Total Number Of Disability-adjusted Life Years Research Articles

The health state of France before COVID-19 pandemic between 1990 and 2019: an analysis of the Global Burden of Disease study 2019

France faces nowadays some major challenges regarding its health care system including medically underserved areas, social health inequalities, and hospital pressures. Various indicators and sources of data allow us to describe the health status of a population and, consequently, to assess the impact of these challenges. We assessed the burden of diseases before COVID-19 in France in 2019 and its evolution from 1990 to 2019, and compared it with Western European countries. We used specific Global Burden of Diseases (GBD) metrics: socio-demographic index (SDI), life expectancy (LE), healthy life expectancy (HALE), years of life lost (YLLs), years lived with disability (YLDs), and disability-adjusted life-years (DALYs) with their 95% uncertainty interval (95% UI). We compared French age-standardized metrics to those for other Western European Countries for both sexes and also between 1990 and 2019. We also described the specific causes of these different metrics. We observed for life expectancy at birth in France a trend to an improvement over time from 77.2 (95% UI: 77.2-77.3) years in 1990 to 82.9 (82.7-83.1) in 2019, which represented the seventh highest life expectancy among 23 Western European countries. HALE at birth in France increased from 67.0 (64.0-69.7) to 71.5 (68.1-74.5), which represented the fourth highest HALE among 23 Western European countries. In France, the total number of DALY per 100.000 population tended to decrease from 25,192 (22,374-28,351) in 1990 to 18,782 (16,408-21,920) in 2019. As compared to other European countries, the burden due to cardiovascular diseases was lower. Neoplasms and cardio-vascular diseases were the two leading causes of YLLs. Mental and musculoskeletal disorders were the two leading causes of YLDs. Overall, these results highlight a clear trend of improvement in the health status in France with certain differences between western European countries. The health policy makers need to devise interventional strategies to reduce the burden of diseases and injuries, with specific attention to causes such as cancers, cardiovascular diseases, mental health and musculoskeletal disorders. Bill & Melinda Gates Foundation.

The pattern and trends of disease burden due to low bone mineral density from 1990 to 2019 in China: findings from the Global Burden of Disease Study 2019.

We aim to investigate the pattern and trends of disease burden due to low BMD by gender, year, and age in China from 1990 to 2019. Data on summary exposure value (SEV) and disability-adjusted life years (DALYs) due to low BMD was obtained from the Global Burden of Disease Study 2019, and analyzed by gender, age, and years. Average annual percent change (AAPC) and annual percent change (APC) were calculated to qualify the trends of burden due to low BMD. In 2019, the age-standardized SEV was higher in females than that in males (23.04, 95% UI = [17.25-29.83] and 12.50, 95% UI = [7.71-19.25], respectively), while the total number of DALYs was higher in males than females with 1,698,705.92 (95% UI = 1,281,580.79 to 2,076,364.25) and 1,621,569 (95% UI = 1,266,284.89 to 2,016,399.16), respectively. Though SEV exhibited decreasing trends during 1990 to 2019 in both sexes, the absolute number of DALYs due to low BMD increased steadily and almost doubled in 2019 compared to that in 1990. The burden of low BMD remains large and continues to increase. Although females are prone to low BMD, the disease burden for males should not be ignored.

DALYs for breast cancer in China, 2000-2050: trend analysis and prediction based on GBD 2019

Objective: Based on the data of Global Burden of Disease 2019 data, to analyze the past, current, and future burden of disability-adjusted life years (DALYs) in China and compare with the international status. Methods: The total number of DALYs, age-standardized DALY rate, and the composition of different subgroups were extracted and described to analyze the time trend in 2000-2019 and the current situation in 2019 for Chinese female breast cancer. The burden of DALYs in 2050 was predicted by Joinpoint using average annual percent change (AAPC). Results: In 2000-2019, the ranking of DALYs caused by female breast cancer in China rose from the fourth to the second in all female cancers. The total DALYs increased by 48.4%, of which the years lived with disability increased from 4.8% to 8.8%. The age-standardized DALY rate only slightly decreased (AAPC=-0.3%; which increased during 2016-2019, AAPC=1.6%). In 2019, the age-standardized DALY rate for breast cancer in China was 278.0/100 000. The DALYs were 2.88 million (accounting for 14.2% of the global burden and 12.1% of all female cancers burden in China), 26.5% of which attributed known risk factors (overweight and obesity were the largest: 0.34 million DALYs, but some common breast cancer risk factors were not available on the platform, such as menstruation and fertility). In 2050, the prediction suggests that the total DALYs caused by female breast cancer in China will reach 3.80 million person-years-5.16 million person-years, increasing 32.1%-79.4% over 2019. From 2000 to 2019, the peak age of DALYs and DALY rate became older, and the DALYs among females aged 65 years and above increased faster than those younger than 65 years (AAPC were 4.8% and 1.3%, respectively). In 2019, females aged 45-74 (the starting age recommended by local guidelines for breast cancer screening) contributed 74.3% of the total DALYs. Conclusions: Over the past 20 years, the age-standardized DALY rate for breast cancer in female populations in China has not changed obviously. Without the continuous expansion of effective intervention and population aging, the burden of DALYs for female breast cancer in China will increase. DALYs for breast cancer attributed leading risk factors were still limited.

The impact of pharmaceutical innovation on the burden of disease in Ireland, 2000-2015.

BackgroundWe perform an econometric assessment of the impact that pharmaceutical innovation had on the burden of disease in Ireland.MethodsWe use a difference-in-differences (or two-way fixed effects) research design: we investigate whether diseases for which more new drugs were launched had larger subsequent reductions in mortality. This design controls for the effects of general economic and societal factors (e.g. income, education, and behavioral risk factors), to the extent that those effects are similar across diseases.ResultsNew Chemical Entities launched during 1983–1997 are estimated to have reduced the total number of disability-adjusted life-years (DALYs) lost in 2015 by about 234 600.ConclusionsPharmaceutical expenditure per DALY gained in 2015 from drugs launched during 1983–1997 was €1137, which indicates that the new drugs launched during 1983–1997 were very cost–effective, overall.

Adjuvant trastuzumab chemotherapy in early breast cancer: meta-analysis of randomised trials and cost-effectiveness analysis.

Trastuzumab has a large financial impact on the average cost of breast cancer treatment. This study reassessed the cost-effectiveness of listing the drug on the subsidised Australian Pharmaceutical Benefits Scheme. Using a continuous-time, discrete-event microsimulation model, we examined the effect of 1-year trastuzumab on the total number of disability-adjusted life-years (DALYs) averted among Australian women with human epidermal growth factor receptor-2 (HER2) positive early breast cancer. Target population was women aged 30–100 years and newly diagnosed with the disease in 2003. The model adjusted for tumour size and followed the women up until death or age 100 years. Uncertainty was examined in univariate and probabilistic multivariate sensitivity analyses. The incremental cost-effectiveness ratio (ICER) was A$132,537 (95% confidence interval 91,172–200,485) per DALY averted. Results were sensitive to restriction of trastuzumab to high-risk (large tumour) and/or high-benefit (young) patients. Suitable combinations of tumour size and age restrictions would improve the cost-effectiveness of trastuzumab. Specifically, restricting trastuzumab to women aged 40 years or younger with tumour sizes 40+ mm reduced the ICER to A$35,290 per DALY averted. Trastuzumab for HER2-positive early breast cancer had a high ICER. It is unclear why the Pharmaceutical Benefits Scheme listing does not use restrictions to improve the cost-effectiveness of the drug.

Estimating the economic and social consequences for patients diagnosed with human African trypanosomiasis in Muchinga, Lusaka and Eastern Provinces of Zambia (2004\u20132014)

BackgroundAcute human African trypanosomiasis (rHAT) caused by Trypanosoma brucei rhodesiense is associated with high mortality and is fatal if left untreated. Only a few studies have examined the psychological, social and economic impacts of rHAT. In this study, mixed qualitative and quantitative research methods were used to evaluate the socio-economic impacts of rHAT in Mambwe, Rufunsa, Mpika and Chama Districts of Zambia.MethodsIndividuals diagnosed with rHAT from 2004 to 2014 were traced using hospital records and discussions with communities. Either they, or their families, were interviewed using a structured questionnaire and focus group discussions were conducted with affected communities. The burden of the disease was investigated using disability adjusted life years (DALYs), with and without discounting and age-weighting. The impact of long-term disabilities on the rHAT burden was also investigated.ResultsSixty four cases were identified in the study. The majority were identified in second stage, and the mortality rate was high (12.5%). The total number of DALYs was 285 without discounting or age-weighting. When long-term disabilities were included this estimate increased by 50% to 462. The proportion of years lived with disability (YLD) increased from 6.4% to 37% of the undiscounted and un-age-weighted DALY total. When a more active surveillance method was applied in 2013–2014 the cases identified increased dramatically, suggesting a high level of under-reporting. Similarly, the proportion of females increased substantially, indicating that passive surveillance may be especially failing this group.An average of 4.9 months of productive time was lost per patient as a consequence of infection. The health consequences included pain, amnesia and physical disability. The social consequences included stigma, dropping out of education, loss of friends and self-esteem. Results obtained from focus group discussions revealed misconceptions among community members which could be attributed to lack of knowledge about rHAT.ConclusionsThe social and economic impact of rHAT on rural households and communities is substantial. Improved surveillance and strengthening of local medical services are needed for early and accurate diagnosis. Disease prevention should be prioritised in communities at risk of rHAT, and interventions put in place to prevent zoonotic disease spill over from domestic animals and wildlife. Supportive measures to mitigate the long-term effects of disability due to rHAT are needed.

Burden of disease from road traffic and railway noise – a quantification of healthy life years lost in Sweden

Objectives National quantifications of the health burden related to traffic noise are still rare. In this study, we use disability-adjusted life-years (DALY) measure to assess the burden of disease from road traffic and railway noise in Sweden. Methods The number of DALY was assessed for annoyance, sleep disturbance, hypertension, myocardial infarction (MI) and stroke using a method previously implemented by the World Health Organization (WHO). Population exposure to noise was obtained from the Swedish Environmental Protection Agency and the Swedish Transport Administration. Data on disease occurrence were gathered from registers held by the National Board of Health and Welfare and Statistics Sweden. Disability weights (DW) and duration were based on WHO definitions. Finally, we used research-based exposure-response functions or relative risks to estimate disease attributable to noise in each exposure category. Results The number of DALY attributed to traffic noise in Sweden was estimated to be 41033 years; 36711 (90%) related to road traffic and 4322 (10%) related to railway traffic. The most important contributor to the disease burden was sleep disturbances, accounting for 22 218 DALY (54%), followed by annoyance, 12 090 DALY (30%), and cardiovascular diseases, 6725 DALY (16%). Conclusions Road traffic and railway noise contribute significantly to the burden of disease in Sweden each year. The total number of DALY should, however, be interpreted with caution due to limitations in data quality.

Burden of disease from road traffic and railway noise in Sweden – Quantification of healthy life years lost

Introduction: Traffic noise is commonly associated with annoyance as well as sleep disturbances and increasing evidence also suggests harmful effects on the cardiovascular system. However, national quantifications of the health burden related to traffic noise are still rare. This study aims to assess the burden of disease from road traffic and railway noise for the complete transportation net in Sweden in terms of Disability Adjusted Life-Years (DALY). Methods: The number of DALYs was assessed for annoyance, sleep disturbance and cardiovascular disease, including hypertension, myocardial infarction (MI) and stroke, using a method previously implemented by the World Health Organization (WHO). Information on population exposure to road traffic and railway noise was obtained from the Swedish Environmental Protection Agency and the Swedish Road Administration. Data on age and sex-specific disease occurrence was gathered from registers held by the Swedish Board of Health and Welfare and Statistics Sweden. Disability weights and duration were based on WHO definitions. Finally, we used research-based exposure-response functions or relative risks to estimate disease attributable to noise in each exposure category. Results: Preliminary findings show that the number of DALYs attributed to road traffic and railway noise in Sweden is approximately 36.600 and 4.000, respectively. The most important contributor to the disease burden was sleep disturbances, which accounted for a total of 22.000 DALYs, followed by annoyance, accounting for 12.100 DALYs, and cardiovascular diseases, accounting for 6.500 DALYs (stroke 2.800, MI 2.100 and hypertension 1.600 DALYs). Conclusions: Road traffic and railway noise contribute significantly to the burden of disease in Sweden each year, in particular with regard to sleep disturbance. The total number of DALYs should, however, be interpreted with caution since the underlying data has several limitations.

The impact of a healthy lifestyle on Disability-Adjusted Life Years: a prospective cohort study.

BackgroundThe association between single health behaviours and incidence of and premature mortality from major chronic diseases, including myocardial infarction, stroke, diabetes mellitus, and cancer, has been demonstrated thoroughly. However, the association of several healthy behaviours with Disability-Adjusted Life Years (DALYs), which is a measure for total health combining Years Lost due to Disability and the Years of Life Lost due to premature mortality, has not been studied yet.MethodsA prospective cohort study was conducted among 33,066 healthy men and women aged 20 to 70 years recruited into the EPIC-NL study during 1993 to 1997. Participants’ smoking status, BMI, physical activity, and adherence to a Mediterranean-style diet (excluding alcohol) were investigated separately and combined into a simple health behaviour score ranging from 0 to 4. Participants were followed until the end of 2007 for occurrence of and mortality from the most important chronic diseases. The association between lifestyle (separate lifestyle factors and a simple health behaviour score) and DALYs were adjusted for relevant confounders.ResultsAfter a median follow-up of 12.4 years, 6,647 disease incidences and 1,482 deaths were documented. Non-smoking, low BMI (BMI <25), being physically active, and adherence to a Mediterranean diet were all associated with a significantly lower disease burden. Persons adhering to all four healthy lifestyle characteristics lived a minimum of 2 years longer in good health (DALYs: −2.13; 95% CI: −2.65 to −1.62) than persons with none. Due to our non-extinct cohort, the total number of DALYs, and consequently the estimates, is underestimated. Therefore, true lifetime health benefits of a healthy lifestyle will be even larger.ConclusionsNon-smoking, a low BMI, being physically active, and adherence to a Mediterranean diet were associated with a lower disease burden. Each additional healthy lifestyle factor contributed to a longer life in good health.Electronic supplementary materialThe online version of this article (doi:10.1186/s12916-015-0287-6) contains supplementary material, which is available to authorized users.

Improving responsiveness of health systems to non-communicable diseases

In almost all countries, development of health systems that are responsive to the challenge of prevention and treatment of non-communicable diseases (NCDs) is a priority. NCDs consist of a vast group of conditions, but in terms of premature mortality, emphasis has been on cardiovascular disease, cancer, diabetes, and chronic respiratory diseases—diseases that were also the focus of the UN high-level meeting on NCDs, held in 2011. In 1990, there were 26·6 million deaths worldwide from NCDs (57·2% of 46·5 million total deaths), increasing in 2010 to 34·5 million (65·5% of 52·8 million deaths) as the leading cause of death in all regions apart from sub-Saharan Africa and south Asia. Similarly, the global burden of NCDs has increased from 43% (1·08 billion of the total 2·50 billion) in 1990, to 54% (1·34 billion of 2·49 billion) of the total number of disability-adjusted life-years in 2010. The global economic burden of NCDs is large, estimated at US$6·3 trillion in 2010, rising to $13 trillion in 2030. A 10% rise in NCDs leads to a 0·5% decrease in gross domestic product. The projected cumulative global loss of economic output due to NCDs for 2011–30 is estimated at $46·7 trillion, with around $21·3 trillion (46%) in low-income and middle-income countries. The growing burden of NCDs in low-income and middle-income countries will compound the poverty and economic hardship created by communicable diseases and hold back development. Yet, few such countries have the fi scal strength to meet the future health, economic, and social burden that NCDs will impose, which raises concerns of economic instability, arrested development, and government fragility—with implications for global security as well as foreign policy. An ageing society, alongside improving health care, means that health systems have to manage not only diseases such as heart disease, stroke, and cancer, but also individuals with multiple chronic disorders. Multimorbidity disproportionately aff ects those who are poorest. Furthermore, around 9 million people in lowincome and middle-income countries now benefi t from antiretroviral treatment (ART), with remarkably im proved survival, but with new comorbidities such as diabetes or cardiovascular disease. Health systems also have to manage patients with new comorbid disease patterns, in which infectious diseases combine with NCDs. Management of people with NCDs and multimor bidity will be particularly challenging in low-income and middle-income countries with weak health systems characterised by fragmented health-care services, which are still designed to respond to single episodes of care, or the long-term prevention and control of infectious diseases such as HIV, tuberculosis, and neglected tropical diseases. These health systems are ill prepared to manage changing disease patterns with a growing burden of NCDs and multimorbidity. To achieve the World Health Assembly target of 25% reduction in preventable deaths from NCDs by 2025, health systems need to be transformed to provide person-centred care with improved outreach and selfmanagement to eff ectively manage risk factors, illness episodes, and multimorbidity over many years. Along with outreach and community-based services, health facilities in low-income and middle-income countries need to be strengthened to develop reliable individual records that enable assessment and management of risks of individuals under their care. Yet, in many such countries, long-term care and risk management that includes follow-up at clinic and repeat prescriptions are a new idea for many patients and health staff . However, existing service delivery platforms can be used to address chronicity, the emerging NCD epidemic, and multi morbidity. Resource constrains imposed by the worldwide economic crisis means that sustaining increases in global health fi nancing will be a challenge. There is an imperative to fi nd solutions that create synergies among investments in low-income and middle-income coun tries for diff erent diseases, especially HIV and tuber culosis, which have substantially benefi ted from international fi nancing and have clear links with NCDs. In this paper we provide examples of how HIV and tuberculosis investments have been used to strengthen health systems and opportunities to integrate NCD prevention and control with HIV and other programmes. We describe the importance of building health services that profi le the risks of NCDs and multimorbidity in their population. Finally, we propose a stepwise approach to scale up health systems by building on existing programmes to tackle NCDs and multimorbidity.

Potential Economic Benefit of Cleft Lip and Palate Repair in Sub‐Saharan Africa

Acceptance of basic surgical care as an essential element of any properly functioning health system is growing. To justify investment in surgical interventions, donors require estimates of the economic benefit of treating surgical disease. The present study aimed to establish a methodology for valuing the potential economic benefit of surgical intervention using cleft lip and palate (CLP) in sub-Saharan Africa (SSA) as a model. Economic modeling of cleft lip and cleft palate (CLP) in SSA was performed with retrospective demographic and economic data from 2008. The total number of Disability-Adjusted Life-Years (DALYs) secondary to CLP in 2008 was calculated from accepted clefting incidence rates and disability weights taken from the Global Burden of Disease Project. DALYs were then converted to monetary terms ($US), using both a human capital approach and Value of a Statistical Life (VSL) approach. With the human capital approach, the potential economic benefit if all incident cases of CLP in SSA in 2008 were repaired at birth ranged from $252 million to $441 million. With VSL, the potential economic benefit of the same CLP repair would range from $5.4 billion to $9.7 billion. Cleft lip and cleft palate can have a substantial impact on the economic health of countries in the developing world. Further studies should be directed at quantifying the economic benefit of surgical interventions and quantifying their costs with an economically sound approach.

The burden of disease and injury in Iran 2003

BackgroundThe objective of this study was to estimate the burden of disease and injury in Iran for the year 2003, using Disability-Adjusted Life Years (DALYs) at the national level and for six selected provinces.MethodsMethods developed by the World Health Organization for National Burden of Disease (NBD) studies were applied to estimate disease and injury incidence for the calculation of Years of Life Lost due to premature mortality (YLL), Years Lived with Disability (YLD), and DALYs. The following adjustments of the NBD methodology were made in this study: a revised list with 213 disease and injury causes, development of new and more specific disease modeling templates for cancers and injuries, and adjustment for dependent comorbidity. We compared the results with World Health Organization (WHO) estimates for Eastern Mediterranean Region, sub-region B in 2002.ResultsWe estimated that in the year 2003, there were 21,572 DALYs due to all diseases and injuries per 100,000 Iranian people of all ages and both sexes. From this total number of DALYs, 62% were due to disability premature deaths (YLD) and 38% were due to premature deaths (YLL); 58% were due to noncommunicable diseases, 28% – to injuries, and 14% – to communicable, maternal, perinatal, and nutritional conditions. Fifty-three percent of the total number of 14.349 million DALYs in Iran were in males, with 36.5% of the total due to intentional and unintentional injuries, 15% due to mental and behavioral disorders, and 10% due to circulatory system diseases; and 47% of DALYs were in females, with 18% of the total due to mental and behavioral disorders, 18% due to intentional and unintentional injuries, and 12% due to circulatory system diseases. The disease and injury causes leading to the highest number of DALYs in males were road traffic accidents (1.071 million), natural disasters (548 thousand), opioid use (510 thousand), and ischemic heart disease (434 thousand). The leading causes of DALYs in females were ischemic heart disease (438 thousand), major depressive disorder (420 thousand), natural disasters (419 thousand), and road traffic accidents (235 thousand). The burden of disease at the province level showed marked variability. DALY estimates by Iran's NBD study were higher than those for EMR-B by WHO.ConclusionThe health and disease profile in Iran has made the transition from the dominance of communicable diseases to that of noncommunicable diseases and road traffic injuries. NBD results are to be used in health program planning, research, and resource allocation and generation policies and practices.