全球阿片类药物依赖的流行病学和负担：来自 2010 年全球疾病负担研究的结果。
The global epidemiology and burden of opioid dependence: results from the global burden of disease 2010 study.
机构信息
National Drug and Alcohol Research Centre, University of New South Wales, Sydney, NSW, Australia; Melbourne School of Population and Global Health, University of Melbourne, Melbourne, Vic., Australia; Institute for Health Metrics and Evaluation, University of Washington, Seattle, WA, USA.
出版信息
Addiction. 2014 Aug;109(8):1320-33. doi: 10.1111/add.12551. Epub 2014 Apr 24.
AIMS
To estimate the prevalence and burden of disease attributable to opioid dependence globally, regionally and at country level.
METHODS
Multiple search strategies: (i) peer-reviewed literature searches; (ii) systematic searches of online databases; (iii) internet searches; (iv) consultation and feedback from experts. Culling and data extraction followed protocols. DisMod-MR, the latest version of the generic disease modelling system, a Bayesian meta-regression tool, imputed prevalence by age, year and sex for 187 countries and 21 regions. Disability weight for opioid dependence was estimated through population surveys and multiplied by prevalence data to calculate the years of life lived with disability (YLDs). Opioid dependence premature mortality was computed as years of life lost (YLLs) and summed with YLDs to calculate disability-adjusted life years (DALYs).
RESULTS
There were 15.5 million opioid-dependent people globally in 2010 [0.22%, 95% uncertainty interval (UI) = 0.20-0.25%]. Age-standardized prevalence was higher in males (0.30%, 95% UI = 0.27-0.35%) than females (0.14%, 95% UI = 0.12-0.16%), and peaked at 25-29 years. Prevalence was higher than the global pooled prevalence in Australasia (0.46%, 95% UI = 0.41-0.53%), western Europe (0.35%, 95% UI = 0.32-0.39) and North America (0.30%, 95% UI = 0.25-0.36). Opioid dependence was estimated to account for 9.2 million DALYs globally (0.37% of global DALYs) in 2010, a 73% increase on DALYs estimated in 1990. Regions with the highest opioid dependence DALY rates were North America (292.1 per 100,000), eastern Europe (288.4 per 100,000), Australasia (278.6 per 100,000) and southern sub-Saharan Africa (263.5 per 100,000). The contribution of YLLs to opioid dependence burden was particularly high in North America, eastern Europe and southern sub-Saharan Africa.
CONCLUSION
Opioid dependence is a substantial contributor to the global disease burden; its contribution to premature mortality (relative to prevalence) varies geographically, with North America, eastern Europe and southern sub-Saharan Africa most strongly affected.
目的
估计全球、地区和国家层面归因于阿片类药物依赖的疾病负担和疾病负担。
方法
采用多种搜索策略：（i）同行评议文献检索；（ii）在线数据库的系统检索；（iii）互联网检索；（iv）专家咨询和反馈。遵循方案进行淘汰和数据提取。DisMod-MR，即通用疾病建模系统的最新版本，是一种贝叶斯荟萃回归工具，按年龄、年份和性别估算了 187 个国家和 21 个地区的流行率。通过人群调查估算了阿片类药物依赖的残疾权重，并将其乘以流行率数据，以计算生命残疾年（YLDs）。阿片类药物依赖的过早死亡被计算为生命损失年（YLLs），并与 YLDs 相加以计算伤残调整生命年（DALYs）。
结果
2010 年全球有 1550 万阿片类药物依赖者[0.22%，95%不确定区间（UI）=0.20-0.25%]。标准化流行率男性（0.30%，95% UI=0.27-0.35%）高于女性（0.14%，95% UI=0.12-0.16%），并在 25-29 岁达到峰值。流行率高于澳大拉西亚（0.46%，95% UI=0.41-0.53%）、西欧（0.35%，95% UI=0.32-0.39%）和北美（0.30%，95% UI=0.25-0.36%）的全球汇总流行率。2010 年，阿片类药物依赖估计占全球残疾调整生命年（DALYs）的 920 万[0.37%，占全球 DALYs 的 37%]，比 1990 年估计的 DALYs 增加了 73%。阿片类药物依赖 DALY 率最高的地区是北美（292.1/10 万）、东欧（288.4/10 万）、澳大拉西亚（278.6/10 万）和南部撒哈拉以南非洲（263.5/10 万）。在北美、东欧和南部撒哈拉以南非洲，阿片类药物依赖对过早死亡的贡献（相对于流行率）尤其高。
结论
阿片类药物依赖是全球疾病负担的一个重要因素；其对过早死亡的贡献（相对于流行率）在地理上有所不同，北美、东欧和南部撒哈拉以南非洲受影响最大。
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