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[大学生论坛]:2015年全球疾病负担研究的系统分析

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Starter_PR 发表于 2017-5-7 23:43:36 | 显示全部楼层 |阅读模式
本帖最后由 Starter_PR 于 2017-5-7 23:54 编辑

Global,regional, and national life expectancy, all-cause mortality, and cause-specificmortality for 249 causes of death, 1980-2015: a systematic analysis for theGlobal Burden of Disease Study 2015.
2015年全球疾病负担研究的系统分析:针对1980~2015年全球国家和地区249种原因引起死亡的预期寿命、全因死亡率及病因死亡率

本文来自:Lancet
发表时间:2016 Oct 8
DOI:10.1016/S0140-6736(16)31012-1
Abstract
摘要
BACKGROUND:
Improving survival andextending the longevity of life for all populations requires timely, robustevidence on local mortality levels and trends. The Global Burden of Disease2015 Study (GBD 2015) provides a comprehensive assessment of all-cause andcause-specific mortality for 249 causes in 195 countries and territories from1980 to 2015. These results informed an in-depth investigation of observed andexpected mortality patterns based on sociodemographic measures.
背景:
提高人们的生存和延长人们寿命需要有关当地死亡率水平和趋势的及时、强有力的证据。2015年全球疾病负担研究报告(GBD2015)对1980年至2015年195个国家和地区的249种原因引起的全因死亡率和病因死亡率进行了综合评估。基于社会人口学测量,这些结果告知了对观测死亡率和预期死亡率模式的深入观察。

METHODS:
We estimated all-causemortality by age, sex, geography, and year using an improved analyticalapproach originally developed for GBD 2013 and GBD 2010. Improvements includedrefinements to the estimation of child and adult mortality and correspondinguncertainty, parameter selection for under-5 mortality synthesis byspatiotemporal Gaussian process regression, and sibling history dataprocessing. We also expanded the database of vital registration, survey, andcensus data to 14 294 geography-year data points. For GBD 2015, eight causes,including Ebola virus disease, were added to the previous GBD cause list formortality. We used six modeling approaches to assess cause-specific mortality,with the Cause of Death Ensemble Model (CODEM) generating estimates for mostcauses. We used a series of novel analyses to systematically quantify thedrivers of trends in mortality across geographies. First, we assessed observedand expected levels and trends of cause-specific mortality as they relate tothe Socio-demographic Index (SDI), a summary indicator derived from measures ofincome per capita, educational attainment, and fertility. Second, we examinedfactors affecting total mortality patterns through a series of counterfactualscenarios, testing the magnitude by which population growth, population agestructures, and epidemiological changes contributed to shifts in mortality.Finally, we attributed changes in life expectancy to changes in cause of death.We documented each step of the GBD 2015 estimation processes, as well as datasources, in accordance with Guidelines for Accurate and Transparent HealthEstimates Reporting (GATHER).
方法:
我们使用最初为GBD2010和GBD 2013开发的优化的分析方法,从年龄、性别、地理位置和年份来估算全因死亡率。这些优化包括了对儿童和成人死亡率以及相应不确定性估算的改进,通过高斯时空回归过程进行5岁以下儿童的死亡率合成的参数选择,以及兄弟姐妹历史数据的处理。我们还将重要的登记、调查和人口普查的数据库扩大到14294个地理-年度数据点。在GBD2015中,包括埃博拉病毒在内的8种原因被加入到以前的GBD死亡原因列表中。我们使用六种建模方法来评估病因死亡率,其中的死因集合模型(CODEM)形成大多数原因的估算。我们用了一系列新的分析来系统地量化跨地区死亡率趋势的驱动因素。首先,我们评估病因死亡率的观测值和期望值的水平和趋势,因为它们与社会-人口指数有关,社会-人口指数是一个来源于人均收入、受教育程度和生育率的总体指标。其次,我们通过一系列虚拟的场景来测试人口增长、人口年龄结构和流行病学变化对死亡率变化的影响程度,以此研究全因死亡率模式的影响因素。最后,我们将期望寿命的变化归因于死因的改变。我们证明GBD2015评价过程中的每一个步骤以及数据来源,与准确和透明的健康评估报告指南(GATHER)一致。

INTERPRETATION:
At the global scale, age-specific mortality has steadilyimproved over the past 35 years; this pattern of general progress continued inthe past decade. Progress has been faster in most countries than expected onthe basis of development measured by the SDI. Against this background ofprogress, some countries have seen falls in life expectancy, andage-standardised death rates for some causes are increasing. Despite progressin reducing age-standardised death rates, population growth and ageing meanthat the number of deaths from most non-communicable causes are increasing inmost countries, putting increased demands on health systems.
解释:
全球范围内,病因死亡率在过去的35年里稳步提高;而这种总体的进步模式在过去的十年中继续存在。在大多数国家,进展比在SDI测量的发展基础上更快。在进步的背景下,一些国家出现预期寿命下降,而一些原因导致的年龄标准化死亡率正在上升。尽管在降低年龄标准化死亡率方面取得了进展,但大多数国家的人口增长和老龄化意味着大多数非传染性疾病造成的死亡人数在增加,这增加了对卫生系统的需求。

Funding
Bill & Melinda Gates Foundation
资金:
比尔与梅琳达·盖茨基金会

2015级医学英语4班 张佩茹 3140090061

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