47 232 000 COPD, 18 106 000 CHD, and 11 052 000 stroke. US smokingattributable costs were: dollar 26.0 billion CHD, dollar 24.9 billion COPD, and dollar 9.0 billion stroke. US smoking-attributable annual hospitalizations were: 520 000 COPD, 460 000 CHD, and 183 000 stroke. CONCLUSIONS: Cardiovascular disease and lung cancer rank high in absolute estimates of disease burden. However, COPD has a more substantial smoking-attributable disease burden. COPD deserves more attention in the health care sector. Smoking cessation programs, pharmacological interruption of the pathophysiology of smoking-related COPD, and effective management of COPD should be key targets of intervention and research.     

Burden of disease related to hepatitis C and hepatitis B in Spain: a methodological challenge of an unfolding health problem

Most previous studies of burden of disease (BoD) in the area of transmissible diseases have assessed the burden of hepatitis C and B without including the end stages of the disease and using an incident approach. We aimed to assess the disability-adjusted life years (DALYs) related to hepatitis C and B in Spain in 2006 taking into account related cirrhosis and liver cancer. A prevalence approach was used to estimate current years lived with disability (YLD) because of viral hepatitis contracted years/decades before. We added years of life lost (YLL) to obtain DALYs. Around 76,000 DALYs were attributed to hepatitis C virus (HCV) and 15,323 to hepatitis B virus (HBV) when calculated without applying social values. Applying the discount rate and age-weighting used in the Global Burden Disease study, the BoD nearly halved. In any case, the burden related to hepatitis C including long-term outputs becomes the leading cause of DALYs among transmissible diseases in Spain. The mortality component (YLL) represents more than 90% of the BoD in both HCV and HBV. The findings emphasize the need to provide good surveillance systems not only concerning acute viral hepatitis, but also chronic and end-stage consequences to allow a reliable assessment of the prevention and public health control policies.     

晚期多原发结直肠癌多学科治疗一例报道

近年来,结直肠癌的发病率显著上升,随着多学科共同参与的多学科团队（multidisciplinary team,MDT）模式的建立,结直肠癌患者特别是晚期结直肠癌患者的生存时间得到明显延长,生活质量得到有效改善。此例晚期多原发结直肠癌患者带瘤生存已达7年,在多学科协作模式下进行的综合治疗使患者病情得到较好控制,生活质量保持较高水平。本文就此例患者诊疗过程中的一些经验和体会与大家一起来分享。