Calculation Of Disability-adjusted Life Years Research Articles

Burden of respiratory failure in pediatric patients: Analysis of a prospective multicenter cohort in Bogotá, Colombia.

The approach to the burden of disease is a demographic, economic, and a health problem, which requires the design and application of specific measures of cost of the disease, such as disability-adjusted life years (DALYs), to establish better public health policies in the pediatric population. The aim of this study is to approach the burden of disease in children with acute respiratory failure (ARF) through the calculation of DALYs. This study was conducted in the framework of a prospective, multicenter cohort in Bogotá, Colombia. Inclusion criteria were all pediatric patients admitted to the emergency department, hospitalization, and intensive care unit with respiratory distress; eligible patients were all those who developed ARF between April 2020 and December 2021. They were followed-up during hospitalization, at 30 and 60 days after admission. The Infant/Toddler Quality of Life Questionnaire and KIDSCREEN quality of life scales were applied for follow-up according to the age group. The results were used to calculate DALYs. Six hundred and eighty-five eligible patients, 296 (43.08%) developed ARF, of these 22 (6.08%) patients died (mortality rate = 7.43%). The total DALYs was 277.164 years. For younger than 9 years, the DALYs were 302.64 years, while for older than 10 years were 40.49 years. ARF is one of the main causes of preventable mortality in pediatrics, its progression to respiratory failure is a highly prevalent condition in pediatric age, a condition that has a great impact on mortality, morbidity, and disability in our patients.

Burden of heart failure in Kazakhstan: data from the unified national healthcare system 2014-2021

Abstract Background Heart failure (HF) affected 64.3 million people worldwide and contributed to 9.9 million years lived with disability globally in 2017. Despite its global relevance, there is a lack of comprehensive statistics on the prevalence, incidence, and burden of HF in developing Central Asian countries. This study aims to fill the gap and present the data for Kazakhstan, the largest Central Asian country. Methods HF cases were identified through the Unified National Electronic Healthcare System records for 2014-2021 using the appropriate ICD-10 codes. Descriptive and survival analyses were used to present demographics, incidence, prevalence, and mortality rates. The calculation of DALYs is done according to the WHO methods. The information on comorbid conditions based on respective ICD-10 codes was collected by merging the databases using unique deidentifying patient numbers. Results During the observation period between 2014-2021 years, 501,663 patients with HF were identified, of them 52% were females, 86% were older than 50 years of age, and 58% were of Kazakh ethnicity. Hypertension, history of cerebrovascular diseases, and myocardial infarction were present in 40%, 34%, and 22% of the cohort, respectively. The age and sex-specific incidence show that women have higher incidence before 30 years of age compared to men. In addition, incidence rates for both sexes and all age categories decreased in 2021 compared to 2014. The prevalence dramatically increased from 4393 people per million population (PMP) to 22,088 PMP, while mortality rates changed from 367 to 721 PMP during the observation period. In 2021, 2,964,062 age and disability-adjusted life years (DALYs) were lost due to HF in Kazakhstan. More than 2 million DALYs belong to years of life lost (YLLs). Conclusions The DALYs show high economic and social loss due to high mortality among patients. Healthcare policymakers should prioritize the enhancement of cardiac services and the mitigation of its risk factors. Key messages • This study highlights the high burden of heart failure in Kazakhstan, with over 2 million DALYs lost in 2021 alone. Healthcare policymakers must prioritize cardiac services and risk factor reduction. • Lack of comprehensive data on HF in Central Asia made it difficult to tackle the burden. This study fills this gap, presenting valuable information for policymakers to reduce social and economic loss.

Barriers in the implementation of burden of disease estimates in Belgium and potential solutions

Abstract Injuries are a leading cause of morbidity and mortality in Europe, and not only place a huge burden on individuals and health care services but on society as a whole. However, estimates on the burden of disease expressed as disability adjusted life years (DALY) are only available in some countries. Other countries don’t have the required data or resources available to calculate DALYs attributable to injuries. The recent report on the European Injury Data Base (IDB) shows that there are important between-country differences in morbidity and mortality related to injuries, emphasizing the important of country-specific estimates. In the current presentation the process of DALY calculations will be briefly discussed, after which a more in-depth scope will be given on the barriers that exist in Belgium to calculate these valuables DALYs. These barriers include, for example, a lack of data availability and specific barriers in linking data registries. Afterwards, the potential solutions to yield estimates based on incomplete information will be discussed.

The Burden of Disease due to COVID-19 (BoCO-19): A study protocol for a secondary analysis of surveillance data in Southern and Eastern Europe, and Central Asia.

The COVID-19 pandemic has had an extensive impact on public health worldwide. However, in many countries burden of disease indicators for COVID-19 have not yet been calculated or used for monitoring. The present study protocol describes an approach developed in the project "The Burden of Disease due to COVID-19. Towards a harmonization of population health metrics for the surveillance of dynamic outbreaks" (BoCO-19). The process of data collection and aggregation across 14 different countries and sub-national regions in Southern and Eastern Europe and Central Asia is described, as well as the methodological approaches used. The study implemented in BoCO-19 is a secondary data analysis, using information from national surveillance systems as part of mandatory reporting on notifiable diseases. A customized data collection template is used to gather aggregated data on population size as well as COVID-19 cases and deaths. Years of life lost (YLL), as one component of the number of Disability Adjusted Life Years (DALY), are calculated as described in a recently proposed COVID-19 disease model (the 'Burden-EU' model) for the calculation of DALY. All-cause mortality data are collected for excess mortality sensitivity analyses. For the calculation of Years lived with disability (YLD), the Burden-EU model is adapted based on recent evidence. Because Covid-19 cases vary in terms of disease severity, the possibility and suitability of applying a uniform severity distribution of cases across all countries and sub-national regions will be explored. An approach recently developed for the Global Burden of Disease Study, that considers post-acute consequences of COVID-19, is likely to be adopted. Findings will be compared to explore the quality and usability of the existing data, to identify trends across age-groups and sexes and to formulate recommendations concerning potential improvements in data availability and quality. BoCO-19 serves as a collaborative platform in order to build international capacity for the calculation of burden of disease indicators, and to support national experts in the analysis and interpretation of country-specific data, including their strengths and weaknesses. Challenges include inherent differences in data collection and reporting systems between countries, as well as assumptions that have to be made during the calculation process.

The burden of disease due to COVID-19 in Sweden 2020-2021: A disability-adjusted life years (DALYs) study.

The burden of COVID-19 disease can be measured in terms of disability-adjusted life years (DALYs), which is composed of two components: the years of life lost through premature death (YLL) and the number of years lived with disability (YLD), adjusted for level of disability. This study measured DALYs due to COVID-19 in Sweden and compared it to the burden of other diseases. The methodology used in the calculation of DALYs was based on the Global Burden of Disease guidelines. The number of patients diagnosed with mild/moderate, severe or critical COVID-19 and/or post-COVID-19 condition between March 2020 and October 2021 was extracted from national registries and used for YLD calculations. In addition, the numbers of death due to COVID-19 in different age groups were used for the YLL calculation. During the study period, 152,877 DALYs were lost to COVID-19 in Sweden, 99.3% of which was attributed to YLL. Loss of DALYs occurred mainly among the elderly, with 66.8% of DALYs attributed to individuals >70 years old. Compared to other diseases, the burden of COVID-19 in 2020 ranked as the eighth leading cause of DALY lost. Similar to other countries, the burden of COVID-19 in Sweden was concentrated mainly among the elderly, who contributed most of the DALY lost due to premature mortality. Yet, DALY loss remained lower for COVID-19 than for several other diseases. The contribution of YLD to DALYs lost was minimal. However empirical data on the occurrence and disability of post-COVID-19 condition are scarce, and YLD may therefore be underestimated.

Calculation of Disability-adjusted Life Years (DALY) in Patients with Indolent Systemic Mastocytosis (ISM)

The DALY is a metric used to quantify the burden of diseases that cause significant patient disability; DALY value of ‘0=perfect health’ and ‘1=death’. DALYs are useful in assessing the number of healthy years lost due to a disabling condition and inform the impact of treatment interventions across patient populations and the allocation of healthcare resources. DALYs have not been calculated for ISM, a mast cell disease which causes debilitating symptoms and impaired quality of life.

The burden of disease due to COVID-19 in Sweden: a disability-adjusted life years (DALY) study

Abstract Background Many countries have been severely affected by the COVID-19 pandemic, including Sweden, which has been in the spotlight regarding its policies and their impact on mortality and morbidity. Therefore, it is of high interest to measure the disease burden of COVID-19 in terms of disability-adjusted life years (DALYs). DALYs have two main components: the years of life lost through premature death (YLL) and the number of years lived with disability (YLD). This study aims to measure DALYs due to COVID-19 in Sweden. Methods This study used data from the nationwide multi-register observational study SCIFI-PEARL (Swedish COVID-19 Investigation for Future Insights - a Population Epidemiology Approach using Register Linkage) covering the entire Swedish population. The methodology used in the modelling and calculation of DALYs was based on the Global Burden of Disease guidelines, using Sweden-specific life tables for estimated life expectancies. Results In Sweden, 152877 DALYs were lost to COVID-19 between March 2020 and October 2021, corresponding to 1447/ 100 000, 99,3% of which was attributed to YLL. DALYs loss occurred mainly among elderly groups with 66,78 % of DALYs being attributed to individuals above 70 years old. 57,6% of the lost DALYs occurred among men that lost more DALYs compared to females in all age groups. Conclusions Similar to other countries, the burden of COVID-19 in Sweden is concentrated mainly among the elderly, which contributed to the highest DALY loss due to mortality. Yet, DALY loss remains lower for COVID-19 compared to other major non-communicable diseases such as cardiovascular diseases and neoplasms. The contribution of YLD was minimal. However, YLD due to post-Covid is not well understood and long-term disability is likely still underestimated. Key messages • The burden of COVID-19 was mainly due to premature mortality in the older age groups. • More research is needed especially on post-COVID disability to derive better estimates of YLD.

Methodological choices in brucellosis burden of disease assessments: A systematic review

Abstract Background Foodborne and zoonotic diseases such as brucellosis present many challenges to public health and economic welfare. Increasingly, researchers and public health institutes use disability-adjusted life years (DALYs) to generate a comprehensive comparison of the population health impact of these conditions. DALY calculations entail several methodological choices and assumptions, with data gaps and uncertainties to accommodate. The following review identifies existing brucellosis burden studies and analyses their methodological choices and assumptions. Methods/Findings A systematic search for brucellosis burden calculations was conducted in pre-selected international and grey literature databases. Using a standardized reporting framework, we evaluated each estimate on a variety of key methodological assumptions necessary to compute a DALY. One study reported estimates at the global level, the rest (13) at national or subnational. Most studies retrieved brucellosis epidemiological data from administrative registries. Incidence data were often estimated based on laboratory-confirmed tests. Not all studies included mortality estimates (YLLs) in their assessments due to the lack of data or the assumption that brucellosis is not a fatal disease. Only two studies used a model with variable health states and corresponding disability weights. The rest used a simplified singular health state approach. Wide variation was seen in the duration chosen for brucellosis, ranging from 2 weeks to 4.5 years, irrespective of whether a chronic state was included. Conclusions Available brucellosis burden assessments vary widely in their methodology and assumptions. Further research is needed to characterize better the total clinical course of brucellosis and estimate case-fatality rate. In addition, reporting of methodological choices should be improved to enhance transparency and comparability of estimates. These steps will increase the value of these estimates for policymakers. Key messages • Inconsistencies in reporting methods and assumptions are found, which hinder transparency and understanding of the methodological choices and the reuse of estimates for prioritization purposes. • Thus, there is a need for a more standardized reporting system for DALY estimates, which could resemble a checklist that reports the methodological choices and assumptions.

Beyond QALYs and DALYs: factoring in the well-being effects of dietary supplementation with omega-3 fatty acids in dry eye syndrome

PurposeThis study aims to explore the use and relevance of WALYs (well-being-adjusted life years) in light of the utilitarian premises of neoclassical economics that continue to dominate health outcomes evaluation. QALYs (quality-adjusted life years) and DALYs (disability-adjusted life years) measure longevity and quality of life in terms of purely health-related aspects and outcomes of medical interventions. However, evaluative questions of subjective well-being may be equally important in comparing outcomes and cost-effectiveness of these interventions.Design/methodology/approachA two-phase online search strategy for refereed research on dry eye treatment with omega-3 fatty acids (omega-3s) was adopted. Phase I aimed to identify and contrast clinical parameters of efficacy in omega-3 dietary supplementation. Phase II aimed to find a preference-based, multi-attribute utility instrument specific and sensitive enough to dry eye and its consequences on patients’ subjective well-being. We then illustrate how WALYs can be conceptualized and calculated based on the search results.FindingsEmpiric therapies like omega-3s can be assessed in terms of reducing or relieving symptomatic discomfort and pain, and enabling the patient to enjoy life and derive satisfaction from daily activities. We find in VisQoL (Vision and Quality of Life Index) a viable alternative to conventional multi-attribute utility instruments, including those typically used in QALY and DALY calculations. Clinical efficacy indices of dry eye can be linked to VisQoL’s quality of life dimensions. Differently weighted outcomes can be aggregated. And WALYs per patient per year can be computed by scaling aggregated outcomes to match the WALY rating scale. The implications of subjective well-being for both patient and society can thus be approached from a broader and richer perspective.Originality/valueTo the best of our knowledge, this is the first study of its kind in pharmaceutical outcomes valuation and marketing. It offers a framework for analyzing life satisfaction and well-being among dry eye patients under treatment. It is also the first to use and adapt a multi-attribute utility measure to treatment outcomes of omega-3s in ocular diseases, from which this study suggests WALYs may be computed. However, it does not suggest that WALYs should supplant QALYs and DALYs in evaluating health outcomes. Medical economics is enriched if alternative methods of outcomes evaluations can help fill in the gaps in existing paradigms and do so by accounting for other effects of condition-specific interventions. Costs and benefits of interventions to the individual and society can then be valued not just more effectively, but also more equitably.

A refined and updated health impact assessment of the Global Programme to Eliminate Lymphatic Filariasis (2000–2020)

BackgroundLymphatic filariasis (LF) is a neglected tropical disease (NTD). In 2000 the World Health Organization (WHO) established the Global Programme to Eliminate Lymphatic Filariasis (GPELF). A key component of this programme is mass drug administration (MDA). Between 2000 and 2020, the GPELF has delivered over 8.6 billion treatments to at-risk populations. The last impact assessment of the programme evaluated the treatments provided between 2000–2014. The goal of this analysis is to provide an updated health impact assessment of the programme, based on the numbers treated between 2000–2020.MethodsWe updated and refined a previously established model that estimates the number of clinical manifestations and disability-adjusted life years (DALYs) averted by the treatments provided by the GPELF. The model comprises three different population cohorts that can benefit from MDA provided (those protected from acquiring infection, those with subclinical morbidity prevented from progressing and those with clinical disease alleviated). The treatment numbers were updated for all participating countries using data from the WHO. In addition, data relating to the estimated number of individuals initially at risk of LF infection were updated where possible. Finally, the DALY calculations were refined to use updated disability weights.ResultsUsing the updated model and corresponding treatment data, we projected that the total benefit cohort of the GPELF (2000–2020) would consist of approximately 58.5 million individuals and the programme would avert 44.3 million chronic LF cases. Over the lifetime of the benefit cohorts, this corresponded to 244 million DALYs being averted.ConclusionThis study indicates that substantial health benefits have resulted from the first 20 years of the GPELF. It is important to note that the GPELF would have both additional benefits not quantified by the DALY burden metric as well as benefits on other co-endemic diseases (such as soil-transmitted helminths, onchocerciasis and scabies)—making the total health benefit underestimated. As with the past impact assessments, these results further justify the value and importance of continued investment in the GPELF.Graphical

Burden of disease of dietary exposure to aflatoxins in European countries

Abstract Aflatoxins (AFTs) are genotoxic and carcinogenic food contaminants causing hepatocellular carcinoma, the third leading cause of cancer deaths worldwide. In 2015, WHO estimated the burden of disease associated with exposure to AFTs and concluded that this exposure corresponds to 636,869 Disability-adjusted Life Years (DALYs) at global level. Particularly for Portugal and recently, there were estimated 0.08-0.30 DALYs/100,000 considering consumption and occurrence in food data, and 1.7 DALYs/100,000 based on human biomonitoring data. The present study considered the exposure data presented in the EFSA scientific opinion “Risk assessment of aflatoxins in food” where data from occurrence of AFTs in food and from food consumption were gathered to estimate the exposure to AFTs in 19 European countries. A deterministic and a bottom-up approach was developed to estimate the health impact of the exposure to AFTs for adult population through the calculation of DALYs associated to the number of estimated extra-cases of hepatocellular carcinoma (HCC). Results showed similar values for all the 19 European countries considered. For adult population and considering the data provided by EFSA using the upper-bound approach (worst-case scenario), the estimated number of DALYs ranged from 0.32 (Spain) to 1.10 (United Kingdom) DALYs/100,000. A total of 11.76 DALYs/100,000 was globally estimated for the considered European countries. The highest burden was estimated for the United Kingdom, that together with The Netherlands, Ireland, Czech Republic, and Austria were the highest contributors to the global estimated European burden associated to the exposure to AFTs. The present study generated reliable and crucial data to characterize the burden associated to exposure to AFTs in the European population. The obtained results constitute an important contribution to define priorities and support the need for further policy actions to protect European citizen's health.

Measuring the Burden of Disease in Korea, 2008-2018.

The study aims to examine the current status and differences in the burden of disease in Korea during 2008-2018. We calculated the burden of disease for Koreans from 2008 to 2018 using an incidence-based approach. Disability adjusted life years (DALYs) were expressed in units per 100 000 population by adding years of life lost (YLLs) and years lived with disability (YLDs). DALY calculation results were presented by gender, age group, disease, region, and income level. To explore differences in DALYs by region and income level, we used administrative district and insurance premium information from the National Health Insurance Service claims data. The burden of disease among Koreans showed an increasing trend from 2008 to 2018. By 2017, the burden of disease among men was higher than that among women. Diabetes mellitus, low back pain, and chronic lower respiratory disease were ranked high in the burden of disease; the sum of DALY rates for these diseases accounted for 18.4% of the total burden of disease among Koreans in 2018. The top leading causes associated with a high burden of disease differed slightly according to gender, age group, and income level. In this study, we measured the health status of Koreans and differences in the population health level according to gender, age group, region, and income level. This data can be used as an indicator of health equity, and the results derived from this study can be used to guide community-centered (or customized) health promotion policies and projects, and for setting national health policy goals.

Burden of healthcare-associated infections in Italy: incidence, attributable mortality and disability-adjusted life years (DALYs) from a nationwide study, 2016

Healthcare-associated infections (HAIs) are an increasing public health threat. Measuring disease burden in disability-adjusted life-years (DALYs) allows the combination of morbidity and mortality into one figure, as it represents the summation of years lived with disability and years of life lost. To evaluate the incidence, attributable deaths and burden of the most significant HAIs in Italy. Prevalence data from the study sample of the 2016 national Point Prevalence Survey of HAIs in acute-care settings were used to estimate the incidence of five HAIs. The methodology from the Burden of Communicable Diseases in Europe (BCoDE)-project was employed for DALY calculations, adapting the disease models to the Italian population. We estimated a total of 641,065 (95% uncertainty interval, UI 585,543.00-699,207.90) new yearly cases of HAIs and 29,375 (95% UI 23,705.97-35,905.80) deaths in Italy in 2016. The total annual DALYs were estimated to be 424,657.45 (95% UI 346,240.35-513,357.28), corresponding to 702.53 DALYs (95% UI 575.22-844.66) per 100,000 general population. Bloodstream infections accounted for the majority of total DALYs (59%), healthcare-associated pneumonia for 29%, surgical site infections for 9%, CDI for 2% and urinary tract infections accounted for less than 1% of total DALYs. Results of this study suggest HAIs have a substantial burden in Italy. Reducing the burden of HAIs through infection prevention and control efforts is an achievable goal. This study provides data that could be used to guide policy-makers in the implementation of these measures.

Burden of Disease of Guillain-Barré Syndrome in Brazil before and during the Zika virus epidemic 2014-2016.

To estimate the burden of disease of Guillain-Barré syndrome (GBS) in Brazil in 2014, 1year before the Zika virus epidemic, and in 2015 and 2016 during the epidemic. The burden of disease of GBS was estimated using the summary measure of population health: Disability Adjusted Life Years (DALY), that combines both mortality (Years of Life Lost YLLs) and morbidity (Years Lived with Disability) components. The study population was composed of GBS hospitalised cases and deaths from the information systems of the Brazilian Unified Health System. The GBS incidence rate in 2014, 2015 and 2016 was 0.74, 0.96, 1.02/100000 respectively, and the mortality rate in the same period was 0.08, 0.009 and 0.11/100000 habitants. The DALYs calculated using the point estimate of GBS disability weight and its values of the confidence interval (0.198 and 0.414) were 5725.90 (5711.79-5742.89) in 2014, 6054.61 (6035.57-6077.54) in 2015 and 7588.49 (7570.20-7610.51) in 2016. The DALYs were high among the male population and in age groups between 20 and 50years. The increase in DALYs in the years 2015 and 2016 compared to 2014 probably resulted from the introduction of ZIKV in Brazil, reinforcing the importance of investments in the prevention of ZIKV infection and in the care of GBS patients.

Disease burden of edentulism – Dental Clinic of Vojvodina, Serbia, 2008-2019

Abstract Background Although there is a decline in the global prevalence of edentulism over the past decade, the tendency is opposite in Serbia. The aim of this study was to estimate the disease burden of edentulism at the Dental Clinic of Vojvodina, tertiary referral public health institution of the northern province of Serbia. Methods Disease burden was expressed in disability-adjusted life years (DALYs). Prevalence (P) was calculated on the database of all patients from 2008 to 2019 at the Dental Clinic of Vojvodina using IBM SPSS Statistics. The number of diagnosed cases rehabilitated by complete dentures was an indicator of edentate people. A total sample of 76287 patients was examined, including 1620 patients restored with complete dentures (44.94% male, 55.06% female). Disability weight (DW) for severe tooth loss was taken from the “Disability weight for the Global Burden of Disease 2013 study”. The prevalence-based years lived with disability (YLD) were calculated as YLD = P x DW. Due to the non-fatal outcome of edentulism, DALY estimates were based on YLDs only (YLL=0). Results For the observed period, the total disease burden (per 1000) was 1.42 DALYs (0.64 for men and 0.78 for women). During observed years, DALYs increased (from 1.66 in 2008 to 1.73 in 2019), in association with population aging, and insufficient support from public health insurance for oral prevention and treatments. For both sexes, DALYs increased gradually with age. The results for age-stratified DALYs (per 1000) were: 0.005 (age 0-24), 0.049 (age 25-34), 0.55 (age 35-44), 2.66 (age 45-54), 4.41 (age 55-64), 7.89 (age 65-74), 8.04 (age 75-84) and 9.05 (age 85-94). Conclusions Considering the calculated disease burden, edentulism has been posing an increasing challenge for the health system in Serbia over the past decade. The quantified burden could contribute to the improvement of evidence-informed policymaking in public oral health in Serbia. Acknowledgment Supported by “Burden-EU” COST Action Key messages The calculated DALYs show an increase in burden of edentulism in Vojvodina, Serbia. DALYs calculations could improve the insufficient monitoring of oral health status in Serbia.

Burden of Osteoporotic Fractures Using Disability-Adjusted Life Years in South Korea.

There is an increase in the number of patients with osteoporotic fractures due to the aging population in Korea. This study investigated the burden of osteoporotic fractures including hip, spine, and wrist fractures in the Korean population by estimating disability-adjusted life years (DALYs). The DALY for a given condition in a population captures years of life lost due to premature death and years of life lived with a disability and its severity and duration. To calculate DALYs from all relevant data collected for the 3 conditions, we used a DALY calculation template provided by the World Health Organization in 2014. DALYs per 100 000 for vertebral fractures (3168) were higher than those of hip fractures (2496) in women. Wrist fractures (1038) had the least burden, and the difference between men and women was the lowest. The aging population is expected to increase the burden of osteoporosis.

The Burden of Functional Disabilities for Middle-Aged and Older Adults in the United States.

Understanding the role of functional capacity on longevity is important as the population in the United States ages. The purpose of this study was to determine the burden of instrumental activities of daily living (IADL) and activities of daily living (ADL) disabilities for a nationally-representative sample of middle-aged and older adults in the United States. Longitudinal-Panel. Core interviews were often performed in person or over the telephone. A sub-sample of 31,055 participants aged at least 50 years from the 1998-2014 waves of the Health and Retirement Study who reported having a functional disability were included. Ability to perform IADLs and ADLs were self-reported at each wave. The National Death Index was used to ascertain date of death. The number of years of life that were lost (YLLs) and years lived with a disability (YLDs) were summed for the calculation of disability-adjusted life years (DALYs). Sampling weights were used in the analyses to make the DALYs nationally-representative. The results for YLLs, YLDs, and DALYs are reported in thousands. Of the participants included, 14,990 had an IADL disability and 13,136 had an ADL disability. Men and women with an IADL disability had 236,037 and 233,772 DALYs, respectively; whereas, there were 178,594 DALYs for males and 253,630 DALYs for females with an ADL disability. Collectively, there were 469,809 years of healthy life lost from IADL impairments, and 432,224 years of healthy life lost from ADL limitations. These findings should be used to inform healthcare providers and guide interventions aiming to preserve the functional capacity of aging adults. Prioritizing health-related resources for mitigating the burden of functional disabilities may help aging adults increase their quality of life and life expectancy over time.

Burden of Mild Mental Retardation attributed to prenatal methylmercury exposure in Amazon: local and regional estimates.

The gold rush in the Amazon Region caused an increase of mercury (Hg) levels in the environment, and, consequently, raised human exposure. Once released into aquatic systems, Hg could generate methylmercury (MeHg), an extremely toxic compound, which is accumulated through trophic chains. Several studies have provided evidences of the brain sensitivity to MeHg, as well as, of the fetus vulnerability during pregnancy. The main objective of this study was to estimate the Mild Mental Retardation (MMR) in Amazonian populations, caused by prenatal exposure to MeHg, using the methodology proposed by Poulin (2008), which quantifies the environmental burden of disease. The estimates of the MMR burden, attributed to prenatal MeHg exposure, were based on the calculation of Disability-Adjusted Life Years (DALY), which were obtained from MMR incidence rate in the studied populations. At the local level, the MMR incidence rate calculations were based on primary data of MeHg exposure of riverine women at childbearing age. The MMR incidence rate was equal to 5.96/1,000 infants, which would result in 2.0 IQ points loss in 34.31% of the newborns. The estimated DALY/1,000 infants was equal to 71.2, while the DALY was 576. For the regional estimates, different exposure scenarios were created. The calculated DALY varied from 3,256 to 65,952 per year.

Impact of infectious diseases on population health using incidence-based disability-adjusted life years (DALYs): results from the Burden of Communicable Diseases in Europe study, European Union and European Economic Area countries, 2009 to 2013.

Background and aimsThe Burden of Communicable Diseases in Europe (BCoDE) study aimed to calculate disability-adjusted life years (DALYs) for 31 selected diseases in the European Union (EU) and European Economic Area (EEA). Methods: DALYs were estimated using an incidence-based and pathogen-based approach. Incidence was estimated through assessment of data availability and quality, and a correction was applied for under-estimation. Calculation of DALYs was performed with the BCoDE software toolkit without applying time discounting and age-weighting. Results: We estimated that one in 14 inhabitants experienced an infectious disease episode for a total burden of 1.38 million DALYs (95% uncertainty interval (UI): 1.25–1.5) between 2009 and 2013; 76% of which was related to the acute phase of the infection and its short-term complications. Influenza had the highest burden (30% of the total burden), followed by tuberculosis, human immunodeficiency virus (HIV) infection/AIDS and invasive pneumococcal disease (IPD). Men had the highest burden measured in DALYs (60% of the total), adults 65 years of age and over had 24% and children less than 5 years of age had 11%. Age group-specific burden showed that infants (less than 1 year of age) and elderly people (80 years of age and over) experienced the highest burden. Conclusions: These results provide baseline estimates for evaluating infectious disease prevention and control strategies. The study promotes an evidence-based approach to describing population health and assessing surveillance data availability and quality, and provides information for the planning and prioritisation of limited resources in infectious disease prevention and control.

Burden of road traffic injuries related to delays in implementing safety belt laws in low- and lower-middle-income countries

ABSTRACTObjective: Delayed implementation of effective road safety policies must be considered when quantifying the avoidable part of the fatal and nonfatal injuries burden. We sought to assess the avoidable part of disability-adjusted life years (DALYs) lost due to road traffic injuries related to delays in implementing road safety laws in low- and lower-middle-income countries.Methods: We chose one country for each of the regions of the World Health Organization (WHO) and World Bank (WB) country income levels. We used freely available data sets (WHO, International Traffic Safety Data and Analysis Group, the WB). Delays in implementation were calculated until 2013, from the year mandatory use of safety belts by motor vehicle front seat occupants was first introduced worldwide. We used life expectancy tables and age groups as social values in the DALY calculation model. From the estimated total burden, avoidable DALYs were calculated using estimates of the effectiveness of seat belt laws on fatal and nonfatal injuries combined, as extracted from published international reviews of evidence.Results: From the reference year 1972, implementation delays varied from 27 years (Uzbekistan) to 41 years in Bolivia (no seat belt law as of 2013). During delays, total absolute numbers of DALYs lost due to road traffic injuries reached 8,462,099 in Nigeria, 7,203,570 in Morocco, 4,695,500 in Uzbekistan, 3,866,391 in Cambodia, 3,253,359 in Bolivia, and 3,128,721 in Sri Lanka. Using effectiveness estimates ranging from 3 to 20% reduction, the avoidable burden of road traffic injuries for car occupants was highest in Uzbekistan (avoidable part from 1.2 to 10.4%) and in Morocco (avoidable part from 1.5 to 12.3%). In countries where users of public transport and pedestrians were the most affected by the burden, the avoidable parts ranged from 0.5 to 4.4% (Nigeria) and from 0.5 to 3.4% (Bolivia). Burden of road traffic injuries mostly affected motorcyclists in Sri Lanka and Cambodia where the avoidable parts were less than 2% in both countries. In all selected countries, burden of traffic injuries mostly affected men (about 80%) as well as young people (15–34 years).Conclusions: Despite limited data availability in low- and middle-income countries, the avoidable part of the burden related to delayed intervention is measurable. These results can be used to convince countries to avoid delaying the provision of better protection to road users.