Steady state assumptions in DALYs: effect on estimates of HIV impact

Measuring the health of populations: explaining composite indicators

Indicators that summarise the health status of a population and that provide comparable measures of a population disease burden are increasingly vital tools for health policy decision making. Decisions concerning health systems across the world are greatly affected by changes in disease profiles and population dynamics, and must develop the capacity to respond to such changes effectively within the resources of each nation. Decisions must be based on evidence of the patterns of diseases, their risk factors and the effectiveness of alternative interventions. This paper focuses on the main approaches used for developing summary measures that include mortality and morbidity occurring in a population. It discusses the rationale for composite measures and reviews the origins of each main approach. The paper also examines methodological differences among these approaches making explicit the value choices that each entails, outlines the advantages and limitations of each measure, and shows how they relate to one another.

The burden of unintentional injuries among the under-five population in South Asia

BACKGROUND

Childhood injuries are a growing global concern, one that falls disproportionately on developing countries where public health systems are least prepared to address this problem.

AIM

This study assesses the impact of childhood injuries in the developing region of South Asia in order to set forth an agenda for improving child health in that region.

METHODS

A systematic review was conducted for literature with quantitative data on unintentional injuries in children 0-4 years of age published between 1980 and 2007. The information was collated to estimate the mean, weighted mean and mortality rate for each type of injury. The rates were then applied to the 2000 UN projected population to estimate the number of childhood deaths due to unintentional injuries.

RESULTS

Unintentional injuries are estimated to cause 389,000 annual child deaths in South Asia. This premature mortality results in the annual loss of 74 healthy life years (HeaLYs) per 1000 population.

CONCLUSION

The current burden of childhood injuries in South Asia is unacceptably high and calls for efforts from all sectors involved in research, policy and funding to not only assess the impact of childhood injuries but to strengthen the health systems to stem this preventable loss of healthy life.

A new challenge to child and adolescent survival in urban Africa: an increasing burden of road traffic injuries

OBJECTIVES

To develop an epidemiological profile and present the burden of urban road-traffic injuries (RTI) in children and adolescents in urban Sub-Saharan Africa.

METHOD

A systematic review of published and gray literature of children and adolescents < or =19 years old involved in RTI in urban regions in Sub-Saharan Africa from January 1980-December 2003.

RESULTS

The mean annual incidence for urban road-traffic injuries was 109.8 per 100,000 children, and males were twice as involved as their female counterparts. Children between 10 to 14 years constitute the most frequent group involved in road crashes (36%) while pedestrians represent an average of 68% of all childhood RTI cases. Twenty Healthy Life Years per 1,000 children and adolescents are being lost annually in the region from RTI.

CONCLUSIONS

There is an urgent need to develop a regional health research agenda to generate an accurate estimate of the burden of road-traffic injuries on children. This is a new challenge for child health and there is a need to raise awareness among policy makers to promote appropriate interventions.

Measuring the burden of major cancers due to smoking in Korea

Morbidity and mortality are classically used to measure disease burden. However, the allocation of limited health-care resources demands an agreed rational allocation principle and, consequently, the setting of priorities is of considerable importance. We collected data from the national death certificate database, and the national health insurance claim database and life tables. Using this data, we calculated disability adjusted life year (DALY) and health life year (HeaLY) values for smoking-related cancer. The burden of cancer due to smoking was estimated by multiplying the population attributable risk due to smoking by the DALY and HeaLY results for cancers. The burden of cancer due to smoking for Korean men was 1930.1 person-years by DALY and 1681.3 person-years by HeaLY per 100 000 people. Similarly, the burden of cancer due to smoking for Korean women was 352.6 person-years for DALY and 313.6 person-years for HeaLY per 100 000 people. Priority rankings for cancer burden due to smoking was somewhat different by DALY and HeaLY. The largest health gap for men was stomach cancer by DALY and lung cancer by HeaLY, whereas for women it was lung cancer by both methods. This study provides a rational basis for national cancer policy planning by presenting the priority burden of cancers caused by smoking.

Estimating the burden of road traffic injuries among children and adolescents in urban South Asia

Over a million people died from road traffic injuries (RTI) globally in the year 2000 and as many as 50 million were injured. Yet there has been little work focused on the South Asia region, let alone the vulnerable segments of population such as children and adolescents. This study aims at measuring the burden of disease caused by urban road traffic injuries among children and adolescents in South Asia. This study selected 26 studies for review and data extraction out of 1505 published articles. Data from the studies were pooled to calculate the proportion and characteristics of child and adolescent RTI, regional RTI incidence and mortality rates, and an estimate of the burden of disease caused by these injuries through the use of the healthy life years lost (HeaLY) composite measure. Our findings showed that the majority of injuries occurred in males (67-80%) and the most frequent age group injured was between ages 0 and 9 representing 40% of cases. Children and adolescents represent an average of 22% of all those with RTI whom seek care. Children and adolescents represented an average of 13% of all RTI deaths. Regional RTI incidence rate was calculated at 880 per 100,000 urban persons aged 0-19. Mortality due to RTI was at 17 deaths per 100,000 urban persons aged 0-19 in South Asia. Burden of disease was calculated 16 HeaLYs per 1000 general population from road traffic mortality alone. With disability data added, then 27.7 HeaLYs per 1000 general population are lost from road traffic injuries in South Asia. The increasing burden of RTI in young persons in South Asia is a call for considering appropriate research and effective interventions. This relatively high loss of healthy life from RTI needs to be addressed by public health systems in South Asia.

Measuring the burden of premature mortality in Pakistan: use of sentinel surveillance systems

INTRODUCTION

In developing countries, finding valid and reliable data is a great challenge. The Federal Bureau of Statistics in Pakistan maintains a surveillance system that records vital events. Results are reported as the Pakistan Demographic Survey (PDS).

METHODS

The adjusted mortality data from PDS-1997 was used to estimate the burden of premature mortality using the healthy life year (HeaLY) methodology.

RESULTS

The burden of premature mortality for Pakistan was 367 HeaLYs lost per 1000 population. More than half of the HeaLYs are being lost due to infection, maternal and perinatal conditions, and malnutrition.

CONCLUSION

In the absence of a system maintaining reliable information regarding vital events, PDS provides a good alternate source of such information that can be used to aid policy making for health care and future research.

Applying burden of disease methods in developing countries: a case study from Pakistan

OBJECTIVES

Disability-adjusted life-year (DALY) and healthy life-year (HeaLY) are composite indicators of disease burden that combine mortality and morbidity into a single measurement. This study examined the application of these methods in a developing country to assess the loss of healthy life from prevalent conditions and their use in resource-poor national contexts.

METHODS

A data set for Pakistan was constructed on the basis of 180 sources for population and disease parameters. The HeaLY approach was used to generate data on loss of healthy life from premature mortality and disability in 1990, categorized by 58 conditions.

RESULTS

Childhood and infectious diseases were responsible for two thirds of the burden of disease in Pakistan. Condition-specific analysis revealed that chronic diseases and injuries were among the top 10 causes of HeaLY loss. Comparison with regional estimates demonstrates consistency of disease trends in both communicable and chronic diseases.

CONCLUSIONS

The burden of disease in countries such as Pakistan can be assessed by using composite indicators. The HeaLY method provides an explicit framework for national health information assessment. Obtaining disease- and population-based data of good quality is the main challenge for any method in the developing world.

Using healthy life years (HeaLYs) to assess programming needs in a public health unit

In December 1997, public health units in Ontario received revised mandatory program guidelines from the Ministry of Health in advance of the downloading of public health to municipalities. Public health units face difficult decisions in allocating municipal resources to meet the Province's mandated programs. To set priorities for resource allocation, it is critical to assess need across program areas and to use a common unit in doing so. This paper applies the Healthy Life Years (HeaLYs) method in assessing health need related to the mandatory programs for the population of Wellington and Dufferin counties in Ontario. The HeaLYs method incorporates duration and severity of ill-health, incidence and mortality in calculating years of healthy life lost (YHLL). For Wellington-Dufferin, the leading causes of YHLL were concentrated in the program areas of chronic disease, injury, and substance abuse and included four areas not addressed in the MPG (suicide, depression, dementia, and osteoarthritis).

Using healthy life years (HeaLYs) to assess programming needs in a public health unit

In December 1997, public health units in Ontario received revised mandatory program guidelines from the Ministry of Health in advance of the downloading of public health to municipalities. Public health units face difficult decisions in allocating municipal resources to meet the Province's mandated programs. To set priorities for resource allocation, it is critical to assess need across program areas and to use a common unit in doing so. This paper applies the Healthy Life Years (HeaLYs) method in assessing health need related to the mandatory programs for the population of Wellington and Dufferin counties in Ontario. The HeaLYs method incorporates duration and severity of ill-health, incidence and mortality in calculating years of healthy life lost (YHLL). For Wellington-Dufferin, the leading causes of YHLL were concentrated in the program areas of chronic disease, injury, and substance abuse and included four areas not addressed in the MPG (suicide, depression, dementia, and osteoarthritis).