Research article
Assessing the Burden of Disease in the United States Using Disability-Adjusted Life Years

https://doi.org/10.1016/j.amepre.2005.02.009Get rights and content

Objectives

Burden of disease studies have been implemented in many countries using the disability-adjusted life year (DALY) to assess major health problems.

Methods

We applied methods developed by the World Bank and World Health Organization (WHO) to data specific to the United States to compute DALYs. We compared the results of this analysis to international estimates published by WHO for developed and developing regions of the world.

Results

In the mid-1990s, the leading sources of premature death and disability in the United States, as measured by DALYs, were cardiovascular conditions, breast and lung cancers, depression, osteoarthritis, diabetes mellitus, and alcohol use and abuse. In addition, motor vehicle-related injuries and the HIV epidemic exacted a substantial toll on the health status of the U.S. population, particularly among racial/ethnic minorities. The major sources of death and disability in these latter populations were more similar to patterns of burden in developing rather than developed countries.

Conclusions

This analysis provides the first detailed, comprehensive estimates using DALYs of the fatal and nonfatal conditions that exact large health burdens in the United States.

Section snippets

Background

Mortality data are the most widely used source of information for identifying most important health problems for a population.1, 2 However, during the 20th century, death rates in economically developed countries have fallen substantially. Correspondingly, many persons live many years with serious illness and disability. Therefore, causes of deaths are increasingly viewed as inadequate measures of the health of a population.3 Assessments that include more than mortality data to measure

Methods

The calculation of DALYs requires estimates for the age-specific incidence, prevalence, and duration of disability associated with nonfatal health outcomes, and the age at death due to individual diseases and injuries. The conceptual and computational details of how these parameters are estimated and then combined to generate DALYs for individual conditions have been presented elsewhere.8 A more detailed presentation on the specific analytic methods, data sources, consultations, and data sets

Results

In 1996, there were 2.3 million deaths in the United States that contributed to over 33 million DALYs (Table 3, Table 4). The greatest number of deaths and DALYs were attributed to chronic disease conditions that occur in adulthood. The leading source of DALYS for both males and females was ischemic heart disease. Other chronic diseases, such as cerebrovascular disease, cancer, and dementias, dominated the list of major causes. Injuries from road traffic events and violence were also prominent

Discussion

In the mid-1990s, the leading sources of premature death and disability in the United States, as measured by DALYs, were chronic diseases such as cardiovascular conditions, cancers (especially breast and lung), depression, osteoarthritis, diabetes mellitus, and alcohol use and abuse. In addition, motor vehicle-related injuries and the HIV epidemic exacted a substantial toll on the health status of the U.S. population. The use of DALYs to enumerate the impact of health conditions produced

References (56)

  • World development report 1993investing in health

    (1993)
  • C.J. Murray et al.

    The global burden of diseasea comprehensive assessment of mortality and disability from diseases, injuries, and risk factors in 1990 and projected to 2020

    (1996)
  • World health report, 2001mental health, new understanding, new hope

    (2001)
  • D. Bradshaw et al.

    Initial burden of disease estimates for South Africa, 2000

    S Afr Med J

    (2003)
  • C.D. Mathers et al.

    The burden of disease and injury in Australia

    Bull World Health Organ

    (2001)
  • J. Melse et al.

    A national burden of disease calculationDutch disability-adjusted life-years

    Am J Public Health

    (2000)
  • A.A. Hyder et al.

    Measuring the burden of diseasehealthy life-years

    Am J Public Health

    (1998)
  • G.F. Kominski et al.

    Assessing the burden of disease and injury in Los Angeles County using disability-adjusted life years

    Public Health Rep

    (2002)
  • C. Bowie et al.

    Estimating the burden of disease in an English region

    J Public Health Med

    (1997)
  • M. Meltzer et al.

    Using disability-adjusted life years to assess the economic impact of Dengue in Puerto Rico1984–1994

    Am J Trop Med Hyg

    (1998)
  • A. Pruss et al.

    Estimating the burden of disease from water, sanitation, and hygiene at a global level

    Environ Health Perspect

    (2002)
  • C. Friedman et al.

    Assessing the burden of disease among an employed populationimplications for employer-sponsored prevention programs

    J Occup Environ Med

    (2004)
  • Jarlais Des et al.

    Small world, big challengesa report from the 9th International Congress of the World Federation of Public Health Associations

    Am J Public Health

    (2001)
  • Michaud CM, McKenna MT, Murray CJL. The burden of disease and injury in the United States—1996: final report to CDC....
  • Third National Health and Nutrition Examination Survey, 1988–1994, NHANES III

    (1996)
  • The National Health Interview Survey, 1992 and 1997

    (2001)
  • D.A. Regier et al.

    The NIMH Epidemiologic Catchment Area programhistorical context, major objectives, and study population characteristics

    Arch Gen Psychiatry

    (1984)
  • R.C. Kessler et al.

    The National Comorbidity Survey

  • Cited by (0)

    The full text of this article is available via AJPM Online at www.ajpm_online.net.

    View full text