Tremendous advancements in science, public health, and material standards of living in recent decades means that people are living longer than ever before. In 1950, when the world’s population was 2.5 billion, life expectancy at birth was 46.5 years. In 2022, those figures rose to 8 billion and 71.2 years, respectively. By 2050, global life expectancy is projected to rise to 77.3 years.
近几十年来，科学、公共卫生和物质生活水平取得了巨大进步，这意味着人们的寿命比以往任何时候都要长。1950 年，世界人口为 25 亿，出生时预期寿命为 46.5 岁。到 2022 年，这两个数字分别上升到 80 亿人和 71.2 岁。到 2050 年，全球预期寿命预计将增至 77.3 岁。
This good news, however, presents a challenge: keeping many more older people healthy than ever before. By 2050, the number of people aged 65 and above is expected to reach 1.6 billion, up from 761 million in 2021, according to the U.N.’s World Social Report 2023.
然而，这一好消息也带来了挑战：让更多的老年人保持健康。根据联合国《2023 年世界社会报告》，到 2050 年，65 岁及以上人口预计将从 2021 年的 7.61 亿增加到 16 亿。
Alzheimer’s disease is one of the gravest threats to this growing population: as more and more people live longer and longer, the total number of people with Alzheimer’s disease worldwide is expected to increase by more than 150 percent in the next 30 years. These people have progressively greater challenges in carrying out their day-to-day activities, are more likely to become injured from falls, and face major challenges managing otherwise straightforward medical problems. Many people with Alzheimer’s disease suffer from hallucinations, confusion, and depression. It is also an ultimately fatal disease.
阿尔茨海默病是这一不断增长的人口所面临的最严重威胁之一：随着越来越多的人寿命越来越长，预计在未来 30 年内，全球阿尔茨海默病患者的总人数将增加 150%以上。这些人在进行日常活动时面临的挑战越来越大，更有可能因跌倒而受伤，在处理其他简单的医疗问题时也面临重大挑战。许多阿尔茨海默病患者会产生幻觉、意识模糊和抑郁。这种疾病最终也会致命。
Alzheimer’s disease can cause horrible suffering among patients and their caregivers. This suffering is part of the large burden Alzheimer’s imposes on people and their families, public-health systems, and nations. The economic cost of this burden is difficult to assess. It involves not only easily quantifiable effects such as treatment and long-term care costs and loss of work productivity and lifespan, but also myriad others that are not easy to measure, such as its effects on the mental health and livelihoods of caregivers and other indirect medical costs.
阿尔茨海默氏症会给患者及其护理人员带来可怕的痛苦。这种痛苦是阿尔茨海默氏症给患者及其家庭、公共卫生系统和国家造成的巨大负担的一部分。这种负担的经济成本很难评估。它不仅包括容易量化的影响，如治疗和长期护理费用、工作效率和寿命的损失，还包括无数其他不易衡量的影响，如对精神健康和照顾者生计的影响以及其他间接医疗费用。
Quantifying the broad economic cost of Alzheimer’s disease is important, not least because it is needed to assess the soundness of the expense to bring tests and, eventually, treatments to so many people through health systems. To this end, we have undertaken a comprehensive analysis, drawing on data from the Institute for Health Metrics and Evaluation (IHME), a leading research organization specializing in analyzing the global burden of diseases, as well as from other organizations and prior studies. We used a methodological approach that estimates the economic burden of Alzheimer’s disease based on people’s willingness to pay to avoid the risk of death. We also developed a macroeconomic model of the productive capacity of a country’s economy that allows for a reduction in labor and capital formation resulting from the disease burden. These methods take into account a wide array of direct and indirect costs of Alzheimer’s disease for individual patients, caregivers, and the aggregate economy.
量化阿尔茨海默病的总体经济成本非常重要，这不仅是因为需要用它来评估通过医疗系统为如此多的人提供检查和最终治疗所需的费用是否合理。为此，我们利用卫生计量与评估研究所（Institute for Health Metrics and Evaluation，IHME）（一家专门从事全球疾病负担分析的领先研究机构）以及其他机构和先前研究的数据进行了全面分析。我们采用的方法是根据人们为避免死亡风险而支付的意愿来估算阿尔茨海默病的经济负担。我们还建立了一个国家经济生产能力的宏观经济模型，该模型考虑到了疾病负担导致的劳动力和资本形成的减少。这些方法考虑到了阿尔茨海默病对患者个人、护理者和整体经济造成的一系列直接和间接成本。
Based on our willingness-to-pay approach, we estimate that the global economic burden of the disease in 2019 was roughly $2 trillion. By 2050, that burden will rise sharply to about $10 trillion and perhaps as high as $13.5 trillion. For comparison, world GDP is projected to be $228 trillion (inflation adjusted) in 2050.
根据我们的支付意愿法，我们估计 2019 年该疾病造成的全球经济负担约为 2 万亿美元。到 2050 年，这一负担将急剧上升到约 10 万亿美元，甚至可能高达 13.5 万亿美元。相比之下，预计 2050 年全球国内生产总值将达到 228 万亿美元（经通胀调整）。
The problem is especially urgent because the economic burden of Alzheimer’s is projected to worsen global economic inequality. Although the current economic costs of Alzheimer’s are concentrated in the wealthiest countries, these will grow much faster in low- and middle-income countries, which are less able to shoulder them. Between now and 2050, the number of people with Alzheimer’s disease in Northern Africa, the Middle East, and Eastern Sub-Saharan Africa is projected to grow by 250 percent, compared to 150 percent worldwide.
这个问题尤为紧迫，因为阿尔茨海默氏症造成的经济负担预计将加剧全球经济不平等。虽然目前阿尔茨海默氏症造成的经济损失主要集中在最富裕的国家，但中低收入国家的经济损失增长速度会更快，因为这些国家承担这些经济损失的能力较弱。从现在到 2050 年，北非、中东和撒哈拉以南非洲东部地区的阿尔茨海默氏症患者人数预计将增长 250%，而全世界的增长率为 150%。
The economic burden of Alzheimer’s disease will be staggering and justifies a substantial scale-up of investments: in R&D spending on Alzheimer’s prevention, early detection, and disease-modifying therapies; the development of new modalities of care; and widespread, equitable access to these innovations. Experts in public health, medicine and policy are beginning to sound the alarm. They warn that massive investments are needed—not just for humanitarian reasons but also as wise economic policy.
阿尔茨海默氏症造成的经济负担将是惊人的，因此有必要大幅增加投资：用于阿尔茨海默氏症预防、早期检测和疾病调整疗法的研发支出；开发新的护理模式；以及广泛、公平地利用这些创新成果。公共卫生、医学和政策方面的专家已经开始敲响警钟。他们警告说，不仅出于人道主义原因，而且作为明智的经济政策，需要进行大规模投资。
The current toll 现行收费
Disease burden research and estimates have typically focused on dementia, which, in addition to Alzheimer’s disease, also includes vascular dementia, frontotemporal dementia, Lewy body dementia, among other forms. Dementia is the sixth-leading source of disability burden among those aged 55 and older. Alzheimer’s disease accounts for approximately 60 to 80 percent of this burden. Based on this proportion, estimates from IHME suggest that in 2019, 34 million to 46 million people around the world had Alzheimer’s. Even if the age- and sex-specific prevalence of dementia remains stable in the coming years, population growth and rising longevity mean more people will be at risk of Alzheimer’s disease. In this vein, the total number of people living with Alzheimer’s disease is projected to rise to about 107 million by 2050. (For this estimate and some others in this article, we give the midpoints of projected ranges; in this case, the range was between 91 million and 122 million.)
疾病负担研究和估算通常侧重于痴呆症，除阿尔茨海默病外，还包括血管性痴呆症、额颞叶痴呆症、路易体痴呆症以及其他形式的痴呆症。痴呆症是造成 55 岁及以上人群残疾负担的第六大来源。阿尔茨海默病约占这一负担的 60% 至 80%。根据这一比例，IHME 估计，2019 年全球将有 3400 万至 4600 万人患有阿尔茨海默氏症。即使按年龄和性别划分的痴呆症患病率在未来几年保持稳定，人口增长和寿命延长也意味着将有更多的人面临阿尔茨海默病的风险。因此，预计到 2050 年，阿尔茨海默氏症患者总数将增至约 1.07 亿人。(本文中的这一估计和其他一些估计，我们给出了预测范围的中点；在这种情况下，预测范围在 9100 万到 1.22 亿之间）。
Despite decades of research, medical interventions that substantially prevent, slow the progression of, or cure Alzheimer’s disease are not yet available. While there are many successful models of coordinated care for people with Alzheimer’s disease, they are not widely implemented. Most face difficult decisions about trying to receive care at home or living in a nursing home, both marked by hospitalizations and visits to the doctor.
尽管经过数十年的研究，但目前还没有能够有效预防、减缓阿尔茨海默病发展或治愈阿尔茨海默病的医疗干预措施。虽然有许多成功的阿尔茨海默病患者协调护理模式，但这些模式并未得到广泛实施。大多数阿尔茨海默病患者都面临着艰难的抉择，是选择在家接受护理，还是住进疗养院，这两种选择都以住院和看医生为标志。
A traditional method for tabulating these expenses is the cost-of-illness (COI) approach, which includes out-of-pocket medical and long-term care expenditures for patients and costs incurred by such payers as insurance companies or government-run healthcare systems. Globally, an estimated $184 billion was spent in direct healthcare costs for people with Alzheimer’s disease in 2019. By 2050, that number is projected to reach $1.1 trillion per year. While high-income countries are expected to see direct costs from Alzheimer’s disease multiply by a factor of five during this time, upper-middle income, lower-middle income, and low-income countries could see these COI estimates grow by factors of 21, 15, and 13, respectively.
计算这些费用的传统方法是疾病成本法（COI），其中包括患者自付的医疗和长期护理费用，以及保险公司或政府运营的医疗保健系统等支付方产生的费用。据估计，2019 年全球阿尔茨海默病患者的直接医疗费用为 1,840 亿美元。到 2050 年，这一数字预计将达到每年 1.1 万亿美元。在此期间，高收入国家的阿尔茨海默病直接成本预计将增加 5 倍，而中上收入、中低收入和低收入国家的 COI 估计值将分别增加 21 倍、15 倍和 13 倍。
A 2018 study using the cost-of-illness approach estimated the combined direct and indirect global costs of Alzheimer’s, including costs associated with seeking medical care (such as transportation and meals), the value of lost economic productivity of patients and caregivers, the medical cost of treating dementia-induced events (such as injuries) and, finally, the cost of the mental suffering of caregivers. The authors estimated the combined direct and indirect global costs of Alzheimer’s disease to be between $575 billion and $766 billion in 2015 and projected that it would increase to about $6.4 trillion by 2050.
2018 年的一项研究采用疾病成本法估算了阿尔茨海默氏症的直接和间接全球综合成本，包括与就医相关的成本（如交通和膳食）、患者和照顾者损失的经济生产力价值、治疗痴呆症诱发事件（如受伤）的医疗成本，以及最后照顾者的精神痛苦成本。作者估计，2015 年阿尔茨海默病的全球直接和间接成本合计为 5,750 亿美元至 7,660 亿美元，预计到 2050 年将增至约 6.4 万亿美元。
COI studies, however, have limitations. Most leave out what economists call “productive nonmarket activities,” which include caring for grandchildren, volunteering in the community, and other unpaid activities that enrich lives. These activities are not measured traditionally in terms of wages or economic output and are rarely included in conventional estimates. In the U.S., 46 percent of a person’s total lifetime economic output is estimated to come after the age of 60—about half of it from employment, half from unpaid activities. Because of lack of data, analyses of the cost of care for Alzheimer’s disease, even if they include formal productivity losses for patients and caregivers, typically do not capture these nonmarket activities.
然而，COI 研究也有局限性。大多数研究忽略了经济学家所说的 "生产性非市场活动"，其中包括照顾孙辈、社区志愿服务以及其他丰富生活的无偿活动。这些活动在传统上并不以工资或经济产出来衡量，也很少被纳入传统的估算中。据估计，在美国，一个人一生中 46% 的经济产出来自 60 岁以后的活动，其中约一半来自就业，一半来自无偿活动。由于缺乏数据，对阿尔茨海默氏症护理成本的分析，即使包括了患者和护理人员的正式生产力损失，通常也不包括这些非市场活动。
The economic costs of Alzheimer’s disease go even further beyond the cost of treatment or long-term care, as we and our colleagues reported in npj Aging in February 2024. A patient may no longer be physically or mentally capable of being employed or be less productive at work, both of which can reduce their own earnings and, in turn, the aggregate economic output of a country. Moreover, in many communities, especially among low-income families that cannot afford expensive nursing homes or home visits by professional caregivers, unpaid caregiving by family members (especially women) remains the norm, likely exacerbating income inequality. In fact, as many as 94 percent of people with dementia in low- and middle-income countries such as Brazil, China and Costa Rica receive their care at home. To quantify the lost economic productivity of unpaid caregivers, some researchers have calculated opportunity cost (potential earnings of the caregiver if they were instead gainfully employed in the market), and others have calculated replacement cost (the economic value of an equivalent amount of care that could be given by a professional caregiver at home instead of the unpaid caregiver). For a person with dementia in the U.S., these indirect cost estimates range from 31 to 49 percent of the total cost of care.
正如我们和我们的同事在 2024 年 2 月的《npj Aging》杂志上所报道的，阿尔茨海默病的经济成本甚至超出了治疗或长期护理的费用。患者可能在身体或精神上不再有能力就业，或者工作效率降低，这两种情况都会减少患者自身的收入，进而减少一个国家的总体经济产出。此外，在许多社区，尤其是那些负担不起昂贵的养老院或专业护理人员上门服务的低收入家庭，由家庭成员（尤其是妇女）提供无偿护理仍是常态，这很可能会加剧收入不平等。事实上，在巴西、中国和哥斯达黎加等中低收入国家，多达 94% 的痴呆症患者在家中接受护理。为了量化无偿照护者所损失的经济生产力，一些研究人员计算了机会成本（如果照护者在市场上有偿就业，他们的潜在收入），另一些研究人员计算了替代成本（由专业照护者在家中代替无偿照护者提供等量照护的经济价值）。对于美国的痴呆症患者来说，这些间接成本估计占护理总成本的 31% 到 49%。
Even considering the lost market productivity of informal caregivers, other factors contribute substantially to the total cost of Alzheimer’s. Caring for people living with the disease is mentally and emotionally difficult for family members, but this pernicious impact is an indirect cost that is typically overlooked. Seeing your parent, grandparent or other loved one suffering from a debilitating disease like Alzheimer’s can be heartbreaking. The caregiver is often a witness to changes to their loved one’s personality and a deterioration of their memories—a decline that often leads to the inability to recognize family members. A comprehensive assessment of the economic burden of Alzheimer’s would include the toll on caregivers and other indirect costs.
即使考虑到非正规护理人员丧失的市场生产力，其他因素也会大大增加阿尔茨海默氏症的总成本。 照顾阿尔茨海默病患者对家庭成员来说在精神上和情感上都很困难，但这一恶性影响却是通常被忽视的间接成本。目睹自己的父母、祖父母或其他亲人罹患阿尔茨海默氏症等使人衰弱的疾病会让人心碎。照顾者往往是亲人性格改变和记忆衰退的见证人--记忆衰退往往会导致无法辨认家人。 对阿尔茨海默氏症造成的经济负担进行全面评估时，应将照顾者付出的代价和其他间接成本包括在内。
A different way of looking at costs
成本的另一种视角
Another method for measuring the potential economic burden of Alzheimer’s is called the value-per-statistical-life, or VSL. The VSL measures a society’s willingness to pay for lowering the risk of death. If a representative person were willing to pay $100 on average for a 1 in 100,000 reduction in the probability of one’s own death, it would take $10 million paid by 100,000 such individuals to collectively avoid one death (or to save one “statistical life”). VSL reflects how individuals value their own lives, presumably encompassing various aspects of healthy living that may range from having a job and earning money to being physically and mentally active, enjoying a good book, a vacation, or spending time with loved ones.
另一种衡量阿尔茨海默氏症潜在经济负担的方法是每统计生命价值，或称 VSL。VSL 衡量社会为降低死亡风险而支付的意愿。如果一个有代表性的人愿意为降低自身死亡概率的十万分之一平均支付 100 美元，那么 10 万个这样的人需要支付 1 千万美元才能共同避免一次死亡（或挽救一条 "统计生命"）。VSL 反映了个人对自己生命的重视程度，大概包括健康生活的各个方面，从拥有工作和赚钱到身心活跃、享受一本好书、一次度假或与亲人共度时光。
The VSL approach to assessing the economic burden of Alzheimer’s typically delivers estimates that encompass a broader range of value than estimates based on macroeconomic modeling or human capital and cost-of-illness approaches. But VSL-based estimates—like estimates based on these other methods—are subject to criticism.
与基于宏观经济模型或人力资本和疾病成本法的估算值相比，VSL 法评估阿尔茨海默氏症经济负担的估算值范围更广。但是，基于 VSL 的估计值与基于这些其他方法的估计值一样，也会受到批评。
Katie Peek; Source: A. Nandi et al., eClinicalMedicine, September 2022, Vol.51:101580.
Katie Peek；来源：A. Nandi et al：A. Nandi 等人，《eClinicalMedicine》，2022 年 9 月，第 51 卷：101580。
One common criticism is that VSL-derived cost estimates increase with income, suggesting that the lives of people living with Alzheimer’s disease in relatively high-income countries are worth more than the lives of people living with Alzheimer’s disease in low- or middle-income countries. This ethically problematic property of the VSL approach arises from the fact that VSL is derived from people’s willingness to pay for relatively small reductions in mortality, which in turn reflects their ability to pay.
一个常见的批评是，VSL 得出的成本估算值会随着收入的增加而增加，这表明相对高收入国家的阿尔茨海默病患者的生命比低收入或中等收入国家的阿尔茨海默病患者的生命更有价值。VSL 方法之所以会产生这种道德问题，是因为 VSL 是根据人们为相对较小的死亡率降低而付费的意愿得出的，而这反过来又反映了人们的支付能力。
This criticism can be addressed in multiple ways, such as by assuming that the value-per-statistical-life year (VSLY)—calculated as VSL divided by the expected number of years of life remaining—is the same for all countries. Modifications like this, however, are atypical in the literature on this topic. To keep our estimates broadly comparable to those of other economists, we chose not to make this adjustment to the VSL estimates in the study reported in this article.
这种批评可以通过多种方式来解决，例如假设每个统计生命年的价值（VSLY）--计算方法是 VSL 除以预期剩余生命年数--对所有国家都是一样的。然而，类似这样的修改在有关该主题的文献中并不常见。为了使我们的估算结果与其他经济学家的估算结果具有广泛的可比性，我们选择不对本文报告的研究中的 VSL 估算结果进行这种调整。
Another criticism of the VSL approach is that it does not include all costs of Alzheimer’s disease, such as those associated with informal caregiving, medical research, or medical care paid for by third parties. This issue can, however, be addressed by interpreting VSL estimates as underestimates of the true costs or by separately calculating the excluded cost components and adding them to the VSL figures.
对 VSL 方法的另一个批评意见是，它没有包括阿尔茨海默病的所有费用，如与非正规护理、医学研究或第三方支付的医疗费用相关的费用。不过，这个问题可以通过将 VSL 估算值解释为低估了真实成本，或者通过单独计算被排除在外的成本部分并将其添加到 VSL 数字中来解决。
In a recently published study in eClinicalMedicine, we adopted the VSL approach to estimate the economic burden of Alzheimer’s disease and other forms of dementia across 168 countries containing more than 99 percent of the world’s population.
在最近发表于《电子临床医学》（eClinicalMedicine）上的一项研究中，我们采用了 VSL 方法来估算阿尔茨海默病和其他形式痴呆症在 168 个国家造成的经济负担，这些国家的人口占世界总人口的 99% 以上。
In this study, we obtained data on disability adjusted life years (DALYs) lost to Alzheimer’s disease from a database prepared by the IHME Global Burden of Diseases study. A DALY represents the loss of the equivalent of one full year of healthy life. DALYs are calculated as the sum of the years of life lost for those who die from Alzheimer’s and the effective years of life lost for those who experience disability from the disease. The more severe the dementia, the more effective years of life are lost. For example, one year of living with severe Alzheimer’s is equivalent to 0.6 year of living without the disease, and one year of living with mild disease is equal to 0.93 year of living without it.
在这项研究中，我们从 IHME 全球疾病负担研究编制的数据库中获得了阿尔茨海默病造成的残疾调整生命年（DALYs）损失数据。一个残疾调整生命年代表相当于一整年健康生活的损失。残疾调整寿命年数的计算方法是，阿尔茨海默氏症患者死亡时所损失的生命年数与因疾病致残时所损失的有效生命年数之和。痴呆症越严重，损失的有效寿命年数就越多。例如，重度阿尔茨海默氏症患者的一年寿命相当于没有患病情况下的 0.6 年寿命，而轻度阿尔茨海默氏症患者的一年寿命相当于没有患病情况下的 0.93 年寿命。
We then monetized each DALY lost to Alzheimer’s disease as being equal to VSLY. For instance, to calculate the VSLY for the U.S., we started by considering the VSL for the U.S., which various U.S. government agencies and researchers have estimated to be approximately $10 million to $12 million. (For other countries, VSL is typically derived by adjusting the U.S. estimate for differences in income and purchasing power.) Based on standard life table estimates, a median-aged U.S. resident in 2019 would have a remaining life expectancy of 43 years. The VSLY figure for the U.S. comes to $246,512 ($10.6 million divided by 43 years). This figure represents the monetary value of each year of full health lost to Alzheimer’s in the U.S., which can be interpreted to include the value of all measurable aspects of a healthy year of life, such as employment, as well as intangible aspects, such as enjoying leisure. It likely does not capture the full economic value of unpaid caregiving, which constitutes a large part of overall care costs for Alzheimer’s.
然后，我们将阿尔茨海默病造成的每一 DALY 损失货币化为 VSLY。例如，为了计算美国的 VSLY，我们首先考虑了美国的 VSL，据美国各政府机构和研究人员估计，美国的 VSL 约为 1,000 万至 1,200 万美元。(对于其他国家，VSL 通常是根据收入和购买力的差异对美国的估计值进行调整后得出的）。根据标准生命表估算，2019 年美国中位年龄居民的剩余预期寿命为 43 岁。美国的 VSLY 数字为 246,512 美元（1,060 万美元除以 43 年）。这个数字代表了美国人因阿尔茨海默症而失去的每一年完全健康的货币价值，可以解释为包括健康生活一年的所有可衡量方面的价值，如就业，以及无形方面的价值，如享受休闲。它很可能没有反映出无偿护理的全部经济价值，而无偿护理在阿尔茨海默氏症的总体护理成本中占了很大一部分。
We projected future VSLY values for each country based on average annual growth rates of gross national income per capita from 2010 to 2019. Based on these figures and our projections of Alzheimer’s cases (which assume that Alzheimer’s would continue to account for 60 to 80 percent of the future global burden of dementia, we estimate the global economic burden of Alzheimer’s disease in 2019 to be about $2 trillion. We also project that the global economic burden of Alzheimer’s would rise to between $2.8 trillion and $3.8 trillion in 2030, to between $5.1 trillion and $6.8 trillion in 2040, and to between $10.1 trillion and $13.5 trillion by 2050. These estimates are reported in 2020 U.S. dollars, with future values discounted at the rate of 3 percent per year.
我们根据 2010 年至 2019 年人均国民总收入的年均增长率预测了每个国家未来的 VSLY 值。根据这些数字和我们对阿尔茨海默病病例的预测（假定阿尔茨海默病将继续占未来全球痴呆症负担的 60% 至 80%），我们估计 2019 年阿尔茨海默病的全球经济负担约为 2 万亿美元。我们还预测，到 2030 年，阿尔茨海默病造成的全球经济负担将增至 2.8 万亿美元至 3.8 万亿美元，到 2040 年增至 5.1 万亿美元至 6.8 万亿美元，到 2050 年增至 10.1 万亿美元至 13.5 万亿美元。这些估算值以 2020 年美元为单位，未来价值以每年 3% 的速度折现。
Our findings also show that the global center of gravity of the economic burden of Alzheimer’s will gradually shift away from high-income countries, which currently have the greatest number of people with Alzheimer’s and toward upper-middle-income countries, which will experience rapid growth in the number of older adults and, as a result, those living with Alzheimer’s. Between 2019 and 2050, the VSL-based economic burden is projected to increase by a factor of 22 in upper-middle-income countries, as compared to 3 in high-income countries. The burden will also grow in other parts of the world at greater rates than in high-income countries, though their absolute magnitude in 2050 will remain low in comparison with upper-middle-income countries.
我们的研究结果还表明，阿尔茨海默氏症经济负担的全球重心将逐渐从目前阿尔茨海默氏症患者人数最多的高收入国家转移到中上收入国家，这些国家的老年人数量将快速增长，因此阿尔茨海默氏症患者的数量也将快速增长。从 2019 年到 2050 年，中上收入国家基于 VSL 的经济负担预计将增加 22 倍，而高收入国家仅为 3 倍。世界其他地区的经济负担增长速度也将高于高收入国家，尽管与中上收入国家相比，2050 年这些国家的绝对值仍然较低。
While the two approaches for assessing the economic burden that we’ve discussed thus far—the COI method and VSL method—can reliably estimate the economic impact of Alzheimer’s disease on people with the disease and their caregivers, neither account for its longer-term and aggregate macroeconomic effects. Deaths and disability from Alzheimer’s disease diminish the size and productivity of the workforce, reducing national economic output.
虽然我们迄今为止讨论过的两种评估经济负担的方法--COI 法和 VSL 法--可以可靠地估算出阿尔茨海默病对患者及其护理者的经济影响，但这两种方法都没有考虑到阿尔茨海默病对宏观经济的长期和总体影响。阿尔茨海默病导致的死亡和残疾会减少劳动力的规模和生产率，从而降低国民经济产出。
Out-of-pocket care costs from Alzheimer’s disease can significantly deplete household savings. These savings might otherwise have been invested in retirement accounts or used to support family businesses or the education of children or grandchildren. Costs incurred by health insurance companies translate to higher insurance premiums and lower household savings for consumers. Similarly, costs paid by social healthcare systems may need to be funded by taxes that, in turn, reduce personal savings. Finally, diverting money to Alzheimer’s care might reduce vital public investments in education, other aspects of health, and infrastructure development that generally have high economic returns.
阿尔茨海默氏症引起的自付护理费用会大大耗尽家庭储蓄。这些积蓄原本可以投资于退休账户或用于支持家族企业或子女或孙辈的教育。医疗保险公司承担的费用会导致保险费增加，消费者的家庭储蓄减少。同样，社会医疗系统支付的费用可能需要通过税收来解决，这反过来又会减少个人储蓄。最后，将资金转用于阿尔茨海默氏症的治疗可能会减少对教育、健康的其他方面以及基础设施建设的重要公共投资，而这些投资通常具有很高的经济回报。
Our macroeconomic model 我们的宏观经济模型
To account for the effects of Alzheimer’s disease on national and global economies, we developed a macroeconomic model that simulates the productive capacity of a country’s overall economy. It accounts for the reductions in labor from Alzheimer’s-related mortality and morbidity, both for patients and caregivers, and reductions in capital formation because of lower savings. It iteratively estimates the value of economic output based on the available labor and capital stock, part of which is then saved by households and invested as capital to spur future economic production.
为了说明阿尔茨海默病对国家和全球经济的影响，我们开发了一个宏观经济模型，模拟一个国家整体经济的生产能力。该模型考虑了与阿尔茨海默氏症相关的死亡率和发病率（包括患者和护理者）导致的劳动力减少，以及储蓄减少导致的资本形成减少。它根据现有的劳动力和资本存量反复估算经济产出的价值，其中一部分由家庭储蓄并作为资本投资，以刺激未来的经济生产。
We estimated that during the 2020-2030 decade, loss of labor and lower rates of capital formation would lead to a global macroeconomic cost of $1.5 trillion. We project cumulative losses between 2020 and 2040 to be about $4.3 trillion and losses from 2020 to 2050 to be about $7.3 trillion. These estimates are conservative, however, in that they do not account for likely economy-wide technological progress, and they do not include the value of productive nonmarket activities of people with Alzheimer’s disease.
我们估计，在 2020-2030 十年间，劳动力流失和资本形成率降低将导致全球宏观经济损失 1.5 万亿美元。我们预计，2020 年至 2040 年的累计损失约为 4.3 万亿美元，2020 年至 2050 年的损失约为 7.3 万亿美元。然而，这些估计是保守的，因为它们没有考虑到整个经济可能出现的技术进步，也没有包括阿尔茨海默病患者的生产性非市场活动的价值。
Macroeconomic analyses provide a fundamentally different view from COI or VSL on the potential future economic burden of Alzheimer’s disease. All take into account demographic and disease-burden patterns, but macroeconomic analyses also account for the underlying rates of household savings, capital formation, and average income in each country. Our macroeconomic analyses find that while low- and middle-income countries are projected to bear the largest health burdens—close to three-quarters of the DALYs lost to Alzheimer’s disease by 2050—their share of the macroeconomic burden would remain just under 50 percent. As another example, South Asia would still account for 19.4 percent of the DALYs lost to Alzheimer’s in 2050 but only 1.6 percent of the macroeconomic burden from 2020 to 2050, while North America would account for only 4.5 percent of the DALYs in 2050 but 28.5 percent of the economic loss from 2020 to 2050.
对于阿尔茨海默病未来可能造成的经济负担，宏观经济分析提供了与 COI 或 VSL 截然不同的观点。 所有分析都考虑了人口和疾病负担模式，但宏观经济分析还考虑了每个国家的基本家庭储蓄率、资本形成率和平均收入。我们的宏观经济分析发现，虽然中低收入国家预计将承受最大的健康负担--到 2050 年，将近四分之三的残疾调整寿命年数损失都是由阿尔茨海默病造成的--但它们在宏观经济负担中所占的份额仍将略低于 50%。再比如，到 2050 年，南亚仍将占阿尔茨海默病残疾调整寿命年数损失的 19.4%，但在 2020 年至 2050 年的宏观经济负担中仅占 1.6%，而北美在 2050 年的残疾调整寿命年数损失中仅占 4.5%，但在 2020 年至 2050 年的经济损失中占 28.5%。
Like our willingness-to-pay (VSL) analysis, our macroeconomic burden modeling uses underlying disease-burden projections that differ from the latest IHME estimates. Our projections assume that the Alzheimer’s disease burden would continue to grow in each country at the same rate as in the past (from 2010 to 2019). By contrast, IHME’s estimates are based on a more detailed methodology that considers several contributing or risk factors for dementia, such as education level, physical activity, and exposure to air pollution. However, the IHME estimates are available only for 2050 and not the intermediate years that we evaluated. The IHME study also does not directly report the DALYs that are used in our analyses. Our linear projections of future Alzheimer’s cases are slightly lower than IHME estimates: 133 percent between 2019 and 2050 versus 166 percent in IHME estimates. This suggests that our estimates of the economic burden of Alzheimer’s disease may be relatively conservative. While our estimates may be limited by some uncertainty surrounding the future disease burden, they nonetheless present a strong economic case for investing in research to prevent and manage Alzheimer’s disease.
与我们的支付意愿（VSL）分析一样，我们的宏观经济负担模型也使用了与 IHME 最新估计不同的基本疾病负担预测。我们的预测假设每个国家的阿尔茨海默病负担将以与过去相同的速度继续增长（从 2010 年到 2019 年）。相比之下，IHME 的估算基于一种更详细的方法，考虑了几种痴呆症的诱因或风险因素，如教育水平、体育活动和空气污染暴露。不过，IHME 的估计值仅适用于 2050 年，而不是我们评估的中间年份。IHME 研究也没有直接报告我们分析中使用的残疾调整生命年。我们对未来阿尔茨海默氏症病例的线性预测略低于 IHME 的估计：2019 年至 2050 年间为 133%，而 IHME 估计为 166%。这表明我们对阿尔茨海默病经济负担的估计可能相对保守。虽然我们的估计可能会受到未来疾病负担不确定性的限制，但这些估计仍为投资研究预防和控制阿尔茨海默病提供了有力的经济支持。
To be sure, recent research has shown that wealth and health are a two-way street. Population health is a benefit of affluence, and healthy populations tend to have more vibrant and robust economies than their less healthy counterparts. Healthy populations also tend to be more stable, cohesive, equitable, and secure. Insofar as global societal well-being is driven by population health in a plethora of ways, the full benefits of population health need to be acknowledged and measured in the interest of efficiently allocating scarce public and private resources and garnering the biggest returns from them.
可以肯定的是，最近的研究表明，财富和健康是双向的。人口健康是富裕带来的好处，健康的人口往往比不那么健康的人口拥有更有活力和更强劲的经济。健康的人口也往往更稳定、更有凝聚力、更公平、更安全。人口健康以多种方式推动着全球社会的福祉，因此，为了有效分配稀缺的公共和私人资源并从中获得最大回报，必须承认和衡量人口健康的全部益处。
The combination of a rapidly aging global population and the lack of treatments for Alzheimer’s is problematic now. In the coming decades, as the toll of the disease swells rapidly, it could become a significant impediment to human progress. In 2020, the U.N. General Assembly declared this decade as the Decade of Healthy Aging, calling upon governments, civil society organizations, the private sector, academic experts, and other stakeholders to join hands in improving the lives of older adults. It would be wise to act now.
目前，全球人口迅速老龄化和阿尔茨海默氏症缺乏治疗方法这两个因素结合在一起，已经成为一个问题。在未来几十年里，随着阿尔茨海默氏症患者人数的迅速增加，它可能会成为人类进步的重大障碍。2020 年，联合国大会宣布本十年为 "健康老龄化十年"，呼吁各国政府、民间社会组织、私营部门、学术专家和其他利益相关方携手改善老年人的生活。明智的做法是现在就行动起来。
This article is part of The New Age of Alzheimer’s, a special report on the advances fueling hope for ending this devastating disease.
这篇文章是《阿尔茨海默氏症的新时代》（The New Age of Alzheimer's ）的一部分，该特别报道介绍了为终结这种毁灭性疾病而取得的进展。
