一個最新的有關全球健康的分析表示：在2013年，世界人口中隻有大約4％沒有任何健康問題。三分之一的人口約23億人，有至少五個以上的健康問題。而且情況越來越糟糕，而不是在變得更好：根據全球疾病負擔研究，世界範圍內的身體健康的人的比例正在逐年丟失——疾病率從1990年的21％上升到2013年的31％。越來越多的老年人也意味著，伴隨健康問題生活的人群數量將在未來幾十年裏迅速攀升。

　　這篇研究結果在線發表在最新的The Lancet。該研究涉及來自188個國家，超過300種疾病和損傷的數據。是目前關於世界人口健康問題趨勢的最大調查，涵蓋了1990年到2013年。

　　在1990年和2013年，全球背景下引起健康狀況不佳的主要問題是：腰背疼痛、抑鬱、缺鐵性貧血、頸部疼痛和年齡相關的聽力損失。在2013年，兩個健康狀況——肌肉骨骼問題（主要如腰痛、頸肩痛和關節炎）和心理健康/物質濫用障礙（主要是抑鬱、焦慮、吸毒和酗酒）占了改變健康生活原因統計的近一半情況。

　　根據這項研究，2013年，世界上每10人中就有1個患有以下疾病中的至少一個：蛀牙、緊張性頭痛、缺鐵性貧血、年齡相關的聽力損失、生殖器皰疹、偏頭痛、腸蛔蟲和稱為葡萄糖-6-磷酸脫氫酶缺乏症的遺傳性血液病症。該研究還發現了1990年至2013年的“驚人”上升：因糖尿病、老年癡呆症和關節炎引起的病症。

　　研究人員指出，社會關注似乎更傾向於應對死亡率而非降低殘疾率。例如，研究發現全球糖尿病患者在過去23年實際增加了43％，而糖尿病死亡人數僅增長了9％。

　　研究報告的作者，華盛頓大學全球衛生計量和評估研究所的教授Theo Vos表示說：“一些可以預防的健康問題，特別是情節特別嚴重肌肉骨骼疾病和精神/行為障礙，大部分並沒有得到應有的重視”。解決這些問題，需要將衛生工作重點轉向世界各地。不能隻是延長壽命，也要保持健康。

　　DOI: 10.1016/S0140-6736(15)60692-4

　　PMC

　　PMID

Global, regional,andnational incidence, prevalence, and years lived with disability for 301 acute and chronicDiseases and injuries in 188 countries, 1990–2013: a systematic analysis for the Global BurdenofDisease Study 2013

　　Global Burden of Disease Study 2013 Collaborators

Summary

　　Background

　　Up-to-date evidence about levels and trends in disease and injury incidence, prevalence, and years lived with disability (YLDs) is an essential input into global, regional, and national health policies. In the Global Burden of Disease Study 2013 (GBD 2013), we estimated these quantities for acute and chronic diseases and injuries for 188 countries between 1990 and 2013.

　　Methods

　　Estimates were calculated for disease and injury incidence, prevalence, and YLDs using GBD 2010 methods with some important refinements. Results for incidence of acute disorders and prevalence of chronic disorders are new additions to the analysis. Key improvements include expansion to the cause andsequelaelist, updated systematic reviews, use of detailed injury codes, improvements to the Bayesian meta-regression method (DisMod-MR), and use of severity splits for various causes. An index of data representativeness, showing data availability, was calculated for each cause and impairment during three periods globally and at the country level for 2013. In total, 35?620 distinct sources of data were used and documented to calculated estimates for 301 diseases and injuries and 2337 sequelae. The comorbidity simulation provides estimates for the number of sequelae, concurrently, by individuals by country, year, age, and sex. Disability weights were updated with the addition of new population-based survey data from four countries.

　　Findings

　　Disease and injury were highly prevalent; only a small fraction of individuals had no sequelae. Comorbidity rose substantially with age and in absolute terms from 1990 to 2013. Incidence of acute sequelae were predominantly infectious diseases and short-term injuries, with over 2 billion cases of upper respiratory infections and diarrhoeal disease episodes in 2013, with the notable exception of tooth pain due to permanent caries with more than 200 million incident cases in 2013. Conversely, leading chronic sequelae were largely attributable to non-communicable diseases, with prevalence estimates for asymptomatic permanent caries and tension-type headache of 2·4 billion and 1·6 billion, respectively. The distribution of the number of sequelae in populations varied widely across regions, with an expected relation between age and disease prevalence. YLDs for both sexes increased from 537·6 million in 1990 to 764·8 million in 2013 due to population growth and ageing, whereas the age-standardised rate decreased little from 114·87 per 1000 people to 110·31 per 1000 people between 1990 and 2013. Leading causes of YLDs included low back pain and major depressive disorder among the top ten causes of YLDs in every country. YLD rates per person, by major cause groups, indicated the main drivers of increases were due to musculoskeletal, mental, and substance use disorders, neurological disorders, and chronic respiratory diseases; however HIV/AIDS was a notable driver of increasing YLDs in sub-Saharan Africa. Also, the proportion of disability-adjusted life years due to YLDs increased globally from 21·1% in 1990 to 31·2% in 2013.

　　Interpretation

　　Ageing of the world's population is leading to a substantial increase in the numbers of individuals with sequelae of diseases and injuries. Rates of YLDs are declining much more slowly than mortality rates. The non-fatal dimensions of disease and injury will require more and more attention from health systems. The transition to non-fatal outcomes as the dominant source of burden of disease is occurring rapidly outside of sub-Saharan Africa. Our results can guide future health initiatives through examination of epidemiological trends and a better understanding of variation across countries.