1990—2019年中国人群退行性二尖瓣病变疾病负担研究

目的探讨1990至2019年中国人群退行性二尖瓣病变(DMVD)疾病负担变化趋势。方法基于2019年全球疾病负担研究(GBD 2019)数据库, 采用患病人数、新发病例数、死亡人数、伤残调整寿命年(DALY)以及患病率、发病率、死亡率、DALY率及其年龄标化率等指标, 分析1990至2019年中国人群DMVD疾病负担变化趋势。结果 2019年中国DMVD患病人数、新发病例数及死亡人数分别为461.2、27.0、0.129万例, 与1990年相比分别增长了209.0%、199.1%和13.2%。2019年DMVD的年龄标化患病率、发病率和死亡率分别为228.1/10万、12.7/10万和0.075/10万, 与1990年相比, 变化率分别为32.6%、42.8%和-54.1%。另外, 2019年的数据还显示, 女性的年龄标化患病率和发病率均高于男性[年龄标化患病率:男性190.1(181.5～198.9)/10万、女性262.0(250.3～273.9)/10万;年龄标化发病率:男性10.5(10.0～11.0)/10万、女性14.9(14.3～15.6)/10万];DMVD患病人数最多...     

Burden of tuberculosis in Serbia

The objective of this study is to estimate the burden of tuberculosis (TB) in Serbia in the period 1992-2002 based on incidence, mortality, and disability adjusted life years (DALY). The average age-adjusted TB incidence rate in the period 1992-2002 was 36.7/100,000 in males and 21.4/100,000 in females. During the period observed, TB incidence levelled of after a long period of decreasing trend during the preceding several decades. The incidence showed slightly increasing tendency in males and decreasing one in females. The average age-adjusted mortality rate was 4.1/100,000 in males and 1.3/100,000 in females. Mortality rates significantly decreased in both males (P = .0001) and females (P = .0001). The burden of TB (DALY) was 0.70/1000 for males and 0.26/1000 for females. DALY rates significantly decreased in both males (P = .009) and females (P = .008). TB incidence and mortality as well as DALY rates increased with aging.     

Global burden attributable to high sodium intake from 1990 to 2019

Background and aimsHigh sodium intake is associated with a higher risk of a wide range of diseases. We aimed to estimate the pattern and trend of the global disease burden associated with high sodium intake from 1990 to 2019.Methods and resultsWe obtained numbers and rates of death and disability-adjusted life year (DALY) attributable to high sodium intake by sex, socio-demographic index, and country from the Global Burden of Disease Study 2019. We calculated the estimated annual percentage change to evaluate the age-standardized rate (ASR) of the burden attributable to high sodium intake between 1990 and 2019. We further calculated the contribution of population growth, population aging, and age-specific rates of death and DALY to the net change in the total number of deaths and DALYs attributable to high sodium intake. From 1990 to 2019, global age-standardized rates of death and DALY attributable to high sodium intake substantially decreased for both sexes. However, there were significant increases in the total numbers of deaths and DALYs attributable to high sodium intake, which were driven by population growth and population aging. The attribution of population growth and population aging varied widely across countries, with a higher contribution of population growth in most developing countries and a higher contribution of population aging in countries with slow population growth.ConclusionsAlthough the global burden attributable to high sodium intake in terms of age-standardized rate declined from 1990 to 2019, the absolute burden increased significantly, which was driven by population growth and population aging.     

To study the occurrence of risk factors for pulmonary tuberculosis in the homeless population in areas of Delhi,India

BackgroundIn India, there are only a few studies done in the area of assessing the risk factors of Tuberculosis (TB) among the homeless population. The homeless population has quite a higher chance of developing Pulmonary Tuberculosis (PTB) as compared with the general population due to the presence of an inappropriate environment and high prevalence of risk factors.MethodsThis study was done among the homeless population in both males and females aged 18 years and above in areas of Delhi (Yamuna Pusta and Mansarovar Park). The participants were screened for TB symptoms and risk factors to diagnose active PTB in them.ResultsOut of 200 participants, 17 were diagnosed with active PTB. The overall occurrence of Tuberculosis among the studied homeless population was found to be 85 cases per 1000 population. The occurrence of behavioral habits such as smoking was found to be 41.2% (7/17), tobacco chewing at 47.1% (8/17), and alcohol at 47.1% (8/17) among the cases. The occurrence of HIV coinfection was 5.9% (1/17) and diabetes was 5.9% (1/17). The prevalence of TB among homeless females was 1.5 times higher than homeless males but out of 17 diagnosed patients, males had a higher prevalence of TB as compared to females.ConclusionThe occurrence of PTB in the homeless population is quite high as it is also reported in a study in the United States that the national incidence of tuberculosis in the homeless population was 36 cases/100,000 and it needs to be addressed to eliminate tuberculosis.⁷ Moreover, the risk factors such as tobacco, smoking, alcohol, coinfections, etc. might have played a major role in the development of PTB. Also, there is a need for larger studies with large sample sizes to provide evidence against the same.     

Burden and Trends of Acute Viral Hepatitis in Asia from 1990 to 2019

Asia has a very high burden of acute hepatitis; thus, a comprehensive study of the current burden and long-term trends of acute hepatitis in Asia is needed. We aimed to assess the current status and trends from 1990 to 2019 of acute hepatitis burden in Asia, using the data from the Global Burden of Diseases Study 2019 (GBD 2019) results. Methods: We used the data from the GBD 2019. Absolute death, incidence, and disability adjusted life years (DALY) number and rate of acute hepatitis in Asia were derived from the database from 1990 to 2019. Age-standardized mortality, incidence and DALY rates (ASMR, ASIR and ASDR) were used to compare populations in different regions and times. The estimated annual percentage change (EAPC) in the rates quantified the trends of the acute hepatitis burden. Results: From 1990 to 2019, the ASMR and ASDR of acute hepatitis decreased significantly at different paces, with the largest decrease in acute hepatitis C and the smallest in acute hepatitis E. The ASIR of acute hepatitis decreased relatively slowly, by an average of 0.06% (95% CI, 0.05–0.08%) per year in acute hepatitis A, 0.91% (0.64–1.18%) per year in acute hepatitis C and 0.26% (0.24–0.28%) per year in acute hepatitis E; while the ASIR of acute hepatitis B decreased by an average of 1.95% (1.08–2.11) per year. From 1990 to 2019, the incidence rate of acute hepatitis A increased in most age groups (from the age of 5 to 70), with the 50–55 years group having the fastest increase by an average of 1.81% (95% CI, 1.67–1.95%) per year. In 2019, Afghanistan had the highest ASMR (10.44 per 100,000) and ASDR (357.85 per 100,000) of acute hepatitis, and the highest ASIR was in Mongolia (4703.14 per 100,000). Conclusions: In Asia, the burden of acute viral hepatitis was at a relatively high level, compared with the other four continents. International cooperation and multifaceted and multisectoral actions are needed for Asian countries to eliminate viral hepatitis and to contribute to the global elimination of viral hepatitis.     

Assessment of prevalence of depression and its associated factors among tuberculosis patients in Ernakulam district,Kerala

BackgroundIndia is one of the few countries where Tuberculosis is still widely prevalent. People with TB, often suffers from depression. It is estimated that more than 300 million people suffer from depression at the global level, accounting to 4.4 percent of the world's population.ObjectivesPrimary objective—To assess the prevalence of depression among tuberculosis patients in Ernakulam district using PHQ9. Secondary objective—To assess the factors associated with depression among tuberculosis patients in Ernakulam district.MethodologyA cross sectional study was carried out among the tuberculosis patients who were currently under treatment from December 2019 to March 2020 in Ernakulam district of Kerala. From the 8 TUs of Ernakulam, 8 clusters were selected using PPS. 485 adult TB patients from these clusters were interviewed using PHQ9 questionnaire to assess prevalence of depression.ResultsThe prevalence of depression among the TB patients in Ernakulam district was found to be 16.1%. The proportion of TB patients with depression were significantly higher among the age group of 18–40 years (36.3%), unmarried (54%) and from urban area of residence (19%). It was also significantly higher among previously treated patients (45.7%) & MDR TB patients (43.8%).ConclusionIt was observed that one-sixth of TB patients suffered from depression. Hence it is crucial that TB patients need to be regularly assessed for depression and managed appropriately. Since depression has affects adherence to TB treatment & thereby result in delay of TB elimination in the state.     

全国结核分枝杆菌潜伏感染率估算专家共识

针对结核分枝杆菌潜伏感染高危人群开展预防性治疗是降低结核病发病率的直接手段,也是实现终结结核病流行(End TB)全球战略目标的重要组成部分。作为结核病高负担国家,我国如何通过开展结核分枝杆菌潜伏感染人群的预防干预,实现结核病发病率快速下降的目标,值得探讨。其中,准确掌握我国的结核分枝杆菌潜伏感染负担和流行特征是讨论策略可行性和科学性的前提。在缺乏全国范围的结核分枝杆菌潜伏感染流行病学调查的背景下,中国医学科学院病原生物学研究所和中国疾病预防控制中心联合中国科学院地理科学与资源研究所,以全国结核病报告发病率为辅助变量,利用多中心的基于γ-干扰素释放试验检测的结核分枝杆菌潜伏感染流行病学调查数据和小样本空间统计模型,开展了全国结核分枝杆菌潜伏感染率的估算。结果显示,2013年我国5周岁及以上人群结核分枝杆菌潜伏感染率为18.1%(95%CI:13.7%~22.4%);15周岁及以上人群结核分枝杆菌潜伏感染率为20.3%(95%CI:15.6%~25.1%),呈现随着年龄升高而增长的趋势,同年龄段内男性高于女性。领域内专家针对估算结果进行了广泛论证并形成了《全国结核分枝杆菌潜伏感染率估算专家共识》,以供我国结核病防治工作者借鉴和参考。     

Global disease burden of stroke attributable to high fasting plasma glucose in 204 countries and territories from 1990 to 2019: An analysis of the Global Burden of Disease Study

BackgroundHigh fasting plasma glucose (HFPG) is the leading risk factor contributing to the increase of stroke burden in the past three decades. However, the global distribution of stroke burden specifically attributable to HFPG was not studied in depth. Therefore, we analyzed the HFPG‐attributable burden in stroke and its subtypes in 204 countries and territories from 1990 to 2019.MethodsDetailed data on stroke burden attributable to HFPG were obtained from the Global Burden of Disease Study 2019. The numbers and age‐standardized rates of stroke disability‐adjusted life years (DALYs), deaths, years lived with disability, and years of life lost between 1990 and 2019 were estimated by age, sex, and region.ResultsIn 2019, the age‐standardized rate of DALYs (ASDR) of HFPG‐attributable stroke was 354.95 per 100 000 population, among which 49.0% was from ischemic stroke, 44.3% from intracerebral hemorrhage, and 6.6% from subarachnoid hemorrhage. The ASDRs of HFPG‐attributable stroke in lower sociodemographic index (SDI) regions surpassed those in higher SDI regions in the past three decades. Generally, the population aged over 50 years old accounted for 92% of stroke DALYs attributable to HFPG, and males are more susceptible to HFPG‐attributable stroke than females across their lifetime.ConclusionsSuccessful key population initiatives targeting HFPG may mitigate the stroke disease burden. Given the soaring population‐attributable fractions of HFPG for stroke burden worldwide, each country should assess its disease burden and determine targeted prevention and control strategies.     

浙江和广东两省耐药和药物敏感性肺结核患者疾病负担研究

目的研究结核病控制项目地区耐药和药物敏感性肺结核患者对社会造成的疾病负担。方法对浙江和广东两省纳入结核病耐药性监测项目，并完成结核病控制项目规定疗程的肺结核患者302例，以比例法测定耐药情况并进行调查。采用失能调整生命年(DALY)方法计算耐药和药物敏感性肺结核患者的疾病负担。结果初治药物敏感性患者平均DALY值为0．26人年，初治耐药患者为0．68人年；复治药物敏感性患者平均DALY值为0．49人年，复治耐药患者为1．04人年。耐药肺结核患者每例平均DALY值为0．86人年，药物敏感性肺结核患者平均DALY值为0．44人年，其差值为0．42人年。结论初、复治耐药肺结核患者每例平均DALY值比药物敏感性肺结核患者增加1倍，表示耐药肺结核造成的健康生命年损失大于药物敏感性肺结核。对耐药肺结核患者必须进行规范治疗，降低耐药肺结核患者的疾病负担。     

Global burden of non-alcoholic fatty liver disease in 204 countries and territories from 1990 to 2019

BackgroundNon-alcoholic fatty liver disease (NAFLD) is a growing epidemic linked to metabolic disease and is the most prevalent cause of chronic liver disease. We, therefore, designed the study to analyze the global and regional burden of NAFLD from 1990 to 2019.MethodsWe collected data on NAFLD from the Global Burden of Disease study 2019, aiming to conduct a systematic assessment of the changes and trends in NAFLD in 204 countries. Secondary analysis of NAFLD was conducted using age-standardized rates (ASRs) and estimated annual percentage changes (EAPCs) to show the changing trends and development characteristics. Data statistics and visualization were executed with the R program.ResultsGlobally, incidence, deaths and disability-adjusted life years (DALYs) of NAFLD all showed an upward trend. Between 1990 and 2019, the incidence of NAFLD increased by 95.4%, from 88,177 to 172,330 cases. Meanwhile, the ASIR of the middle SDI region had the highest increase, followed by the low-middle SDI region. Of all countries, the most incident cases were in China, which accounted for approximately 23.6% of NAFLD. China was also the country with the largest cases of deaths and DALYs. And behavioral risk, metabolic factors, smoking and high fasting plasma glucose were the critical risk factors associated with the mortality and DALYs of NAFLD.ConclusionNAFLD has become a considerable health burden in many countries. Therefore, we should control the risk factors of NAFLD and take corresponding measures to achieve its early prevention and treatment.     

A review of population studies from India to estimate national burden of chronic obstructive pulmonary disease and its association with smoking

An attempt has been made to estimate the gross burden of chronic obstructive pulmonary disease (COPD) and its smoking association by reviewing the population studies available from India. Of the 14 studies which were reviewed, there were 11 conducted in general populations. The median values of different prevalence rates (i.e. 5 percent in male and 2.7 percent in female population) were accepted as the most appropriate figures to calculate the overall estimates. The overall M:F ratio was 1.6:1, i.e. 61.6 percent males. The estimated total number of adult patients aged 30 years and above in 1996 were 8.15 million males and 4.21 million females. The smoker:non-smoker ratio in males was assessed at 82.3 percent with an estimated burden of 6.7 millions. When the prevalence rates of COPD and its smoking associations were assessed in three different time periods (before 1970; between 1971-1990; after 1990), the median rates of 1971-1990, when the maximum number of studies were conducted, were nearly the same as the overall rates. However, the total burden as well as the smoking associated COPD, increased with time due to an increase in the eligible base population. In conclusion, these figures can be used to estimate the burden of COPD and its smoking association in India for different statistical analyses.     

Prevalence of tuberculosis infection and its relationship to stunting in children (under five years) household contact with new tuberculosis cases

BackgroundChildren who inhabit the same house with tuberculosis (TB) patients are at high risk for infection and illness with TB. Nutritional status (stunting) in children is related to the child's ability to withstand MTB (Mycobacterium Tuberculosis). This study aims to estimated the prevalence of tuberculosis infection and its relationship to stunting in children (under five years) with household contact (HHC) with new TB cases.MethodsA cross-sectional design was implemented. Conducted in July 2018–April 2019 at 13 Public Health Center in Makassar City. The sample size was calculated using one sample situation-about precision formula. Samples were children under five who had contact with new diagnosed TB cases. Tuberculosis infection was measured by TST (tuberculin skin test). Logistic regression with causal model to examine TB infection relationship with stunting and covariate variable, analyzed using Stata/MP 13.0 software.ResultsOne hundred twenty-six (126) eligible children. Prevalence of tuberculosis infection was 38.10%. Frequency of stunted was 31 children (24.60%). Stunted nutritional status (aPR): 2.36, 95% CI 1.60–3.44), boys (aPR: 1.47, 95% CI 0.96–2.25), not getting BCG immunization (aPR: 1.58, 95%) CI 0.89–2.82), and high contact intensity (aPR: 2.62, 95% CI 1.10–6.22) best predicted the tuberculosis infection in children with TB case household contacts with a model contribution of 64%.ConclusionStunted nutritional status (moderate and severe), boys, not getting BCG immunization, and high contact intensity are the determinants of TB infection transmission in children HHC with TB. Children under five years of age who have close contact with TB cases should be targeted for priority interventions to prevent the transmission of TB infection and progressing to TB cases.     

Risk factors for death during treatment in pulmonary tuberculosis patients in South India: A cohort study

ObjectiveIdentifying the risk factors for deaths during tuberculosis (TB) treatment is important for achieving the vision of India's National Strategic Plan of ‘Zero Deaths’ by 2025. We aimed to determine the proportion of deaths during TB treatment and its risk factors among smear positive pulmonary TB patients aged more than 15 years.Study designWe performed a cohort study using data collected for RePORT India Consortium (Regional Prospective Observational Research in Tuberculosis).SettingRevised TB Control Program (RNTCP) in three districts of South India.ParticipantsThe cohort consisted of newly diagnosed drug sensitive patients enrolled under the Revised National TB Control Program during 2014–2018 in three districts of southern India. Information on death was collected at homes by trained project staff.Primary outcome measuresWe calculated ‘all-cause mortality’ during TB treatment and expressed this as a proportion with 95% confidence interval (CI). Risk factors for death were assessed by calculating unadjusted and adjusted relative risks with 95% CI.ResultsThe mean (SD) age was of the 1167 participants was 45 (14.5) years and 79% of them were males. Five participants (0.4%) were HIV infected. Among the males, 560 (61%) were tobacco users and 688 (75%) reported consuming alcohol. There were 47 deaths (4%; 95% CI 3.0–5.3) of which 28 deaths (60%) occurred during first two months of treatment. In a bi-variable analysis, age of more than 60 years (RR 2.27; 95%CI: 1.24–4.15), male gender (RR 3.98; 95% CI: 1.25–12.70), alcohol use in last 12 months (RR 2.03; 95%CI: 1.07–3.87), tobacco use (RR 1.87; 95%CI: 1.05–3.36) and severe anaemia (RR 3.53: 95%CI: 1.34–9.30) were associated with a higher risk of death. In adjusted analysis, participants with severe anaemia (<7gm/dl) had 2.4 times higher risk of death compared to their counterparts.ConclusionThough deaths during TB treatment was not very high, early recognition of risk groups and targeted interventions are required to achieve zero TB deaths.     

Trends and sub-national disparities in TB notifications in India: Insights from HMIS data

Background/objectivesTuberculosis (TB) is a public health crisis across the globe, especially in the developing world including India. Around 27% of 10 million TB cases and 33% of 1.2 million TB deaths were contributed from India alone during 2018. Present study aims to estimate TB notification rates at national and sub-national levels up to District administrative blocks, which is very important with policy perspective.MethodsThe study mainly uses data from India's Health Management Information System (HMIS) for three consecutive years, 2017-18, 2018-19 and 2019-20. TB notification rates were calculated for India up to the lowest administrative level of health Districts. GIS maps were being used for mapping District-wise TB notification rates for 2017-18 and 2019-20.ResultsResults show that TB notification rates have increased from 152/lakh population in 2017-18 to 197 in 2019-20, an increase of 30%. Similarly, the increasing trends in TB notification rates were also observed at State as well as District level. However, wide rural-urban and public-private differences were observed in TB notification rates. Further, results illustrated huge inter-State and inter-District variations; and half of the TB cases in India were contributed only by six larger States.ConclusionsThe findings of the study shows the increasing notification in India since 2017-18, which is a clear indication of the efforts put in the TB program to achieve targets and goals committed to end TB by 2025. In this regard present estimates based on HMIS data significantly contributes to the policy formulation even at the lowest administrative level of health Districts.     

Global burden of ischemic heart disease attributable to high sugar-sweetened beverages intake from 1990 to 2019

Background and aimsExcessive sugar-sweetened beverages (SSBs) intake is associated with a higher risk of ischemic heart disease (IHD). However, global patterns and trends in the burden of IHD attributable to high SSBs intake have not been systematically assessed.Methods and resultsWe retrieved data from the Global Burden of Disease Study (GBD) 2019. We obtained the numbers and age-standardized mortality rate (ASMR) and disability-adjusted life years (DALYs) rate (ASDR) of IHD attributable to high SSBs intake by sex, year, socio-demographic index (SDI), and country between 1990 and 2019. Furthermore, we used a validated decomposition algorithm to attribute changes to population growth, population aging, and epidemiologic changes in the 21 GBD regions. From 1990 to 2019, the global IHD mortality attributable to high SSBs intake, as quantified by ASMR and ASDR declined significantly, while the burden increased saliently in absolute numbers. Population decomposition suggested that changes in epidemiology in most GBD regions have reduced IHD mortality due to high SSBs intake, but this trend has been counteracted by population growth and aging.ConclusionsAlthough the age-standardized rate of IHD deaths and DALYs attributable to high SSBs intake decreased overall from 1990 to 2019, the absolute IHD burden remains high in some countries, especially in some developing countries in Asia and Oceania. Action is needed to enhance the prevention of diseases associated with high SSBs intake.     

Economic burden of tuberculosis in patients attending DOT centres in Delhi

Tuberculosis inflicts a negative impact on global socioeconomic prosperity. Though India carries one third of the global burden of the disease, few studies have focussed in the country on this aspect. The present study was therefore, framed to estimate economic loss amongst TB patients. A total of 156 patients attending two DOT centres were interviewed in depth, regarding economic loss due to tuberculosis, using a semi structured pretested interview schedule during a period of 5 months. More than 75% of the subjects belonged to the age group of 15-44 years of which 71.6% were males. 34.6% of patients were housewives and 10.9% were students. Mean expenditure before registration in DOT centre was Rs. 3385.5 irrespective of all socioeconomic classes. The upper lower socio-economic class of patients incurred maximum mean expenditure of Rs. 9782.0. Mean duration of wage loss was found to be 47.1 days. Study participants incurred economic loss both in terms of direct and indirect costs, more so in lower socio-economic group, besides delay in attending DOT centres for treatment. Awareness campaign focussing on treatment availability and DOT centre could help in reducing such economic loss.     

The growing burden of tuberculosis: global trends and interactions with the HIV epidemic

BACKGROUND: The increasing global burden of tuberculosis (TB) is linked to human immunodeficiency virus (HIV) infection. METHODS: We reviewed data from notifications of TB cases, cohort treatment outcomes, surveys of Mycobacterium tuberculosis infection, and HIV prevalence in patients with TB and other subgroups. Information was collated from published literature and databases held by the World Health Organization (WHO), the Joint United Nations Programme on HIV/Acquired Immunodeficiency Syndrome (UNAIDS), the US Census Bureau, and the US Centers for Disease Control and Prevention. RESULTS: There were an estimated 8.3 million (5th-95th centiles, 7.3-9.2 million) new TB cases in 2000 (137/100,000 population; range, 121/100,000-151/100,000). Tuberculosis incidence rates were highest in the WHO African Region (290/100,000 per year; range, 265/100,000-331/100,000), as was the annual rate of increase in the number of cases (6%). Nine percent (7%-12%) of all new TB cases in adults (aged 15-49 years) were attributable to HIV infection, but the proportion was much greater in the WHO African Region (31%) and some industrialized countries, notably the United States (26%). There were an estimated 1.8 million (5th-95th centiles, 1.6-2.2 million) deaths from TB, of which 12% (226 000) were attributable to HIV. Tuberculosis was the cause of 11% of all adult AIDS deaths. The prevalence of M tuberculosis-HIV coinfection in adults was 0.36% (11 million people). Coinfection prevalence rates equaled or exceeded 5% in 8 African countries. In South Africa alone there were 2 million coinfected adults. CONCLUSIONS: The HIV pandemic presents a massive challenge to global TB control. The prevention of HIV and TB, the extension of WHO DOTS programs, and a focused effort to control HIV-related TB in areas of high HIV prevalence are matters of great urgency.