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Findings and implications of the Global Burden of Disease Study 2010 Royal Society, London, 14 December 2012 Professor Theo Vos School of Population Health
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Non-Fatal Health Outcomes:
Years Lived with Disability
Findings and implications of the Global Burden of Disease Study 2010Royal Society, London, 14 December 2012
Professor Theo Vos
School of Population Health
Summary of methods
Results
Reflections
Outline
2
GBD 2010 Previous method
Prevalence * DW
“True” systematic reviews and synthesis of all available data
Consistency check between disease parameters
Adjustments for comorbidity
Uncertainty quantified
DWs: paired comparisons; population surveys
3
Incidence * duration * DW
Choice of single data set for a given population/time
Consistency check between disease parameters
Comorbidity ignored
No uncertainty
DWs: panel of health experts; person trade off
New approach
3
Analytical steps
4
Systematic review
Dismod-MR
Covariates:‒ Study characteristics
• Definition• Study type• Representative?
‒ Country characteristics• GDP• Access to health
services• Conflict
‒ Adjustment data points
‒ Pooling info‒ Predicting “gaps” ‒ Consistency between
parameters
Prevalence
DisMod-MRBayesian meta-regression
5
5
Example of inconsistent data: osteoarthritis knee
6
DisMod-MRBayesian meta-regression
Prevalence
Disability weight surveys
DWs
Severity distribution
YLDsSystematic
reviewDisMod-MR
Covariates:‒ Study characteristics
• Definition• Study type• Representative?
‒ Country characteristics.• GDP• Access to health
services• Conflict
‒ Adjustment data points
‒ Pooling info‒ Predicting “gaps” ‒ Consistency between
parameters
7
Analytical steps
GBD 2010 disability weights
Large empirical effort– In-person surveys in Indonesia, Bangladesh, Tanzania, and Peru– Telephone survey in US– Internet survey
Parsimonious set of 220 health states presented as short lay descriptions prepared with expert groups
Pair-wise comparisons: “Who is the healthier?” Random set of 15 pairs for each respondent Some of the web survey respondents answered
population health equivalence questions to help anchor on scale 0-1
8
Heat maps paired comparisons
9
Best Worst
Best
Worst
First sequela in pair
Second sequela in pair
High agreement in choices between very healthy vs. unhealthy outcomes (>90%)
… or vice versa (<10%)
Split responses for similar outcomes (~50%)
9
Comparisons between surveys
10
Survey and pooled results
High degree of consistency across diverse cultural settings and respondent characteristics
11
Special analytical cases
Impairments such as vision loss and intellectual disability
‒ Outcome from many diseases and injuries
‒ Measure total distribution by underlying cause constrain to total
Injuries
‒ Cause of injury (road traffic accident or fall)
‒ Nature of injury that causes disability (head injury or fracture)
‒ Short-term and long-term disabling consequences
12
Summary of methods
Results
Reflections
13
Outline
Global YLDs per person by age and sex, 1990 and 2010
14
15
-50%
-25%
0%
25%
50%
all causes Group 1 NCD Injuries
Drivers of change in YLDs1990–2010
% change 1990-2000 % change due to change in rates
% change due to ageing % change due to population growth
33%40%
38%
5%
Percentage of YLDs in 2010by cause and age
Males Females
16
17
Percentage of YLDs in 2010by cause and region
Global YLDs ranks, 1990 and 2010
18
Prevalence and DW for top 5 conditions
Prevalence Average DW
Back pain 9% 0.14
Depression 4% 0.23
Anaemia 14% 0.04
Neck pain 5% 0.11
COPD 5% 0.10
19
Outline
Summary of methods
Results
Reflections
20
Advances
Much more data-driven process
Less researcher ‘choices’
Uncertainty
Greater involvement by disease/injury experts and understanding of methods
– …. old adagio of GBD “decoupling epidemiology from advocacy” more acute than ever ….
21
Challenges
Large heterogeneity
– True variation in disease experience
– Methodological differences
Plea for greater standardisation in data collections
Data gaps
– “Underserved” world regions
– “Underserved” diseases
– Surprising lack of data on severity and often not comparable
Plea for representative large data collections with diagnostic and severity information to allow co-morbidity adjusted severity measures
Mapping from patient derived severity measures to our “DW space”
22
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