Reevaluating health metrics:Unraveling the limitations of disabilityadjusted life years as an indicator in disease burden assessment

In 1993,the World Bank released a global report on the efficacy of health promotion,introducing the disability-adjusted life years(DALY)as a novel indicator.The DALY,a composite metric incorporating temporal and qualitative data,is grounded in preferences regarding disability status.This review delineates the algorithm used to calculate the value of the proposed DALY synthetic indicator and elucidates key methodological challenges associated with its application.In contrast to the quality-adjusted life years approach,derived from multi-attribute utility theory,the DALY stands as an independent synthetic indicator that adopts the assumptions of the Time Trade Off utility technique to define Disability Weights.Claiming to rely on no mathematical or economic theory,DALY users appear to have exempted themselves from verifying whether this indicator meets the classical properties required of all indicators,notably content validity,reliability,specificity,and sensitivity.The DALY concept emerged primarily to facilitate comparisons of the health impacts of various diseases globally within the framework of the Global Burden of Disease initiative,leading to numerous publications in international literature.Despite widespread adoption,the DALY synthetic indicator has prompted significant methodological concerns since its inception,manifesting in inconsistent and non-reproducible results.Given the substantial diffusion of the DALY indicator and its critical role in health impact assessments,a reassessment is warranted.This reconsideration is imperative for enhancing the robustness and reliability of public health decisionmaking processes.

Tuberculosis Control Priorities Defined by Using Cost-Effectiveness and Burden of Disease

Objective To define TB control priorities using cost-effectiveness and burden of disease.Methods An assumed cohort of 2 000 cases was set up based on age-specific incidence of 794 newly registered smear-positive cases in Beijing in1994.Prognostic trees and model diagrams of infectivity with natural history and DOTS intervention were constructed based on the epidemiological parameters.Results DOTS reduced 89.19% of YLL,78.90% of YLD,and 99.98% of infectivity BOD.One DALY could be saved with 45.70% Yuan by DOTS with 3% discount.Sensitivity analysis showed that discount had effect on CER.Weight of age was insensitive to CER.The higher the DOTS coured rate,the more the cost-effectiveness.Conclusions DOTS is a good cost-effectiveness TB control strategy.Cost-effectiveness and burden of disease can be used to define TB control priorities.

Distribution of and associated factors for dengue burden in the state of Odisha,India during 2010-2016

This study is aimed to estimate the epidemiological burden of dengue in Odisha,India using the disability adjusted life year(DALY)methods and to explore the associated factors in the year 2010-2016.During the period of 2010-2016,27772 cases(68.4%male)were reported in the state.Mean age(years)of male and female was 31.63 and 33.82,respectively.Mean district wise disability adjusted life years(DALY)per 100000 people was higher in the year 2016(0.45)and mean DALY lost per person was highest in the year 2015(34.90 years).Adjusted regression model indicates,every unit increase in humidity and population density increases DALY by 1.05 and 1.02 units respectively.Whereas,unit change in sex ratio(females per 1000 males)and forest coverage increases the DALY by 0.98 units.Our results indicate geographical variation of DALY in Odisha,which is associated with population density,humidity and forest cover.Discrepancies identified between standard incidence and DALY maps suggests,latter can be used to present disease burden more effectively.More prevalence among young males suggests the need of strengthening the targeted prevention and control measures.