Italy's health performance, 1990-2017: findings from the Global Burden of Disease Study 2017

被引：63

作者：

Monasta, Lorenzo ^{[1
]}

Abbafati, Cristiana ^{[2
]}

Logroscino, Giancarlo ^{[3
,4
]}

Remuzzi, Giuseppe ^{[8
]}

Perico, Norberto ^{[8
]}

Bikbov, Boris ^{[8
]}

Tamburlini, Giorgio ^{[9
]}

Beghi, Ettore ^{[6
]}

Traini, Eugenio ^{[1
]}

Redford, Sofia Boston ^{[11
]}

Ariani, Filippo ^{[12
]}

Borzi, Antonio M. ^{[14
]}

Bosetti, Cristina ^{[7
]}

Carreras, Giulia ^{[16
]}

Caso, Valeria ^{[17
]}

Castelpietra, Giulio ^{[18
,19
]}

Cirillo, Massimo ^{[20
]}

Conti, Sara ^{[22
]}

Cortesi, Paolo Angelo ^{[22
]}

Damiani, Giovanni ^{[23
,25
]}

D'Angiolella, Lucia Sara ^{[21
]}

Fanzo, Jessica ^{[26
,27
]}

Farioli, Andrea ^{[28
]}

Fornari, Carla ^{[22
]}

Gallus, Silvano ^{[5
]}

Giussani, Giorgia ^{[6
]}

Gorini, Giuseppe ^{[15
]}

Grosso, Giuseppe ^{[13
]}

Guido, Davide ^{[29
,30
]}

La Vecchia, Carlo ^{[24
]}

Lauriola, Paolo ^{[31
]}

Leonardi, Matilde ^{[32
]}

Levi, Miriam ^{[12
]}

Madotto, Fabiana ^{[33
]}

Mondello, Stefania ^{[34
,35
]}

Naldi, Luigi ^{[36
,37
]}

Olgiati, Stefano ^{[38
]}

Palladino, Raffaele ^{[39
,40
]}

Piccinelli, Cristiano ^{[41
]}

Piccininni, Marco ^{[3
,42
]}

Pupillo, Elisabetta ^{[6
]}

Raggi, Alberto ^{[32
]}

Rubino, Salvatore ^{[43
]}

Santalucia, Paola ^{[44
]}

Vacante, Marco ^{[14
]}

Vidale, Simone ^{[45
,46
]}

Violante, Francesco S. ^{[28
,47
]}

Naghavi, Mohsen ^{[10
,11
]}

Ronfani, Luca ^{[1
]}

机构：

[1] Burlo Garofolo Inst Maternal & Child Hlth, Clin Epidemiol & Publ Hlth Res Unit, Trieste, Italy

[2] Univ Roma La Sapienza, Dept Law Philosophy & Econ Studies, Rome, Italy

[3] Univ Bari Aldo Moro, Dept Basic Med Sci Neurosci & Sense Organs, Bari, Italy

[4] Fdn Cardinale Giovanni Panico Hosp, Dept Clin Res Neurol, Tricase, Italy

[5] Dept Environm Hlth Sci, Bergamo, Italy

[6] Dept Neurosci, Bergamo, Italy

[7] Dept Oncol, Bergamo, Italy

[8] Mario Negri Inst Pharmacol Res, Bergamo, Italy

[9] Ctr Salute Bambino Onlus, Trieste, Italy

[10] Univ Washington, Sch Med, Dept Hlth Metr Sci, Seattle, WA USA

[11] Univ Washington, Inst Hlth Metr & Evaluat, Seattle, WA USA

[12] Local Hlth Unit Tuscany Ctr, Reg Ctr Anal Data Occupat & Work Related Injuries, Florence, Italy

[13] Univ Catania, Dept Biomed & Biotechnol Sci, Catania, Italy

[14] Univ Catania, Dept Gen Surg & Med Surg Specialties, Catania, Italy

[15] Occupat & Environm Epidemiol Sect, Florence, Italy

[16] Inst Canc Res Prevent & Clin Network ISPRO, Florence, Italy

[17] Univ Perugia, Dept Neurosci, Perugia, Italy

[18] Cent Hlth Directorate, Primary Care Serv Area, Trieste, Italy

[19] Univ Udine, Dept Med, Udine, Italy

[20] Univ Salerno, Scuola Med Salernitana, Baronissi, Italy

[21] Univ Milano Bicocca, Publ Hlth Dept, Monza, Italy

[22] Univ Milano Bicocca, Sch Med & Surg, Monza, Italy

[23] Case Western Reserve Univ, Dept Dermatol, Cleveland, OH 44106 USA

[24] Univ Milan, Clin Med & Community Hlth, Milan, Italy

[25] Univ Milan, Dept Dermatol, Milan, Italy

[26] Johns Hopkins Univ, Berman Inst Bioeth, Baltimore, MD USA

[27] Food & Agr Org United Nat, Nutr & Food Syst Div, Rome, Italy

[28] Univ Bologna, Dept Med & Surg Sci, Bologna, Italy

[29] Agcy Hlth Protect, Epidemiol Unit, Milan, Italy

[30] Univ Pavia, Pavia, Italy

[31] Italian Natl Res Council, Inst Clin Physiol, Pisa, Italy

[32] Fdn IRCCS Ist Neurol Carlo Besta, Neurol Publ Hlth & Disabil Unit, Milan, Italy

[33] IRCCS MultiMed, Value Based Healthcare, Sesto San Giovanni, Italy

[34] Univ Messina, Dept Biomed & Dent Sci, Morphofunct Imaging, Messina, Italy

[35] Oasi Res Inst IRCCS, Dept Neurol, Troina, Italy

[36] San Bortolo Hosp, Dept Dermatol, Vicenza, Italy

[37] GISED Study Ctr, Bergamo, Italy

[38] MIT, 77 Massachusetts Ave, Cambridge, MA 02139 USA

[39] Univ Naples Federico II, Dept Publ Hlth, Naples, Italy

[40] Imperial Coll London, Publ Hlth, London, England

[41] AOU Citta Salute & Sci, CPO Piemonte, Turin, Italy

[42] Charite Med Univ Berlin, Inst Publ Hlth, Berlin, Germany

[43] Univ Sassari, Dept Biomed Sci, Sassari, Italy

[44] IRCCS Neurolesi Ctr Bonino Pulejo Piemonte Hosp, Dept Neurol, Messina, Italy

[45] St Anna Hosp, Dept Neurol, Como, Italy

[46] St Anna Hosp, Stroke Unit, Como, Italy

[47] St Orsola Malpighi Hosp, Occupat Hlth Unit, Bologna, Italy

来源：

LANCET PUBLIC HEALTH | 2019年 / 4卷 / 12期

基金：

比尔及梅琳达.盖茨基金会;

关键词：

SEX-SPECIFIC MORTALITY; SYSTEMATIC ANALYSIS; 195; COUNTRIES; LIFE EXPECTANCY; TERRITORIES; DISABILITY; INJURIES;

D O I：

10.1016/S2468-2667(19)30189-6

中图分类号：

R1 [预防医学、卫生学];

学科分类号：

100235 [预防医学];

摘要：

Background Through a comprehensive analysis of Italy's estimates from the Global Burden of Diseases, Injuries, and Risk Factors Study (GBD) 2017, we aimed to understand the patterns of health loss and response of the health-care system, and offer evidence-based policy indications in light of the demographic transition and government health spending in the country. Methods Estimates for Italy were extracted from GBD 2017. Data on Italy are presented for 1990 and 2017, on prevalence, causes of death, years of life lost, years lived with disability, disability-adjusted life-years (DALYs), life expectancy at birth and at age 65 years, healthy life expectancy, and Healthcare Access and Quality (HAQ) Index. We compared the estimates for Italy with those of 15 other western European countries. Findings The quality of the universal health system and healthy behaviours contribute to favourable overall health, even in comparison with other western European countries. In 2017, life expectancy and HAQ Index score in Italy were among the highest globally, with life expectancy at birth reaching 85.3 years for females and 80.8 for males in 2017, ranking Italy eighth globally for females and sixth for males, and an HAQ Index score of 94.9 in 2016 compared with 81.54 in 1990, keeping Italy ranked as ninth globally. Between 1990 and 2017 age-standardised death rates for cardiovascular diseases decreased by 53.7% (95% uncertainty interval -56.1 to -51.4), for neoplasms decreased by 28.2% (-32.3 to -24.6), and for transport injuries decreased by 62.1% (-64.6 to -59.2). However, population ageing is causing an increase in the burden of specific diseases, such as Alzheimer's disease and other dementias (DALYs increased by 77.9% [68.4 to 87.2]) and pancreatic (DALYs increased by 39.7% [28.4 to 51.7]) and uterine cancers (DALYs increased by 164.7% [129.7 to 202.5]). Behavioural risk factors, which are potentially modifiable, still have a strong effect, particularly on cardiovascular diseases and neoplasms. For instance, in 2017, 44 400 (41 200 to 47 800) cancer deaths were attributed to smoking, 12 000 (9600 to 14 800) to alcohol use, and 9500 (5400 to 14 200) to high body-mass index, while 47 000 (31 100 to 65 700) deaths due to cardiovascular diseases could be attributed to high LDL cholesterol, 28 700 (19 700 to 38 500) to diets low in whole grains, and 15 900 (8500 to 24 900) to low physical activity. Interpretation Italy provides an interesting example of the results that can be achieved by a mix of relatively healthy lifestyles and a universal health system. Two main issues require attention, population ageing and gradual decrease of public health financing, which both pose several challenges to the future of Italy's health status. Our findings should be useful to Italy's policy makers and health system experts elsewhere. Copyright (C) 2019 The Author(s). Published by Elsevier Ltd.

引用

页码：E645 / E657

页数：13

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