Current Global Burden Of Disease Research Articles

Ecological and socioeconomic factors associated with the human burden of environmentally mediated pathogens: a global analysis

Billions of people living in poverty are at risk of environmentally mediated infectious diseases-that is, pathogens with environmental reservoirs that affect disease persistence and control and where environmental control of pathogens can reduce human risk. The complex ecology of these diseases creates a global health problem not easily solved with medical treatment alone. We quantified the current global disease burden caused by environmentally mediated infectious diseases and used a structural equation model to explore environmental and socioeconomic factors associated with the human burden of environmentally mediated pathogens across all countries. We found that around 80% (455 of 560) of WHO-tracked pathogen species known to infect humans are environmentally mediated, causing about 40% (129 488 of 359 341 disability-adjusted life years) of contemporary infectious disease burden (global loss of 130 million years of healthy life annually). The majority of this environmentally mediated disease burden occurs in tropical countries, and the poorest countries carry the highest burdens across all latitudes. We found weak associations between disease burden and biodiversity or agricultural land use at the global scale. In contrast, the proportion of people with rural poor livelihoods in a country was a strong proximate indicator of environmentally mediated infectious disease burden. Political stability and wealth were associated with improved sanitation, better health care, and lower proportions of rural poverty, indirectly resulting in lower burdens of environmentally mediated infections. Rarely, environmentally mediated pathogens can evolve into global pandemics (eg, HIV, COVID-19) affecting even the wealthiest communities. The high and uneven burden of environmentally mediated infections highlights the need for innovative social and ecological interventions to complement biomedical advances in the pursuit of global health and sustainability goals. Bill & Melinda Gates Foundation, National Institutes of Health, National Science Foundation, Alfred P. Sloan Foundation, National Institute for Mathematical and Biological Synthesis, Stanford University, and the US Defense Advanced Research Projects Agency.

Improving and Expanding Estimates of the Global Burden of Disease Due to Environmental Health Risk Factors

The Global Burden of Disease (GBD) study, coordinated by the Institute for Health Metrics and Evaluation (IHME), produces influential, data-driven estimates of the burden of disease and premature death due to major risk factors. Expanded quantification of disease due to environmental health (EH) risk factors, including climate change, will enhance accuracy of GBD estimates, which will contribute to developing cost-effective policies that promote prevention and achieving Sustainable Development Goals. We review key aspects of the GBD and introduce the Global Burden of Disease–Pollution and Health Initiative (GBD-PHI), which aims to work with IHME and the GBD study to improve estimates of disease burden attributable to EH risk factors and to develop an innovative approach to estimating climate-related disease burden—both current and projected. We discuss strategies for improving GBD quantification of specific EH risk factors, including air pollution, lead, and climate change. We highlight key methodological challenges, including new EH risk factors, notably evidence rating and global exposure assessment. A number of issues present challenges to the scope and accuracy of current GBD estimates for EH risk factors. For air pollution, minimal data exist on the exposure–risk relationships associated with high levels of pollution; epidemiological studies in high pollution regions should be a research priority. For lead, the GBD’s current methods do not fully account for lead’s impact on neurodevelopment; innovative methods to account for subclinical effects are needed. Decisions on inclusion of additional EH risk–outcome pairs need to be guided by findings of systematic reviews, the size of exposed populations, feasibility of global exposure estimates, and predicted trends in exposures and diseases. Neurotoxicants, endocrine-disrupting chemicals, and climate-related factors should be high priorities for incorporation into upcoming iterations of the GBD study. Enhancing the scope and methods will improve the GBD’s estimates and better guide prevention policy.

The Morbidity and Mortality of Plastic Surgery Disease in Canada: A Perspective Based on the Global Burden of Disease Study

PURPOSE: Identifying the burden of disease related to plastic and reconstructive surgery in Canada will provide timely population-based data, will inform policy, and will generate important research funding. Using the most current Global Burden of Disease (GBD) data, we present results on the years of life lost (YLLs), years lived with disability (YLDs), and disability-adjusted life years (DALYs) for diseases relevant to our field. METHODS AND PATIENTS: Data were extracted through the GBD 2017 results tool for all available and relevant plastic surgery diseases. Incidence, prevalence, mortality, and cost were calculated for each disease. The data were analyzed using a Bayesian meta-regression modelling tool to provide epidemiological estimates of YLLs, YLDs and DALYs by combining other available parameters. To quantify and compare the costs of adverse health end points, the monetary value (CAD) of a DALY was ascertained based on previous analysis. RESULTS: In 2017, plastic surgery-related conditions in Canada had an overall age-standardized DALY rate of 481 per 100,000 (95% UI, 409–562). Of these conditions, breast cancer was responsible for over 50% of the overall burden of disease, with an age-standardized DALY rate of 247 per 100,000 (95% UI, 222–274), followed by thermal burns (64 per 100,000 [95% UI, 51–82]) and malignant skin melanoma (54 per 100,000 [95% UI, 39–68]). Age-standardized incidence rates were highest for cellulitis (3,008 per 100,000 [95% UI, 2,814–3,192]) followed by pyoderma (1,432 per 100,000 [95% UI, 1,391–1,478]). Breast cancer had the highest age-standardized cost of care of all plastic surgery-related diseases, at $4.6 billion. Summed values for all 13-plastic surgery-related diseases demonstrate a total age-standardized cost of $9.2 billion. CONCLUSION: Plastic and reconstructive surgery-related diseases are responsible for a high burden of disease and significant cost to the Canadian healthcare system. Unsurprisingly, breast cancer is the leading cause of morbidity and mortality of these diseases, followed by thermal burns and malignant melanoma. These results will help guide national policy on healthcare and research funding for plastic surgery-related diseases and will direct current efforts toward the highest impact diseases facing the Canadian healthcare system.

Review of the burden of eating disorders: mortality, disability, costs, quality of life, and family burden.

Purpose of reviewTo review the recent literature on the burden of eating disorders in terms of mortality, disability, quality of life, economic cost, and family burden, compared with people without an eating disorder.Recent findingsEstimates are that yearly over 3.3 million healthy life years worldwide are lost because of eating disorders. In contrast to other mental disorders, in anorexia nervosa and bulimia nervosa years lived with disability (YLDs) have increased. Despite treatment advances, mortality rates of anorexia nervosa and bulimia nervosa remain very high: those who have received inpatient treatment for anorexia nervosa still have a more than five times increased mortality risk. Mortality risks for bulimia nervosa, and for anorexia nervosa treated outside the hospital, are lower but still about twice those of controls. In people with an eating disorder, quality of life is reduced, yearly healthcare costs are 48% higher than in the general population, the presence of mental health comorbidity is associated with 48% lower yearly earnings, the number of offspring is reduced, and risks for adverse pregnancy and neonatal outcomes are increased.SummaryPeople with a current or former eating disorder are at risk of increased mortality, high YLD rates, a reduced quality of life, increased costs, and problems with childbearing.

Adjusting for comorbidity in incidence-based DALY calculations: an individual-based modeling approach

BackgroundThe co-occurrence of two or more medical conditions in the same individual is not uncommon. If disability-adjusted life year (DALY) calculations are carried out for each condition separately, multimorbidity may lead to an overestimation of the morbidity component, the Years Lived with Disability (YLD). Adjusting for comorbidity may be straightforward if all symptoms have same onset and duration; however, when the comorbid health states occur at different time points, an analytical solution to the comorbidity problem becomes more complex. The aim of this study was to develop an individual-based modelling (IBM) approach to adjust incidence-based disease burden estimation for multimorbidity that allows simulating hypothetical individuals and tracking their disease history, including possible comorbidities, over time.MethodsWe demonstrated the IBM approach using an example of external comorbidity, i.e., colon cancer comorbid with healthcare-associated pneumonia (HAP) and by assuming an independent multiplicative model. First, each cumulative progression probabilities were converted to a daily transition probabilities. Second, disability weights for simultaneously experienced health states and duration in each health state were determined. Third, YLD, adjusted for comorbidity, was calculated at every time step. We simulated a cohort of 1000 colorectal cancer patients aged 65 years. Ninety-five percent uncertainty intervals around median YLD values were estimated by Monte Carlo methods.ResultsThe median estimated YLD per 1000 cases (due to both cancer and HAP) adjusted for co-morbidity was 545 YLD/1000 (95% interval: 513–585). The impact of not adjusting disability weights for co-existent health states varied from minimal to small; YLD for colorectal cancer would be overestimated only slightly – by 1.6 YLD/1000 – by not adjusting for concurrent HAP. YLD for those HAP patients who have concurrent early-stage colorectal cancer would be overestimated by 2.3 YLD/1000.ConclusionsThe computation of disease burden in the presence of multimorbidity using the incidence-based DALY approach can be handled through IBM. Our approach can be extended to other, more complicated multimorbidity scenarios which are responsible for a high current global disease burden, such as tuberculosis and HIV infection.

Improving and Expanding Estimates of the Global Burden of Disease Due to Environmental Health Risk Factors.

Background:The Global Burden of Disease (GBD) study, coordinated by the Institute for Health Metrics and Evaluation (IHME), produces influential, data-driven estimates of the burden of disease and premature death due to major risk factors. Expanded quantification of disease due to environmental health (EH) risk factors, including climate change, will enhance accuracy of GBD estimates, which will contribute to developing cost-effective policies that promote prevention and achieving Sustainable Development Goals.Objectives:We review key aspects of the GBD for the EH community and introduce the Global Burden of Disease–Pollution and Health Initiative (GBD-PHI), which aims to work with IHME and the GBD study to improve estimates of disease burden attributable to EH risk factors and to develop an innovative approach to estimating climate-related disease burden—both current and projected.Methods:We discuss strategies for improving GBD quantification of specific EH risk factors, including air pollution, lead, and climate change. We highlight key methodological challenges, including new EH risk factors, notably evidence rating and global exposure assessment.Discussion:A number of issues present challenges to the scope and accuracy of current GBD estimates for EH risk factors. For air pollution, minimal data exist on the exposure–risk relationships associated with high levels of pollution; epidemiological studies in high pollution regions should be a research priority. For lead, the GBD’s current methods do not fully account for lead’s impact on neurodevelopment; innovative methods to account for subclinical effects are needed. Decisions on inclusion of additional EH risk–outcome pairs need to be guided by findings of systematic reviews, the size of exposed populations, feasibility of global exposure estimates, and predicted trends in exposures and diseases. Neurotoxicants, endocrine-disrupting chemicals, and climate-related factors should be high priorities for incorporation into upcoming iterations of the GBD study. Enhancing the scope and methods will improve the GBD’s estimates and better guide prevention policy. https://doi.org/10.1289/EHP5496

Dietary behaviour changes to improve nutritional quality and health outcomes

This narrative review examines the changes required in dietary behaviours to address the current global burden of disease resulting from diet-associated cardiometabolic dysfunction. Beginning with known relationships between nutritional factors and health outcomes, the review identifies a number of problems with current dietary behaviours, using examples from the Australian context. Implications for practice are then discussed drawing on insights from research in dietary trials. From a concerted research effort across the globe, the effects of foods, food components and dietary patterns on cardiometabolic parameters have been reasonably well exposed. The evidence base for these effects underpins dietary guidelines, which aim to meet nutritional requirements and protect against cardiometabolic disease. Thus foods recommended in dietary guidelines tend to be consistent with research that identifies foods that appear protective and those that appear detrimental to health. The need for dietary behaviour change is apparent through analyses that have exposed increasing consumption of detrimental foods, despite the availability of healthy foods. However, behaviour change is a complex area, and where weight loss is also required, there is high level evidence that interdisciplinary efforts combining diet, physical activity and psychological support are warranted. Insights from dietary trials and research indicate that focussing on foods and dietary patterns is integral to the specific dietary change required for health outcomes, but social and behavioural factors will influence the achievement of these changes.

Hypertension

Hypertension is an independent risk factor for cardiovascular disease. The prevalence of hypertension in England is about 30%. The World Health Organization estimates that hypertension is responsible for ‘4.5% of current global disease burden’. Hypertension is asymptomatic in the majority of patients, making diagnosis and management more challenging. However, the associated mortality and morbidity from stroke and myocardial infarction is significant. Once blood pressure (BP) is over 115/70 mmHg, the risk of myocardial infarction or stroke doubles with each 20/10 mmHg increase in BP. The majority of hypertensive patients (90%) will have primary hypertension with no known cause. The term ‘essential hypertension’ has been used to describe primary hypertension, based on the assumption that an elevated BP was required to maintain adequate organ perfusion. A minority of hypertensive patients will have ‘secondary hypertension’ with an underlying pathological cause, such as chronic kidney disease or Conn’s syndrome.

CO-INFECTION OF BRUCELLA AND DENGUE VIRUS

ABSTRACTObjective: Brucellosis is an important zoonotic infection having a worldwide distribution. In South East Asian developing countries like India, brucellosisis yet well-known but often neglected disease. Although dengue fever has a global distribution, South East Asian region together with the WesternPacific region represents 75% of the current global disease burden. Frequent dengue fever outbreaks have been encountered in different parts of India.Both brucellosis and dengue fever may present with many nonspecific symptoms. This study was designed to identify the trend of their co-infection.Methods: The study was carried out from February 2015 to July 2016 in Eastern India. Blood samples collected from clinically suspected denguefever cases were confirmed serologically by dengue specific NS1, IgM, and IgG capture ELISA methods. The confirmed dengue samples were furthersubjected to Brucella specific serological and molecular investigations.Results: Out of 37 serologically confirmed dengue cases, 8 (21.6%) showed co-infection of brucellosis and dengue fever. Female predominance wasobserved among the co-infection cases. Most of these cases belonged to the age group 21-40 years and resided in and around Kolkata.Conclusion: This study portrays the simultaneous acquisition of these two pathogens in a few patients. Co-infection of these two pathogens, whilefeasible, has not been accounted previously in this part of India. Thus, this report highlights the significance of studying the possibility of occurrenceof dual infection of these two diseases and its outcome in patients with febrile illness thereby providing future scope of preventing case fatalities.Keywords: Brucellosis, Dengue, Co-infection, ELISA, Polymerase chain reaction.

Methodological Challenges in Estimating Trends and Burden of Cardiovascular Disease in Sub-Saharan Africa.

Background. Although 80% of the burden of cardiovascular disease (CVD) is in developing countries, the 2010 global burden of disease (GBD) estimates have been cited to support a premise that sub-Saharan Africa (SSA) is exempt from the CVD epidemic sweeping across developing countries. The widely publicized perspective influences research priorities and resource allocation at a time when secular trends indicate a rapid increase in prevalence of CVD in SSA by 2030. Purpose. To explore methodological challenges in estimating trends and burden of CVD in SSA via appraisal of the current CVD statistics and literature. Methods. This review was guided by the Critical review methodology described by Grant and Booth. The review traces the origins and evolution of GBD metrics and then explores the methodological limitations inherent in the current GBD statistics. Articles were included based on their conceptual contribution to the existing body of knowledge on the burden of CVD in SSA. Results/Conclusion. Cognizant of the methodological challenges discussed, we caution against extrapolation of the global burden of CVD statistics in a way that underrates the actual but uncertain impact of CVD in SSA. We conclude by making a case for optimal but cost-effective surveillance and prevention of CVD in SSA.

The state of global health in 2014.

The global health landscape looks more promising than ever, although progress has been uneven. Here, we describe the current global burden of disease throughout the life cycle, highlighting regional differences in the unfinished agenda of communicable diseases and reproductive, maternal, and child health and the additive burden of emerging noncommunicable diseases and injuries. Understanding this changing landscape is an essential starting point for effective allocation of both domestic and international resources for health.

The genetics of alcohol dependence

Alcohol consumption dates back to the Neolithic period, and alcohol dependence contributes substantially to the current global burden of disease. Despite this, optimal therapies and preventive strategies are lacking. Formal genetic studies of alcohol dependence have shown that genetic factors play as large a role in disease etiology as environmental factors. Molecular genetic studies may identify causal factors and facilitate the development of novel preventive and therapeutic approaches. Whereas earlier studies involved the use of linkage- and candidate-gene approaches, recent years have witnessed the introduction of genome-wide association studies (GWAS). The present review provides a brief overview of the findings of formal genetic studies, summarizes the results of earlier molecular-genetic investigations, and presents a detailed overview of all published GWAS in the field of alcohol dependence research. To date, few genome-wide significant findings have been reported. However, through the polygenic approach, GWAS have both confirmed the existence of a multitude of novel risk genes and indicated interesting new candidates.

Mortality and potential years of life lost attributable to alcohol consumption in Canada in 2005.

BackgroundAlcohol is a substantial risk factor for mortality according to the recent 2010 World Health Assembly strategy to reduce the harmful use of alcohol which outlined the need to characterize and monitor this burden. Accordingly, using new methodology we estimated 1) the number of deaths caused and prevented by alcohol consumption, and 2) the potential years of life lost (PYLLs) attributable to alcohol consumption in Canada in 2005.MethodsMortality attributable to alcohol consumption was estimated by calculating Alcohol-Attributable Fractions (AAFs) (defined as the proportion of mortality that would be eliminated if the exposure was eliminated) using data from various sources. Indicators for alcohol consumption were obtained from the Canadian Alcohol and Drug Use Monitoring Survey 2008 and corrected for adult per capita recorded and unrecorded alcohol consumption. Risk relations were taken from the Comparative Risk Assessment within the current Global Burden of Disease (GBD) study. Due to concerns about the reliability of information specifying causes of death for people aged 65 or older, our analysis was limited to individuals aged 0 to 64 years. Calculation of the 95% confidence intervals (CIs) for the AAFs was performed using Monte Carlo random sampling. Information on mortality was obtained from Statistics Canada. A sensitivity analysis was performed comparing the mortality results obtained using our study methods to results obtained using previous methodologies.ResultsIn 2005, 3,970 (95% CI: 810 to 7,170) deaths (4,390 caused and 420 prevented) and 134,555 (95% CI: 36,690 to 236,376) PYLLs were attributable to alcohol consumption for individuals aged 0 to 64 years. These figures represent 7.7% (95% CI: 1.6% to 13.9%) of all deaths and 8.0% (95% CI: 2.2% to 14.1%) of all PYLLs for individuals aged 0 to 64 years. The sensitivity analysis showed that the number of deaths as measured by this new methodology is greater than that if mortality was estimated using previous methodologies.ConclusionsThe mortality burden attributable to alcohol consumption for Canada is large, unnecessary, and could be substantially reduced in a short period of time if effective public health policies were implemented. A monitoring system on alcohol consumption is imperative and would greatly assist in planning and evaluating future Canadian public health policies related to alcohol consumption.

Measuring the burden of arboviral diseases: the spectrum of morbidity and mortality from four prevalent infections.

BackgroundGlobally, arthropod-borne virus infections are increasingly common causes of severe febrile disease that can progress to long-term physical or cognitive impairment or result in early death. Because of the large populations at risk, it has been suggested that these outcomes represent a substantial health deficit not captured by current global disease burden assessments.MethodsWe reviewed newly available data on disease incidence and outcomes to critically evaluate the disease burden (as measured by disability-adjusted life years, or DALYs) caused by yellow fever virus (YFV), Japanese encephalitis virus (JEV), chikungunya virus (CHIKV), and Rift Valley fever virus (RVFV). We searched available literature and official reports on these viruses combined with the terms "outbreak(s)," "complication(s)," "disability," "quality of life," "DALY," and "QALY," focusing on reports since 2000. We screened 210 published studies, with 38 selected for inclusion. Data on average incidence, duration, age at onset, mortality, and severity of acute and chronic outcomes were used to create DALY estimates for 2005, using the approach of the current Global Burden of Disease framework.ResultsGiven the limitations of available data, nondiscounted, unweighted DALYs attributable to YFV, JEV, CHIKV, and RVFV were estimated to fall between 300,000 and 5,000,000 for 2005. YFV was the most prevalent infection of the four viruses evaluated, although a higher proportion of the world's population lives in countries at risk for CHIKV and JEV. Early mortality and long-term, related chronic conditions provided the largest DALY components for each disease. The better known, short-term viral febrile syndromes caused by these viruses contributed relatively lower proportions of the overall DALY scores.ConclusionsLimitations in health systems in endemic areas undoubtedly lead to underestimation of arbovirus incidence and related complications. However, improving diagnostics and better understanding of the late secondary results of infection now give a first approximation of the current disease burden from these widespread serious infections. Arbovirus control and prevention remains a high priority, both because of the current disease burden and the significant threat of the re-emergence of these viruses among much larger groups of susceptible populations.

Unveiling the Role of Multidrug Resistance Proteins in Hypertension

Hypertension is a chronic condition associated with an increased risk of mortality and morbidity. It is estimated to cause 4.5% of current global disease burden, and its prevalence is similar in both developing and developed countries.1 According to a recent review, ≈54% of stroke, 47% of ischemic heart disease, 75% of hypertensive disease, and 25% of other cardiovascular disease worldwide can be attributable to high blood pressure.2 Altered levels of angiotensin and aldosterone are common findings in hypertension. Aldosterone has been shown to play an important role in the pathophysiology of numerous cardiovascular disorders, including heart failure and hypertension,3 and the renin-angiotensin-aldosterone system is currently an important target for 5 antihypertensive drug classes: β-blockers, renin inhibitors, angiotensin-conversion enzyme inhibitors, angiotensin receptor blockers, and aldosterone antagonists.4 In the last few years, increasing evidence has pointed to an involvement of multidrug resistance (MDR)-related proteins with hypertension. Both ABCB1 (P-glycoprotein) and ABCC1 (MDR-associated protein 1), the 2 main proteins first described in multidrug-resistant tumors, are known to physiologically transport several endobiotics, including hormones.5,6 Moreover, ABCB1 and ABCG2 (the third protein related to MDR), seem to also be related to the secretion of several drugs to urine, including some antihypertensives.7,8 This review summarizes the recent findings regarding the relationship between MDR-related proteins and hypertension. MDR is still the main cause of failure in cancer chemotherapy. Although it is a multifactorial phenomenon, virtually all MDR cells present an ATP-dependent reduction in intracellular drug accumulation because of the overexpression of ≥1 of 3 proteins belonging to the ATP-binding cassette (ABC) family of transporters.9,10 The ABC superfamily is one of the largest protein families, and its members have been found in virtually all organisms examined up to now. It is consisted of 7 subfamilies, ABCA, ABCB, ABCC, ABCD, ABCE, ABCF, …

Role of early detection and pharmacotherapy in chronic obstructive pulmonary disease

Chronic obstructive pulmonary disease (COPD) is defined as airflow limitation that is not fully reversible, usually progressive and associated with an abnormal inflammatory response to noxious particles or gases. By the time COPD has progressed to the point of clinical symptoms, over half of lung function may have been lost. This review will first describe studies that have examined the feasibility and yield of early detection of COPD using spirometry as a gold standard. Next, we will review existing studies that have examined the effects of pharmacotherapy on early (mild-to-moderate) COPD, specifically focusing on studies that have attempted to alter the natural history of disease. Finally, we will briefly discuss studies that have tested the effects of various pharmacologic interventions on biomarkers felt to be relevant to disease pathogenesis. Discovery of effective pharmacotherapy that can prevent disease progression in early-stage COPD has enormous public-health implications, given the current global burden of disease and the proportion of individuals at risk – aging current and former smokers.

Decision-Model Estimation of the Age-Specific Disability Weight for Schistosomiasis Japonica: A Systematic Review of the Literature

Schistosomiasis is among the most prevalent parasitic infections worldwide. However, current Global Burden of Disease (GBD) disability-adjusted life year estimates indicate that its population-level impact is negligible. Recent studies suggest that GBD methodologies may significantly underestimate the burden of parasitic diseases, including schistosomiasis. Furthermore, strain-specific disability weights have not been established for schistosomiasis, and the magnitude of human disease burden due to Schistosoma japonicum remains controversial. We used a decision model to quantify an alternative disability weight estimate of the burden of human disease due to S. japonicum. We reviewed S. japonicum morbidity data, and constructed decision trees for all infected persons and two age-specific strata, <15 years (y) and ≥15 y. We conducted stochastic and probabilistic sensitivity analyses for each model. Infection with S. japonicum was associated with an average disability weight of 0.132, with age-specific disability weights of 0.098 (<15 y) and 0.186 (≥15 y). Re-estimated disability weights were seven to 46 times greater than current GBD measures; no simulations produced disability weight estimates lower than 0.009. Nutritional morbidities had the greatest contribution to the S. japonicum disability weight in the <15 y model, whereas major organ pathologies were the most critical variables in the older age group. GBD disability weights for schistosomiasis urgently need to be revised, and species-specific disability weights should be established. Even a marginal increase in current estimates would result in a substantial rise in the estimated global burden of schistosomiasis, and have considerable implications for public health prioritization and resource allocation for schistosomiasis research, monitoring, and control.

“The Right Stuff”: The Global Burden of Disease

PLoS Medicine is one of the few journals with a dedicated forum for neglected diseases, and the suggestion by its editors that journals should give preference to diseases based on their relative contributions to the global burden of disease is noteworthy as a positive step towards optimising the global research agenda [1]. Undoubtedly, the recent report by Mathers and Loncar, like earlier versions of the Global Burden of Disease (GBD) study, represents the best effort yet at providing a level playing field for diverse diseases and health conditions globally [2]. A key feature of this project is the evaluation of health outcomes in terms of mortality and burden of disease indexed by disability-adjusted life years (DALYs). However, a few concerns still linger on the application and current scope of the study which have significant implications for health-care policy, particularly in the developing world. The concept of the “burden of disease” was introduced to redress the inequality and inequity occasioned by the exclusive use of mortality as the summary measure of population health [3,4]. The DALY was thus intended to provide information on non-fatal health outcomes of diseases that have been largely neglected in health planning because of the “conceptual and definitional complexity of measuring morbidity and disability in populations” [5]. However, it is uncertain how far the well-intentioned paradigm shift in disease evaluation has been achieved, as global health initiatives are still rarely concerned with reduction in “burden of disease” besides mortality. This is also applicable to health planning at country or community level. In fact, the significance of noncommunicable/chronic health conditions such as cardiovascular diseases, cancer, diabetes, and mental illness is still being predominantly promoted on the basis of case fatality rather than disease burden. Conceptually, DALY and its variants like quality-adjusted life years (QALYs) represent equitable measures of population health that should be more actively promoted, but more work is required to address some of the methodological and equity concerns that have been raised since their introduction to global health [6,7]. The continued ranking of childhood diseases alongside adult diseases in the GBD report often portrays children as “young adults”. This practice distracts from diseases and conditions that have significant impacts on optimal early childhood development. Moreover, the risk of death for children younger than five years is projected to fall by more than 40% between 2005 and 2030, while life expectancy globally is expected to improve significantly by 2030, with the largest increases occurring in Africa and South Asia [1]. This trend is likely to bring to the fore the neglected discourse on the quality of life for the many survivors of acute childhood illnesses, particularly as the years lived with disability for chronic diseases of childhood onset far exceed those of adult onset. For instance, it is difficult to justify the continued failure to address a highly preventable perinatal condition such as neonatal jaundice, which may not be a leading cause of mortality but currently causes substantial burden in low-income countries [8]. Similarly, hearing loss of adult onset remains one of the ten leading causes of DALYs globally, particularly in high-income and middle-income countries, but is not expected to be a leading health problem in low-income countries by 2030 [1]. While this is gratifying to note, the current trend in the prevalence of disabling hearing loss (which more than doubled from 120 million in 1995 to about 278 million persons in 2005, two-thirds of whom reside in developing countries) may have much greater impact than projected, considering the envisaged improvement in life expectancy [9]. But more importantly, the exclusion of hearing loss of childhood onset or the failure to adequately account for permanent childhood hearing loss in these projections underrepresents the true burden of hearing loss. It disfranchises about 718,000 babies born annually in the developing world with neonatal hearing loss from available time-bound early detection and intervention services now a standard of neonatal care in developed countries [10]. The call by Mathers and Loncar for more robust studies across the regions of the world must not be overlooked or considered lightly. As new evidence emerges from such studies, the projected trend and ranking in many countries may ultimately differ from the overall global and regional picture in the current GBD report. Meanwhile, systematic steps to address these and other concerns should be considered urgently to effectively promote the concept of the burden of disease. Invariably, we all need to be guided by a variety of sources and perspectives in determining “the right stuff” for the heterogeneous populations of the world.