美国国立卫生研究院对阿尔茨海默氏病的基金资助策略

本文从美国围立卫生研究院（NIH）1992—2008年间的阿尔茨海默氏病（Alzheimer＇s disease,AD）基金资助项日出发,从基金年度资助项目数、年度资助金额、项日发布机构、公告类别、资助模式、主题分布等几个角度分析了近几年来NIH对AD的资助方式,得出了NIH对AD资助的行为特征和AD研究的战略布局,旨在为我国的AD研究战略布局提供支持。     

NSFC Health Research Funding and Burden of Disease in China

Background

Allocation of health research funds among diseases has never been evaluated in China. This study aimed to examine the relationship between disease-specific funding levels of National Nature Science Foundation of China (NSFC), the main governmental resource for health research in China, and burden of disease.

Methods

Funding magnitudes for 53 diseases or conditions were obtained from the website of NSFC. Measures of disease burden, mortality, years of life lost (YLLs) and disability-adjusted life years (DALYs), were derived from the Global Burden of Disease Study 2010. The relationship between NSFC funding and disease burden was analyzed with univariate linear regression. For each measure associated with funding, regression-derived estimates were used to calculate the expected funds for each disease. The actual and expected funds were then compared. We also evaluated the impacts of changes of disease burden metrics since 1990, and differences from the world averages on NSFC funding.

Results

NSFC health research funding was associated with disease burden measured in mortality (R = 0.33, P = 0.02), YLLs (R = 0.39, P = 0.004), and DALYs (R = 0.40, P = 0.003). But none of the changes of mortality (R = 0.22, P = 0.12), YLLs (R = −0.04, P = 0.79) and DALYs (R = −0.003, P = 0.98) since 1990 was associated with the funding magnitudes. None of the differences of mortality (R = −0.11, P = 0.45), YLLs (R = −0.11, P = 0.43) and DALYs (R = −0.12, P = 0.38) from that of the concurrent world averages were associated with the funding magnitudes. Measured by DALY, stroke and COPD received the least funding compared to expected; while leukemia and diabetes received the most funding compared to expected.

Conclusion

Although NSFC funding were roughly associated with disease burden as measured in mortality, YLLs and DALYs. Some major diseases such as stroke were underfunded; while others such as leukaemia were overfunded. Change of disease burden during the last 20 years and country-specialized disease burden were not reflected in current allocation of NSFC funds.     

美国国立卫生研究院概况

美国国立卫生研究院(the National Institutes of Health,NIH)是美国主要的医学与行为学(medical and behavioral research)研究机构,拥有27个研究所及研究中心和1个院长办公室(office of the director,OD),任务是探索生命本质和行为学方面的基础知识,并充分运用这些知识延长人类寿命,以及预防、诊断和治疗各种疾病和残障。NIH不仅拥有自己的实验室从事医学研究,还通过各种资助方式和研究基金全力支持各大学、医学院校、医院等的非政府科学家及其他国内外研究机构的研究工作,并协助进行研究人员培训,促进医学信息交流。世界一流的科学家在NIH的支持下,自由探索科学问题,取得了辉煌的成就,极大地改善了人类的健康和生存状况。本文旨在介绍NIH的概况、基金管理模式、经费预算等,希望对我国的医学研究事业有所借鉴。     

Health Insurance Status as a Barrier to Ideal Cardiovascular Health for U.S. Adults: Data from the National Health and Nutrition Examination Survey (NHANES)

Background

Little is known about the association between cardiovascular (CV) health and health insurance status. We hypothesized that U.S. adults without health insurance coverage would have a lower likelihood of ideal cardiovascular health.

Methods and Results

Using National Health and Nutrition Examination Survey (NHANES) data from 2007–2010, we examined the relationship between health insurance status and ideal CV health in U.S. adults aged ≥19 years and <65 (N = 3304). Ideal CV health was defined by the American Heart Association (AHA) as the absence of clinically manifested CV disease and the simultaneous presence of 6–7 “ideal” CV health factors and behaviors. Logistic regression modeling was used to determine the relationship between health insurance status and the odds of ideal CV health. Of the U.S. adult population, 5.4% attained ideal CV health, and 23.5% were without health insurance coverage. Those without health insurance coverage were more likely to be young (p<0.0001), male (p<0.0001), non-white (p<0.0001), with less than a high school degree (p<0.0001), have a poverty-to-income ratio less than 1 (p<0.0001) and unemployed (p<0.0001) compared to those with coverage. Lack of health insurance coverage was associated with a lower likelihood of ideal CV health; however, this relationship was attenuated by socioeconomic status.

Conclusions

U.S. adults without health insurance coverage are less likely to have ideal CV health. Population-based strategies and interventions directed at the community-level may be one way to improve overall CV health and reach this at-risk group.