本帖最后由 感控雏鹰 于 2018-11-9 22:40 编辑
下呼吸道感染是世界上死亡率和发病率的首要原因。2018年9月，发表在《Lancet Infect Dis》的一项全球疾病负担研究2016的系统分析，评估了195个国家下呼吸道感染的全球、地区和国家发病率、死亡率和病因。 背景：下呼吸道感染是世界上死亡率和发病率的首要原因。全球疾病负担、损伤和风险因素研究（GBD）2016提供了195个国家下呼吸道感染负担的更新分析。本研究评估了过去26年的病例、死亡、病因，展示了所有年龄中下呼吸道感染负担如何改变。 方法：研究人员对GBD2016的下呼吸道感染使用了3个独立的建模策略：贝叶斯分层集成建模平台（死因集成建模），该平台使用了人口登记、死因推断数据和监测系统数据，从而预测因下呼吸道感染造成的死亡；分隔Meta回归工具（DisMod-MR），该工具使用了科学文献、人口代表调查和医疗数据，从而预测发病率、患病率和死亡率；因肺炎链球菌、B型流感嗜血杆菌、流感、呼吸道合胞病毒造成的下呼吸道感染发作的人口归因分数的反事实估计模型。对于每个年龄、性别、年份和地点，研究人员计算了每个模型的评估值。研究人员使用DisMod-MR和时空高斯过程回归，对给定风险因素人群的暴露水平进行了建模，并评估了5岁以下儿童中，每个风险因素的靶向干预的有效性。研究人员使用GBD2016中下呼吸道感染相关的风险因素，对2000~2016年下呼吸道感染死亡的改变进行了分解分析。 结果：2016年，下呼吸道感染造成世界上652572例5岁以下儿童死亡（95%不确定区间（UI），586475~720612），1080958例70岁以上成人死亡（943749~1170638），2377697例所有年龄死亡（2145584~2512809）。肺炎链球菌为全球下呼吸道感染发病率和死亡率的首要原因，2016年，其造成的死亡比所有其他病因造成死亡的组合还要多（1189937例；95% UI，690445~1770660）。儿童营养不良仍然是5岁以下儿童下呼吸道感染死亡的首要风险因素，占到了2016年下呼吸道感染死亡的61.4%（95% UI，45.7~69.6）。在下呼吸道感染负担最高的国家中，每对4000名儿童实施改善营养不良、家庭空气污染、大气颗粒物污染和扩大抗生素使用的干预措施，可避免1例下呼吸道感染造成的5岁以下儿童死亡。 结论：结果表明，在降低下呼吸道感染负担上取得了实质性进展，但是该进展并不是在所有地区都相等。取得的进展主要由一些主要风险因素的降低造成，需要对老年人给予更多的努力。通过强调具有最高负担的地区和人口负担，以及具有最高影响的风险因素，资助者、政策制定者和项目实施者可更有效地减少世界上最易感人群的下呼吸道感染。 Estimates of the global, regional, and national morbidity, mortality, and aetiologies of lower respiratory infections in 195 countries, 1990-2016: a systematic analysis for the Global Burden of Disease Study 2016.[size=1.0769em]
AbstractBACKGROUND:[size=1.04em]Lower respiratory infections are a leading cause of morbidity and mortality around the world. The Global Burden of Diseases, Injuries, and Risk Factors (GBD) Study 2016, provides an up-to-date analysis of the burden of lower respiratory infections in 195 countries. This study assesses cases, deaths, and aetiologies spanning the past 26 years and shows how the burden of lower respiratory infection has changed in people of all ages. METHODS:[size=1.04em]We used three separate modelling strategies for lower respiratory infections in GBD 2016: a Bayesian hierarchical ensemble modelling platform (Cause of Death Ensemble model), which uses vital registration, verbal autopsy data, and surveillance system data to predict mortality due to lower respiratory infections; a compartmental meta-regression tool (DisMod-MR), which uses scientific literature, population representative surveys, and health-care data to predict incidence, prevalence, and mortality; and modelling of counterfactual estimates of the population attributable fraction of lower respiratory infection episodes due to Streptococcus pneumoniae, Haemophilus influenzae type b, influenza, and respiratory syncytial virus. We calculated each modelled estimate for each age, sex, year, and location. We modelled the exposure level in a population for a given risk factor using DisMod-MR and a spatio-temporal Gaussian process regression, and assessed the effectiveness of targeted interventions for each risk factor in children younger than 5 years. We also did a decomposition analysis of the change in LRI deaths from 2000-16 using the risk factors associated with LRI in GBD 2016. FINDINGS:[size=1.04em]In 2016, lower respiratory infections caused 652 572 deaths (95% uncertainty interval [UI] 586 475-720 612) in children younger than 5 years (under-5s), 1 080 958 deaths (943 749-1 170 638) in adults older than 70 years, and 2 377 697 deaths (2 145 584-2 512 809) in people of all ages, worldwide. Streptococcus pneumoniae was the leading cause of lower respiratory infection morbidity and mortality globally, contributing to more deaths than all other aetiologies combined in 2016 (1 189 937 deaths, 95% UI 690 445-1 770 660). Childhood wasting remains the leading risk factor for lower respiratory infection mortality among children younger than 5 years, responsible for 61·4% of lower respiratory infection deaths in 2016 (95% UI 45·7-69·6). Interventions to improve wasting, household air pollution, ambient particulate matter pollution, and expanded antibiotic use could avert one under-5 death due to lower respiratory infection for every 4000 children treated in the countries with the highest lower respiratory infection burden. INTERPRETATION:[size=1.04em]Our findings show substantial progress in the reduction of lower respiratory infection burden, but this progress has not been equal across locations, has been driven by decreases in several primary risk factors, and might require more effort among elderly adults. By highlighting regions and populations with the highest burden, and the risk factors that could have the greatest effect, funders, policy makers, and programme implementers can more effectively reduce lower respiratory infections among the world's most susceptible populations.
Estimates of the global, regional, and national morbidity, mortality, and aetiol.pdf
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发表于 2018-11-9 22:32:45
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发表于 2018-11-10 05:28:22
