Skip to main page content
U.S. flag

An official website of the United States government

Dot gov

The .gov means it’s official.
Federal government websites often end in .gov or .mil. Before sharing sensitive information, make sure you’re on a federal government site.

Https

The site is secure.
The https:// ensures that you are connecting to the official website and that any information you provide is encrypted and transmitted securely.

Access keys NCBI Homepage MyNCBI Homepage Main Content Main Navigation
Comparative Study
. 2015 Jan 16:15:16.
doi: 10.1186/s12879-014-0728-4.

Deconstructing the differences: a comparison of GBD 2010 and CHERG's approach to estimating the mortality burden of diarrhea, pneumonia, and their etiologies

Stephanie D Kovacs  1 , Kim Mullholland  2   3   4 , Julia Bosch  5 , Harry Campbell  6 , Mohammad H Forouzanfar  7 , Ibrahim Khalil  8 , Stephen Lim  9 , Li Liu  10 , Stephen N Maley  11 , Colin D Mathers  12 , Alastair Matheson  13 , Ali H Mokdad  14 , Kate O'Brien  15 , Umesh Parashar  16 , Torin T Schaafsma  17 , Duncan Steele  18 , Stephen E Hawes  19 , John T Grove  20
Affiliations
Comparative Study

Deconstructing the differences: a comparison of GBD 2010 and CHERG's approach to estimating the mortality burden of diarrhea, pneumonia, and their etiologies

Stephanie D Kovacs et al. BMC Infect Dis. .

Abstract

Background: Pneumonia and diarrhea are leading causes of death for children under five (U5). It is challenging to estimate the total number of deaths and cause-specific mortality fractions. Two major efforts, one led by the Institute for Health Metrics and Evaluation (IHME) and the other led by the World Health Organization (WHO)/Child Health Epidemiology Reference Group (CHERG) created estimates for the burden of disease due to these two syndromes, yet their estimates differed greatly for 2010.

Methods: This paper discusses three main drivers of the differences: data sources, data processing, and covariates used for modelling. The paper discusses differences in the model assumptions for etiology-specific estimates and presents recommendations for improving future models.

Results: IHME's Global Burden of Disease (GBD) 2010 study estimated 6.8 million U5 deaths compared to 7.6 million U5 deaths from CHERG. The proportional differences between the pneumonia and diarrhea burden estimates from the two groups are much larger; GBD 2010 estimated 0.847 million and CHERG estimated 1.396 million due to pneumonia. Compared to CHERG, GBD 2010 used broader inclusion criteria for verbal autopsy and vital registration data. GBD 2010 and CHERG used different data processing procedures and therefore attributed the causes of neonatal death differently. The major difference in pneumonia etiologies modeling approach was the inclusion of observational study data; GBD 2010 included observational studies. CHERG relied on vaccine efficacy studies.

Discussion: Greater transparency in modeling methods and more timely access to data sources are needed. In October 2013, the Bill & Melinda Gates Foundation (BMGF) hosted an expert meeting to examine possible approaches for better estimation. The group recommended examining the impact of data by systematically excluding sources in their models. GBD 2.0 will use a counterfactual approach for estimating mortality from pathogens due to specific etiologies to overcome bias of the methods used in GBD 2010 going forward.

PubMed Disclaimer

Figures

Figure 1
Figure 1
Percent difference in IGME vs. GBD 2010 estimated U5 deaths, 2010.
Figure 2
Figure 2
Percent difference in CHERG vs. GBD 2010 estimated U5 pneumonia deaths, 2010.
Figure 3
Figure 3
Percent difference in CHERG vs. GBD 2010 estimated U5 diarrhea deaths, 2010.
Figure 4
Figure 4
GBD 2010 analytical approach for estimating the global mortality burden due to LRI, diarrhea and their etiologies.
Figure 5
Figure 5
CHERG analytical approach for estimating the burden of disease in children under five in 2010 (adapted from Black 2010).
See this image and copyright information in PMC

References

    1. Murray CJ, Lopez AD. Global and regional cause-of-death patterns in 1990. Bull World Health Organ. 1994;72:447–80. - PMC - PubMed
    1. Murray CJ, Lopez AD. Mortality by cause for eight regions of the world: Global Burden of Disease Study. Lancet. 1997;349:1269–76. doi: 10.1016/S0140-6736(96)07493-4. - DOI - PubMed
    1. Child Mortality Fact Sheet [http://www.who.int/pmnch/media/press_materials/fs/fs_mdg4_childmortality...]
    1. UN Millennium Project . Investing in Development A Practical Plan to Achieve the Mellennium Development Goals. London: Earthscan; 2005.
    1. Wang H, Dwyer-Lindgren L, Lofgren KT, Rajaratnam JK, Marcus JR, Levin-Rector A, et al. Age-specific and sex-specific mortality in 187 countries, 1970–2010: a systematic analysis for the Global Burden of Disease Study 2010. Lancet. 2012;380:2071–94. doi: 10.1016/S0140-6736(12)61719-X. - DOI - PubMed

Publication types