昆明市石林县脑卒中疾病负担分析

目的分析石林县人群脑卒中的疾病负担。方法以残疾调整生命年DALYs作为疾病负担的测量指标。结果石林县脑卒中每千人口DALYs女性高于男性；60岁以上组的早死所致生命损失年YLLs伤残所致生命损失年YLDs和DALYs最大。结论应加强对石林县女性脑卒中的预防和治疗工作，降低脑卒中对人群健康的危害。     

南通市经济技术开发区居民2013年恶性肿瘤疾病负担分析

目的 分析2013年南通市经济技术开发区(开发区)恶性肿瘤的死亡流行特征及疾病负担,为恶性肿瘤防治提供科学依据。 方法 通过计算恶性肿瘤死亡率、标化死亡率、伤残调整寿命年(disability adjusted life years,DALYs)、早死所致寿命年(years of life lost,YLLs)和残疾所致寿命年(years lived with disability,YLDs)指标,分析主要恶性肿瘤的疾病负担和人群分布特征。 结果 2013年南通市开发区恶性肿瘤死亡率为209.88/10万,标化死亡率为103.20/10万。恶性肿瘤所致DALYs率为20.66/千人,男性和女性分别为26.97/千人和14.50/千人。恶性肿瘤DALYs损失以YLLs为主,占86.27%。DALYs前5位与死亡率顺位一致,依次为肺癌、肝癌、胃癌、结直肠癌和食管癌,其中男性DALYs率最高的为肝癌6.66/千人,女性DALYs率最高的是肺癌3.13/千人。 结论 肺癌和肝癌仍是危害南通市开发区居民健康的主要癌种,45岁以上人群是预防和干预的重点人群,应针对性开展筛查和防治工作,以减少疾病负担。     

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.     

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.     

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.     

Health burden in the Netherlands due to infection with thermophilic Campylobacter spp

Infection with thermophilic Campylobacter spp. usually leads to an episode of acute gastroenteritis. Occasionally, more severe diseases may be induced, notably Guillain Barré syndrome and reactive arthritis. For some, the disease may be fatal. We have integrated available data in one public health measure, the Disability Adjusted Life Year (DALY). DALYs are the sum of Years of Life Lost by premature mortality and Years Lived with Disability, weighted with a factor between 0 and 1 for the severity of illness. The mean health burden of campylobacter-associated illness in the Dutch population in the period 1990-5 is estimated as 1400 (90% CI 900-2000) DALY per year. The main determinants of health burden are acute gastroenteritis (440 DALY), gastroenteritis related mortality (310 DALY) and residual symptoms of Guillain-Barré syndrome (340 DALY). Sensitivity analysis demonstrated that alternative model assumptions produced results in the above-mentioned range.     

The burden of disease and injury in the United States 1996

Background

Burden of disease studies have been implemented in many countries using the Disability-Adjusted Life Year (DALY) to assess major health problems. Important objectives of the study were to quantify intra-country differentials in health outcomes and to place the United States situation in the international context.

Methods

We applied methods developed for the Global Burden of Disease (GBD) to data specific to the United States to compute Disability-Adjusted Life Years. Estimates are provided by age and gender for the general population of the United States and for each of the four official race groups: White; Black; American Indian or Alaskan Native; and Asian or Pacific Islander. Several adjustments of GBD methods were made: the inclusion of race; a revised list of causes; and a revised algorithm to allocate cardiovascular disease garbage codes to ischaemic heart disease. We compared the results of this analysis to international estimates published by the World Health Organization for developed and developing regions of the world.

Results

In the mid-1990s the leading sources of premature death and disability in the United States, as measured by DALYs, were: cardiovascular conditions, breast and lung cancers, depression, osteoarthritis, diabetes mellitus, and alcohol use and abuse. In addition, motor vehicle-related injuries and the HIV epidemic exacted a substantial toll on the health status of the US population, particularly among racial minorities. The major sources of death and disability in these latter populations were more similar to patterns of burden in developing rather than developed countries.

Conclusion

Estimating DALYs specifically for the United States provides a comprehensive assessment of health problems for this country compared to what is available using mortality data alone.     

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.     

Quantitative Microbial Risk Analysis to evaluate health effects of interventions in the urban water system of Accra, Ghana

A quantitative microbial risk assessment was applied to evaluate the microbial risks of the Accra Urban Water System (AUWS). The exposure assessment was based on the count of indicator organisms in waste water from open roadside drains and in water and sand samples from the beach. The predicted total disease burden generated in a representative catchment of the AUWS (Odaw Catchment) was 36,329 Disability Adjusted Life Years (DALYs) per year, of which 12 and 88% are caused by, respectively, shortcomings in the water supply system and inappropriate sanitation. The DALYs per person per year were above the WHO reference value. The open roadside drain had the highest contribution to the disease burden. Of four possible interventions evaluated for health risk reduction, the highest efficiency in terms of DALYs averted per euro invested would be achieved by providing covers for the open roadside drains.     

Using disability-adjusted life years to assess the burden of disease and injury in Rhode Island

Objectives

Disability-adjusted life years (DALYs) measure the burden of disease and injury in a population. We tested the feasibility of calculating DALYs to assess the burden of disease and injury in Rhode Island (RI).

Methods

We computed DALYs for the 2008 RI population using methods developed by the World Health Organization, Harvard University, and the World Bank. DALYs are a composite measure that sum years of life lost (YLLs) due to premature mortality with years lived with disability (YLDs). We calculated crude mortality, YLLs, YLDs, and DALYs for 90 major health conditions for RI and stratified them by gender and age. Calculations for YLLs and YLDs were based on five-year averages. We compared our results with U.S. and Los Angeles County, California, estimates.

Results

A DALYs ranking produces a different picture of RI''s disease and injury burden than does mortality-based ranking. Of 90 major health conditions assessed for RI, six of the top 10 causes for mortality and DALYs were the same, but were ranked differently: ischemic heart disease, cerebrovascular disease, Alzheimer dementia and other dementias, trachea/bronchus/lung cancer, chronic obstructive pulmonary disease, and diabetes mellitus. These six conditions accounted for 59% of deaths but only 35% of DALYs. Causes and rank orders for DALYs differed between males and females and among age groups.

Conclusions

Including nonfatal health conditions in an assessment of population health provides a different picture than traditional mortality-based assessments. This study demonstrates the feasibility and constraints of using DALYs to assess the burden of disease and injury at the state level.Mortality data have been used traditionally to identify a population''s most important health problems.¹ However, falling death rates often mean people are living longer but with years of illness and disability. Mortality measures provide incomplete information about overall population health, necessitating the development of alternate summary measures.^1,2 The World Health Organization (WHO), Harvard University, and the World Bank introduced disability-adjusted life years (DALYs) in the Global Burden of Disease (GBD) study.^3,4 DALYs reflect the years of life lost (YLLs) to premature death and the years spent in unhealthy states, combining the impacts of mortality and disability.DALYs are a “health gap” measure that represents the gap between the current health status of a population and one in which everyone lives into old age free of disease and injury.^5,6 It includes the impact of usually nonfatal conditions, such as alcohol use, mental disorders, arthritis, and injuries, and provides a different picture of population health than traditional mortality-based assessments.Several studies have implemented DALYs and published disease and injury burden reports for countries and subnational entities, ^1–3,5,7 including for the United States² and for Los Angeles (LA) County, California.³ In this study, we applied DALYs to the Rhode Island (RI) population using the GBD study methods.⁴ We estimated DALYs for major health conditions, compared DALYs results with traditional mortality measures, and assessed the benefits and limitations of estimating DALYs at the state level. To our knowledge, RI is the first U.S. state to attempt the use of DALYs to evaluate the burden of disease and injury at the state level.     

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。     

Differences in individual-level terrorism preparedness in Los Angeles County

BACKGROUND: Increasing individual preparedness for disasters, including large-scale terrorist attacks, is a significant concern of public health planners. As with natural disasters, individuals can help protect their health and safety by preparing for the emergency situation that may follow a terrorist event. Our study describes variations in preparedness among the population of Los Angeles County after the September 11, 2001 and subsequent anthrax attacks. METHODS: In 2004, the data were analyzed from the Los Angeles County Health Survey, a random-digit-dialed telephone survey of the non-institutionalized population in Los Angeles County fielded October 2002 through February 2003. RESULTS: Overall, 28.0% of respondents had emergency supplies, and 17.1% developed an emergency plan in the past year in response to the possibility of terrorism. Factors associated with having emergency supplies included African American (adjusted odds ratio [AOR] 1.8, 95% confidence interval [CI]=1.1-3.1) and Latino (AOR=1.5, 95% CI=1.0-2.4) race/ethnicity; having a household dependent aged相似文献   

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.     

Pulmonary impairment after tuberculosis and its contribution to TB burden

Background  

The health impacts of pulmonary impairment after tuberculosis (TB) treatment have not been included in assessments of TB burden. Therefore, previous global and national TB burden estimates do not reflect the full consequences of surviving TB. We assessed the burden of TB including pulmonary impairment after tuberculosis in Tarrant County, Texas using Disability-adjusted Life Years (DALYs).     

The burden of cancer in New Zealand: a comparison of incidence and DALY metrics and its relevance for ethnic disparities

Aim : Cancer burden measured in disability adjusted life years (DALYs) captures survival and disability impacts of incident cancers. In this paper, we estimate the prospective burden of disease arising from 27 cancer sites diagnosed in 2006, by sex and ethnicity; and determine how its distribution differs from that for incidence rates alone. Methods : Using a prospective approach, Markov and cancer disease models were used to estimate DALYs with inputs of population counts, incidence and excess mortality rates, disability weights, and background mortality. DALYs were discounted at 3.5% per year. Results : The age standardised Māori:non‐Māori incidence rate ratios were 1.00 for males and 1.19 for females, whereas for DALYs they were greater at 1.42 for males and 1.68 for females. The total burden of cancer for 2006 incident cases (i.e. not age standardised) was estimated to be approximately 127,000 DALYs. Breast (27%), lung (14%) and colorectal (13%) cancers for females and lung (16%), colorectal (14%), and prostate (16%) cancers for males were the top contributors. By ethnicity, Māori experienced a substantially higher burden from lung cancer (around 25% for both sexes). Conclusions: Due to Māori both having higher rates of cancers with a worse survival (e.g. lung cancer), and tending to have worse survival for each cancer site, ethnic disparities in the age‐standardised DALY burden were greater than those for incidence (rate ratios of 1.52 and 1.07 respectively, sexes pooled).     

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。     

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.     

Disease burden due to vaccinable diseases in the Spanish population aged less than 15 years old

OBJECTIVES: To estimate the burden of disease due to vaccinable diseases and the relative importance of these diseases in the health of the Spanish population aged less than 15 years old. METHODS: Disease burden was measured in disability-adjusted life years (DALYs). DALYs were computed by adding years of life lost (YLL) to years lived with disability (YLD). The DALYs of the Spanish population aged less than 15 years old were estimated for 1999 and were stratified by diseases according to the classification system of the Global Burden of Disease (adapted to the aim of the study), age group and gender. Diseases included in the childhood vaccination schedule, varicella, and pneumococcal disease were targeted for this study. The sources used were: the national mortality register to compute YLL, the Epidemiologic Surveillance National Network, hospital discharge data (CMBD) and the scientific literature to compute YLD due to vaccinable diseases, and World Health Organization estimates (Euro-A) or, when these were lacking, morbidity hospital data (Hospital Morbidity Survey) to compute the YLD due to non-vaccinable diseases. RESULTS: The burden of disease due to vaccinable diseases was 1.2% of global DALYS (the overall DALYs rate was 46,57/1,000 habitants): excluding meningococcal disease (0.5% to 3.3%), diseases included in the vaccination schedule represented 0.00% to 0.03%, depending on age groups, except meningococcal infection (between 0.5% and 3.3%). Pneumococcal meningitis represented 0.06% to 0.65% and varicella 0.00% to 0.15%, also depending on age groups. CONCLUSIONS: Disease burden due to vaccinable diseases is a good indicator of the health of the young population in Spain. This measure summarizes and combines information on mortality, morbidity and disability caused by diseases. The DALYs attributable to diseases included in the vaccination schedule demonstrate that immunization programs have achieved their goals.     

Peer Reviewed: Increasing Prevalence of Gestational Diabetes and Pregnancy-Related Hypertension in Los Angeles County,California, 1991–2003

Introduction

Gestational diabetes and pregnancy-related hypertension can lead to adverse health effects in mothers and infants. We assessed recent trends in the rates of these conditions in Los Angeles County, California.

Methods

Hospital discharge data were used to identify all women aged 15–54 years who resided in the county, had a singleton delivery from 1991 through 2003, and had gestational diabetes or pregnancy-related hypertension listed as a discharge diagnosis at the time of delivery. The prevalence of each condition was calculated by calendar year, race/ethnicity, and age group. Temporal trends in the rates were assessed by using negative binomial regression models, controlling for race/ethnicity and age. Separate models were run for each racial/ethnic and age group.

Results

The age-adjusted prevalence of gestational diabetes increased more than threefold (from 14.5 cases per 1000 women in 1991 to 47.9 cases per 1000 in 2003). The age-adjusted prevalence of pregnancy-related hypertension also increased (from 40.5 cases per 1000 in 1991 to 54.4 cases per 1000 in 2003). In the multivariable regression analysis, the annual rate increase for gestational diabetes was 8.3% overall and was highest among Hispanics (9.9%). The annual rate increase for pregnancy-related hypertension was 2.8% overall and was highest among blacks (4.8%).

Conclusion

The rates of gestational diabetes and pregnancy-related hypertension are increasing in Los Angeles County. Further research is needed to determine the causes of the observed increases and the growing racial/ethnic disparities in those rates.     

山东省主要危险因素的归因死亡和疾病负担分析

目的 定最评价部分危险因素的健康负担,以确定严重影响山东省人群健康的莺点危险因素,为疾病预防决策提供直接依据.方法 以山东省第三次死因调查资料为基础,按照全球疾病负担(GBD)研究方法计算寿命损失年(YLL)、健康寿命损失年(YLD)和伤残调整寿命年(DALY),然后根据各种危险因素的人群归因比(PAF)数据测算各种危险因素的归因死亡数和归因DALY.YLD采用间接法进行估算;19种危险PAF资料参考2001年GBD研究. 结果 山东省人群51.09%的死亡和31.83%的DALY由纳入分析的19种危险因素所致,其中高血压、吸烟、蔬菜水果摄入少、饮酒、室内燃煤污染、高胆固醇、室外空气污染、缺乏体力锻炼、超重和肥胖、不安全注射为前10种死亡危险因素,归因死亡数合计占总死亡的50.21%;饮酒、吸烟、高血压、蔬菜水果摄入少、室内燃煤污染、超重和肥胖、高胆固醇、缺乏体力锻炼、室外空气污染和缺铁性贫血为前10种疾病负担危险因素,归因DALY合计占全部疾病负担的29.04%.结论 饮酒、吸烟和高血压为严重影响山东省人群健康的重点危险因素,如有效控制这些危险因素,可显著降低人群死亡率和减轻疾病负担.