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The Lancet :报告显示人类延寿疾病相伴

来源:新华国际 2012-12-19 16:58

根据周四公布的一项全球健康研究报告,人类与1970年相比平均寿命增加了10年,但这幸运的10年中却有大部分时间是在与癌症等疾病作斗争。

在医学期刊《柳叶刀》上刊登的研究汇总指出,到2010年,男性出生时的预期寿命与1970年相比已上升了11.1年,女性上升了12.1年。

但是,尽管我们活得更长,我们却更多地受到疾病的侵扰,罹患如癌症和心脏病等非传染性疾病的患者越来越多。

哈佛大学公共卫生学院一项研究的合作者乔希·萨洛蒙在接受法新社记者电邮采访时说:“在过去的20年中,人类的寿命在全球范围内已增加大约5年,但其中只有约4年的健康寿命。”

他说:“你可以把这理解为相当于增加了4年的健康和1年的病痛。”

这项杰出的研究汇集了来自50个国家近500名作者的工作,整合了来自学术研究论文、尸检报告、医院记录和普查的数据,覆盖187个国家和地区的291种疾病和损伤类型。

这项研究显示,除了撒哈拉以南非洲,其他地区出现明显转变,人类的病痛从多发于较低龄人群的营养不良、传染病和出生并发症等传统疾病,转化为癌症、心脏病和糖尿病等可能持续数年的疾病。

萨洛蒙说,病患丧失劳动能力造成的负担日益沉重,“意味着额外的医疗需求,社会与财政成本增加,以及在卫生保健服务系统方面的需求。”

研究报告说,2010年,癌症、糖尿病和心脏病等非传染性疾病占据每三例死亡中的两例,而1990年的比例仅为二分之一。

2010年死于癌症的人比1990年多38%,从580万人上升到800万人。

营养不良、传染病、孕产妇和新生儿疾病的死亡数量从1990年的1590万下降到2010年的1320万。

研究负责人、华盛顿大学卫生统计评估研究所的克里斯托弗·默里在一次新闻发布会上说:“现在最大的问题是,真正与贫困相关的疾病风险在全球层面上转变为与一系列跟非传染疾病和人类生活方式更密切相关的风险。”

研究报告说,2010年,高血压(造成940万人死亡)和吸烟(造成630万人死亡)是全球人类健康面临的最大风险,排名第三的是酒精(造成500万人死亡)。

不健康的饮食和缺乏运动也与约1250万人的死亡有关。

研究指出,精神障碍、滥用药物、糖尿病和肌肉骨骼疾病导致更多的人渐渐失去劳动能力。

默里说:“这些疾病将导致人渐渐失去劳动能力,往往与年龄有关,因此,随着人口年龄的增长,早亡率下降,更多的人进入这些疾病多发的年龄组。”(生物谷Bioon.com)

Common values in assessing health outcomes from disease and injury: disability weights measurement study for the Global Burden of Disease Study 2010

Joshua A Salomon PhD a †, Prof Theo Vos PhD d, Daniel R Hogan PhD a, Michael Gagnon MS a, Mohsen Naghavi PhD g, Prof Ali Mokdad PhD g, Nazma Begum MA l, Razibuzzaman Shah MSS h, Muhammad Karyana MD i, Soewarta Kosen MD i, Mario Reyna Farje BS j, Gilberto Moncada MA j, Arup Dutta MBA k, Sunil Sazawal MD k, Andrew Dyer MBA m, Jason Seiler BA m, Prof Victor Aboyans MD n *, Lesley Baker BS g *, Amanda Baxter MPH e *, Prof Emelia J Benjamin MD o *, Kavi Bhalla PhD c *, Aref Bin Abdulhak MD p *, Fiona Blyth PhD t *, Prof Rupert Bourne MD u *, Tasanee Braithwaite BMBCh v *, Prof Peter Brooks MD z *, Prof Traolach S Brugha MD aa *, Claire Bryan-Hancock BPsych ab *, Prof Rachelle Buchbinder MBBS ac ae *, Prof Peter Burney MD ag *, Bianca Calabria BPsych ah *, Honglei Chen PhD ai *, Prof Sumeet S Chugh MD aj *, Rebecca Cooley EdM g *, Prof Michael H Criqui MD ak *, Marita Cross PhD t *, Kaustubh C Dabhadkar MBBS al *, Nabila Dahodwala MD am *, Prof Adrian Davis PhD an *, Prof Louisa Degenhardt PhD w ah *, Cesar Díaz-Torné MD ao *, E Ray Dorsey MD l *, Tim Driscoll PhD s *, Karen Edmond PhD ap *, Alexis Elbaz MD aq *, Prof Majid Ezzati PhD af ar *, Prof Valery Feigin MD as *, Cleusa P Ferri PhD at *, Abraham D Flaxman PhD g *, Louise Flood MBBS ab *, Marlene Fransen PhD q *, Kana Fuse PhD au *, Belinda J Gabbe PhD ad *, Prof Richard F Gillum MD av *, Juanita Haagsma PhD ax *, Prof James E Harrison MBBS ab *, Rasmus Havmoeller MD aj ba *, Prof Roderick J Hay DM ay *, Prof Abdullah Hel-Baqui DRPH k *, Prof Hans W Hoek MD bb *, Howard Hoffman MA bc *, Emily Hogeland BA bd *, Damian Hoy PhD ac *, Deborah Jarvis FFPH ag *, Ganesan Karthikeyan MD be *, Lisa Marie Knowlton MD b *, Tim Lathlean BA ab *, Janet L Leasher OD bf *, Stephen S Lim PhD g *, Prof Steven E Lipshultz MD bg *, Prof Alan D Lopez PhD d *, Prof Rafael Lozano MD g *, Prof Ronan Lyons MD bh *, Prof Reza Malekzadeh MD bi *, Prof Wagner Marcenes PhD bj *, Prof Lyn March MD r *, Prof David J Margolis MD am *, Neil McGill FRACP t *, Prof John McGrath MD f *, Prof George A Mensah MD bk *, Ana-Claire Meyer MD bd *, Catherine Michaud MD bm *, Andrew Moran MD bn *, Rintaro Mori MD bo *, Michele E Murdoch FRCP bp *, Luigi Naldi MD bq *, Prof Charles R Newton MD br *, Rosana Norman PhD d *, Saad B Omer MBBS bs *, Prof Richard Osborne PhD bt *, Prof Neil Pearce PhD ap *, Fernando Perez-Ruiz MD bu *, Norberto Perico MD bv *, Prof Konrad Pesudovs PhD ab *, David Phillips BS g *, Farshad Pourmalek MD bw *, Prof Martin Prince MD az *, Prof Jürgen T Rehm PhD bx *, Prof Guiseppe Remuzzi MD bv *, Kathryn Richardson MSc bz *, Prof Robin Room PhD x by *, Sukanta Saha PhD e *, Prof Uchechukwu Sampson MD ca *, Lidia Sanchez-Riera MD r cb *, Maria Segui-Gomez MD cc *, Saeid Shahraz MD cd *, Prof Kenji Shibuya MD ce *, David Singh MD cf *, Prof Karen Sliwa MD bl *, Emma Smith PhD q *, Isabelle Soerjomataram MD aw *, Prof Timothy Steiner MB ch *, Wilma A Stolk PhD ax *, Prof Lars Jacob Stovner PhD cg *, Christopher Sudfeld ScM a *, Prof Hugh R Taylor MD z *, Imad M Tleyjeh MD p *, Marieke J van der Werf PhD ci *, Wendy L Watson PhD ah *, David J Weatherall FRCP br *, Robert Weintraub MBBS y cj *, Marc G Weisskopf PhD a *, Prof Harvey Whiteford MBBS e *, Prof James D Wilkinson MD bg *, Prof Anthony D Woolf MBBS ck *, Prof Zhi-Jie Zheng MD cl *, Prof Christopher JL Murray MD

Background Measurement of the global burden of disease with disability-adjusted life-years (DALYs) requires disability weights that quantify health losses for all non-fatal consequences of disease and injury. There has been extensive debate about a range of conceptual and methodological issues concerning the definition and measurement of these weights. Our primary objective was a comprehensive re-estimation of disability weights for the Global Burden of Disease Study 2010 through a large-scale empirical investigation in which judgments about health losses associated with many causes of disease and injury were elicited from the general public in diverse communities through a new, standardised approach. Methods We surveyed respondents in two ways: household surveys of adults aged 18 years or older (face-to-face interviews in Bangladesh, Indonesia, Peru, and Tanzania; telephone interviews in the USA) between Oct 28, 2009, and June 23, 2010; and an open-access web-based survey between July 26, 2010, and May 16, 2011. The surveys used paired comparison questions, in which respondents considered two hypothetical individuals with different, randomly selected health states and indicated which person they regarded as healthier. The web survey added questions about population health equivalence, which compared the overall health benefits of different life-saving or disease-prevention programmes. We analysed paired comparison responses with probit regression analysis on all 220 unique states in the study. We used results from the population health equivalence responses to anchor the results from the paired comparisons on the disability weight scale from 0 (implying no loss of health) to 1 (implying a health loss equivalent to death). Additionally, we compared new disability weights with those used in WHO's most recent update of the Global Burden of Disease Study for 2004. Findings 13 902 individuals participated in household surveys and 16 328 in the web survey. Analysis of paired comparison responses indicated a high degree of consistency across surveys: correlations between individual survey results and results from analysis of the pooled dataset were 0·9 or higher in all surveys except in Bangladesh (r=0·75). Most of the 220 disability weights were located on the mild end of the severity scale, with 58 (26%) having weights below 0·05. Five (11%) states had weights below 0·01, such as mild anaemia, mild hearing or vision loss, and secondary infertility. The health states with the highest disability weights were acute schizophrenia (0·76) and severe multiple sclerosis (0·71). We identified a broad pattern of agreement between the old and new weights (r=0·70), particularly in the moderate-to-severe range. However, in the mild range below 0·2, many states had significantly lower weights in our study than previously. Interpretation This study represents the most extensive empirical effort as yet to measure disability weights. By contrast with the popular hypothesis that disability assessments vary widely across samples with different cultural environments, we have reported strong evidence of highly consistent results. Funding Bill & Melinda Gates Foundation.

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