Cost-Effectiveness Analysis of Oral Health Care Package of Services within a Comprehensive PhilHealth Benefit Package

Trends in the global, regional, and national burden of oral conditions from 1990 to 2021: a systematic analysis for the Global Burden of Disease Study 2021.

The global and regional burden of stroke.

Background Low back pain (LBP) is a leading global cause of all-age years lived with disability (YLD). Studies conducted in Malta reported that musculoskeletal complaints were the commonest in primary care. The aim was to estimate for the first time the burden of LBP at population level in Malta in terms of disability-adjusted life years (DALYs) and compare to estimates obtained by the Global Burden of Disease (GBD) study. Methods LBP prevalence data were obtained from the Maltese European Health Interview Survey dataset for 2015 through representative self-reported history of chronic LBP for 12 months in combination to the extent of daily activities limitation. Proportions of LBP severity (with and without leg pain -mild, moderate, severe and most severe) and their corresponding disability weights followed values reported in GBD study. YLDs for LBP were estimated for the whole population by sex. Since LBP does not carry any mortality, YLDs reflected DALYs. The estimated local DALYs per100,000 were compared to the GBD study for Malta for the same year. Results Point prevalence of LBP causing a limitation was of 6.3% (5.6% males; 7.0% females), contributing to a total of 27,006 Maltese suffering from LBP. Global LBP DALYs were of 783 per100,000. Females experienced higher LBP burden per100,000 (876 DALYs) than males (689 DALYs). On comparing these DALYs to those reported by GBD study, a discrepancy was observed per 100,000 (Global LBP 1,828 DALYs; Males 1,657 DALYs; Females 1,999 DALYs). Conclusions LBP imposes substantial burden in Malta, which is expected to increase with the ageing population. Since etiology of LBP is multifactorial, it is suggested that a multi-disciplinary targeted preventive and management approach is considered. Differences observed between local estimates and those of the GBD study suggest the integration of locally sourced data into the model in order to improve the DALYs estimates of each country. Key messages Low back pain is a public health burden. Locally sourced data is suggested to be integrated with the GBD study to improve the DALYs estimation for each country.

The story of GBD 2010: a “super-human” effort

ABSTRACTAimTo (i) assess the prevalence, incidence, and burden of lip and oral cavity cancer, untreated caries, and “other oral conditions” (a group that includes temporomandibular disorders, malocclusion, and dental trauma, among others) in 2021; and (ii) forecast their estimates in 2050. Aggregate estimates for overall oral conditions (comprising caries, periodontitis, and edentulism, but excluding cancer) were also evaluated.MethodsPrevalence, incidence, Years Lived with Disability (YLDs), Years of Life Lost (YLLs), Disability‐Adjusted Life Years (DALYs), and deaths were reported for lip and oral cavity cancer. Untreated caries and “other oral conditions” were described as prevalence and YLDs, with incidence included only for caries. Aggregate estimates for overall oral conditions encompassed prevalence, incidence, and YLDs. Data were gathered globally, covering 204 countries, seven super‐regions, and 21 regions from the Global Burden of Disease (GBD) study in 2021, with projections up to 2050 using mixed‐effects models.ResultsIn 2021, over 1.54 million (95% UI 1.44; 1.63) people worldwide were affected by lip and oral cavity cancer, with a global age‐standardized prevalence of 0.02%. The burden included 1.28 YLDs per 100 000 (0.97; 1.59), 65.86 YLLs per 100 000 (59.53; 71.00), 67.71 DALYs per 100 000 (61.32; 73.17), and 2.42 deaths per 100 000 (2.21; 2.60). By 2050, prevalence and incidence are projected to increase by +68.7% and + 82.6%, respectively. By that time, lip and oral cavity cancer is expected to rank 119th in terms of YLDs. In 2021, 7.55% (6.29–8.78) of children had untreated caries in deciduous teeth, 27.54% (23.98–32.02) of the adult population had caries in permanent teeth, and 1.86% (1.78–1.93) were affected by “other oral conditions”, with 45.91% (42.26–49.78) of the global population experiencing at least one oral condition. By 2050, the prevalence of deciduous caries is projected to decrease by −15.80%, while permanent caries is predicted to rise by +23.77%, and “other oral conditions” will increase by +22.28%. Overall oral conditions (including periodontitis and edentulism, but excluding cancer) are projected to affect 46.17% (42.52–49.95) of the global population in 2050, ranking as the 10th leading cause of YLDs, surpassing conditions such as stroke and Alzheimer's disease.ConclusionLip and oral cavity cancer, along with oral conditions aggregated (caries, periodontitis, edentulism, “other oral conditions”), continued to pose significant public health challenges in 2021, with the number of affected individuals expected to increase substantially in the coming decades, largely driven by rising estimates of edentulism and severe periodontitis.

Children with HIV are a special group with limited access to care and high prevalence of dental caries. Silver Diamine Fluoride (SDF) is approved universally for the management of asymptomatic carious lesions but research on the psychological impact of black staining is scarce. Effect of silver diamine fluoride (SDF) application as an interim caries management on the child's oral health-related quality of life of children with HIV over a period of 4 months until definitive care was provided. A pilot study conducted among children with HIV in a care home. It was a pilot trial to check the acceptability of SDF among these children. Forty-two children (12.3 ± 3.5 years) participated in this pilot study. Prevalence of caries (DMFT), candidiasis, gingival inflammation, and cervical lymphadenitis was evaluated. OHRQoL inventory (COHIP-SF) was completed by the students at baseline, immediately, 4 months after SDF application. One-way ANOVA with post hoc Tukey HSD test. Poor oral hygiene was universal and mean DMFT was 3.2 ± 2.5. OHRQoL was not significantly affected at baseline (26.2 ± 6.4), but immediately following SDF application, OHRQoL was significantly poor (48.7 ± 8.2), remained poor even after 4 months (42.6 ± 6.1). Emotional wellbeing was significantly impacted negatively following SDF application (p < 0.001); whereas oral health, functional wellbeing dimensions were not impacted. SDF should be used with caution among special children as the black discoloration of the teeth can cause emotional trauma and negatively impacting their OHRQoL while trying to improve the same.

BackgroundChina has undergone a rapid demographic and epidemiological transition with fast ecomonic development since the 1980s. Oral health is becoming a major public health problem as the prevalence of non-communicable diseases has greatly increased. Periodontal disease (PD) and caries are among the most prevalent oral diseases. PD accounts for the majority of tooth loss and increases with age. China’s third national epidemiological investigation on oral diseases (2005) revealed that periodontitis affected >50% of the adult population. The Global Burden of Disease Study 2013 (GBD2013) have been used to estimate DALYs for 301 acute and chronic diseases and injuries in 188 countries for 1990–2013. The estimation of burden of PD between 1990 and 2013 will provide a unique perspective for planning interventions and developing public health policies for PD even chronic diseases in China.MethodsWe used the GBD 2013 results for Years of Life Lost (YLLs) and Years Lived with Disability (YLDs) to calculate Disability Adjusted Life Years (DALYs) for PD in China. PD standardized DALYs rate (SDR) per 100,000 persons, the percentage of PD standardized DALYs rate (% PD SDR) in all diseases DALYs, and variance ratio of these two indexes between the years of 1990 and 2013 were compared by province, gender and age groups.ResultsNationwide, compared to 1990, the SDR in 2013 increased slightly from 24.7 to 25.7, while the variance ratio of SDR for provinces in the middle, west and south of China showed a greater variation(4.8–6.2%). The % PD SDR in all disease DALYs increased from 0.06 to 0.11% for all groups. The four highest variance ratios % PD SDR in all diseases DALYs between 1990 and 2013 occurred in the west of China (97, 98.6, 108.4 and 112.8%). The PD SDR changed slightly in the women (20.3 to 21.7), meanwhile the variance ratio of PD SDR and % PD SDR in all diseases DALYs for the women (6.7 and 94.5%) was also higher than for men (2.1 and 60.6%). The highest variance ratio % PD SDR in all oral diseases DALYs occurred between 1990 and 2013 in ages 20 to 24 (50.7%) and 25 to 29 years (50.5%).ConclusionThe PD standardized DALYs rate and % PD SDR in all diseases DALYs in China in 2013 has increased from 1990. Especially, the variance ratio of % PD SDR in all disease DALYs among Young population and women, in the west provinces of China have been becoming the highest in all age groups and national wide. Future intervention measurements should include young women of child-bearing age because women’s health impacts infant health. Periodontal disease has risk factors in common with a number of other non-communicable diseases (NCD) and conditions, and focusing on the common behavioral and environmental risk factors would be instrumental in the effective prevention of periodontal disease.

Global Disease Burden From Acute Glomerulonephritis 1990–2019

ObjectiveTo describe the temporal and spatial trends of mortality and disability adjusted life years (DALYs) due to chronic respiratory diseases, by age and sex, across the world during 1990-2017 using...

Disclosure: S. Khan: None. H. Ahmad: None. M. Kakakhel: None. M. Ali: None. F. Ahmed: None. H. Ilyas: None. I. Ahmad: None. M. Haider: None. Background: Effective health system planning requires a detailed understanding of the epidemiology of chronic kidney disease (CKD) attributable to type 1 diabetes mellitus (T1DM). However, data on the morbidity and mortality of this condition remain scarce. Disability-adjusted life years (DALYs) are widely used to quantify the burden of disease in terms of morbidity, while mortality rates are calculated separately to measure the frequency of deaths. In this analysis of the Global Burden of Disease Study 2021, we aimed to characterize global trends in DALYs and mortality rates associated with CKD due to T1DM over the 30-year period from 1990 to 2021. Methods: Using data from the Global Burden of Disease (GBD) Study, we analyzed long-term trends in DALYs and mortality rates associated with CKD due to T1DM from 1990 to 2021. The Annual Percentage Change (APC) and Average Annual Percentage Change (AAPC) with 95% confidence intervals (CI) were used to quantify these trends, with statistical significance assessed using p-values. Results: The global burden of CKD attributable to T1DM has significantly increased from 1990 to 2021. Over this 30-year period, CKD due to T1DM resulted in 26.7 million DALYs, peaking in 2021 with 1.28 million DALYs. In terms of mortality, CKD due to T1DM accounted for 16,950 deaths in 1990, which increased 2.6 times by 2021, reaching 42,875 deaths, contributing to a total of 870,700 deaths over the three decades. Overall, CKD due to T1DM caused a higher burden of morbidity compared to mortality. The AAPC analysis demonstrated a significant rise in both DALYs (AAPC: 0.4103, 95% CI: 0.3916-0.4306, p &amp;lt; 0.000001) and mortality rates (AAPC: 0.4472, 95% CI: 0.4247-0.4642, p &amp;lt; 0.000001) associated with CKD due to T1DM from 1990 to 2021. Following the APC analysis, several notable trends emerged. The most significant increase in DALYs occurred between 1996 and 2004 (APC: 1.0240, 95% CI: 0.9336-1.1542, p &amp;lt; 0.000001), while the slowest rise in DALYs was observed from 2007 to 2021 (APC: 0.4580, 95% CI: 0.4208-0.5081, p &amp;lt; 0.000001). In contrast, mortality rates increased most sharply from 1997 to 2000 (APC: 1.5067, 95% CI: 1.0084-1.6929, p = 0.010398), while the slowest increase in mortality rates occurred from 1990 to 1997 (APC: 0.2798, 95% CI: 0.1254-0.3182, p = 0.011998). Conclusion: The global burden of CKD attributable to T1DM has risen substantially over the past three decades, with notable increases in both DALYs and mortality rates. Despite a slowing trend in recent years, the overall burden of morbidity continues to outpace mortality, highlighting the need for enhanced global health strategies to address this growing concern. Presentation: Saturday, July 12, 2025

36-fold higher estimate of deaths attributable to red meat intake in GBD 2019: is this reliable?

Background: The Global Burden of Disease Study 2017 estimates that oral diseases affected 3.5 billion people worldwide, with untreated dental caries being among the most prevalent non-communicable diseases. If left untreated, it could lead to pain, swelling, and eventual tooth loss. Tooth loss results in changes in diet, impairment of speech, and reduces one’s quality of life. A 2016 study found that almost 1 in 3 Singaporeans aged 60 and above did not have any teeth. As such, oral health should be part of the comprehensive care for the general well-being of older adults in the community. Aim: To Increase awareness of oral health knowledge among older adults with chronic diseases from 33% to 83% in 3 months. Methodology: We recruited the community-dwelling participants who are i) aged 60 years and above, ii) with a minimum of 8 natural teeth, iii) able to comprehend simple instructions, and iv) perform basic activity of daily living. Focused discussions were conducted to explore issues and concerns pertaining to oral health among the participants, followed by individual health coaching with return demonstration. Pre- and post-intervention questionnaires about oral hygiene awareness and Oral-health related Quality of Life (OHRQoL) were conducted. The General Oral Health Assessment Index (GOHAI) questionnaire was used to evaluate the oral health self-perception in older adults. Results: Seventy-seven participants were included. The educational aid was enhanced with emphasis on oral care and appropriate escalation to seek timely treatment. The post-intervention results showed that there were significant improvements in oral hygiene awareness from 33% to 83% (p&lt;0.05). There was a reduction in the oral pain and discomfort, as reflected by the improvement in the GOHAI score from 47 vs 50 (p&lt;0.05). Conclusion: The findings highlighted the importance and benefits of increasing oral hygiene awareness through targeted health coaching among older adults in the community. The project team will continue to advocate these enhanced interventions and plan to incorporate oral hygiene assessment and health coaching as standard community nursing practice in the future. Sustainability: This project is able to achieve the sustainability through incorporating oral frailty assessment and health coaching to community nursing practice, active outreach, and capability building. Singapore General Hospital community nursing team continues to promote Oral Health Movement 8020 in collaboration with National Dental Centre, Singapore at various community engagement platforms.

Erratum: Global, regional, and national comparative risk assessment of 84 behavioural, environmental and occupational, and metabolic risks or clusters of risks for 195 countries and territories, 1990–2017: a systematic analysis for the Global Burden of Disease Study 2017 (The Lancet (2018) 392(10159) (1923–1994), (S0140673618322256), (10.1016/S0140-6736(18)32225-6))

SummaryBackgroundMeasurement of changes in health across locations is useful to compare and contrast changing epidemiological patterns against health system performance and identify specific needs for resource allocation in research, policy development, and programme decision making. Using the Global Burden of Diseases, Injuries, and Risk Factors Study 2016, we drew from two widely used summary measures to monitor such changes in population health: disability-adjusted life-years (DALYs) and healthy life expectancy (HALE). We used these measures to track trends and benchmark progress compared with expected trends on the basis of the Socio-demographic Index (SDI).MethodsWe used results from the Global Burden of Diseases, Injuries, and Risk Factors Study 2016 for all-cause mortality, cause-specific mortality, and non-fatal disease burden to derive HALE and DALYs by sex for 195 countries and territories from 1990 to 2016. We calculated DALYs by summing years of life lost and years of life lived with disability for each location, age group, sex, and year. We estimated HALE using age-specific death rates and years of life lived with disability per capita. We explored how DALYs and HALE differed from expected trends when compared with the SDI: the geometric mean of income per person, educational attainment in the population older than age 15 years, and total fertility rate.FindingsThe highest globally observed HALE at birth for both women and men was in Singapore, at 75·2 years (95% uncertainty interval 71·9–78·6) for females and 72·0 years (68·8–75·1) for males. The lowest for females was in the Central African Republic (45·6 years [42·0–49·5]) and for males was in Lesotho (41·5 years [39·0–44·0]). From 1990 to 2016, global HALE increased by an average of 6·24 years (5·97–6·48) for both sexes combined. Global HALE increased by 6·04 years (5·74–6·27) for males and 6·49 years (6·08–6·77) for females, whereas HALE at age 65 years increased by 1·78 years (1·61–1·93) for males and 1·96 years (1·69–2·13) for females. Total global DALYs remained largely unchanged from 1990 to 2016 (–2·3% [–5·9 to 0·9]), with decreases in communicable, maternal, neonatal, and nutritional (CMNN) disease DALYs offset by increased DALYs due to non-communicable diseases (NCDs). The exemplars, calculated as the five lowest ratios of observed to expected age-standardised DALY rates in 2016, were Nicaragua, Costa Rica, the Maldives, Peru, and Israel. The leading three causes of DALYs globally were ischaemic heart disease, cerebrovascular disease, and lower respiratory infections, comprising 16·1% of all DALYs. Total DALYs and age-standardised DALY rates due to most CMNN causes decreased from 1990 to 2016. Conversely, the total DALY burden rose for most NCDs; however, age-standardised DALY rates due to NCDs declined globally.InterpretationAt a global level, DALYs and HALE continue to show improvements. At the same time, we observe that many populations are facing growing functional health loss. Rising SDI was associated with increases in cumulative years of life lived with disability and decreases in CMNN DALYs offset by increased NCD DALYs. Relative compression of morbidity highlights the importance of continued health interventions, which has changed in most locations in pace with the gross domestic product per person, education, and family planning. The analysis of DALYs and HALE and their relationship to SDI represents a robust framework with which to benchmark location-specific health performance. Country-specific drivers of disease burden, particularly for causes with higher-than-expected DALYs, should inform health policies, health system improvement initiatives, targeted prevention efforts, and development assistance for health, including financial and research investments for all countries, regardless of their level of sociodemographic development. The presence of countries that substantially outperform others suggests the need for increased scrutiny for proven examples of best practices, which can help to extend gains, whereas the presence of underperforming countries suggests the need for devotion of extra attention to health systems that need more robust support.FundingBill & Melinda Gates Foundation.

The Burden of Hematologic Malignancies in Southeast Asia from 1990 to 2021: Estimates from the Global Burden of Disease Study