2017—2019年广州市糖尿病早死概率及疾病负担分析

目的 了解2017—2019年广州市糖尿病死亡特征、早死概率及疾病负担情况,为制定糖尿病防治干预措施提供参考。方法 以2017—2019年广州市死亡登记数据和人口监测数据为基础,计算糖尿病的粗死亡率、标化死亡率、早死概率、早死损失寿命年（Years of Life Lost,YLL）、伤残损失寿命年（Years Lived with Disability,YLD）和伤残调整寿命年（Disability Adjusted Life Year,DALY）。结果 2017—2019年广州市居民的糖尿病粗死亡率为13.78/10万,标化死亡率为8.16/10万。糖尿病早死概率为0.47%,年均增长速度为-3.18%。糖尿病DALY率、YLL率、YLD率分别为3.52、1.50、2.02人年/千人。男性、女性居民每千人口因糖尿病分别损失3.92、3.12个DALY。居民糖尿病死亡率及DALY率均随着年龄的增加逐渐升高,60岁以上居民是糖尿病死亡高发人群。结论 糖尿病给广州市居民带来较重的疾病负担,应加强糖尿病的防控工作,针对重点人群的主要死因进行干预。     

Measures of burden of disease--new indicators of the health situation

The objective of this paper is to present an initial information on the construction and usefulness of new indicators of population health situation (Human Development Index - HDI, Disability Adjusted Life Years - DALY and other indices). Some of these indicators are referred in the literature as the measures of disease burden. These measures are discussed here in the context of problems related to health inequalities, epidemiological transformation and concept of Lalonde's health fields.     

辽宁省城乡居民糖尿病及其并发症疾病负担研究

目的了解辽宁省城乡居民糖尿病及其并发症的疾病负担水平和特征。方法依据辽宁省糖尿病患病和死亡资料,采用全球疾病负担研究方法,计算辽宁省城乡居民糖尿病的伤残调整生命年(DisabilityAdjusted Life Years,DALY)。结果辽宁省糖尿病疾病负担(DALY)每10万人损失健康寿命299.4人.a,女性高于男性(351.1/10万:252.3/10万),城市高于农村(474.1/10万:215.8/10万),农村YLD/YLL比值(0.47)明显低于城市(0.96)。结论辽宁省糖尿病DALY是GBD2000对中国糖尿病及其并发症疾病负担估计值的2.0倍,城市居民糖尿病DALY已接近发达国家水平。     

Measuring health in a vacuum: examining the disability weight of the DALY

The Disability Adjusted Life Year (DALY) is a widely used summary measure of population health combining years of life lost due to mortality and years of healthy life lost due to disability. A feature of the DALY is that, in the assessment of morbidity, each health condition is associated with a disability weight. The disability weight lies on a scale between 0 (indicating the health condition is equivalent to full health) and 1 (indicating the health condition is equivalent to death). The disability weight associated with each health condition is currently fixed across all social, cultural and environmental contexts. Thus blindness in the United Kingdom has the same disability weight as blindness in Niger in spite of structural interventions in the UK that make the disability less severe than in Niger. Although the fixed disability weight is defended on grounds that it supports a strongly egalitarian flavour in the DALY, we argue that the lack of consideration of realistic contexts results in a measure that will underestimate the burden associated with morbidity in disadvantaged populations and overestimate the burden in advantaged populations. There is, consequently, a loss of information on possible non-clinical points of intervention. Disaggregated estimates of the burden of disease such as those in the World Health Report 2000 should be interpreted with caution.     

城镇居民基本医疗保险覆盖人群疾病负担测量分析

目的:测算城镇居民的疾病负担,提出城镇居民基本医疗保险覆盖人群主要健康问题。方法:利用伤残调整生命年(DALY)作为衡量疾病负担的指标。结果:2006年城镇居民主要疾病负担是非感染性疾病,其疾病负担强度为105.8DALYs/千人,疾病负担谱前五类疾病是循环系统疾病、恶性肿瘤、神经和精神疾病、呼吸系统疾病和意外伤害。0～44岁人群中,神经和精神疾病均为第1顺位疾病;45～59岁人群中,恶性肿瘤疾病负担居首位;60岁以上人群,循环系统、恶性肿瘤和呼吸系统疾病为疾病负担的主要病因。结论:城镇居民疾病负担以非感染性疾病为主,城镇居民基本医疗保险应重点加强对循环系统疾病、恶性肿瘤、神经和精神疾病及呼吸系统疾病的保障。     

Costs of gastroenteritis in The Netherlands

In order to target the most important cost components of gastroenteritis in The Netherlands and to indicate which change of policy yields the largest decrease in costs, the cost of illness of gastroenteritis and the number of Disability Adjusted Life Years (DALYs) in the Dutch population in 1999 were determined. The costs of gastroenteritis were estimated using data mainly from a community-based cohort study. For calculating DALYs, data on the number of deaths due to gastroenteritis were used from Statistics Netherlands. On average, the costs for gastroenteritis were 77 Euro (euros) per case. For all patients in The Netherlands, the costs were estimated at 345 million euros (ranging between 252 and 531 million euros). Indirect costs made up 82% of this total. An estimate of costs for patients with campylobacter, salmonella or norovirus infections was, in total, 10-17% of the costs of gastroenteritis. Gastroenteritis was associated with a loss of approximately 67,000 DALYs.     

疾病负担研究--失能调整寿命年指标的应用

目前,全球受到传染病和非传染病的双重威胁,为了对不同疾病的危害进行综合的评价,以达到公平、合理、有效地分配有限卫生资源,确定优先发展的卫生领域及优先解决的卫生问题,世界卫生组织及各国政府正致力于疾病负担的研究。该文主要对疾病负担研究中失能调整寿命年(DALY)的引入、构成和国内外研究现状进行综述,虽然DALY较全面地综合了疾病、伤残、死亡对人的影响,但一个真正的疾病负担应包括患者周围支持环境的负担情况,它的一些参数仍存在技术缺陷,还需要对DALY进一步完善。     

Injury in the Americas: the relative burden and challenge.

OBJECTIVES: To present evidence to support a higher priority for injury prevention in initiatives, research, and budget allocations. METHODS: Recent data (2000) for deaths from injury, infectious disease, heart disease, and cancer from 11 countries in the Region of the Americas were analyzed. Analyses focused on: first, Potentially Productive Years of Life Lost (PPYLL, discounted) from deaths occurring from 0-64 years of age; second, Years of Potential Life Lost (YPLL) from 1-64 years; and third, Years Lived with Disability (YLD). The burdens of injury and infectious disease were compared to the Pan American Health Organization (PAHO) budget allocations for these areas. RESULTS: There is a clear-cut disparity between funds allocated and the magnitude of injury burden as compared to the burden of infectious disease. CONCLUSIONS: In making decisions on budgetary allocations, the Member States of PAHO must consider the potential impact of injury research and control on the health of their populations.     

Disease burden in The Netherlands due to infections with Shiga toxin-producing Escherichia coli O157

Surveys carried out between 1990 and 2000 indicated that the incidence of STEC O157-associated gastroenteritis in The Netherlands was 1250 cases/year (median), of which 180 visited a general practitioner, 40 are reported and 0.6 are fatal, mainly in the elderly. There are approximately 20 cases of STEC O157-associated haemolytic-uraemic syndrome (HUS) per year, mainly in children. There are 2.5 HUS patients per year who develop end-stage renal disease (ESRD). There are an estimated 2 HUS-related and 0.5 ESRD-related fatalities per year. The mean disease burden associated with STEC O157 in the Dutch population is 116 (90% confidence interval 85-160) Disability Adjusted Life Years (DALYs) per year. Mortality due to HUS (58 DALYs), and ESRD (21 DALYs) and dialysis due to ESRD (21 DALYs) constitute the main determinants of disease burden. Sensitivity analysis indicates that uncertainty associated with model assumptions did not have a major effect on these estimates.     

The burden of disease and injury in Serbia

BACKGROUND: In the last decade of the 20th century, a considerable effort has been put into the development of summary measures of population health that combine information on mortality and non-fatal health outcomes. We used the DALYs (Disability adjusted life years) method to assess the burden of disease and injury in the population of Serbia. METHODS: Our study, largely based on the methods developed for the Global burden of disease study, was conducted between October 2002 and September 2003. DALYs, stratified by gender and age, were calculated for 18 selected health conditions for the population of Serbia, Serbia and Montenegro for 2000. Years of life lost (YLL) were calculated using country mortality statistics, while years lived with disability (YLD) were calculated using different sources of information. Also, the YLD/YYL ratio and age-adjusted rates of DALYs were calculated. RESULTS: Ischaemic heart disease, cerebrovascular diseases, lung cancer, unipolar depressive disorders, and diabetes mellitus were responsible for almost two-thirds (70%) of the total burden of 18 selected disorders in Serbia 2000. The leading five causes for males were ischaemic heart disease (26.1 DALY per 1000), stroke (17.9), lung cancer (12.7), road traffic accidents (6.5), and self-inflicted injuries (5.5). For females, the leading five causes were stroke (18.1 DALY per 1000), ischaemic heart disease (14.1), depression (8.7), breast cancer (6.1), and diabetes mellitus (5.2). CONCLUSIONS: The final results of the study have shown that the national health priority areas should cover cardiovascular diseases, cancers, and mental health.     

Assessing the burden of disease and injury in Los Angeles County using disability-adjusted life years

OBJECTIVE: This study was designed to assess the burden of disease and injury in the Los Angeles County population using Disability-Adjusted Life Years (DALYs), a composite measure of premature mortality and disability that equates to years of healthy life lost. METHODS: DALYs, stratified by gender and race/ethnicity, were calculated for 105 health conditions and aggregated groups of conditions for the Los Angeles County population for 1997. Years of Life Lost (YLLs) were calculated using 1997 county mortality statistics and published life tables. Years Lived with Disability (YLDs) were derived from age- and gender-specific disease incidence and disability data from the Global Burden of Disease Study. RESULTS: DALYs produced a substantially different ranking of disease and injury burden than did mortality rates alone. The leading five causes of DALYs for males in the county were ischemic heart disease, violence, alcohol dependence, drug overdose and other intoxications, and depression. For females, the leading five causes were ischemic heart disease, alcohol dependence, diabetes, depression, and osteoarthritis. Differences in the rank order were also observed by race/ethnicity. The age-adjusted rate of DALYs for all health conditions combined was highest in African Americans (190 per 1,000), followed by American Indians (149 per 1,000), whites (113 per 1,000), Latinos (94 per 1,000), and Asians/Pacific Islanders (77 per 1,000). CONCLUSIONS: The DALYs measure is a promising new tool to improve the capacity of local health departments and other health agencies to assess population health and establish an evidence base for public health decisions.     

肝癌的健康生命年损失研究

目的:了解1999～2005年哈尔滨市居民肝癌的疾病负担分布,对肝癌预防和控制提出合理化建议。方法:根据哈尔滨市居民1999～2005年肝癌的发病及死亡资料,利用DALY指标,参考全球疾病负担体系中有关参数,计算哈尔滨市居民肝癌的健康生命年损失。结果:1999～2005年哈尔滨市居民因肝癌死亡和残疾所造成的疾病负担基本呈现逐年增加的趋势,由死亡所造成的疾病负担占肝癌疾病负担的主要部分,各年均占94%以上;城区的疾病负担明显高于郊县;男性高于女性;随着年龄的增长,肝癌的健康生命年损失有两个增长高峰,分别出现在55岁和60～70岁年龄组,疾病负担主要集中在40～75岁之间。结论:哈尔滨市居民肝癌的疾病负担逐年增加,城区高于郊县,男性高于女性,40~75岁年龄段人群是肝癌的高危人群,应该重点保护40岁以上人群,死亡引起的损失比重较大,因此,要特别关注肝癌的治疗,同时也不可忽视肝癌的预防。     

The breast cancer related burden of morbidity and mortality in six European countries: the European Disability Weights project

BACKGROUND: The burden of breast cancer expressed in Disability Adjusted Life Years (DALYs) was compared for six European countries and its sensitivity to different sources of variation examined. METHODS: DALYs were calculated using country-specific epidemiological data and European Disability Weights. Epidemiological data for 1996 were obtained for Denmark, England and Wales, France, The Netherlands, Spain and Sweden. Disability weights were empirically derived. RESULTS: Denmark and The Netherlands lost the largest number of DALYs (approximately 1100 DALYs per 100,000 women). They were followed by England (87% of the Danish burden), France (72%), Sweden (68%) and Spain (67%). 70 to 80% of the burden was caused by mortality. Cross-national variation in disease epidemiology was the largest source of variation in the burden of breast cancer. Variation in disability weights and uncertainty in epidemiological data had smaller effects. CONCLUSION: To compare the burden of breast cancer and most other types of cancer mortality rates provide sufficient information.     

Measuring the burden of disease due to premature mortality using Standard Expected Years of Life Lost (SEYLL) in North Rhine-Westphalia, a Federal State of Germany, in 2005

Aims and subjects

Burden of disease (BoD) estimates are increasingly used in public health for assessing population health. Disability Adjusted Life Years (DALYs)—a summary measure frequently used in BoD studies—sum up the impact on health due to premature death and non-fatal health outcomes and allow for comprehensive and comparable assessments. To provide first estimates on the burden of disease in North Rhine-Westphalia (NRW), we calculated the burden due to premature death using Standard Expected Years of Life Lost (SEYLL), which is one of the two components of DALYs.

Materials and methods

Methods provided by the World Health Organisation (WHO) and developed for the Global BoD (GBoD) study were used to estimate SEYLL in NRW in 2005. We used administrative death and cause of death statistics provided by local authorities.

Results

In 2005, the total burden of disease due to premature death was 1,774,926 SEYLLs. According to the GBoD disease categories, non-communicable (group II) diseases accounted for 89.1% of the burden. Communicable, maternal, perinatal and nutritional (group I) conditions contributed to 5.6% and injuries (group III conditions) to 5.3% of the total burden. The three leading single causes of the burden of disease due to premature death were ischaemic heart diseases, lung cancers and cerebrovascular diseases, together accounting for 558,785 SEYLLs (32%).

Conclusion

First estimates of the burden of disease were feasible for NRW by use of WHO tools and administrative data. The findings of our study are consistent with WHO GBoD estimates and studies performed for other high-income countries. Our SEYLL results usefully complement the available health statistics highlighting diseases and injuries leading to death at an early age of life. However, our estimates are restricted to the impact of premature death and do not provide information on non-fatal health outcomes. Thus, future work should target estimates of the Years of Life Lost due to Disability (YLD) to provide a comprehensive assessment of the burden of disease in NRW.     

Overview of research activities associated with the World Health Organization: results of a survey covering 2006/07

Background

This paper presents the first comprehensive effort to provide an overview of the research associated with the World Health Organization (WHO) headquarters in 2006/07.

Methods

Information was obtained by questionnaire and interviews with senior staff operating at WHO headquarters in Geneva. Research type, purpose and resources (both financial and staff) were defined and compared for each of the 37 departments identified and a comparative analysis was made with the global burden of disease as expressed by Disability Adjusted Life Years (DALY).

Results

Research expenditure in 2006/07 was estimated at US$215 million. WHO is involved in more than 60 research networks/partnerships and often WHO itself is the network host. Using the DALY model, 84% of the funding WHO allocates to research goes to DALY Type I diseases (communicable, maternal, perinatal and nutritional diseases) which represents 40% of DALY. 4% is allocated to Daly Type II (non-communicable diseases) which contributes to 48% of DALY. 45% of WHO permanent staff are involved with health research and the WHO's approach to research is predominantly focused on policy, advocacy, health systems and population based research. The Organization principally undertakes secondary research using published data and commissions others to conduct this work through contracts or research grants. This approach is broadly in line with the stated strategy of the Organization.

Conclusions

The difficulty in undertaking this survey highlights the complexity of obtaining an Organization-wide assessment of research activity in the absence of common standards for research classification, methods for priority setting and a mechanism across WHO, or within the governance of global health research more generally, for managing a research portfolio. This paper presents a strategic birds-eye view of the WHO research portfolio using methodologies that, with further development, may provide the strategic information required if there is to be balancing of research efforts between communicable disease, non-communicable disease and other pressing public health needs. As the rollout of the WHO strategy on research for health proceeds we would hope to see similar exercises undertaken at the WHO Regional Offices and in support of capacity building of national health research systems within Member States.     

Dealing with uncertainties in environmental burden of disease assessment

Disability Adjusted Life Years (DALYs) combine the number of people affected by disease or mortality in a population and the duration and severity of their condition into one number. The environmental burden of disease is the number of DALYs that can be attributed to environmental factors. Environmental burden of disease estimates enable policy makers to evaluate, compare and prioritize dissimilar environmental health problems or interventions. These estimates often have various uncertainties and assumptions which are not always made explicit. Besides statistical uncertainty in input data and parameters – which is commonly addressed – a variety of other types of uncertainties may substantially influence the results of the assessment. We have reviewed how different types of uncertainties affect environmental burden of disease assessments, and we give suggestions as to how researchers could address these uncertainties. We propose the use of an uncertainty typology to identify and characterize uncertainties. Finally, we argue that uncertainties need to be identified, assessed, reported and interpreted in order for assessment results to adequately support decision making.     

Estimating the “avoidable” burden of disease by Disability Adjusted Life Years (DALYs)

The World Bank's Global Burden of Disease Study pioneered the use of Disability Adjusted Life Years (DALYs). In this paper we distinguish between the total and the “avoidable” burden of disease. We identify different ways of measuring DALYs: incidence‐based DALYs are appropriate where the means of reducing the burden of disease is by prevention; prevalence‐based DALYs are appropriate when a disease cannot be prevented but effective treatment is available. The methods of estimating each are explained and we describe how we have applied these methods to seven causes of death and disability in the South and West Region. We discuss the relevance of this work for monitoring the health of populations and deciding how best to use scarce resources to improve health. This revised version was published online in July 2006 with corrections to the Cover Date.     

The Global Impact of Alcohol Consumption on Premature Mortality and Health in 2016

This study aimed to estimate the impact of alcohol use on mortality and health among people 69 years of age and younger in 2016. A comparative risk assessment approach was utilized, with population-attributable fractions being estimated by combining alcohol use data from the Global Information System on Alcohol and Health with corresponding relative risk estimates from meta-analyses. The mortality and health data were obtained from the Global Health Observatory. Among people 69 years of age and younger in 2016, 2.0 million deaths and 117.2 million Disability Adjusted Life Years (DALYs) lost were attributable to alcohol consumption, representing 7.1% and 5.5% of all deaths and DALYs lost in that year, respectively. The leading causes of the burden of alcohol-attributable deaths were cirrhosis of the liver (457,000 deaths), road injuries (338,000 deaths), and tuberculosis (190,000 deaths). The numbers of premature deaths per 100,000 people were highest in Eastern Europe (155.8 deaths per 100,000), Central Europe (52.3 deaths per 100,000 people), and Western sub-Saharan Africa (48.7 deaths per 100,000). A large portion of the burden of disease caused by alcohol among people 69 years of age and younger is preventable through the implementation of cost-effective alcohol policies such as increases in taxation.     

Potential cost-effectiveness of vaccination for rotavirus gastroenteritis in eight Latin American and Caribbean countries.

OBJECTIVES: To estimate the costs, benefits and cost-effectiveness of vaccination for rotavirus gastroenteritis in eight Latin American and Caribbean countries: Argentina, Brazil, Chile, the Dominican Republic, Honduras, Mexico, Panama, and Venezuela. METHODS: An economic model was constructed to estimate the cost-effectiveness of vaccination from the health care system perspective, using national administrative and published epidemiological evidence, country-specific cost estimates, and vaccine efficacy data. The model was applied to the first five years of life for the 2003 birth cohort in each country. The main health outcome was the disability-adjusted life year (DALY), and the main summary measure was the incremental cost per DALY averted. A 3% discount rate was used for all predicted costs and benefits. Sensitivity analyses evaluated the impact of uncertainty regarding key variables on cost-effectiveness estimates. RESULTS: According to the estimates obtained with the economic model, vaccination would prevent more than 65% of the medical visits, deaths, and treatment costs associated with rotavirus gastroenteritis in the eight countries analyzed here. At a cost of US$ 24 per course (for a two-dose vaccine), the incremental cost-effectiveness ratio ranged from 269 US dollars/DALY in Honduras to 10,656 US dollars/DALY in Chile. Cost-effectiveness ratios were sensitive to assumptions about vaccine price, mortality, and vaccine efficacy. CONCLUSIONS: Vaccination would effectively reduce the disease burden and health care costs of rotavirus gastroenteritis in the Latin American and Caribbean countries analyzed here. From the health care system perspective, universal vaccination of infants is predicted to be cost-effective, based on current standards.     

A comparison of cancer burden and research spending reveals discrepancies in the distribution of research funding

ABSTRACT: BACKGROUND: Ideally, the distribution of research funding for different types of cancer should be equitable with respect to the societal burden each type of cancer imposes. These burdens can be estimated in a variety of ways; "Years of Life Lost" (YLL) measures the severity of death in regard to the age it occurs, "Disability-Adjusted Life-Years" (DALY) estimates the effects of non-lethal disabilities incurred by disease and economic metrics focus on the losses to tax revenue, productivity or direct medical expenses. We compared research funding from the National Cancer Institute (NCI) to a variety of burden metrics for the most common types of cancer to identify mismatches between spending and societal burden. METHODS: Research funding levels were obtained from the NCI website and information for societal health and economic burdens were collected from government databases and published reports. We calculated the funding levels per unit burden for a wide range of different cancers and burden metrics and compared these values to identify discrepancies. RESULTS: Our analysis reveals a considerable mismatch between funding levels and burden. Some cancers are funded at levels far higher than their relative burden suggests (breast cancer, prostate cancer, and leukemia) while other cancers appear underfunded (bladder, esophageal, liver, oral, pancreatic, stomach, and uterine cancers). CONCLUSIONS: These discrepancies indicate that an improved method of health care research funding allocation should be investigated to better match funding levels to societal burden.