近日，挪威卑尔根大学Dean T Jamison团队研究了1970年至2050年全球卫生的流行病学和人口趋势及预测。相关论文于2025年8月30日发表在《柳叶刀》杂志上。

对全球卫生趋势的系统分析可以准确地说明进展和挑战。研究组分析了年龄特异性死亡率（流行病学）和年龄结构（人口学）变化对粗死亡率（CDR）和死亡率高或上升的死亡原因的影响，为第三届《柳叶刀》健康投资委员会提供信息。

来自《2024年世界人口展望》和《2021年全球卫生估计》的数据用于评估流行病学和人口趋势，包括CDR（定义为死亡总人数除以每1000人报告的年中人口总数）、1970-2050年的全因年龄特定死亡率，以及2000-19年选定的特定原因死亡率。研究组排除了2020-23年的数据，以避免疫情的影响。为了估计死因特异性死亡率的年代际变化，研究组将这些估计值合并到以下年龄组：0-14岁、15-49岁、50-69岁和70岁及以上。

在大多数区域，各年龄组的死亡率大幅下降，近几十年来观察到迅速改善。在2000年代（即2000 - 2010年）和2010年代（即2010 - 2019年）期间，中国、中欧和东欧、印度、拉丁美洲和加勒比0-14岁和15-49岁年龄组的死亡率下降速度加快，但在北大西洋、美国、西太平洋和东南亚下降速度减慢。50-69岁年龄组的死亡率下降速度在除撒哈拉以南非洲以外的所有区域都有所减缓。美国15-49岁和50-69岁人群的死亡率不仅有所下降，而且有所上升。在全球范围内，2019年报告的CDR最低。过去，CDR的下降主要是因为特定年龄死亡率的下降。未来趋势表明，不断变化的人口年龄结构将推动CDR大幅增长。一旦考虑到人口变化，主要疾病造成的特定年龄死亡率就会下降。唯一的例外是糖尿病，各区域按年龄划分的死亡率都在加速上升，中欧、东欧和印度的死亡率尤其高。

研究组有理由对全球卫生进展感到乐观，但差距和新出现的挑战依然存在。按年龄划分的死亡率下降显示出进展；然而，快速老龄化带来了新的挑战。减缓某些区域死亡率下降的速度需要加强努力。美国中年人死亡率的上升强调了持续的改善需要共同的努力。主要建议包括确定干预措施的优先次序，以应对具体的卫生挑战，并使卫生保健系统适应人口结构的转变。

附：英文原文

Title: Epidemiological and demographic trends and projections in global health from 1970 to 2050: a descriptive analysis from the third Lancet Commission on Investing in Health, Global Health 2050

Author: Angela Y Chang, Sarah Bolongaita, Bochen Cao, Marcia C Castro, Omar Karlsson, Wenhui Mao, Ole F Norheim, Osondu Ogbuoji, Dean T Jamison

Issue&Volume: 2025/08/30

Abstract:

Background

Systematic analyses of global health trends can provide an accurate narrative of progress and challenges. We analysed the impact of changing age-specific mortality (epidemiology) and age structure (demography) on crude death rates (CDRs) and causes of death with large or rising mortality to inform the third Lancet Commission on Investing in Health.

Methods

Data from the World Population Prospects 2024 and Global Health Estimates 2021 were used to assess epidemiological and demographic trends, including CDR (defined as the total number of deaths divided by the total mid-year population, reported per 1000 population), all-cause age-specific mortality rates for 1970–2050, and selected cause-specific mortality rates from 2000–19. We excluded data for 2020–23 to avoid effects of the COVID-19 pandemic. For estimating decadal changes in cause-specific mortality rates, we combined the estimates into the following age groups: 0–14, 15–49, 50–69, and 70 years and older.

Findings

Mortality rates declined substantially across age groups in most regions, with rapid improvements observed in recent decades. Between the 2000s (ie, 2000–10) and 2010s (ie, 2010–19), the mortality decline accelerated in China, central and eastern Europe, India, and Latin America and the Caribbean in ages 0–14 years and 15–49 years, but decelerated in the north Atlantic, the USA, and western Pacific and southeast Asia. For ages 50–69 years, mortality decline decelerated in all regions except sub-Saharan Africa. The USA experienced not only deceleration but increase in mortality rates in those aged 15–49 years and 50–69 years. Globally, the lowest CDR was reported in 2019. In the past, CDR has declined primarily because of decreasing age-specific mortality rates. Future trends suggest that changing population age structure will drive a large increase in CDR. Age-specific mortality rates from major diseases declined once population changes were accounted for. The exception was diabetes, with accelerating increase in age-specific death rates in all regions, with especially high rates in central and eastern Europe and India.

Interpretation

There is reason for optimism regarding global health progress, but disparities and emerging challenges persist. Falling age-specific mortality rates show progress; however, rapid ageing brings new challenges. Slowing mortality declines in some regions require enhanced efforts. Rising mortality among middle-aged Americans emphasises that continuous improvements require concerted efforts. Key recommendations include prioritising interventions to address specific health challenges and adapting health-care systems to demographic transitions.

DOI: 10.1016/S0140-6736(25)00902-X

Source: https://www.thelancet.com/journals/lancet/article/PIIS0140-6736(25)00902-X/abstract