Global burden of diseases, injuries and risk factors, a bridge between disease epidemiology, risk assessment and public health policy

摘要

The Global Burden of Diseases, Injuries and Risk Factors study (GBD) is a systematic, scientific effort to quantify the comparative magnitude of health loss. In GBD 2013 the health loss due to 240 causes of death and 301 causes of morbidity, and 79 risk factors was estimated in terms of deaths, years of life lost due to premature death and years lived with disability. Estimates were generated for 188 countries and for subnational locations in China, Mexico, and the United Kingdom by age and by sex and 5 years intervals from 1990 to 2015. More than 1400 collaborators provided feedback and oversaw the project. Moreover, GBD is equipped with a rich scientific team as well as a strong computational infrastructure, visualizations, and communication experts for the global dissemination of results and engagement. In GBD 2013, we estimated that 802 million deaths were related to exposure to environmental and occupational risks in 2013. More than 5.5 million deaths were caused by air pollution and about one million by lead and residential exposure to radon. Satellite measurements, a chemical transport model and ground monitoring measurements of air particulate matter concentration were analyzed to estimate the annual average of fine particle (PM2.5) at 0.1 ° x 0.1 ° spatial resolution. Concentration response curve analysis provided the effect size of air pollution on the health outcomes. In 2013, 3.0% (95% Cl: 2.5 - 3.5%) of the total burden (in terms of disability adjusted life years, DALYs) was lost due to the exposure to PM2.5 pollution. Globally, 14.6% of cardiovascular deaths, 4.2% of lower respiratory infection, 4.0% of chronic respiratory diseases deaths, and 3.6% of cancer deaths can be attributed to exposure to PM2.5 of more than 8.7 μg/m3. Exposure to ambient air pollution is the top environmental risk in Western Europe. The age-standardized mortality rate in southern Europe including Italy, Spain and France is about three-folds higher than Nordic countries except the Netherlands and Denmark with 24.8 and 15.5 deaths per 100,000 in 2013, respectively. In this presentation, I will present an overview of the methodology for estimating disease and risk factor burden in GBD and discuss results and challenges of quantifying ambient air pollution adverse health effects.