Abstract
When disability-adjusted life years are used to measure the burden of disease on a population in a time interval, they can be calculated in several different ways: from an incidence, pure prevalence, or hybrid perspective. I show that these calculation methods are not equivalent and discuss some of the formal difficulties each method faces. I show that if we don’t discount the value of future health, there is a sense in which the choice of calculation method is a mere question of accounting. Such questions can be important, but they don’t raise deep theoretical concerns. If we do discount, however, choice of calculation method can change the relative burden attributed to different conditions over time. I conclude by recommending that studies involving disability-adjusted life years be explicit in noting what calculation method is being employed and in explaining why that calculation method has been chosen.
Highlights
When used to measure the burden of disease on a population during a time interval, disability-adjusted life years (DALYs) can be calculated in different ways – or, as it is usually put, from different perspectives
I’ve explained the many different ways to calculate DALYs – from a pure prevalence, hybrid, or incidence perspective – and I’ve explained some of the conceptual choices and problems that arise for each method
Returning to the question that opened the last section: which is the right one to use? Which perspective should we take when measuring health? I think the answer, unsurprisingly, is that since each measures a different quantity, each is useful in different situations
Summary
When used to measure the burden of disease on a population during a time interval, disability-adjusted life years (DALYs) can be calculated in different ways – or, as it is usually put, from different perspectives. Your blindness which struck in 2003, wouldn’t be counted at all; its full impact would have been registered in 2003’s YLD count This approach is called an incidence perspective, and it is the method most commonly used to calculate DALYs. With a few qualifications to be discussed below, I-DALYs (incidence DALYs) for period T measure the stream of lost health connected with events in T. It is important to resist the temptation to describe I-DALYs as measuring the amount of ill health lost due to causes of a particular type in a time period This may be true for some methods of event individuation, but it is certainly not true for all of them. The choice of perspective here no longer seems like mere accounting.j
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