HLTC07_Lec 2 - very detailed, near-verbatim

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Health Studies
Caroline Barakat

HLTC07 Lecture 2: The Burden of Disease and Disability PY Date: Sept 19, 2012 Burden of Disease Report Look at trends Discuss DALYs For exam: not looking for us to memorize numbers o Info that is significant o Leading causes o Patterns o How is it diff between high-income and low-income o Leading cause of death of children in Africa Tutorials: standardized rates of mortality, odds ratio, relative risk ratio Slide 2: Lecture Outline Global burden of disease: o Intro/history Why do we need to find out about Global Burden of Disease? How is it usually done? How this data is aggregate and presented? Theres an update to the 2004, that was supposed to be published end of 2011 still in draft info from diff unis and centres Soon well have update which looks at trends btn 2004-2010; then we can see if the projections are where theyre supposed to be What are the main causes of death/disability? And how much do they impact diff countries? o Measures DALYs At the popn level At the individual level o Findings Slide 3: Global Burden of Disease Individual-level aggregated to generate estimates of quantities o In order to quantify and describe the burden of disease generally use aggregated data Individual level data Aggregated data o When talking about GLOBAL burden of disease, youre taking info at diff levels based on individuals and putting it together and youre aggregating and forming an estimate (based on a region, country etc;) o Essentially, were working w/ aggregated data o Problems with working w/ aggregated data: May fall with the notion of ecological fallacy; is it working, does it actually portray an accurate picture? But these are the best estimates that we have using individual data, aggregate to get estimate of general quantities Ex) proportion of the popn that suffers from particular health problem Ex) proportion of the popn that dies from specific cause 1 HLTC07 Lecture 2: The Burden of Disease and Disability PY Date: Sept 19, 2012 Limitations: (when we aggregate data at the certain level) o Difficulties in comparing indicators One region may say for ex) rates of mortality by certain categories that arent the same for another place The ease in terms of comparing diff indicators may not exist Nowadays, we do have general forms that we use Every country looks at mortality of children under the age of 12 months, under age of 5; these are indicators that seem to be generally accepted But before and different places even currently dont work as such When aggregating data, you may face certain difficulties in comparing certain indicators These are all estimates (as close as possible to reality) numbers may have been hard to compare so ppl wouldve had to resort to estimates/projections to make it work o Statistics may be partial or fragmented Ex) in some places, theres no interest in recording death rates or it could be recorded in another way rather than what the real cause is etc; - common in many places Were talking about 200+ countries and within that, many diff levels (towns, cities); and not every region does the same thing Some places captures data that is non-fatal Ex) neurological or muscular conditions how do you capture this type of info in diff countries theres no clear reporting of these types of conditions, even in developed places o Under- or over-estimates In some places, analyses of incidence, prevalence, mortality of any single cause may be under/over estimated Ties into partial fragmented data thats available Ex) person dies but ppl dont do any investigation/record why that person died These tend to be constrained within demographically plausible limits and sometimes not so internally consistent So within a region, for instance, someone may die and its clear they died of respiratory infection but theres no reason of what caused it, what kind of infection, specificity of that infection becomes the case of over/under estimation of certain condition o Require detailed and comprehensive assessments When gvts have the role to provide better healthcare to their populations, they need to set priorities, and they do set these priorities based on detailed and comprehensive assessments But the limitation wrt is how do they know that this is the most complete assessment so that they can set those priorities That becomes also a limitations in terms of what the gvts can do o All the limitations are tied in, keep in back of mind Why do we want to know about the global burden of disease? -to plan for future infrastructure at all levels 2HLTC07 Lecture 2: The Burden of Disease and Disability PY Date: Sept 19, 2012 -but at the global level, there are certain organizations whose mandate is to improve the health of popns (WHO, diff conferences of diff countries, millennium development goal goal foresets certain goals for children, ppl have to be healthy) -to meet these developmental goals we need to have good data Slide 4: WHOs GBD Study GBD started in 1990s; was first commissioned by the WHO in early 1990s to take place o It took place but wasnt very large scale o Eventually expanded done in 2002 and published 2004 GBD Goal: consistent set of estimates of mortality and morbidity by age, sex and region comparative basis First study was done based on 8 different world bank regions and was eventually expanded to diff regions and there was that distinction made high-income countries and low-income countries So when reading 2004 report, itll say how it was revised know the basics how was it expanded and why did they look for better info (injuries, other diseases etc;) New metric disability-adjusted life year (DALY) o Simultaneously quantifies the burden of the disease from premature mortality and then looks at certain diseases and looks at how many years of lost life occurred due to this disability o So puts these 2 components together: how many years were lost due to early death + how many years lost due to premature disability Main findings of the earlier report (of 1990s): o Neuropsychiatric disorders and injuries were major causes of lost years of healthy life (aka DALYs) o Non-communicable diseases, including neuropsychiatric disorders were estimated to have caused 41%
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