背景:这项研究考察了获得性免疫缺陷综合征(AIDS)发病率的全球趋势,死亡率,和1990年至2019年的残疾调整寿命年(DALYs),重点关注艾滋病发病率的地区差异,死亡率,不同水平的社会人口指数(SDI)和DALY。它还调查了艾滋病发病率的变化,死亡率,和不同年龄段的DALY,并预测未来25年的具体趋势。
方法:从GBD研究中获得了204个国家和地区1990年至2019年艾滋病的综合数据。这包括艾滋病发病率的信息,死亡率,DALYs,和年龄标准化率(ASR)。使用贝叶斯年龄周期队列模型生成了未来25年艾滋病发病率和死亡率的预测。
结果:从1990年到2019年,全球HIV病例发病率从1,989,282增加到2,057,710,而年龄标准化发病率(ASIR)从37.59下降到25.24,估计年变化百分比(EAPC)为-2.38。ASIR在高SDI和中高SDI地区表现出上升趋势,SDI中部地区的稳定趋势,中低SDI和低SDI地区呈下降趋势。在SDI较高的地区,男性的ASIR高于女性,而在较低的SDI地区则相反。整个1990年至2019年,年龄标准化死亡率(ASDR)和年龄标准化DALY率保持稳定,EAPC分别为0.24和0.08。影响妇女和五岁以下儿童的艾滋病毒负担最高的国家主要位于SDI较低地区,特别是在撒哈拉以南非洲。预测显示,今后25年艾滋病按年龄标出的发病率和死亡率持续显著下降,总体和性别。
结论:全球ASIR从1990年到2019年下降。在较低的SDI地区观察到较高的发病率和死亡率,表明女性和<15岁的人更容易感染艾滋病。这突出表明,迫切需要增加该地区防治艾滋病的资源,重点关注保护妇女和<15岁的优先群体。在撒哈拉以南非洲,艾滋病的流行仍然很严重。未来25年的预测表明,年龄标准化的发病率和死亡率都将大幅下降。
BACKGROUND: This study examines global trends in acquired immune deficiency syndrome (AIDS) incidence, mortality, and disability-adjusted life years (DALYs) from 1990 to 2019, focusing on regional disparities in AIDS incidence, mortality, and DALYs across various levels of socio-demographic index (SDI). It also investigates variations in AIDS incidence, mortality, and DALYs across different age groups, and projects specific trends for the next 25 years.
METHODS: Comprehensive data on AIDS from 1990 to 2019 in 204 countries and territories was obtained from a GBD study. This included information on AIDS incidence, mortality, DALYs, and age-standardized rates (ASRs). Projections for AIDS incidence and mortality over the next 25 years were generated using the Bayesian age-period-cohort model.
RESULTS: From 1990 to 2019, the global incidence of HIV cases increased from 1,989,282 to 2,057,710, while the age-standardized incidence rate (ASIR) decreased from 37.59 to 25.24 with an estimated annual percentage change (EAPC) of -2.38. The ASIR exhibited an upward trend in high SDI and high-middle SDI regions, a stable trend in middle SDI regions, and a downward trend in low-middle SDI and low SDI regions. In regions with higher SDI, the ASIR was higher in males than in females, while the opposite was observed in lower SDI regions. Throughout 1990 to 2019, the age-standardized death rate (ASDR) and age-standardized DALY rate remained stable, with EAPCs of 0.24 and 0.08 respectively. Countries with the highest HIV burden affecting women and children under five years of age are primarily situated in lower SDI regions, particularly in sub-Saharan Africa. Projections indicate a significant continued decline in the age-standardized incidence and mortality rates of AIDS over the next 25 years, for both overall and by gender.
CONCLUSIONS: The global ASIR decreased from 1990 to 2019. Higher incidence and death rates were observed in the lower SDI region, indicating a greater susceptibility to AIDS among women and < 15 years old. This underscores the urgent need for increased resources to combat AIDS in this region, with focused attention on protecting women and < 15 years old as priority groups. The AIDS epidemic remained severe in sub-Saharan Africa. Projections for the next 25 years indicate a substantial and ongoing decline in both age-standardized incidence and mortality rates.