Between-Country Inequalities in the Neglected Tropical Disease Burden in 1990 and 2010, with Projections for 2020

Background
The World Health Organization (WHO) has set ambitious time-bound targets for the control and elimination of neglected tropical diseases (NTDs). Investing in NTDs is not only seen as good value for money, but is also advocated as a pro-poor policy since it would improve population health in the poorest populations. We studied the extent to which the disease burden from nine NTDs (lymphatic filariasis, onchocerciasis, schistosomiasis, soil-transmitted helminths, trachoma, Chagas disease, human African trypanosomiasis, leprosy, visceral leishmaniasis) was concentrated in the poorest countries in 1990 and 2010, and how this would change by 2020 in case the WHO targets are met.
Principal Findings
Our analysis was based on 1990 and 2010 data from the Global Burden of Disease (GBD) 2010 study and on projections of the 2020 burden. Low and lower-middle income countries together accounted for 69% and 81% of the global burden in 1990 and 2010 respectively. Only the soil-transmitted helminths and Chagas disease caused a considerable burden in upper-middle income countries. The global burden from these NTDs declined by 27% between 1990 and 2010, but reduction largely came to the benefit of upper-middle income countries. Achieving the WHO targets would lead to a further 55% reduction in the global burden between 2010 and 2020 in each country income group, and 81% of the global reduction would occur in low and lower-middle income countries.
Conclusions
The GBD 2010 data show the burden of the nine selected NTDs in DALYs is strongly concentrated in low and lower-middle income countries, which implies that the beneficial impact of NTD control eventually also largely comes to the benefit of these same countries. While the nine NTDs became increasingly concentrated in developing countries in the 1990–2010 period, this trend would be rectified if the WHO targets were met, supporting the pro-poor designation.

研究背景
世界卫生组织（World Health Organization, WHO）已为被忽视的热带病（neglected tropical diseases, NTDs）的防控制定了兼具雄心与明确时限的目标。对被忽视热带病的投入不仅被视为具备高性价比的举措，更被倡导为一项亲贫政策，因其可改善最贫困人群的整体健康水平。本研究针对9种被忽视热带病——包括淋巴丝虫病（lymphatic filariasis）、盘尾丝虫病（onchocerciasis）、血吸虫病（schistosomiasis）、土源性蠕虫病（soil-transmitted helminths）、沙眼（trachoma）、恰加斯病（Chagas disease）、非洲人类锥虫病（human African trypanosomiasis）、麻风病（leprosy）以及内脏利什曼病（visceral leishmaniasis）——探讨了1990年与2010年其疾病负担在最贫困国家的集中程度，并模拟了若达成世界卫生组织既定防控目标，至2020年该集中程度将发生的变化。

主要研究结果
本分析基于全球疾病负担（Global Burden of Disease, GBD）2010研究的1990年与2010年实测数据，以及2020年疾病负担的预测模型。1990年与2010年，低收入及中低收入国家的疾病负担分别占全球总负担的69%与81%。仅土源性蠕虫病与恰加斯病在中高收入国家造成了可观的疾病负担。1990至2010年间，此类被忽视热带病的全球总负担下降了27%，但该降幅的获益主体主要为中高收入国家。若达成世界卫生组织的防控目标，2010至2020年间各收入组别国家的全球疾病负担将进一步降低55%，其中81%的降幅将惠及低收入及中低收入国家。

研究结论
全球疾病负担2010研究数据显示，以伤残调整生命年（Disability Adjusted Life Years, DALYs）计量的9种选定被忽视热带病的疾病负担，高度集中于低收入及中低收入国家，这意味着被忽视热带病防控的获益最终也将主要惠及这些国家。尽管1990至2010年间，9种被忽视热带病的负担愈发向发展中国家集中，但若达成世界卫生组织的防控目标，这一趋势将得到扭转，从而印证了其亲贫政策属性。