One in 100 US deaths is related to sexual behaviour
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《英国医生杂志》
More than one in every 100 deaths in the United States can be attributed to sexual behaviour, according to a new study (Sexually Transmitted Infections 2005;81:38-40). Rates of illness and premature death attributable to sexual behaviour in the United States are triple the rates in other wealthy nations, the authors say.
Using updated data from the 1996 US burden of disease study, the researchers reported that 29 782 deaths in 1998 could be attributed to sexual behaviour, constituting 1.3% of all deaths in the United States that year. They calculated a total of more than one million disability adjusted life years (DALYs) in 1998 and more than 20 million adverse health events attributable to sexual behaviour. DALYs are a time based composite of years of life lost to premature death or disability.
Adverse events quantified by the researchers included infertility, cervical cancer, hepatitis, and other infections attributable to sexual activity. Elective abortions were included in adverse events but not in the DALYs. More than 7500 DALYs for every 10 000 people were attributable to sexual behaviour, according to the researchers.
More deaths attributable to sexual behaviour occurred among men (19 634) than among women (10 148), and 18 221 of the deaths in men were caused by HIV or AIDS. Cervical cancer attributable to sexually transmitted disease was the leading cause of death among the women, claiming the lives of 4921 women. HIV or AIDS was the cause of death for 4234 women.
Although cervical cancer caused more deaths than HIV and AIDS in women, the estimated DALY for HIV among women was almost double that for cervical cancer, as cervical cancer tends to occur later in life.
Dr Shahul Ebrahim, senior scientist at the Centers for Disease Control and Prevention in Atlanta and lead author of the study, said that the higher disease burden in the United States is due to both a higher prevalence of sexually transmitted infections and to worse health outcomes among those affected.
HIV and AIDS were responsible for a large part of the higher prevalence, he said. The greater disease burden, or DALY, per person in the United States was due, in part, to the country抯 heterogeneous population, with "gaps in between socioeconomic groups" and "gaps in access to care and prevention."
Dr Ebrahim said the key message of the study is that virtually all of the deaths and disability attributable to sexual behaviour can be prevented by the "ABC" approach: abstinence, be faithful, and use condoms.
Countries that have successfully reduced the burden of disease from sexually transmitted diseases, especially HIV and AIDS, include Senegal, Thailand, and Uganda, according to Dr Desmond Johns, director of the New York office of UNAIDS, the joint United Nations programme on HIV and AIDS. These countries, said Dr Johns, keep the overall prevalence of HIV and AIDS down through "massive political mobilisation" and addressing sexual issues "openly and honestly." In this way these countries have been able to reduce the prevalence of both HIV and AIDS from roughly 25% to 30% to less than 10%.
"The greatest factor in dealing with HIV/AIDS," said Dr Johns, "is dealing with all the social and moral baggage that comes with discussions about sex, gay sex, and drug use."(New York Jeanne Lenzer)
Using updated data from the 1996 US burden of disease study, the researchers reported that 29 782 deaths in 1998 could be attributed to sexual behaviour, constituting 1.3% of all deaths in the United States that year. They calculated a total of more than one million disability adjusted life years (DALYs) in 1998 and more than 20 million adverse health events attributable to sexual behaviour. DALYs are a time based composite of years of life lost to premature death or disability.
Adverse events quantified by the researchers included infertility, cervical cancer, hepatitis, and other infections attributable to sexual activity. Elective abortions were included in adverse events but not in the DALYs. More than 7500 DALYs for every 10 000 people were attributable to sexual behaviour, according to the researchers.
More deaths attributable to sexual behaviour occurred among men (19 634) than among women (10 148), and 18 221 of the deaths in men were caused by HIV or AIDS. Cervical cancer attributable to sexually transmitted disease was the leading cause of death among the women, claiming the lives of 4921 women. HIV or AIDS was the cause of death for 4234 women.
Although cervical cancer caused more deaths than HIV and AIDS in women, the estimated DALY for HIV among women was almost double that for cervical cancer, as cervical cancer tends to occur later in life.
Dr Shahul Ebrahim, senior scientist at the Centers for Disease Control and Prevention in Atlanta and lead author of the study, said that the higher disease burden in the United States is due to both a higher prevalence of sexually transmitted infections and to worse health outcomes among those affected.
HIV and AIDS were responsible for a large part of the higher prevalence, he said. The greater disease burden, or DALY, per person in the United States was due, in part, to the country抯 heterogeneous population, with "gaps in between socioeconomic groups" and "gaps in access to care and prevention."
Dr Ebrahim said the key message of the study is that virtually all of the deaths and disability attributable to sexual behaviour can be prevented by the "ABC" approach: abstinence, be faithful, and use condoms.
Countries that have successfully reduced the burden of disease from sexually transmitted diseases, especially HIV and AIDS, include Senegal, Thailand, and Uganda, according to Dr Desmond Johns, director of the New York office of UNAIDS, the joint United Nations programme on HIV and AIDS. These countries, said Dr Johns, keep the overall prevalence of HIV and AIDS down through "massive political mobilisation" and addressing sexual issues "openly and honestly." In this way these countries have been able to reduce the prevalence of both HIV and AIDS from roughly 25% to 30% to less than 10%.
"The greatest factor in dealing with HIV/AIDS," said Dr Johns, "is dealing with all the social and moral baggage that comes with discussions about sex, gay sex, and drug use."(New York Jeanne Lenzer)