introduction to public health january 29, 2015 1

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Introduction to Public HealthJanuary 29, 2015

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Learning Objectivesfor January 29

Introduce the Global Burden of Disease (GBD) Study

Learn the Meaning of: 1) Years of Life Lost, 2) Years Lost to Disability, and 3) Disability-adjusted life years lost

as measures of mortality and morbidity

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Learning Objectives

Review global trends in mortality and morbidity

Compare trends in KSA to global trends

Identify the major causes of death and disability globally and in KSA

Identify the major risk factors that cause death and disability

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The Global Burden of Disease Study

GBD was launched in 2007 to develop systematic global data on morbidity, mortality, and their causes.

It is directed by a consortium of seven partners, including Harvard University, the Institute for Health Metrics and Evaluation, and the WHO.

It’s mission is to provide systematic global data on disease, injuries, and risk

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The Global Burden of Disease Study

GBD 2010 was a massive effort to report mortality and morbidity data for 187 countries

Data were reported for 235 diseases and injuries, along with 67 behavioral, medical, and environmental causes.

Almost all of the December 15, 2012 issue of The Lancet is devoted to results from GBD.

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Sources

Global and regional mortality from 235 causes of death for 20 age groups in 1990 and 2010: a systematic analysis for the Global Burden of Disease Study 2010. Lancet 2012; 380:2095-2128.

A comparative risk assessment of burden of disease and injury attributable to 67 risk factors and risk factor clusters in 21 regions, 1990–2010: a systematic analysis for the Global Burden of Disease Study 2010. Lancet 2012; 380: 2224–60

The Global Burden of Disease: Generating Evidence, Guiding Policy. Institute for Health Metrics and Evaluation, 2010 IHME Website: http://www.healthmetricsandevaluation.org/

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Years of Life Lost

Years of Life Lost (YLL) is calculated by comparing the years lost by a premature death relative to the highest life expectancy for males or females in any country for that age group.

Example: If a 20-year old male died in a car accident in KSA in 2010, he lost 66 years of expected life based on the highest life expectancy among 20-year-olds, namely, 86 years for 20-year old females in Japan.

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Data Visualization

The Institute for Health Metrics and Evaluation website provides many tools for displaying the results of the GBD study.

One such tool is GBD compare. It displays health levels and trends in one interactive tool. It also enables comparisons between and within countries.

To begin, we display the numbers of years of life lost by cause of death for all countries combined.

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Causes of YLL Globally:1990

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Causes of YLL Globally:2010

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GBD Display

GBD Compare

http://vizhub.healthdata.org/gbd-compare/

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Causes of YLL in KSA:1990

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Causes of YLL in KSA:2010

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Comparing KSA to Global BD: 2010

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Comparing KSA to Western Europe

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Years of Life Lost

http://vizhub.healthdata.org/gbd-compare/

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Global Trends in YLL1990 to 2010

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Trends in YLL in KSA1990 to 2010

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10 Leading Causes of YLL in KSA in 2010

Percent Global RankRoad Injury 16 8Ischemic Heart Disease 12 1Preterm Birth Complications 11 7 Stroke 13 3Congenital Anomalies 6 14 Lower Resp Infections 4 2Chronic Kidney Disease 3 24Diabetes 3 19Neonatal Encephalopathy 2 10Neonatal Sepsis 2 12

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Global Highlights

Life expectancy is increasing for both men and womenThe burdens of HIV and malaria are fallingFar fewer children younger than 5 are dyingInfectious diseases are being controlled

Huge global disparitiesTuberculosis and malaria each killed 1.2M people in 2010Deaths by road traffic injuries have increased by 50%

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Years Lost to Disability (YLDs)

YLD was developed to account for the health burden of disability.

Each disability is assigned a weight. The years lost due to that disability (YLDs) are calculated as the duration of a disability multiplied by the disability weight.

A weight of 0 represents perfect health, a weight of 1 is equivalent to death

For example, if the disability weight after myocardial infarction is 0.439 and life expectancy after MI is 20, YLD = 0.439*20 = 8.78

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Global YLD: 2010

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Years Lost to Disability

http://vizhub.healthdata.org/gbd-compare/

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10 Leading Causes of YLD in KSA

Percent Global RankMajor Depressive Disorder 11 2Low Back Pain 10 1Diabetes 8 9Iron-Deficiency Anemia 5 3Anxiety Disorders 5 7Neck Pain 3 4Osteoarthritis 3 11Drug Use Disorders 3 12Other Musculoskeletal 3 6COPD 3 5

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The 10 leading causes of death and YLD in Saudi Arabia 2010

0 5 10 15 20 25 30

Deaths (%)

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YLD

(%)

Occupational

Drug Use

Iron Deficiency

High BMI

Ambient AP High Blood Pressure

Dietary

Smoking

High Fasting Plasma Glucose

Physical Inactivity

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Disability Adjusted Life Years (DALYs)

DALYs is the sum of years of life lost (YLL) and years of healthy life lost to disability (YLD)

DALYs = YLL + YLD

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Leading Causes of Lost DALYs in KSA

Percent Global RankRoad Injury 9 10Ischemic Heart Disease 6 1Major Depressive Disorder 6 11Diabetes 6 14Low Back Pain 5 7Preterm Birth 5 8Stroke 3 3Congenital Anomalies 3 17Iron-Deficiency Anemia 3 15Anxiety Disorders 3 26

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The 10 leading diseases globally in 2010 based on percentages of deaths and DALYs

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The 10 leading diseases in Saudi Arabia in 2010 based on percentages of deaths and DALYs

Ischemic Heart Disease

Road Injury

Stroke

Preterm Birth

Lower Resp Infections

Chronic Kidney Disease

Diabetes

Hypertension

Congenital Anomalies

Other Cardiac/Circulatory

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Discussion Point

What do these data tell us about the major health problems in Saudi Arabia?

What are the major risk factors For YLL? For YLD?

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The 10 leading diseases and injuries globally in 2010, and the 10 leading causes based on percentages of deaths and DALYs

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The 10 leading diseases and injuries in Saudi Arabia in 2010, and the 10 leading causes based on percentages of deaths and DALYs

Ischemic Heart Disease

Road Injury

Stroke

Preterm Birth

Lower Resp Infections

Chronic Kidney Disease

Diabetes

Hypertension

Congenital Anomalies

Other Cardiac/Circulatory

High Body Mass Index

Dietary Risks

High Fasting Plasma Glucose

High BP

Physical Inactivity

Ambient PM Pollution

SmokingDrug UseOccupational

Iron Deficiency

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GBD Cause Patterns

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Demography

KSA has the largest and fastest growing population in the GCC.

The total KSA population will reach 31.6 million by 2016, of which 22.8 million will be Saudi nationals.