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[JAMA最新发表]:1980-2014年美国感染性疾病死亡率的变化趋势
2018年03月30日 时讯速递, 进展交流 暂无评论

Original Investigation

March 27, 2018

Trends and Patterns of Differences in Infectious Disease Mortality Among US Counties, 1980-2014

Charbel el Bcheraoui, Ali H. Mokdad, Laura Dwyer-Lindgren, et al

JAMA. 2018;319(12):1248-1260. doi:10.1001/jama.2018.2089

Abstract

Importance 背景

Infectious diseases are mostly preventable but still pose a public health threat in the United States, where estimates of infectious diseases mortality are not available at the county level.

尽管感染性疾病可以预防,但在美国仍然是重要的公共卫生威胁。尚缺乏县级水平感染性疾病死亡率的数据。

Objective 目的

To estimate age-standardized mortality rates and trends by county from 1980 to 2014 from lower respiratory infections, diarrheal diseases, HIV/AIDS, meningitis, hepatitis, and tuberculosis.

估算1980年至2014年各个县因下呼吸道感染、腹泻、HIV/AIDS、脑膜炎、肝炎和结核致死的年龄标化死亡率及其变化趋势

Design and Setting 设计及场景

This study used deidentified death records from the National Center for Health Statistics (NCHS) and population counts from the US Census Bureau, NCHS, and the Human Mortality Database. Validated small-area estimation models were applied to these data to estimate county-level infectious disease mortality rates.

研究采用了国家卫生统计中心(NCHS)的死亡记录,以及美国人口统计局、NCHS及人类死亡数据库的人口数据资料。针对上述资料进行小范围估算模型验证,以估算县级水平的感染性疾病死亡率。

Exposures 暴露因素

County of residence.

居住地所在县

Main Outcomes and Measures 主要预后指标

Age-standardized mortality rates of lower respiratory infections, diarrheal diseases, HIV/AIDS, meningitis, hepatitis, and tuberculosis by county, year, and sex.

按照县、年份及性别划分的下呼吸道感染、腹泻、HIV/AIDS、脑膜炎、肝炎和结核的年龄标化死亡率

Results 结果

Between 1980 and 2014, there were 4 081 546 deaths due to infectious diseases recorded in the United States. In 2014, a total of 113 650 (95% uncertainty interval [UI], 108 764-117 942) deaths or a rate of 34.10 (95% UI, 32.63-35.38) deaths per 100 000 persons were due to infectious diseases in the United States compared to a total of 72 220 (95% UI, 69 887-74 712) deaths or a rate of 41.95 (95% UI, 40.52-43.42) deaths per 100 000 persons in 1980, an overall decrease of 18.73% (95% UI, 14.95%-23.33%). Lower respiratory infections were the leading cause of infectious diseases mortality in 2014 accounting for 26.87 (95% UI, 25.79-28.05) deaths per 100 000 persons (78.80% of total infectious diseases deaths). There were substantial differences among counties in death rates from all infectious diseases. Lower respiratory infection had the largest absolute mortality inequality among counties (difference between the 10th and 90th percentile of the distribution, 24.5 deaths per 100 000 persons). However, HIV/AIDS had the highest relative mortality inequality between counties (10.0 as the ratio of mortality rate in the 90th and 10th percentile of the distribution). Mortality from meningitis and tuberculosis decreased over the study period in all US counties. However, diarrheal diseases were the only cause of infectious diseases mortality to increase from 2000 to 2014, reaching a rate of 2.41 (95% UI, 0.86-2.67) deaths per 100 000 persons, with many counties of high mortality extending from Missouri to the northeastern region of the United States.

1980年至2014年间,美国共有4081546人因感染性疾病死亡。在2014年,美国共有113650人(95%不确定区间[UI],108764-117942)因感染性疾病死亡,相当于每100000人34.10例死亡 (95% UI, 32.63-35.38),1980年共有72 220人 (95% UI, 69 887-74 712) 因感染性疾病死亡,相当于每100000人 41.95例 (95% UI, 40.52-43.42) 死亡,下降18.73% (95% UI, 14.95%-23.33%) 。在2014年感染性疾病死亡率中,下呼吸道感染位居首位,死亡率为每100000人 26.87 例(95% UI, 25.79-28.05) (占感染性疾病死亡的78.80%)。对于所有感染性疾病而言,各个县的死亡率存在显著差异。各县之间下呼吸道感染死亡率的绝对值差异最大(分布的第10和第90百分位差异,每100000人24.5例死亡),而HIV/AIDS死亡率的相对差异最大(分布的第90与第10百分位比值为10.0)。脑膜炎和结核死亡率在所有县均呈现下降趋势。然而,在所有感染性疾病中,仅有腹泻的死亡率在2000-2014年间呈升高趋势,达到每100000人2.41例(95% UI, 0.86-2.67)死亡,从密苏里州到美国东北部的死亡率较高。

Conclusions and Relevance 结论和意义

Between 1980 and 2014, there were declines in mortality from most categories of infectious diseases, with large differences among US counties. However, over this time there was an increase in mortality for diarrheal diseases.

在1980至2014年间,美国多数感染性疾病的死亡率降低,县级水平存在较大差异。然而,在此期间,腹泻的死亡率呈升高趋势。

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