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Coste J, Robine JM, Van Oyen H, Carcaillon-Bentata L. Metrological performances of the global chronic morbidity indicator of the Minimum European Health Module and implications for chronic disease prevalence and socioeconomic gradient estimations. Eur J Public Health 2024; 34:774-780. [PMID: 38553026 PMCID: PMC11293826 DOI: 10.1093/eurpub/ckae064] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 08/03/2024] Open
Abstract
BACKGROUND Although the global chronic morbidity indicator (GCMI) of the Minimum European Health Module (MEHM) was not specifically designed to monitor chronic disease in the population, it is increasingly used for this purpose in Europe and elsewhere. However, its metrological characteristics have seldom been examined, with various sensitivity issues being raised. The present study investigated the metrological performances of the GCMI and analyzed its implications in terms of prevalence and demographic and socioeconomic gradients of chronic conditions in the population. METHODS We used data from two large French nationwide representative surveys with cross-sectional and longitudinal data conducted between 2010 and 2021. The surveys used MEHM and collected data on numerous chronic conditions and socioeconomic indicators. Criterion and predictive validity of the GCMI regarding chronic conditions and the resultant socioeconomic gradients were compared with indicators based on reports of individual chronic conditions. RESULTS GCMI sensitivity to capture chronic conditions varied from <20 to 80% depending on the chronic condition. Number of chronic conditions, gender, age and education were also associated with GCMI endorsement. However, the GCMI was predictive of mortality and activity limitations independently of individual conditions. CONCLUSION The varying lack of sensitivity depending on the chronic condition and the respondent's sociodemographic status may bias estimates of demographic and socioeconomic gradients compared with indicators based on reports of individual chronic conditions. Differences between GCMI and list-based approaches should be more cautiously considered when monitoring chronic conditions in the population. These approaches should be viewed as complementary rather than contradictory or interchangeable.
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Affiliation(s)
- Joël Coste
- French Public Health Agency (Santé Publique France), Saint-Maurice, France
| | - Jean-Marie Robine
- MMDN, University of Montpellier, EPHE, Montpellier, France
- PSL Research University, Paris, France
| | - Herman Van Oyen
- Department of Epidemiology and Public Health, Sciensano, Brussels, Belgium
- Department of Public Health and Primary Care, Ghent University, Ghent, Belgium
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Pelgrims I, Devleesschauwer B, Vandevijvere S, De Clercq EM, Van der Heyden J, Vansteelandt S. The potential impact fraction of population weight reduction scenarios on non-communicable diseases in Belgium: application of the g-computation approach. BMC Med Res Methodol 2024; 24:87. [PMID: 38616261 PMCID: PMC11016220 DOI: 10.1186/s12874-024-02212-7] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/20/2023] [Accepted: 04/04/2024] [Indexed: 04/16/2024] Open
Abstract
BACKGROUND Overweight is a major risk factor for non-communicable diseases (NCDs) in Europe, affecting almost 60% of all adults. Tackling obesity is therefore a key long-term health challenge and is vital to reduce premature mortality from NCDs. Methodological challenges remain however, to provide actionable evidence on the potential health benefits of population weight reduction interventions. This study aims to use a g-computation approach to assess the impact of hypothetical weight reduction scenarios on NCDs in Belgium in a multi-exposure context. METHODS Belgian health interview survey data (2008/2013/2018, n = 27 536) were linked to environmental data at the residential address. A g-computation approach was used to evaluate the potential impact fraction (PIF) of population weight reduction scenarios on four NCDs: diabetes, hypertension, cardiovascular disease (CVD), and musculoskeletal (MSK) disease. Four scenarios were considered: 1) a distribution shift where, for each individual with overweight, a counterfactual weight was drawn from the distribution of individuals with a "normal" BMI 2) a one-unit reduction of the BMI of individuals with overweight, 3) a modification of the BMI of individuals with overweight based on a weight loss of 10%, 4) a reduction of the waist circumference (WC) to half of the height among all people with a WC:height ratio greater than 0.5. Regression models were adjusted for socio-demographic, lifestyle, and environmental factors. RESULTS The first scenario resulted in preventing a proportion of cases ranging from 32.3% for diabetes to 6% for MSK diseases. The second scenario prevented a proportion of cases ranging from 4.5% for diabetes to 0.8% for MSK diseases. The third scenario prevented a proportion of cases, ranging from 13.6% for diabetes to 2.4% for MSK diseases and the fourth scenario prevented a proportion of cases ranging from 36.4% for diabetes to 7.1% for MSK diseases. CONCLUSION Implementing weight reduction scenarios among individuals with excess weight could lead to a substantial and statistically significant decrease in the prevalence of diabetes, hypertension, cardiovascular disease (CVD), and musculoskeletal (MSK) diseases in Belgium. The g-computation approach to assess PIF of interventions represents a straightforward approach for drawing causal inferences from observational data while providing useful information for policy makers.
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Affiliation(s)
- Ingrid Pelgrims
- Department of Chemical and Physical Health Risks, Sciensano, Rue Juliette Wytsman 14, 1050, Brussels, Belgium.
- Department of Applied Mathematics, Computer Science and Statistics, Ghent University, Krijgslaan 281, S9, BE-9000, Ghent, Belgium.
- Department of Epidemiology and Public Health, Sciensano, Rue Juliette Wytsman 14, 1050, Brussels, Belgium.
| | - Brecht Devleesschauwer
- Department of Epidemiology and Public Health, Sciensano, Rue Juliette Wytsman 14, 1050, Brussels, Belgium
- Department of Translational Physiology, Infectiology and Public Health, Ghent University, Salisburylaan 133, Hoogbouw, B-9820, Merelbeke, Belgium
| | - Stefanie Vandevijvere
- Department of Epidemiology and Public Health, Sciensano, Rue Juliette Wytsman 14, 1050, Brussels, Belgium
| | - Eva M De Clercq
- Department of Chemical and Physical Health Risks, Sciensano, Rue Juliette Wytsman 14, 1050, Brussels, Belgium
| | - Johan Van der Heyden
- Department of Epidemiology and Public Health, Sciensano, Rue Juliette Wytsman 14, 1050, Brussels, Belgium
| | - Stijn Vansteelandt
- Department of Applied Mathematics, Computer Science and Statistics, Ghent University, Krijgslaan 281, S9, BE-9000, Ghent, Belgium
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Lee WC, Wu YC. Disease Attribution to Multiple Exposures Using Aggregate Data. J Epidemiol 2023; 33:405-409. [PMID: 35283399 PMCID: PMC10319529 DOI: 10.2188/jea.je20210084] [Citation(s) in RCA: 1] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/04/2021] [Accepted: 02/14/2022] [Indexed: 08/06/2023] Open
Abstract
BACKGROUND Identifying which exposures cause disease and quantifying their impacts is essential in promoting and monitoring public health. When multiple exposures are involved, measuring individual contributions becomes challenging. METHODS The authors propose a disease attribution method based on aggregate data or summary statistics of individual-level data, possibly from multiple data sources. RESULTS Using the proposed method, the burden of disease is apportioned to the independent and interaction effects of each of its major risk factors and all the other factors as a whole. This scheme guarantees that 100% is the total share of the burden. CONCLUSION The calculation is simple and straightforward; therefore, it is recommended for use in studies on disease burden.
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Affiliation(s)
- Wen-Chung Lee
- Institute of Epidemiology and Preventive Medicine, College of Public Health, National Taiwan University, Taipei, Taiwan
- Innovation and Policy Center for Population Health and Sustainable Environment, College of Public Health, National Taiwan University, Taipei, Taiwan
| | - Yun-Chun Wu
- Institute of Epidemiology and Preventive Medicine, College of Public Health, National Taiwan University, Taipei, Taiwan
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Plass D, Hilderink H, Lehtomäki H, Øverland S, Eikemo TA, Lai T, Gorasso V, Devleesschauwer B. Estimating risk factor attributable burden - challenges and potential solutions when using the comparative risk assessment methodology. Arch Public Health 2022; 80:148. [PMID: 35624479 PMCID: PMC9137119 DOI: 10.1186/s13690-022-00900-8] [Citation(s) in RCA: 9] [Impact Index Per Article: 4.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/12/2021] [Accepted: 05/12/2022] [Indexed: 03/21/2024] Open
Abstract
Background Burden of disease analyses quantify population health and provide comprehensive overviews of the health status of countries or specific population groups. The comparative risk assessment (CRA) methodology is commonly used to estimate the share of the burden attributable to risk factors. The aim of this paper is to identify and address some selected important challenges associated with CRA, illustrated by examples, and to discuss ways to handle them. Further, the main challenges are addressed and finally, similarities and differences between CRA and health impact assessments (HIA) are discussed, as these concepts are sometimes referred to synonymously but have distinctly different applications. Results CRAs are very data demanding. One key element is the exposure-response relationship described e.g. by a mathematical function. Combining estimates to arrive at coherent functions is challenging due to the large variability in risk exposure definitions and data quality. Also, the uncertainty attached to this data is difficult to account for. Another key issue along the CRA-steps is to define a theoretical minimal risk exposure level for each risk factor. In some cases, this level is evident and self-explanatory (e.g., zero smoking), but often more difficult to define and justify (e.g., ideal consumption of whole grains). CRA combine all relevant information and allow to estimate population attributable fractions (PAFs) quantifying the proportion of disease burden attributable to exposure. Among many available formulae for PAFs, it is important to use the one that allows consistency between definitions, units of the exposure data, and the exposure response functions. When combined effects of different risk factors are of interest, the non-additive nature of PAFs and possible mediation effects need to be reflected. Further, as attributable burden is typically calculated based on current exposure and current health outcomes, the time dimensions of risk and outcomes may become inconsistent. Finally, the evidence of the association between exposure and outcome can be heterogeneous which needs to be considered when interpreting CRA results. Conclusions The methodological challenges make transparent reporting of input and process data in CRA a necessary prerequisite. The evidence for causality between included risk-outcome pairs has to be well established to inform public health practice.
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Affiliation(s)
- Dietrich Plass
- German Environment Agency, Section Exposure Assessment and Environmental Health Indicators, Berlin, Germany.
| | - Henk Hilderink
- National Institute for Public Health and the Environment (RIVM), Bilthoven, The Netherlands
| | - Heli Lehtomäki
- Finnish Institute for Health and Welfare (THL), Health Security, Environmental Health, Helsinki, Finland.,University of Eastern Finland (UEF), Faculty of Health Sciences, School of Pharmacy, Kuopio, Finland
| | - Simon Øverland
- Section for Health Care Collaboration, Haukeland University Hospital, Bergen, Norway
| | - Terje A Eikemo
- Centre for Global Health Inequalities Research (CHAIN), Department of Sociology and Political Science, Norwegian University of Science and Technology (NTNU), Trondheim, Norway
| | - Taavi Lai
- Fourth View Consulting, Tallinn, Estonia
| | - Vanessa Gorasso
- Department of Epidemiology and Public Health, Sciensano, Brussels, Belgium
| | - Brecht Devleesschauwer
- Department of Epidemiology and Public Health, Sciensano, Brussels, Belgium.,Department of Translational Physiology, Infectiology and Public Health, Ghent University, Merelbeke, Belgium
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Zitko P, Bakolis I, Vitoratou S, Chua KC, Margozzini P, Markkula N, Araya R. Psychometric Evaluation of the Health State Description Questionnaire in Chile: A Proposal for a Latent Variable Approach for Valuating Health States. Value Health Reg Issues 2021; 26:142-149. [PMID: 34454395 DOI: 10.1016/j.vhri.2021.06.002] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/21/2020] [Revised: 05/13/2021] [Accepted: 06/26/2021] [Indexed: 10/20/2022]
Abstract
BACKGROUND A few instruments that identify and valuate health states are based on the International Classification of Functioning, Disability and Health States of the World Health Organization. One of them is the Health State Description (HSD) questionnaire first used in the World Health Survey (WHS) initiative (HSD-WHS), whose psychometric properties have not been evaluated in Chile. Additionally, the use of latent variables for the valuation process of health states has been scarcely investigated in the context of population health metrics. We aim to evaluate the psychometric properties and factorial structure of the HSD-WHS for Chile and describe a latent variable method for valuating health states associated with diseases. METHODS We used data from the second Chilean National Health population-based survey from 2009 to 2010 (N = 5293). We explored the factorial structure of the HSD-WHS through exploratory and confirmatory factor analyses, the reliability, and the discriminant validity of the latent variable of disability. Disability weights for diseases were calculated using a linear regression model. RESULTS We found an adequate goodness of fit for a second-order model with 9 factors corresponding to disability domains (Tucker-Lewis index = 0.99, comparative fit index = 0.99, root mean square error of approximation = 0.060), and good reliability estimates (standardized α = 0.91). The rescaled (between 0 and 100) latent variable of disability showed significant difference according to the explored variables. We estimated disability weights for the following: (1) depressive episode, 13.6 (12.1-15.2), (2) hypertension, 1.6 (0.0-3.3), and (3) diabetes, 5.0 (2.5-7.4). CONCLUSIONS This study supports the use of the HSD-WHS questionnaire in the Chilean population and a latent variable approach for valuating health states associated with diseases.
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Affiliation(s)
- Pedro Zitko
- Health Services and Population Research Department, Institute of Psychiatry, Psychology, and Neuroscience, King's College London, London, England, UK; Departamento de Salud Pública, Pontificia Universidad Católica de Chile, Santiago, Chile.
| | - Ioannis Bakolis
- Biostatistics and Health Informatics, Institute of Psychiatry, Psychology, and Neuroscience, King's College London, London, England, UK; Centre for Implementation Science, Health Services and Population Research Department, Institute of Psychiatry, Psychology, and Neuroscience, King's College London, London, England, UK
| | - Silia Vitoratou
- Biostatistics and Health Informatics, Institute of Psychiatry, Psychology, and Neuroscience, King's College London, London, England, UK
| | - Kia-Chong Chua
- Centre for Implementation Science, Health Services and Population Research Department, Institute of Psychiatry, Psychology, and Neuroscience, King's College London, London, England, UK
| | - Paula Margozzini
- Departamento de Salud Pública, Pontificia Universidad Católica de Chile, Santiago, Chile
| | - Niina Markkula
- Department of Psychiatry, Helsinki University and Helsinki University Hospital, Helsinki, Finland
| | - Ricardo Araya
- Centre of Global Mental Health, Institute of Psychiatry, Psychology, and Neuroscience, King's College London, London, England, UK
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Zitko P, Bilbeny N, Balmaceda C, Abbott T, Carcamo C, Espinoza M. Prevalence, burden of disease, and lost in health state utilities attributable to chronic musculoskeletal disorders and pain in Chile. BMC Public Health 2021; 21:937. [PMID: 34001042 PMCID: PMC8130395 DOI: 10.1186/s12889-021-10953-z] [Citation(s) in RCA: 3] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/01/2020] [Accepted: 05/03/2021] [Indexed: 12/03/2022] Open
Abstract
Background Musculoskeletal disorders are a leading cause of disability adjusted life years (DALY) in the world. We aim to describe the prevalence and to compare the DALYs and loss of health state utilities (LHSU) attributable to common musculoskeletal disorders in Chile. Methods We used data from the Chilean National Health Survey carried out in 2016–2017. Six musculoskeletal disorders were detected through the COPCOPRD questionnaire: chronic musculoskeletal pain, chronic low back pain, chronic shoulder pain, osteoarthritis of hip and knee, and fibromyalgia. We calculated the DALY for each disorder for 18 sex and age strata, and LHSU following an individual and population level approaches. We also calculated the fraction of LHSU attributable to pain. Results Chronic musculoskeletal pain disorder affects a fifth of the adult population, with a significant difference between sexes. Among specific musculoskeletal disorders highlights chronic low back pain with the highest prevalence. Musculoskeletal disorders are a significant cause of LHSU at the individual level, especially in the case of fibromyalgia. Chronic musculoskeletal pain caused 503,919 [283,940 - 815,132] DALYs in 2017, and roughly two hundred thousand LSHU at population level, which represents 9.7% [8.8–10.6] of the total LSHU occurred in that year. Discrepancy in the burden of musculoskeletal disorders was observed according to DALY or LSHU estimation. The pain and discomfort domain of LHSU accounted for around half of total LHSU in people with musculoskeletal disorders. Conclusion Chronic musculoskeletal pain is a major source of burden and LHSU. Fibromyalgia should deserve more attention in future studies. Using the attributable fraction offers a straightforward and flexible way to explore the burden of musculoskeletal disorders. Supplementary Information The online version contains supplementary material available at 10.1186/s12889-021-10953-z.
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Affiliation(s)
- Pedro Zitko
- Department of Heath Service & Population Research, IoPPN, Kings College London, London, UK.,Departamento de Salud Pública, Pontificia Universidad Católica de Chile, Diagonal Paraguay, 362, Piso 2, Santiago, Chile
| | | | - Carlos Balmaceda
- Unidad de Evaluación de Tecnologías Sanitarias, Centro de Investigación Clínica, Pontificia Universidad Católica de Chile, Santiago, Chile
| | - Tomas Abbott
- Unidad de Evaluación de Tecnologías Sanitarias, Centro de Investigación Clínica, Pontificia Universidad Católica de Chile, Santiago, Chile
| | - Cesar Carcamo
- Asociación Chilena para el Estudio del Dolor, Santiago, Chile
| | - Manuel Espinoza
- Departamento de Salud Pública, Pontificia Universidad Católica de Chile, Diagonal Paraguay, 362, Piso 2, Santiago, Chile. .,Unidad de Evaluación de Tecnologías Sanitarias, Centro de Investigación Clínica, Pontificia Universidad Católica de Chile, Santiago, Chile.
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Cao R, Wang Y, Huang J, He J, Ponsawansong P, Jin J, Xu Z, Yang T, Pan X, Prapamontol T, Li G. The Mortality Effect of Apparent Temperature: A Multi-City Study in Asia. INTERNATIONAL JOURNAL OF ENVIRONMENTAL RESEARCH AND PUBLIC HEALTH 2021; 18:4675. [PMID: 33924779 PMCID: PMC8124769 DOI: 10.3390/ijerph18094675] [Citation(s) in RCA: 10] [Impact Index Per Article: 3.3] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Subscribe] [Scholar Register] [Received: 03/10/2021] [Revised: 04/19/2021] [Accepted: 04/20/2021] [Indexed: 12/22/2022]
Abstract
(1) Background: The health effect of temperature has become a rising public health topic. The objective of this study is to assess the association between apparent temperature and non-accidental deaths, and the mortality burden attributed to cold and heat temperature; (2) Methods: The daily data on temperature and deaths were collected from 10 cities in Thailand, Korea and China. We fitted a time-series regression with a distributed lag nonlinear model (DLNM) to derive the health risk of temperature for each city and then pooled them to get the overall cumulative risk by multivariate meta-analysis. Additionally, we calculated the attributable fraction of deaths for heat and cold, which was defined as temperatures above and below minimum-mortality temperature (MMT); (3) Results: There are regional heterogeneities in the minimum mortality percentiles (MMP) and attributable fractions for different countries. The MMP varied from about the 5-10th percentile in Thailand to 63-93rd percentile in China and Korea. The attributable fractions of the total deaths due to short-term exposure to temperature in Asia is 7.62%, of which the cold effect (6.44%) is much higher than the heat effect (1.18%); (4) Conclusions: Our study suggested that apparent temperature was associated with an increase in non-accidental mortality. Most of the temperature-related mortality burden was attributable to cold, except for Thailand.
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Affiliation(s)
- Ru Cao
- Department of Occupational and Environmental Health Sciences, Peking University School of Public Health, 38 Xueyuan Road, Haidian District, Beijing 100191, China; (R.C.); (Y.W.); (J.H.); (J.J.); (Z.X.); (T.Y.); (X.P.)
| | - Yuxin Wang
- Department of Occupational and Environmental Health Sciences, Peking University School of Public Health, 38 Xueyuan Road, Haidian District, Beijing 100191, China; (R.C.); (Y.W.); (J.H.); (J.J.); (Z.X.); (T.Y.); (X.P.)
| | - Jing Huang
- Department of Occupational and Environmental Health Sciences, Peking University School of Public Health, 38 Xueyuan Road, Haidian District, Beijing 100191, China; (R.C.); (Y.W.); (J.H.); (J.J.); (Z.X.); (T.Y.); (X.P.)
| | - Jie He
- Peking University School of Nursing, 38 Xueyuan Road, Haidian District, Beijing 100191, China;
| | - Pitakchon Ponsawansong
- Environment and Health Research Unit, Research Institute for Health Science, Chiang Mai University, Chiang Mai 50200, Thailand; (P.P.); (T.P.)
| | - Jianbo Jin
- Department of Occupational and Environmental Health Sciences, Peking University School of Public Health, 38 Xueyuan Road, Haidian District, Beijing 100191, China; (R.C.); (Y.W.); (J.H.); (J.J.); (Z.X.); (T.Y.); (X.P.)
| | - Zhihu Xu
- Department of Occupational and Environmental Health Sciences, Peking University School of Public Health, 38 Xueyuan Road, Haidian District, Beijing 100191, China; (R.C.); (Y.W.); (J.H.); (J.J.); (Z.X.); (T.Y.); (X.P.)
| | - Teng Yang
- Department of Occupational and Environmental Health Sciences, Peking University School of Public Health, 38 Xueyuan Road, Haidian District, Beijing 100191, China; (R.C.); (Y.W.); (J.H.); (J.J.); (Z.X.); (T.Y.); (X.P.)
| | - Xiaochuan Pan
- Department of Occupational and Environmental Health Sciences, Peking University School of Public Health, 38 Xueyuan Road, Haidian District, Beijing 100191, China; (R.C.); (Y.W.); (J.H.); (J.J.); (Z.X.); (T.Y.); (X.P.)
- Environment and Health Research Unit, Research Institute for Health Science, Chiang Mai University, Chiang Mai 50200, Thailand; (P.P.); (T.P.)
| | - Tippawan Prapamontol
- Environment and Health Research Unit, Research Institute for Health Science, Chiang Mai University, Chiang Mai 50200, Thailand; (P.P.); (T.P.)
| | - Guoxing Li
- Department of Occupational and Environmental Health Sciences, Peking University School of Public Health, 38 Xueyuan Road, Haidian District, Beijing 100191, China; (R.C.); (Y.W.); (J.H.); (J.J.); (Z.X.); (T.Y.); (X.P.)
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Zitko P, Bilbeny N, Vargas C, Balmaceda C, Eberhard ME, Ahumada M, Rodríguez MF, Flores J, Markkula N, Espinoza MA. Different Alternatives to Assess the Burden of Disease Using Attributable Fraction on a Disability Variable: The Case of Pain and Chronic Musculoskeletal Disorders in Chile. Value Health Reg Issues 2021; 26:15-23. [PMID: 33765545 DOI: 10.1016/j.vhri.2020.12.007] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/23/2020] [Revised: 12/10/2020] [Accepted: 12/14/2021] [Indexed: 10/21/2022]
Abstract
OBJECTIVES To estimate the burden of disease through 4 complementary procedures to years lived with disability (YLDs) using the concept of attributable fraction and including analysis of subdomains of disability. METHODS We explored the burden on disability for 7 common musculoskeletal disorders (CMD) using the 2009 to 2010 Chilean National Health Survey, which included the Community Oriented Programme for the Control of Rheumatic Disease Core Questionnaire to identify cases with CMD, and an 8-domain questionnaire for health state descriptions. We calculated the proportion of disability attributable to pain in the general population and people with CMD. We also estimated the burden of CMD expressed as YLD and as the proportion of the disability in the general population attributable to people with CMD, with a particular focus in the pain domain of disability. Second order of uncertainty around point estimations was also characterized. RESULTS Pain domain of disability accounted for 23.4% of the total disability in the general population, and between 20% (fibromyalgia) to 27.1% (osteoarthritis of the hip) in people with some of the selected CMD. People with chronic musculoskeletal pain accounted for 21.2% of total disability from general population, which generated 1.2 million of YLD (6679 YLD/100 000 inhabitants). Chronic low back pain and osteoarthritis of the knee were in the top position of specific CMDs, explaining the highest national burden. CONCLUSION Pain is an essential component of disability in people with CMD and also in the general population. The approach used can be easily applied to other health conditions and other domains of disability.
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Affiliation(s)
- Pedro Zitko
- Unidad de Evaluación de Tecnologías Sanitarias, Centro de Invetsigación Clínica, Pontificia Universidad Católica de Chile, Chile; Departamento de Salud Pública, Pontificia Universidad Católica de Chile, Chile; Health Services & Population Research Department, IoPPN, King's College London, England, UK
| | | | - Constanza Vargas
- Unidad de Evaluación de Tecnologías Sanitarias, Centro de Invetsigación Clínica, Pontificia Universidad Católica de Chile, Chile; Centre for Health Economics Research and Evaluation (CHERE), University of Technology Sydney, Sydney, Australia
| | - Carlos Balmaceda
- Unidad de Evaluación de Tecnologías Sanitarias, Centro de Invetsigación Clínica, Pontificia Universidad Católica de Chile, Chile
| | | | | | | | - Javiera Flores
- Departamento de Salud Pública, Pontificia Universidad Católica de Chile, Chile
| | - Niina Markkula
- Department of Psychiatry, Helsinki University and Helsinki University Hospital, Finland
| | - Manuel A Espinoza
- Unidad de Evaluación de Tecnologías Sanitarias, Centro de Invetsigación Clínica, Pontificia Universidad Católica de Chile, Chile; Departamento de Salud Pública, Pontificia Universidad Católica de Chile, Chile.
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