The Lancet Global Health ( IF 19.9 ) Pub Date : 2020-03-18 , DOI: 10.1016/s2214-109x(20)30035-8 Ramon Martinez 1 , Peter Lloyd-Sherlock 2 , Patricia Soliz 1 , Shah Ebrahim 3 , Enrique Vega 1 , Pedro Ordunez 1 , Martin McKee 3
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Background
The reduction by a third of premature non-communicable disease (NCD) mortality by 2030 is the ambitious target of Sustainable Development Goal (SDG) 3.4. However, the indicator is narrowly defined, including only four major NCDs (cardiovascular diseases, cancer, diabetes, and chronic respiratory diseases) and only for people aged 30–70 years. This study focuses on premature avertable mortality from NCDs—premature deaths caused by NCDs that could be prevented through effective public policies and health interventions or amenable to high-quality health care—to assess trends at global, regional, and national levels using estimates from the Global Burden of Disease, Injuries, and Risk Factors Study (GBD) 2017.
Methods
We reviewed existing lists of NCD causes of death that are either preventable through public health policies and interventions or amenable to health care to create a list of avertable NCD causes of death, which was mapped to the GBD cause list. We estimated age-standardised years of life lost (YLL) per 100 000 population due to premature avertable mortality from NCDs, avertable NCD cause clusters, and non-avertable NCD causes by sex, location, and year and reported their 95% uncertainty intervals (UIs). We examined trends in age-standardised YLL due to avertable and non-avertable NCDs, assessed the progress of premature avertable mortality from NCDs in achieving SDG 3.4, and explored specific avertable NCD cause clusters that could make a substantial contribution to overall trends in premature mortality.
Findings
Globally, premature avertable mortality from NCDs for both sexes combined declined −1·3% (95% UI −1·4 to −1·2) per year, from 12 855 years (11 809 to 14 051) in 1990 to 9008 years (8329 to 9756) in 2017. However, the absolute number of avertable NCD deaths increased 49·3% (95% UI 47·3 to 52·2) from 23·1 million (22·0–24·1) deaths in 1990 to 34·5 million (33·4 to 35·6) in 2017. Premature avertable mortality from NCDs reduced in every WHO region and in most countries and territories between 1990 and 2017. Despite these reductions, only the Western Pacific and European regions and 25 countries (most of which are high-income countries) are on track to achieve SDG target 3.4. Since 2017, there has been a global slowdown in the reduction of premature avertable mortality from NCDs. In 2017, high premature avertable mortality from NCDs was clustered in low-income and middle-income countries, mainly in the South-East Asia region, Eastern Mediterranean region, and African region. Most countries with large annual reductions in such mortality between 1990 and 2017 had achieved low levels of premature avertable mortality from NCDs by 2017. Some countries, the most populous examples being Afghanistan, the Central African Republic, Uzbekistan, Haiti, Mongolia, Turkmenistan, Pakistan, Ukraine, Laos, and Egypt, reported both an upward trend and high levels of premature avertable mortality from NCDs. Cardiovascular diseases, cancers, and chronic respiratory diseases have been the main drivers of the global and regional reduction in premature avertable mortality from NCDs, whereas premature mortality from substance use disorders, chronic kidney disease and acute glomerulonephritis, and diabetes have been increasing.
Interpretation
Worldwide, there has been a substantial reduction in premature avertable mortality from NCDs, but progress has been uneven across populations. Countries vary substantially in current levels and trends and, hence, the extent to which they are on track to achieve SDG 3.4. By accounting for premature avertable mortality while avoiding arbitrary age cutoffs, premature avertable mortality from NCDs is a robust, comprehensive, and actionable indicator for quantifying and monitoring global and national progress towards NCD prevention and control.
Funding
None.
中文翻译：
1990年至2017年，195个国家和地区的非传染性疾病可避免的过早死亡趋势：一项基于人群的研究。
背景
到2030年将过早的非传染性疾病（NCD）死亡率降低三分之一是可持续发展目标（SDG）3.4的宏伟目标。但是，该指标定义狭窄，仅包括四个主要的非传染性疾病（心血管疾病，癌症，糖尿病和慢性呼吸道疾病），并且仅适用于30-70岁的人群。这项研究的重点是非传染性疾病的可避免的过早死亡，即可以通过有效的公共政策和卫生干预措施预防的非传染性疾病所导致的过早死亡，或者可以接受高质量的卫生保健的疾病，以评估全球，区域和国家各级的趋势，并使用非传染性疾病的估计值。 2017年全球疾病，伤害和危险因素研究（GBD）。
方法
我们审查了可以通过公共卫生政策和干预措施预防的或适合医疗保健的NCD死因现有清单，以创建可避免的NCD死因清单，并将其映射到GBD病因清单。我们估计了按性别，地理位置和年份划分的每10万人由于非传染性疾病可避免的过早死亡，可预防的非传染性疾病成因和非平均非传染性疾病导致的每10万人的年龄标准化生命损失（YLL），并报告了其95％的不确定性区间（用户界面）。我们研究了可预防和非可预防性非传染性疾病导致的按年龄标准化的YLL趋势，评估了非传染性疾病可预防的过早死亡在实现SDG 3.4方面的进展，并探讨了可预防性非传染性疾病的成因集群，这些因素可对早产死亡率的总体趋势做出重大贡献。
发现
从全球来看，男女非传染性疾病的可避免的过早合并死亡率每年从1990年的12 855年（11 809年至14051年）下降到1990年至9008年的-1·3％（UI -1·4降至95％UI -1·2）。 （2017年为8329至9756）。可预防的NCD绝对死亡人数从2002年的23·1百万（22·0-24·1）死亡增加了49·3％（95％的UI 47·3至52·2）。 1990年降至2017年的34·500万（33·4至35·6）。1990年至2017年之间，世卫组织每个区域以及大多数国家和地区的非传染性疾病可避免的过早死亡人数减少。尽管有这些减少，但只有西太平洋和欧洲区域25个国家（其中大多数是高收入国家）有望实现SDG目标3.4。自2017年以来，全球范围内非传染性疾病可避免的过早死亡的减少一直在放缓。在2017年，非传染性疾病可避免的过早高死亡率集中在低收入和中等收入国家，主要集中在东南亚地区，东地中海地区和非洲地区。在1990年至2017年期间，此类死亡率每年大幅降低的大多数国家到2017年均可从非传染性疾病中实现较低的可避免的过早死亡水平。一些国家，其中人口最多的例子是阿富汗，中非共和国，乌兹别克斯坦，海地，蒙古，土库曼斯坦，巴基斯坦乌克兰，老挝和埃及报告非传染性疾病的上升趋势和可避免的过早死亡水平很高。心血管疾病，癌症和慢性呼吸道疾病已成为全球和区域性降低非传染性疾病可避免的过早死亡的主要驱动力，而物质使用障碍导致的过早死亡，
解释
在世界范围内，非传染性疾病的可避免的过早死亡已大大减少，但是各个人群的进步并不平衡。各国的当前水平和趋势存在很大差异，因此，它们在实现可持续发展目标3.4方面的步入正轨。通过考虑可避免的过早死亡，同时避免任意年龄限制，非传染性疾病可避免的过早死亡是量化和监测全球和国家在预防和控制非传染性疾病方面的进展的有力，全面和可操作的指标。
资金
没有。
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