一个最新的有关全球健康的分析表示：在2013年，世界人口中只有大约4％没有任何健康问题。三分之一的人口约23亿人，有至少五个以上的健康问题。而且情况越来越糟糕，而不是在变得更好：根据全球疾病负担研究，世界范围内的身体健康的人的比例正在逐年丢失——疾病率从1990年的21％上升到2013年的31％。越来越多的老年人也意味着，伴随健康问题生活的人群数量将在未来几十年里迅速攀升。

　　这篇研究结果在线发表在最新的The Lancet。该研究涉及来自188个国家，超过300种疾病和损伤的数据。是目前关于世界人口健康问题趋势的最大调查，涵盖了1990年到2013年。

　　在1990年和2013年，全球背景下引起健康状况不佳的主要问题是：腰背疼痛、抑郁、缺铁性贫血、颈部疼痛和年龄相关的听力损失。在2013年，两个健康状况——肌肉骨骼问题（主要如腰痛、颈肩痛和关节炎）和心理健康/物质滥用障碍（主要是抑郁、焦虑、吸毒和酗酒）占了改变健康生活原因统计的近一半情况。

　　根据这项研究，2013年，世界上每10人中就有1个患有以下疾病中的至少一个：蛀牙、紧张性头痛、缺铁性贫血、年龄相关的听力损失、生殖器疱疹、偏头痛、肠蛔虫和称为葡萄糖-6-磷酸脱氢酶缺乏症的遗传性血液病症。该研究还发现了1990年至2013年的“惊人”上升：因 、老年痴呆症和关节炎引起的病症。

　　研究人员指出，社会关注似乎更倾向于应对死亡率而非降低残疾率。例如，研究发现全球 患者在过去23年实际增加了43％，而 死亡人数仅增长了9％。

　　研究报告的作者，华盛顿大学全球卫生计量和评估研究所的教授Theo Vos表示说：“一些可以预防的健康问题，特别是情节特别严重肌肉骨骼疾病和精神/行为障碍，大部分并没有得到应有的重视”。解决这些问题，需要将卫生工作重点转向世界各地。不能只是延长寿命，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.