Ethical Dimensions of the Global Burden of Disease

Measuring the Global Burden of Disease ◽

10.1093/med/9780190082543.003.0003 ◽

2020 ◽

pp. 24-48

Author(s):

Christopher J. L. Murray ◽

S. Andrew Schroeder

Keyword(s):

Health Outcomes ◽

Burden Of Disease ◽

Personal Responsibility ◽

Epidemiological Studies ◽

Global Burden Of Disease ◽

Global Burden ◽

Health States ◽

Complex Information ◽

Disease Study ◽

Multiple Domains

This chapter suggests that descriptive epidemiological studies like the Global Burden of Disease Study can usefully be divided into four tasks: describing individuals’ health states over time, assessing their health states under a range of counterfactual scenarios, summarizing the information collected, and then packaging it for presentation. The authors show that each of these tasks raises important and challenging ethical questions. They comment on some of the philosophical issues involved in measuring health states, attributing causes to health outcomes, choosing the counterfactual against which to assess causes, aggregating and summarizing complex information across multiple domains, discounting, age-weighting, handling fetal deaths, measuring health inequalities, representing uncertainty, and assessing personal responsibility for health outcomes.

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Measuring the Global Burden of Disease

10.1093/med/9780190082543.001.0001 ◽

2020 ◽

Keyword(s):

Burden Of Disease ◽

Philosophy Of Medicine ◽

Epidemiological Data ◽

Global Burden Of Disease ◽

Global Burden ◽

Complex Data ◽

Health States ◽

Research Collaborations ◽

Disease Study ◽

Philosophical Questions

In this volume, a group of leading philosophers, economists, epidemiologists, and policy scholars continue a twenty-year discussion of philosophical questions connected to the Global Burden of Disease Study (GBD), one of the largest-scale research collaborations in global health. Chapters explore issues in ethics, political philosophy, metaphysics, the philosophy of economics, and the philosophy of medicine. Some chapters identify previously unappreciated aspects of the GBD, including the way it handles causation and aggregates complex data while others offer fresh perspectives on frequently discussed topics such as discounting, age-weighting, and the valuation of health states. The volume concludes with a set of chapters discussing how epidemiological data should and shouldn’t be used.

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Depressive disorders in Brazil: results from the Global Burden of Disease Study 2017

10.21203/rs.3.rs-28450/v1 ◽

2020 ◽

Author(s):

Cecília Silva Costa Bonadiman ◽

Deborah Carvalho Malta ◽

Valéria Maria de Azeredo Passos ◽

Mohsen Naghavi ◽

Ana Paula Melo

Keyword(s):

Burden Of Disease ◽

Depressive Disorders ◽

Epidemiological Studies ◽

Global Burden Of Disease ◽

Global Burden ◽

Adult Women ◽

Santa Catarina ◽

Uncertainty Interval ◽

Disability Adjusted Life ◽

Disease Study

Abstract Background Depression is one of the major causes of disability worldwide. The objective of this study was to analyze the results of the Global Burden of Disease Study 2017 (GBD-2017) for depressive disorders in Brazil and its Federated Units (FUs) in 1990 and 2017. Methods We used GBD-2017 study methodology to evaluate the prevalence estimates, the disability-adjusted life-year (DALY) and the years lived with disability (YLDs) for depressive disorders, which include major depressive disorder and dysthymia. The YLD estimates and the position of these disorders in the DALY and YLD rankings were compared to those of seven other countries. The observed versus expected YLD, based on the sociodemographic index (SDI), were compared. Results In GBD-2017, the prevalence of depressive disorders in Brazil was 3.30% (95% uncertainty interval [UI]: 3.08 to 3.57), ranging from 3.79% (3.53 to 4.09) in Santa Catarina to 2.78% in Pará (2.56 to 3.03), with significant differences between the Federated Units. From 1990 to 2017, there was an increase in number of YLD (55.19%, 49.57 to 60.73), but a decrease in the age-standardized rates (-9.01%, -11.66 to -6.31). The highest proportion of YLD was observed in the age range of 15–64 years and among females. These disorders rank 4th and 13th as leading causes of YLD and DALY, respectively, in Brazil. In the other countries evaluated, the ranking of these disorders in the YLD classification was close to Brazil´s, while in the DALY classification, there was higher variability. All countries had YLD rates similar to the overall rate. The observed/expected YLD ratio ranged from 0.81 in Pará to 1.16 in Santa Catarina. Morbidity of depressive disorders was not associated with SDI. Conclusions Depressive disorders have been responsible for a high disability burden since 1990, especially in adult women living in the Southern region of the country. The number of people affected by these disorders in the country tends to increase, requiring more investment in mental health aimed at advancements and quality of services. The epidemiological studies of these disorders throughout the national territory can contribute to this planning and to making the Brazilian health system more equitable.

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Depressive disorders in Brazil: results from the Global Burden of Disease Study 2017

Population Health Metrics ◽

10.1186/s12963-020-00204-5 ◽

2020 ◽

Vol 18 (S1) ◽

Author(s):

Cecília Silva Costa Bonadiman ◽

Deborah Carvalho Malta ◽

Valéria Maria de Azeredo Passos ◽

Mohsen Naghavi ◽

Ana Paula Souto Melo

Keyword(s):

Burden Of Disease ◽

Depressive Disorders ◽

Epidemiological Studies ◽

Global Burden Of Disease ◽

Global Burden ◽

Adult Women ◽

Santa Catarina ◽

Uncertainty Interval ◽

Disability Adjusted Life ◽

Disease Study

Abstract Background Depression is one of the major causes of disability worldwide. The objective of this study was to analyze the results of the Global Burden of Disease Study 2017 (GBD-2017) for depressive disorders in Brazil and its Federated Units (FUs) in 1990 and 2017. Methods We used GBD-2017 study methodology to evaluate the prevalence estimates, the disability-adjusted life-year (DALY), and the years lived with disability (YLDs) for depressive disorders, which include major depressive disorder and dysthymia. The YLD estimates and the position of these disorders in the DALY and YLD rankings were compared to those of seven other countries. The observed versus expected YLD, based on the sociodemographic index (SDI), were compared. Results In GBD-2017, the prevalence of depressive disorders in Brazil was 3.30% (95% uncertainty interval [UI]: 3.08 to 3.57), ranging from 3.79% (3.53 to 4.09) in Santa Catarina to 2.78% in Pará (2.56 to 3.03), with significant differences between the Federated Units. From 1990 to 2017, there was an increase in number of YLD (55.19%, 49.57 to 60.73), but a decrease in the age-standardized rates (− 9.01%, − 11.66 to − 6.31). The highest proportion of YLD was observed in the age range of 15–64 years and among females. These disorders rank 4th and 13th as leading causes of YLD and DALY, respectively, in Brazil. In the other countries evaluated, the ranking of these disorders in the YLD classification was close to Brazil’s, while in the DALY classification, there was higher variability. All countries had YLD rates similar to the overall rate. The observed/expected YLD ratio ranged from 0.81 in Pará to 1.16 in Santa Catarina. Morbidity of depressive disorders was not associated with SDI. Conclusions Depressive disorders have been responsible for a high disability burden since 1990, especially in adult women living in the Southern region of the country. The number of people affected by these disorders in the country tends to increase, requiring more investment in mental health aimed at advancements and quality of services. The epidemiological studies of these disorders throughout the national territory can contribute to this planning and to making the Brazilian health system more equitable.

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