Disability indicators ppt

disability indicators./ DALY/QALY
COMMUNITY MEDICINE/ PUBLIC HEALTH

1. DISABILITY INDICATORS -DR.SNEHA 1 ST YEAR PG DEPARTMENT OF COMMUNITY MEDICINE

2. CONTEXT Introduction & types Global burden of disease (GBD) Current trends in GBD Measures of population health LE & HLE DFLE

3. CONTEXT 7. HALE/DALE 8. DALY 9. QALY 10. Summary

4. INTRODUCTION & TYPES DISABILTY: An impairment/ limitation/ restriction experienced by a person in executing a task or action. TYPES: Sullivan index DALY QALY HALE

5. GLOBAL BURDEN OF DISEASE Comprehensive worldwide observational epidemiological study. Describes mortality and morbidity from major diseases, injuries and risk factors to health at global, national and regional levels. First GBD study was started in 1990, quantified health effects for more than 100 diseases and injuries for eight regions of the world .

6. GLOBAL BURDEN OF DISEASE Standardized measure to estimate the GBD is DALY. Epidemiological survey, health survey and health facility data are the various sources for assessing the global burden of disease. GBD varies according to disease. Eg : polio: has high GBD because of increased surveillance data compared to others .

7. CURRENT TRENDS IN GBD-2017 1. Trends in cause of death 2. Trends in cause of disability 3. Trends in cause of early death and disability 4. Trends in leading risk factors for early death and disability

8. 1.TRENDS IN CAUSE OF DEATH Decrease in under 5 mortality Females live longer than males Increase in proportion of death in those over 75years by 39%

9. 2.TRENDS IN CAUSE OF DISABILITY - disability has accounted for increase in global burden by 52%

10. 3.TRENDS IN CAUSE OF EARLY DEATH AND DISABILITY 41% decrease in deaths due to communicable disease and neonatal disease 40% increase in deaths due to non communicable disease . LOW SDI COUNTRIES HIGH SDI COUNTRIES 1.Neonatal disorders 1.Ischemic heart disease 2.LRI 2. Low back pain 3.Diarrhoea 3.Stroke 4.Malaria 4.Lung cancer 5.Congenital disease 5.COPD

11. 4.TRENDS IN LEADING RISK FACTORS FOR EARLY DEATH AND DISABIITY MALES FEMALES Smoking 1. Increased SBP 2. Increased SBP 2. Increased FBS 3. Increased FBS 3. Increased BMI 4. Alcohol 4. Short gestation for birth weight 5. Short gestation for birth weight 5. LBW for gestation

12. MEASURES OF POPULATION HEALTH - to reflect the impact of morbidity or disability

13. LE & HLE (healthy life expectancy)

14. LIFE EXPECTANCY Average number o f years an individual is expected to live from birth. As of 2019 , Indians have a life expectancy of 69years. (#165 ) WORLD RANKING AND LE -2019 COUNTRY RANK LE Monaco 1 89.32 Japan 2 85.77 Singapore 3 85.73

15. HEALTHY LIFE EXPECTANCY Average number of years an individual is expected to live in GOOD HEALTH from birth by taking into account years lived in less than full health due to disease or injury. According to WHO 2016, HLE at birth for SEAR countries = 60.4 and globally = 63.3 years HLE = LE – YEARS LIVED IN DISABILITY

16. 1. HEALTH EXPECTANCY MEASURE ( i ) DALE/HALE : Earlier the term disability adjusted life expectancy was used an now it has been replaced by HALE ( health adjusted life expectancy) HALE is based on life expectancy at birth with inclusion to life spent in poor health. Similar to HLE. LE, HLE, HALE are not applied to individuals. They are applied to a specified group of population in a defined period of time .

17. (ii) DFLE( disability free life expectancy) Average number of years an individual is expected to live free of disability if current pattern of mortality and disability continue to apply. According to recent research, highest DFLE is noted in MEXICO ( male=15.4years and female=16.5yrs) India has the lowest DFLE ( male=11.5yrs and female=11.7yrs)

18. 2. Health gaps measure : ( i ) DALY(Disability adjusted life years) Developed by WHO in collaboration with World bank. Quantitative estimate of burden of disease and disability across populations in different nations. Disability plays a major role in determining the overall health status of a population. Used to quantify both burden of fatal and non fatal outcomes under one measure. Unit: Time

19. DALY= MORBIDITY +MORTALITY

20. YLD( YEARS LOST TO DISABILITY) Based on incidence: Based on prevalence: YLD = no of incident cases at each average duration disability age ( Dx ) x of a condition x weight YLD = PREVALENCE X DISABILITY WEIGHT

21. YLD can also be calculated based on; Eg : For oncocerchiasis , YLD = average no of cases (or) adding the YLD for the sequelae of low vision, blindness and itchy dermatitis. the average number of incident cases of a given disease ( or) one / more disabling sequelae of the disease.

22. DISABILITY WEIGHTS -disability weightage score given for each condition

23. OTHER DISABILITY WEIGHTS CONDITION Dw HIV 0.135 Filariasis 0.073 Leprosy case Disabling leprosy 0.152 dengue 0.197 DISABILITY SCORE : 0 = FULL HEALTH 1 = DEAD

24. YLL ( years of life lost) YLL = no of deaths at that age global standard life expectancy X

25. AGE WEIGHTING AND TIME DISCOUNTING AGE WEIGHTING: Value of a year of life rises from birth and peaks at 20’s and then declines. Young people are given more importance than children and older people. Young individual are important for family and for the community too. So non uniform age weighting is applied .

26. DISCOUNTING We discount future benefits over present health. Social preference of healthy years now than future DALY can be calculated with or without discounting Usually 3% discounting is used. Discounting future health reduces the value of interventions that provide future benefit. Eg : hep b vaccine -> reduces the incidence of liver cancer .

27. DALY ONE DALY = ONE LOST YEAR OF HEALTHY LIFE TOTAL DALYS = MEASURE OF THE GAP B/W CURRENT HEALTH OF A POPULATION AND IDEAL SITUATION WHEN A PERSON GETS OLD IN FULL HEALTH .

28. QALY ( quality adjusted life years) Measure of disease burden which includes both QUALITY and QUANTITY of life lived. QUALITY of life is based on UTILITY SCORE, which is the reverse of disability score. One full year lived with healthy life = 1 QALY Half year lived with healthy life = 0.5 QALY QUALY = QUANTITY OF LIFE X QUALITY OF LIFE

29. USES OF QALY It is used to assess the value for money of an intervention. (cost effectiveness) GOLD STANDARD for measuring how well a medical treatement improves and lengthens patient’s lives. Also based on the no of years added because of an intervention.

30. QALY GAIN

31. DIFFERENCE B/W DALY AND QALY DALY QALY 1. Measure of both morbidity and mortality 1. Measure of both quality and quantity of life 2. Uses disability weight score 2. Uses utility score 3. Uses age weighting and discounting 3. No age weighting and discounting 4. Used to determine an appropriate allocation of resources for health care and rehabilitation 4. Used to assess the cost effectiveness of an intervention 5. One gain in DALY is a negative outcome 4. One gain in QALY is a positive outcome

32. SUMMARY LE is no of years a person is expected to live including good and bad health. HLE is no of years a person is expected to live only in good health. Similar terms : HLE, DALE/HALE, DFLE DALY quantifies the burden of a disease .

33. SUMMARY QALY quantifies health. All above discussed indicators are used for whole specified population in a defined time and not for individuals D ALY : 0 = healthy / 1 = D EAD Q ALY: 0 = dead / 1 = H ealthy Sullivan index: expectation of life free of disability Sullivan index : LE of country – propable duration of disability Most advanced indicator

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