Transcript www.euro.who.int Programme

Summary measures in public health
activities in WHO
7th Task Force on Health Expectancies Meeting
Luxembourg, 2 December 2008
Dr. Enrique Loyola
Health Intelligence Service
Summary measures of health
WHO work in the recent past
• 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 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 recalibrate 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
Summary measures of health
Global Burden of Disease 2010 (DALY)
What is planned for the future?
• Working with the Health Metrics Institute,
Harvard, Johns Hopkins University, University
of Queensland and other institutions
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–
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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
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
Mortality data availability in EURO
Country/year
Albania
Andorra
Armenia
Austria
Azerbaijan
Belarus
Belgium
Bosnia and Herzegovina
Bulgaria
Croatia
Cyprus
Czech Republic
Denmark
Estonia
Finland
France
Georgia
Germany
Greece
Hungary
Iceland
Ireland
Israel
Italy
Kazakhstan
Kyrgyzstan
Latvia
Lithuania
Luxembourg
Malta
Monaco
Montenegro
Netherlands
Norway
Poland
Portugal
Republic of Moldova
Romania
Russian Federation
San Marino
Serbia
Slovakia
Slovenia
Spain
Sweden
Switzerland
Tajikistan
TFYR Macedonia
Turkey
Turkmenistan
Ukraine
United Kingdom
UK-England and Wales
UK-Scotland
UK-N Ireland
Uzbekistan
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