GBD 2021口腔疾病合作者报道了1990年至2021年全球、区域和国家口腔疾病负担的趋势。2025年2月27日，国际知名学术期刊《柳叶刀》发表了这一成果。

背景:世卫组织《全球口腔卫生行动计划》确定了到2030年将口腔疾病患病率降低10%的总体全球目标。关于全球口腔疾病负担的可靠和最新信息对于监测实现这一目标的进展至关重要。本系统数据分析的目的是对1990年至2021年期间未经治疗的龋齿、严重牙周炎、牙髓病、其他口腔疾病、唇腔癌和口腔癌以及口面裂的患病率和残疾调整生命年（DALYs）进行全球、世卫组织区域和国家一级的估计。

方法:本报告基于《2021年全球疾病、伤害和风险因素负担研究》（GBD）。输入数据来自流行病学调查、基于人口的登记和生命统计。数据采用DisMod-MR 2.1（一种贝叶斯元回归建模工具）建模，以确保口腔疾病的患病率、发病率、缓解和死亡率估计之间的一致性。DALYs是由于过早死亡导致的生命损失年数（YLLs）和残疾生活年数（YLDs）的总和。通过将患病率估计值、口腔状况严重程度、后遗症（残疾体重）和后遗症持续时间相乘来计算YLDs。虽然所有的口腔疾病都会导致YLDs，但只有唇癌和口腔癌以及口面部裂也会导致YLLs。95%的不确定区间（UIs）为每一个指标与后验分布的第25和第975个顺序的1000个绘制值生成。

发现:2021年，全球主要口腔疾病（未经治疗的龋齿、重度牙周炎、无牙症和其他口腔疾病）的年龄标准化患病率为每10万人45900人（95%UI 42300至49800人），全球受影响人数为36.9亿人（3.40至4.00人）。未经治疗的恒牙龋齿和严重牙周炎是最常见的口腔疾病，全球年龄标准化患病率分别为每10万人27500（24000至32000）和每10万人口12500（10500至14500）。根据其DALY计数和年龄标准DALY率，水肿、严重牙周炎和唇口癌症造成的负担最高。1990-2021年的现有趋势显示，患病率和负担的变化相对较小（向上或向下）。除未经治疗的乳牙龋齿（患病率或残疾调整生命年无百分比变化）和口唇腭裂（残疾调整生命周期减少-68.3%[-79.3至-46.5]）外，所有口腔疾病的患病率和残疾调整生命期都在增加。未治疗的恒牙龋和缺牙症的年龄标准患病率和DALY率均下降，未治疗的乳牙龋和重度牙周炎的发病率和DALI率均无变化，癌症唇口癌的患病率上升但DALY率无变化，口腔裂的患病率无变化但DALY比率下降。按世界卫生组织区域划分，非洲和东地中海区域的流行病例和大多数口腔疾病的DALY增幅最大，而欧洲区域的增幅最小或没有变化。欧洲地区是唯一一个乳牙（-9.88%；-12.6至-6.71）和恒牙（-5.94%（-8.38至-3.62）未经治疗龋齿年龄标准化患病率下降的地区。非洲地区重度牙周炎的患病率和DALY率下降，而非洲地区、东南亚地区和西太平洋地区的无牙症患病率和DALY率下降。此外，欧洲地区和美洲地区的唇口癌症DALY发生率均有所下降，而所有地区的口腔裂DALI发生率均下降。

研究结果表明，过去30年来口腔疾病负担的微小变化表明，过去和目前控制口腔疾病的努力并不成功，需要采取不同的方法。许多国家现在面临着双重挑战，既要控制新发口腔疾病病例的发生，又要解决大量未得到满足的口腔卫生保健需求。

附：英文原文

Title: Trends in the global, regional, and national burden of oral conditions from 1990 to 2021: a systematic analysis for the Global Burden of Disease Study 2021

Author: Eduardo Bernabe, Wagner Marcenes, Rizwan Suliankatchi Abdulkader, Lucas Guimares Abreu, Saira Afzal, Fadwa Naji Alhalaiqa, Sadeq Al-Maweri, Ubai Alsharif, Anayochukwu Edward Anyasodor, Amit Arora, Saeed Asgary, Tahira Ashraf, Madhan Balasubramanian, Morteza Banakar, Amadou Barrow, Azadeh Bashiri, Sefealem Assefa Belay, Uzma Iqbal Belgaumi, Alemshet Yirga Berhie, Pankaj Bhardwaj, Sonu Bhaskar, Ali Bijani, Souad Bouaoud, Yin Cao, Akhilanand Chaurasia, Meng Xuan Chen, Dinh-Toi Chu, Natalia Cruz-Martins, Omid Dadras, Xiaochen Dai, Daniel Diaz, Mi Du, Michael Ekholuenetale, Temitope Cyrus Ekundayo, Maha El Tantawi, Muhammed Elhadi, Adeniyi Francis Fagbamigbe, Nima Farshidfar, Ali Fatehizadeh, Florian Fischer, Morenike Oluwatoyin Folayan, Piyada Gaewkhiew, Márió Gajdács, Mahaveer Golechha, Bhawna Gupta, Sapna Gupta, Hailey Hagins, Esam S Halboub, Samer Hamidi, Ninuk Hariyani, Simon I Hay, Mohammad Heidari, Brenda Yuliana Herrera-Serna, Demisu Zenbaba Heyi, Sorin Hostiuc, Kyle Matthew Humphrey, Segun Emmanuel Ibitoye, Milena D Ilic, Gaetano Isola, Eswar Kandaswamy, Rami S Kantar, Navjot Kaur, Laura Kemmer, Yousef Saleh Khader, Sorour Khateri, Adnan Kisa, Kewal Krishan, Estie Kruger, Ratilal Lalloo, An Li, Stephen S Lim, Tomislav Mestrovic, Ali H Mokdad, Rafael Silveira Moreira, Shane Douglas Morrison, Christopher J L Murray, Zuhair S Natto, Biswa Prakash Nayak, Trang Nguyen, Van Thanh Nguyen, Abiodun Olusola Omotayo, Alicia Padron-Monedero, Jay Patel, Shankargouda Patil, Shrikant Pawar, Ionela-Roxana Petcu, Ibrahim Qattea, Mosiur Rahman, Zubair Ahmed Ratan, Abanoub Riad, Manjula S, Chandan S N, Siamak Sabour, Fatemeh Saheb Sharif-Askari, Amirhossein Sahebkar, Joseph W Sakshaug, Abdallah M Samy, Sachin C Sarode, Monika Sawhney, Falk Schwendicke, Masood Ali Shaikh, Santosh Kumar Tadakamadla, Riki Tesler, Arulmani Thiyagarajan, Marcos Roberto Tovani-Palone, Muhammad Umair, Bhaskaran Unnikrishnan, Sahel Valadan Tahbaz, Siddhartha Alluri Varma, Ana Petar Vukovic, Cong Wang, Nuwan Darshana Wickramasinghe, Lalit Yadav, Arzu Yiit, Iman Zare, Zhi-Jiang Zhang, Nicholas J Kassebaum

Issue&Volume: 2025-02-27

Abstract: Background

The WHO Global Oral Health Action Plan has set an overarching global target of achieving a 10% reduction in the prevalence of oral conditions by 2030. Robust and up-to-date information on the global burden of oral conditions is paramount to monitor progress towards this target. The aim of this systematic data analysis was to produce global, WHO region, and country-level estimates of the prevalence of, and disability-adjusted life-years (DALYs) attributed to, untreated caries, severe periodontitis, edentulism, other oral disorders, lip and oral cavity cancer, and orofacial clefts from 1990 to 2021.

Methods

This report is based on the Global Burden of Diseases, Injuries, and Risk Factors Study (GBD) 2021. Input data were extracted from epidemiological surveys, population-based registries, and vital statistics. Data were modelled with DisMod-MR 2.1, a Bayesian meta-regression modelling tool, to ensure consistency between prevalence, incidence, remission, and mortality estimates for oral conditions. DALYs were estimated as the aggregation of the years of life lost (YLLs) due to premature mortality and years lived with disability (YLDs). YLDs were calculated by multiplying prevalence estimates, the severity of the oral condition's sequelae (disability weight) and duration of the sequelae. Although all oral conditions lead to YLDs, only lip and oral cavity cancer and orofacial clefts lead to YLLs as well. 95% uncertainty intervals (UIs) were generated for every metric with the 25th and 975th ordered 1000 draw values of the posterior distribution.

Findings

The combined global age-standardised prevalence of the main oral conditions (untreated caries, severe periodontitis, edentulism, and other oral disorders) was 45900 (95% UI 42300 to 49800) per 100000 population in 2021, with 3·69 billion (3·40 to 4·00) people affected globally. Untreated dental caries of permanent teeth and severe periodontitis were the most common oral conditions, with a global age-standardised prevalence of 27500 (24000 to 32000) per 100000 population and 12500 (10500 to 14500) per 100000 population, respectively. Edentulism, severe periodontitis, and lip and oral cavity cancer caused the highest burden as demonstrated by their counts of DALYs and age-standardised DALY rates. Existing trends for 1990–2021 reveal relatively small changes (upward or downward) in prevalence and burden. Increasing counts of prevalent cases and DALYs were noted for all oral conditions but untreated caries of deciduous teeth (no percentage change in prevalence or DALYs) and orofacial clefts (–68·3% [–79·3 to –46·5] decrease in DALYs). There were decreases in both age-standardised prevalence and DALY rate for untreated caries of permanent teeth and edentulism, no change in both for untreated caries of deciduous teeth and severe periodontitis, an increase in the prevalence but no change in the DALY rate for lip and oral cavity cancer, and no change in the prevalence but a decrease in the DALY rate for orofacial clefts. By WHO region, the African and Eastern Mediterranean regions showed the largest increases in prevalent cases and DALYs for most oral conditions, while the European region showed the smallest increases or no change. The European region was the only region with decreasing age-standardised prevalence of untreated caries in both deciduous (–9·88%; –12·6 to –6·71) and permanent teeth (–5·94% (–8·38 to –3·62). The prevalence and DALY rate of severe periodontitis decreased in the African region, while the prevalence and DALY rate of edentulism decreased in the African region, South-East Asia region, and Western Pacific region. Furthermore, DALY rates of lip and oral cavity cancer decreased in the European region and the region of the Americas, while DALY rates of orofacial clefts decreased in all regions.

Interpretation

The minor changes in the burden of oral conditions over the past 30 years demonstrate that past and current efforts to control oral conditions have not been successful and that different approaches are needed. Many countries now face the double challenge of controlling the occurrence of new cases of oral conditions and addressing the huge unmet need for oral health care.

DOI: 10.1016/S0140-6736(24)02811-3

Source: https://www.thelancet.com/journals/lancet/article/PIIS0140-6736(24)02811-3/abstract