Estimating National Burden of Disease.

The Burden of Disease in Andhra Pradesh, 1990s.

Author: Prasanta Mahapatra

Publication Year: 2001

About the book:

The concept of health underwent significant changes during the twentieth century. A twentieth century hallmark was the WHO’s founding definition, in 1948, of health as “a state of physical, mental and psychological wellbeing, and not merely the absence of dis-ease”. But mere enlightenment is usually not enough to change the way we do things. The epidemiological transition from high to low mortality conditions made it necessary to look at new ways of measuring population health by combining the mortality and morbidity experience. These transitions produce characteristic changes in disease profile and age composition, namely: (a) reduced incidence or prevalence of infectious diseases, (b) increased prevalence of noncommunicable and degenerative diseases, and (c) increase in proportion of elderly and geriatric population. Each of these changes has its impact on the measurement of health status. Rising costs of health care, provided added impetus towards development of summary measures of health status to facilitate cost-effectiveness studies. Although, the WHO adopted an inclusive definition of health in 1948, conventional measures of health status like the life expectancy, infant mortality rate, and disease specific measures of morbidity continued to provide the basic framework of indicators of health status.

By end of the twentieth century, after 52 years of its founding, WHO adopted a set of summary measures of population health status. These new measures are being commonly referred to as burden of disease measures, since they combine the impact of diseases on mortality as well as morbidi-ty. The World Health Report, 2000 (WHR, 2000) contained a set of health status measure-ments for different countries using the Burden of disease framework. Publication of the WHR 2000 has stimulated interest in National Burden of Disease studies. This book describes the experience and insights from the first National Burden of Disease study started after publication of the Global Burden of Disease (GBD) estimates in the World Bank’s World Development Report, 1993. The Andhra Pradesh Burden of Disease study was started in 1993. However, it took about seven years for the study to partially complete, leading to publication of these results. This book is result of this long exercise. The book describes in detail various aspects of the NBD estimation process, focusing on the Andhra Pradesh state in India. A major concern addressed by the book is how to anchor NBD estimates to local data and there by provide a strong foundation of evidence and information for policy. Although the book revolves around the AP state in India, it has wider application and will be a useful guide for National Burden of Disease Studies.

View and Download Chapters.

Ch	Title	Chapter Author(s)	Page	View	MB
0	Front Pages, Table of Contents, List of Tables & Figures.			👁	0.8
1	Introduction. Setting priorities in health sector. Aids to priority setting in the health sector. Motivation for development of synthetic measures of health status. Quantifying health and illness in populations. The Global Burden of Disease study. Research questions.	Prasanta Mahapatra	1	👁	2.5
2	General demographic inputs for estimation of disease burden. Mortality in Andhra Pradesh, India. Overview of demographic inputs for estimation of disease burden. Population data for burden of disease study. Identification of suit- able stable population models. Mortality data in Andhra Pradesh and completeness of registration of deaths. Standard life expect ancies by single year. Summary of demographic estimates.	Prasanta Mahapatra	33	👁	3.4
3	Causes of death in Andhra Pradesh,1990. A brief overview of the cause of death reporting system in India. Characteristics of an usable cause of death reporting system. Cause of death reporting in India. A performance analysis. Can we improve the cause of death reporting system in India? A study to estimate cause of death in rural areas of AP (APRCD study, 1998). Cause of death in urban areas. Summary and conclusion.	Prasanta Mahapatra, PV Chalapathi Rao & GNV Ramana	55	👁	7.7
4	General approach to estimation of epidemiological inputs for computation of National Burden of Disease. Setting priority for estimation of descriptive epidemiology. Disease specific estimates. Criteria to assess the level of anchorage to local data. Building national capacity in descriptive epidemiology.	Prasanta Mahapatra	102	👁	1.7
5	An illustration of steps leading to epidemiological estimates for a National Burden of Disease study. Adult tuberculosis in Andhra Pradesh, during the 1990s. Problem definition. Steps leading to estimation of TB incidence & prevalence in AP. Natural history. Case defition. Time trends. Adjustment factor for urban areas. Review of studies on TB prevalence in AP. Deriving age & sex specific incidence of Tuberculosis in rural and urban areas of AP using DISMOD.	Prasanta Mahapatra & GNV Ramana	113	👁	4.0
6	Health State Valuations Study in Andhra Pradesh: Review of Literature and Methods. Review of literature. Methods of the health state valuation study in Andhra Pradesh. Socioeconomic profile of valuers and overview of data collected from two arms of the study. Reliability of heatlh state valuation tools. Validity of the health tate valution measurement.	Prasanta Mahapatra, Josh A. Salomon, Lipika Nanda & K.T. Rajshree	139	👁	12.0
7	Results from the community survey in Andhra Pradesh to measure health state valuations. Distribution of valuations for different health states. Comparison with disability weights reported by other studies. Incorporating Local Health State Valuation into NBD estimate. Future research needs for health state valuation. Summary and conclusions from the health state valuation study.	Prasanta Mahapatra	209	👁	2.6
8	Local age preference, age weight and discounting parameters for computation of DALYs. Reviewing difference between time based measure versus conventional measures of disease burden. Understanding the age weight function. Discounting years of life. Combined effect of age weighting and discounting parameters.	Prasanta Mahapatra	227	👁	1.4
9	Burden of disease estimates for Andhra Pradesh and implications for policy. Andhra Pradesh Burden of Disease Study results and important causes of disease burden. Levels of anchorage to local data and NBD Results. Summary and Conclusion.	Prasanta Mahapatra	237	👁	4.0
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List of Tables.

#	Table Title	Page
1.1	US "Closing the gap" project - common data format	5
1.2	Ordered functional states defined by Fanshel and Bush (1970).	12
1.3	Family of health expectancy indicators (HEI).	16
2.1	Mortality changes in Andhra Pradesh	38
2.2	Exponential intercensal growth factors for urban and rural population of AP.	39
2.3	Index of dissimilarity (ID) of age composition between AP SRS 1991 and selected Coale and Demeny stable populations.	41
2.4	Estimated completeness of registration and adjustment factors.	44
2.5	Estimated M_x values in 1991 for different regions of Andhra Pradesh.	46
2.6	Selected life table functions for different sub populations in AP.	46
3.1	Premature mortality (YLLs) and disability (YLLs) components of disease burden in India as per GBD Version-5.	55
3.2	General design features of a good VA system and the SCD (Rural) scheme in India.	61
3.3	SCD (Rural) cause groups, availability of expert opinion or validity information on each cause and concordance of SCD questions with expert opinion.	65
3.4	Percentage of estimated deaths covered by SCD-Rural, during 1991-1995.	68
3.5	Percentage of medically certified deaths to expected urban deaths in major States.	69
3.6	MCCD in AP, 1998: Compliance by municipalities and Health Care Institutions (HCIs) within municipalities.	70
3.7	Percentage of deaths coded as unclassifiable by the SCD-Rural and MCCD Scheme.	73
3.8	Ag, sex cause-specific mortality proportions data points not satisfying model based expectations based on general mortality.	75
3.9	Instances of deaths with clear age-sex dependency reported under other age sex groups.	76
3.10	Percentage deaths in all ages attributed to major cause grops by SCD-Rural and MCCD schemes in different years.	79
3.11	Time taken for publication of cause of death reports in India.	80
3.12	Overall assessment of performance of cause of death reporting system in India.	82
3.13	Comparison of age specific death rates from the rural cause of death study (study ASDR) with an independent estimate of ASDR (General ASDR).	88
3.14	Review of SCD-Rural cause of death reports. Movement of deaths to and from other major cause groups.	90
3.15	Biased reporting by the SCD-Rural for some top causes of death.	91
3.16	Top ten non medical list causes of death in rural areas of Andhra Pradesh.	92
3.17	Top ten causes of death in rural areas of Andhra Pradesh.	93
3.18	Top ten causes of death in urban areas of Maharashtra and probably in AP.	94
3.19	Top ten causes of death - all age grops in Andhra Pradesh, 1991.	97
4.1	Group-1 conditions contributing more than 100,000 YLLs to disease burden in India and number of published articles from India in two medical and health bibliographical data bases.	104
4.2	Group-2 conditions contributing more than 100,000 YLLs to disease burden in India and number of published articles from India in two medical and health bibliographical data bases.	106
4.3	Accidents and injuries contributing more than 100,000 YLLs to disease burden in India and number of published articles from India in two medical and health bibliographical data bases.	108
4.4	Coverage of top causes of YLLs by ongoing disease control programmes in AP.	109
5.1	BCG Trial - Age, sex specific incidence of tuberculosis, over 2.5 years.	118
5.2	Adjustment factor for urban areas based on Madanapalle data of ICMR NSS.	120
5.3	Yield of cases by method of screening, from TRC study in North Arcot.	121
5.4	Adjustment factor for type of screening procedure, based on North Arcot study data.	122
5.5	Adjustment factor for Extra pulmonary tuberculosis.	123
5.6	Data from the Medak survey, 1992.	125
5.7	Data from the Bhadrahalam study, 1982.	125
5.8	Adjusted TB prevalence estimate from ICMR Natinal Sample Survey.	126
5.9	Adjusted TB prevalence estimates from Medak and Bhadrachalam Studies.	127
5.10	Outcome of TB cases diagnosed in NTI survey.	128
5.11	Outcome of TB cases attending PHIs by age and sex.	129
5.12	Outcome of TB cases not attending PHIs by age and sex.	130
5.13	Computation of remission rates in males and females.	130
5.14	Mortality data among TB patients from NTI study.	131
5.15	Age and sex specific instantaneous rates used as inputs for DISMOD.	133
5.16	Tuberculosis - output from DISMOD for rural AP.	134
5.17	Comparison of incidence rates from DISMOD with TRC and NTI study results.	134
5.18	Comparison of prevalence estimates from DISMOD with TRC and NTI study results.	135
5.19	Estimated annual incidence and prevalence in urban and rural AP with DISMOD.	136
5.20	Comparison of cause specific deaths due to tuberculosis estimated from DISMOD and Mortality data from SCD & MCCD.	136
6.1	Mapping of selected health status description systems to EQ-5D.	143
6.2	Mapping of MOS dimensions to EQ-5D.	145
6.3	Short and long disease tables used in health state valuation exercises.	165
6.4	Age and literacy of health state valuers.	174
6.5	Number of valuations obtained for each health state.	175
6.6	Feasibility of test-retest reliability measures for health state valuation instruments.	179
6.7	Intra class correlation coefficients (ICC) by health state from workshop and village population survey.	185
6.8	Estimated variance components for VAS-based health state valuations from village population.	188
6.9	Generalizability of health state values by VAS. Variance components in perentages, reported by different studies.	189
6.10	TTO test retest ICC by health states.	190
6.11	Correlation of health state values obtained from different methods and effect of deliberation.	192
6.12	Within health state correlation of valuations by different instruments.	194
6.13	Incidence of counter intuitive valuations for dominating and dominated pairs.	195
6.14	Mean disability weights from workshops.	197
7.1	Classification of health states by degree of crystalisation of community valuations.	214
7.2	Comparative statement of mean disability weights from different studies.	216
7.3	Mean VAS disability weights from APHSV99 and Dutch health state valuation study 1997.	219
8.1	Relative count of a death at different ages using a time based measure like the YLL, without any discounting or age weighting.	228
8.2	Age weight scaling constants for AP corresponding to different age weight parameters.	231
8.3	Implications of different age weight parameters.	232
9.1	Leading causes of disease burden (DALY) in rural and urban areas of AP.	240
9.2	Leading causes of premature mortality (YLL) in rural and urban areas.	243
9.3	Leading causes of disability (YLD) in Andhra Pradesh.	244
9.4	Leading casues of disease burden (DALY) in rural and urban areas of AP (Community Rated Disability Weights).	246
9.5	Overview of Burden of Disease Estimates for Andhra Pradesh with different levels of anchorage to local data.	248
9.6	Magnitude of disease burden in AP, and mortality-disability composition obtained by different estimates.	249
9.7	Age, sex distributio of DALYs from different estimates.	250
9.8	YLL:YLD Ratio by age sex groups from different estimates.	251
9.9	Leading casues of burden from different estimates.	251
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List of Figures.

#	Figure Title	Page
2.1	The general demographic estimation process for computation of DALYs.	35
2.2	Andhra Pradesh - age composition of population over time 1961 to 1991, Census.	39
2.3	Andhra Pradesh Population trend in the 20th century.	40
2.4	Ratio of completeness of death registration by SRS, by age.	43
2.5	Age pattern of M_x values for different subpopulations in AP, 1991.	45
3.1	Age distribution of deaths attributed to selected causes by SCD-Rural and MCCD.	77
3.2	Flow chart of deaths investigated in rural areas of AP, 1998.	87
3.3	Completeness of recorded deaths: Age specific death rates from the APRCD study, 1998 and general estimate of age specific death rates.	98
3.4	Age pattern of cause specific mortality proportions of top ten causes of death in AP.	108
4.1	Basic framework to generate descriptive epidemiological estimates for GBD.	107
6.1	6D5L Graphics for Self Care.	162
6.2	Continuous Moderate Back Pain	162
6.3	6D5L code and dimensions.	166
6.4	A scaled down picture of the visual analogue scale (Actual size= Legal).	168
6.5	A report generated by the HSV Workshop Data Entry Program.	170
6.6	Potential for Rank Reversal of Health States in retesting.	180
6.7	Distribution of within valuer test retest rank correlation (Kendal's Tau).	181
6.8	Distribution of test retest agreement weighted Kappa statistic.	182
6.9	Distribution of within valuer test retest product moment correlation and intra class correlation coefficients (ICC). Data from workshops and community survey.	184
6.10	Distribution of TTO test retest product moment and intra class correlation.	190
6.11	Frequency distribution within valuer correlations' between VAS and TTO valuations.	193
6.12	Power function models of TTO from VAS.	198
6.13	Two way scatter plot of mean disability weights from TTO and VAS.	200
6.14	One way scatter plot of mean disability weights for different health states obtained by visual scaling (VAS) and time trade off (TTO).	200
6.15	One way scatter plot of mean disability weights for different health states obtained by visual scaling (VAS) from MDHSV workshops and Community Survey.	201
7.1	Distribution of disability weights. Group-A health states.	211
7.2	Distribution of disability weights. Group-B health states.	212
7.3	Distribution of disability weights. Group-C health states.	213
7.4	Scatter plot of GBD96 disability weights versus APHSV weights.	215
7.5	Mean VAS disability weights from APHSV study and BOD Workshop 1999.	218
7.6	APHSV99-VAS weights for AP versus GBD96 weights.	220
8.1	Effect of discounting without age weights on the relative YLL value of a death at different ages.	233
8.2	Effect of discounting with age weights (β=0.04) on the relative YLL value of a death at different ages.	234
9.1	Rural - Urban distribution of disease burden in AP.	239
9.2	Distribution of DALYs and YLL:YLD ratio by age sex groups.	239
9.3	Age distributio of DALYs lost on account of IHD and Falls.	241
9.4	Age sex distribution of DALYs lost on account of suicide and fires.	241
9.5	Rural - Urban and YLL-YLD breakup of DALYs lost on account of suicide and fires.	242
9.6	Age sex distribution and composition of DALYs lost on account of road accidents.	242
9.7	Age sex distribution of premature mortality due to malaria in rural areas.	244
9.8	Rural - Urban distribution of disease burden in AP (Community Rated DWts).	245
9.9	Distribution of DALYs and YLL:YLD ratio by age sex groups.	246
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List of Appendices.

A‑#	Title	Page	View	MB
1‑1	The DALY Formula	A1	👁	0.3
2‑1	Population estimates for Andhra Pradesh in 1991.	A5	👁	0.2
2‑2	Age specific estimate of deaths in Andhra Pradesh, 1991.	A7	👁	0.2
2‑3	Age at death (a) and Expectation of life at age a [E(a)] equivalent to duration of life lost (L) by those dying at age a in AP in 1991.	A9	👁	0.3
2‑4	Interpolated standard life expectancies by single year obtained from Coale and Guo model life tables using piece wise exponential method.	A11	👁	0.1
2‑5	Age composition of population in AP at different points of time.	A12	👁	0.3
2‑6	Comparison of degree of fit of different interpolations.	A15	👁	0.1
3‑1	SCD (Rural) algorithms and current knowledge base on verbal autopsy.	A16	👁	1.8
3‑2	AP rural cause of death study, 1998: Movement of deaths between detailed causes and detection of additional deaths.	A28	👁	0.3
3‑3.1	Non medical list causes of death - rural females.	A32	👁	0.2
3‑3.2	Non medical list causes of death - rural males.	A34	👁	0.2
3‑4	Mapping of non medical list (NML) causes of death to single burden of disease list (BDL) causes of death.	A36	👁	0.2
3‑5	One to many map of non medical list (NML) causes of death to burden of disease list (BDL) causes.	A38	👁	0.5
3‑6.1	All AP female deaths by cause and age groups, 1991.	A42	👁	0.3
3‑6.2	All AP male deaths by cause and age groups, 1991.	A45	👁	0.3
3‑7.1	Rural AP femaled deaths by cause and age groups, 1991.	A48	👁	0.3
3‑7.2	Rural AP maled deaths by cause and age groups, 1991.	A51	👁	0.3
3‑8.1	Urban AP femaled deaths by cause and age groups, 1991.	A54	👁	0.3
3‑8.2	Urban AP maled deaths by cause and age groups, 1991.	A57	👁	0.3
6‑1	6D5L Health State Description System. Dimensions and Severity Levels.	A60	👁	0.4
6‑2	Identification of 6D5L profiles: Provisional, panel recommended and final.	A63	👁	0.3
6‑3.1	Sample TTO Worksheet with Alternative - 2 Progressively increasing.	A65	👁	0.4
6‑3.2	Sample TTO Worksheet with Alternative - 2 Progressively decreasing.	A66	👁	0.4
6‑4.1	Sample PTO1 Worksheet.	A67	👁	0.4
6‑4.2	Sample PTO2 Worksheet.	A68	👁	0.4
9‑1.1	DALYs by age sex and cause - Andhra Pradesh - Using Expert Rated Disability Weights.	A69	👁	0.6
9‑1.2	YLLs by age sex and cause - Andhra Pradesh - Using Expert Rated Disability Weights.	A75	👁	0.7
9‑1.3	YLLs by age sex and cause - Andhra Pradesh - Using Expert Rated Disability Weights.	A83	👁	0.6
9‑2.1	DALYs by age sex and cause - Andhra Pradesh Rural Areas - Using Expert Rated Disability Weights.	A89	👁	0.6
9‑2.2	YLLs by age sex and cause - Andhra Pradesh Rural Areas - Using Expert Rated Disability Weights.	A96	👁	0.7
9‑2.3	YLLs by age sex and cause - Andhra Pradesh Rural Areas - Using Expert Rated Disability Weights.	A104	👁	0.5
9‑3.1	DALYs by age sex and cause - Andhra Pradesh Urban Areas - Using Expert Rated Disability Weights.	A110	👁	0.6
9‑3.2	YLLs by age sex and cause - Andhra Pradesh Urban Areas - Using Expert Rated Disability Weights.	A116	👁	0.7
9‑3.3	YLLs by age sex and cause - Andhra Pradesh Urban Areas - Using Expert Rated Disability Weights.	A124	👁	0.5
9‑4.1	DALYs by age sex and cause - Andhra Pradesh - Using Community Rated Disability Weights.	A130	👁	0.6
9‑4.2	YLLs by age sex and cause - Andhra Pradesh - Using Community Rated Disability Weights.	A136	👁	0.7
9‑4.3	YLLs by age sex and cause - Andhra Pradesh - Using Community Rated Disability Weights.	A144	👁	0.5
9‑5.1	DALYs by age sex and cause - Andhra Pradesh Rural Areas - Using Community Rated Disability Weights.	A150	👁	0.7
9‑5.2	YLLs by age sex and cause - Andhra Pradesh Rural Areas - Using Community Rated Disability Weights.	A157	👁	0.7
9‑5.3	YLLs by age sex and cause - Andhra Pradesh Rural Areas - Using Community Rated Disability Weights.	A165	👁	0.6
9‑6.1	DALYs by age sex and cause - Andhra Pradesh Urban Areas - Using Community Rated Disability Weights.	A171	👁	0.6
9‑6.2	YLLs by age sex and cause - Andhra Pradesh Urban Areas - Using Community Rated Disability Weights.	A177	👁	0.7
9‑6.3	YLLs by age sex and cause - Andhra Pradesh Urban Areas - Using Community Rated Disability Weights.	A185	👁	0.6
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