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首页> 外文期刊>The Lancet >Global and regional mortality from 235 causes of death for 20 age groups in 1990 and 2010: a systematic analysis for the Global Burden of Disease Study 2010.
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Global and regional mortality from 235 causes of death for 20 age groups in 1990 and 2010: a systematic analysis for the Global Burden of Disease Study 2010.

机译：1990年和2010年全球20个年龄组的235个死因的全球和区域死亡率：《 2010年全球疾病负担研究》的系统分析。

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摘要

Reliable and timely information on the leading causes of death in populations, and how these are changing, is a crucial input into health policy debates. In the Global Burden of Diseases, Injuries, and Risk Factors Study 2010 (GBD 2010), we aimed to estimate annual deaths for the world and 21 regions between 1980 and 2010 for 235 causes, with uncertainty intervals (UIs), separately by age and sex.We attempted to identify all available data on causes of death for 187 countries from 1980 to 2010 from vital registration, verbal autopsy, mortality surveillance, censuses, surveys, hospitals, police records, and mortuaries. We assessed data quality for completeness, diagnostic accuracy, missing data, stochastic variations, and probable causes of death. We applied six different modelling strategies to estimate cause-specific mortality trends depending on the strength of the data. For 133 causes and three special aggregates we used the Cause of Death Ensemble model (CODEm) approach, which uses four families of statistical models testing a large set of different models using different permutations of covariates. Model ensembles were developed from these component models. We assessed model performance with rigorous out-of-sample testing of prediction error and the validity of 95% UIs. For 13 causes with low observed numbers of deaths, we developed negative binomial models with plausible covariates. For 27 causes for which death is rare, we modelled the higher level cause in the cause hierarchy of the GBD 2010 and then allocated deaths across component causes proportionately, estimated from all available data in the database. For selected causes (African trypanosomiasis, congenital syphilis, whooping cough, measles, typhoid and parathyroid, leishmaniasis, acute hepatitis E, and HIV/AIDS), we used natural history models based on information on incidence, prevalence, and case-fatality. We separately estimated cause fractions by aetiology for diarrhoea, lower respiratory infections, and meningitis, as well as disaggregations by subcause for chronic kidney disease, maternal disorders, cirrhosis, and liver cancer. For deaths due to collective violence and natural disasters, we used mortality shock regressions. For every cause, we estimated 95% UIs that captured both parameter estimation uncertainty and uncertainty due to model specification where CODEm was used. We constrained cause-specific fractions within every age-sex group to sum to total mortality based on draws from the uncertainty distributions.In 2010, there were 52·8 million deaths globally. At the most aggregate level, communicable, maternal, neonatal, and nutritional causes were 24·9% of deaths worldwide in 2010, down from 15·9 million (34·1%) of 46·5 million in 1990. This decrease was largely due to decreases in mortality from diarrhoeal disease (from 2·5 to 1·4 million), lower respiratory infections (from 3·4 to 2·8 million), neonatal disorders (from 3·1 to 2·2 million), measles (from 0·63 to 0·13 million), and tetanus (from 0·27 to 0·06 million). Deaths from HIV/AIDS increased from 0·30 million in 1990 to 1·5 million in 2010, reaching a peak of 1·7 million in 2006. Malaria mortality also rose by an estimated 19·9% since 1990 to 1·17 million deaths in 2010. Tuberculosis killed 1·2 million people in 2010. Deaths from non-communicable diseases rose by just under 8 million between 1990 and 2010, accounting for two of every three deaths (34·5 million) worldwide by 2010. 8 million people died from cancer in 2010, 38% more than two decades ago; of these, 1·5 million (19%) were from trachea, bronchus, and lung cancer. Ischaemic heart disease and stroke collectively killed 12·9 million people in 2010, or one in four deaths worldwide, compared with one in five in 1990; 1·3 million deaths were due to diabetes, twice as many as in 1990.
机译：可靠，及时地提供有关人口主要死亡原因以及这些原因如何变化的信息，这是卫生政策辩论的关键内容。在《 2010年全球疾病，伤害和危险因素负担研究》（GBD 2010）中，我们旨在估算1980年至2010年期间全球和21个地区每年的235种病因的死亡人数，其中235种病因的不确定性区间（UI）分别按年龄和我们试图找出1980年至2010年间187个国家/地区的所有可用死因数据，包括生命登记，口头验尸，死亡率监测，人口普查，调查，医院，警察记录和房。我们评估了数据的完整性，诊断准确性，数据丢失，随机变化以及可能的死亡原因。我们根据数据强度应用了六种不同的建模策略来估计特定原因的死亡率趋势。对于133个原因和三个特殊集合，我们使用了死亡原因集合模型（CODEm）方法，该方法使用四个统计模型系列，使用协变量的不同排列来测试大量不同的模型。从这些组件模型开发了模型集成。我们通过对预测误差进行严格的样本外测试以及95％UI的有效性来评估模型性能。对于观察到的低死亡人数的13个原因，我们开发了具有合理协变量的负二项式模型。对于罕见死亡的27个原因，我们在GBD 2010的原因层次结构中对较高级别的原因进行了建模，然后根据数据库中的所有可用数据按比例在各个原因之间分配了死亡。对于某些原因（非洲锥虫病，先天性梅毒，百日咳，麻疹，伤寒和甲状旁腺，利什曼病，急性戊型肝炎和艾滋病毒/艾滋病），我们根据发病率，患病率和病死率信息使用自然史模型。我们通过病因学分别估计了腹泻，下呼吸道感染和脑膜炎的病因分数，以及由于慢性肾脏病，母体疾病，肝硬化和肝癌的原因引起的分类。对于因集体暴力和自然灾害造成的死亡，我们使用了死亡率冲击回归。对于每种原因，我们估计有95％的用户界面同时捕获了参数估计不确定性和使用CODEm的模型规范引起的不确定性。根据不确定性分布得出的结论，我们限制了每个年龄性别组中特定原因的比例，以求和总死亡率。2010年，全球有52·800万人死亡。从总体上看，传染病，孕产妇，新生儿和营养原因占2010年全球死亡的24·9％，低于1990年的46·500万的15·900万（34·1％）。这一下降在很大程度上由于腹泻病死亡率降低（从2·5降低到1-4百万），下呼吸道感染（从3·4降低到2·800万），新生儿疾病（从3·1降低到2·200万），麻疹（从0·63到0·1300万）和破伤风（从0·27到0·600万）。艾滋病毒/艾滋病致死人数从1990年的0·3000万增加到2010年的1·500万，在2006年达到高峰，达到1·700万。自1990年以来，疟疾死亡率估计也上升了19·9％，达到1·1700万2010年有死亡。2010年，结核病导致100万人死亡。1990年至2010年，非传染性疾病死亡人数增加了近800万人，到2010年占全世界三分之二的死亡人数（34·500万人）。800万人们在2010年死于癌症，比二十年前多了38％;其中有1·5百万（19％）来自气管，支气管和肺癌。缺血性心脏病和中风在2010年共造成1千2百万人死亡，占全球死亡人数的四分之一，而1990年为五分之一。糖尿病导致1百万人死亡，是1990年的两倍。

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