Abstract
Current methods of measuring the population burden of injuries rely on many assumptions and limited data available to the global burden of diseases (GBD) studies. The aim of this study was to compare the population burden of injuries using different approaches from the UK Burden of Injury (UKBOI) and GBD studies. The UKBOI was a prospective cohort of 1,517 injured individuals that collected patient-reported outcomes. Extrapolated outcome data were combined with multiple sources of morbidity and mortality data to derive population metrics of the burden of injury in the UK. Participants were injured patients recruited from hospitals in four UK cities and towns: Swansea, Nottingham, Bristol, and Guildford, between September 2005 and April 2007. Patient-reported changes in quality of life using the EQ-5D at baseline, 1, 4, and 12 months after injury provided disability weights used to calculate the years lived with disability (YLDs) component of disability adjusted life years (DALYs). DALYs were calculated for the UK and extrapolated to global estimates using both UKBOI and GBD disability weights. Estimated numbers (and rates per 100,000) for UK population extrapolations were 750,999 (1,240) for hospital admissions, 7,982,947 (13,339) for emergency department (ED) attendances, and 22,185 (36.8) for injury-related deaths in 2005. Nonadmitted ED-treated injuries accounted for 67% of YLDs. Estimates for UK DALYs amounted to 1,771,486 (82% due to YLDs), compared with 669,822 (52% due to YLDs) using the GBD approach. Extrapolating patient-derived disability weights to GBD estimates would increase injury-related DALYs 2.6-fold. The use of disability weights derived from patient experiences combined with additional morbidity data on ED-treated patients and inpatients suggests that the absolute burden of injury is higher than previously estimated. These findings have substantial implications for improving measurement of the national and global burden of injury.
Highlights
Quantifying the burden placed on society is an essential component of the public health response to conditions, supporting development of policy, priority setting, and monitoring of interventions [1,2]
The use of disability weights derived from patient experiences combined with additional morbidity data on emergency department (ED)-treated patients and inpatients suggests that the absolute burden of injury is higher than previously estimated
Central to the global burden of diseases (GBD) methodology is the concept of disability adjusted life year (DALY), a combination of premature mortality, termed years of life lost (YLLs), and years lived with disability (YLDs) [15]
Summary
Quantifying the burden placed on society is an essential component of the public health response to conditions, supporting development of policy, priority setting, and monitoring of interventions [1,2]. The 1990 Global Burden of Diseases, Injuries and Risk Factors (GBD) Study led the way in developing population burden of disease studies [3] This seminal study and subsequent publications revealed that injuries accounted for more than 15% of the global disability adjusted life years (DALYs) lost in 1990 and are forecasted to increase to 20% by 2020 [4,5,6]. Whilst the GBD was a major development, limited incidence data and the absence of disability weights for many injury types underestimated the population burden of injuries [16]. The Global Burden of Diseases, Injuries and Risk Factors (GBD) Studies are instrumental in quantifying the burden of injuries placed on society and are essential for the public health response, priority setting, and policy development. The GBD has been a major development, it may have underestimated the population burden
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