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Summary Measures of Population Health: Measuring the impact of disease, injuries and risk factors

Summary Measures of Population Health: Measuring the impact of disease, injuries and risk factors. Objectives. To derive internally consistent estimates of incidence, prevalence, disease progression and mortality for over 100 disease and injury categories

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Summary Measures of Population Health: Measuring the impact of disease, injuries and risk factors

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  1. Summary Measures of Population Health: Measuring the impactof disease, injuries and risk factors

  2. Objectives • To derive internally consistent estimates of incidence, prevalence, disease progression and mortality for over 100 disease and injury categories • Communicable, maternal, perinatal and nutritional conditions • Non-communicable diseases • Injuries • To elicit a numerical value (weight) reflecting the general population’s relative preference for each disease/disability state on an interval scale

  3. Summary Measures of Population Health (SMPH) • Expectancy - life years lived • Health Adjusted Life Expectancy (HALE) • Disability Adjusted Life Expectancy (DALE) • Disability Free Life Expectancy (DFLE) • Gap - life years lost (compared to ideal) • Disability Adjusted Life Year (DALY) • Health Adjusted Life Years Lost (HALY)

  4. Death Disease (Stage and Severity) Birth Potential limits to life Year Equivalents of life lost due to Reduced Functioning (YERF) Years of Life Lost due to premature mortality (YLL) + = HealthAdjusted Life Years lost Calculating HALYsHALY = YERF + YLL “Full Health” “Partial Health” “Premature mortality”

  5. Calculating YLL DeathLife Expectancy Years of life lost to premature mortality YLL = M * L where M = number of deaths L = remaining life expectancy

  6. Calculating YERFs DiseaseDeath Years of life lived with the disease YERF = I * (1-P) * D where I = incident cases P = preference score D = average duration model

  7. Key inputs to summary measures • Mortality by age, sex and cause • Epidemiological data on non-fatal health outcomes by age, sex and cause • Valuations of health states

  8. Leading cause of death 1 Ischaemic heart disease 2 Stroke 3 Lung Cancer 4 COPD 5 Colorectal cancer 6 Dementia 7 Diabetes mellitus 8 Prostate Cancer 9 Breast Cancer 10 Suicide DALYs 1 Ischaemic heart disease 2 Stroke 3 COPD 4 Depression 5 Lung cancer 6 Dementia 7 Diabetes mellitus 8 Colorectal cancer 9 Asthma 10 Osteoarthritis Top 10 Leading Causes of Death and DALYs (data from Canada)

  9. Burden attributable to 10 risk factors Tobacco Physical inactivity High blood pressure Alcohol harm Alcohol benefit Obesity YLL Lack of fruit/veg. YLD High blood cholesterol Illicit drugs Occupation Unsafe sex -4 -2 0 2 4 6 8 10 12 Attributable DALYs as a proportion of total DALYs

  10. HALYTotal for top 15 cancers

  11. Attribution of total HALYS for all cancers combined to Risk Factors Total = 49%

  12. Part 2: Weighting of Health States • To elicit a numerical value (preference score) on an interval scale reflecting the population’s relative preference for health states • Describe health in terms of functional status or capacity

  13. Eliciting Health State Preferences Methods Tested: • Visual Analog Scale (VAS) • Standard Gamble (SG) • Time Trade Off (TTO) • Person Trade Off (PTO)

  14. Visual Analog Scale 1 Full Health 0.75 0.5 Poor Health 0.25 Death 0

  15. Give instantaneous and lasting improvement to full health with probability p Give immediate death with probability 1-p Standard Gamble You have a lifelong stationary impaired health state and are given a choice. Do you take a hypothetical procedure that will:

  16. Time Trade-Off • Years of healthy life you would give up to avoid living in a state of poor health

  17. 1,000 healthy individuals N 1,000 individuals in a disabling health state Person Trade Off (PTO)

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