Disability-Adjusted Life Years, Years of Life Lived with Disability, and Years of Life Lost in Stroke: Italian Perspectives

Abstract

This chapter evaluates the impact of > stroke in Italy in 1999, expressed in terms of disability adjusted life years (>DALYs) using mostly the methods developed by WHO in the Global Burden of Disease (GBD) Study. For mortality, the official mortality data for Italy from ISTAT (Italian National Statistical Institute) was used. For disability, the data on first-ever stroke incidence (FES), remission rate and case fatality derived from the health information system and a research on post-FES disability of the Friuli Venezia-Giulia (FVG) region and similar data from the Tuscany region and from the province of Verona in the Veneto region were used and pooled. Both the mortality and disability aspects of the impact of stroke are taken into account and >YLLs (years of life lost) and >YLDs (years of life lived with disability) respectively are calculated and then summed to obtain the DALYs. To calculate the YLDs, several epidemiological quantities are estimated by sex and age class and for each of the three areas considered in the study. A mean of the pooled data was used to extrapolate the results to the whole Italy. About 258,000 YLLs and 153,000 YLDs due to FES were estimated in 1999 for Italy. The results in terms of YLLs, YLDs and DALYs were compared with other studies for which detailed results were available, relative to populations with similar characteristics of development: YLD rates per 100,000 people were similar in Italy to the values obtained in the US BOD study both for men (228 vs. 244) and women (308 vs. 301), but values considerably lower were obtained in the Australian BOD study (175 for men and 118 for women). In terms of DALYs rates per 100,000 people, Italy (723) is more similar to the EURO-A group (the European area including Italy) of the GBD study (671) than to the US (569) or Australia (435), because YLLs in Italy are higher than in those other areas. List of Abbreviations: BOD, Burden of Disease; DALY(s), Disability Adjusted Life Years; GBD, Global Burden of Disease; EURO-A, (a group of 26 economically developed European countries); FES, First-Ever Stroke; MONICA, MONItoring of trends and determinants in CArdiovascular disease; ICD, International Classification of Diseases; ISTAT, Italian National Statistical Institute; TIA, Transient Ischemic Attack; WHO, World Health Organization; FVG, Friuli Venezia-Giulia; YLD(s), Years of life Lived with Disability; YLL(s), Years of Life Lost