贫血是造成全球疾病负担的重要因素,其中地中海贫血是最常见的遗传性贫血疾病。以前的估计是基于地理有限的数据,缺乏全面的全球分析。这项研究提供了患病率,发病率,1990年至2021年期间,204个国家和地区的地中海贫血死亡率和残疾调整寿命年(DALYs),重点关注疾病负担的年龄结构和时间趋势。为卫生政策提供有效的信息,医疗资源配置和优化患者管理方案。
■使用标准化的全球疾病负担(GBD)方法,我们旨在通过考虑四种不同类型的流行病学数据来更准确地表示地中海贫血造成的健康负担,即出生时的发病率,患病率,死亡率和DALY。所提供的数据经过精心估算,并显示为数字计数和每100,000人口的年龄标准化率,伴随着不确定性区间(UI),以突出潜在的统计变异性。使用Joinpoint回归分析对1990-2021年的时间趋势进行了严格的检查。这种方法有助于计算年百分比变化(APC)和平均年百分比变化(AAPC),以及它们相应的95%置信区间(CI)。
■全球,年龄标准化患病率(ASPR),年龄标准化发病率(ASIR),年龄标准化死亡率(ASMR),2021年地中海贫血的年龄标准化DALYs率为每100,000人中18.28人(95%UI15.29-22.02),每100,000人1.93(95%UI1.51-2.49),每100,000人0.15(95%UI0.11-0.20),和每100,000人11.65(95%UI8.24-14.94),分别。与1990年相比,这些比率下降了0.18(95%UI-0.22至-0.14),0.25(95%UI-0.30至-0.19),0.48(95%UI-0.60至-0.28),和0.49(95%UI-0.62至-0.29)。2021年,东亚地区地中海贫血的ASIR最高,为每100,000人7.35(95%UI5.37-10.04),东南亚ASMR最高,为每100,000人中0.37人(95%UI0.29-0.45)。性别比较显示疾病负担差异可忽略不计,五岁以下儿童的患病率最高,随着年龄的增长而减少。从1990年到2021年,全球ASPR和ASMR总体下降,尽管老年人的患病率呈上升趋势。Joinpoint分析显示,全球ASPR在2018年至2021年期间增长(APC=9.2%,95%CI:4.8%-13.8%,P<0.001),ASIR下降(APC=-7.68%,95%CI:-10.88%至-4.36%,P<0.001),从2019年到2021年,ASMR大幅上升(APC=4.8%,95%CI:0.1%-9.6%,P<0.05)。ASPR和ASMR的趋势因地区而异,南亚发生了显著的变化。
■地中海贫血的全球负担,反映在它的流行程度上,发病率,死亡率,和DALYs,表现出显著的差异。从1990年到2021年,已经观察到疾病分布的地理和人口变化,负担总体下降。然而,老年人口的病例有所增加。随着时间的流行病学趋势分析突出了卫生政策和重大公共卫生干预措施对地中海贫血结局的影响。数据对医疗保健专业人员至关重要,政策制定者,和研究人员完善和加强管理策略,旨在进一步减轻地中海贫血的全球影响。
■国家自然科学基金;贵州省科技项目;贵州省卫生健康委员会科技基金。
UNASSIGNED: Anemia is a significant contributor to the global disease burden, of which thalassemia is the most common hereditary anaemic disease. Previous estimates were based on data that were geographically limited and lacked comprehensive global analysis. This study provides the prevalence, incidence, mortality and disability-adjusted life years (DALYs) of thalassemia in 204 countries and regions of thalassemia between 1990 and 2021, focusing on the age structure and time trends of the disease burden. To provide effective information for health policy, allocation of medical resources and optimization of patient management programs.
UNASSIGNED: Using the standardised Global Burden of Disease (GBD) methodologies, we aimed to derive a more precise representation of the health burden posed by thalassemia by considering four distinct types of epidemiological data, namely the incidence at birth, prevalence, mortality and DALYs. The presented data were meticulously estimated and displayed both as numerical counts and as age-standardised rates per 100,000 persons of the population, accompanied by uncertainty interval (UI) to highlight potential statistical variability. The temporal trends spanning the years 1990-2021 were subjected to a rigorous examination utilizing Joinpoint regression analysis. This methodological approach facilitated the computation of the annual percentage change (APC) and the average annual percentage change (AAPC), along with their corresponding 95% confidence intervals (CIs).
UNASSIGNED: Globally, the age-standardized prevalence rates (ASPR), age-standardized incidence rates (ASIR), age-standardized mortality rates (ASMR), and age-standardized DALYs rates for thalassemia in 2021 were 18.28 per 100,000 persons (95% UI 15.29-22.02), 1.93 per 100,000 persons (95% UI 1.51-2.49), 0.15 per 100,000 persons(95% UI 0.11-0.20), and 11.65 per 100,000 persons (95% UI 8.24-14.94), respectively. Compared to 1990, these rates have decreased by 0.18 (95% UI -0.22 to -0.14), 0.25 (95% UI -0.30 to -0.19), 0.48 (95% UI -0.60 to -0.28), and 0.49 (95% UI -0.62 to -0.29) respectively. In 2021, the ASIR of thalassemia was highest in East Asia at 7.35 per 100,000 persons (95% UI 5.37-10.04), and ASMR was highest in Southeast Asia at 0.37 per 100,000 persons (95% UI 0.29-0.45).Gender comparisons showed negligible differences in disease burden, with the highest prevalence noted in children under five, decreasing with age. The global ASPR and ASMR declined from 1990 to 2021 overall, though an increasing trend in prevalence was found among the elderly. Joinpoint analysis revealed that the global ASPR increased between 2018 and 2021 (APC = 9.2%, 95% CI: 4.8%-13.8%, P < 0.001), ASIR decreased (APC = -7.68%, 95% CI: -10.88% to -4.36%, P < 0.001), and there was a significant rise in ASMR from 2019 to 2021 (APC = 4.8%, 95% CI: 0.1%-9.6%, P < 0.05). Trends in ASPR and ASMR varied across regions, with notable changes in South Asia.
UNASSIGNED: The global burden of thalassemia, reflected in its prevalence, incidence, mortality, and DALYs, exhibits significant disparities. Geographic and demographic shifts in disease distribution have been observed from 1990 to 2021, with an overall decrease in burden, yet an increase in cases among the elderly population. Analysis of epidemiological trends over time highlights the influence of health policies and significant public health interventions on thalassemia outcomes. There data are crucial for healthcare professionals, policymakers, and researchers to refine and enhance management strategies, aiming to further mitigate thalassemia\'s global impact.
UNASSIGNED: National Natural Science Foundation of China; Guizhou Province Science and Technology Project; Guizhou Province Science and Technology Foundation of Health Commission.