Meeting Abstracts
National and regional estimates of disability-adjusted life-years (DALYs) in Brazil, 2008: a systematic analysis Iuri C Leite, Joaquim G Valente, Joyce M A Schramm, Andreia F Oliveira, Maria de Fátima Santos Costa, Monica R Campos, Raulino S Silva, Regina P Daumas
Abstract Background Since Murray and Lopez’s 1996 seminal study on burden of disease, the disability-adjusted life-year (DALY) has become a valuable tool to measure the health loss of populations and evaluate health-system performance. Such indicators are essential in a country like Brazil, marked with rapidly changing epidemiology and wide regional inequalities. This study presents timely subnational estimates of burden of disease in Brazil in 2008 to inform health policy. Methods DALYs are the sum of years of life lost (YLLs) and years lived with disability (YLDs). Mortality data were used to estimate YLLs for Brazil, with adjustments for incomplete information on cause of death, sex, and age. YLDs were estimated from multiple sources, including health databases, literature reviews, and expert consensus. Findings We estimated a national average of 195 DALYs per 1000 inhabitants (95% CI 194–196) in 2008. Five causes accounted for almost a third of total DALYs: depression (8∙31%, 95% CI 8·31–8·32), ischaemic heart disease (6∙78%, 6·76–6·80), diabetes (4∙72%, 4·70–4·74), stroke (4·60%, 4·58–4·61), and homicide/violence (3∙70%, 3·69–3·71). Large regional disparities were found: from a low of 177 DALYs per 1000 inhabitants (95% CI 177–178) in the Central West region to a high of 209 per 1000 inhabitants (208–210) in the Northeast. In the (more affluent) Southeast and South regions, chronic obstructive pulmonary disease was a greater contributor to health loss than homicide/violence. Neonatal sepsis and birth trauma and asphyxia were among the 20 principal DALY contributors in the (poorer) North and Northeast regions.
Published Online June 17, 2013 Department of Epidemiology (I C Leite PhD, J G Valente PhD, J M A Schramm PhD, A F Oliveira PhD, M R Campos PhD), Germano Sinval Faria Health School Center, ENSP/Fiocruz, Rio de Janeiro, RJ, Brazil (R P Daumas PhD); Fernandes Figueira Institute, IFF/Fiocruz, Rio de Janeiro, RJ, Brazil (M de Fátima Santos Costa MSc); and Private Consultant, Rio de Janeiro, Brazil (R S Silva) Correspondence to: Iuri C Leite, ENSP–Escola Nacional de Saude Publica Sergio Arouca, Rua Leopoldo Bulhões, 1480, Manguinhos, Rio de Janeiro, Rio de Janeiro, Brazil iuri.fi
[email protected]
Interpretation Non-communicable chronic diseases, mental health, and injuries weigh heavily on the Brazilian epidemiological profile. However, in the more vulnerable regions, the North and Northeast, diseases associated with poverty and health-system precariousness persist. Health policies need to consider the balance between acute care services and chronic care management to meet population health needs across the country. More research is needed on the underlying social and economic determinants contributing to disparities in health outcomes. Funding Department of Science and Technology, Secretary of Science, Technology and Strategic Inputs, Ministry of Health of Brazil (DECIT/MoH). Contributors JGV, ICL, and JMAS designed the study and supervised the estimation process. MRC was responsible for data analysis and literature review. AFO was responsible for the literature review. MdFSC and RSS were responsible for data analysis and RPD designed the study. Conflicts of interest We declare that we have no conflicts of interest.
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