Estimates Of Disability-adjusted Life-years Research Articles

Measuring the global burden of chikungunya and Zika viruses: A systematic review.

Throughout the last decade, chikungunya virus (CHIKV) and Zika virus (ZIKV) infections have spread globally, causing a spectrum of disease that ranges from self-limited febrile illness to permanent severe disability, congenital anomalies, and early death. Nevertheless, estimates of their aggregate health impact are absent from the literature and are currently omitted from the Global Burden of Disease (GBD) reports. We systematically reviewed published literature and surveillance records to evaluate the global burden caused by CHIKV and ZIKV between 2010 and 2019, to calculate estimates of their disability-adjusted life year (DALY) impact. Extracted data on acute, chronic, and perinatal outcomes were used to create annualized DALY estimates, following techniques outlined in the GBD framework. This study is registered with PROSPERO (CRD42020192502). Of 7,877 studies identified, 916 were screened in detail, and 21 were selected for inclusion. Available data indicate that CHIKV and ZIKV caused the average yearly loss of over 106,000 and 44,000 DALYs, respectively, between 2010 and 2019. Both viruses caused substantially more burden in the Americas than in any other World Health Organization (WHO) region. This unequal distribution is likely due to a combination of limited active surveillance reporting in other regions and the lack of immunity that left the previously unexposed populations of the Americas susceptible to severe outbreaks during the last decade. Long-term rheumatic sequelae provided the largest DALY component for CHIKV, whereas congenital Zika syndrome (CZS) contributed most significantly for ZIKV. Acute symptoms and early mortality accounted for relatively less of the overall burden. Suboptimal reporting and inconsistent diagnostics limit precision when determining arbovirus incidence and frequency of complications. Despite these limitations, it is clear from our assessment that CHIKV and ZIKV represent a significant cause of morbidity that is not included in current disease burden reports. These results suggest that transmission-blocking strategies, including vector control and vaccine development, remain crucial priorities in reducing global disease burden through prevention of potentially devastating arboviral outbreaks.

Estimating the disease burden of Korean type 2 diabetes mellitus patients considering its complications.

The burden of diabetes is considerable not only globally but also nationally within Korea. The Global Burden of Disease study derived the disability-adjusted life years (DALYs) of diabetes depending on its complications as individual severity using prevalence-based approach from 2017. Conversely, the Korean National Burden of Disease study based on an incidence-based approach does not incorporate the severity of diseases. This study aimed to simulate incidence-based DALYs of type 2 diabetes mellitus (T2DM), given diabetic complications as disease severity using a Markov model. We developed a model with six Markov states, including incident and existing prevalent cases of diabetes and its complications and death. We assumed that diabetes and its complications would not be cured. The cycle length was one year, and the endpoint of the simulation was 100 years. A 5% discount rate was adopted in the analysis. Transition cases were counted by 5-year age groups above 30 years of age. Age- and sex-specific transition probabilities were calculated based on the incident rate. The total DALY estimates of T2DM were 5,417 and 3,934 per 100,000 population in men and women, respectively. The years of life lost in men were relatively higher than those in women in most age groups except the 80-84 age group. The distribution of years lived with disability by gender and age group showed a bell shape, peaking in the 55-59 age group in men and 65-69 age group in women. The burden of T2DM considering its complications was larger compared to the outcomes from previous studies, with more precise morbid duration using the Markov model.

Estimation of Disability-Adjusted Life Years among Patients Presenting with End-Stage Liver Disease

Introduction: Disability-adjusted life years (DALYs) is a multidimensional metric utilized to quantify specific disease burdens. It has the potential to highlight both fatal and non-fatal outcomes of disease and thus help in policymaking and health resource allocation. Chronic liver disease, secondary to preventable causes, is one of the main contributors to morbidity and mortality. It demands the attention of researchers and policymakers alike. The primary aim of this study was to quantify the disease burden due to end-stage liver disease in terms of years of life lost (YLL), years lost to disability (YLD), and DALYs.

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.

The burden of legionnaires\u2019 disease in Belgium, 2013 to 2017

BackgroundLegionnaires’ disease (LD) is a severe bacterial infection causing pneumonia. Surveillance commonly underestimates the true incidence as not all cases are laboratory confirmed and reported to public health authorities. The aim of this study was to present indicators for the impact of LD in Belgium between 2013 and 2017 and to estimate its true burden in the Belgian population in 2017, the most recent year for which the necessary data were available.MethodsBelgian hospital discharge data, data from three infectious disease surveillance systems (mandatory notification, sentinel laboratories and the national reference center), information on reimbursed diagnostic tests from the Belgian National Institute for Health and Disability Insurance and mortality data from the Belgian statistical office were used. To arrive at an estimate of the total number of symptomatic cases in Belgium, we defined a surveillance pyramid and estimated a multiplication factor to account for LD cases not captured by surveillance. The multiplication factor was then applied to the pooled number of LD cases reported by the three surveillance systems. This estimate was the basis for our hazard- and incidence-based Disability-Adjusted Life Years (DALYs) calculation. To account for uncertainty in the estimations of the DALYs and the true incidence, we used Monte Carlo simulations with 10,000 iterations.ResultsWe found an average of 184 LD cases reported by Belgian hospitals annually (2013–2017), the majority of which were male (72%). The surveillance databases reported 215 LD cases per year on average, 11% of which were fatal within 90 days after diagnosis. The estimation of the true incidence in the community yielded 2674 (95% Uncertainty Interval [UI]: 2425–2965) cases in 2017. LD caused 3.05 DALYs per case (95%UI: 1.67–4.65) and 8147 (95%UI: 4453–12,426) total DALYs in Belgium in 2017, which corresponds to 71.96 (95%UI: 39.33–109.75) DALYs per 100,000 persons.ConclusionsThis analysis revealed a considerable burden of LD in Belgium that is vastly underestimated by surveillance data. Comparison with other European DALY estimates underlines the impact of the used data sources and methodological approaches on burden estimates, illustrating that national burden of disease studies remain essential.

Dutch DALYs, current and future burden of disease in the Netherlands

BackgroundThe Disability Adjusted Life Year (DALY) is a measure to prioritize in the public health field. In the Netherlands, the DALY estimates are calculated since 1997 and are included in the Public Health Status and Foresight studies which is an input for public health priority setting and policy making. Over these 20 years, methodological advancements have been made, including accounting for multimorbidity and performing projections for DALYs into the future. Most important methodological choices and improvements are described and results are presented.MethodsThe DALY is composed of the two components years of life lost (YLL) due to premature mortality and years lost due to disability (YLD). Both the YLL and the YLD are distinguished by sex, age and health condition, allowing aggregation to the ICD-10 chapters. The YLD is corrected for multimorbidity, assuming independent occurrence of health conditions and a multiplicative method for the calculation of combined disability weights. Future DALYs are calculated based on projections for causes of death, and prevalence and incidence.ResultsThe results for 2015 show that cancer is the ICD-10 chapter with the highest disease burden, followed by cardiovascular diseases and mental disorders. For the individual health conditions, coronary heart disease had the highest disease burden in 2015. In 2040, we see a strong increase in disease burden of dementia and arthrosis. For dementia this is due to a threefold increase in dementia as a cause of death, while for arthrosis this is mainly due to the increase in prevalence.ConclusionsTo calculate the DALY requires a substantial amount of data, methodological choices, interpretation and presentation of results, and the personnel capacity to carry out all these tasks. However, doing a National Burden of Disease study, and especially doing that for more than 20 years, proved to have an enormous additional value in population health information and thus supports better public health policies.

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 foodborne disease in the Netherlands: from science to policy

Abstract In the Netherlands, the Ministry of Health mandates the National Institute for Public Health and the Environment (RIVM) to provide annual updates of the number of illnesses, disease burden and cost-of-illness caused by an agreed-upon standard panel of 14 enteric pathogens. These pathogens are mainly transmitted by food, but also via direct contact with animals, environment-mediated and human-to-human transmission routes. The disease burden is expressed in DALYs (Disability Adjusted Life Years), a metric integrating morbidity and mortality into one unit. Furthermore, the cost-of-illness (COI) related to these 14 pathogens is estimated and expressed in euros. The COI estimates include healthcare costs, the costs for the patient and/or his family, such as travel expenses, as well as costs in other sectors, for example due to productivity losses. Moreover, using different approaches to source attribution, the estimated DALYs and associated COI estimates are attributed to five major transmission pathways (i.e. food, environment, direct animal contact, human-human transmission, and travel) and 11 food groups within the foodborne pathway itself. The most recent DALY and COI estimates referring to the year 2018 show that the 14 pathogens in question are cumulatively responsible for about 11,000 DALYs and €426 million costs for the Dutch population in 2018, with a share for foodborne transmission being estimated at 4,300 DALYs and €171 million costs, which is comparable to previous years. These estimates have been providing vital insights for policy making as to guide public health interventions and resource allocation for over two decades in the Netherlands. Herewith, the approach and outcomes of the burden of disease and COI estimates in the Netherlands will be presented, with a focus on how these estimates enable policy-makers and the scientific community to monitor trends, generate scientific hypotheses, and undertake public health actions.

The burden of low back pain in Malta at a population level

Abstract Background Low back pain (LBP) is a leading global cause of all-age years lived with disability (YLD). Studies conducted in Malta reported that musculoskeletal complaints were the commonest in primary care. The aim was to estimate for the first time the burden of LBP at population level in Malta in terms of disability-adjusted life years (DALYs) and compare to estimates obtained by the Global Burden of Disease (GBD) study. Methods LBP prevalence data were obtained from the Maltese European Health Interview Survey dataset for 2015 through representative self-reported history of chronic LBP for 12 months in combination to the extent of daily activities limitation. Proportions of LBP severity (with and without leg pain -mild, moderate, severe and most severe) and their corresponding disability weights followed values reported in GBD study. YLDs for LBP were estimated for the whole population by sex. Since LBP does not carry any mortality, YLDs reflected DALYs. The estimated local DALYs per100,000 were compared to the GBD study for Malta for the same year. Results Point prevalence of LBP causing a limitation was of 6.3% (5.6% males; 7.0% females), contributing to a total of 27,006 Maltese suffering from LBP. Global LBP DALYs were of 783 per100,000. Females experienced higher LBP burden per100,000 (876 DALYs) than males (689 DALYs). On comparing these DALYs to those reported by GBD study, a discrepancy was observed per 100,000 (Global LBP 1,828 DALYs; Males 1,657 DALYs; Females 1,999 DALYs). Conclusions LBP imposes substantial burden in Malta, which is expected to increase with the ageing population. Since etiology of LBP is multifactorial, it is suggested that a multi-disciplinary targeted preventive and management approach is considered. Differences observed between local estimates and those of the GBD study suggest the integration of locally sourced data into the model in order to improve the DALYs estimates of each country. Key messages Low back pain is a public health burden. Locally sourced data is suggested to be integrated with the GBD study to improve the DALYs estimation for each country.

Measuring disability-adjusted life years (DALYs) due to low back pain in Malta

BackgroundLow back pain (LBP) is a public health concern and a leading cause of ill health. A high prevalence of musculoskeletal complaints has been reported for Malta, a small European state. The aim was to estimate for the first time the burden of LBP at population level in Malta in terms of disability-adjusted life years (DALYs) and compare to estimates obtained by the Global Burden of Disease (GBD) study.MethodThe Maltese European Health Interview Survey dataset for 2015 provided the LBP prevalence data through representative self-reported history of chronic LBP within the past 12 months in combination with limitations to daily activities. Proportions of LBP severity (with and without leg pain – mild, moderate, severe and most severe) and their corresponding disability weights followed values reported in the GBD study. Years lived with disability (YLD) for LBP were estimated for the whole population by age and sex. Since LBP does not carry any mortality, YLD reflected DALYs. The estimated local DALYs per 100,000 were compared to the GBD 2017 study results for Malta for the same year.ResultsLBP with activity limitation gave a point prevalence of 6.4% (95% Uncertainty Interval [UI] 5.7–7.2%) (5.6% males [95% UI 4.6–6.6%]; 7.3% females [95% UI 6.2–8.4%]), contributing to a total of 23,649 (95% UI 20,974–26,463) Maltese suffering from LBP. The LBP DALYs were of 716 (95% UI 558–896) per 100,000. Females experienced higher LBP burden (739 [95% UI 575–927] DALYs per 100,000) than males (693 [95% UI 541–867] DALYs per 100,000). Our DALY estimates were lower than those reported by the GBD 2017 study (i.e., 1829 [95% UI 1300–2466] per 100,000).ConclusionsLBP imposes a substantial burden on the Maltese population. Differences observed between national estimates and those of the GBD study suggest the integration of updated locally sourced data into the model and encouraging local contributors in order to improve the DALY estimates of each country.

Impact of the Burden of COVID-19 in Italy: Results of Disability-Adjusted Life Years (DALYs) and Productivity Loss.

The WHO declared the novel coronavirus disease a pandemic, with severe consequences for health and global economic activity and Italy is one of the hardest hit countries. This study aims to assess the socio-economic burden of COVID-19 pandemic in Italy through the estimation of Disability-Adjusted Life Years (DALYs) and productivity loss. The observational study was based on data from official governmental sources collected since the inception of epidemic until 28 April 2020. DALYs for a disease combines the years of life lost due to premature mortality in the population and the years lost due to disability of the disease. In addition to DALYs, temporary productivity loss due to absenteeism from work and permanent productivity loss due to premature mortality were estimated using the Human Capital Approach. The total DALYs amount to 2.01 per 1000 persons. The total permanent productivity loss was around EUR 300 million while the temporary productivity loss was around EUR 100 million. This evaluation does not consider other economic aspects related to lockdown, quarantine of contacts, healthcare direct costs etc. The burden of disease methodology is functional metric for steering choices of health policy and allowing the government to be accountable for the utilization of resources.

ESTIMATING BURDEN OF DISEASE DUE TO CONTINUOUS PROPAGATION OF HIV INFECTION AMONG INJECTING DRUG USERS

Despite long period of propagation of HIV infection among injecting drug users (IDU) in Russian Federation there is still capacity for appearance of new cases. Based on results of integrated bio-behavioral study conducted in six cities of Russian Federation burden of HIV infection was estimated. Several approaches to calculate disability-adjusted life years (DALY) were used. Estimates of DALY depend mostly on mortality associated with HIV infection. It was shown, that estimates also change depending on changing age-dependent productivity and discount rate. Average loss was estimated at 15,1 DALY per one case of infection. Extrapolating these results on Russian Federation as a whole show that due to continuation of HIV spread among IDU every year 595 thousand DALYs are lost. Summary measures of public health should be used to prioritize investment in prevention.

Socioeconomic inequality in the global burden of refraction disorders: results from the Global Burden of Diseases Study 2017.

To explore socioeconomic inequality in global burden of refraction disorders using disability-adjusted life years (DALYs). World Bank categorical and national DALY numbers, crude rates and age-standardized rates caused by refraction disorders between 1990 and 2017 were obtained. Gini coefficient and concentration index were computed to assess trends in global health inequality in refraction disorders burden. Lower middle-income countries had the highest burden of refraction disorders and greatest decline in age-standardized DALY rates of 15.9% (171.0 in 1990; 143.8 in 2017), followed by upper middle-income countries, with a 9.7% decline (103.7 in 1990; 93.7 in 2017). High-income countries had the lowest age-standardized DALY rates (70.4 in 1990; 65.7 in 2017), while low-income countries had the lowest DALY numbers. Between-country inequality decreased, with Gini coefficient declining from 0.203 in 1990 to 0.184 in 2017. Socioeconomic-associated inequality also decreased, with concentration index changing from -0.060 in 1990 to -0.041 in 2017. Small peaks of DALY numbers and crude rates occurred in the age group of 5-9years in countries with different income levels. An earlier occurrence of high peaks of DALY estimates in older adults had been observed in countries with lower income. Middle-income countries are more burdened with refraction disorders but have achieved great progress in the last few decades. The global health improvement in refraction disorders has been accompanied by narrowing inequality. Older adults in lower income countries tend to suffer from refraction disorders at an earlier age, compared with older adults in higher income countries.

Global, Regional and Country-Specific Burden of Ischaemic Stroke, Intracerebral Haemorrhage and Subarachnoid Haemorrhage: A Systematic Analysis of the Global Burden of Disease Study 2017

Background: Stroke is a leading cause of death and disability in globally and particularly in low- and middle-income countries, and this burden is increasing. The burden of stroke pathological subtypes varies in terms of incidence, disability and mortality. Previous Global Burden of Diseases, Injuries, and Risk Factors Studies (GBD) reports did not provide separate global burden and trends estimates for haemorrhagic stroke by primary intracerebral haemorrhage (PICH) and subarachnoid haemorrhage (SAH). Aim: To summarise the GBD 2017 findings for the burden and 27-year trends for ischaemic stroke (IS), intracerebral haemorrhage and SAH by age, sex and country income level in 21 world regions and associated risk factors. Methods: Data on stroke incidence, prevalence, mortality and disability-adjusted life-years (DALY) lost and the burden of IS, PICH and SAH were derived from all available datasets from the GBD 2017 studies. Data were analysed in terms of absolute numbers and age-standardised rates per 100,000 (95% uncertainty interval [UI]), with estimates stratified by age, sex and economic development level by the World Bank classification. We also analysed changes in the patterns of incidence, mortality and DALYs estimates between 1990 and 2017. Results: In 2017, there were 11.9 million incident (95% UI 11.1–12.8), 104.2 million prevalent (98.6–110.2), 6.2 million fatal (6.0–6.3) cases of stroke and 132.1 million stroke-related DALYs (126.5–137.4). Although stroke incidence, prevalence, mortality and DALY rates declined from 1990 to 2017, the absolute number of people who developed new stroke, died, survived or remained disabled from stroke has almost doubled. The bulk of stroke burden (80% all incident strokes, 77% all stroke survivors, 87% of all deaths from stroke and 89 of all stroke-related DALYs) in 2017 was in low- to middle-income countries. Globally in 2017, IS constituted 65%, PICH –26% and SAH –9% of all incident strokes. Discussion: The latest GBD estimates of stroke burden in 195 countries supersede previous GBD stroke burden findings and provide most accurate data for stroke care planning and resource allocation globally, regionally and for 195 countries. Stroke remains the second leading cause of deaths and disability worldwide. The increased stroke burden continues to exacerbate a huge pressure on people affected by stroke, their families and societies. It is imperative to develop and implement more effective primary prevention strategies to reduce stroke burden and its impact.

The global, regional, and national burden of cirrhosis by cause in 195 countries and territories, 1990–2017: a systematic analysis for the Global Burden of Disease Study 2017

SummaryBackgroundCirrhosis and other chronic liver diseases (collectively referred to as cirrhosis in this paper) are a major cause of morbidity and mortality globally, although the burden and underlying causes differ across locations and demographic groups. We report on results from the Global Burden of Diseases, Injuries, and Risk Factors Study (GBD) 2017 on the burden of cirrhosis and its trends since 1990, by cause, sex, and age, for 195 countries and territories.MethodsWe used data from vital registrations, vital registration samples, and verbal autopsies to estimate mortality. We modelled prevalence of total, compensated, and decompensated cirrhosis on the basis of hospital and claims data. Disability-adjusted life-years (DALYs) were calculated as the sum of years of life lost due to premature death and years lived with disability. Estimates are presented as numbers and age-standardised or age-specific rates per 100 000 population, with 95% uncertainty intervals (UIs). All estimates are presented for five causes of cirrhosis: hepatitis B, hepatitis C, alcohol-related liver disease, non-alcoholic steatohepatitis (NASH), and other causes. We compared mortality, prevalence, and DALY estimates with those expected according to the Socio-demographic Index (SDI) as a proxy for the development status of regions and countries.FindingsIn 2017, cirrhosis caused more than 1·32 million (95% UI 1·27–1·45) deaths (440 000 [416 000–518 000; 33·3%] in females and 883 000 [838 000–967 000; 66·7%] in males) globally, compared with less than 899 000 (829 000–948 000) deaths in 1990. Deaths due to cirrhosis constituted 2·4% (2·3–2·6) of total deaths globally in 2017 compared with 1·9% (1·8–2·0) in 1990. Despite an increase in the number of deaths, the age-standardised death rate decreased from 21·0 (19·2–22·3) per 100 000 population in 1990 to 16·5 (15·8–18·1) per 100 000 population in 2017. Sub-Saharan Africa had the highest age-standardised death rate among GBD super-regions for all years of the study period (32·2 [25·8–38·6] deaths per 100 000 population in 2017), and the high-income super-region had the lowest (10·1 [9·8–10·5] deaths per 100 000 population in 2017). The age-standardised death rate decreased or remained constant from 1990 to 2017 in all GBD regions except eastern Europe and central Asia, where the age-standardised death rate increased, primarily due to increases in alcohol-related liver disease prevalence. At the national level, the age-standardised death rate of cirrhosis was lowest in Singapore in 2017 (3·7 [3·3–4·0] per 100 000 in 2017) and highest in Egypt in all years since 1990 (103·3 [64·4–133·4] per 100 000 in 2017). There were 10·6 million (10·3–10·9) prevalent cases of decompensated cirrhosis and 112 million (107–119) prevalent cases of compensated cirrhosis globally in 2017. There was a significant increase in age-standardised prevalence rate of decompensated cirrhosis between 1990 and 2017. Cirrhosis caused by NASH had a steady age-standardised death rate throughout the study period, whereas the other four causes showed declines in age-standardised death rate. The age-standardised prevalence of compensated and decompensated cirrhosis due to NASH increased more than for any other cause of cirrhosis (by 33·2% for compensated cirrhosis and 54·8% for decompensated cirrhosis) over the study period. From 1990 to 2017, the number of prevalent cases more than doubled for compensated cirrhosis due to NASH and more than tripled for decompensated cirrhosis due to NASH. In 2017, age-standardised death and DALY rates were lower among countries and territories with higher SDI.InterpretationCirrhosis imposes a substantial health burden on many countries and this burden has increased at the global level since 1990, partly due to population growth and ageing. Although the age-standardised death and DALY rates of cirrhosis decreased from 1990 to 2017, numbers of deaths and DALYs and the proportion of all global deaths due to cirrhosis increased. Despite the availability of effective interventions for the prevention and treatment of hepatitis B and C, they were still the main causes of cirrhosis burden worldwide, particularly in low-income countries. The impact of hepatitis B and C is expected to be attenuated and overtaken by that of NASH in the near future. Cost-effective interventions are required to continue the prevention and treatment of viral hepatitis, and to achieve early diagnosis and prevention of cirrhosis due to alcohol-related liver disease and NASH.FundingBill & Melinda Gates Foundation.

Direct estimates of disability-adjusted life years lost due to stroke : a cross-sectional observational study in a demographic surveillance site in rural Gadchiroli, India

ObjectiveTo directly estimate disability-adjusted life years (DALYs) lost due to stroke in rural Gadchiroli, India and measure the contribution of mortality and disability to total DALYs lost.DesignCross-sectional descriptive study using...

The burden of health conditions across race and ethnicity for aging Americans: Disability-adjusted life years.

Despite evidence suggesting race and ethnicity are important factors in responses to environmental exposures, drug therapies, and disease risk, few studies focus on the health needs of racially- and ethnically-diverse aging adults.The objective of this study was to determine the burden of 10 health conditions across race and ethnicity for a nationally-representative sample of aging Americans.Data from the 1998 to 2014 waves of the Health and Retirement Study, an ongoing longitudinal-panel study, were analyzed.Those aged over 50 years who identified as Black, Hispanic, or White were included. There were 5510 Blacks, 3423 Hispanics, and 21,168 Whites in the study.At each wave, participants reported if they had cancer, chronic obstructive pulmonary disease, congestive heart failure, diabetes, back pain, hypertension, a fractured hip, myocardial infarction, rheumatism or arthritis, and a stroke. Disability-adjusted life years (DALYs) were calculated for each health condition by race and ethnicity. Ranked DALYs determined how race and ethnicity was differentially impacted by the burden of each health condition. Sample weights were utilized to make DALY estimates nationally-representative.Weighted DALY estimates (in thousands) ranged from 1405 to 55,631 for Blacks, 931 to 28,442 for Hispanics, and 15,313 to 295,623 for Whites. Although the health conditions affected each race and ethnicity differently, hypertension had the largest number of DALYs, and hip fractures had the fewest across race and ethnicity. In total, there were an estimated 198,621, 101,462, and 1,187,725 DALYs for older Black, Hispanic, and White aging adults.Our findings indicate that race and ethnicity may be influential on health and disease for aging adults in the United States. Monitoring DALYs may help guide the flow of health-related expenditures, improve the impact of health interventions, advance inclusive health care for diverse aging adult populations, and prepare healthcare providers for serving the health needs of aging adults.

Using disability-adjusted life years to estimate the cancer risks of low-level arsenic in drinking water

Recent studies have shown that long-term exposure to low-level arsenic (<10 μg/L) may cause human health problems. However, the induced cancer risks and differences among multisite cancers have not been well-understood. In this study, the concentrations of low-level arsenic in drinking water in XP city, Northwest China were investigated. A health risk assessment was carried out for different age groups and exposure pathways based on Monte Carlo simulations and disability-adjusted life years (DALYs). The measured arsenic levels were in the range of 7.61–9.25 μg/L with a mean of 8.23 μg/L. For the public, the average total lifetime cancer risk was 3.87 × 10−4, and the total DALYs estimation for all age groups was 20.58 person-year. The average individual DALYs lost was 3.35 × 10−5 per person-year (ppy), which was 33.5 times the reference value (1.00 × 10−6 ppy). The mortality burden had a considerably larger contribution (97.31%) to the total disease burden, and the 60–65-year age group exhibited the largest DALYs lost. Skin cancer exhibited the largest burden of 2.15 × 10−5 ppy, followed by lung cancer (1.20 × 10−5 ppy). This study might be useful for potential strategies of risk control and management in XP drinking water.

Disability-adjusted life years for severe acute malnutrition: implications of alternative model specifications.

Reducing the burden of childhood severe acute malnutrition (SAM) is key to improving global child health outcomes. Assessing cost-effectiveness of nutrition interventions remains an important evidence gap. Disability-adjusted life years (DALYs) are a common indicator used in cost-effectiveness analyses. DALYs were established by the Global Burden of Disease (GBD) study. Recent iterations of the GBD have changed the methods used to calculate DALYs by dropping age-weighting and discounting (AD) and updating disability weights (DW). Cost-effectiveness analyses may use either local or international standard life expectancies (LE). Changes in model specifications for calculating DALYs may have implications for cost-effectiveness analyses using DALYs, interpreting historical DALY estimates, and related resource allocation decisions. The present study aimed to quantify the magnitude of change in estimates of DALYs attributable to SAM given recent methodological changes. From secondary data analysis, using parameter values from routine programme monitoring data for two SAM treatment programmes and published literature, eight calculation models were created to estimate DALYs with and without AD, using different sets of DW, and local v. standard LE. Different DW had a marginal effect on DALY estimates. Different LE had a small effect when AD was used, but a large effect when AD was not used. DALY estimates are sensitive to the model used. This complicates comparisons between studies using different models and needs to be accounted for in decision making. It seems sensible for analyses to report results using models with and without AD and using local and standard LE.

Calculating disability adjusted life years (DALY) for traffic accidents and its economic consequences in Ecuador

Road traffic fatalities in Ecuador are 20.4 deaths per 100,000 people. Men are the most affected by traffic accidents: 4.2 times higher than women (33 vs. 7.8 deaths per 100,000 people, respectively). Traffic accidents show a decrease: from 22 deaths per 100,000 people in 2010 to 18 deaths per 100,000 people in 2016. The estimation of DALY by the life expectancy method used age weighting β = 0.04, r = 0.03, C = 0.1658. The average burden of disease is 141,430 DALY or 897 DALY per 100,000 people (95% CI 892-902). The cost of DALY, using the approach of human capital, is US$ 806.8 million equivalent to 0.89% of GDP, 81% caused by males and 19% by females. This percentage of GDP lost for road fatalities is equivalent as if each individual in Ecuador paid US$ 358 annually. The provinces with the largest population (Guayas, Pichincha, &amp; Manabí) contribute with the 52% to the total population, 67% to the number of vehicles and 49% of total deaths due to traffic accidents. However, when we analyze deaths per number of people and number of vehicles, these provinces are not the most dangerous for dying in a traffic accident. Considering number of deaths per 100,000 people, the most dangerous provinces are Sucumbíos (33.5), Cotopaxi (32.0), Orellana (31.2), together, they constitute just the 5.9% of the population and 3.8% of the total vehicles, however, the average death rate of these three provinces is 1.58 times the national average (20.4 per 100,000 people). Considering the number of deaths per 100,000 vehicles, the most dangerous provinces are Napo (460), Imbabura (429) and Morona Santiago (400), together, they constitute just the 4.5% of the population and 1.9% of the total vehicles, however, the average death rate of these three provinces is 2.7 times the national average (156 per 100,000 vehicles).