ࡱ> ]\fH(h  D <james.harrison@flinders.edu.auJmailto:james.harrison@flinders.edu.au.kavi_bhalla@harvard.edu<mailto:kavi_bhalla@harvard.eduf/ 0DTimes New RomanllXg0DArialNew RomanllXg0" B (.  @n?" dd@  @@``  M!%= ;     ?$!+ 8  0 [a<@CU gֳgֳ     A@  A5% 8c8c     ?1 d0u0@Ty2 NP'p<'pA)BCD|E|| ff3f@8 g4JdJd 0ppp@ <4BdBd8A10l4gg4KdKdx 0|p4 p]}I ʚ; +8ʚ;<4dddd8108H___PPT10( pp26___PPT9t/ 0{@(? %O =1#Global Burden of Disease and Injury$  $ bJames Harrison and Kavi Bhalla-Bawa Co-leaders, GBD project Injury Expert Group Merida, March 2008 cPP@    @ ROverview  GBD What is it? Why does it matter? Method Critiques New GBD project What is it? Why does it matter? Injury in the project Opportunity to participate  Z1 Z ZQ Z!Z1Q  GBD: What is it?  Global Burden of Diseases, Injuries and Risk Factors One of several methods to summarise impact of diseases and injuries in populations Decreased duration of life and decreased functional capacity are combined and presented in units of DALYs Initial project: commissioned by the World Bank, led by Murray & Lopez; with WHO involvement, reported in 1996 on burden in 1990. Subsequent national & regional studies, risk factor study, WHO regular updates for 14 regions, etc. P&   GBD: Why does it matter?  Fairly wide-spread use for health sector priority-setting and related processes. This seems likely to increase. A force for improving knowledge of health status and burden, especially for parts of the world where this has been lacking.  GBD: Method (1)  YLL: years of life lost due to condition(s) of interest. YLD: years lived with disability due to condition(s) of interest. (In GBD  disability means reduced functional capacity) YLL + YLD = DALYs (Disability Adjusted Life Years) A period with reduced functional capacity is equated to a period of lost life by means of  Disability Weights n|8!o|8!oZ  7  T   GBD: Method (2)  Disability Weights: A summary of overall decrease in health related to a disease or a particular consequence of a disease. Several variations in method to obtain & apply weights: Six domains (certain activities of daily living, procreation, occupation, education, recreation); values assigned were average ratings of a panel of public health experts. Panel of health professionals evaluated 22 indicator conditions using two types of person trade-off; clustered into 7 severity classes; distribution of these estimated for each of c 500 disabling  Sequelae . Where relevant, done separately for treated & untreated cases and for age groups. Dutch disability weights study: similar method, plus health state distributions in terms of EQ-5D instrument. LZZ?" Z?&$   GBD: Method (3)  Numerous other issues and decisions: By how much to discount future vs current health Whether to weight differently by age-group Bounding and scaling e.g. The sum of cause-specific mortality estimates is bounded by separate all-cause mortality  envelopes . Disability weights are scaled to cover full spectrum from full health to death. Allowing for missing and imperfect data estimation and modelling, including use of DisMod software Ascribing causality categorical and counterfactual approaches%r(;*%Q(;  *@D  _  I GBD: Practical difficulty  Data deficiencies: non-existent, scanty, incomplete, unreliable, hidden, inaccessible, etc. This constrains: Estimating incidence or prevalence of conditions Assessing duration & degree of decrements in functioning due to conditions Making  Disability Weights LII  GBD: Critiques  bNumerous. For example: Is it meaningful to equate unhealthy with shortened life? Are available input data too deficient to allow meaningful estimates? Are Disability Weights conceived and developed appropriately? Do they account adequately for: Late consequences? Minor consequences of very frequent conditions? Are GBD methods documented sufficiently? VZZDZ*ZD* c New GBD project: What is it?   The first major effort since the original GBD 1990 study to carry out a complete systematic assessment of the data on all diseases and injuries and produce comprehensive and comparable estimates of the burden of diseases, injuries and risk factors for two time periods, 1990 and 2005. (Operations Manual) Lead investigators from Harvard Initiative for Global Health, Institute for Health Metrics & Evaluation, (U Washington), Johns Hopkins University, University of Queensland, World Health Organization. Funded by Gates Foundation; strong focus on less developed regions To run for about three years from mid-2007. Will make estimates for 21 regions, by age-groups and sex. Some foreshadowed differences: the new project will Use additional data (new sources or not found previously) Use new estimation methods (eg to estimate mortality and cause composition) Develop a new set of disability weights, using revised methods Involve many more people than previous projects Be more open concerning methods, assumptions, etc.DP(P(&/   $New GBD project: Why does it matter?%%( % Generally: Potential for better methods and estimates. Better information for less developed regions. More transparent. For injury: As above. Also: Opportunity to improve the completeness and validity of measurement of injury burden, by improving: reporting groups e.g. better match with importance; more homogenous for burden disability weights incidence estimates better data and better searching/reviewing ZnZ ZtZZ>Z(Z+Z n t  >  (+  New GBD project: Injury  @Starting point: as in previous GBD projects  Disease =external cause (e.g. falls; traffic crashes)  Sequelae =injuries (e.g. fractured hip; TBI), some are qualified as short or long term; burns by area. Weights largely as in earlier studies Responsibilities Injury Expert Group Main role in developing YLD estimates Various other tasks Also Other groups in Cluster C of the project with relevant scope e.g. alcohol, other drugs, musculoskeletal diseases, mental diseases, occupational risks, intimate partner violence Parts of the project with overarching responsibilities e.g. lead role in obtaining and analysing mortality data; development of new disability weights ,PPPP:PP=PtP7PaP,:  =t7a&d  5 Opportunity to participate  GBD Injury Expert Group One of about 40 in the GBD project. Commencing work now. Has large tasks; people willing to contribute are welcome. Contact james.harrison@flinders.edu.au or kavi_bhalla@harvard.edu&<     T0T0/8 T 0` f33` 3f3` ___>?" dd@,f|?" dd@   " @ `"  n?" dd@   @@``@n?" dd@  @@``PR    @ ` ` p>> %   $l ( T}0  lF J l JZ l s *?PP fN +  l + Z2 l s *?+ U Z2 l s *?  Z2 l s *?+TZ2 l s *?Z2  l s *?+UZ2  l s *?Z2  l s *?+UZ2  l s *?Z  l s *?Z2 l s *?J%tZ2 l s *?%Z2 l s *?j% l N3gֳgֳ ?P 3 T Click to edit Master title style! !. l H3gֳgֳ ? 3 RClick to edit Master text styles Second level Third level Fourth level Fifth level!     S l Zx!:1 ?`` 3 Z* 2 l Z%:1 ?` P  : Research Centre for Injury Studies " Flinders University " AustraliaE(E0#  N l 6޽h? ? f33 &Contemporary jh.pot 0  yq0p(  p p N6:gֳgֳ ?P   T Click to edit Master title style! ! p H9Vgֳgֳ ?@  : W#Click to edit Master subtitle style$ $ p Z?V1 ?`` : ^* 2 p ZD4V1 ?  V @* Research Centre for Injury Studies Flinders University " Adelaide " AustraliaL%(2+B" &M N p 6޽h? ? f33L0 @\( o( )` 0X 0 C Bv    0 S ZV ;}   @f H 0 0gq ? ̙33R0 ` ,8(  ,d , c $Bv   R , s *R ;}  R " H , 0gq ? ̙33rhd3]  nHNW fikmv%y]{/p}rt}1Oh+'0 px    $ 0 <HP\ Two information issues in injury surveillance: 1. Classification 2. Signal detection 98@4a@tUP@tUP@WEGL g  C  yf--$xx--'@Times New Roman-. :2 n["Research Centre for Injury Studies."SystemX -@Times New Roman-. %2 sOFlinders University .-@Times New Roman-.  2 so.-@Times New Roman-. 2 sq Adelaide .-@Times New Roman-.  2 s.-@Times New Roman-. 2 s Australia.-3--$ <<  --'@Times New Roman-. f+2 "Global Burden of Disease.-@Times New Roman-. 2 .: and Injury.-@Times New Roman-. $2 I/James Harrison and s.-@Times New Roman-.  2 IRKavi.-@Times New Roman-. 2 I\Bhalla.-@Times New Roman-.  2 Ih-.-@Times New Roman-.  2 IiBawa.-@Times New Roman-.  2 O)Co.-@Times New Roman-.  2 O.-.-@Times New Roman-. C2 O/(leaders, GBD project Injury Expert Group.-@Times New Roman-. "2 SBMerida, March 2008.-i՜.+,D՜.+,H    On-screen Showj  Times New RomanArialContemporary jh.pot$Global Burden of Disease and Injury OverviewGBD: What is it?GBD: Why does it matter?GBD: Method (1)GBD: Method (2)GBD: Method (3)GBD: Practical difficultyGBD: CritiquesNew GBD project: What is it?%New GBD project: Why does it matter?New GBD project: InjuryOpportunity to participate  Fonts UsedDesign Template Slide Titles @ 8@ _PID_HLINKSA &mailto:james.harrison@flinders.edu.aumailto:kavi_bhalla@harvard.edu_[e    !"#$%&'()*+,-./0123456789:;<=>?@ABCEFGHIJKMNOPQRSUVWXYZ[^Root EntrydO)Current UserTSummaryInformation(DPowerPoint Document(DocumentSummaryInformation8L