The increasing significance of disease severity in a burden of disease framework

Abstract

Recent estimates have reiterated that non-fatal causes of disease, such as low back pain, headaches and depressive disorders, are amongst the leading causes of disability-adjusted life years (DALYs). For these causes, the contribution of years lived with disability (YLD) - put simply, ill-health - is what drives DALYs, not mortality. Being able to monitor trends in YLD closely is particularly relevant for countries that sit high on the socio-demographic spectrum of development, as it contributes more than half of all DALYs. There is a paucity of data on how the population-level occurrence of disease is distributed according to severity, and as such, the majority of global and national efforts in monitoring YLD lack the ability to differentiate changes in severity across time and location. This raises uncertainties in interpreting these findings without triangulation with other relevant data sources. Our commentary aims to bring this issue to the forefront for users of burden of disease estimates, as its impact is often easily overlooked as part of the fundamental process of generating DALY estimates. Moreover, the wider health harms of the COVID-19 pandemic have underlined the likelihood of latent and delayed demand in accessing vital health and care services that will ultimately lead to exacerbated disease severity and health outcomes. This places increased importance on attempts to be able to differentiate by both the occurrence and severity of disease.

Keywords: Burden of disease; DALY; European burden of disease network; Scottish burden of disease; YLD; disability-adjusted life year; disease severity; severity distribution; years lived with disability.

Figure 1.

Relationship between the age-standardised prevalence rate and age-standardised years lived with disability (YLD) rate for low back pain by (a) time and (b) location. (a) Global relationship by time, 1990–2019. Each data point represents an annual estimate (total of 30; 1990–2019). Rates illustrated are per 100,000 population. Data extracted from Global Burden of Disease (GBD) study results tool. (b) Relationship across 204 countries and territories, 2019. Each data point represents a country/territory (total of 204). Rates illustrated are per 100,000 population. Data extracted from GBD study results tool.