Measuring Global Burden of Disease
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Transcript of Measuring Global Burden of Disease
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MeasuringGlobal Burden of Disease
Ashwini KalantriModerator:
Dr Pradeep Deshmukh
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Global Burden of Disease• Rationale (Why?)– Assess health status over time– Input to health decision-making and
planning processes
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Global Burden of Disease – How?• Morbidity
indicators• Mortality indicators• Disability indicators• Nutritional status
indicators• Health Care
delivery indicators• Utilization Rates
• Indicators of Social and Mental Health
• Environmental Indicators
• Socio-economic Indicators
• Health Policy Indicators
• Indicators of quality of Life
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Global Burden of Disease• Summary measures of
population health: measures that combine information on mortality and non-fatal health outcomes to represent the health of a particular population as a single number
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History• 1940s: Concept of “Years of Life
Lost”.• 1971: Sullivan’s Index • 1983: Quality Adjusted Life
Expectancy (QALE).• 1990: GBD study – DALYs.• 1998: HeaLY• DALE, HALE, QALY, DFLE followed
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SMPH - TypesHealth ExpectancyHealth expectancies measure years of life gained or years of improved quality of life.
– Disability-free life expectancy (DFLE)
– Disability-adjusted life expectancy (DALE)
– Healthy adjusted life expectancy (HALE)
– Quality adjusted life expectancy (QALE)
Health GapsHealth gaps measure lost years of full health in comparison with some ‘ideal’ health status or accepted standard.
– Potential Years of Life Lost (PYLL)
– Quality Adjusted Life Years (QALY),
– Disability Adjusted Life Years (DALY)
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Survival Curve
0 5 10 15 20 25 30 35 40 45 50 55 60 65 70 75 80 85 90 100
0102030405060708090
100
Age
% S
urvi
ving
A
BC
Time lived in optimal health
Time lived in suboptimal health
Time lost due to mortality
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Life Expectancy• Total life expectancy at birth is given
by the area under the upper curve• Total life expectancy at birth = A + B
020406080
100
A
BC
• A = time lived in optimal health
• B = time lived in suboptimal health
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Health Expectancy• Health expectancies are population
indicators that estimate the average time that a person could expect to live in a defined state of health
• Health Expectancy = A + f (B)
020406080
100
A
BC• A = time lived in optimal
health• B = time lived in suboptimal
health• f (B) = function that assigns
weights to years lived in suboptimal health (optimal health has a weight of 1)
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Health Gaps• Health gaps measure the difference
between actual population health and some specified standard or goal
• Health Gap = C + f (B)
020406080
100
A
BC
• B = time lived in suboptimal health
• C = time lost due to mortality
• f (B) = function that assigns weights to health states lived during time B, but where a weight of 1 equals to time lived in a health state equivalent to death
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DALEDisability Adjusted Life Expectancy
• DALE integrates data on– Mortality– Long – term institutionalization– Activity limitations
• Measures Quality and Quantity of life• A set of weights is assigned to four states
of health – no activity limitations– activity limitations in leisure activities or
transportation– activity limitations at work, home and/or school– institutionalization in a health care facility
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HALEHealth Adjusted Life Expectancy
• Health-adjusted life expectancy is the number of years in full health that an individual can expect to live given the current morbidity and mortality conditions.
• Health-adjusted life expectancy uses the Health Utility Index (HUI) to weigh years lived in good health higher than years lived in poor health.
• Measure of quantity and quality of life
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QALYQuality Adjusted Life Years
• Measures both quality and quantity• Used for cost-benefit analysis• Number of years added due to the
intervention
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DALYDisability Adjusted Life Years
DALY is a measure of overall disease burden, expressed as the cumulative number of years lost due to ill-health, disability or early death
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DALYObjectives
• Inclusion of non-fatal health outcomes in the debate on international health policy
• To quantify the burden of disease using a measure that could also be used for cost-effectiveness analysis.
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DALYDisability Weights
• The ‘valuation’ of time lived in non-fatal health states
• Weights are measured as a number on a scale of 0 to 1, where 0 is assigned to a state comparable to death and 1 is assigned to a state of optimal health
• Because the DALY measures loss of health, the weights are inverted for DALY calculation with 0 representing a state of optimal health (no loss) and 1 representing a state equivalent to death.
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DALYDisability Weights
• Weight for paraplegia of 0.57 - does not mean– Half dead– Halfway between life and death– Society values them as a person less than anyone else.
• A year with blindness (weight 0.43) > a year with paraplegia (weight 0.57) > a year with unremitting unipolar major depression (weight 0.76).
• A year in good health followed by death > a year with paraplegia followed by death.
• A person to live three years with paraplegia followed by death > one year of good health followed by death – (3 years x (1-0.57) = 1.3 ‘healthy’ years is greater than
1 year of good health).
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DALYDisability Weights
Disease Disability WeightsTuberculosis 0.331 (0.222– 0.450)HIV/AIDS 0.547 (0.382–0.715)Major Depression 0.655 (0.469–0.816)Moderate Generalized Musculoskeletal Problems
0.292 (0.197–0.410)
Iodine-deficiency goitre 0.200 (0.134–0.283)Kwashiorkor 0.055 (0.033–0.085)Severe wasting 0.127 (0.081–0.183)
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DALYDiscounting
• The GBD applied a 3% time discount rate to years of life lost in the future to estimate the net present value of years of life lost.
• With this discount rate, a year of healthy life gained in 10 years’ time is worth 24% less than one gained now.
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DALYDiscounting – Why?
• To be consistent with measurement of health outcomes in cost-effectiveness analyses
• To prevent giving excessive weight to deaths at younger ages
• Disease eradication/research paradox
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DALY Calculations
DALY = Years Lived with Disability (YLD) + Years of Life Lost (YLL)
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YLDYears Lived with Disability
• YLD = I x DW x L• I = number of incident cases• DW = disability weight• L = average duration of the case until
remission or death (years)
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Example
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YLLYears of Life Lost
• YLL = N x L• N = number of deaths• L = standard life expectancy at age of death
in yrs
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DALYCritique
• Doesn’t help determine the right intervention
• The true “burden” of disease will depend on the economic, family and social circumstances
• Multi-pathology is not the same as multi-causality.
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DALYCritique
• Discriminates against young and the old
• Does not assess qualitative difference in outcomes
• No Male-Female difference in length of life
• Discounting future health outcomes
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The Global Burden of Disease Study 2010
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DALYs / 1,00,000GBD Study 2010
Cause 1990 2010 ChangeTuberculosis 1155 717 -37.9%HIV/AIDS 342 1184 246.3%Malaria 1304 1200 -8.0%Common Infectious Diseases
10245 4107 -59.9%
Maternal Disorder
407 234 -42.6%
Mental disorders
2539 2688 5.9%
Endocrine Disorders
1605 1777 10.7%
Musculoskeletal Disorders
2198 2462 12%
All Causes 47205 36145 -23.4%
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Global DALY Trends
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India - DALY Trends
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Thank You
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References1. Donev D, Zaletel-Kragelj L, Bjegović V, Burazeri G. Measuring the burden
of disease: Disability Adjusted Life Years (DALY). Methods and tools in public health. 2010;30:715.
2. Murray CJL, Lopez AD. Global comparative assessments in the health sector: disease burden, expenditures and intervention packages : collected reprints from the Bulletin of the World Health Organization: World Health Organization; 1994.
3. Mathers CD, Vos T, Lopez AD, Salomon J, Ezzati M (ed.) 2001. National Burden of Disease Studies: A Practical Guide. Edition 2.0. Global Program on Evidence for Health Policy. Geneva: World Health Organization.
4. Murray CJL, Vos T, Lozano R, Naghavi M, Flaxman AD, Michaud C, et al. Disability-adjusted life years (DALYs) for 291 diseases and injuries in 21 regions, 1990?2010: a systematic analysis for the Global Burden of Disease Study 2010. The Lancet. 2012;380(9859):2197-223.
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References5. Mathers CD, Fat DM, Boerma JT, Organization WH. The Global Burden
of Disease: 2004 Update: World Health Organization; 2008.6. Murray CJL. Summary measures of population health, 2002: concepts,
ethics, measurement and applications: World Health Organization; 2002.
7. Global Burden of Disease. Institute of Health Metrics and Evaluation; 2012 [cited 2013 24 July]; Available from: http://www.healthmetricsandevaluation.org/gbd.
8. Sayers B, Fliedner T. The critique of DALYs: a counter-reply. Bulletin of the World Health Organization. 1997;75(4):383.
9. Salomon JA, Vos T, Hogan DR, Gagnon M, Naghavi M, Mokdad A, et al. Common values in assessing health outcomes from disease and injury: disability weights measurement study for the Global Burden of Disease Study 2010. The Lancet. 2013;380(9859):2129-43.