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临床时讯 > 专家论坛


2011,看全球疾病负担到底有多重


  全球癌症新发病例数明显增加,结直肠癌发病率攀升

  2011年7月,《CA:临床医师癌症杂志》相继公布了全球和美国癌症统计数据。结果显示,癌症新发病例数明显增加。

  全球恶性肿瘤新发病例数由2002年的1090万升至2008年的1270万,死亡人数从670万升至760万。结直肠癌发病例数在男性中已超越胃癌位列第三位,在女性中已超越宫颈癌位列第二位,2008年新发病例数和死亡病例数分别为120万和60.87万,较2002年分别增长17.3%和6.6%,即6年间结直肠癌的新发病例数年均增加2.9%,而死亡病例数年均增加1.1%。在经济发达程度不同的国家,肿瘤新发病例的分布差别也较大。

CA Cancer J Clin. 2011 Jul-Aug;61(4):212-36.

Cancer statistics, 2011: the impact of eliminating socioeconomic and racial disparities on premature cancer deaths.

Siegel R, Ward E, Brawley O, Jemal A.

Surveillance Information, Surveillance Research, American Cancer Society, Atlanta, GA 30303-1002, USA.

Each year, the American Cancer Society estimates the numbers of new cancer cases and deaths expected in the United States in the current year and compiles the most recent data on cancer incidence, mortality, and survival based on incidence data from the National Cancer Institute, the Centers for Disease Control and Prevention, and the North American Association of Central Cancer Registries and mortality data from the National Center for Health Statistics. A total of 1,596,670 new cancer cases and 571,950 deaths from cancer are projected to occur in the United States in 2011. Overall cancer incidence rates were stable in men in the most recent time period after decreasing by 1.9% per year from 2001 to 2005; in women, incidence rates have been declining by 0.6% annually since 1998. Overall cancer death rates decreased in all racial/ethnic groups in both men and women from 1998 through 2007, with the exception of American Indian/Alaska Native women, in whom rates were stable. African American and Hispanic men showed the largest annual decreases in cancer death rates during this time period (2.6% and 2.5%, respectively). Lung cancer death rates showed a significant decline in women after continuously increasing since the 1930s. The reduction in the overall cancer death rates since 1990 in men and 1991 in women translates to the avoidance of about 898,000 deaths from cancer. However, this progress has not benefitted all segments of the population equally; cancer death rates for individuals with the least education are more than twice those of the most educated. The elimination of educational and racial disparities could potentially have avoided about 37% (60,370) of the premature cancer deaths among individuals aged 25 to 64 years in 2007 alone. Further progress can be accelerated by applying existing cancer control knowledge across all segments of the population with an emphasis on those groups in the lowest socioeconomic bracket.

CA Cancer J Clin. 2011 Mar-Apr;61(2):69-90.

Global cancer statistics.

Jemal A, Bray F, Center MM, Ferlay J, Ward E, Forman D.

Surveillance Research, American Cancer Society, Atlanta, GA, USA.

The global burden of cancer continues to increase largely because of the aging and growth of the world population alongside an increasing adoption of cancer-causing behaviors, particularly smoking, in economically developing countries. Based on the GLOBOCAN 2008 estimates, about 12.7 million cancer cases and 7.6 million cancer deaths are estimated to have occurred in 2008; of these, 56% of the cases and 64% of the deaths occurred in the economically developing world. Breast cancer is the most frequently diagnosed cancer and the leading cause of cancer death among females, accounting for 23% of the total cancer cases and 14% of the cancer deaths. Lung cancer is the leading cancer site in males, comprising 17% of the total new cancer cases and 23% of the total cancer deaths. Breast cancer is now also the leading cause of cancer death among females in economically developing countries, a shift from the previous decade during which the most common cause of cancer death was cervical cancer. Further, the mortality burden for lung cancer among females in developing countries is as high as the burden for cervical cancer, with each accounting for 11% of the total female cancer deaths. Although overall cancer incidence rates in the developing world are half those seen in the developed world in both sexes, the overall cancer mortality rates are generally similar. Cancer survival tends to be poorer in developing countries, most likely because of a combination of a late stage at diagnosis and limited access to timely and standard treatment. A substantial proportion of the worldwide burden of cancer could be prevented through the application of existing cancer control knowledge and by implementing programs for tobacco control, vaccination (for liver and cervical cancers), and early detection and treatment, as well as public health campaigns promoting physical activity and a healthier dietary intake. Clinicians, public health professionals, and policy makers can play an active role in accelerating the application of such interventions globally.

  COPD:2030年将成全球第三大死因,中国印度形势严峻

  2011年9月9日,《柳叶刀》杂志刊出呼吸系统疾病专刊,在分析加拿大1300万公民14年健康资料后指出,高收入国家慢性阻塞性肺疾病(COPD)人群终生患病率超过25%,社会经济地位较低者及农村居民患病风险较高。中国印度等控烟不得力、空气污染严重国家形势严峻,各国资金投入仍显不足。

Lancet. 2011 Sep 10;378(9795):991-6.

Lifetime risk of developing chronic obstructive pulmonary disease: a longitudinal population study.

Gershon AS, Warner L, Cascagnette P, Victor JC, To T.

Institute for Clinical Evaluative Sciences, Toronto, ON, Canada.

BACKGROUND: Although chronic obstructive pulmonary disease (COPD) is one of the most deadly, prevalent, and costly chronic diseases, no comprehensive estimates of the risk of developing COPD in the general population have been published. We aimed to quantify the lifetime risk of developing physician-diagnosed COPD in a large, multicultural North American population.

METHODS: We did a retrospective longitudinal cohort study using population-based health administrative data from Ontario, Canada (total population roughly 13 million). All individuals free of COPD in 1996 were monitored for up to 14 years for three possible outcomes; diagnosis of COPD by a physician, reached 80 years of age, or death. COPD was identified with a previously validated case definition based on COPD health services claims. The cumulative incidence of physician-diagnosed COPD over a lifetime adjusted for the competing risk of death was calculated by a modified survival analysis technique. Results were stratified by sex, socioeconomic status, and whether individuals lived in a rural or urban setting.

FINDINGS: A total of 579,466 individuals were diagnosed with COPD by a physician over the study period. The overall lifetime risk of physician-diagnosed COPD at age 80 years was 27.6%. Lifetime risk was higher in men than in women (29.7%vs 25.6%), individuals of lower socioeconomic status than in those of higher socioeconomic status (32.1%vs 23.0%), and individuals who lived in a rural setting than in those who lived in an urban setting (32.4%vs 26.7%).

INTERPRETATION: About one in four individuals are likely to be diagnosed and receive medical attention for COPD during their lifetime. Clinical evidence-based approaches, public health action, and more research are needed to identify effective strategies to prevent COPD and ensure that those with the disease have the highest quality of life possible.

FUNDING: Government of Ontario, Canada.

  糖尿病:全球患病人数达3.47亿

  2011年6月25日,《柳叶刀》杂志刊文,对1980~2008年间199个国家和地区血糖数据进行分析。结果显示,随着人口增长和老龄化发展,全球成年男性和女性年龄标准化糖尿病流行率分别由8.3%和7.5%增至9.8%和9.2%;糖尿病患病人数由1.53亿增至3.47亿。

  全球男性和女性年龄标准化空腹血糖(FPG)平均每10年分别增长0.07和0.09mmol/L;撒哈拉以南非洲、东亚、东南亚和高收入的亚太地区国家平均FPG水平最低,南亚、拉丁美洲、加勒比海地区、中亚、北非和中东较高。高收入地区的西欧平均FPG水平增幅最小,北美增幅最大。

Lancet. 2011 Jul 2;378(9785):31-40.

National, regional, and global trends in fasting plasma glucose and diabetes prevalence since 1980: systematic analysis of health examination surveys and epidemiological studies with 370 country-years and 2.7 million participants.

Danaei G, Finucane MM, Lu Y, Singh GM, Cowan MJ, Paciorek CJ, Lin JK, Farzadfar F, Khang YH, Stevens GA, Rao M, Ali MK, Riley LM, Robinson CA, Ezzati M; Global Burden of Metabolic Risk Factors of Chronic Diseases Collaborating Group (Blood Glucose).

Department of Epidemiology, Harvard School of Public Health, Boston, MA, USA.

BACKGROUND: Data for trends in glycaemia and diabetes prevalence are needed to understand the effects of diet and lifestyle within populations, assess the performance of interventions, and plan health services. No consistent and comparable global analysis of trends has been done. We estimated trends and their uncertainties in mean fasting plasma glucose (FPG) and diabetes prevalence for adults aged 25 years and older in 199 countries and territories.

METHODS: We obtained data from health examination surveys and epidemiological studies (370 country-years and 2.7 million participants). We converted systematically between different glycaemic metrics. For each sex, we used a Bayesian hierarchical model to estimate mean FPG and its uncertainty by age, country, and year, accounting for whether a study was nationally, subnationally, or community representative.

FINDINGS: In 2008, global age-standardised mean FPG was 5.50 mmol/L (95% uncertainty interval 5.37-5.63) for men and 5.42 mmol/L (5.29-5.54) for women, having risen by 0.07 mmol/L and 0.09 mmol/L per decade, respectively. Age-standardised adult diabetes prevalence was 9.8% (8.6-11.2) in men and 9.2% (8.0-10.5) in women in 2008, up from 8.3% (6.5-10.4) and 7.5% (5.8-9.6) in 1980. The number of people with diabetes increased from 153 (127-182) million in 1980, to 347 (314-382) million in 2008. We recorded almost no change in mean FPG in east and southeast Asia and central and eastern Europe. Oceania had the largest rise, and the highest mean FPG (6.09 mmol/L, 5.73-6.49 for men; 6.08 mmol/L, 5.72-6.46 for women) and diabetes prevalence (15.5%, 11.6-20.1 for men; and 15.9%, 12.1-20.5 for women) in 2008. Mean FPG and diabetes prevalence in 2008 were also high in south Asia, Latin America and the Caribbean, and central Asia, north Africa, and the Middle East. Mean FPG in 2008 was lowest in sub-Saharan Africa, east and southeast Asia, and high-income Asia-Pacific. In high-income subregions, western Europe had the smallest rise, 0.07 mmol/L per decade for men and 0.03 mmol/L per decade for women; North America had the largest rise, 0.18 mmol/L per decade for men and 0.14 mmol/L per decade for women.

INTERPRETATION: Glycaemia and diabetes are rising globally, driven both by population growth and ageing and by increasing age-specific prevalences. Effective preventive interventions are needed, and health systems should prepare to detect and manage diabetes and its sequelae.

FUNDING: Bill & Melinda Gates Foundation and WHO.

  BMI:30年间全球肥胖率翻倍

  1980~2008年间每10年,全球男性和女性平均体质指数(BMI)分别增加0.4和0.5kg/㎡;肥胖(30kg/㎡)男性和女性分别由4.8%和7.9%增至9.8%和13.8%。

  孟加拉国女性和刚果共和国男性平均BMI最低,分别为20.5和19.9kg/㎡;高收入国家中,日本BMI最低,其次为新加坡,美国BMI最高,其次为新西兰。大洋洲国家平均BMI最高,为34~35kg/㎡。

Lancet. 2011 Feb 12;377(9765):557-67.

National, regional, and global trends in body-mass index since 1980: systematic analysis of health examination surveys and epidemiological studies with 960 country-years and 9.1 million participants.

Finucane MM, Stevens GA, Cowan MJ, Danaei G, Lin JK, Paciorek CJ, Singh GM, Gutierrez HR, Lu Y, Bahalim AN, Farzadfar F, Riley LM, Ezzati M; Global Burden of Metabolic Risk Factors of Chronic Diseases Collaborating Group (Body Mass Index).

Department of Biostatistics, Harvard School of Public Health, Boston, MA, USA.

BACKGROUND: Excess bodyweight is a major public health concern. However, few worldwide comparative analyses of long-term trends of body-mass index (BMI) have been done, and none have used recent national health examination surveys. We estimated worldwide trends in population mean BMI.

METHODS: We estimated trends and their uncertainties of mean BMI for adults 20 years and older in 199 countries and territories. We obtained data from published and unpublished health examination surveys and epidemiological studies (960 country-years and 9.1 million participants). For each sex, we used a Bayesian hierarchical model to estimate mean BMI by age, country, and year, accounting for whether a study was nationally representative.

FINDINGS: Between 1980 and 2008, mean BMI worldwide increased by 0.4 kg/m(2) per decade (95% uncertainty interval 0.2-0.6, posterior probability of being a true increase >0.999) for men and 0.5 kg/m(2) per decade (0.3-0.7, posterior probability >0.999) for women. National BMI change for women ranged from non-significant decreases in 19 countries to increases of more than 2.0 kg/m(2) per decade (posterior probabilities >0.99) in nine countries in Oceania. Male BMI increased in all but eight countries, by more than 2 kg/m(2) per decade in Nauru and Cook Islands (posterior probabilities >0.999). Male and female BMIs in 2008 were highest in some Oceania countries, reaching 33.9 kg/m(2) (32.8-35.0) for men and 35.0 kg/m(2) (33.6-36.3) for women in Nauru. Female BMI was lowest in Bangladesh (20.5 kg/m(2), 19.8-21.3) and male BMI in Democratic Republic of the Congo 19.9 kg/m(2) (18.2-21.5), with BMI less than 21.5 kg/m(2) for both sexes in a few countries in sub-Saharan Africa, and east, south, and southeast Asia. The USA had the highest BMI of high-income countries. In 2008, an estimated 1.46 billion adults (1.41-1.51 billion) worldwide had BMI of 25 kg/m(2) or greater, of these 205 million men (193-217 million) and 297 million women (280-315 million) were obese.

INTERPRETATION: Globally, mean BMI has increased since 1980. The trends since 1980, and mean population BMI in 2008, varied substantially between nations. Interventions and policies that can curb or reverse the increase, and mitigate the health effects of high BMI by targeting its metabolic mediators, are needed in most countries.

FUNDING: Bill & Melinda Gates Foundation and WHO.

  总胆固醇:总体下降,高收入国家仍最高

  1980~2008年间,每10年世界平均总胆固醇(TC)下降≤0.1mmol/L;高收入国家TC平均降低0.2mmol/L,东亚、东南亚和太平洋地区男性和女性TC分别增加0.08和0.09mmol/L。2008年,男性和女性全球平均年龄标准化TC分别为4.64和4.76mmol/L,高收入国家最高,撒哈拉以南非洲最低。

Lancet. 2011 Feb 12;377(9765):578-86.

National, regional, and global trends in serum total cholesterol since 1980: systematic analysis of health examination surveys and epidemiological studies with 321 country-years and 3.0 million participants.

Farzadfar F, Finucane MM, Danaei G, Pelizzari PM, Cowan MJ, Paciorek CJ, Singh GM, Lin JK, Stevens GA, Riley LM, Ezzati M; Global Burden of Metabolic Risk Factors of Chronic Diseases Collaborating Group (Cholesterol).

Department of Global Health and Population, Harvard School of Public Health, Boston, MA, USA.

BACKGROUND: Data for trends in serum cholesterol are needed to understand the effects of its dietary, lifestyle, and pharmacological determinants; set intervention priorities; and evaluate national programmes. Previous analyses of trends in serum cholesterol were limited to a few countries, with no consistent and comparable global analysis. We estimated worldwide trends in population mean serum total cholesterol.

METHODS: We estimated trends and their uncertainties in mean serum total cholesterol for adults 25 years and older in 199 countries and territories. We obtained data from published and unpublished health examination surveys and epidemiological studies (321 country-years and 3.0 million participants). For each sex, we used a Bayesian hierarchical model to estimate mean total cholesterol by age, country, and year, accounting for whether a study was nationally representative.

FINDINGS: In 2008, age-standardised mean total cholesterol worldwide was 4.64 mmol/L (95% uncertainty interval 4.51-4.76) for men and 4.76 mmol/L (4.62-4.91) for women. Globally, mean total cholesterol changed little between 1980 and 2008, falling by less than 0.1 mmol/L per decade in men and women. Total cholesterol fell in the high-income region consisting of Australasia, North America, and western Europe, and in central and eastern Europe; the regional declines were about 0.2 mmol/L per decade for both sexes, with posterior probabilities of these being true declines 0.99 or greater. Mean total cholesterol increased in east and southeast Asia and Pacific by 0.08 mmol/L per decade (-0.06 to 0.22, posterior probability=0.86) in men and 0.09 mmol/L per decade (-0.07 to 0.26, posterior probability=0.86) in women. Despite converging trends, serum total cholesterol in 2008 was highest in the high-income region consisting of Australasia, North America, and western Europe; the regional mean was 5.24 mmol/L (5.08-5.39) for men and 5.23 mmol/L (5.03-5.43) for women. It was lowest in sub-Saharan Africa at 4.08 mmol/L (3.82-4.34) for men and 4.27 mmol/L (3.99-4.56) for women.

INTERPRETATION: Nutritional policies and pharmacological interventions should be used to accelerate improvements in total cholesterol in regions with decline and to curb or prevent the rise in Asian populations and elsewhere. Population-based surveillance of cholesterol needs to be improved in low-income and middle-income countries.

FUNDING: Bill & Melinda Gates Foundation and WHO.

  收缩压:高收入国家下降,低收入国家上升

  在1980~2008年间,每10年,全球男性和女性平均收缩压(SBP)分别降低0.8和1.0mmHg,北美高收入国家男性和西欧、澳大利亚女性平均SBP下降最多,分别为2.8mmHg和≥3.5mmHg。

  2008年,男性和女性年龄标准化SBP分别为128.1和124.4mmHg。

  大洋洲、东非、南亚和东南亚国家男性和女性SBP增加。

  韩国、柬埔寨、澳大利亚、加拿大和美国平均SBP最低,男性和女性分别为125和120mmHg;波罗的海、东非和西非国家最高,男性和女性分别为138和135mmHg。

Lancet. 2011 Feb 12;377(9765):568-77.

National, regional, and global trends in systolic blood pressure since 1980: systematic analysis of health examination surveys and epidemiological studies with 786 country-years and 5.4 million participants.

Danaei G, Finucane MM, Lin JK, Singh GM, Paciorek CJ, Cowan MJ, Farzadfar F, Stevens GA, Lim SS, Riley LM, Ezzati M; Global Burden of Metabolic Risk Factors of Chronic Diseases Collaborating Group (Blood Pressure).

Department of Epidemiology, Harvard School of Public Health, Boston, MA, USA.

BACKGROUND: Data for trends in blood pressure are needed to understand the effects of its dietary, lifestyle, and pharmacological determinants; set intervention priorities; and evaluate national programmes. However, few worldwide analyses of trends in blood pressure have been done. We estimated worldwide trends in population mean systolic blood pressure (SBP).

METHODS: We estimated trends and their uncertainties in mean SBP for adults 25 years and older in 199 countries and territories. We obtained data from published and unpublished health examination surveys and epidemiological studies (786 country-years and 5.4 million participants). For each sex, we used a Bayesian hierarchical model to estimate mean SBP by age, country, and year, accounting for whether a study was nationally representative.

FINDINGS: In 2008, age-standardised mean SBP worldwide was 128.1 mmHg (95% uncertainty interval 126.7-129.4) in men and 124.4 mmHg (123.0-125.9) in women. Globally, between 1980 and 2008, SBP decreased by 0.8 mmHg per decade (-0.4 to 2.2, posterior probability of being a true decline=0.90) in men and 1.0 mmHg per decade (-0.3 to 2.3, posterior probability=0.93) in women. Female SBP decreased by 3.5 mmHg or more per decade in western Europe and Australasia (posterior probabilities ≥0.999). Male SBP fell most in high-income North America, by 2.8 mmHg per decade (1.3-4.5, posterior probability >0.999), followed by Australasia and western Europe where it decreased by more than 2.0 mmHg per decade (posterior probabilities >0.98). SBP rose in Oceania, east Africa, and south and southeast Asia for both sexes, and in west Africa for women, with the increases ranging 0.8-1.6 mmHg per decade in men (posterior probabilities 0.72-0.91) and 1.0-2.7 mmHg per decade for women (posterior probabilities 0.75-0.98). Female SBP was highest in some east and west African countries, with means of 135 mmHg or greater. Male SBP was highest in Baltic and east and west African countries, where mean SBP reached 138 mmHg or more. Men and women in western Europe had the highest SBP in high-income regions.

INTERPRETATION: On average, global population SBP decreased slightly since 1980, but trends varied significantly across regions and countries. SBP is currently highest in low-income and middle-income countries. Effective population-based and personal interventions should be targeted towards low-income and middle-income countries.

FUNDING: Funding Bill & Melinda Gates Foundation and WHO.

  先心病:总体患病率升高,地域差别大

  2011年11月15日,《美国心脏病学会杂志》发表综述,首次系统性回顾了全球1930~2010年先天性心脏病(先心病)及其8个最常见亚型的出生患病率:从1930~1934年的0.6例/1000名新生儿到1995年后的9.1例/1000名新生儿,患病率呈S型增长;1930~1960年是第1个快速增长期,1961~1975年进入平稳期,1970~1995年为第2个快速增长期。

  亚洲患病率最高(9.3例/1000名新生儿);欧洲次之(8.2例/1000名新生儿),非洲最低(1.9例/1000名新生儿)。各主要亚型患病率亦存在明显地域差异。

  高、中高、中低收入国家患病率分别为8.0、7.3和6.9例/1000名新生儿,尚无低收入国家数据。

J Am Coll Cardiol. 2011 Nov 15;58(21):2241-7.

Birth prevalence of congenital heart disease worldwide: a systematic review and meta-analysis.

van der Linde D, Konings EE, Slager MA, Witsenburg M, Helbing WA, Takkenberg JJ, Roos-Hesselink JW.

Department of Cardiology, Erasmus Medical Center, Rotterdam, the Netherlands.

Congenital heart disease (CHD) accounts for nearly one-third of all major congenital anomalies. CHD birth prevalence worldwide and over time is suggested to vary; however, a complete overview is missing. This systematic review included 114 papers, comprising a total study population of 24,091,867 live births with CHD identified in 164,396 individuals. Birth prevalence of total CHD and the 8 most common subtypes were pooled in 5-year time periods since 1930 and in continent and income groups since 1970 using the inverse variance method. Reported total CHD birth prevalence increased substantially over time, from 0.6 per 1,000 live births (95% confidence interval [CI]: 0.4 to 0.8) in 1930 to 1934 to 9.1 per 1,000 live births (95% CI: 9.0 to 9.2) after 1995. Over the last 15 years, stabilization occurred, corresponding to 1.35 million newborns with CHD every year. Significant geographical differences were found. Asia reported the highest CHD birth prevalence, with 9.3 per 1,000 live births (95% CI: 8.9 to 9.7), with relatively more pulmonary outflow obstructions and fewer left ventricular outflow tract obstructions. Reported total CHD birth prevalence in Europe was significantly higher than in North America (8.2 per 1,000 live births [95% CI: 8.1 to 8.3] vs. 6.9 per 1,000 live births [95% CI: 6.7 to 7.1]; p < 0.001). Access to health care is still limited in many parts of the world, as are diagnostic facilities, probably accounting for differences in reported birth prevalence between high- and low-income countries. Observed differences may also be of genetic, environmental, socioeconomical, or ethnic origin, and there needs to be further investigation to tailor the management of this global health problem.

  抑郁:富裕国家重性抑郁患病率高

  2011年7月26日,《生物医学中心·医学》(BMC Medicine)杂志刊出18个国家(10个高收入国家、8个中低收入国家)联合研究显示,重性抑郁发作(MDE)是严重的公共健康问题。

  在高收入和中低收入国家中,根据美国疾病与诊断手册第四版(DSM-Ⅳ)评估的MDE终生和12个月患病率分别为14.6%和5.5%、11.1%和5.9%;以回顾性方式确定的MDE平均发病年龄分别为25.7岁和24.0岁,男女性别比例为1∶2。

BMC Med. 2011 Jul 26;9:90.

Cross-national epidemiology of DSM-IV major depressive episode.

Bromet E, Andrade LH, Hwang I, Sampson NA, Alonso J, de Girolamo G, de Graaf R, Demyttenaere K, Hu C, Iwata N, Karam AN, Kaur J, Kostyuchenko S, Lépine JP, Levinson D, Matschinger H, Mora ME, Browne MO, Posada-Villa J, Viana MC, Williams DR, Kessler RC.

Department of Psychiatry, State University of New York at Stony Brook, South Campus, Stony Brook, NY 11794-8790, NY, USA.

BACKGROUND: Major depression is one of the leading causes of disability worldwide, yet epidemiologic data are not available for many countries, particularly low- to middle-income countries. In this paper, we present data on the prevalence, impairment and demographic correlates of depression from 18 high and low- to middle-income countries in the World Mental Health Survey Initiative.

METHODS: Major depressive episodes (MDE) as defined by the Diagnostic and Statistical Manual of Mental Disorders, fourth edition (DMS-IV) were evaluated in face-to-face interviews using the World Health Organization Composite International Diagnostic Interview (CIDI). Data from 18 countries were analyzed in this report (n = 89,037). All countries surveyed representative, population-based samples of adults.

RESULTS: The average lifetime and 12-month prevalence estimates of DSM-IV MDE were 14.6% and 5.5% in the ten high-income and 11.1% and 5.9% in the eight low- to middle-income countries. The average age of onset ascertained retrospectively was 25.7 in the high-income and 24.0 in low- to middle-income countries. Functional impairment was associated with recency of MDE. The female: male ratio was about 2:1. In high-income countries, younger age was associated with higher 12-month prevalence; by contrast, in several low- to middle-income countries, older age was associated with greater likelihood of MDE. The strongest demographic correlate in high-income countries was being separated from a partner, and in low- to middle-income countries, was being divorced or widowed.

CONCLUSIONS: MDE is a significant public-health concern across all regions of the world and is strongly linked to social conditions. Future research is needed to investigate the combination of demographic risk factors that are most strongly associated with MDE in the specific countries included in the WMH.

  10~24岁人群神经精神问题突出

  10~24岁人群占全球总人口的27%,但其疾病和健康问题一直被人们忽视。2011年6月7日,《柳叶刀》杂志刊出的一项多国联合研究分析了该人群健康问题。

  在10~24岁人群中,总体伤残调整生命年(DALY,包括早死损失生命年(YLL)和残疾损失生命年(YLD))为23600万,占全部人群的15.5%;非洲DALY率最高,比高收入国家高2.5倍;3个主要YLD原因为神经精神疾病(45%)、非故意外伤(12%)及传染性和寄生虫病(10%);主要健康危险因素为酒精(7%)、不安全性行为(4%)、铁缺乏(3%)、不避孕(2%)和使用违禁药品(2%)。对于15~19岁人群,女性较男性DALY率高12%。

Lancet. 2011 Jun 18;377(9783):2093-102. Epub 2011 Jun 7.

Global burden of disease in young people aged 10-24 years: a systematic analysis.

Gore FM, Bloem PJ, Patton GC, Ferguson J, Joseph V, Coffey C, Sawyer SM, Mathers CD.

Department of Health Statistics and Informatics, WHO, Geneva, Switzerland.

BACKGROUND: Young people aged 10-24 years represent 27% of the world's population. Although important health problems and risk factors for disease in later life emerge in these years, the contribution to the global burden of disease is unknown. We describe the global burden of disease arising in young people and the contribution of risk factors to that burden.

METHODS: We used data from WHO's 2004 Global Burden of Disease study. Cause-specific disability-adjusted life-years (DALYs) for young people aged 10-24 years were estimated by WHO region on the basis of available data for incidence, prevalence, severity, and mortality. WHO member states were classified into low-income, middle-income, and high-income countries, and into WHO regions. We estimated DALYs attributable to specific global health risk factors using the comparative risk assessment method. DALYs were divided into years of life lost because of premature mortality (YLLs) and years lost because of disability (YLDs), and are presented for regions by sex and by 5-year age groups.

FINDINGS: The total number of incident DALYs in those aged 10-24 years was about 236 million, representing 15.5% of total DALYs for all age groups. Africa had the highest rate of DALYs for this age group, which was 2.5 times greater than in high-income countries (208 vs 82 DALYs per 1000 population). Across regions, DALY rates were 12% higher in girls than in boys between 15 and 19 years (137 vs 153). Worldwide, the three main causes of YLDs for 10-24-year-olds were neuropsychiatric disorders (45%), unintentional injuries (12%), and infectious and parasitic diseases (10%). The main risk factors for incident DALYs in 10-24-year-olds were alcohol (7% of DALYs), unsafe sex (4%), iron deficiency (3%), lack of contraception (2%), and illicit drug use (2%).

INTERPRETATION: The health of young people has been largely neglected in global public health because this age group is perceived as healthy. However, opportunities for prevention of disease and injury in this age group are not fully exploited. The findings from this study suggest that adolescent health would benefit from increased public health attention.

FUNDING: None.

  HIV/AIDS:总体稳定,部分国家下降

  2011年艾滋病日前夕,WHO最新发布的人类免疫缺陷病毒/艾滋病(HIV/AIDS)流行状况报告显示,全球HIV感染率稳定,部分国家开始出现下降,但在部分特殊人群如性工作者、男男同性恋者、变性者、静脉吸毒者、囚犯及移民者中,HIV感染呈现与地区流行趋势不一致的高发趋势。

  2010年,HIV新感染人数270万(<15岁儿童39万),较2001年减少40万;至2010年底,全球HIV感染者共计3400万(<15岁儿童340万)。

  在撒哈拉以南非洲,估计2010年感染人数为190万,较2001年减少16%,较峰值的1996~1998年减少27%。但在中东和北非,HIV新感染人数由2001年的4.3万增至2010年的5.9万。在本世纪初短暂下降后,至2008年,东欧和中亚的年新感染率持续上升。

  AIDS相关年死亡人数由最高的2005年的220万降至2010年的180万;在撒哈拉以南非洲、南亚、东南亚和加勒比海地区,AIDS相关死亡率自2005~2006年开始持续下降。2001~2010年,东欧和中亚AIDS相关死亡增长超过10倍,中东和北非增长60%,东亚则几乎翻倍。2010年,估计25万15岁以下儿童死于AIDS相关疾病,较2005年减少20%。

  报告还显示,接受HIV检测和咨询的人数从2009年的640万增至2010年的720万(87个有报告国家);妊娠女性接受HIV检测和咨询率由2005年的8%增至2010年的35%,在妊娠女性感染人数最多的东非和南非,妊娠女性HIV检测和咨询率由2005年的14%增至2010年的61%。自1995年对感染HIV妊娠女性进行预防性抗逆转录病毒治疗(ART)以来,新感染儿童减少35万。

  提供ART的卫生机构数量由2007年的7700家增至2010年底的22400家。中低收入国家中47%的HIV感染者接受ART,但仍有约750万感染者不知其感染状况,无法接受ART,且以医疗机构为基础的检测体系使无症状感染者不能被早期发现。

  儿童与成人ART覆盖率存在23%的差距,仅不足1/4符合条件的儿童接受ART,且治疗12个月时的流失率超过20%。

  结核:年发病率和死亡率下降,资金设备仍不足

  2011年10月11日,WHO发布《2011年全球结核病(TB)控制报告》显示,2010年,全球TB新发病例880万,死亡145万(35万为HIV阳性)。自2002年起,TB发病率以1.3%/年速度下降,估计的年TB死亡率下调。自2006年起,全球病例绝对数下降。1990~2010年,中国TB流行率减半、死亡率降低近80%,且发病率以3.4%/年速度递减。

  2009年,痰菌阳性的肺结核新发病例治疗成功率为87%;2010年,仅不足5%的新发和既往病例接受多重耐药TB(MDR-TB)检测,接受治疗病例数有所增加,但仅占估计病例数的16%。

  至2012年,TB病例数占全球病例92%的97个国家对TB防控的投入将增至44亿美元,但仍有10亿美元的资金缺口。

  8个高TB疾病负担国家(HBC)仍不能达到每10万人拥有1台显微镜的标准;36个HBC和高MDR-TB负担国家中的20个不能实现每500万人拥有1个细菌培养和药敏检测实验室。

  2010年,全球TB患者的HIV检测率达34%,非洲为59%,共68个国家超过75%;在联合感染患者中,80%已开始复方新诺明预防治疗,46%接受ART;无急性TB表现的HIV感染者接受预防性异烟肼治疗的比例增加。

  目前,有10种新药在研发中;10种疫苗处于Ⅰ期或Ⅱ期试验中,至少一种处于Ⅱ期阶段的疫苗有望在2~3年内进入Ⅲ期,并可能在2018年上市。

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