7th Task Force on Health Expectancies Meeting

Luxembourg, 2 December 2008

Dr. Enrique Loyola Health Intelligence Service

Summary measures in public healthactivities in WHO

• Two main types of measures– Health life expectancies (HALE)

• Initial estimations produced are from 2002• Initially not planned, however, due to high demand, a

next iteration update will be done in 2009

– Disability adjusted life expectancy (DALY)• Initial estimations produced for Global Burden of

Disease are from 2002• A review has just been published a few weeks ago,

including 2004 estimated data

Summary measures of healthWHO work in the recent past

Summary measures of health Global Burden of Disease 2008 (DALY)

What is new?

• In general– The 2008 version does not include a complete review and

revision of data inputs and estimates for every cause from the 2002 edition

– More recent and higher quality mortality data– Improved estimations of prevalence and incidence of

diseases• Higher number of participants - publications• Large projects – more robust estimates• Newer estimations – recent work

– African estimates involve different mix of causes– More additional emphasis in some diseases and disorders– Data available on incidence, prevalence, deaths, mortality

rates, years of life lost (YLL), years of life expectancy lost (YLD) globally and by WHO and other regional and economic assessments

Summary measures of health Global Burden of Disease 2008 (DALY)

What is new?

• Mortality– Complete update of estimated deaths by age, sex and

cause for all Member States• Includes revisions in death estimates for AIDS, wars, and

natural disasters• Latest death registration data from 112 countries• Updated country level mortality estimates for all Member

States for 17 causes of death• Incorporation of cause specific and multiple cause models for

causes of death for children under 5 and neonates, resulting in consistent cause specific estimates

• Revision of cause specific models for countries without usable death registration data and regional patterns for cause specific mortality distributions were updated for Africa

Summary measures of health Global Burden of Disease 2008 (DALY)

What is new?

• Morbidity, disability and years lost to disability (YLD) – Revised for 52 causes where updated information was

available, resulting in significant changes in some cases, while for other causes they were only projected from 2002 estimates

– Incidence and prevalence of AIDS and mortality estimates based on advances of methodologies, yielding substantial changes

• HIV infection prevalence down from 38 to 32 million globally, and deaths from 2.7 to 2 million.

• Impact of retroviral drugs on survival also taken into account.

– Updated estimates for vaccine-preventable childhood diseases

Summary measures of health Global Burden of Disease 2008 (DALY)

What is new?

• Morbidity, disability and years lost to disability (YLD)– Revised incidence and mortality estimates for malaria

forms and specifically for Plasmodium falciparum based on national reports and transmission-intensity-based models, resulting in 21% increase proportion of such deaths among children under 5 years

– Estimates of dengue fever, Japanese encephalitis and other tropical diseases were revised with data on population at risk, levels of endemicity, reported cases, case fatality and treatment coverage.

– Site-specific cancer incidence and mortality estimates were updated using revised estimates of site-specific survival probabilities and incidence distributions from IARC

Summary measures of health Global Burden of Disease 2008 (DALY)

What is new?

• Morbidity, disability and years lost to disability (YLD)– Diabetes incidence and prevalence estimates revised to

account for recently published population surveys that used oral glucose tolerance tests and WHO criteria

– Recent WHO country-level data of underweight, stunting and wasting and anaemia were used to update estimates of protein-energy malnutrition and iron-deficiency anaemia

– Incidence and prevalence estimates of alcohol disordes were revised based on a new review of post-1990 studies using high-quality survey instruments. Disability weights downwards from 0.18 to 0.122-0.137 depending on age and based on WHO MICS

– Prevalence estimates for low vision and blindness from specific disease and injuries causes were revised to take into account WHO analyses and regional distributions of causes of blindness

Summary measures of health Global Burden of Disease 2008 (DALY)

What is new?

• Morbidity, disability and years lost to disability (YLD)– Calculations for ischaemic heart disease used a revised

model used to estimate incidence and prevalence of angina pectoris based on recent national BoD* studies, resulting in an increase of global prevalence from 25 to 54 million and corresponding 78% increase in YLD and 7% in DALYs for IHD

– Data from two recent national BoD studies wereused to re-calibrate long-term case fatality from stroke, resulting in a reduction in the prevalence of stroke survivors from 50 to 30 million and a reduction of 30% in YLD

– Population estimates are based on the latest revisions by the United Nations Population Division

* BoD = Burden of Disease

What is planned for the future?• Working with the Health Metrics Institute,

Harvard, Johns Hopkins University, University of Queensland and other institutions

– reviewing methodologies, – re-assessing estimations– calculating detailed estimates for specific causes– new estimates on comparative risk assessments for

various diseases updated and used on estimations of attributable fractions

– publication planned for 2010

Summary measures of health Global Burden of Disease 2010 (DALY)

Summary measures of health Data availability at EURO for SMPH

European Health for All (HFA) databases • On- and off-line versions last updated July 2008

Accessible at WHO/EURO website: www.euro.who.int/hfadb

WHO availability of cause-of-death statistics, countries - years as of 1 Oct 2008

Country/year 80 81 82 83 84 85 86 87 88 89 90 91 92 93 94 95 96 97 98 99 00 01 02 03 04 05 06 07

Albania 87 88 89 92 93 94 95 96 97 98 99 00 01 02 03 04AndorraArmenia 81 82 85 86 87 88 89 90 91 92 93 94 95 96 97 98 99 00 01 02 03 06Austria 80 81 82 83 84 85 86 87 88 89 90 91 92 93 94 95 96 97 98 99 00 01 02 03 04 05 06 07Azerbaijan 81 82 85 86 87 88 89 90 91 92 93 94 95 96 97 98 99 00 01 02 03 04 07Belarus 81 82 85 86 87 88 89 90 91 92 93 94 95 96 97 98 99 00 01 02 03 04 05Belgium 80 81 82 83 84 85 86 87 88 89 90 91 92 93 94 95 96 97Bosnia and Herzegovina 85 86 87 88 89 90 91 99Bulgaria 80 81 82 83 84 85 86 87 88 89 90 91 92 93 94 95 96 97 98 99 00 01 02 03 04Croatia 85 86 87 88 89 90 91 92 93 94 95 96 97 98 99 00 01 02 03 04 05 06Cyprus 96 97 98 99 00 02 03 04 06Czech Republic 86 87 88 89 90 91 92 93 94 95 96 97 98 99 00 01 02 03 04 05Denmark 80 81 82 83 84 85 86 87 88 89 90 91 92 93 94 95 96 97 98 99 00 01Estonia 81 82 85 86 87 88 89 90 91 92 93 94 95 96 97 98 99 00 01 02 03 04 05Finland 80 81 82 83 84 85 86 87 88 89 90 91 92 93 94 95 96 97 98 99 00 01 02 03 04 05 06France 80 81 82 83 84 85 86 87 88 89 90 91 92 93 94 95 96 97 98 99 00 01 02 03 04 05Georgia 81 82 85 86 87 88 89 90 91 92 94 95 96 97 98 99 00 01Germany 80 81 82 83 84 85 86 87 88 89 90 91 92 93 94 95 96 97 98 99 00 01 02 03 04 05 06Greece 80 81 82 83 84 85 86 87 88 89 90 91 92 93 94 95 96 97 98 99 00 01 02 03 04 05 06Hungary 80 81 82 83 84 85 86 87 88 89 90 91 92 93 94 95 96 97 98 99 00 01 02 03 04 05Iceland 80 81 82 83 84 85 86 87 88 89 90 91 92 93 94 95 96 97 98 99 00 01 02 03 04 05 06Ireland 80 81 82 83 84 85 86 87 88 89 90 91 92 93 94 95 96 97 98 99 00 01 02 03 04 05 06Israel 80 81 82 83 84 85 86 87 88 89 90 91 92 93 94 95 96 97 98 99 00 01 02 03 04 05Italy 80 81 82 83 84 85 86 87 88 89 90 91 92 93 94 95 96 97 98 99 00 01 02 03Kazakhstan 81 82 85 86 87 88 89 90 91 92 93 94 95 96 97 98 99 00 01 02 03 04 05 06Kyrgyzstan 81 82 85 86 87 88 89 90 91 92 93 94 95 96 97 98 99 00 01 02 03 04 05 06Latvia 80 81 82 83 84 85 86 87 88 89 90 91 92 93 94 95 96 97 98 99 00 01 02 03 04 05 06Lithuania 81 82 85 86 87 88 89 90 91 92 93 94 95 96 97 98 99 00 01 02 03 04 05 06Luxembourg 80 81 82 83 84 85 86 87 88 89 90 91 92 93 94 95 96 97 98 99 00 01 02 03 04 05Malta 80 81 82 83 84 85 86 87 88 89 90 91 92 93 94 95 96 97 98 99 00 01 02 03 04 05Monaco 86 87MontenegroNetherlands 80 81 82 83 84 85 86 87 88 89 90 91 92 93 94 95 96 97 98 99 00 01 02 03 04 05 06Norway 80 81 82 83 84 85 86 87 88 89 90 91 92 93 94 95 96 97 98 99 00 01 02 03 04 05Poland 80 81 82 83 84 85 86 87 88 89 90 91 92 93 94 95 96 97 98 99 00 01 02 03 04 05 06Portugal 80 81 82 83 84 85 86 87 88 89 90 91 92 93 94 95 96 97 98 99 00 01 02 03 04Republic of Moldova 81 82 85 86 87 88 89 90 91 92 93 94 95 96 97 98 99 00 01 02 03 04 05 06 07Romania 80 81 82 83 84 85 86 87 88 89 90 91 92 93 94 95 96 97 98 99 00 01 02 03 04 05 06 07Russian Federation 80 81 82 83 84 85 86 87 88 89 90 91 92 93 94 95 96 97 98 99 00 01 02 03 04 05 06San Marino 95 96 97 98 99 00 02 03 04 05Serbia 04 05 06Slovakia 92 93 94 95 96 97 98 99 00 01 02 03 04 05Slovenia 85 86 87 88 89 90 91 92 93 94 95 96 97 98 99 00 01 02 03 04 05 06Spain 80 81 82 83 84 85 86 87 88 89 90 91 92 93 94 95 96 97 98 99 00 01 02 03 04 05Sweden 80 81 82 83 84 85 86 87 88 89 90 91 92 93 94 95 96 97 98 99 00 01 02 03 04 05 06Switzerland 80 81 82 83 84 85 86 87 88 89 90 91 92 93 94 95 96 97 98 99 00 01 02 03 04 05Tajikistan 81 82 85 86 87 88 89 90 91 92 93 94 95 96 97 98 99 00 01 02 03 04 05TFYR Macedonia 91 92 93 94 95 96 97 98 99 00 01 02 03Turkey 81 82 83 84 87 88 89 90 91 92 93 94 95 96 97 98 03 05 06Turkmenistan 81 82 85 86 87 88 89 90 91 92 93 94 95 96 97 98Ukraine 81 82 85 86 87 88 89 90 91 92 93 94 95 96 97 98 99 00 01 02 03 04 05United Kingdom 80 81 82 83 84 85 86 87 88 89 90 91 92 93 94 95 96 97 98 99 00 01 02 03 04 05 06 UK-England and Wales 80 81 82 83 84 85 86 87 88 89 90 91 92 93 94 95 96 97 98 99 00 01 02 03 04 05 06 UK-Scotland 80 81 82 83 84 85 86 87 88 89 90 91 92 93 94 95 96 97 98 99 00 01 02 03 04 05 06 07 UK-N Ireland 80 81 82 83 84 85 86 87 88 89 90 91 92 93 94 95 96 97 98 99 00 01 02 03 04 05 06Uzbekistan 81 82 85 86 87 88 89 90 91 92 93 94 95 96 97 98 99 00 01 02 03 04 05

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