Temporal Trends in the Incidence and Disability Adjusted Life Years of Schizophrenia in China Over 30 Years

BACKGROUND

Schizophrenia is an important public health problem in China. This study aims to assess the long-term trends in the incidence and disability-adjusted life years (DALYs) rate of schizophrenia in China between 1990 and 2019.

METHODS

The incidence and DALYs data were drawn from the Global Burden of Disease Study 2019, and an age-period-cohort model was used in the analysis.

RESULTS

The age-standardized incidence rate (ASIR) and age-standardized DALYs rate (ASDR) of schizophrenia increased by 0.3 and 3.7% for both sexes between 1990 and 2019. For males, the local drift for incidence was higher than 0 (P < 0.05) in those aged 10 to 29 years (local drifts, 0.01 to 0.26%) and lower than 0 (P < 0.05) in those aged 35 to 74 years (local drifts, -1.01 to -0.06%). For females, the local drift was higher than 0 (P < 0.05) in those aged 10 to 34 years (local drifts, 0.05 to 0.26%) and lower than 0 (P < 0.05) in those aged 40 to 74 years (local drifts, -0.86 to -0.11%). The local drift for DALYs rate was higher than 0 (P < 0.05) in the age group from 10 to 69 years (local drifts, 0.06 to 0.26% for males and 0.06 to 0.28% for females). The estimated period and cohort relative risks (RR) for DALYs rate of schizophrenia were found in monotonic upward patterns, and the cohort RR for the incidence increased as the birth cohort moved forward starting with those born in 1972.

CONCLUSION

Although the crude incidence of schizophrenia has decreased in China, the ASIR, ASDR, and crude DALYs rate all showed a general increasing trend over the last three decades. The DALYs rate continue to increase as the birth cohort moved forward, and the increasing trend of incidence was also found in individuals born after 1972. More efforts are needed to promote mental health in China.

Burden of injuries and its associated hospitalization expenditure in India

Injuries are a major public health concern, affect the most productive age group i.e. (15-60 years) and increases disability adjusted life years (DALYs) and results in a huge financial burden on the household. Disease burden is represented by DALYs and economic burden represents the out of pocket (OOP) and catastrophic health expenditure (CHE). We examined the burden of injury and its impact on household financial burden among the working population (15-60 years) in India. We used data on National and State Level DALYs for Injuries for 2017 from the published National Disease Burden Estimate (NBE, 2019) Study. The cost of treatment was extracted from 75th round of the National Sample Survey Organization (NSSO, 2017-18). DALYs is the sum of YLLs and YLDs. OOPEs were estimated as a per episode of hospitalization expenses after reimbursement and CHE was defined as out of pocket expenditure exceeding 10% of household consumption expenditure. Accidental injuries particularly road traffic injuries have higher DALY rates among 15-60 years in India (1288 DALYs per 100,000). However, the mean OOPE was found to be higher due to intentional self-harm. Persons suffering from injury in states like Punjab, Haryana, UP, Gujarat, Karnataka and Andhra Pradesh approached private facilities more compared to public facilities. Whereas, people from states like Jammu and Kashmir, Orissa, West Bengal, North East availed public facilities more than private. OOPE was found to be five times more in private facilities than in public. The households who sought treatment in private facilities were faced 3 times more to Catastrophic expenditure than those who took the treatment in public hospital of any injury. The present study indicated high DALYs, OOPE and % CHE for injury in India. Higher proportion of households were pushed to catastrophic expenditure due to high OOPE of injury treatment. Disease and economic burden due to road traffic injury and fall was found to be high as compared to other injuries. Our study strengthens the need for executing effective financial protection approach in India like PM-JAY, to minimize the financial burden incurred due to injuries in India.

Cost-utility of burns management in Nigeria: a case study of the National Orthopaedic Hospital, Enugu

A major problem of burns is the high cost of management, as well as the discrimination and disability they can cause to patients. Maximising resource utilisation is of key importance for lower-middle-income countries (LMICs) like Nigeria. There is a need to know if Nigerian patients who were victims of burns get the best value for money. This study aimed to evaluate the average cost of managing burns in Nigeria, and determine if the treatment approach is cost-effective. The study was a cost-utility analysis from the perspective of health service providers in Nigeria, a case study of the National Orthopaedic Hospital Enugu (NOHE) using 2013 Microsoft excel. Data on the cost of burn management were obtained from a retrospective study conducted in NOHE in 2012 on 285 patients. Costs were adjusted to reflect the future (2015) value using a real interest rate of 3%. These costs were presented in 2015 US dollars, and a discount rate of 3% was used for both cost and outcome. Health outcome was presented in disability adjusted life years (DALYs). Based on a cost-effectiveness threshold of $2,758.4 (i.e. representing Nigerian GDP/capita), burn management is cost-effective in Nigeria ($526.68/DALY averted). The result also showed that the cost of managing burns in Nigeria is $7,123.28 per patient, which is more than the average income. Burn management in Nigeria is cost-effective but too expensive for most Nigerians to afford.