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Global Burden of Disease
Chapter 3
Key Ideas
Global health community needs to shift focus from how many
people get sick to why they are sick and what can be done
Burden of disease analysis tells how much suffering and death
exists among a group
Cost-effectiveness analysis tells us how many lives we can save
with a given amount of money
Burden of Disease
How much disease and death are present in a given place or
among a group of people
How do we decide where to intervene?
Geography (e.g., Latin America)
Income (e.g., countries with low GDP)
Burden of disease analysis can help inform the kinds of policies
and investments that will have the greatest impact on disease
burden
Leading Causes of Death by Disease Category & Country
Classification
Leading Causes of Death by Economic
DevelopmentDisease/injury% Deaths in Low
Income Countries% Deaths in Middle Income Countries%
Deaths in High Income CountriesIschemic heart
disease6.113.715.6Stroke, CVD4.912.88.7Lower respiratory
infections11.35.43.8Diarrheal
diseases8.24.4XHIV/AIDS7.82.7XTuberculosis4.32.4XRoad
traffic accidentsX2.4XPrematurity, LBW3.2XX
X: Not a top 10 cause of death in the category of countries
Child Mortality Rates by Cause & Region
Leading Causes of Death by Disease &
InterventionDiseaseNumber of Deaths (millions)Percent of all
DeathsMost Relevant PoliciesHeart disease7.2512.8Nutrition,
transit, green citiesStroke6.1510.8Nutrition, transit, green
citiesPneumonia3.466.1Transit, green
citiesCOPD3.285.8Transit, green citiesDiarrhea2.464.3Sewage,
sanitation, nutritionHIV/AIDS1.783.1Preventive
practicesTuberculosis1.342.4Nutrition, medical care, housing
Alternative Ways of Measuring Life
Death at age 3 may be different than death at age 83
Conditions that do not cause death directly or cause death rarely
do not show up in mortality rankings but may still be public
health issues
e.g., Depression, migraine headaches
Potentially important components:
Years of life lost
Quality of life lived with disease
Measures of Disease Burden
Quality adjusted life year (QALY): accounts for morbidity and
mortality; one QALY is equivalent to one year lived in perfect
health
All conditions are score from 0 (death) to 1 (perfect health) and
applied to the years lived with the condition
Based on general population’s ratings
Disability adjusted life year (DALY)
Conditions scored from 0 (perfect health) to 1 (death)
Based on ratings by health experts
Highest DALY Burden by Country Categories of IncomePoorest
CountriesMiddle-Income CountriesWealthy
CountriesPneumoniaDepressionDepressionDiarrheaHeart
diseaseHeart
diseaseHIV/AIDSStrokeStrokeMalariaAccidentsAlzheimer’s
diseasePremature birthPneumoniaAlcohol
abuseDepressionEmphysemaHearing loss
Cost-effectiveness Analysis
Method to maximize the number of adjusted life years (QALYs
or DALYs) within a given budget
Cost-benefit analysis: places a dollar value on the health
outcome and compares cost of intervention to no intervention
Compares relative costs of different interventions
League table commonly constructed to visualize options and
make decisions
Validity
Internal validity: measuring variables accurately so that
conclusions reached within a study are true (valid)
Requires correct temporal (time) sequence between exposure
and outcome, accounting for other factors that could confound
the relationship
External validity: applying the results of one study to other
populations or settings
Requires making assumptions about other settings and whether
your findings can be generalized
Global Burden of DiseaseChapter 3.docx

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Global Burden of DiseaseChapter 3.docx

  • 1. Global Burden of Disease Chapter 3
  • 2.
  • 3. Key Ideas Global health community needs to shift focus from how many people get sick to why they are sick and what can be done Burden of disease analysis tells how much suffering and death exists among a group Cost-effectiveness analysis tells us how many lives we can save with a given amount of money
  • 4. Burden of Disease How much disease and death are present in a given place or among a group of people How do we decide where to intervene? Geography (e.g., Latin America) Income (e.g., countries with low GDP) Burden of disease analysis can help inform the kinds of policies and investments that will have the greatest impact on disease burden
  • 5.
  • 6. Leading Causes of Death by Disease Category & Country Classification
  • 7. Leading Causes of Death by Economic DevelopmentDisease/injury% Deaths in Low Income Countries% Deaths in Middle Income Countries% Deaths in High Income CountriesIschemic heart disease6.113.715.6Stroke, CVD4.912.88.7Lower respiratory infections11.35.43.8Diarrheal diseases8.24.4XHIV/AIDS7.82.7XTuberculosis4.32.4XRoad traffic accidentsX2.4XPrematurity, LBW3.2XX X: Not a top 10 cause of death in the category of countries
  • 8. Child Mortality Rates by Cause & Region
  • 9. Leading Causes of Death by Disease & InterventionDiseaseNumber of Deaths (millions)Percent of all
  • 10. DeathsMost Relevant PoliciesHeart disease7.2512.8Nutrition, transit, green citiesStroke6.1510.8Nutrition, transit, green citiesPneumonia3.466.1Transit, green citiesCOPD3.285.8Transit, green citiesDiarrhea2.464.3Sewage, sanitation, nutritionHIV/AIDS1.783.1Preventive practicesTuberculosis1.342.4Nutrition, medical care, housing
  • 11. Alternative Ways of Measuring Life Death at age 3 may be different than death at age 83 Conditions that do not cause death directly or cause death rarely do not show up in mortality rankings but may still be public health issues e.g., Depression, migraine headaches Potentially important components: Years of life lost Quality of life lived with disease
  • 12. Measures of Disease Burden Quality adjusted life year (QALY): accounts for morbidity and mortality; one QALY is equivalent to one year lived in perfect health All conditions are score from 0 (death) to 1 (perfect health) and applied to the years lived with the condition Based on general population’s ratings Disability adjusted life year (DALY) Conditions scored from 0 (perfect health) to 1 (death) Based on ratings by health experts
  • 13.
  • 14. Highest DALY Burden by Country Categories of IncomePoorest CountriesMiddle-Income CountriesWealthy CountriesPneumoniaDepressionDepressionDiarrheaHeart diseaseHeart diseaseHIV/AIDSStrokeStrokeMalariaAccidentsAlzheimer’s diseasePremature birthPneumoniaAlcohol abuseDepressionEmphysemaHearing loss
  • 15. Cost-effectiveness Analysis Method to maximize the number of adjusted life years (QALYs or DALYs) within a given budget Cost-benefit analysis: places a dollar value on the health outcome and compares cost of intervention to no intervention Compares relative costs of different interventions League table commonly constructed to visualize options and make decisions
  • 16. Validity Internal validity: measuring variables accurately so that conclusions reached within a study are true (valid) Requires correct temporal (time) sequence between exposure and outcome, accounting for other factors that could confound the relationship External validity: applying the results of one study to other
  • 17. populations or settings Requires making assumptions about other settings and whether your findings can be generalized