Attributable Disability-adjusted Life-years Research Articles

Global statistics on alcohol, tobacco and illicit drug use: 2017 status report.

This review provides an up-to-date curated source of information on alcohol, tobacco and illicit drug use and their associated mortality and burden of disease. Limitations in the data are also discussed, including how these can be addressed in the future. Online data sources were identified through expert review. Data were obtained mainly from the World Health Organization, United Nations Office on Drugs and Crime and Institute for Health Metrics and Evaluation. In 2015, the estimated prevalence among the adult population was 18.4% for heavy episodic alcohol use (in the past 30days); 15.2% for daily tobacco smoking; and 3.8, 0.77, 0.37 and 0.35% for past-year cannabis, amphetamine, opioid and cocaine use, respectively. European regions had the highest prevalence of heavy episodic alcohol use and daily tobacco use. The age-standardized prevalence of alcohol dependence was 843.2 per 100 000 people; for cannabis, opioids, amphetamines and cocaine dependence it was 259.3, 220.4, 86.0 and 52.5 per 100 000 people, respectively. High-income North America region had among the highest rates of cannabis, opioid and cocaine dependence. Attributable disability-adjusted life-years (DALYs) were highest for tobacco smoking (170.9 million DALYs), followed by alcohol (85.0 million) and illicit drugs (27.8 million). Substance-attributable mortality rates were highest for tobacco smoking (110.7 deaths per 100 000 people), followed by alcohol and illicit drugs (33.0 and 6.9 deaths per 100 000 people, respectively). Attributable age-standardized mortality rates and DALYs for alcohol and illicit drugs were highest in eastern Europe; attributable age-standardized tobacco mortality rates and DALYs were highest in Oceania. In 2015 alcohol use and tobacco smoking use between them cost the human population more than a quarter of a billion disability-adjusted life years, with illicit drugs costing further tens of millions. Europeans suffered proportionately more, but in absolute terms the mortality rate was greatest in low- and middle-income countries with large populations and where the quality of data was more limited. Better standardized and rigorous methods for data collection, collation and reporting are needed to assess more accurately the geographical and temporal trends in substance use and its disease burden.

Abstract P062: The Impact of High Fasting Plasma Glucose on Cardiovascular Health at the State-level in the United States

Introduction: High fasting plasma glucose (FPG) is an established risk factor for cardiovascular disease (CVD). However, the impact of FPG on CVD mortality and morbidity at the state-level in the US has not been systematically evaluated. Objective: To quantify the number of CVD deaths and disability adjusted life years (DALYs) attributable to high FPG by age, sex, year and state among US adults from 1990 to 2016. Methods: We used a spatio-temporal Gaussian process regression (ST-GPR) to estimate the mean FPG level by age, sex, year and state. The inputs to the ST-GPR model included data from National Health and Nutrition Examination Survey, state-specific prevalence of obesity, and per-capita lag-distributed income in each state. Using the mean FPG and prevalence of diabetes in each state, we characterized the distribution of the FPG at the state-level. Then, we used the Global Burden of Disease study comparative risk assessment framework to estimate the CVD deaths and DALYs attributable to high FPG. Results: In 2016, there were 180,440 CVD deaths attributable to high FPG in the United States: 77% due to ischemic stroke, 21% due to cerebrovascular disease, and <1% due to peripheral artery disease. Alaska had the lowest attributable death rate for both males and females (66.9 per 100,000 and 55.4 per 100,000, respectively) and West Virginia had the highest attributable death rate for both males and females (227.3 per 100,000 and 186.4 per 100,000, respectively). This is contrasted to DALYS, where Colorado had the lowest attributable DALYS rate for both males and females (1,732 DALYS per 100,000 1,379 DALYS per 100,000, respectively) and West Virginia had the highest attributable DALY rate for both males and females (5,219 DALYS per 100,000 and 3,965 DALYS per 100,000, respectively). (Figure) Conclusions: Our results highlight the need for evidence-based intervention to control FPG to effectively prevent CVD.

Global, regional, and national comparative risk assessment of 84 behavioural, environmental and occupational, and metabolic risks or clusters of risks, 1990–2016: a systematic analysis for the Global Burden of Disease Study 2016

SummaryBackgroundThe Global Burden of Diseases, Injuries, and Risk Factors Study 2016 (GBD 2016) provides a comprehensive assessment of risk factor exposure and attributable burden of disease. By providing estimates over a long time series, this study can monitor risk exposure trends critical to health surveillance and inform policy debates on the importance of addressing risks in context.MethodsWe used the comparative risk assessment framework developed for previous iterations of GBD to estimate levels and trends in exposure, attributable deaths, and attributable disability-adjusted life-years (DALYs), by age group, sex, year, and location for 84 behavioural, environmental and occupational, and metabolic risks or clusters of risks from 1990 to 2016. This study included 481 risk-outcome pairs that met the GBD study criteria for convincing or probable evidence of causation. We extracted relative risk (RR) and exposure estimates from 22 717 randomised controlled trials, cohorts, pooled cohorts, household surveys, census data, satellite data, and other sources, according to the GBD 2016 source counting methods. Using the counterfactual scenario of theoretical minimum risk exposure level (TMREL), we estimated the portion of deaths and DALYs that could be attributed to a given risk. Finally, we explored four drivers of trends in attributable burden: population growth, population ageing, trends in risk exposure, and all other factors combined.FindingsSince 1990, exposure increased significantly for 30 risks, did not change significantly for four risks, and decreased significantly for 31 risks. Among risks that are leading causes of burden of disease, child growth failure and household air pollution showed the most significant declines, while metabolic risks, such as body-mass index and high fasting plasma glucose, showed significant increases. In 2016, at Level 3 of the hierarchy, the three leading risk factors in terms of attributable DALYs at the global level for men were smoking (124·1 million DALYs [95% UI 111·2 million to 137·0 million]), high systolic blood pressure (122·2 million DALYs [110·3 million to 133·3 million], and low birthweight and short gestation (83·0 million DALYs [78·3 million to 87·7 million]), and for women, were high systolic blood pressure (89·9 million DALYs [80·9 million to 98·2 million]), high body-mass index (64·8 million DALYs [44·4 million to 87·6 million]), and high fasting plasma glucose (63·8 million DALYs [53·2 million to 76·3 million]). In 2016 in 113 countries, the leading risk factor in terms of attributable DALYs was a metabolic risk factor. Smoking remained among the leading five risk factors for DALYs for 109 countries, while low birthweight and short gestation was the leading risk factor for DALYs in 38 countries, particularly in sub-Saharan Africa and South Asia. In terms of important drivers of change in trends of burden attributable to risk factors, between 2006 and 2016 exposure to risks explains an 9·3% (6·9–11·6) decline in deaths and a 10·8% (8·3–13·1) decrease in DALYs at the global level, while population ageing accounts for 14·9% (12·7–17·5) of deaths and 6·2% (3·9–8·7) of DALYs, and population growth for 12·4% (10·1–14·9) of deaths and 12·4% (10·1–14·9) of DALYs. The largest contribution of trends in risk exposure to disease burden is seen between ages 1 year and 4 years, where a decline of 27·3% (24·9–29·7) of the change in DALYs between 2006 and 2016 can be attributed to declines in exposure to risks.InterpretationIncreasingly detailed understanding of the trends in risk exposure and the RRs for each risk-outcome pair provide insights into both the magnitude of health loss attributable to risks and how modification of risk exposure has contributed to health trends. Metabolic risks warrant particular policy attention, due to their large contribution to global disease burden, increasing trends, and variable patterns across countries at the same level of development. GBD 2016 findings show that, while it has huge potential to improve health, risk modification has played a relatively small part in the past decade.FundingThe Bill & Melinda Gates Foundation, Bloomberg Philanthropies.

National and sub-national age-sex specific and cause-specific mortality and disability-adjusted life years (DALYs) attributable to household air pollution from solid cookfuel use (HAP) in Iran, 1990–2013

National and sub-national mortality, years of life lost due to premature mortality (YLLs), years lived with disability (YLDs) and disability-adjusted life years (DALYs) for household air pollution from solid cookfuel use (HAP) in Iran, 1990–2013 were estimated based on the Global Burden of Disease Study 2013 (GBD 2013). The burden of disease attributable to HAP was quantified by the comparative risk assessment method using four inputs: (1) exposure to HAP, (2) the theoretical minimum risk exposure level (TMREL), (3) exposure-response relationships of related causes (4) disease burden of related causes. All across the country, solid fuel use decreased from 5.26% in 1990 to 0.15% in 2013. The drastic reduction of solid fuel use leaded to DALYs attributable to HAP fell by 97.8% (95% uncertainty interval 97.7–98.0%) from 87,433 (51072–144303) in 1990 to 1889 (1016–3247) in 2013. Proportion of YLLs in DALYs from HAP decreased from 95.7% in 1990 to 86.6% in 2013. Contribution of causes in the attributable DALYs was variable during the study period and in 2013 was in the following order: ischemic heart disease for 43.4%, chronic obstructive pulmonary disease for 24.7%, hemorrhagic stroke for 9.7%, lower respiratory infections for 9.3%, ischemic stroke for 7.8%, lung cancer for 3.4% and cataract for 1.8%. Based on the Gini coefficient, the spatial inequality of the disease burden from HAP increased during the study period. The remained burden of disease was relatively scarce and it mainly occurred in seven southern provinces. Further reduction of the disease burden from HAP as well as compensation of the increasing spatial inequality in Iran could be attained through an especial plan for providing cleaner fuels in the southern provinces.

The Global Burden of Lead Toxicity Attributable to Informal Used Lead-Acid Battery Sites

BackgroundPrior calculations of the burden of disease from environmental lead exposure in low- and middle-income countries (LMICs) have not included estimates of the burden from lead-contaminated sites because of a lack of exposure data, resulting in an underestimation of a serious public health problem. ObjectiveWe used publicly available statistics and detailed site assessment data to model the number of informal used lead-acid battery (ULAB) recyclers and the resulting exposures in 90 LMICs. We estimated blood lead levels (BLLs) using the US Environment Protection Agency’s Integrated Exposure Uptake Biokinetic Model for Lead in Children and Adult Lead Model. Finally, we used data and algorithms generated by the World Health Organization to calculate the number of attributable disability adjusted life years (DALYs). ResultsWe estimated that there are 10,599 to 29,241 informal ULAB processing sites where human health is at risk in the 90 countries we reviewed. We further estimated that 6 to 16.8 million people are exposed at these sites and calculate a geometric mean BLL for exposed children (0-4 years of age) of 31.15 μg/dL and a geometric mean BLL for adults of 21.2 μg/dL. We calculated that these exposures resulted in 127,248 to 1,612,476 DALYs in 2013. ConclusionsInformal ULAB processing is currently causing widespread lead poisoning in LMICs. There is an urgent need to identify and mitigate exposures at existing sites and to develop appropriate policy responses to minimize the creation of new sites.

Combined Evaluation of International Estimations of Environmentally Attributable Disability-Adjusted Life Years and Health Care Costs to Support National Decision-Making

Combined Evaluation of International Estimations of Environmentally Attributable Disability-Adjusted Life Years and Health Care Costs to Support National Decision-Making

Burden on blood-pressure-related diseases among the Chinese population, in 2010

To quantify the burden of disease related to high blood pressure in the Chinese population. We used results from the Global Burden of Diseases, Injuries, and Risk Factors Study 2010 (GBD 2010) in China. Data for mean systolic blood pressure, burden of deaths,Years of Life Lost(YLLs), Years Lived with Disability (YLDs), disability-adjusted life years (DALYs), and relative risk were corrected for regression dilution bias to calculate the population impact fractions and estimate the attributable deaths and DALYs. Among all the deaths due to cardiovascular diseases and DALYs, 64.0% of them were caused by high blood pressure. In 2010, a total number of 2.043 million deaths were caused by high blood pressure, including 1.154 million males. 2.007 million deaths were due to cardiovascular diseases, 35 000 due to chronic kidney diseases. Deaths caused by high blood pressure accounted for 24.6% of all the deaths. In total, 37.94 million person-years DALYs were caused by high blood pressure, of which 23.33 million person-years were males and 14.61 million person-years were females. There were 2.365 million person-years of YLDs and 35.57 million person-years of YLLs, which both accounted for 12% of the total DALYs. Compared to the global results of GBD 160, on either deaths or DALYs, the proportion attributable to high blood pressure were quite high for a country like China. The health effects caused by high blood pressure seemed to be quite serious which called for attention.

P1-185 Estimating the attributable burden of cardiovascular disease following reducing the prevalence of diabetes to theoretical and feasible minimum risk level

IntroductionKnowledge of the magnitude of attributable burden to cardiovascular disease (CVD) by diabetes, especially based on updated data are needed for health policy, priority setting and preventing CVD. This study...

Estimating the burden of disease attributable to lead exposure in South Africa in 2000.

To estimate the burden of disease attributable to lead exposure in South Africa in 2000. World Health Organization comparative risk assessment (CRA) methodology was followed. Recent community studies were used to derive mean blood lead concentrations in adults and children in urban and rural areas. Population-attributable fractions were calculated and applied to revised burden of disease estimates for the relevant disease categories for South Africa in the year 2000. Monte Carlo simulation-modelling techniques were used for the uncertainty analysis. South Africa. Children under 5 and adults 30 years and older. Cardiovascular mortality and disability-adjusted life years (DALYs) in adults 30 years and older and mild mental disability DALYs in children under 5 years. Lead exposure was estimated to cause 1,428 deaths (95% uncertainty interval 1,086-1,772) or 0.27% (95% uncertainty interval: 0.21 - 0.34%) of all deaths in South Africa in 2000. Burden of disease attributed to lead exposure was dominated by mild mental disability in young children, accounting for 75% of the total 58,939 (95% uncertainty interval 55,413 - 62,500) attributable DALYs. Cardiovascular disease in adults accounted for the remainder of the burden. Even with the phasing out of leaded petrol, exposure to lead from its ongoing addition to paint, para-occupational exposure and its use in backyard 'cottage industries' will continue to be an important public health hazard in South Africa for decades. Young children, especially those from disadvantaged communities, remain particularly vulnerable to lead exposure and poisoning.

An Overview of Methods for Calculating the Burden of Disease Due to Specific Risk Factors

There are a number of measures that quantify the public health burden due to specific risk factors for specific diseases. Although these measures are of importance for policymakers, epidemiologists do not often calculate them or may be unfamiliar with some of the issues involved when they do. The primary measure of interest is the attributable fraction (AF), representing the fraction of cases or deaths from a specific disease that would not have occurred in the absence of exposure to a specific risk factor either in the exposed population or the population as a whole. AFs can be multiplied by the total number of cases of a given disease to obtain a "body count"--the absolute number of preventable cases due to a specific risk factor. Two other measures of public health burden, used in conjunction with AFs, are attributable years-of-life-lost and attributable disability-adjusted life-years. We provide an overview of the AF and related measures and discuss some of the specific issues involved in calculating AFs. These issues include calculating the variance of AFs (such as Monte Carlo sensitivity methods), biases arising from some formulas for the AF, sources of data for calculating AFs, dependence of AFs on basic decisions about what exposure-disease associations are causal, and extrapolation from the source population to the target population.