Abstract
ObjectiveTo systematically review the methodology of general burden of disease studies. Three key questions were addressed: 1) what was the quality of the data, 2) which methodological choices were made to calculate disability adjusted life years (DALYs), and 3) were uncertainty and risk factor analyses performed? Furthermore, DALY outcomes of the included studies were compared.MethodsBurden of disease studies (1990 to 2011) in international peer-reviewed journals and in grey literature were identified with main inclusion criteria being multiple-cause studies that quantified the burden of disease as the sum of the burden of all distinct diseases expressed in DALYs. Electronic database searches included Medline (PubMed), EMBASE, and Web of Science. Studies were collated by study population, design, methods used to measure mortality and morbidity, risk factor analyses, and evaluation of results.ResultsThirty-one studies met the inclusion criteria of our review. Overall, studies followed the Global Burden of Disease (GBD) approach. However, considerable variation existed in disability weights, discounting, age-weighting, and adjustments for uncertainty. Few studies reported whether mortality data were corrected for missing data or underreporting. Comparison with the GBD DALY outcomes by country revealed that for some studies DALY estimates were of similar magnitude; others reported DALY estimates that were two times higher or lower.ConclusionsOvercoming “error” variation due to the use of different methodologies and low-quality data is a critical priority for advancing burden of disease studies. This can enlarge the detection of true variation in DALY outcomes between populations or over time.
Highlights
The burden of disease concept provides 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) [1,2]
The following key questions were addressed: 1) what was the quality of the data and were there any data gaps, 2) which methodological choices were made in order to calculate years of life lost due to mortality (YLL) and years lost due to disability (YLD), and 3) which methods were used to handle uncertainty and risk factor analysis
Large differences in used methodology exist between general burden of disease studies
Summary
The burden of disease concept provides 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) [1,2]. Since the launch of the Global Burden of Disease (GBD) study in 1993, the burden of disease concept has been widely adopted by countries and health development agencies alike to identify the relative magnitude of different health problems. This information serves as crucial input for debates about priorities in the health sector. The interpretation of results of burden of disease studies requires detailed methodological knowledge
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