Disability-adjusted Life Expectancy Research Articles

Trends and distribution patterns of infant mortality and maternal HIV positivity in South Africa: A decade review (2007 - 2016).

The infant mortality rate (IMR) (24 per 1 000 live births) remains high in South Africa (SA), well above the recommended sustainable development goal (SDG) 3 of 12 deaths per 1 000 live births. High infant mortality is a poor indicator of the health of a population and will hamper attainment of the SDGs. To investigate the trends and distribution patterns of IMR between 2007 and 2016 and its association with HIV-positive pregnant mothers in SA. This study used a cross-sectional study design by analysing secondary data on infant mortality from the 2007 and 2016 Statistics South Africa Community Surveys (CSs), as well as data from the 2007 National Antenatal Sentinel HIV and Syphilis Prevalence Survey. (Antenatal HIV Sentinel Survey - ANCHSS). Line charts with descriptive statistics were used to detail trends in IMRs, and multiple logistic regression models were used to identify risk factors for infant mortality in the 2007 and 2016 CS datasets. Spearman's rank-order correlation (rho) was used to correlate infant mortality with data from the 2007 ANCHSS. All analyses were performed with Stata version 16.0. A total sample of 87 805, comprising 43 922 males and 43 883 females, was included in the analysis. The results revealed a decline in IMR from 55 deaths per 1 000 live births in 2007 to 32 in 2016. Overall, there was a significant decrease in the mortality rate from 2007 to 2016. The infant mortality proportions by province showed KwaZulu-Natal Province having the highest IMR (17.5 deaths per 1 000 live births in 2007 and 6.3 in 2016). Males had a higher IMR (28 deaths per 1 000 live births in 2007 and 17.7 in 2016) compared with females at 26.7 deaths per 1 000 live births in 2007 and 13.8 in 2016. IMR data from the 2007 CS was correlated with the 2007 ANCHSS (28% HIV prevalence in 2007), using Spearman's rank-order correlation, which showed a moderate correlation of 0.58 (p<0.001). The study findings showed a reduction in the trends of infant mortality between 2007 and 2016 in SA; despite the reduction, health inequalities persist. There is a correlation evident between maternal HIV prevalence and IMR in SA. We recommend the use of disability-adjusted life expectancy in SA to measure population health and introduce robust data sets that can better inform policy.

Environmental sustainability and health outcomes: Do ICT diffusion and technological innovation matter?

This research aims to determine the nexus between environmental sustainability, proxied by environmental performance index, and human health outcomes, particularly disability-adjusted life-year and life expectancy, in the presence of policy variables, namely information and communication technology (ICT) as well as technological innovation (TI) in Saudi Arabia for an annual period spanning from 2000 to 2020. We used the DOLS estimator to solve the issues of serial correlation and endogeneity that were present in the model. The findings indicate that the influence of environmental performance on human health outcomes is improved with the existence of good and sophisticated technologies. We find that over the long term, the parameters of the interaction terms between environmental performance and all dimensions of technological indicators are negative (positive) and statistically relevant for the disability-adjusted life-year (life expectancy) specification. Policymakers in Saudi Arabian economy should therefore include the use of technological indicators in the already established programs and policies to maximize their positive impacts on health outcomes.

Disability-Adjusted Life Expectancy and Cognitive Function among Community-Dwelling Adults.

We aimed to calculate disability-adjusted life expectancy (DALE) for Korean older adults based on their sex, educational attainment, and residential region across their cognitive status. We included 3,854 participants (aged 65-91years) from the Korean Longitudinal Study of Aging's seventh survey data. The participant's cognitive function status (normal, moderately impaired, or severely impaired) was determined based on cognitive examination and physical function independence, which was used to calculate their DALE. Females with normal cognition had higher DALE (7.60years, Standard Deviation (SD) = 3.88) than males (6.76, SD = 3.40); however, both sexes had comparable DALE for cognitive impairment. In contrast, the DALE values increased with higher educational achievements. Regarding residential areas, the DALE value for participants with normal cognition and moderate impairment was the highest among urban dwellers, while DALE for participants with severely impaired cognitive function was highest among rural dwellers; however, there were no statistically significant differences based on residential conditions. Our findings suggest that demographic characteristics should be considered when developing health policies and treatment strategies to meet the needs of the aging population in Korea.

The changing health convergence for life expectancy and spatial interactions

ABSTRACT Spatial interactions are important to consider issues like health convergence between the European Union countries and Spanish provinces. Health status is measured by a combination of objective health outcome indicators, such as life expectancy: at birth, at age 65, disability-adjusted life expectancy and healthy life expectancy based on self-perceived health. The period analysed differs from one indicator to another considering 1998–2018. There are two forms of convergence: σ-convergence and absolute β-convergence. Furthermore, the Moran Test is performed to disentangle the degree of spatial dependencies and two models of spatial regression are used to include these dependencies in the absolute β-convergence estimation. Our findings suggest that there is a convergence process among European Union countries and the Spanish provinces. On the other hand, β-convergence is higher in women among European countries and in men for Spanish provinces. Nevertheless, the rise of the dispersion means that there is not clear evidence about trends in the period considered. There are two contributions in our research: to achieve an updated vision of health convergence and to incorporate spatial econometrics in Health Economics research. These insights can help to reduce health inequalities.

Well-Being Adjusted Health Expectancy: A New Summary Measure of Population Health

We propose a new summary measure of population health (SMPH), the well-being-adjusted health expectancy (WAHE). WAHE belongs to a subgroup of health-adjusted life expectancy indicators and gives the number of life years equivalent to full health. WAHE combines health and mortality information into a single indicator with weights that quantify the reduction in well-being associated with decreased health. WAHE's advantage over other SMPHs lies in its ability to differentiate between the consequences of health limitations at various levels of severity and its transparent, simple valuation function. Following the guidelines of a Committee on Summary Measures of Population Health, we discuss WAHE's validity, universality, feasibility sensitivity and ensure its reproducibility. We evaluate WAHE's performance compared to life expectancy, the most commonly used indicators of health expectancy (HE) and disability-adjusted life expectancy (DALE) in an empirical application for 29 European countries. Data on health and well-being are taken from the 2018 EU-SILC, and the life tables are from Eurostat. DALE is taken from the database of the Global Burden of Disease Programme. WAHE's sensitivity to univariate and multivariate state specifications is studied using the three Minimum European Health Module health dimensions: chronic morbidity, limitations in activities of daily living, and self-rated health. The empirical tests of the indicators’ correspondence reveal that WAHE has the strongest correlation with the other SMPHs. Moreover, WAHE estimates are in agreement with all other SMPHs. Additionally, WAHE and all other SMPHs form a group of reliable indicators for studying population health in European countries. Finally, WAHE estimates are robust, regardless of whether health is defined across one or multiple simultaneous dimensions of health. We conclude that WAHE is a useful and reliable indicator of population health and performs at least as well as other commonly used SMPHs.

A Review of the Types and Characteristics of Healthy Life Expectancy and Methodological Issues.

An index that evaluates the health level of a population group considering both death and loss of function due to disease is called a summary measure of population health (SMPH). SMPHs are broadly divided into life year indices and life expectancy indices, the latter of which comprise healthy life expectancy (HLE). HLE is included as a policy target in various national and regional level healthcare plans, and the term “HLE” is commonly used in academia and by the public. However, the overall level of understanding of HLE—such as the precise definition of HLE and methods of calculating HLE—still seems to be low. As discussed in this study, the types of HLE are classified into disability-free life expectancy, disease-free life expectancy, quality-adjusted life expectancy, self-rated HLE, and disability-adjusted life expectancy. Their characteristics are examined to facilitate a correct understanding and appropriate utilization of HLE. In addition, the Sullivan method, as a representative method for calculating HLE, is presented in detail, and major issues in the process of calculating HLE, such as selection of the population group and age group, estimation of death probability, calculation of life years, and incorporation of health weights, are reviewed. This study will help researchers to select an appropriate HLE type and evaluate the validity of HLE research results, and it is expected to contribute to the vitalization of HLE research.

Sex Differences in the Association Between Obesity and Hypertension: A Systematic Review

Introduction: Obesity is associated with multiple health-related complications, which together can decrease quality of life, disability-adjusted life years and life expectancy.1 Systematic reviews and meta-analyses have demonstrated that sex can influence the association between obesity and health complications, such as rheumatoid arthritis and many types of cancer.2-4 However, no systematic review or meta-analysis has been conducted to review the effect of sex on the association between obesity and hypertension, thus far. Knowing whether or not sex influences this relationship can help tailor the prevention, prediction, and care of this condition towards each sex. Objectives: To evaluate current studies on the association between sex, obesity, and hypertension, so as to obtain an overall estimate of the effect of sex on the prevalence of hypertension in obese individuals. Methods: A systematic search of EMBASE, MEDLINE, and PubMed was conducted. Search terms, such as “obesity,” “sex differences,” and “hypertension,” were used to filter results. After reviewing 406 articles, eight articles were included. Results: Four articles showed that obese women were at a greater risk of developing hypertension than obese men.5-8 Conversely, the results of two studies found that obese men are at a greater risk of developing hypertension.9,10 The remaining two studies showed that the difference between the sexes was insignificant.11,12 Discussion/Limitations: Stronger evidence shows that obese women are at a greater risk of developing hypertension than obese men. The two studies that had contradictory conclusions had small sample sizes relative to the other studies. Additionally, the two studies that concluded that both sexes are at a similar risk highlighted that most other studies have determined that obese women are at a greater risk and that their limitations may have caused this discrepancy. Limitations of this review include the limited ethnicity of participants and the use of BMI to classify obesity, which can sometimes lead to misclassification due to varying muscle to fat ratios. These factors limit the generalizability of the results. Conclusion: Obese women are seemingly at a greater risk of developing hypertension than obese men. However, this conclusion remains statistically inconclusive. Therefore, it would be beneficial to complete a meta-analysis in order to conclusively determine which sex is statistically more at risk of developing hypertension, when obese.

A Unified Probabilistic Framework for Cancer Risk Management.

Cancer risk assessments in the regulatory realm are often deterministic. Probabilistic approaches that allow characterizing and propagating uncertainty and variability are better suited to predict the socioeconomic impacts of regulating carcinogens. In this article, I present a unified framework for cancer risk management consisting of (i) a probabilistic exposure model that takes into account variability in individual exposure to the substance of concern; (ii) a probabilistic dose-response model that accounts for differences in individual cancer susceptibility; (iii) an impact assessment model that quantifies individuals' excess lifetime cancer risk; and (iv) a welfare model that values changes in disability-adjusted life expectancy based on workers' willingness-to-pay and aggregates individual valuations across the population at risk. I illustrate the framework with data on occupational exposure to hexavalent chromium in France. In a cohort of 10,000 synthetic workers, about one third of the exposed benefit from the introduction of a binding occupational exposure limit (BOEL). Limiting hexavalent chromium exposure to the BOEL reduces the statistical worker's excess lifetime risk of fatal and nonfatal lung cancer by 4.7E-3 and 1.5E-3, respectively. At cohort level, the risk reduction corresponds to 738.4 full and 30.7 disability-adjusted life years saved. The expected welfare gain of introducing the BOEL is close to €30 million. A major advantage of the framework is its ability to visualize uncertainty and variability inherent to cancer risk assessment. Notwithstanding some implementation challenges, the framework provides a transparent characterization of regulatory impacts that supports informed risk management decisions.

Disability-adjusted life expectancy lost due to pain severity and usual analgesic treatment among older adults with osteoarthritis in Spain.

Osteoarthritis (OA) is a seriously debilitating disease, which prevalence is growing in aging population becoming a substantial burden (BoD) to society. To assess disability-adjusted life expectancy (DALE) lost by pain severity and usual analgesic treatment among OA adults 65 + year in Spain. The National Health Survey, a large, nationally representative, cross-sectional general health survey administered to 23,089 individuals was the data source. Data on subjects of 65 + years with a self-reported physician diagnosis of OA were analysed. Records were cross-classified by pain severity (no pain/mild pain, moderate pain and severe pain) and use of usual analgesics. DALE lost was used as a summary measure of BoD and expressed as both number of years of healthy life-expectancy lost due to disability and percentage of life-expectancy lost. 3389 records were analysed [women 73.3%; age 77.4 (SD 7.5) years]. Older OA patients showed a mean (95% CI) DALE loss of 3.5 (3.3-3.7) years, that represented on average a loss of 35.6% (33.8-37.4) as a percentage of life expectancy. Higher pain severity and analgesic treatment was statistically linked to more years of DALE lost; from 2.8 (2.3-3.2), in no/mild, to 9.0 (8.6-9.4) years in severe pain, and from 32.2% (27.5-36.9) to 90.9% (86.5-95.3) of life expectancy, respectively. In Spain, older adults with moderate to severe OA pain receiving usual analgesics showed a substantial BoD in terms of years of DALE lost and percentage of life expectancy lost. Patients with treated moderate to severe pain showed a more significant burden in term of DALE lost despite analgesic treatment, which apparently fails to meet pain management needs.

Ranked Performance of Canada's Health System on the International Stage: A Scoping Review.

Introduction:Since the release of the World Health Report in 2000, health system performance ranking studies have garnered significant health policy attention. However, this literature has produced variable results. The objective of this study was to synthesize the research and analyze the ranked performance of Canada's health system on the international stage.Method:We conducted a scoping review exploring Canada's place in ranked health system performance among its peer Organisation for Economic Co-operation and Development countries. Arksey and O'Malley's five-stage scoping review framework was adopted, yielding 48 academic and grey literature articles. A literature extraction tool was developed to gather information on themes that emerged from the literature.Synthesis:Although various methodologies were used to rank health system performance internationally, results generally suggested that Canada has been a middle-of-the-pack performer in overall health system performance for the last 15 years. Canada's overall rankings were 7/191, 11/24, 10/11, 10/17, “Promising” and “B” grade across different studies. According to past literature, Canada performed well in areas of efficiency, productivity, attaining health system goals, years of life lived with disability and stroke mortality. By contrast, Canada performed poorly in areas related to disability-adjusted life expectancy, potential years of life lost, obesity in adults and children, diabetes, female lung cancer and infant mortality.Conclusion:As countries introduce health system reforms aimed at improving the health of populations, international comparisons are useful to inform cross-country learning in health and social policy. While ranking systems do have shortcomings, they can serve to shine a spotlight on Canada's health system strengths and weaknesses to better inform the health policy agenda.

Enfermedades crónicas y factores de riesgo en adultos mayores de Argentina: años 2001 - 2009

RESUMEN El presente documento evalúa el impacto de las enfermedades crónicas prevalentes en la población mayor de 65 años en Argentina en el período 2001 - 009, a través del método de la Esperanza de Vida Ajustada por Discapacidad. Complementariamente, se describe la prevalencia de estas enfermedades en el país en el mismo período de tiempo, así como de los factores de riesgo asociadas a ellas. Se evidencia un aumento de la prevalencia de enfermedades crónicas no transmisibles, como son la hipertensión arterial y la diabetes, entre otras, pero también un progreso en la calidad de vida de las personas afectadas por estas enfermedades, que mejoraría a medida que envejece la población.

Application of different death evaluation indicators for HIV/AIDS prevention and treatment

AIDS has gradually changed from a fatal disease to a manageable chronic disease since the advent of antiretroviral drugs. In 2003, China initiated a national free antiretroviral treatment program for people living with HIV/AIDS, several death evaluation indicators have been used to evaluate public health effect of the program. Death evaluation indicators used frequently in domestic and overseas include mortality, case fatality rate, excess mortality, standard mortality ratio, years of potential life lost, disability-adjusted life year and life expectancy. This paper summarizes the different death indicators applied in effectiveness evaluation of HIV/AIDS prevention and treatment, elaborates the application range and significance of these indicators and suggests the research in related life expectancy and burden of disease which have not been conducted in China.

Evaluating causes of death and morbidity in Iran, global burden of diseases, injuries, and risk factors study 2010.

we aimed to recap and highlight the major results of the Global Burden of Diseases, Injuries, and Risk Factors Study 2010 by mortality and morbidity to clarify the current health priorities and challenges in Iran. We estimated Iran's mortality and burden of 289 diseases with 67 risk factors and 1160 sequelae, which were used to clinically present each disease and its disability or cause of death. We produced several measures to report health loss and status: all-cause mortality, cause-specific mortality, years of life lost due to death (YLL), healthy years of life lost due to disability (YLD), disability-adjusted life years (DALYs), life expectancy, and healthy life expectancy, for three time periods: 1990, 2005, and 2010. We found out that life expectancy at birth was 71.6 years in men and 77.8 years in women. Almost 350 thousand deaths occurred in both sexes and all age groups in 2010. In both males and females and all age groups, ischemic heart disease was the main cause of death, claiming about 90 thousand lives. The main contributors to DALYs were: ischemic heart disease (9.1%), low back pain (9.0%), road injuries (7.3%), and unipolar depressive disorders (6.3%). The main causes of death under 5 years of age included: congenital anomalies (22.4%), preterm birth complications (18.3%), and other neonatal disorders (13.5%). The main causes of death among 15 - 49 year olds in both sexes included: injuries (23.6%) and ischemic heart disease (12.7%) The highest rates of YLDs were observed among 70+ year olds for both sexes (27,365 per 100,000), mainly due to low back pain, osteoarthritis, diabetes, falls, and major depressive disorder. The main risk factors to which deaths were attributable among children under 5 years included: suboptimal breast feeding, ambient PM pollution, tobacco smoking, and underweight. The most important risk factors among 15 to 49 year olds were: dietary risks, high blood pressure, high body mass index, physical inactivity, smoking, and ambient PM pollution. The pattern was similar among 50+ year olds. Although non-communicable diseases had the greatest burden in 2010, the challenge of communicable and maternal diseases for health system is not over yet. Diet and physiological risk factors appear to be the most important targets for public health policy in Iran. Moreover, Iranians would greatly benefit from effective strategies to prevent injury and musculoskeletal disorders and expand mental care. Persistent improvement is possible by strengthening the health information system to monitor the population health and evaluate current programs.

A Structural Model of Health-Related Quality of Life in Parkinson’s Disease Patients

Disability-adjusted life expectancy is focused on more than just extending life span; thus, health-related quality of life (HRQOL) has emerged as an important issue for elderly patients with chronic disease. The number of patients with Parkinson's disease (PD) is predicted to grow along with the aging population, so it is essential to identify the predictors of HRQOL. This study utilized structural equation modeling (SEM) to predict the HRQOL of patients with PD. Participants (N = 217) were patients diagnosed with PD (M age = 66.01). Demographic and disease-related characteristics, sleep quality, pain, depression, and HRQOL were investigated via a structured questionnaire. Participants' functional factors were measured using physical function evaluations. The hypothetical model verified disease-related factors, depression, and pain as direct factors that significantly predicted HRQOL of patients with PD (Goodness of Fit Index = 0.93 and Comparative Fit Index = 0.96). These findings are useful for developing comprehensive interventions to improve the HRQOL of patients with PD.

Impact of road traffic injuries on disability rates and long-term care costs in Spain

Road traffic injuries are one of the leading causes of increasing disability-adjusted life expectancy. We analyze long-term care needs associated with motor vehicle crash-related disability in Spain and conclude that needs attributable traffic injuries are most prevalent during victims’ mid-life years, they create a significant burden for both families and society as a whole given that public welfare programmes supporting these victims need to be maintained over a long time frame. High socio-economic costs of road traffic accidents (in Spain 0.04% of the GDP in 2008) are clearly indicative of the need for governments and policymakers to strengthen road accident preventive measures.

Urban greenways have the potential to increase physical activity levels cost-effectively

For many, physical activity has been engineered out of daily life, leading to high levels of sedentariness and obesity. Multi-faceted physical activity interventions, combining individual, community and environmental approaches, have the greatest potential to improve public health, but few have been evaluated. Approximately 100,000 people may benefit from improved opportunities for physical activity through an urban regeneration project in Northern Ireland, the Connswater Community Greenway. Using the macro-simulation PREVENT model, we estimated its potential health impacts and cost-effectiveness. To do so, we modelled its potential impact on the burden from cardiovascular disease, namely, ischaemic heart disease, type 2 diabetes mellitus and stroke, and colon and breast cancer, by the year 2050, if feasible increases in physical activity were to be achieved. If 10% of those classified as 'inactive' (perform less than 150 minutes of moderate activity/week) became 'active', 886 incident cases (1.2%) and 75 deaths (0.9%) could be prevented with an incremental cost-effectiveness ratio of £4469/disability-adjusted life year. For effectiveness estimates as low as 2%, the intervention would remain cost-effective (£18 411/disability-adjusted life year). Small gains in average life expectancy and disability-adjusted life expectancy could be achieved, and the Greenway population would benefit from 46 less years lived with disability. The Greenway intervention could be cost-effective at improving physical activity levels. Although the direct health gains are predicted to be small for any individual, summed over an entire population, they are substantial. In addition, the Greenway is likely to have much wider benefits beyond health.

Potential Cost-Effectiveness of Universal Access to Modern Contraceptives in Uganda

BackgroundOver two thirds of women who need contraception in Uganda lack access to modern effective methods. This study was conducted to estimate the potential cost-effectiveness of achieving universal access to modern contraceptives in Uganda by implementing a hypothetical new contraceptive program (NCP) from both societal and governmental (Ministry of Health (MoH)) perspectives.Methodology/Principal FindingsA Markov model was developed to compare the NCP to the status quo or current contraceptive program (CCP). The model followed a hypothetical cohort of 15-year old girls over a lifetime horizon. Data were obtained from the Uganda National Demographic and Health Survey and from published and unpublished sources. Costs, life expectancy, disability-adjusted life expectancy, pregnancies, fertility and incremental cost-effectiveness measured as cost per life-year (LY) gained, cost per disability-adjusted life-year (DALY) averted, cost per pregnancy averted and cost per unit of fertility reduction were calculated. Univariate and probabilistic sensitivity analyses were performed to examine the robustness of results. Mean discounted life expectancy and disability-adjusted life expectancy (DALE) were higher under the NCP vs. CCP (28.74 vs. 28.65 years and 27.38 vs. 27.01 respectively). Mean pregnancies and live births per woman were lower under the NCP (9.51 vs. 7.90 and 6.92 vs. 5.79 respectively). Mean lifetime societal costs per woman were lower for the NCP from the societal perspective ($1,949 vs. $1,987) and the MoH perspective ($636 vs. $685). In the incremental analysis, the NCP dominated the CCP, i.e. it was both less costly and more effective. The results were robust to univariate and probabilistic sensitivity analysis.Conclusion/SignificanceUniversal access to modern contraceptives in Uganda appears to be highly cost-effective. Increasing contraceptive coverage should be considered among Uganda's public health priorities.

Multiple Risk Factor Intervention to Prevent Cardiovascular Disease. A High Powered and Evidence Based Approach

On a worldwide scale cardiovascular disease is estimated to be the leading cause of death and loss of disability-adjusted life expectancy in the next decade. The INTERHEART study has demonstrated that classic risk factors such as abnormal lipids, smoking, hypertension, lack of regular physical activity, diabetes, abdominal obesity, psychosocial factors, excessive alcohol consumption, and inadequate intake of fruits and vegetables, account for most of the risk of myocardial infarction worldwide in both sexes and at all ages in all regions. In total, risk factors accounted for 90% of the observed risk in men and 94% in women in this large case-control study of acute myocardial infarction in 52 countries, suggesting that approaches to prevention have the potential to prevent most premature cases of myocardial infarction. In secondary prevention of cardiovascular disease, numerous clinical trials have tested the effects of single risk factor intervention in both myocardial infarction and stroke, leading to several sets of guidelines on both national and international levels. With this abundance of knowledge, the obvious question is: why does cardiovascular disease still account for around half of deaths in subjects below the age of 70 years? Much of the gap between recommended and actual levels of chronic disease care is attributable to medication nonadherence. The importance of this factor has been clearly demonstrated in a recent United States trial in myocardial infarction. In a prospective registry of 1521 patients admitted with a myocardial infarction and discharged with treatment with acetylsalicylic acid, beta-blockers and statins, 184 discontinued use of all 3 medications, 56 discontinued use of 2 medications, 272 discontinued use of 1 medication, and 1009 continued taking all 3 medications at 1 month. The consequences of discontinuing treatment were devastating. Patients who discontinued use of all medications at 1 month had lower 1-year survival (88.5% vs. 97.7%, P < .001) compared with patients who continued to take 1 or more of the medications.

Burden of disability in a Chandigarh village

Life expectancy has increased substantially in last 50 years all over the world. The pattern of disease is also shifting from acute communicable to chronic non-communicable ones. Such diseases lead to a lot of disability. More and more people with disability continue to survive as compared to previous times. Because of such a scenario, new indicators of health have been developed viz disability adjusted life expectancy (DALE) rather than traditional life expectancy. The focus is on quality of life i.e. how much of life is lived without any disability. Ten percent of the world population suffers from various disabilities (WHO).(1) In India, however, varying prevalence (1-4%)(2) has been reported. But there is lack of data on how disability affects the concerned families. Against this background, the present study was planned with an objective to ascertain the pattern and extent of disability in a Chandigarh village and to ascertain the response of affected families to such disability.

Muerte prematura y discapacidad en los derechohabientes del Instituto Mexicano del Seguro Social

To carry out estimations of the burden of disease for 129 causes in order to identify health priorities in the different geographic regions of the country and to present comparative data between 1995 and 2000. Indicators such as disability-adjusted life years (DALYs) and disability adjusted life expectancy (DALE) were analyzed for the population covered by IMSS in 1995 and 2000; for both years, the methodology proposed by the Burden of Disease Worldwide Study was applied. Data corresponding to 1995 were analyzed in 1997, while data corresponding to 2000 were analyzed in 2001. The comparative study was carried out in 2006 by IMSS, Mexico. The higher proportion of DALYs was due to chronic diseases, although the 2000 rate is 1.5 times higher than that of 1995. Priorities that were identified were diabetes mellitus, ischemic cardiopathy, and cerebrovascular disease, with a loss that is mainly accounted for by premature death, as well as by diseases related to disability with an important burden of disease, such as AIDS or depression. Epidemiological backlogs can still be observed. The population covered by IMSS is still in a phase of epidemiologic transition, favoring polarization in health conditions. Health policies need to be directed toward bringing about an improved response and reversing the trend in diseases that represent an institutional risk for the financing of health care.