柳叶刀 | 2023年，全球超十亿女性和儿童遭受暴力侵害

《柳叶刀》最新发表一项全新的GBD 2023研究。分析显示，2023年，全球约有6.08亿15岁及以上女性遭受亲密伴侣暴力（IPV），包括来自现任或前任伴侣的躯体暴力和性暴力。与此同时，超过10亿15岁及以上的个体在童年时期遭受过性暴力（ SVAC） 。这些经历与一系列长期健康问题密切相关，包括抑郁和焦虑、慢性疾病以及过早死亡风险的增加。

该研究还揭示了显著的地域差异。 亲密伴侣暴力和性暴力发生率最高的地区集中在撒哈拉以南非洲和南亚，在这些地区，艾滋病的高感染率以及其他慢性疾病的发生，也加剧了暴力对健康的影响。 在一些地区，医疗体系较为脆弱，且对女性和儿童遭受暴力侵害的法律保护也相对有限，因此在应对和预防这些问题时将面临更大的挑战。

虽然研究发现高收入国家（HICs）的总体发生率往往较低，但仍然面临着严峻的挑战，其中亲密伴侣暴力和性暴力是导致疾病负担的主要风险因素之一，尤其是在15至49岁的年轻人中。在较富裕的国家，药物滥用问题和非传染性疾病等因素加剧了暴力对健康的重大影响。

作者指出，这些数据凸显了采取预防措施的迫切性，包括加强法律框架、促进性别平等以及扩大对受暴者的支持服务，以减少暴力造成的健康损害。他们强调，解决针对女性和儿童的暴力问题不仅关乎人权，也是一项至关重要的公共卫生优先事项，可以拯救数百万人的生命，改善心理健康状况，并建设具有韧性的社区。

文章摘要

1990–2023年，204个国家和地区归因于针对女性的亲密伴侣暴力及针对儿童的性暴力的疾病负担：2023年全球疾病负担研究的系统分析

背景

针对女性和儿童的暴力行为是侵犯人权的行为，会对受暴者和整个社会造成持久伤害。亲密伴侣暴力和针对儿童的性暴力是此类暴力的两种主要形式。尽管这些风险因素对个人和社区健康有着广泛的影响，但它们作为全球健康负担的关键驱动因素并未得到充分重视。迫切需要全面且可靠的数据，比较评估亲密伴侣暴力和针对儿童的性暴力的健康负担，从而为国家和全球层面预防暴力及支持受暴者的投入提供依据。

方法

作为GBD 2023研究的一部分，本研究估算了1990年至2023年间204个国家和地区中，针对女性的亲密伴侣暴力和针对儿童（包括男童和女童）的性暴力的发生率及其归因负担，并按年龄和性别进行了分析。我们检索了多个全球数据库，收集了自我报告的关于遭受亲密伴侣暴力以及针对儿童的性暴力暴露情况的数据，并进行了系统评价，以确定与每种风险因素相关的各类健康结局。我们使用时空高斯过程回归模型对IPV和SVAC的患病率进行建模，并应用数据调整方法来解释测量异质性。我们采用“证据权重”（burden-of-proof）来估算与IPV和SVAC相关结局的相对风险。这些估算结果用于计算人群归因分数（population attributable fractions），进而量化每种风险因素导致的伤残调整寿命年（DALYs）。

结果

据估计，2023年，全球有6.08亿（95%不确定区间：5.18亿至7.24亿）15岁及以上女性曾遭受亲密伴侣暴力，10.1亿（7.64亿至14.8亿）15岁及以上个体在童年时期经历过性暴力。2023年，女性因亲密伴侣暴力导致损失1850万（874万至3000万）DALYs，因童年时期遭受的性暴力导致男性和女性损失3220万（1640万至5250万）DALYs。亲密伴侣暴力和童年时期遭受的性暴力是2023年全球疾病负担的主要因素之一，尤其是在15至49岁女性中，分别位列该人群DALYs负担的第四和第五大风险因素。在与亲密伴侣暴力相关的八种健康结局中，焦虑和重度抑郁是导致亲密伴侣暴力相关DALYs的主要原因，分别占2023年DALYs的543万（-125万至1460万）和396万（171万至692万）。童年时期遭受的性暴力则与14种健康结局相关，包括精神健康障碍、药物滥用问题以及慢性病和传染性疾病。 自残和精神分裂症是与童年时期性暴力相关疾病负担的主要来源 ，其中，2023年，童年时期遭受的性暴力导致自残相关的DALYs为671万（200万至1270万），导致精神分裂症相关的DALYs为415万（-192万至1310万）。

解释

亲密伴侣暴力和针对儿童的性暴力是全球健康负担的重要因素，其健康结局涵盖多种个体健康结果。值得注意的是，精神障碍在受暴者疾病负担中所占比例最大。投资预防这些可避免的风险因素，每年有可能避免数百万DALYs损失以及大量过早死亡。研究结果为全球和国家领导人提供了有力证据，促使将亲密伴侣暴力和针对儿童的性暴力提升为公共卫生优先事项。我们需要持续投资，来预防亲密伴侣暴力和针对儿童的性暴力，并实施旨在支持受暴者复杂的社会和健康需求的干预措施。 END

Funding

Gates Foundation.

Declaration of interests

S Afzal reports support for the present manuscript from the Institute of Public Health Lahore; payment or honoraria for lectures, presentations, speakers bureaus, manuscript writing or educational seminars provided by the Dean Institute of Public Health Lahore; support for attending meetings and travel provided by the Dean Institute of Public Health, Lahore Pakistan; participation on a data and safety monitoring board or advisory board as member of the Pakistan National Bioethics Committee, member of the Institutional Review Board of Fatima Jinnah Medical University, member of the Ethical Review Board and Data Monitoring Board Institute of Public Health Lahore Pakistan, and in-charge Clinical Research Organization King Edward Medical University; leadership or fiduciary roles in other board, society, committee or advocacy groups (paid or unpaid) as member of the Pakistan Higher Education Commission Research Committee, member of the Pakistan Medical and Dental Commission Research and Journals Committee, member of the Pakistan Society of Internal Medicine, member of the Pakistan Association of Medical Editors, member of the Medical Microbiology and Infectious Diseases Society, Fellow of Leads International, Fellow of Faculty of Public Health UK, and as a Fellow of the College of Physicians and Surgeons Pakistan; receipt of computer software and equipment from Bergen University Norway for research writing; other financial or non-financial support from the Dean Public Health and Preventive Medicine King Edward Medical University; outside the submitted work. J S Chandan reports support for the present manuscript from the National Institute for Health and Care Research; grants or contracts from the National Institute for Health and Care Research, Youth Endowment Fund, College of Policing, University of Birmingham, Birmingham City Council; consulting fees from Dexter AI (Chief Medical Officer); support for attending meetings and/or travel from the University of Miami and the University of Washington; outside the submitted work. K Deuba reports grants or contracts from the Research Council of Norway (project no 335495); outside the submitted work. D Dias da Silva reports grants or contracts from Fundação para a Ciência e a Tecnologia, project 2024.06933 RESTART (payment made to institution) and E2S|P.Porto—Escola Superior de Saúde do Politécnico do Porto (tenure position as an Adjunct Professor), LAQV-Requimte PT national funds (FCT/MECI, Fundação para a Ciência e Tecnologia and Ministério da Educação, Ciência e Inovação) through the project UID/50006—Laboratório Associado para a Química Verde—Tecnologias e Processos Limpos; payment or honoraria for lectures, presentations, speakers bureaus, manuscript writing or educational events from Faculdade de Farmácia da Universidade do Porto (Portugal) payment made to institution for lectures, Faculdade de Medicina da Universidade do Porto (Portugal) payment made to institution for lectures; support for attending meetings and/or travel from E2S|P.Porto—Escola Superior de Saúde do Politécnico do Porto, Portugal, and travel and meetings expenses from Research Unit LAQV-REQUIMTE, Portugal; outside the submitted work. A Faro reports support for the present manuscript from National Council for Scientific and Technological Development (CNPq), Brazil, CNPq Researcher (PQ B). R C Franklin reports support for attending meetings and/or travel from Australasian College of Tropical Medicine Annual Conference 2022-2025; leadership or fiduciary roles in other board, society, committee or advocacy groups (paid or unpaid) as President of Australasian College of Tropical Medicine, President of Kidsafe Australia, Board Member of the Royal Life Saving Society Australia, and Board Member of Auschem Trainingas; outside the submitted work. D Fry reports support for attending meetings and/or travel from the Institute for Health Metrics and Evaluation for attending an advisory group meeting related to this work; leadership or fiduciary roles in other board, society, committee or advocacy groups (paid or unpaid) on the Childlight's Index Technical Sub-Committee which is also around the topic of child sexual abuse data. F M Knaul reports grants or contracts with Merck KGaA/EMD Serono (research grant paid to the University of Miami), Tides Foundation via the Oak Foundation (two research grants paid to the University of Miami), Fondation Botnar, and the Finker-Frenkel Family Foundation. FMK also reports gifts to the University of Miami from the Wellcome Trust, Mena Catering, the Gloria Estefan Foundation, and the Jose Milton Foundation to support the Lancet Commission on Gender-based Violence and Maltreatment of Young People; consulting fees from Tecnológico de Monterrey; provided strategic guidance on research priorities and lectures for the Institute for Obesity Research at the Tecnólogico de Monterrey (university); payment or honoraria for lectures, presentations, speakers bureaus, manuscript writing or educational events from Cannon Medical Systems—FMK received honoraria for participation in two webinars related reducing disparities in women's health; leadership or fiduciary roles as Founding President of Tómatelo a Pecho, a Mexican non-profit organisation that promotes research, advocacy, awareness, and early detection of breast cancer and has expanded its mission to promote women's health more broadly; Senior Economist (unpaid) with the Mexican Health Foundation; Member of the Board of Directors (unpaid) for Esperanza United; and Member of the Board of Directors for Kristi House Children's Advocacy Center; outside the submitted work. K Krishan acknowledges non-financial support from the University Grants Commission (UGC) Centre of Advanced Study, CAS II, awarded to the Department of Anthropology, and RUSA 2.O grant awarded to Panjab University, Chandigarh, India, outside the submitted work. A-M L Laslett reports support for the present manuscript from the National Health and Medical Research Council of Australia (GNT 2016706; fellowship/salary); support for attending meetings and/or travel from the University of Agder, Norway for the Visiting Travel Award—local airfares and accommodation provided for visit (no conflict of interest); leadership or fiduciary roles in other board, society, committee or advocacy groups (paid or unpaid) as a member of the International Society for Addiction Journal Editors and as Secretary of the Kettil Bruun Society for Social and Epidemiological Research on Alcohol (La Trobe University Academic Board); outside the submitted work. J Liu reports support for the present manuscript from the National Natural Science Foundation (72474005) and Beijing Youth Scholar Program (081); grants or contracts from the National Natural Science Foundation (72474005) and Beijing Youth Scholar Program (081); outside the submitted work. K S-K Ma reports grants or contracts from a research grant from the International Team for Implantology; outside the submitted work. L Monasta reports support for the present manuscript from the Italian Ministry of Health to the Institute of Maternal and Child Health—IRCCS Burlo Garofol. LM received funds from the Italian Ministry of Health payments made to the Institute for Maternal and Child Health—IRCCS Burlo Garofolo under project RC 34/2017. R S Moreira reports grants or contracts from CNPq Research Productivity Scholarship (National Council for Scientific and Technological Development); scholarship registration number 308986/2025-3, outside the submitted work. R F Palma-Alvarez reports payment or honoraria for lectures, presentations, speakers bureaus, manuscript writing, or educational events from Angelini, Casen Recordati, Lundbeck, Neuraxpharm, Rubió, Servier, Takeda; support for attending meetings and/or travel from Angelini, Italfarmaco, Advanz Pharma, Takeda, Lundbeck, Camurus; outside the submitted work. L Ronfani reports support for the present manuscript from the Italian Ministry of Health (Ricerca Corrente 34/2017), payments made to the Institute for Maternal and Child Health IRCCS Burlo Garofolo. V Sharma acknowledges support from the Directorate of Forensic Science Services (DFSS) Ministry of Home Affairs (MHA) research project (DFSS28(1)2019/EMR/6) at Institute of Forensic Science & Criminology, Panjab University, Chandigarh, India, and RUSA grant to Panjab University by Ministry of Education, Govt. of India, outside the submitted work. D J Stein reports support from consultancy honoraria from Discovery Vitality, Kanna, L'Oreal, Lundbeck, Orion, Servier, Seaport Therapeutics, Takeda, and Wellcome; outside the submitted work. R Tabares-Seisdedos reports grants or contracts from the Valencian Regional Government's Ministry of Education (PROMETEO/CIPROM/2022/58) and the Spanish Ministry of Science, Innovation and Universities (PID2021-129099OB-I00); these funders were not involved in the design of the manuscript or decision to submit the manuscript for publication, nor will they be involved in any aspect of the study's conduct, outside the submitted work. S J Tromans reports grants or contracts from the 2023/4 Adult Psychiatric Morbidity Survey team, collecting epidemiological data on community-based adults living in England (a contracted study from NHS Digital, via the Department of Health and Social Care); contributed to multiple chapters of the 2023/4 Adult Psychiatric Morbidity Survey report (payments made to University of Leicester); grants or contracts as lead on a study funded by the National Institute for Health and Care Research Clinical Research Network, on optimising survey design for people with learning disability and autistic people (payments made to University of Leicester); served as the lead on a study from the National Institute for Health and Care Research related to evaluating a national training programme for health and social care professionals relating to learning disability and autism (payments made to University of Leicester); was co-applicant on a study funded by the National Institute for Health and Care Research related to identification, recording, and reasonable adjustments for people with a learning disability and autistic people in NHS electronic clinical record systems (payments made to University of Leicester); was co-applicant on a study funded by the National Institute for Health and Care Research related to medication support interventions and strategies for people with learning disabilities (payments made to University of Leicester); served as lead applicant on a study funded by the Baily Thomas Charitable Fund investigating barriers, enablers and interventions to facilitate de-prescribing for people with intellectual disability (payments made to University of Leicester); has received support for attending meetings and/or travel from the Royal College of Psychiatrists for accommodation and travel to conference events due to academic secretary role in the faculty of the Psychiatry of Intellectual Disability, including conference fees waived for Royal College of Psychiatrists events; reports leadership or fiduciary roles in other board, society, committee or advocacy groups (unpaid) as Academic Secretary and Executive Committee Member for the Neurodevelopmental Psychiatry Special Interest Group and Psychiatry of Intellectual Disability Faculty at the Royal College of Psychiatrists; is Associate Editor for the Journal of Mental Health Research in Intellectual Disabilities; is Editorial Board Member for Progress in Neurology and Psychiatry, Advances in Mental Health and Intellectual Disability, Advances in Autism, BMC Psychiatry, and BJPsych Open; and received royalties as Editor of Psychiatry of Intellectual Disability Across Cultures (Oxford University Press); all outside the submitted work. A C Tsai reports support for the present manuscript from the US National Institutes of Health (K24DA061696); leadership or fiduciary roles in other board, society, committee or advocacy groups (paid) with Elsevier, receipt of financial honorarium for work as Co-Editor in Chief of the Elsevier-owned journal SSM—Mental Health, and from BMJ Publishing Group, receipt of financial honorarium for work as Clinical Editorial Advisor for the BMJ Publishing-owned journal The BMJ, outside the submitted work. A Vieira reports leadership or fiduciary roles in other board, society, committee or advocacy groups (unpaid) with the American Academy of Sleep Medicine as the ambassador 2025; outside the submitted work. S Zadey reports payment or honoraria for lectures, presentations, speakers bureaus, manuscript writing or educational events from Hindu; leadership or fiduciary roles in other board, society, committee or advocacy groups (paid or unpaid) as Co-founder and Board Member of The Association for Socially Applicable Research, an Advisor with Nivarana, a Permanent Council Member for G4 Alliance and Chair of the Asia Working Group, a Drafting Committee Member for the Maharashtra State Mental Health Policy, a Fellow for a Lancet Commission, a Fellow for the Blood DESERT Coalition, and an Adjunct Appointment at Dr D Y Patil Vidyapeeth (deemed to be university); outside the submitted work. G Zamagni reports support for the present manuscript from the Italian Ministry of Health (Ricerca Corrente 34/2017), payments made to the Institute for Maternal and Child Health IRCCS Burlo Garofolo.

中文翻译仅供参考，所有内容以英文原文为准。

DOI: 10.1016/S0140-6736(25)02503-6