scholarly journals Conflict-related intentional injuries in Baghdad, Iraq, 2003–2014: A modeling study and proposed method for calculating burden of injury in conflict

PLoS Medicine ◽  
2021 ◽  
Vol 18 (8) ◽  
pp. e1003673
Author(s):  
Guy W. Jensen ◽  
Riyadh Lafta ◽  
Gilbert Burnham ◽  
Amy Hagopian ◽  
Noah Simon ◽  
...  
Keyword(s):  
Life Expectancy ◽  
Health Effects ◽  
Population Health ◽  
Burden Of Disease ◽  
Household Composition ◽  
Years Of Life Lost ◽  
Intentional Injuries ◽  
Total Burden ◽  
Modeling Study

Background Previous research has focused on the mortality associated with armed conflict as the primary measure of the population health effects of war. However, mortality only demonstrates part of the burden placed on a population by conflict. Injuries and resultant disabilities also have long-term effects on a population and are not accounted for in estimates that focus solely on mortality. Our aim was to demonstrate a new method to describe the effects of both lives lost, and years of disability generated by a given conflict, with data from the US-led 2003 invasion and subsequent occupation of Iraq. Methods and findings Our data come from interviews conducted in 2014 in 900 Baghdad households containing 5,148 persons. The average household size was 5.72 persons. The majority of the population (55.8%) were between the ages of 19 and 60. Household composition was evenly divided between males and females. Household sample collection was based on methodology previously designed for surveying households in war zones. Survey questions were answered by the head of household or senior adult present. The questions included year the injury occurred, the mechanism of injury, the body parts injured, whether injury resulted in disability and, if so, the length of disability. We present this modeling study to offer an innovative methodology for measuring “years lived with disability” (YLDs) and “years of life lost” (YLLs) attributable to conflict-related intentional injuries, using the Global Burden of Disease (GBD) approach. YLDs were calculated with disability weights, and YLLs were calculated by comparing the age at death to the GBD standard life table to calculate remaining life expectancy. Calculations were also performed using Iraq-specific life expectancy for comparison. We calculated a burden of injury of 5.6 million disability-adjusted life years (DALYs) lost due to conflict-related injuries in Baghdad from 2003 to 2014. The majority of DALYs lost were attributable to YLLs, rather than YLDs, 4.99 million YLLs lost (95% uncertainty interval (UI) 3.87 million to 6.13 million) versus 616,000 YLDs lost (95% UI 399,000 to 894,000). Cause-based analysis demonstrated that more DALYs were lost to due to gunshot wounds (57%) than any other cause. Our study has several limitations. Recall bias regarding the reporting and attribution of injuries is possible. Second, we have no data past the time of the interview, so we assumed individuals with ongoing disability at the end of data collection would not recover, possibly counting more disability for injuries occurring later. Additionally, incomplete data could have led to misclassification of deaths, resulting in an underestimation of the total burden of injury. Conclusions In this study, we propose a methodology to perform burden of disease calculations for conflict-related injuries (expressed in DALYs) in Baghdad from 2003 to 2014. We go beyond previous reports of simple mortality to assess long-term population health effects of conflict-related intentional injuries. Ongoing disability is, in cross section, a relatively small 10% of the total burden. Yet, this small proportion creates years of demands on the health system, persistent limitations in earning capacity, and continuing burdens of care provision on family members.

scholarly journals 32.L. Workshop: Deconstructing the DALY: step by step guide to calculating YLL and YLD

2020 ◽  
Vol 30 (Supplement_5) ◽  
Author(s):  
◽  
Keyword(s):  
Population Health ◽  
Burden Of Disease ◽  
Local Population ◽  
Real Life ◽  
Estimation Methods ◽  
Years Of Life Lost ◽  
Supporting Evidence ◽  
Methodological Choices ◽  
Multiple Components ◽  
Life Years

Abstract A Burden of Disease (BoD) approach can be used to summarise the debilitating effects of morbidity and premature mortality in a population in a consistent and comparable manner. Summary measures of population health such as the Disability-Adjusted Life Year (DALY) have become key metrics for quantifying burden of disease. DALYs quantify the health gap between a life lived in perfect health and current health status, as the number of healthy life years lost due to illness (Years Lived with Disability, YLDs) and premature death (Years of Life Lost, YLLs). DALYs combine the effects of morbidity and mortality in an equitable way, and can therefore be used to identify the leading causes of disease or injury that cause BoD and to quantify the relative importance of specific risk factors. BoD studies are becoming an increasingly popular way to assess national and local population health as a means to influence national and local policy decisions. The increasing prominence of the burden of disease approach, however, comes at a cost. Calculations of DALYs involve multiple components and as such can be difficult for people to interpret. Burden of disease methodology is complex and highly data intensive, which has led to major disparities across researchers and nations in their capacity to perform studies, to interpret the soundness of available estimates, or to evidence and advocate for the use of particular methodological choices. In this skills-building seminar, we will give an overview of the methodology of calculating the DALY. It will outline the single steps to be undertaken, and the necessary assumptions that have to be taken, on the way to the calculation of the DALYs. This workshop will be supported by technical presentations from burden of disease experts about different choices of estimation methods to calculate both the fatal burden (YLL) and the non-fatal burden (YLD). Throughout the presentations, cerebrovascular disease will be used as a case study, giving a complete, real-life example of how DALYs are calculated. Overall, the aim is to demonstrate the importance of the choices researchers make when designing and interpreting BoD studies as a means of supporting evidence-based decision making. The workshop will foresee ample time for interaction with the audience and discussion of the implications of the different methodological choices. Key messages Although burden of disease methodology is complex, with calculations of DALYs involving multiple components, simple roadmaps can be created to enhance methodological knowledge. The choices and assumptions researchers make are important when designing and interpreting burden of disease studies.

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.

scholarly journals Global, Regional, National, and Subnational Big Data to Inform Health Equity Research: Perspectives from the Global Burden of Disease Study 2017

2019 ◽  
Vol 29 (Suppl 1) ◽  
pp. 159-172 ◽  
Author(s):  
Ali H. Mokdad ◽  
George A. Mensah ◽  
Varsha Krish ◽  
Scott D. Glenn ◽  
Molly K. Miller-Petrie ◽  
...  
Keyword(s):  
Life Expectancy ◽  
Burden Of Disease ◽  
High Body Mass Index ◽  
Global Burden Of Disease ◽  
Global Burden ◽  
Years Of Life Lost ◽  
Healthy Life ◽  
Research Perspectives ◽  
Life Years ◽  
Disease Study

Objectives: Everyone deserves a long and healthy life, but in reality, health outcomes differ across populations. We use results from the Global Burden of Disease Study 2017 (GBD 2017) to report patterns in the burden of diseases, injuries, and risks at the global, regional, national, and subnational level, and by sociodemographic index (SDI), from 1990 to 2017.Design: GBD 2017 undertook a systematic analysis of published studies and available data providing information on prevalence, incidence, remission, and excess mortal­ity. We computed prevalence, incidence, mortality, life expectancy, healthy life expectancy, years of life lost due to prema­ture mortality, years lived with disability, and disability-adjusted life years with 95% uncertainty intervals for 23 age groups, both sexes, and 918 locations, including 195 countries and territories and subnational locations for 16 countries from 1990 to 2017. We also computed SDI, a summary indicator combining measures of income, education, and fertility.Results: There were wide disparities in the burden of disease by SDI, with smaller burdens in affluent countries and in specific regions within countries. Select diseases and risks, such as drug use disorders, high blood pressure, high body mass index, diet, high fasting plasma glucose, smoking, and alco­hol use disorders warrant increased global attention and indicate a need for greater investment in prevention and treatment across the life course.Conclusions: Policymakers need a com­prehensive picture of what risks and causes result in disability and death. The GBD provides the means to quantify health loss: these findings can be used to examine root causes of disparities and develop pro­grams to improve health and health equity.Ethn Dis. 2019;29(Suppl 1): 159-172; doi:10.18865/ed.29.S1.159.

scholarly journals Premature Adult Mortality and Years of Life Lost Attributed to Long-Term Exposure to Ambient Particulate Matter Pollution and Potential for Mitigating Adverse Health Effects in Tuzla and Lukavac, Bosnia and Herzegovina

Atmosphere ◽  
2020 ◽  
Vol 11 (10) ◽  
pp. 1107
Author(s):  
Vlatka Matkovic ◽  
Maida Mulić ◽  
Selma Azabagić ◽  
Marija Jevtić
Keyword(s):  
Air Pollution ◽  
Air Quality ◽  
Life Expectancy ◽  
Health Effects ◽  
Bosnia And Herzegovina ◽  
Ambient Air ◽  
World Health ◽  
Years Of Life Lost ◽  
Adverse Health Effects ◽  
Adverse Health

Ambient air pollution is one of eight global risk factors for deaths and accounts for 38.44 all causes death rates attributable to ambient PM pollution, while in Bosnia and Herzegovina, it is 58.37. We have estimated health endpoints and possible gains if two policy scenarios were implemented and air pollution reduction achieved. Real-world health and recorded PM pollution data for 2018 were used for assessing the health impacts and possible gains. Calculations were performed with WHO AirQ+ software against two scenarios with cut-off levels at country-legal values and WHO air quality recommendations. Ambient PM2.5 pollution is responsible for 16.20% and 22.77% of all-cause mortality among adults in Tuzla and Lukavac, respectively. Our data show that life expectancy could increase by 2.1 and 2.4 years for those cities. In the pollution hotspots, in reality, there is a wide gap in what is observed and the implementation of the legally binding air quality limit values and, thus, adverse health effects. Considerable health gains and life expectancy are possible if legal or health scenarios in polluted cities were achieved. This estimate might be useful in providing additional health burden evidence as a key component for a clean air policy and action plans.

Forecasting the extent of future public health challenges using the Scottish Burden of Disease study

2020 ◽  
Vol 30 (Supplement_5) ◽  
Author(s):  
G M A Wyper ◽  
E Fletcher ◽  
I Grant ◽  
G McCartney ◽  
D L Stockton
Keyword(s):  
Public Health ◽  
Population Health ◽  
Burden Of Disease ◽  
Years Of Life Lost ◽  
Ageing Population ◽  
Health Trends ◽  
Life Years ◽  
The Future ◽  
Public Health Challenges ◽  
Disease Study

Abstract Background Over the next 25 years in Scotland there is expected to be negative natural change in population growth in a rapidly ageing population. Recent evidence has highlighted the slowing of life expectancy gains and worsening trends in self-assessed general health. We have adapted the Scottish Burden of Disease study to forecast how demographic and health trends will shape future public health challenges. This is important in order to inform policy, service and workforce planning to meet anticipated needs. Methods For a baseline period of 2014-16 Disability-Adjusted Life Years (DALYs) were estimated for 132 causes of burden using routine data sources and patient-level record linkage techniques. Disability weights and disease models used to calculate Years Lived with Disability (YLD) were largely based on those from the Global Burden of Disease study, with life tables used to facilitate calculations of Years of Life Lost (YLL). The leading 20 causes were identified and trends in the occurrence of morbidity and mortality are currently being estimated up until 2019, and forecast to 2040, using age-period-cohort modelling. Crude and age-standardised rates will be used to monitor changes due to demography and exposure to the wider social determinants of health. Results In 2014-16, the leading causes of burden were ischaemic heart disease, neck and low back pain, depression, lung cancer and cerebrovascular disease. The leading 20 causes represented 68% of all-cause DALYs with ill-health and disability causing almost half of the burden. Conclusions Insights of the future trajectory of population health equip us with strong evidence to influence the need for a strong policy response on prevention. Estimates of the future occurrence of morbidities can be embedded in planning to ensure that services and the care workforce are proportionately designed to meet the increasing needs of a vulnerable ageing population. Key messages The most recent assessment highlighted that non-fatal and fatal health states approximately contribute equally to the overall disease burden in Scotland. Evidencing how future demographic and population health trends interact allows us to ensure that policy responses, care services and the care workforce can be designed based on anticipated needs.

scholarly journals The burden of disease among Brazilian older adults and the challenge for health policies. Results of the Global Burden of Disease Study 2017

2020 ◽  
Author(s):  
VALÉRIA MARIA DE AZEREDO PASSOS ◽  
Ana Paula Silva Champs ◽  
Renato Teixeira ◽  
Maria Fernanda Furtado Lima-Costa ◽  
Renata Kirkwood ◽  
...  
Keyword(s):  
Older Adults ◽  
Information System ◽  
Life Expectancy ◽  
Burden Of Disease ◽  
Health Policies ◽  
Global Burden Of Disease ◽  
Global Burden ◽  
Years Of Life Lost ◽  
Life Expectancy At Birth ◽  
Life Years

Abstract Background Brazil is the world’s fifth most populous nation, and is currently experimenting a fast demographic ageing process in a context of scarce resources and social inequalities. To understand the health profile of older adults in Brazil is fundamental for planning public policies. Methods The estimates were derived from data obtained through the collaboration between Brazilian Ministry of Health with the Institute of Health Metrics and Evaluation of the University of Washington. The Brazilian Institute of Geography and Statistics provided the population estimates. Data on causes of death came from the Mortality Information System. To calculate morbidity, population-based studies on the prevalence of diseases in Brazil were comprehensively searched, in addition to information obtained from national databases such as the Hospital Information System, the Outpatient Information System, and the Injury Information System. We presented the Global Burden of Disease (GBD) 2017 estimates among Brazilian older adults (60 + years old) for life expectancy at birth (LE), healthy life expectancy (HALE), cause-specific mortality, years of life lost (YLLs), years lived with disability (YLDs), and disability-adjusted life-years (DALYs), from 2000 to 2017. Results LE at birth significantly increased from 71.3 years (95%UI to 70.9–71.8) to 75.2 years (95%UI 74.7–75.7). There was a trend of increasing HALE, from 62.2 years (95%UI 59.54–64.5) to 65.5 years (95%UI 62.6–68.0). The proportion of DALYs among older adults increased from 7.3–10.3%. Chronic noncommunicable diseases are the leading cause of death among middle-aged and older adults, while Alzheimer's disease is a leading cause only among older adults. Mood disorders, musculoskeletal pain and hearing or vision losses are among the leading causes of disability. Conclusions The increase in LE and the decrease of the DALYs rates are probably results of the improvement of social conditions and health policies. However, the smaller increase of HALE than LE means that despite living more, people spend a substantial time of their old age with disability and illness. Preventable or potentially controllable diseases are responsible for most of the burden of disease among Brazilian older adults. Health investments are necessary to obtain longevity with quality of life in Brazil.

scholarly journals Several Effective Measures for Minus Excess Mortality of COVID-19 in Japan Including Mutual Interrelationships and Long-Term Care Facilities (LTCF)

2021 ◽  
Vol 4 (3) ◽  
pp. 191-194
Author(s):  
Hiroshi Bando
Keyword(s):  
Life Expectancy ◽  
Long Term Care ◽  
Years Of Life Lost ◽  
Term Care ◽  
Excess Death ◽  
Care Facilities ◽  
Characteristic Points ◽  
High Degree ◽  
The Impact

The impact of COVID-19 can be shown by life expectancy, excess death and total years of life lost (YLL). United States showed life expectancy minus 1.67 years, excess deaths 375,235 and total YLL 7,362,555. The excess death of Japan has remained minus value for long, in which long-term care facilities (LTCF) may contribute. LTCF has characteristic points as i) mutual interrelationships between hospitals, medical societies and prefectural offices, ii) rapid communication channels for regulatory official authorities, iii) high degree of citizenship and cooperation of all Japanese people for daily life and iv) mild lockdown without any punishment with declaration.

scholarly journals The burden of disease among Brazilian older adults and the challenge for health policies: results of the Global Burden of Disease Study 2017

2020 ◽  
Vol 18 (S1) ◽  
Author(s):  
Valéria Maria de Azeredo Passos ◽  
Ana Paula Silva Champs ◽  
Renato Teixeira ◽  
Maria Fernanda Furtado Lima-Costa ◽  
Renata Kirkwood ◽  
...  
Keyword(s):  
Older Adults ◽  
Information System ◽  
Life Expectancy ◽  
Burden Of Disease ◽  
Health Policies ◽  
Global Burden Of Disease ◽  
Global Burden ◽  
Years Of Life Lost ◽  
Life Expectancy At Birth ◽  
Life Years

Abstract Background Brazil is the world’s fifth most populous nation, and is currently experimenting a fast demographic aging process in a context of scarce resources and social inequalities. To understand the health profile of older adults in Brazil is fundamental for planning public policies. Methods The estimates were derived from data obtained through the collaboration between the Brazilian Ministry of Health and the Institute of Health Metrics and Evaluation of the University of Washington. The Brazilian Institute of Geography and Statistics provided the population estimates. Data on causes of death came from the Mortality Information System. To calculate morbidity, population-based studies on the prevalence of diseases in Brazil were comprehensively searched, in addition to information obtained from national databases such as the Hospital Information System, the Outpatient Information System, and the Injury Information System. We presented the Global Burden of Disease (GBD) 2017 estimates among Brazilian older adults (60+ years old) for life expectancy at birth (LE), healthy life expectancy (HALE), cause-specific mortality, years of life lost (YLLs), years lived with disability (YLDs), and disability-adjusted life years (DALYs), from 2000 to 2017. Results LE at birth significantly increased from 71.3 years (95% UI to 70.9-71.8) to 75.2 years (95% UI 74.7-75.7). There was a trend of increasing HALE, from 62.2 years (95% UI 59.54-64.5) to 65.5 years (95% UI 62.6-68.0). The proportion of DALYs among older adults increased from 7.3 to 10.3%. Chronic noncommunicable diseases are the leading cause of death among middle aged and older adults, while Alzheimer’s disease is a leading cause only among older adults. Mood disorders, musculoskeletal pain, and hearing or vision losses are among the leading causes of disability. Conclusions The increase in LE and the decrease of the DALYs rates are probably results of the improvement of social conditions and health policies. However, the smaller increase of HALE than LE means that despite living more, people spend a substantial time of their old age with disability and illness. Preventable or potentially controllable diseases are responsible for most of the burden of disease among Brazilian older adults. Health investments are necessary to obtain longevity with quality of life in Brazil.

The Badness of Death

2019 ◽  
pp. 33-47
Author(s):  
Ole Frithjof Norheim
Keyword(s):  
Life Expectancy ◽  
Population Health ◽  
Burden Of Disease ◽  
Life Expectancy At Birth ◽  
Disability Adjusted Life ◽  
Life Years ◽  
Life Years Lost ◽  
Badness Of Death ◽  
Disease Study

In this chapter, I discuss the Time-Relative Interest Account (TRIA) and the Life Comparative Account (LCA) and their implications for summary measures of population health and fair priority setting in health care. First, I argue that an extreme interpretation of TRIA is incompatible with the standard practice of measuring population health by life expectancy at birth as an indicator. Implementing a policy of always saving adults before children would decrease life expectancy in a population. This implication is untenable. Second, I argue that a moderate interpretation of TRIA is compatible with earlier attempts to measure the burden of disease in populations by using marginal age weights in the valuation of Disability-Adjusted Life Years lost. The authors of the Global Burden of Disease study subsequently abandoned age weights. Third, I argue that marginal age weights used for determining social priority for health improvements may be appropriate.

scholarly journals Variability in the burden of disease estimates with or without age weighting and discounting: a methodological study

BMJ Open ◽  
2019 ◽  
Vol 9 (8) ◽  
pp. e027825 ◽  
Author(s):  
Oluwaseun Egunsola ◽  
Jacques Raubenheimer ◽  
Nicholas Buckley
Keyword(s):  
Young Adults ◽  
Burden Of Disease ◽  
The Elderly ◽  
Mortality Data ◽  
Years Of Life Lost ◽  
Relative Contribution ◽  
National Burden ◽  
Acceptable Method ◽  
Total Burden ◽  
The Impact

ObjectivesThis study examines the impact of the type of method used on the estimation of the burden of diseases.DesignComparison of methods of estimating disease burden.SettingFour metrics of burden of disease estimation, namely, years of potential life lost (YPLL), non-age weighted years of life lost (YLL) without discounting and YLL with uniform or non-uniform age weighting and discounting were used to calculate the burden of selected diseases in three countries: Australia, USA and South Africa.ParticipantsMortality data for all individuals from birth were obtained from the WHO database.OutcomesThe burden of 10 common diseases with four metrices, and the relative contribution of each disease to the overall national burden when each metric is used.ResultsThere were variations in the burden of disease estimates with the four methods. The standardised YPLL estimates were higher than other methods of calculation for diseases common among young adults and lower for diseases common among the elderly. In the three countries, discounting decreased the contributions of diseases common among younger adults to the total burden of disease, while the contributions of diseases of the elderly increased. After discounting with age weighting, there were no distinct patterns for diseases of the elderly and young adults in the three countries.ConclusionsGiven the variability in the estimates of the burden of disease with different approaches, there should be transparency regarding the type of metric used and a generally acceptable method that incorporates all the relevant social values should be developed.

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