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Common values in assessing health outcomes from disease and injury: disability weights measurement study for the Global Burden of Disease Study 2010
The Lancet, Volume: 380, Issue: 9859, Pages: 2129 - 2143
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Background Measurement of the global burden of disease with disability-adjusted life-years (DALYs) requires disabilityweights that quantify health losses for all non-fatal consequences of disease and injury. There has been extensivedebate about a range of conceptual and methodological issues concern...
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Background Measurement of the global burden of disease with disability-adjusted life-years (DALYs) requires disabilityweights that quantify health losses for all non-fatal consequences of disease and injury. There has been extensivedebate about a range of conceptual and methodological issues concerning the defi nition and measurement of theseweights. Our primary objective was a comprehensive re-estimation of disability weights for the Global Burden ofDisease Study 2010 through a large-scale empirical investigation in which judgments about health losses associatedwith many causes of disease and injury were elicited from the general public in diverse communities through a new,standardised approach.Methods We surveyed respondents in two ways: household surveys of adults aged 18 years or older (face-to-faceinterviews in Bangladesh, Indonesia, Peru, and Tanzania; telephone interviews in the USA) between Oct 28, 2009,and June 23, 2010; and an open-access web-based survey between July 26, 2010, and May 16, 2011. The surveys usedpaired comparison questions, in which respondents considered two hypothetical individuals with diff erent, randomlyselected health states and indicated which person they regarded as healthier. The web survey added questions aboutpopulation health equivalence, which compared the overall health benefi ts of diff erent life-saving or diseasepreventionprogrammes. We analysed paired comparison responses with probit regression analysis on all 220 uniquestates in the study. We used results from the population health equivalence responses to anchor the results from thepaired comparisons on the disability weight scale from 0 (implying no loss of health) to 1 (implying a health lossequivalent to death). Additionally, we compared new disability weights with those used in WHO’s most recent updateof the Global Burden of Disease Study for 2004.Findings 13 902 individuals participated in household surveys and 16 328 in the web survey. Analysis of pairedcomparison responses indicated a high degree of consistency across surveys: correlations between individual surveyresults and results from analysis of the pooled dataset were 0·9 or higher in all surveys except in Bangladesh (r=0·75).Most of the 220 disability weights were located on the mild end of the severity scale, with 58 (26%) having weightsbelow 0·05. Five (11%) states had weights below 0·01, such as mild anaemia, mild hearing or vision loss, andsecondary infertility. The health states with the highest disability weights were acute schizophrenia (0·76) and severemultiple sclerosis (0·71). We identifi ed a broad pattern of agreement between the old and new weights (r=0·70),particularly in the moderate-to-severe range. However, in the mild range below 0·2, many states had signifi cantlylower weights in our study than previously.Interpretation This study represents the most extensive empirical eff ort as yet to measure disability weights. Bycontrast with the popular hypothesis that disability assessments vary widely across samples with diff erent culturalenvironments, we have reported strong evidence of highly consistent results.
Faculty of Medicine, Health and Life Sciences