건강과 대안 » The Lancet

[통계] 세계질병부담연구 2010

건강과대안 — Fri, 14 Dec 2012 12:32:26 +0000

Global Burden of Disease Study 2010

The Lancet Published Dec 13, 2012

http://www.thelancet.com/themed/global-burden-of-disease

Executive summary

The Global Burden of Disease Study 2010 (GBD 2010) is the largest ever systematic effort to describe the global distribution and causes of a wide array of major diseases, injuries, and health risk factors. The results show that infectious diseases, maternal and child illness, and malnutrition now cause fewer deaths and less illness than they did twenty years ago. As a result, fewer children are dying every year, but more young and middle-aged adults are dying and suffering from disease and injury, as non-communicable diseases, such as cancer and heart disease, become the dominant causes of death and disability worldwide. Since 1970, men and women worldwide have gained slightly more than ten years of life expectancy overall, but they spend more years living with injury and illness.

GBD 2010 consists of seven Articles, each containing a wealth of data on different aspects of the study (including data for different countries and world regions, men and women, and different age groups), while accompanying Comments include reactions to the study’s publication from WHO Director-General Margaret Chan and World Bank President Jim Yong Kim. The study is described by Lancet Editor-in-Chief Dr Richard Horton as “a critical contribution to our understanding of present and future health priorities for countries and the global community.”

“아프지만 오래 산다”…수명·만성질환 모두↑

연합뉴스 2012/12/14 09:51 송고 http://www.yonhapnews.co.kr/international/2012/12/14/0606000000AKR20121214056600009.HTML?template=2087
: 전 세계 평균 기대수명이 늘어난 가운데 만성질환에 시달리는 경우도 함께 증가했다는 연구결과가 나왔다. 미국 워싱턴대학의 보건계량평가연구소 등이 진행한 ‘세계질병부담연구2010′ 결과, ‘건강 기대수명(건강수명)’이 1990년부터 2010년 사이 평균 10세가량 연장된 것으로 나타났다. 사진은 건강검진 받는 노인들.(자료사진)

전세계 평균 건강수명 20년전보다 10세 늘어

만성질환에 시달리는 경우도 늘어

(런던 AP·블룸버그=연합뉴스) 전 세계 평균 기대수명이 늘어난 가운데 만성질환에 시달리는 경우도 함께 증가했다는 연구결과가 나왔다.

미국 워싱턴대학의 보건계량평가연구소 등이 진행한 ‘세계질병부담연구2010′ 결과, ‘건강 기대수명(건강수명)’이 1990년부터 2010년 사이 평균 10세가량 연장된 것으로 나타났다. 건강수명이란 평균 수명에서 질병이나 부상 때문에 활동하지 못하는 기간을 뺀 기간을 의미한다.

50개국의 연구진 480여명이 참여한 이번 연구는 영국 의학전문잡지 ‘란셋’ 인터넷판에 13일(현지시간) 게재됐다.

조사 결과 남성의 건강수명은 62.8세에서 67.5세로, 여성은 68.1세에서 73.3세로 늘어났다.

국가별로는 1990년과 마찬가지로 일본이 2010년에도 건강수명이 가장 높은 국가 1위를 차지했다. 일본 남성과 여성의 기대수명은 각각 79세, 86세인 것으로 확인됐다.

1990년 이후 건강수명이 많이 늘어난 국가 중에는 한국과 싱가포르, 대만 등 아시아 국가가 다수 포함됐다.

이런 가운데 심장병이나 뇌졸중을 비롯한 만성질환이 인류를 죽음에 내모는 가장 위협적인 요인으로 부상했다.

연구진은 예방접종이 활발해지면서 감염성 질환에 따른 사망자 수는 줄어든 반면, 고령화가 진행됨에 따라 만성질환이 그 자리를 대신한 것이라고 설명했다.

1990년 1위를 차지했던 심장질환과 뇌졸중은 2010년에도 여전히 공동 1위를 지켰다. 한편, 폐암은 5위에, 간암과 위암, 결장암 등이 상위 20위권에 올라섰다.

연구에 참여한 페터 피오트 영국 런던대학 위생열대의학대학원장은 “우리는 가능한 한 오래 살면서도 생을 마감할 때까지 건강하게 살아야 하는데, 실상은 그렇지 못하다”고 말했다.

폐결핵이나 말라리아 같은 감염성 질환은 순위권 밖으로 밀려났다. 다만, 1990년 조사에서 35위에 그쳤던 에이즈(AIDS)가 20년 사이 사망원인 6위까지 뛰어올랐다.

에이즈는 특히 사하라 이남 아프리카에서 집중적으로 발병하는 것으로 확인됐다. 이 지역의 에이즈 발병은 2000년대 중반 최고점을 찍은 뒤 지금은 감소 추세를 보이고 있다.

한편, 국가에 따라 주요 사망원인이 다르게 나타나 연구진의 눈길을 끌었다.

남미 지역에서는 ‘살인’이 남성 사망원인 3위에 올랐다. 살인은 전 세계 사망원인으로는 20위 수준이며, 서유럽권에선 57위에 그쳤다.

전 세계 사망원인 21위에 오른 ‘자살’의 경우, 인도부터 중국에 걸친 아시아권에서 여성 사망원인 9위에 올랐다. 북미권에선 사망원인 14위, 서유럽에서 15위를 기록했다.

yuni@yna.co.kr

[돼지독감] 멕시코의 신종플루 감염 및 사망 분석 (랜싯)

건강과대안 — Thu, 12 Nov 2009 18:32:54 +0000

멕시코에서 2009년 4월 28일~6월 31일 인플루엔자 감시체계에 의해 수집된 정보를 분석함.

6월 31일까지 63,479건의 influenza-like illness 보고됨. 6,945건(11%) influenza A H1N1으로 확정진단. 확정진단을 받은 사례 중 6407건(92%)은 외래환자. 475건(7%)은 생존, 63건(<1%)은 사망. 10세~39세의 감염자는 3922건(56%). 치명율은 J자 모양의 곡선(J-shaped curve)을 보임. 70세 이상 사망율은 10·3%로 고연령군에서 가장 위험이 높게 나왔음.

계절성 독감 백신을 접종 받은 사람들의 사망 위험이 낮게 나왔음.(OR 0·65 [95% CI 0·55—0·77]). ) 입원이 지연되거나(1·19 [1·11—1·28] per day) 만성 질환자((6·1 [2·37—15·99])의 경우에 사망 위험이 더 높게 나왔음.

신종플루 치명율을 낮추기 위한 핵심요인은 위험정보교환(Risk communication)과 병원의 대응체계(hospital preparedness)라고 볼 수 있음.

이번에 [랜싯]지에 발표된 유사한 역학조사 결과 외에도 지난 10월 Journal of the American Medical Association (JAMA)에도 실린 멕시코의 중증환자 역학조사 결과(참고 : 10월 13일자 식품/의약품 자료실에 올려 놓은 논문 Critically Ill Patients With 2009 Influenza A(H1N1) in Mexico)도 참고할 것.

[랜싯]의 연구 결과를 HealthDay News는 “노령층일수록 돼지독감 위험 높아”로 보도하였고, AFP통신은 “젊은층일수록 돼지독감 감염 잘 돼”로 보도하였는데… 동일한 연구결과를 서로 다른 측면에서 해석한 것으로 볼 수 있음.

[참고 : 멕시코의 2009 인플루엔자 A(H1N1) 중증환자]

멕시코의 6개 병원에서 3월 18일~6월 1일 신종플루 확정진단 및 가진단을 받은 사람은 899명이었으며, 그 중에서 58명은 중증으로 진행되었으며, 중증환자의 평균 연령은 44세였습니다.

대부분의 중증 환자들에게 항생제를 투여했으며, 54명은 인공호흡기에 의지하였고, 그 중 45명은 타미플루나 릴렌자 같은 항바이러스제를 처방하였습니다.

58명의 중증환자 중에서 24명 (41.4%)이 입원한 지 60일 이내에 사망했습니다. (24명 중 19명은 입원한 지 2주 내에 사망했습니다)

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The Lancet, Early Online Publication, 12 November 2009

doi:10.1016/S0140-6736(09)61638-X Cite or Link Using DOI
http://www.thelancet.com/journals/lancet/article/PIIS0140-6736(09)61638-X/fulltext

Infection and death from influenza A H1N1 virus in Mexico: a retrospective analysis

Santiago Echevarría-Zuno MD a, Juan Manuel Mejía-Aranguré PhD b, Alvaro J Mar-Obeso MD b, Concepción Grajales-Muñiz MD b, Eduardo Robles-Pérez MSc b, Margot González-León MD b, Manuel Carlos Ortega-Alvarez MSc b, Cesar Gonzalez-Bonilla PhD b, Ramón Alberto Rascón-Pacheco MSc b, Dr Víctor Hugo Borja-Aburto PhD b

Summary

Background

In April, 2009, the first cases of influenza A H1N1 were registered in Mexico and associated with an unexpected number of deaths. We report the timing and spread of H1N1 in cases, and explore protective and risk factors for infection, severe disease, and death.

Methods

We analysed information gathered by the influenza surveillance system from April 28 to July 31, 2009, for patients with influenza-like illness who attended clinics that were part of the Mexican Institute for Social Security network. We calculated odds ratios (ORs) to compare risks of testing positive for H1N1 in those with influenza-like illness at clinic visits, the risk of admission for laboratory-confirmed cases of H1N1, and of death for inpatients according to demographic characteristics, clinical symptoms, seasonal influenza vaccine status, and elapsed time from symptom onset to admission.

Findings

By July 31, 63 479 cases of influenza-like illness were reported; 6945 (11%) cases of H1N1 were confirmed, 6407 (92%) were outpatients, 475 (7%) were admitted and survived, and 63 (<1%) died. Those aged 10—39 years were most affected (3922 [56%]). Mortality rates showed a J-shaped curve, with greatest risk in those aged 70 years and older (10·3%). Risk of infection was lowered in those who had been vaccinated for seasonal influenza (OR 0·65 [95% CI 0·55—0·77]). Delayed admission (1·19 [1·11—1·28] per day) and presence of chronic diseases (6·1 [2·37—15·99]) were associated with increased risk of dying.

Interpretation

Risk communication and hospital preparedness are key factors to reduce mortality from H1N1 infection. Protective effects of seasonal influenza vaccination for the virus need to be investigated.

Funding

None.

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Older People at Greater Risk of Swine Flu Death

출처 : HealthDay Wed Nov 11, 11:48 pm ET

WEDNESDAY, Nov. 11 (HealthDay News) — A study of H1N1 swine flu in Mexico finds that while babies and people under the age of 40 are most likely to get sick, elderly people have the highest death rates.

The research, published online Nov. 11 in The Lancet, analyzed medical records of patients at clinics in the Mexican Institute for Social Security network, who became sick with flu-like illnesses between April 28 and July 31, 2009.

The researchers found 63,479 cases of flu-like illness. Of the 6,945 confirmed cases of H1N1 swine flu, about 1 percent (63 patients) died. Seven percent (475 patients) were admitted to the hospital and lived.

Of those aged 70 and older who got sick, 10.3 percent died. By contrast, 0.9 percent of those aged 20 to 29 died, the study authors noted.

The researchers found that the risk of infection fell by 35 percent in those who received vaccinations for seasonal flu. Chronic disease boosted the risk of death by six times.

Those who didn’t go to the hospital within four days after developing symptoms boosted their risk of death by 20 percent for each extra day they delayed a hospital visit.

Pregnant women made up 6 percent of the deaths in Mexico. That rate is a bit lower than in the United States (8 percent) over the same time period.

“In Mexico, all pregnant workers were sent home during the peak of the pandemic, which probably accounts for this difference,” Dr. Victor Borja-Aburto of the Mexican Institute for Social Security in Mexico City, and colleagues wrote.

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Youngest likeliest to be infected, swine flu study confirms

출처 : AFP Wed Nov 11, 7:10 pm ET

PARIS (AFP) – New data from Mexico, the epicentre of the swine flu pandemic, has confirmed that young people are most at risk of catching the A(H1N1) virus but elderly patients are most at risk of dying from it.

The study bolsters the belief that the pathogen is not as virulent as first feared but also stresses the need for caution, as a mutation into a more lethal form cannot be ruled out.

Epidemiologists led by Victor Borja-Aburto of the Mexican Institute for Social Security looked at data for 63,479 people who had been treated for flu-like symptoms in public clinics from the start of the scare in April until the end of July.

Of the 6,945 cases confirmed by tests as H1N1, 56 percent occurred among people between 10 and 39 years, an age group with a high risk of contact through social interaction.

There were far fewer cases among older patients, which suggests that people in this age group were exposed in the past to a cousin to swine flu and may have gained some immunity, the author say.

But when analysed for mortality, a “J-shaped curve” revealed a preponderance of deaths among the elderly.

Among patients aged between 60 and 69, the death rate was 5.7 percent, compared with only 0.9 percent among patients aged between 20 and 29 years.

The study adds to several previous analyses which suggest vaccination against seasonal flu provides a partial shield.

It also strengthens warnings that people with chronic underlying disease are especially vulnerable. Individuals in this category increased their risk of death sixfold.

As of November, 1, more than 199 countries had reported lab-confirmed cases of swine flu, according to a toll published by the World Health Organisation (WHO) last Friday. There have been more than 482,300 notified cases and at least 6,071 deaths.

But the real number of swine flu infections is likely to be very much higher as many countries have stopped counting individual cases, says the WHO.

In addition, the count does not include people who have only mild symptoms — or no symptoms at all — and thus do not bother seeing a doctor.

The mortality rate from swine flu has been variously estimated at between 0.2 and 1.23 percent, according to the country or region or social group that is analysed.

At its lower range, this estimate is akin to the death toll from ordinary, so-called seasonal flu, of around 0.1 percent.

But even the highest figure is still only half of that for the 1918 Spanish flu, where the mortality rate is estimated to have been at least 2.5 percent. Tens of millions of people were killed in that event.

“Some researchers believe, with the information available up to now, that the present H1N1 influenza virus will not cause a pandemic on the scale of those during the 20th century,” said the new study, published online on Thursday by The Lancet.

“This pandemic might not be the one we expected; however, the virus is evolving and the threat continues.”

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