Warum ist die „Anzahl vorzeitiger Todesfälle durch Umweltexpositionen“ nicht angemessen quantifizierbar?

2019 ◽  
Vol 81 (02) ◽  
pp. 144-149
Author(s):  
Peter Morfeld ◽  
Thomas Erren
Keyword(s):  
Public Health ◽  
Burden Of Disease ◽  
Disability Adjusted Life Years ◽  
Disability Adjusted Life ◽  
Life Years

ZusammenfassungIn epidemiologischen Studien und deren Anwendung bei Schadstoffregulierungen (z. B. durch WHO, USA, EU) werden Wirkungen von Umweltexpositionen auf Bevölkerungen („Burden Of Disease“, „Krankheitslast“) oft mittels der verursachten „Anzahl vorzeitiger Todesfälle“, d. h. der durch die Exposition zeitlich vorverlagerten Todesfälle, quantifiziert. Ein aktuelles Beispiel ist die Studie von Schneider et al. zu Krankheitslasten durch Stickstoffdioxid (NO2)-Exposition in Deutschland, durchgeführt im Auftrag des Umweltbundesamtes. Die Autoren ermittelten den Anteil der durch die Exposition verursachten vorzeitigen Todesfälle mittels der „Attributablen Fraktion“ (AF). Gleichwohl können die wahren Zahlen vorzeitiger Todesfälle durch NO2 viel größer oder kleiner sein. Tatsächlich hatten Robins und Greenland bereits 1989 gezeigt, dass der AF-Ansatz nicht angemessen ist. Trotz der weitreichenden Bedeutung für Epidemiologie und Public Health wurde ihre wegweisende Arbeit nicht adäquat berücksichtigt, möglicherweise aufgrund der anspruchsvollen mathematischen Argumentation. Unser Beitrag erläutert – mit einfachen Methoden – unbeachtete aber bedeutende Fallstricke. Wir empfehlen, auf das Konzept der „Anzahl vorzeitiger Todesfälle“ zu verzichten und stattdessen die durch die Exposition verlorene Lebenszeit anzugeben, berechnet pro Person. Diese sollte aber nicht für unterschiedliche Todesursachen (Erkrankungen) und/oder Altersverteilungen aufgeschlüsselt werden. Wir zeigen zudem, dass „Disability Adjusted Life Years“ (DALY) kein angemessenes Maß sind, um Expositionswirkungen in der Bevölkerung zu bewerten.

Identifying Public Health Problems

2018 ◽  
Author(s):  
Scott Burris ◽  
Micah L. Berman ◽  
Matthew Penn, and ◽  
Tara Ramanathan Holiday
Keyword(s):  
Public Health ◽  
Health Problems ◽  
Health Priorities ◽  
Disability Adjusted Life Years ◽  
Quality Adjusted Life Years ◽  
Disability Adjusted Life ◽  
Life Years ◽  
Study Designs ◽  
Quality Adjusted Life

Chapter 5 discusses the use of epidemiology to identify the source of public health problems and inform policymaking. It uses a case study to illustrate how researchers, policymakers, and practitioners detect diseases, identify their sources, determine the extent of an outbreak, and prevent new infections. The chapter also defines key measures in epidemiology that can indicate public health priorities, including morbidity and mortality, years of potential life lost, and measures of lifetime impacts, including disability-adjusted life years and quality-adjusted life years. Finally, the chapter reviews epidemiological study designs, differentiating between experimental and observational studies, to show how to interpret data and identify limitations.

Examination of incidence, mortality and disability-adjusted life years and risk factors of breast cancer in 49 Asian countries, 1990–2019: estimates from Global Burden of Disease Study 2019

2021 ◽  
Author(s):  
Rajesh Sharma
Keyword(s):  
Breast Cancer ◽  
Risk Factors ◽  
Mortality Rate ◽  
Burden Of Disease ◽  
Global Burden ◽  
Disability Adjusted Life Years ◽  
Asian Countries ◽  
Disability Adjusted Life ◽  
Life Years ◽  
Standardized Mortality Rate

Abstract Background This study presents an up-to-date, comprehensive and comparative examination of breast cancer’s temporal patterns in females in Asia in last three decades. Methods The estimates of incidence, mortality, disability-adjusted-life-years and risk factors of breast cancer in females in 49 Asian countries were retrieved from Global Burden of Disease 2019 study. Results In Asia, female breast cancer incidence grew from 245 045[226 259–265 260] in 1990 to 914 878[815 789–1025 502] in 2019 with age-standardized incidence rate rising from 21.2/100 000[19.6–22.9] to 35.9/100 000[32.0–40.2] between 1990 and 2019. The death counts more than doubled from 136 665[126 094–148 380] to 337 822[301 454–375 251]. The age-standardized mortality rate rose marginally between 1990 and 2019 (1990: 12.1[11.0–13.1]; 2019: 13.4[12.0–14.9]). In 2019, age-standardized incidence rate varied from 17.2/100 000[13.95–21.4] in Mongolia to 122.5[92.1–160.7] in Lebanon and the age-standardized mortality rate varied 4-fold from 8.0/100 000 [7.2–8.8] in South Korea to 51.9[39.0–69.8] in Pakistan. High body mass index (5.6%), high fasting plasma glucose (5.6%) and secondhand smoke (3.5%) were the main contributory risk factors to all-age disability-adjusted-life-years due to breast cancer in Asia. Conclusion With growing incidence, escalating dietary and behavioural risk factors and lower survival rates due to late-disease presentation in low- and medium-income countries of Asia, breast cancer has become a significant public health threat. Its rising burden calls for increasing breast cancer awareness, preventive measures, early-stage detection and cost-effective therapeutics in Asia.

Assessing antiretroviral therapy success in HIV/AIDS morbidity and mortality trends in Brazil, 1990–2017: an interrupted time series study

2020 ◽  
pp. 095646242095298
Author(s):  
Augusto Cesar Lara de Sousa ◽  
Tatiana de Araujo Eleuterio ◽  
José Victor Afonso Coutinho ◽  
Raphael Mendonça Guimarães
Keyword(s):  
Time Series ◽  
Antiretroviral Therapy ◽  
Burden Of Disease ◽  
Interrupted Time Series ◽  
People Living With Hiv ◽  
Disability Adjusted Life Years ◽  
Disability Adjusted Life ◽  
Life Years ◽  
The Impact ◽  
Hiv Aids

To describe the trends of HIV/AIDS metrics related to the burden of disease for Brazil between 1990 and 2017 we conducted a timeseries analysis for HIV/AIDS indicators by extracting data from the Global Burden of Disease study. We calculated traditional prevalence, incidence and mortality rates, the number of years lost by HIV-related deaths (YLL) and disability (YLD), and disability-adjusted life years (DALY). We estimated time series models and assessed the impact of highly active antiretroviral therapy (HAART) on the same indicators. In the set of disability-adjusted life years (DALY), the highest weight of its magnitude was due to YLL. There was a decline, especially after 1996, of DALY, mortality and YLL for HIV/AIDS. However, YLD, incidence, and prevalence increased over the same period. Also, the analysis of interrupted time series showed that the introduction of HAART into health policy had a significant impact on indicators, especially for DALY and YLL. We need to assess the quality of life of people living with HIV, especially among older adults. In addition, we need to focus on primary prevention, emphasizing methods to avoid infection and public policies should reflect this.

Life Years at Stake

2019 ◽  
pp. 48-60
Author(s):  
Andreas Mogensen
Keyword(s):  
Life Expectancy ◽  
Global Health ◽  
Burden Of Disease ◽  
Global Burden ◽  
Years Of Life Lost ◽  
Disability Adjusted Life Years ◽  
Disability Adjusted Life ◽  
Life Years ◽  
Ethical Basis

In quantifying the global burden of disease in terms of Disability-Adjusted Life Years (DALYs), we must determine both Years of Life Lost (YLLs) and Years Lost to Disability (YLDs). In setting priorities for global health, many have felt that YLLs should not always simply equal life expectancy at death. To this end, Dean Jamison and colleagues recommend the use of a DALY metric that incorporates Acquisition of Life Potential (ALP). When an individual dies, the YLLs that we would otherwise count are multiplied by the value of the ALP function, which rises gradually from 0 to 1 during the first stages of an individual’s life. Jamison et al. do not provide a detailed philosophical justification for the use of gradual ALP. In this chapter I explain why I believe the Time-Relative Interest Account represents the most plausible ethical basis for the ALP approach and describe how we might model ALP in light of this account.

The global unmet need of congenital cardiac care: a quantitative analysis of the global burden of disease

2020 ◽  
Vol 30 (11) ◽  
pp. 1688-1693 ◽  
Author(s):  
Dominique Vervoort ◽  
Marcelo Cardarelli
Keyword(s):  
Burden Of Disease ◽  
Unmet Need ◽  
Morbidity And Mortality ◽  
Global Burden Of Disease ◽  
Cardiac Care ◽  
Global Burden ◽  
Disability Adjusted Life Years ◽  
Disability Adjusted Life ◽  
Life Years ◽  
The World

AbstractBackground:CHDs are one of the most frequent congenital malformations, affecting one in hundred live births. In total, 70% will require treatment in the first year of life, but over 90% of cases in low- and middle-income countries receive no treatment or suboptimal treatment. As a result, CHDs are responsible for 66% of preventable deaths due to congenital malformations in low- and middle-income countries. This study examines the unmet need of congenital cardiac care around the world based on the global burden of disease.Materials and methods:CHD morbidity and mortality data for 2006, 2011, and 2016 were collected from the Institute for Health Metrics and Evaluation Global Burden of Disease Results Tool and analysed longitudinally to assess trends in excess morbidity and mortality.Results:Between 2006 and 2016, a 20.7% reduction in excess disability-adjusted life years and 20.6% reduction in excess deaths due to CHDs were observed for children under 15. In 2016, excess global morbidity and mortality due to CHDs remained high with 14,788,418.7 disability-adjusted life years and 171,761.8 paediatric deaths, respectively. In total, 90.2% of disability-adjusted life years and 91.2% of deaths were considered excess.Conclusion:This study illustrates the unmet need of congenital cardiac care around the world. Progress has been made to reduce morbidity and mortality due to CHDs but remains high and largely treatable around the world. Limited academic attention for global paediatric cardiac care magnifies the lack of progress in this area.

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