1、全球卫生公平性研究及中国省级健康差异提要1. 全球卫生的差距与不公平性：全球疾病负担研究及其带给我们的启示2. 中国省级疾病负担的差异及其对我国医疗卫生改革的潜在影响2全球疾病负担研究 Global Burden of Disease1) 为全球192个国家和地区提供可对比的流行病水平和趋势分析2) 研究囊括306种疾病，2337 种后遗症和76种风险因素。3) 研究提供横向和纵向可比的死亡率，死亡数，发病率，患病率，伤残调整生命年，生命损失年，等等。4) 全球疾病负担研究的结果自2012年以来发表在柳叶刀17篇，JAMA， NEJM, PLoS Medicine 等顶级学术期刊。研究结果作为
2、公益数据，可以在我们的网站获得：http:/www.healthdata.org/results/data-visualizations3全球疾病负担研究的主要数据使用和结果All-cause MortalityCauses of DeathEstimation of the number and rate of deaths byage and sex is a key first stage for calculatingthe burden of disease in order to constrainestimates of cause-specific mortality and
3、tomeasure premature mortality.Estimation of specific causes of death by ageand sex is important for informing health policyand interventions. These estimates are then fitto all-cause mortality estimates. The GBD causelist is mutually exclusive and collectivelyexhaustive.YLLs, DALYs,YLDs, HALENon-Fat
4、al OutcomesNon-fatal health outcomes from diseases andinjuries are a crucial consideration in thepromotion andmonitoring of individual and population health.Sequelae are estimated for all GBD causeswhich cause disability.Risk FactorsQuantification of the disease burden caused bydifferent risks infor
5、ms prevention by providingan account of health loss different to thatprovided by a disease-by-disease analysis. Riskburden is estimated for death and disabilityusing cause-risk pairs.61990和2013年的全球死亡数分布7分年龄死亡率的全球不公平性：基尼系数81990年到2013年全球预期寿命变化的死因分解2013年全球寿命损失的主要死因贡献1990年至2013年全球儿童死亡率变化的经济学分析11全球伤残调整年的
6、主要死因贡献12Epidemiological transition: predicted DALY rates for YLLs andYLDs by cause as a function of socio-demographic status13按伤残划分的存活水平及其与社会人口因素的关系，社会经济水平最低的20%的全球人口，2013按伤残划分的存活水平及其与社会人口因素的关系，社会经济水平最高的20%的全球人口，2013提要1. 全球卫生的差距与不公平性：全球疾病负担研究及其带给我们的启示2. 中国省级疾病负担的差异及其对我国医疗卫生改革的潜在影响16中国的流行病与人口转型Life e
7、xpectancy in 90and 13 and change inlife expectancy from 9013 decomposed intothe contribution ofmajor groups of causesof death for eachprovince, males.Life expectancy in90 and 13 andchange in lifeexpectancy from 9013 decomposedinto the contributionof major groups ofcauses of death foreach province,fe
8、males.18我国2013年分省的男性主要死因：按年龄标化死亡率计算19我国2013年分省的女性主要死因：按年龄标化死亡率计算20中国疾病负担研究的主要结果1) China has made extraordinary progress reducing childmortality and increasing life expectancy.2) Gaps between best and worst have narrowed substantially interms of life expectancy at birth for males and females butremai
9、n very large.3) Shift from infectious diseases to non-communicable causes isoccurring in all provinces. On top of this general theme, thereare important local or regional variations.4) Pace of demographic change is fast; the number of non-communicable YLLs has increased from 47.4% in 1990 to75.4% in
10、 2013. This trend is highly likely to continue, alongwith the associated health system implications.脑卒中1) Stroke remains the leading cause of premature mortality inChina and in 23 of 33 provinces.2) Age-standardized rates vary more than five-fold from a low of49.1 in women in Hong Kong to a high of
11、289.4 in men inGuizhou.3) 11 of 33 provinces for men and 18 of 33 provinces for womenhad significant declines in age-standardized stroke deathrates.4) Given the prominence of stroke as a cause of death and thehuge gradients in the country, China needs a strokeprevention policy focused on the poorer
12、provinces with thehighest rates.癌症1) China has high rates of cancer mortality, particularly for lung,liver, stomach and esophageal cancer. China ranked 8th forlung cancer mortality, 18th for liver cancer, 10th for stomachcancer and 12th for esophageal cancer across 188 countries.2) Some fraction of
13、all four cancers can be related to tobaccoconsumption. Prevalence of daily smoking in males was 45%in 2012 and 2% for females, pointing to the huge potential inmales of reducing cancer through reducing tobaccoconsumption.3) The role of hepatitis B and hepatitis C is well recognized forliver cancer.
14、Liver cancer is a particular problem in Fujian,Heilongjiang, Sichuan, Guangxi, and Henan.道路伤害1) Road injury death rates in men peaked in 2005. Acrossprovinces, rates vary nearly 20-fold from 49.9 per 100,000 inQinghai males to as low as 2.7 per 100,000 in Hong Kongfemales.2) Relatively constant rate
15、s overtime during a period ofextraordinary increase in motorization suggests that fatalitiesper vehicle have declined substantially.3) The majority of road injury deaths， 70.9%， are inpedestrians and motorcyclists. Studies have demonstratedthat effective and often inexpensive interventions such asse
16、atbelts, helmet use for motorcycles, traffic separation, trafficcalming and drunk driving interventions have low levels ofcost for implementation.自杀1) Age-standardized rates for China overall in 1990 were 23.6but varied across provinces from a low of 8.4 (6.0, 10.2) inBeijing to a high of 46.1 (36.6
17、, 55.3) per 100,000 in Hubei.2) Over the period 1990 to 2013, the age-standardized femalesuicide rate declined 69.9% for China, ranging acrossprovinces from a decline of 35.9 % in Hong Kong to 81.3% inTianjin.3) Because of progress in nearly all provinces, the variation infemale suicide rates remain
18、s 10 fold across provinces. Maleage-standardized rates are now higher than female in all 33provinces.4) Given that suicide is a top ten cause of YLLs in 12 of 33provinces, active intervention strategies are needed despitethe progress driven by socio-economic development.COPD1. Despite continued high
19、 levels of tobacco consumption inmales and low levels in females, COPD has been decliningsubstantially in both sexes.2. Other key determinants of COPD may include exposure tohousehold air pollution, ambient air pollution, history oftuberculosis, lower respiratory tract infections in childhood,and poverty.3. Given the importance of COPD as a cause of death in China,the recent declines are welcome. Learning from provinces orcommunities where declines have been the largest mightprovide insights into accelerating progress in otherpopulations.我国流病和人口健康分布的主要特征PM2.5的分布情况（2013）28PM2.5 对预期寿命的主要影响
