Prevalence and attributable health burden of chronic respiratory diseases, 1990–2017 : a systematic analysis for the Global Burden of Disease Study 2017

Background Previous attempts to characterise the burden of chronic respiratory diseases have focused only on specific disease conditions, such as chronic obstructive pulmonary disease (COPD) or asthma. In this study, we aimed to characterise the burden of chronic respiratory diseases globally, providing a comprehensive and up-to-date analysis on geographical and time trends from 1990 to 2017. Methods Using data from the Global Burden of Diseases, Injuries, and Risk Factors Study (GBD) 2017, we estimated the prevalence, morbidity, and mortality attributable to chronic respiratory diseases through an analysis of deaths, disability-adjusted life-years (DALYs), and years of life lost (YLL) by GBD super-region, from 1990 to 2017, stratified by age and sex. Specific diseases analysed included asthma, COPD, interstitial lung disease and pulmonary sarcoidosis, pneumoconiosis, and other chronic respiratory diseases. We also assessed the contribution of risk factors (smoking, second-hand smoke, ambient particulate matter and ozone pollution, household air pollution from solid fuels, and occupational risks) to chronic respiratory disease-attributable DALYs. Findings In 2017, 544.9 million people (95% uncertainty interval [UI] 506.9- 584.8) worldwide had a chronic respiratory disease, representing an increase of 39.8% compared with 1990. Chronic respiratory disease prevalence showed wide variability across GBD super-regions, with the highest prevalence among both males and females in high-income regions, and the lowest prevalence in sub-Saharan Africa and south Asia. The age-sex- specific prevalence of each chronic respiratory disease in 2017 was also highly variable geographically. Chronic respiratory diseases were the third leading cause of death in 2017 (7.0% [95% UI 6.8-7 .2] of all deaths), behind cardiovascular diseases and neoplasms. Deaths due to chronic respiratory diseases numbered 3 914 196 (95% UI 3 790 578-4 044 819) in 2017, an increase of 18.0% since 1990, while total DALYs increased by 13.3%. However, when accounting for ageing and population growth, declines were observed in age-standardised prevalence (14.3% decrease), agestandardised death rates (42.6%), and age-standardised DALY rates (38.2%). In males and females, most chronic respiratory disease-attributable deaths and DALYs were due to COPD. In regional analyses, mortality rates from chronic respiratory diseases were greatest in south Asia and lowest in sub-Saharan Africa, also across both sexes. Notably, although absolute prevalence was lower in south Asia than in most other super-regions, YLLs due to chronic respiratory diseases across the subcontinent were the highest in the world. Death rates due to interstitial lung disease and pulmonary sarcoidosis were greater than those due to pneumoconiosis in all super-regions. Smoking was the leading risk factor for chronic respiratory disease-related disability across all regions for men. Among women, household air pollution from solid fuels was the predominant risk factor for chronic respiratory diseases in south Asia and sub-Saharan Africa, while ambient particulate matter represented the leading risk factor in southeast Asia, east Asia, and Oceania, and in the Middle East and north Africa super-region. Interpretation Our study shows that chronic respiratory diseases remain a leading cause of death and disability worldwide, with growth in absolute numbers but sharp declines in several age-standardised estimators since 1990. Premature mortality from chronic respiratory diseases seems to be highest in regions with less-resourced health systems on a per-capita basis

Global, regional, and national cancer incidence, mortality, years of life lost, years lived with disability, and disability-Adjusted life-years for 29 cancer groups, 1990 to 2017 : A systematic analysis for the global burden of disease study

Importance: Cancer and other noncommunicable diseases (NCDs) are now widely recognized as a threat to global development. The latest United Nations high-level meeting on NCDs reaffirmed this observation and also highlighted the slow progress in meeting the 2011 Political Declaration on the Prevention and Control of Noncommunicable Diseases and the third Sustainable Development Goal. Lack of situational analyses, priority setting, and budgeting have been identified as major obstacles in achieving these goals. All of these have in common that they require information on the local cancer epidemiology. The Global Burden of Disease (GBD) study is uniquely poised to provide these crucial data. Objective: To describe cancer burden for 29 cancer groups in 195 countries from 1990 through 2017 to provide data needed for cancer control planning. Evidence Review: We used the GBD study estimation methods to describe cancer incidence, mortality, years lived with disability, years of life lost, and disability-Adjusted life-years (DALYs). Results are presented at the national level as well as by Socio-demographic Index (SDI), a composite indicator of income, educational attainment, and total fertility rate. We also analyzed the influence of the epidemiological vs the demographic transition on cancer incidence. Findings: In 2017, there were 24.5 million incident cancer cases worldwide (16.8 million without nonmelanoma skin cancer [NMSC]) and 9.6 million cancer deaths. The majority of cancer DALYs came from years of life lost (97%), and only 3% came from years lived with disability. The odds of developing cancer were the lowest in the low SDI quintile (1 in 7) and the highest in the high SDI quintile (1 in 2) for both sexes. In 2017, the most common incident cancers in men were NMSC (4.3 million incident cases); tracheal, bronchus, and lung (TBL) cancer (1.5 million incident cases); and prostate cancer (1.3 million incident cases). The most common causes of cancer deaths and DALYs for men were TBL cancer (1.3 million deaths and 28.4 million DALYs), liver cancer (572000 deaths and 15.2 million DALYs), and stomach cancer (542000 deaths and 12.2 million DALYs). For women in 2017, the most common incident cancers were NMSC (3.3 million incident cases), breast cancer (1.9 million incident cases), and colorectal cancer (819000 incident cases). The leading causes of cancer deaths and DALYs for women were breast cancer (601000 deaths and 17.4 million DALYs), TBL cancer (596000 deaths and 12.6 million DALYs), and colorectal cancer (414000 deaths and 8.3 million DALYs). Conclusions and Relevance: The national epidemiological profiles of cancer burden in the GBD study show large heterogeneities, which are a reflection of different exposures to risk factors, economic settings, lifestyles, and access to care and screening. The GBD study can be used by policy makers and other stakeholders to develop and improve national and local cancer control in order to achieve the global targets and improve equity in cancer care. © 2019 American Medical Association. All rights reserved.Peer reviewe

睡眠時無呼吸症候群患者の睡眠に関連した生活習慣の調査

SAS患者は日中の眠気や倦怠感などの疾患に起因する症状を紛らわすために睡眠にとって悪い習慣を取ってしまっている可能性が指摘されている。しかしSAS患者の生活実態は明らかになっていない。そこで本研究はSAS患者の生活習慣の実態を明らかにし、Apnea Hypopnea Index (AHI)、Epworth Sleepiness Scale (ESS)、Pittsburgh Sleep Quality Index (PSQI)、Body Mass Index(BMI)との関連を検討することを目的として行った。方法は質問紙およびAHIのデータをカルテより転載し、分析を行った。対象者は睡眠時無呼吸症候群と診断され治療前の方、56名を対象として行い、回収率は86%であった。AHI、ESS、PSQI、BMIと喫煙、飲酒、カフェインの摂取、睡眠時間などとの関連をみたところ、飲酒とBMIとの間に有意な関連がみられた。また喫煙とPSQIに有意な関連がみられ、睡眠の質が低いと評価している人ほど喫煙本数が多かった。睡眠時間とESSおよび希望睡眠時間と睡眠時間の差とESSの間に相関がみられ、SASによる睡眠障害だけでなく、睡眠時間の不足も問題である可能性があると考えられた。ベッドパートナーの有無が睡眠を阻害する因子になりうる可能性が示唆された。今回の対象者では治療開始前であったが、SASの治療の第一選択であるCPAP療法には家族のサポートも重要である。そのため今後ベッドパートナーの有無がCPAP療法にどのような影響を及ぼすのかについても検討していくことが重要であると考える。It has been pointed out that Sleep Apnea Syndrome (SAS) patients may have adopted life-styles which are poor for their sleep in order to alleviate symptoms that originate in disorders such as sleepiness and fatigue during the day. However, there is no clear evidence of what kind of maladaptive life-styles have been adopted by SAS patients. This research was therefore conducted with the aim of revealing the life-styles of SAS patients, and exploring the relationships between those life-styles and their correlation with the Apnea Hypopnea Index (AHI) data, the Epworth Sleepiness Scale (ESS), Pittsburgh Sleep Quality Index (PSQI) and the Body Mass Index (BMI). It was conducted on 56 pre-treated patients diagnosed with SAS via analysis of questionnaires and AHI data from their medical records. The response-rate was 86%. An analysis of the relationships between the data derived from AHI, ESS, PSQI, and BMI to smoking, alcohol consumption, caffeine intake and sleeping hours showed a significant relationship between alcohol consumption and BMI data. Furthermore, a significant relationship was evident between smoking and PSQI data, with those who evaluated their sleep quality as poor smoking the most. A correlation could also be seen between sleeping time and the ESS data, and the difference between desired hours of sleep and actual sleeping time and the ESS data, indicating that not only sleep disturbance was caused by SAS, but also the lack of sleep time could be a problem. In addition, it was also suggested that the existence of a bed partner could be one factor disturbing sleep. While the subjects of this research had not yet been treated, family support is important to CPAP treatment. For this reason, it will also be essential to study the effect of a bed partner on CPAP treatment in the future

Effects of Body Position during an Afternoon Nap on Body Temperature and Heart Rate Variability in Healthy Young Japanese Adults

Objective : To examine the effect of body position during an afternoon nap on body temperature and heart rate variability in young healthy Japanese participants. Method : Within-subject laboratory experiment with two sessions. After sleep had been restricted the previous night, the participants were required to take a nap (60 min.) in a semi-recumbent position on a reclining chair at either 60 degrees (A) or 30 degrees (B) from the horizontal. The experiment was performed from 13 : 00 to 16 : 00 in the laboratory of Nursing Science in the School of Health Sciences, Faculty of Medicine, Kyoto University. An electrocardiogram (ECG), Polysomnography (Sleep electroencephalogram), core body temperature (rectal) and skin temperatures of the leg and foot were measured. Autonomic nervous function was evaluated by heart rate variability. Participants : Eight healthy Japanese men aged 19 to 24 yrs. Results : The decrease in rectaltemperature during the first 20 minutes was greater in B than in A. There were no significant differences in parasympathetic function between A and B, while the sympathetic function in B was more activated after the nap. In B sleepiness declined significantly after the nap. Conclusion : Napping in a posture similar to that when lying in bed deepened sleep adversely, with the possibility of a more prolonged phase delay

Effects of Body Position during an Afternoon Nap on Body Temperature and Heart Rate Variability in Healthy Young Japanese Adults

Objective : To examine the effect of body position during an afternoon nap on body temperature and heart rate variability in young healthy Japanese participants. Method : Within-subject laboratory experiment with two sessions. After sleep had been restricted the previous night, the participants were required to take a nap (60 min.) in a semi-recumbent position on a reclining chair at either 60 degrees (A) or 30 degrees (B) from the horizontal. The experiment was performed from 13 : 00 to 16 : 00 in the laboratory of Nursing Science in the School of Health Sciences, Faculty of Medicine, Kyoto University. An electrocardiogram (ECG), Polysomnography (Sleep electroencephalogram), core body temperature (rectal) and skin temperatures of the leg and foot were measured. Autonomic nervous function was evaluated by heart rate variability. Participants : Eight healthy Japanese men aged 19 to 24 yrs. Results : The decrease in rectaltemperature during the first 20 minutes was greater in B than in A. There were no significant differences in parasympathetic function between A and B, while the sympathetic function in B was more activated after the nap. In B sleepiness declined significantly after the nap. Conclusion : Napping in a posture similar to that when lying in bed deepened sleep adversely, with the possibility of a more prolonged phase delay

「まちの保健室」における睡眠相談の試み

本研究の目的は、「まちの保健室」を訪れる地域住民の睡眠の実態を調査するとともに、睡眠相談の活動方法を検討することである。研究協力者はH大学「まちの保健室」に来訪した男女102名(平均年齢55.9歳)で、質問紙調査を行った。また、個別睡眠相談を利用した女性17名(平均年齢60.9歳)には、アクチウォッチを用いた個別相談と介入を行いその反応について分析した。得られた結果は以下のとおりである。1)質問紙調査の判定で睡眠が良好だった人は49.0%、要注意の人は21.6%、不眠の疑いがある人は29.4%で、「まちの保健室」に来訪した人の約5割は、睡眠に関して何らかの問題や不満を抱えていた。2)個別睡眠相談来訪者の主な相談内容は、寝つきが悪い、中途覚醒がある、いびき、ほてり、自己の睡眠の測定などで、「不眠の悩みを相談しやすい状況をつくる」、「介入のきっかけの一つとしてアクチウォッチのデータを用いる」、「来訪者と共に生活の仕方を振り返る」、「眠れていることや良い生活習慣等できていることを認める」、「睡眠に関する知識・情報を提供する」などの介入を行った。3)個別睡眠相談を利用した17名のうち7名に、1ヶ月後以降の睡眠や生活の様子について聞き取り調査を行ったところ、「自分の睡眠を知ることによる安心感」、「自分の行動を認める」、「睡眠に対する関心の高まり」などの、視点や考え方の変化がみられた。また、7名中3名には睡眠が改善したという発言があった。睡眠相談は相談に来る人を待つスタイルであるが、今後は集団を対象とした睡眠衛生教育など、より積極的な介入も必要であると考える。「まちの保健室」睡眠相談で、アクチウォッチを用いながら個別の生活に合わせた介入を行うことにより、来訪者の睡眠に対する考え方や生活行動に変化が現れ、睡眠が改善する効果があることが示唆された。The purpose of this study was to investigate the sleep status of the local residents who visited the "Neighborhood Health Station" and to examine the action method used for sleep consultations. The study volunteers consisted of 102 persons (average age: 55.9 years) who visited the "Neighborhood Health Station" established by H University. The investigation was carried out using questionnaires. Seventeen females (average age: 60.9 years) received individual sleep consultations using an Actiwatch and interventions were made. The results were then analyzed. Results 1) According to the questionnaire data, 49.0% were classified as good sleepers; 21.6% as marginal; and 29.4% were suspected of being insomniacs. About 50% of those who visited the "Neighborhood Health Station" had some issues or dissatisfaction with their sleep. 2) The main topics raised by individuals during sleep consultations were their difficulty in falling asleep, waking up in the middle of the night, snoring, hot flashes and also how to get advice on how to monitor their own sleep patterns. We conducted interventions such as a) creating an environment where visitors can freely discuss their insomnia problems, b) making use of the Actigraph\u27s data as one way of initiating intervention, c) examining clients\u27 lifestyles and having them reflect on this with the support of the counselor, d) acknowledging that a good sleep and good life habits are being achieved, and e) providing knowledge and information about sleep". 3) Of 17 visitors who had individual sleep consultations, seven were chosen for further interviews regarding their sleep status and lives at more than one month after the initial consultation. We witnessed changes in the visitors\u27 viewpoints and thinking, such as a) feeling assured by understanding their own sleep, b) acknowledging their own actions, and c) increased interest in sleep. Moreover, three out of the seven claimed that their sleep had improved. These sleep consultations were relied on waiting for clients to simply come in; however, in the future, we think that more active intervention will be necessary, such as conducting sleep health classes for groups. Intervening, in accordance with individual lifestyles by using the Actiwatch at the "Neighborhood Health Station" consultations, suggests that the clients\u27 ideas about sleep and lifestyle were modified and such interventions were effective in improving sleep