Disability-adjusted life years (DALYs) for 291 diseases and injuries in 21 regions, 1990-2010: a systematic analysis for the Global Burden of Disease Study 2010 (vol 380, pg 2197, 2012)

https://www.thelancet.com/pdfs/journals/lancet/PIIS0140-6736(12)61689-4.pdf

Disability-adjusted life years (DALYs) for 291 diseases and injuries in 21 regions, 1990-2010: a systematic analysis for the Global Burden of Disease Study 2010

http://depts.washington.edu/sphnet/wp-content/uploads/2013/01/Coovadia.pdf

The health and health system of South Africa: historical roots of current public health challenges

https://www.thelancet.com/pdfs/journals/lancet/PIIS0140-6736(09)61087-4.pdf

The burden of non-communicable diseases in South Africa.

https://profiles.uonbi.ac.ke/odundo_paul/files/strengthening_the_science_thelancet_040508.pdf

Health metrics and evaluation: strengthening the science

BACKGROUND: This paper describes the first national burden of disease study for South Africa The main focus is the burden due to premature mortality, ie years of life lost (YLLs) In addition, estimates of the burden contributed by morbidity, ie the years lived with disability (YLDs), are obtained to calculate disability-adjusted life years (DALYs); and the impact of AIDS on premature mortality in the year 2010 is assessed METHOD: Owing to the rapid mortality transition and the lack of timely data, a modelling approach has been adopted The total mortality for the year 2000 is estimated using a demographic and AIDS model The non-AIDS cause-of-death profile is estimated using three sources of data: Statistics South Africa, the National Department of Home Affairs, and the National Injury Mortality Surveillance System A ratio method is used to estimate the YLDs from the YLL estimates RESULTS: The top single cause of mortality burden was HIV/AIDS followed by homicide, tuberculosis, road traffic accidents and diarrhoea HIV/AIDS accounted for 38% of total YLLs, which is proportionately higher for females (47%) than for males (33%) Pre-transitional diseases, usually associated with poverty and underdevelopment, accounted for 25%, non-communicable diseases 21% and injuries 16% of YLLs The DALY estimates highlight the fact that mortality alone underestimates the burden of disease, especially with regard to unintentional injuries, respiratory disease, and nervous system, mental and sense organ disorders The impact of HIV/AIDS is expected to more than double the burden of premature mortality by the year 2010 CONCLUSION: This study has drawn together data from a range of sources to develop coherent estimates of premature mortality by cause South Africa is experiencing a quadruple burden of disease comprising the pre-transitional diseases, the emerging chronic diseases, injuries, and HIV/AIDS Unless interventions that reduce morbidity and delay morbidity become widely available, the burden due to HIV/AIDS can be expected to grow very rapidly in the next few years An improved base of information is needed to assess the morbidity impact more accurately

/pdf/initial-burden-of-disease-estimates-for-south-africa-2000-1tccc4hluf.pdf

Initial burden of disease estimates for South Africa, 2000.

Objective To estimate the magnitude and characteristics of the injury burden in South Africa within a global context. Methods The Actuarial Society of South Africa demographic and AIDS model (ASSA 2002) – calibrated to survey, census and adjusted vital registration data – was used to calculate the total number of deaths in 2000. Causes of death were determined from the National Injury Mortality Surveillance System profile. Injury death rates and years of life lost (YLL) were estimated using the Global Burden of Disease methodology. National years lived with disability (YLDs) were calculated by applying a ratio between YLLs and YLDs found in a local injury data source, the Cape Metropole Study. Mortality and disability-adjusted life years’ (DALYs) rates were compared with African and global estimates. Findings Interpersonal violence dominated the South African injury profile with age-standardized mortality rates at seven times the global rate. Injuries were the second-leading cause of loss of healthy life, accounting for 14.3% of all DALYs in South Africa in 2000. Road traffic injuries (RTIs) are the leading cause of injury in most regions of the world but South Africa has exceedingly high numbers – double the global rate. Conclusion Injuries are an important public health issue in South Africa. Social and economic determinants of violence, many a legacy of apartheid policies, must be addressed to reduce inequalities in society and build community cohesion. Multisectoral interventions to reduce traffic injuries are also needed. We highlight this heavy burden to stress the need for effective prevention programmes.

https://www.who.int/bulletin/volumes/85/9/06-037184.pdf

The high burden of injuries in South Africa

The objective was to quantify the HIV/AIDS deaths misclassified to AIDS-related conditions in South Africa. Design: Retrospective analysis of vital registration data. Cause-specific death rates for 1996 and 2000–2001 were calculated using vital registration cause-of-death profiles applied to a model (ASSA2000) estimate of total mortality rates by age and sex. The difference in the age-specific death rates for these two periods was examined to identify conditions where there was a noticeable increase in mortality following the same age pattern as the HIV deaths thus likely to be misclassified AIDS deaths. The increase in the age-specific death rates for HIV-related deaths showed a distinct age pattern which has been observed elsewhere. Out of the 22 potential causes of death investigated there were nine that increased in the same distinct age pattern (tuberculosis pneumonia diarrhoea meningitis other respiratory disease non-infective gastroenteritis other infectious and parasitic diseases deficiency anaemias and protein energy malnutrition) and could be considered AIDS-related conditions. The increase in these conditions accounted for 61% of the total deaths related to HIV/AIDS. When added to the deaths classified as HIV-related on the death certificate the total accounts for 93% of the ASSA2000 model estimates of the number of AIDS deaths in 2000. As a large proportion of AIDS deaths appear to be classified to AIDS related conditions without reference to HIV interpretation of death statistics in South Africa cannot be made on face value as a large proportion of deaths caused by HIV infection are misclassified. (authors)

https://catalogue.safaids.net/sites/default/files/publications/2005%2002%2001%20Estimating%20AIDS%20deaths.pdf

Identifying deaths from AIDS in South Africa.

Objectives. 

To quantify the burden of disease attributable to physical inactivity in persons 15 years or older, by age group and sex, in South Africa for 2000. 

Design. 

The global comparative risk assessment (CRA) methodology of the World Health Organization was followed to estimate the disease burden attributable to physical inactivity. Levels of physical activity for South Africa were obtained from the World Health Survey 2003. A theoretical minimum risk exposure of zero, associated outcomes, relative risks, and revised burden of disease estimates were used to calculate population-attributable fractions and the burden attributed to physical inactivity. Monte Carlo simulation-modelling techniques were used for the uncertainty analysis. 

Setting. 

South Africa. 

Subjects. 

Adults ≥ 15 years. 

Outcome measures.

Deaths and disability-adjusted life years (DALYs) from ischaemic heart disease, ischaemic stroke, breast cancer, colon cancer, and type 2 diabetes mellitus. 

Results. 

Overall in adults ≥ 15 years in 2000, 30% of ischaemic heart disease, 27% of colon cancer, 22% of ischaemic stroke, 20% of type 2 diabetes, and 17% of breast cancer were attributable to physical inactivity. Physical inactivity was estimated to have caused 17 037 (95% uncertainty interval 11 394 - 20 407), or 3.3% (95% uncertainty interval 2.2 - 3.9%) of all deaths in 2000, and 176 252 (95% uncertainty interval 133 733 - 203 628) DALYs, or 1.1% (95% uncertainty interval 0.8 - 1.3%) of all DALYs in 2000. 

Conclusions. 

Compared with other regions and the global average, South African adults have a particularly high prevalence of physical inactivity. In terms of attributable deaths, physical inactivity ranked 9th compared with other risk factors, and 12th in terms of DALYs. There is a clear need to assess why South Africans are particularly inactive, and to ensure that physical activity/inactivity is addressed as a national health priority.

Estimating the burden of disease attributable to physical inactivity in South Africa in 2000

Objectives To quantify the burden of disease attributable to physical inactivity in persons 15 years or older, by age group and sex, in South Africa for 2000. Design The global comparative risk assessment (CRA) methodology of the World Health Organization was followed to estimate the disease burden attributable to physical inactivity. Levels of physical activity for South Africa were obtained from the World Health Survey 2003. A theoretical minimum risk exposure of zero, associated outcomes, relative risks, and revised burden of disease estimates were used to calculate population-attributable fractions and the burden attributed to physical inactivity. Monte Carlo simulation-modelling techniques were used for the uncertainty analysis. Setting South Africa. Subjects Adults >or= 15 years. Outcome measures Deaths and disability-adjusted life years (DALYs) from ischaemic heart disease, ischaemic stroke, breast cancer, colon cancer, and type 2 diabetes mellitus. Results Overall in adults >or= 15 years in 2000, 30% of ischaemic heart disease, 27% of colon cancer, 22% of ischaemic stroke, 20% of type 2 diabetes, and 17% of breast cancer were attributable to physical inactivity. Physical inactivity was estimated to have caused 17,037 (95% uncertainty interval 11,394 - 20,407), or 3.3% (95% uncertainty interval 2.2 - 3.9%) of all deaths in 2000, and 176,252 (95% uncertainty interval 133,733 - 203,628) DALYs, or 1.1% (95% uncertainty interval 0.8 - 1.3%) of all DALYs in 2000. Conclusions Compared with other regions and the global average, South African adults have a particularly high prevalence of physical inactivity. In terms of attributable deaths, physical inactivity ranked 9th compared with other risk factors, and 12th in terms of DALYs. There is a clear need to assess why South Africans are particularly inactive, and to ensure that physical activity/inactivity is addressed as a national health priority.

/pdf/estimating-the-burden-of-disease-attributable-to-physical-4x313lhl6o.pdf

Pam Groenewald

Papers

Initial burden of disease estimates for South Africa, 2000.

The high burden of injuries in South Africa

Identifying deaths from AIDS in South Africa.

Estimating the burden of disease attributable to physical inactivity in South Africa in 2000

Estimating the burden of disease attributable to physical inactivity in South Africa in 2000