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Muñoz Laguna J, Puhan MA, Rodríguez Artalejo F, De Pauw R, Wyper GMA, Devleesschauwer B, Santos JV, Hincapié CA. Certainty of the Global Burden of Disease 2019 Modelled Prevalence Estimates for Musculoskeletal Conditions: A Meta-Epidemiological Study. Int J Public Health 2023; 68:1605763. [PMID: 37325175 PMCID: PMC10266422 DOI: 10.3389/ijph.2023.1605763] [Citation(s) in RCA: 7] [Impact Index Per Article: 7.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/09/2023] [Accepted: 04/27/2023] [Indexed: 06/17/2023] Open
Abstract
Objectives: To describe and assess the risk of bias of the primary input studies that underpinned the Global Burden of Disease Study (GBD) 2019 modelled prevalence estimates of low back pain (LBP), neck pain (NP), and knee osteoarthritis (OA), from Australia, Brazil, Canada, Spain, and Switzerland. To evaluate the certainty of the GBD modelled prevalence evidence. Methods: Primary studies were identified using the GBD Data Input Sources Tool and their risk of bias was assessed using a validated tool. We rated the certainty of modelled prevalence estimates based on the GRADE Guidelines 30-the GRADE approach for modelled evidence. Results: Seventy-two primary studies (LBP: 67, NP: 2, knee OA: 3) underpinned the GBD estimates. Most studies had limited representativeness of their study populations, used suboptimal case definitions and applied assessment instruments with unknown psychometric properties. The certainty of modelled prevalence estimates was low, mainly due to risk of bias and indirectness. Conclusion: Beyond the risk of bias of primary input studies for LBP, NP, and knee OA in GBD 2019, the certainty of country-specific modelled prevalence estimates still have room for improvement.
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Affiliation(s)
- Javier Muñoz Laguna
- Department of Preventive Medicine, Public Health and Microbiology, School of Medicine, Universidad Autónoma de Madrid, Madrid, Spain
- Epidemiology, Biostatistics and Prevention Institute, University of Zurich, Zurich, Switzerland
- University Spine Centre Zurich (UWZH), Balgrist University Hospital, University of Zurich, Zurich, Switzerland
- EBPI-UWZH Musculoskeletal Epidemiology Research Group, University of Zurich and Balgrist University Hospital, Zurich, Switzerland
| | - Milo A. Puhan
- Epidemiology, Biostatistics and Prevention Institute, University of Zurich, Zurich, Switzerland
| | - Fernando Rodríguez Artalejo
- Department of Preventive Medicine, Public Health and Microbiology, School of Medicine, Universidad Autónoma de Madrid, Madrid, Spain
- CIBERESP (CIBER of Epidemiology and Public Health), Madrid, Spain
- IMDEA Food Institute, CEI UAM + CSIC, Madrid, Spain
| | - Robby De Pauw
- Department of Epidemiology and Public Health, Sciensano, Brussels, Belgium
- Department of Rehabilitation Sciences, Ghent University, Ghent, Belgium
| | - Grant M. A. Wyper
- School of Health & Wellbeing, University of Glasgow, Glasgow, United Kingdom
- Place and Wellbeing Directorate, Public Health Scotland, Glasgow, United Kingdom
| | - Brecht Devleesschauwer
- Department of Epidemiology and Public Health, Sciensano, Brussels, Belgium
- Department of Translational Physiology, Infectiology and Public Health, Ghent University, Merelbeke, Belgium
| | - João V. Santos
- MEDCIDS—Department of Community Medicine, Information and Health Decision Sciences, Faculty of Medicine, University of Porto, Porto, Portugal
- CINTESIS—Centre for Health Technology and Services Research, Porto, Portugal
- Public Health Unit, ACES Grande Porto V – Porto Ocidental, ARS Norte, Porto, Portugal
| | - Cesar A. Hincapié
- Epidemiology, Biostatistics and Prevention Institute, University of Zurich, Zurich, Switzerland
- University Spine Centre Zurich (UWZH), Balgrist University Hospital, University of Zurich, Zurich, Switzerland
- EBPI-UWZH Musculoskeletal Epidemiology Research Group, University of Zurich and Balgrist University Hospital, Zurich, Switzerland
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Schüssel K, Breitkreuz J, Brückner G, Schröder H. [Utilizing Routine Health Insurance Data for Calculation of Disease Frequencies in the Project BURDEN 2020]. DAS GESUNDHEITSWESEN 2023; 85:S101-S110. [PMID: 35738301 DOI: 10.1055/a-1806-2115] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/17/2022]
Abstract
OBJECTIVE The concept of disease burden enables a comprehensive analysis of the health status of a population. Key indicators are years of life lost due to mortality (YLL) and morbidity (years lived with disability, YLD), summarised in the DALY indicator (disability adjusted life years). These indicators are suitable for planning prevention, health care or provision of health services. With the project BURDEN 2020, funded by the German Federal Joint Committee's Innovation Fund, a national and regionalised calculation of burden of disease for Germany is being carried out for the first time, based on the methodology of the international "Global Burden of Disease" study. METHODS Calculation of YLD requires data on the frequency and severity of diseases, with routine health insurance data constituting an important data source. Case definitions for 18 selected diseases and severity levels for 11 of these diseases were developed in expert meetings. Based on these case definitions, the AOK Research Institute (WIdO) calculated disease frequencies from health utilisation data of patients insured with the AOK. A specific concept for prevalence calculation takes into account the dynamics of an open cohort of insurees. For severity levels, the results of the AOK insurees were extrapolated to the total population in Germany according to age and gender groups. For disease frequencies, the results were additionally adjusted for morbidity and estimated on regional levels. RESULTS Disease frequencies measured by prevalences or rates are available for 18 diseases from seven categories (cardiovascular diseases, diabetes, cancer, mental disorders, dementia, COPD and lower respiratory tract infections) at the regional levels of the 16 federal states and 96 regional planning areas. Severity distributions are provided on the national level stratified by age groups and gender. The results and documentation of methods are available at www.krankheitslage-deutschland.de (in German language). CONCLUSION Routine health insurance data are an important data source in the BURDEN 2020 project because regional figures and, in some cases, severity levels can be determined on the basis of a large number of cases. A comprehensive publication of results creates transparency and allows reutilisation of methods in further projects. Future research should extend burden of disease calculations to other diseases. In addition, there is an increasing demand for health data linkage.
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Affiliation(s)
| | - Jan Breitkreuz
- Wissenschaftliches Institut der AOK (WIdO), Berlin, Germany
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Porst M, von der Lippe E, Leddin J, Anton A, Wengler A, Breitkreuz J, Schüssel K, Brückner G, Schröder H, Gruhl H, Plaß D, Barnes B, A. Busch M, Haller S, Hapke U, Neuhauser H, Reitzle L, Scheidt-Nave C, Schlotmann A, Steppuhn H, Thom J, Ziese T, Rommel A. The Burden of Disease in Germany at the National and Regional Level. DEUTSCHES ARZTEBLATT INTERNATIONAL 2022; 119:785-792. [PMID: 36350160 PMCID: PMC9902892 DOI: 10.3238/arztebl.m2022.0314] [Citation(s) in RCA: 6] [Impact Index Per Article: 3.0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Received: 05/01/2022] [Revised: 05/01/2022] [Accepted: 08/29/2022] [Indexed: 11/11/2022]
Abstract
BACKGROUND .Summary measures such as disability-adjusted life years (DALY) are becoming increasingly important for the standardized assessment of the burden of disease due to death and disability. The BURDEN 2020 pilot project was designed as an independent burden-of-disease study for Germany, which was based on nationwide data, but which also yielded regional estimates. METHODS DALY is defined as the sum of years of life lost due to death (YLL) and years lived with disability (YLD). YLL is the difference between the age at death due to disease and the remaining life expectancy at this age, while YLD quantifies the number of years individuals have spent with health impairments. Data are derived mainly from causes of death statistics, population health surveys, and claims data from health insurers. RESULTS In 2017, there were approximately 12 million DALY in Germany, or 14 584 DALY per 100 000 inhabitants. Conditions which caused the greatest number of DALY were coronary heart disease (2321 DALY), low back pain (1735 DALY), and lung cancer (1197 DALY). Headache and dementia accounted for a greater disease burden in women than in men, while lung cancer and alcohol use disorders accounted for a greater disease burden in men than in women. Pain disorders and alcohol use disorders were the leading causes of DALY among young adults of both sexes. The disease burden rose with age for some diseases, including cardiovascular diseases, dementia, and diabetes mellitus. For some diseases and conditions, the disease burden varied by geographical region. CONCLUSION The results indicate a need for age- and sex-specific prevention and for differing interventions according to geographic region. Burden of disease studies yield comprehensive population health surveillance data and are a useful aid to decision-making in health policy.
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Affiliation(s)
- Michael Porst
- Robert Koch Institute, Department 2, Epidemiology and Health Monitoring, Berlin
| | - Elena von der Lippe
- Robert Koch Institute, Department 2, Epidemiology and Health Monitoring, Berlin
| | - Janko Leddin
- Robert Koch Institute, Department 2, Epidemiology and Health Monitoring, Berlin
| | - Aline Anton
- Robert Koch Institute, Department 2, Epidemiology and Health Monitoring, Berlin
| | - Annelene Wengler
- Robert Koch Institute, Department 2, Epidemiology and Health Monitoring, Berlin
| | | | | | | | | | - Heike Gruhl
- German Federal Environment Agency, Department II 1 Environmental Hygiene, Berlin
| | - Dietrich Plaß
- German Federal Environment Agency, Department II 1 Environmental Hygiene, Berlin
| | - Benjamin Barnes
- Robert Koch Institute, Department 2, Epidemiology and Health Monitoring, Berlin
| | - Markus A. Busch
- Robert Koch Institute, Department 2, Epidemiology and Health Monitoring, Berlin
| | - Sebastian Haller
- Robert Koch Institute, Department 3, Infectious Disease Epidemiology, Berlin
| | - Ulfert Hapke
- Robert Koch Institute, Department 2, Epidemiology and Health Monitoring, Berlin
| | - Hannelore Neuhauser
- Robert Koch Institute, Department 2, Epidemiology and Health Monitoring, Berlin
| | - Lukas Reitzle
- Robert Koch Institute, Department 2, Epidemiology and Health Monitoring, Berlin
| | | | | | - Henriette Steppuhn
- Robert Koch Institute, Department 2, Epidemiology and Health Monitoring, Berlin
| | - Julia Thom
- Robert Koch Institute, Department 2, Epidemiology and Health Monitoring, Berlin
| | - Thomas Ziese
- Robert Koch Institute, Department 2, Epidemiology and Health Monitoring, Berlin
| | - Alexander Rommel
- Robert Koch Institute, Department 2, Epidemiology and Health Monitoring, Berlin
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Weye N, Momen NC, Whiteford HA, Christensen MK, Iburg KM, Santomauro DF, Agerbo E, Mortensen PB, Pedersen CB, McGrath JJ, Plana-Ripoll O. The contribution of general medical conditions to the non-fatal burden of mental disorders: register-based cohort study in Denmark. BJPsych Open 2022; 8:e180. [PMID: 36205020 PMCID: PMC9634585 DOI: 10.1192/bjo.2022.583] [Citation(s) in RCA: 2] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/23/2022] Open
Abstract
BACKGROUND General medical conditions (GMCs) often co-occur with mental and substance use disorders (MSDs). AIMS To explore the contribution of GMCs to the burden of disease in people with MSDs, and investigate how this varied by age. METHOD A population-based cohort of 6 988 507 persons living in Denmark during 2000-2015 followed for up to 16 years. Danish health registers were used to identify people with MSDs and GMCs. For each MSD, years lived with disability and health loss proportion (HeLP) were estimated for comorbid MSDs and GMCs, using a multiplicative model for disability weights. RESULTS Those with any MSD lost the equivalent of 43% of healthy life (HeLP = 0.43, 95% CI 0.40-0.44) after including information on GMCs, which was an increase from 25% before including GMCs (HeLP = 0.25, 95% CI 0.23-0.27). Schizophrenia was associated with the highest burden of disease (HeLP = 0.77, 95% CI 0.68-0.85). However, within each disorder, the relative contribution of MSDs and GMCs varied. For example, in those diagnosed with schizophrenia, MSDs and GMCs accounted for 86% and 14% of the total health loss; in contrast, in those with anxiety disorders, the same proportions were 59% and 41%. In general, HeLP increased with age, and was mainly associated with increasing rates of pulmonary, musculoskeletal and circulatory diseases. CONCLUSIONS In those with mental disorders, the relative contribution of comorbid GMCs to the non-fatal burden of disease increases with age. GMCs contribute substantially to the non-fatal burden of disease in those with MSDs.
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Affiliation(s)
- Nanna Weye
- National Centre for Register-based Research, Aarhus University, Denmark
| | - Natalie C Momen
- National Centre for Register-based Research, Aarhus University, Denmark
| | - Harvey A Whiteford
- School of Public Health, The University of Queensland, Australia; and Queensland Centre for Mental Health Research, The Park Centre for Mental Health, Australia
| | - Maria Klitgaard Christensen
- National Centre for Register-based Research, Aarhus University, Denmark; and Department of Public Health, Aarhus University, Denmark
| | | | - Damian F Santomauro
- School of Public Health, The University of Queensland, Australia; Queensland Centre for Mental Health Research, The Park Centre for Mental Health, Australia; and Institute for Health Metrics and Evaluation, University of Washington, USA
| | - Esben Agerbo
- National Centre for Register-based Research, Aarhus University, Denmark; Centre for Integrated Register-based Research (CIRRAU), Aarhus University, Denmark; and Lundbeck Foundation Initiative for Integrative Psychiatric Research (iPSYCH), Aarhus, Denmark
| | - Preben Bo Mortensen
- National Centre for Register-based Research, Aarhus University, Denmark; Lundbeck Foundation Initiative for Integrative Psychiatric Research (iPSYCH), Aarhus, Denmark; and Centre for Integrated Register-based Research (CIRRAU), Aarhus University, Denmark
| | - Carsten Bøcker Pedersen
- National Centre for Register-based Research, Aarhus University, Denmark; and Centre for Integrated Register-based Research (CIRRAU), Aarhus University, Denmark
| | - John J McGrath
- National Centre for Register-based Research, Aarhus University, Denmark; Queensland Centre for Mental Health Research, The Park Centre for Mental Health, Australia; and Queensland Brain Institute, The University of Queensland, Australia
| | - Oleguer Plana-Ripoll
- National Centre for Register-based Research, Aarhus University, Denmark; and Department of Clinical Epidemiology, Aarhus University and Aarhus University Hospital, Denmark
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McMonagle C, Brown D, Reeve R, Mancy R. Trends in the diversity of mortality causes and age-standardised mortality rates among subpopulations within Scotland, 2001-2019. SSM Popul Health 2022; 19:101192. [PMID: 36039349 PMCID: PMC9418986 DOI: 10.1016/j.ssmph.2022.101192] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/23/2022] [Revised: 07/25/2022] [Accepted: 07/29/2022] [Indexed: 02/09/2023] Open
Abstract
Previous research has demonstrated increasing diversity in causes of mortality among high-income nations in recent decades, associated with improvements in health and increasing life expectancies. Health outcomes are known to vary widely between communities within these countries and inequalities between sexes and other subpopulations are key in understanding the health of populations. Despite this, little is known about variation in the diversity of mortality causes between these subpopulations. Diversification in mortality causes indicates an increase in the pool of potential causes of mortality an individual is likely to face. This poses challenges for the public health and medical sectors by increasing diagnostic uncertainty and broadening the range of causes to be addressed by public health and medical interventions. Here we examine trends over time in the diversity in causes of mortality in Scotland by sex and area-level deprivation, also examining deaths among those younger than 75 years and those 75 years and older separately. We find that diversity in causes of mortality has increased across subpopulations; that it has risen more quickly in men than women; that the rate of increase has been similar across age categories; and that there is no clear ranking in the trends by deprivation quintile, despite slower improvements in mortality rates among the most deprived. Increasing diversity in mortality causes suggests that a greater public health focus on reducing death rates from a broader range of causes is likely to be required, and this may be especially important for men who face a faster rate of diversification.
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Affiliation(s)
- Ciaran McMonagle
- MRC/CSO Social and Public Health Sciences Unit, University of Glasgow, G3 7HR, UK,Boyd Orr Centre for Population and Ecosystem Health, University of Glasgow, Glasgow, UK,Corresponding author. MRC/CSO Social and Public Health Sciences Unit, University of Glasgow, G3 7HR, UK.
| | - Denise Brown
- MRC/CSO Social and Public Health Sciences Unit, University of Glasgow, G3 7HR, UK
| | - Richard Reeve
- Boyd Orr Centre for Population and Ecosystem Health, University of Glasgow, Glasgow, UK,School of Biodiversity, One Health and Veterinary Medicine, College of Medical, Veterinary and Life Sciences, University of Glasgow, Glasgow, G12 8QQ, UK
| | - Rebecca Mancy
- MRC/CSO Social and Public Health Sciences Unit, University of Glasgow, G3 7HR, UK,School of Biodiversity, One Health and Veterinary Medicine, College of Medical, Veterinary and Life Sciences, University of Glasgow, Glasgow, G12 8QQ, UK
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Measuring disability-adjusted life years (DALYs) due to COVID-19 in Scotland, 2020. Arch Public Health 2022; 80:105. [PMID: 35365228 PMCID: PMC8972687 DOI: 10.1186/s13690-022-00862-x] [Citation(s) in RCA: 22] [Impact Index Per Article: 11.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/06/2022] [Accepted: 03/20/2022] [Indexed: 12/05/2022] Open
Abstract
Background Disability-adjusted life years (DALYs) combine the impact of morbidity and mortality and can enable comprehensive, and comparable, assessments of direct and indirect health harms due to COVID-19. Our aim was to estimate DALYs directly due to COVID-19 in Scotland, during 2020; and contextualise its population impact relative to other causes of disease and injury. Methods National deaths and daily case data were used. Deaths were based on underlying and contributory causes recorded on death certificates. We calculated DALYs based on the COVID-19 consensus model and methods outlined by the European Burden of Disease Network. DALYs were presented as a range, using a sensitivity analysis based on Years of Life Lost estimates using: cause-specific; and COVID-19 related deaths. All COVID-19 estimates were for 2020. Results In 2020, estimates of COVID-19 DALYs in Scotland ranged from 96,500 to 108,200. Direct COVID-19 DALYs were substantial enough to be framed as the second leading cause of disease and injury, with only ischaemic heart disease having a larger impact on population health. Mortality contributed 98% of total DALYs. Conclusions The direct population health impact of COVID-19 has been very substantial. Despite unprecedented mitigation efforts, COVID-19 developed from a single identified case in early 2020 to a condition with an impact in Scotland second only to ischaemic heart disease. Periodic estimation of DALYs during 2021, and beyond, will provide indications of the impact of DALYs averted due to the national rollout of the vaccination programme and other continued mitigation efforts, although new variants may pose significant challenges. Supplementary Information The online version contains supplementary material available at 10.1186/s13690-022-00862-x.
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Gorasso V, Silversmit G, Arbyn M, Cornez A, De Pauw R, De Smedt D, Grant I, Wyper GMA, Devleesschauwer B, Speybroeck N. The non-fatal burden of cancer in Belgium, 2004-2019: a nationwide registry-based study. BMC Cancer 2022; 22:58. [PMID: 35026995 PMCID: PMC8756629 DOI: 10.1186/s12885-021-09109-4] [Citation(s) in RCA: 3] [Impact Index Per Article: 1.5] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/06/2021] [Accepted: 12/06/2021] [Indexed: 11/23/2022] Open
Abstract
BACKGROUND The importance of assessing and monitoring the health status of a population has grown in the last decades. Consistent and high quality data on the morbidity and mortality impact of a disease represent the key element for this assessment. Being increasingly used in global and national burden of diseases (BoD) studies, the Disability-Adjusted Life Year (DALY) is an indicator that combines healthy life years lost due to living with disease (Years Lived with Disability; YLD) and due to dying prematurely (Years of Life Lost; YLL). As a step towards a comprehensive national burden of disease study, this study aims to estimate the non-fatal burden of cancer in Belgium using national data. METHODS We estimated the Belgian cancer burden from 2004 to 2019 in terms of YLD, using national population-based cancer registry data and international disease models. We developed a microsimulation model to translate incidence- into prevalence-based estimates, and used expert elicitation to integrate the long-term impact of increased disability due to surgical treatment. RESULTS The age-standardized non-fatal burden of cancer increased from 2004 to 2019 by 6 and 3% respectively for incidence- and prevalence-based YLDs. In 2019, in Belgium, breast cancer had the highest morbidity impact among women, followed by colorectal and non-melanoma skin cancer. Among men, prostate cancer had the highest morbidity impact, followed by colorectal and non-melanoma skin cancer. Between 2004 and 2019, non-melanoma skin cancer significantly increased for both sexes in terms of age-standardized incidence-based YLD per 100,000, from 49 to 111 for men and from 15 to 44 for women. Important decreases were seen for colorectal cancer for both sexes in terms of age-standardized incidence-based YLD per 100,000, from 105 to 84 for men and from 66 to 58 for women. CONCLUSIONS Breast and prostate cancers represent the greatest proportion of cancer morbidity, while for both sexes the morbidity burden of skin cancer has shown an important increase from 2004 onwards. Integrating the current study in the Belgian national burden of disease study will allow monitoring of the burden of cancer over time, highlighting new trends and assessing the impact of public health policies.
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Affiliation(s)
- Vanessa Gorasso
- Department of Epidemiology and Public Health, Sciensano, Rue J Wytsman 14, 1050, Brussels, Belgium.
- Department of Public Health and Primary Care, Ghent University, Ghent, Belgium.
| | | | - Marc Arbyn
- Department of Epidemiology and Public Health, Sciensano, Rue J Wytsman 14, 1050, Brussels, Belgium
- Department of Human Structure and Repair, Faculty of Medicine and Health Sciences, Ghent University, Ghent, Belgium
| | - Astrid Cornez
- Department of Epidemiology and Public Health, Sciensano, Rue J Wytsman 14, 1050, Brussels, Belgium
| | - Robby De Pauw
- Department of Epidemiology and Public Health, Sciensano, Rue J Wytsman 14, 1050, Brussels, Belgium
- Department of Rehabilitation Sciences, Ghent University, Ghent, Belgium
| | - Delphine De Smedt
- Department of Public Health and Primary Care, Ghent University, Ghent, Belgium
| | - Ian Grant
- Public Health Scotland, Edinburgh, Scotland
| | | | - Brecht Devleesschauwer
- Department of Epidemiology and Public Health, Sciensano, Rue J Wytsman 14, 1050, Brussels, Belgium
- Department of Translational Physiology, Infectiology and Public Health, Ghent University, Merelbeke, Belgium
| | - Niko Speybroeck
- Institute of Health and Society (IRSS), Catholic University of Louvain, Brussels, Belgium
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Guthold R, White Johansson E, Mathers CD, Ross DA. Global and regional levels and trends of child and adolescent morbidity from 2000 to 2016: an analysis of years lost due to disability (YLDs). BMJ Glob Health 2021; 6:bmjgh-2021-004996. [PMID: 33731441 PMCID: PMC7978089 DOI: 10.1136/bmjgh-2021-004996] [Citation(s) in RCA: 17] [Impact Index Per Article: 5.7] [Reference Citation Analysis] [Abstract] [Key Words] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/12/2021] [Accepted: 01/14/2021] [Indexed: 11/04/2022] Open
Abstract
INTRODUCTION Non-fatal health loss makes a substantial contribution to the total disease burden among children and adolescents. An analysis of these morbidity patterns is essential to plan interventions that improve the health and well-being of children and adolescents. Our objective was to describe current levels and trends in the non-fatal disease burden from 2000 to 2016 among children and adolescents aged 0-19 years. METHODS We used years lost due to disability (YLD) estimates in WHO's Global Health Estimates to describe the non-fatal disease burden from 2000 to 2016 for the age groups 0-27 days, 28 days-11 months, 1-4 years, 5-9 years, 10-14 years and 15-19 years globally and by modified WHO region. To describe causes of YLDs, we used 18 broad cause groups and 54 specific cause categories. RESULTS In 2016, the total number of YLDs globally among those aged 0-19 years was about 130 million, or 51 per 1000 population, ranging from 30 among neonates aged 0-27 days to 67 among older adolescents aged 15-19 years. Global progress since 2000 in reducing the non-fatal disease burden has been limited (53 per 1000 in 2000 for children and adolescents aged 0-19 years). The most important causes of YLDs included iron-deficiency anaemia and skin diseases for both sexes, across age groups and regions. For young children under 5 years of age, congenital anomalies, protein-energy malnutrition and diarrhoeal diseases were important causes of YLDs, while childhood behavioural disorders, asthma, anxiety disorders and depressive disorders were important causes for older children and adolescents. We found important variations between sexes and between regions, particularly among adolescents, that need to be addressed context-specifically. CONCLUSION The disappointingly slow progress in reducing the global non-fatal disease burden among children and adolescents contrasts starkly with the major reductions in mortality over the first 17 years of this century. More effective action is needed to reduce the non-fatal disease burden among children and adolescents, with interventions tailored for each age group, sex and world region.
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Affiliation(s)
- Regina Guthold
- Maternal, Newborn, Child and Adolescent Health and Ageing Department, WHO, Geneva, Switzerland
| | | | | | - David A Ross
- Maternal, Newborn, Child and Adolescent Health and Ageing Department, WHO, Geneva, Switzerland
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Register-based metrics of years lived with disability associated with mental and substance use disorders: a register-based cohort study in Denmark. Lancet Psychiatry 2021; 8:310-319. [PMID: 33743882 DOI: 10.1016/s2215-0366(21)00029-8] [Citation(s) in RCA: 28] [Impact Index Per Article: 9.3] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 11/26/2020] [Revised: 01/19/2021] [Accepted: 01/20/2021] [Indexed: 11/22/2022]
Abstract
BACKGROUND Mental disorders account for a substantial proportion of the years lived with disability (YLDs) globally. These estimates have generally been calculated top down based on summary statistics. The aim for this study was to calculate YLDs and a novel related measure, Health Loss Proportion (HeLP), for 18 mental and substance use disorders, based on person-level register data (bottom up). METHODS A cohort of 6 989 627 Danish residents (5·9% had a diagnosis of a mental or substance use disorder registered in the Danish Psychiatric Central Research Register) was investigated. YLDs (the duration of disease multiplied by a disability weight) were calculated for the disorder of interest and for comorbid mental and substance use disorders. HeLPs were estimated as YLDs associated with an index disorder and comorbid mental and substance use disorders divided by person-years at risk in persons with the index disorder. All analyses were adjusted for mental and substance use comorbidity using a multiplicative model of disability weights. FINDINGS Major depressive disorder was the most prevalent disorder, although schizophrenia was the leading cause of YLDs in both sexes combined (YLDs 273·3 [95 % CI 232·3-313·6] per 100 000 person-years). People diagnosed with schizophrenia lost the equivalent of 73% (63-83%) of healthy life per year due to mental and substance use disorders, the largest HeLP of all mental and substance use disorders. Comorbidity of mental and substance use disorders accounted for 69-83% of HeLPs in people with either cannabis use disorders, other drug use disorder and ADHD. By contrast, comorbidity explained 11-23% of the HeLPs in people with autism spectrum disorders, conduct disorder, and schizophrenia. INTERPRETATION Substantial variation in disability was observed across age, sex, and disorders. The new HeLP metric provides novel details of the contribution of comorbidity to the disability associated with mental and substance use disorders. FUNDING The Danish National Research Foundation, Queensland Government Department of Health, European Union's Horizon 2020, Lundbeck Foundation, Stanley Medical Research Institute. TRANSLATION For the Danish translation of the abstract see Supplementary Materials section.
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von der Lippe E, Krause L, Porst M, Wengler A, Leddin J, Müller A, Zeisler ML, Anton A, Rommel A. Prevalence of back and neck pain in Germany. Results from the BURDEN 2020 Burden of Disease Study. JOURNAL OF HEALTH MONITORING 2021; 6:2-14. [PMID: 35586774 PMCID: PMC8832370 DOI: 10.25646/7855] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [Download PDF] [Figures] [Subscribe] [Scholar Register] [Received: 11/20/2020] [Accepted: 01/18/2021] [Indexed: 11/20/2022]
Abstract
Back and neck pain are widespread and can significantly reduce quality of life. A cross-sectional telephone survey (N=5,009) was carried out between October 2019 and March 2020 to gain a valid estimate of the prevalence of back and neck pain among adults in Germany. In addition to the frequency and intensity of back and neck pain, the study collected information about quality of life and comorbidity. The findings showed that 61.3% of respondents reported back pain in the last twelve months. Lower back pain was reported about twice as often as upper back pain, with 15.5% of respondents stating that they experienced chronic back pain. 45.7% reported neck pain, and 15.6% of respondents have experienced lower and upper back pain in addition to neck pain in the past year. Women are affected by all types of pain more often than men. About half of the respondents categorise their back or neck pain as moderate; older respondents report significantly more pain episodes per month than younger respondents. The results described here provide a comprehensive picture of the population-related limitations associated with back and neck pain and are used within the framework of the BURDEN 2020 study to quantify key indicators of burden of disease calculation.
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Affiliation(s)
- Elena von der Lippe
- Robert Koch Institute, Berlin Department of Epidemiology and Health Monitoring
| | - Laura Krause
- Robert Koch Institute, Berlin Department of Epidemiology and Health Monitoring
| | - Michael Porst
- Robert Koch Institute, Berlin Department of Epidemiology and Health Monitoring
| | - Annelene Wengler
- Robert Koch Institute, Berlin Department of Epidemiology and Health Monitoring
| | - Janko Leddin
- Robert Koch Institute, Berlin Department of Epidemiology and Health Monitoring
| | - Anja Müller
- Robert Koch Institute, Berlin Department of Epidemiology and Health Monitoring
| | - Marie-Luise Zeisler
- Robert Koch Institute, Berlin Department of Epidemiology and Health Monitoring
| | - Aline Anton
- Robert Koch Institute, Berlin Department of Epidemiology and Health Monitoring
| | - Alexander Rommel
- Robert Koch Institute, Berlin Department of Epidemiology and Health Monitoring
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von der Lippe E, Devleesschauwer B, Gourley M, Haagsma J, Hilderink H, Porst M, Wengler A, Wyper G, Grant I. Reflections on key methodological decisions in national burden of disease assessments. Arch Public Health 2020; 78:137. [PMID: 33384020 PMCID: PMC7774238 DOI: 10.1186/s13690-020-00519-7] [Citation(s) in RCA: 17] [Impact Index Per Article: 4.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/15/2020] [Accepted: 12/08/2020] [Indexed: 01/10/2023] Open
Abstract
BACKGROUND Summary measures of population health are increasingly used in different public health reporting systems for setting priorities for health care and social service delivery and planning. Disability-adjusted life years (DALYs) are one of the most commonly used health gap summary measures in the field of public health and have become the key metric for quantifying burden of disease (BoD). BoD methodology is, however, complex and highly data demanding, requiring a substantial capacity to apply, which has led to major disparities across researchers and nations in their resources to perform themselves BoD studies and interpret the soundness of available estimates produced by the Global Burden of Disease Study. METHODS BoD researchers from the COST Action European Burden of Disease network reflect on the most important methodological choices to be made when estimating DALYs. The paper provides an overview of eleven methodological decisions and challenges drawing on the experiences of countries working with BoD methodology in their own national studies. Each of these steps are briefly described and, where appropriate, some examples are provided from different BoD studies across the world. RESULTS In this review article we have identified some of the key methodological choices and challenges that are important to understand when calculating BoD metrics. We have provided examples from different BoD studies that have developed their own strategies in data usage and implementation of statistical methods in the production of BoD estimates. CONCLUSIONS With the increase in national BoD studies developing their own strategies in data usage and implementation of statistical methods in the production of BoD estimates, there is a pressing need for equitable capacity building on the one hand, and harmonization of methods on the other hand. In response to these issues, several BoD networks have emerged in the European region that bring together expertise across different domains and professional backgrounds. An intensive exchange in the experience of the researchers in the different countries will enable the understanding of the methods and the interpretation of the results from the local authorities who can effectively integrate the BoD estimates in public health policies, intervention and prevention programs.
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Affiliation(s)
- Elena von der Lippe
- Department of Epidemiology and Health Monitoring, Robert Koch Institute, Berlin, Germany.
| | | | - Michelle Gourley
- Indigenous Data Analysis and Reporting Unit, Australian Institute of Health and Welfare, Canberra, Australia
| | - Juanita Haagsma
- Department of Public Health, Erasmus MC University Medical Center, Rotterdam, The Netherlands
| | - Henk Hilderink
- Centre for Public Health Forecasting, National Institute for Public Health and the Environment, Bilthoven, The Netherlands
| | - Michael Porst
- Department of Epidemiology and Health Monitoring, Robert Koch Institute, Berlin, Germany
| | - Annelene Wengler
- Department of Epidemiology and Health Monitoring, Robert Koch Institute, Berlin, Germany
| | - Grant Wyper
- Public Health Scotland, Edinburgh, Scotland, UK
| | - Ian Grant
- Public Health Scotland, Edinburgh, Scotland, UK
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Paalanen L, Reinikainen J, Härkänen T, Mattila T, Laatikainen T, Jousilahti P, Tolonen H. Comparing data sources in estimating disability-adjusted life years (DALYs) for ischemic heart disease and chronic obstructive pulmonary disease in a cross-sectional setting in Finland. Arch Public Health 2020; 78:58. [PMID: 32566225 PMCID: PMC7302348 DOI: 10.1186/s13690-020-00439-6] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/01/2020] [Accepted: 06/11/2020] [Indexed: 02/08/2023] Open
Abstract
Background The disability-adjusted life years (DALYs) summarize the burden of years of life lost (YLL) due to premature mortality and years lost due to disability (YLD). Our aim was to estimate the burden of ischemic heart disease (IHD) and chronic obstructive pulmonary disease (COPD) in Finland in 2012, and to examine, how much the YLD are affected by the use of different data sources. Methods The YLL were calculated using mortality data for the Finnish 25–74-year-old population in 2012. The YLD were calculated using data from the FINRISK 2012 survey (3041 males, 3383 females aged 25–74 years) and then directly adjusted to the corresponding population. Different administrative registers on 1) hospital inpatient episodes and specialist outpatient visits, 2) entitlement to specially reimbursed medicines, and 3) purchases of prescribed medicines were used for estimation of the YLD in addition to self-reported data. The DALYs were calculated without age-weighting. Results The YLL for IHD were 37.5 for males and 9.1 for females per 1000 population among 25–74-year-old people in Finland in 2012. The YLD for IHD varied markedly depending on which data sources were used. All data sources combined, the YLD per 1000 were 5.3 for males and 2.5 for females resulting in estimated 42.8 and 11.6 DALYs per 1000 due to IHD among males and females, respectively. For COPD, the YLL were 4.7 for males and 2.0 for females per 1000. Also for COPD, the YLD varied markedly depending on data sources used. The YLD per 1000 based on all data sources combined were 2.0 for males and 1.6 for females. As a result, estimated 6.7 and 3.6 DALYs per 1000 were due to COPD among males and females, respectively. Conclusions Especially for COPD, all mild disease cases could probably not be identified from the included registers. Thereby, including survey data improved the coverage of the data. The YLD of IHD and COPD varied markedly between the data sources used in the calculations. However, as YLL constituted a major part of DALYs for these diseases, the variation in YLD did not lead to substantial variation in DALYs.
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Moon L, Gourley M, Goss J, Lum On M, Laws P, Reynolds A, Juckes R. History and development of national burden of disease assessment in Australia. Arch Public Health 2020; 78:88. [PMID: 33005402 PMCID: PMC7523303 DOI: 10.1186/s13690-020-00467-2] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/02/2020] [Accepted: 09/04/2020] [Indexed: 01/15/2023] Open
Abstract
Australia's 1996 national burden of disease (BoD) study was one of the first in the world and updates have continued over the following two decades with the fifth study now underway. The studies adapt the global framework most recently implemented by the Global Burden of Disease Study and the World Health Organization to suit Australia's specific needs, producing estimates of fatal and non-fatal burden via the Disability Adjusted Life Year (DALY) metric, as well as attribution of the burden to many risk factors. Detailed Australian data are used with minimal reliance on modelling to fill data gaps. Comprehensive estimates are produced, including for the Indigenous population, for each of the eight states and territories, the five remoteness areas and five socioeconomic quintiles. A number of method developments have been made as part of these studies, including redistribution of deaths data and a detailed quality framework for describing the robustness of the underlying data and methods. Data and methods continue to be refined as part of the studies, and developments in global studies and other national studies are incorporated where appropriate.
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Affiliation(s)
- Lynelle Moon
- Health Group, Australian Institute of Health and Welfare, GPO Box 570, Canberra, ACT 2601 Australia
| | - Michelle Gourley
- Health Group, Australian Institute of Health and Welfare, GPO Box 570, Canberra, ACT 2601 Australia
| | - John Goss
- Faculty of Health, University of Canberra, Canberra, Australia
| | - Miriam Lum On
- Health Group, Australian Institute of Health and Welfare, GPO Box 570, Canberra, ACT 2601 Australia
| | - Paula Laws
- Health Group, Australian Institute of Health and Welfare, GPO Box 570, Canberra, ACT 2601 Australia
| | - Anna Reynolds
- Health Group, Australian Institute of Health and Welfare, GPO Box 570, Canberra, ACT 2601 Australia
| | - Richard Juckes
- Health Group, Australian Institute of Health and Welfare, GPO Box 570, Canberra, ACT 2601 Australia
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Porst M, Wengler A, Leddin J, Neuhauser H, Katsarava Z, von der Lippe E, Anton A, Ziese T, Rommel A. Migraine and tension-type headache in Germany. Prevalence and disease severity from the BURDEN 2020 Burden of Disease Study. JOURNAL OF HEALTH MONITORING 2020; 5:2-24. [PMID: 35146296 PMCID: PMC8734075 DOI: 10.25646/6990.2] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Abstract] [Key Words] [Download PDF] [Figures] [Subscribe] [Scholar Register] [Received: 04/17/2020] [Accepted: 06/22/2020] [Indexed: 11/18/2022]
Abstract
Headache disorders are widespread among women and men in Germany and are primarily associated with restrictions on quality of life. The two most common types of headache disorders are migraine and tension-type headache. In order to gain valid estimates of the prevalence of these conditions, a cross-sectional telephone-based survey was conducted among adults in Germany (N=5,009) between October 2019 and March 2020. The frequency, duration, the characteristics and comorbidities associated with headache were measured using the diagnostic criteria defined in the International Classification of Headache Disorders. 57.5% of women and 44.4% of men in Germany stated that they had had a headache in the last twelve months. 14.8% of women and 6.0% of men meet all of the diagnostic criteria for migraine. Tension-type headache affects 10.3% of women and 6.5% of men. Migraine and tension-type headache are predominantly found among people of working age and steadily decrease with age. Migraine is often accompanied by comorbidities such as depressive symptoms and anxiety disorders. People affected by headache disorders tend to receive very little professional medical care, with only a minority seeking treatment within a year. These results provide a comprehensive picture of the population-related impact of headache disorders and are used in the BURDEN 2020 study to quantify key indicators for burden of disease assessment.
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Affiliation(s)
- Michael Porst
- Robert Koch Institute, Berlin Department of Epidemiology and Health Monitoring
| | - Annelene Wengler
- Robert Koch Institute, Berlin Department of Epidemiology and Health Monitoring
| | - Janko Leddin
- Robert Koch Institute, Berlin Department of Epidemiology and Health Monitoring
| | - Hannelore Neuhauser
- Robert Koch Institute, Berlin Department of Epidemiology and Health Monitoring
| | - Zaza Katsarava
- Evangelic HospitalUnna
- University of Duisburg-Essen, Department of Neurology
- EVEX Medical Corporation, Tbilisi, Georgia
- I.M. First State Medical University of Setchenov Moscow, Russia
| | - Elena von der Lippe
- Robert Koch Institute, Berlin Department of Epidemiology and Health Monitoring
| | - Aline Anton
- Robert Koch Institute, Berlin Department of Epidemiology and Health Monitoring
| | - Thomas Ziese
- Robert Koch Institute, Berlin Department of Epidemiology and Health Monitoring
| | - Alexander Rommel
- Robert Koch Institute, Berlin Department of Epidemiology and Health Monitoring
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Wyper GMA, Assunção R, Cuschieri S, Devleeschauwer B, Fletcher E, Haagsma JA, Hilderink HBM, Idavain J, Lesnik T, Von der Lippe E, Majdan M, Milicevic MS, Pallari E, Peñalvo JL, Pires SM, Plaß D, Santos JV, Stockton DL, Thomsen ST, Grant I. Population vulnerability to COVID-19 in Europe: a burden of disease analysis. Arch Public Health 2020; 78:47. [PMID: 32501409 PMCID: PMC7256342 DOI: 10.1186/s13690-020-00433-y] [Citation(s) in RCA: 27] [Impact Index Per Article: 6.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/04/2020] [Accepted: 05/19/2020] [Indexed: 02/06/2023] Open
Abstract
BACKGROUND Evidence has emerged showing that elderly people and those with pre-existing chronic health conditions may be at higher risk of developing severe health consequences from COVID-19. In Europe, this is of particular relevance with ageing populations living with non-communicable diseases, multi-morbidity and frailty. Published estimates of Years Lived with Disability (YLD) from the Global Burden of Disease (GBD) study help to characterise the extent of these effects. Our aim was to identify the countries across Europe that have populations at highest risk from COVID-19 by using estimates of population age structure and YLD for health conditions linked to severe illness from COVID-19. METHODS Population and YLD estimates from GBD 2017 were extracted for 45 countries in Europe. YLD was restricted to a list of specific health conditions associated with being at risk of developing severe consequences from COVID-19 based on guidance from the United Kingdom Government. This guidance also identified individuals aged 70 years and above as being at higher risk of developing severe health consequences. Study outcomes were defined as: (i) proportion of population aged 70 years and above; and (ii) rate of YLD for COVID-19 vulnerable health conditions across all ages. Bivariate groupings were established for each outcome and combined to establish overall population-level vulnerability. RESULTS Countries with the highest proportions of elderly residents were Italy, Greece, Germany, Portugal and Finland. When assessments of population-level YLD rates for COVID-19 vulnerable health conditions were made, the highest rates were observed for Bulgaria, Czechia, Croatia, Hungary and Bosnia and Herzegovina. A bivariate analysis indicated that the countries at high-risk across both measures of vulnerability were: Bulgaria; Portugal; Latvia; Lithuania; Greece; Germany; Estonia; and Sweden. CONCLUSION Routine estimates of population structures and non-fatal burden of disease measures can be usefully combined to create composite indicators of vulnerability for rapid assessments, in this case to severe health consequences from COVID-19. Countries with available results for sub-national regions within their country, or national burden of disease studies that also use sub-national levels for burden quantifications, should consider using non-fatal burden of disease estimates to estimate geographical vulnerability to COVID-19.
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Affiliation(s)
- Grant M. A. Wyper
- Place and Wellbeing Directorate, Public Health Scotland, Glasgow, Scotland, UK
| | - Ricardo Assunção
- Food and Nutrition Department, National Institute of Health Dr. Ricardo Jorge, Lisbon, Portugal
| | - Sarah Cuschieri
- Department of Anatomy, Faculty of Medicine and Surgery, University of Malta, Msida, Malta
| | - Brecht Devleeschauwer
- Department of Epidemiology and Public Health, Sciensano, Brussels, Belgium
- Department of Veterinary Public Health and Food Safety, Ghent University, Merelbeke, Belgium
| | - Eilidh Fletcher
- Data Driven Innovation Directorate, Public Health Scotland, Edinburgh, Scotland, UK
| | - Juanita A. Haagsma
- Department of Public Health, Erasmus MC University Medical Center, Rotterdam, The Netherlands
| | - Henk B. M. Hilderink
- National Institute for Public Health and the Environment (RIVM), Bilthoven, The Netherlands
| | - Jane Idavain
- National Institute for Health Development, Tallinn, Estonia
| | - Tina Lesnik
- National Institute of Public Health, Ljubljana, Slovenia
| | - Elena Von der Lippe
- Department of Epidemiology and Health Monitoring, Robert Koch Institute, Berlin, Germany
| | - Marek Majdan
- Department of Public Health, Institute for Global Health and Epidemiology, Faculty of Health Sciences and Social Work, Trnava University, Trnava, Slovakia
| | | | - Elena Pallari
- MRC Clinical Trials and Methodology Unit, University College London, London, UK
| | - José L. Peñalvo
- Unit of Noncommunicable Diseases, Department of Public Health, Institute of Tropical Medicine, Antwerp, Belgium
| | - Sara M. Pires
- National Food Institute, Technical University of Denmark, Lyngby, Denmark
| | - Dietrich Plaß
- Exposure Assessment and Environmental Health Indicators, German Environment Agency, Berlin, Germany
| | - João V. Santos
- MEDCIDS, Department of Community Medicine, Information and Health Decision Sciences, Faculty of Medicine, University of Porto, Porto, Portugal
- CINTESIS, Centre for Health Technology and Services Research, Porto, Portugal
- Public Health Unit, ACES Grande Porto VIII - Espinho/Gaia, ARS Norte, Porto, Portugal
| | - Diane L. Stockton
- Place and Wellbeing Directorate, Public Health Scotland, Glasgow, Scotland, UK
| | | | - Ian Grant
- Data Driven Innovation Directorate, Public Health Scotland, Edinburgh, Scotland, UK
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Wyper GMA, Grant I, Fletcher E, Chalmers N, McCartney G, Stockton DL. Prioritising the development of severity distributions in burden of disease studies for countries in the European region. ACTA ACUST UNITED AC 2020; 78:3. [PMID: 31921418 PMCID: PMC6950931 DOI: 10.1186/s13690-019-0385-6] [Citation(s) in RCA: 13] [Impact Index Per Article: 3.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/18/2019] [Accepted: 12/20/2019] [Indexed: 11/24/2022]
Abstract
Severity distributions are a means of summarising the range of health loss suffered to disease which enables estimates of disease occurrence to be paired with disability weights to estimate Years Lost to Disability (YLD) in burden of disease studies. There is a lack of current data exploring severity distributions, which has led to the Global Burden of Disease (GBD) study relying on using the same severity distributions across countries and regions across the world. This is also largely true for some national studies, although there are exceptions. Recent evidence has raised concerns that severity distributions are unlikely to be generalisable as major differences arise when using country-specific data to develop severity distributions. These issues raise uncertainties over interpreting YLD estimates, particularly if they are being used to develop and influence policies and to determine priorities across diseases and populations. It is clear that GBD researchers and those carrying out national studies need to work towards ensuring that estimates are based upon country-specific data, and, if possible, that the impact of assumptions are fully tested and understood. There is a lack of strategy about if, where, and how, this could be achieved, particularly around how efforts should be prioritised. This commentary advocates and presents a possible strategic approach to better understanding how efforts may be best placed.
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Affiliation(s)
- Grant M A Wyper
- Public Health Science Directorate, NHS Health Scotland, Meridian Court, 5 Cadogan Street, Glasgow, Scotland G2 6QE
| | - Ian Grant
- 2Information Services Division, NHS National Services Scotland, Gyle Square, 1 South Gyle Crescent, Edinburgh, Scotland EH12 9EB
| | - Eilidh Fletcher
- 2Information Services Division, NHS National Services Scotland, Gyle Square, 1 South Gyle Crescent, Edinburgh, Scotland EH12 9EB
| | - Neil Chalmers
- Public Health Science Directorate, NHS Health Scotland, Meridian Court, 5 Cadogan Street, Glasgow, Scotland G2 6QE
| | - Gerry McCartney
- Public Health Science Directorate, NHS Health Scotland, Meridian Court, 5 Cadogan Street, Glasgow, Scotland G2 6QE
| | - Diane L Stockton
- Public Health Science Directorate, NHS Health Scotland, Meridian Court, 5 Cadogan Street, Glasgow, Scotland G2 6QE
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Wyper GMA, Grant I, Fletcher E, McCartney G, Fischbacher C, Stockton DL. How do world and European standard populations impact burden of disease studies? A case study of disability-adjusted life years (DALYs) in Scotland. ACTA ACUST UNITED AC 2020; 78:1. [PMID: 31908777 PMCID: PMC6941317 DOI: 10.1186/s13690-019-0383-8] [Citation(s) in RCA: 69] [Impact Index Per Article: 17.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/14/2019] [Accepted: 12/13/2019] [Indexed: 11/10/2022]
Abstract
Background Disability-Adjusted Life Years (DALYs) are an established method for quantifying population health needs and guiding prioritisation decisions. Global Burden of Disease (GBD) estimates aim to ensure comparability between countries and over time by using age-standardised rates (ASR) to account for differences in the age structure of different populations. Different standard populations are used for this purpose but it is not widely appreciated that the choice of standard may affect not only the resulting rates but also the rankings of causes of DALYs. We aimed to evaluate the impact of the choice of standard, using the example of Scotland. Methods DALY estimates were derived from the 2016 Scottish Burden of Disease (SBoD) study for an abridged list of 68 causes of disease/injury, representing a three-year annual average across 2014-16. Crude DALY rates were calculated using Scottish national population estimates. DALY ASRs standardised using the GBD World Standard Population (GBD WSP) were compared to those using the 2013 European Standard Population (ESP2013). Differences in ASR and in rank order within the cause list were summarised for all-cause and for each individual cause. Results The ranking of causes by DALYs were similar using crude rates or ASR (ESP2013). All-cause DALY rates using ASR (GBD WSP) were around 26% lower. Overall 58 out of 68 causes had a lower ASR using GBD WSP compared with ESP2013, with the largest falls occurring for leading causes of mortality observed in older ages. Gains in ASR were much smaller in absolute scale and largely affected causes that operated early in life. These differences were associated with a substantial change to the ranking of causes when GBD WSP was used compared with ESP2013. Conclusion Disease rankings based on DALY ASRs are strongly influenced by the choice of standard population. While GBD WSP offers international comparability, within-country analyses based on DALY ASRs should reflect local age structures. For European countries, including Scotland, ESP2013 may better guide local priority setting by avoiding large disparities occurring between crude and age-standardised results sets, which could potentially confuse non-technical audiences.
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Affiliation(s)
- Grant M A Wyper
- Public Health Science Directorate, NHS Health Scotland, Meridian Court, 5 Cadogan Street, Glasgow, G2 6QE Scotland
| | - Ian Grant
- 2Information Services Division, NHS National Services Scotland, Gyle Square, 1 South Gyle Crescent, Edinburgh, EH12 9EB Scotland
| | - Eilidh Fletcher
- 2Information Services Division, NHS National Services Scotland, Gyle Square, 1 South Gyle Crescent, Edinburgh, EH12 9EB Scotland
| | - Gerry McCartney
- Public Health Science Directorate, NHS Health Scotland, Meridian Court, 5 Cadogan Street, Glasgow, G2 6QE Scotland
| | - Colin Fischbacher
- 2Information Services Division, NHS National Services Scotland, Gyle Square, 1 South Gyle Crescent, Edinburgh, EH12 9EB Scotland
| | - Diane L Stockton
- Public Health Science Directorate, NHS Health Scotland, Meridian Court, 5 Cadogan Street, Glasgow, G2 6QE Scotland
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Yi J, Duling MG, Bowers LN, Knepp AK, LeBouf RF, Nurkiewicz TR, Ranpara A, Luxton T, Martin SB, Burns DA, Peloquin DM, Baumann EJ, Virji MA, Stefaniak AB. Particle and organic vapor emissions from children's 3-D pen and 3-D printer toys. Inhal Toxicol 2019; 31:432-445. [PMID: 31874579 PMCID: PMC6995422 DOI: 10.1080/08958378.2019.1705441] [Citation(s) in RCA: 17] [Impact Index Per Article: 3.4] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/05/2019] [Accepted: 12/11/2019] [Indexed: 01/09/2023]
Abstract
Objective: Fused filament fabrication "3-dimensional (3-D)" printing has expanded beyond the workplace to 3-D printers and pens for use by children as toys to create objects.Materials and methods: Emissions from two brands of toy 3-D pens and one brand of toy 3-D printer were characterized in a 0.6 m3 chamber (particle number, size, elemental composition; concentrations of individual and total volatile organic compounds (TVOC)). The effects of print parameters on these emission metrics were evaluated using mixed-effects models. Emissions data were used to model particle lung deposition and TVOC exposure potential.Results: Geometric mean particle yields (106-1010 particles/g printed) and sizes (30-300 nm) and TVOC yields (
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Affiliation(s)
- Jinghai Yi
- Department of Physiology and Pharmacology, and the Center for Inhalation Toxicology, West Virginia University School of Medicine, Morgantown, WV, 26506
| | - Matthew G. Duling
- National Institute for Occupational Safety and Health, Morgantown, WV, 26505
| | - Lauren N. Bowers
- National Institute for Occupational Safety and Health, Morgantown, WV, 26505
| | - Alycia K. Knepp
- National Institute for Occupational Safety and Health, Morgantown, WV, 26505
| | - Ryan F. LeBouf
- National Institute for Occupational Safety and Health, Morgantown, WV, 26505
| | - Timothy R. Nurkiewicz
- Department of Physiology and Pharmacology, and the Center for Inhalation Toxicology, West Virginia University School of Medicine, Morgantown, WV, 26506
- National Institute for Occupational Safety and Health, Morgantown, WV, 26505
| | - Anand Ranpara
- National Institute for Occupational Safety and Health, Morgantown, WV, 26505
| | - Todd Luxton
- U.S. Environmental Protection Agency, Office of Research and Development, National Risk Management Research Laboratory, Cincinnati, OH, 45224
| | - Stephen B. Martin
- National Institute for Occupational Safety and Health, Morgantown, WV, 26505
| | - Dru A. Burns
- National Institute for Occupational Safety and Health, Morgantown, WV, 26505
| | | | | | - M. Abbas Virji
- National Institute for Occupational Safety and Health, Morgantown, WV, 26505
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