Abstract
Reliable, comparable information about the main causes of disease and injury in populations, and how these are changing, is a critical input for debates about priorities in the health sector. Traditional sources of information about the descriptive epidemiology of diseases, injuries, and risk factors are generally incomplete, fragmented, and of uncertain reliability and comparability. The Global Burden of Disease (GBD) study has provided a conceptual and methodological framework to quantify and compare the health of populations using a summary measure of both mortality and disability, the disability-adjusted life year (DALY).This paper describes key features of the Global Burden of Disease analytic approach, which provides a standardized measurement framework to permit comparisons across diseases and injuries, as well as risk factors, and a systematic approach to the evaluation of data. The paper describes the evolution of the GBD, starting from the first study for the year 1990, summarizes the methodological improvements incorporated into GBD revisions for the years 2000–2004 carried out by the World Health Organization, and examines priorities and issues for the next major GBD study, funded by the Bill & Melinda Gates Foundation, and commencing in 2007.The paper presents an overview of summary results from the Global Burden of Disease study 2002, with a particular focus on the neglected tropical diseases, and also an overview of the comparative risk assessment for 26 global risk factors. Taken together, trypanosomiasis, Chagas disease, schistosomiasis, leishmaniasis, lymphatic filariasis, onchocerciasis, intestinal nematode infections, Japanese encephalitis, dengue, and leprosy accounted for an estimated 177,000 deaths worldwide in 2002, mostly in sub-Saharan Africa, and about 20 million DALYs, or 1.3% of the global burden of disease and injuries. Further research is currently underway to revise and update these estimates.
Highlights
Governments and international agencies are faced with setting priorities for health research and investment in health systems and health interventions in a context of increasing health care costs, increasing availability of effective interventions, and numerous and diverse priorities and interest groups
The comparative risk assessment for 26 global risk factors, carried out as part of the Global Burden of Disease (GBD) 2000 study, suggests that risk factors for communicable, maternal, perinatal, and nutritional conditions—whose burden is primarily concentrated in the low-income regions of sub-Saharan Africa and South Asia—and risk factors for noncommunicable diseases are leading causes of global disease burden, and that the latter are globally widespread
Comparative rankings of disability-adjusted life year (DALY) have led to strategic decisions by some agencies, such as World Health Organization (WHO), to invest greater effort in program developments to address priority health concerns such as tobacco control and injury prevention
Summary
Governments and international agencies are faced with setting priorities for health research and investment in health systems and health interventions in a context of increasing health care costs, increasing availability of effective interventions, and numerous and diverse priorities and interest groups. New methods were developed for a number of components of the GBD 2000, including: a new system of model life tables for estimating age-specific death rates [34], better methods for modeling the relationship between the level of mortality and the broad cause structure in populations without complete death registration data [35], better and more consistent methods for calculating mortality and burden of disease attributable to major risk factors, individually and in combination [36], and more systematic approaches to the assessment of uncertainty [28].
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