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Global disease burden

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DrZahid Khan
DrZahid Khan

This document discusses global disease burden and methods for measuring and comparing the impacts of different diseases. It introduces the Global Burden of Disease database developed by Harvard University to assess overall health loss from diseases, injuries, and risk factors using metrics like disability-adjusted life years (DALYs). DALYs consider both years of life lost due to premature mortality and years lost due to disability. The document provides examples of DALY calculations and shows data on leading causes of death and disease burden globally and in different country income levels. It discusses trends over time in life expectancy, causes of death, and population growth.

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Global Disease Burden: Dr Zahid Khan King Faisl University,KSA.
Two public health questions: • What is the total impact of disease and injury in the population? -- the overall target for public health interventions? • How do we compare the impacts of different diseases, risk factors, and interventions that affect different populations?
Ultimate Measure of Ill-health? • Death is most common • Easy to determine • Commonly tabulated • Severe problems • Everyone dies • Health never achieved • Age is clearly important • Deaths + Illness = ?
Global Burden of Disease Database • Developed at Harvard University originally for the World Bank • Extended greatly in the mid-1990s and now adopted by the World Health Organization • Dozens of countries now have NBDs
Quality Adjusted Life Years QALY • Basically the number of fully healthy life years lost to a particular disease or risk factor. • Considers the age at which the disease or death occurs and the duration and severity of any disability created.
Disability Adjusted Life Year The DALY, a kind of QALY • The only differences in the rating of a death or disability should be due to age and sex, not to income, culture, location, social class. • Everyone in the world has right to best life expectancy in world • DALY = YLL + YLD • Years of Lost Life (due to mortality) • Years Lost to Disability (due to injury & illness)
Schema for Assessing Non-fatal Health Outcomes Disease Impairment Disability Handicap Polio Paralyzed legs Inability to walk Unemployed Difficulty learning Social isolation Brain injury Mild mental retardation
Disability Adjusted Life Year The DALY,s calculation.
Sample DALY Calculations Diseases A and B • A. 100,000 children are stricken for 1 week with a disability weighting of 0.3; 2% die at 1 year old. • B. 100,000 adults are stricken for 2 years with a disability weighting of 0.6; 20% die at 80 years old. • A: YLL (= 2000 x 80) + YLD (=100k x (7/365) x 0.3) = 160,000 + 575 = 160,600 • B: YLL (= 20,000 x 1) + YLD (=100k x 2 x 0.6) = 20,000 + 120,000 = 140,000
Definitions • Impairment: loss or abnormality of psychological, physiological, or anatomical structure or function • Disability: any restriction or lack of ability to perform an activity in the manner or within the range considered normal. • Handicap: disadvantage resulting from impairment or disability that limits or prevents the fulfillment of a role that is normal (depending on age, sex, social, and cultural factors).
Deaths attributed to 19 leading factors, by country income level, 2004
Percentage of disability-adjusted life years (DALYs) attributed to 19 leading risk factors, by country income level, 2004
Changing in causes of death Percentage distribution 1909 Respiratory Diseases Cardiovascular diseases Source: WHO 1999 Other Infectious Diseases TB Diarrhoeal Diseases Injuries 1999 Cancer
Expectation of life at birth (years) Life expectancy trends 90 80 More developed 70 World 60 Less developed Least developed 50 40 30 1950 1960 1970 1980 1990 2000 2010 2020 2030 2040 2050 Period Source: Population division of the Dept. of Economic and Social Affairs, United States Secretariat (2003). World Population Prospects: The 2002 Revision Highlights. New York: United Nations.
Population growth 9 Billions 8 7 6 5 4 3 2 1 Developed countries 1 9 5 1 0 9 5 1 5 9 6 1 0 9 6 1 5 9 7 1 0 9 7 1 5 9 8 1 0 9 8 1 5 9 9 1 0 9 9 2 5 0 0 2 0 0 0 2 5 0 1 2 0 0 1 2 5 0 2 2 0 0 2 2 5 0 3 2 0 0 3 2 5 0 4 2 0 0 4 2 5 0 5 0 0 Developing countries Source: United Nations Populations Division, World Population Prospects, The 2004 Revision, medium variant.
Conclusions • Inequality • Universal coverage • Nutrition transition: high levels of child under-nutrition and adult obesity coexist • Double burden of diseases • Communicable, maternal, perinatal and nutritional conditions • Non communicable diseases • Injuries • Health promotion can play important role
Any Queries !!! • Thank You

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Global disease burden

  • 1. Global Disease Burden: Dr Zahid Khan King Faisl University,KSA.
  • 2. Two public health questions: • What is the total impact of disease and injury in the population? -- the overall target for public health interventions? • How do we compare the impacts of different diseases, risk factors, and interventions that affect different populations?
  • 3. Ultimate Measure of Ill-health? • Death is most common • Easy to determine • Commonly tabulated • Severe problems • Everyone dies • Health never achieved • Age is clearly important • Deaths + Illness = ?
  • 4. Global Burden of Disease Database • Developed at Harvard University originally for the World Bank • Extended greatly in the mid-1990s and now adopted by the World Health Organization • Dozens of countries now have NBDs
  • 5. Quality Adjusted Life Years QALY • Basically the number of fully healthy life years lost to a particular disease or risk factor. • Considers the age at which the disease or death occurs and the duration and severity of any disability created.
  • 6. Disability Adjusted Life Year The DALY, a kind of QALY • The only differences in the rating of a death or disability should be due to age and sex, not to income, culture, location, social class. • Everyone in the world has right to best life expectancy in world • DALY = YLL + YLD • Years of Lost Life (due to mortality) • Years Lost to Disability (due to injury & illness)
  • 7. Schema for Assessing Non-fatal Health Outcomes Disease Impairment Disability Handicap Polio Paralyzed legs Inability to walk Unemployed Difficulty learning Social isolation Brain injury Mild mental retardation
  • 8. Disability Adjusted Life Year The DALY,s calculation.
  • 9. Sample DALY Calculations Diseases A and B • A. 100,000 children are stricken for 1 week with a disability weighting of 0.3; 2% die at 1 year old. • B. 100,000 adults are stricken for 2 years with a disability weighting of 0.6; 20% die at 80 years old. • A: YLL (= 2000 x 80) + YLD (=100k x (7/365) x 0.3) = 160,000 + 575 = 160,600 • B: YLL (= 20,000 x 1) + YLD (=100k x 2 x 0.6) = 20,000 + 120,000 = 140,000
  • 10. Definitions • Impairment: loss or abnormality of psychological, physiological, or anatomical structure or function • Disability: any restriction or lack of ability to perform an activity in the manner or within the range considered normal. • Handicap: disadvantage resulting from impairment or disability that limits or prevents the fulfillment of a role that is normal (depending on age, sex, social, and cultural factors).
  • 11. Deaths attributed to 19 leading factors, by country income level, 2004
  • 12. Percentage of disability-adjusted life years (DALYs) attributed to 19 leading risk factors, by country income level, 2004
  • 13. Changing in causes of death Percentage distribution 1909 Respiratory Diseases Cardiovascular diseases Source: WHO 1999 Other Infectious Diseases TB Diarrhoeal Diseases Injuries 1999 Cancer
  • 14. Expectation of life at birth (years) Life expectancy trends 90 80 More developed 70 World 60 Less developed Least developed 50 40 30 1950 1960 1970 1980 1990 2000 2010 2020 2030 2040 2050 Period Source: Population division of the Dept. of Economic and Social Affairs, United States Secretariat (2003). World Population Prospects: The 2002 Revision Highlights. New York: United Nations.
  • 15. Population growth 9 Billions 8 7 6 5 4 3 2 1 Developed countries 1 9 5 1 0 9 5 1 5 9 6 1 0 9 6 1 5 9 7 1 0 9 7 1 5 9 8 1 0 9 8 1 5 9 9 1 0 9 9 2 5 0 0 2 0 0 0 2 5 0 1 2 0 0 1 2 5 0 2 2 0 0 2 2 5 0 3 2 0 0 3 2 5 0 4 2 0 0 4 2 5 0 5 0 0 Developing countries Source: United Nations Populations Division, World Population Prospects, The 2004 Revision, medium variant.
  • 16. Conclusions • Inequality • Universal coverage • Nutrition transition: high levels of child under-nutrition and adult obesity coexist • Double burden of diseases • Communicable, maternal, perinatal and nutritional conditions • Non communicable diseases • Injuries • Health promotion can play important role