Suchergebnisse

BackgroundA criticism of Burden of Disease (BOD) estimates has been that they only provide evidence for national policy and aren't relevant for local needs. This has led to a growing call for BOD studies to provide more granular estimates for sub-national geographies, particularly within European countries, to help support local policy makers with evidence-based decision making.
AimTo develop local BOD estimates and investigate inequalities in BOD within and across local areas of Scotland.
MethodsEstimates of Years Lived with Disability (YLD), Years of Life Lost (YLL), DALYs (Disability-adjusted Life Years), prevalent cases and mortality counts were developed for 68 conditions. Morbidity estimates were calculated based on a three-year average of 5-year age-group, sex and deprivation decile rates per person (from the SBOD 2016 study) which were applied to 2016 mid-year local population estimates. Mortality estimates were based on a three-year average (2014-16) sourced from the National Records of Scotland register of deaths. Direct age-standardised rates and numbers were produced for regions (3), NHS boards (14) and local authorities (32) by age-group and sex.
ResultsAcross local authorities the male rate of all-cause DALYs ranged from 20,996 (per 100,000 population) to 33,442 and the female rate of all-cause DALYs ranged from 19,889 to 27,684. Inequalities in age-group (15-24; 25-44; 45-64; and 65+ years) differences between all-cause DALYs rates in the area with the highest and lowest rates ranged from 58.4% to 98.0% in males. Comparable estimates were slightly lower for females, but inequalities in rates were wider (41.4% to 87.4%).
ConclusionInequalities in BOD across areas highlight the need for action at all levels. These local estimates provide a huge opportunity to work towards and beyond the 2020 vision of the Scottish Government by ensuring that we have the right workforce and services to achieve a healthier Scotland.

BackgroundIncreasingly Burden of Disease (BOD) measures are being used to influence policy decisions because they summarise health loss in an equitable manner. An important part of producing non-fatal BOD estimates are severity distributions (SDs). The Global Burden of Disease (GBD) study use the same SDs across countries due to a lack of available data.
Aim To develop and assess the impact of national SDs compared with GBD worldwide severity distributions for 21 cancer types.
MethodsPatient-level records from the Scottish Cancer Registry for 21 cancers were obtained and linked to death registrations. We estimated prevalent cancer cases for 2016 and assigned each case to one of four phases (diagnosis and treatment; controlled; metastatic; and terminal) using GBD 2016 study definitions. SDs were calculated by considering relative proportions. The impact of choice of SDs was evaluated by comparing relative differences between weighted-average disability weights (DW) derived using GBD 2016 worldwide SDs with those derived from Scottish SDs.
ResultsFor the majority of cancers the most prevalent phase was the controlled phase, which contributed a higher proportion than the combined proportion from the other three phases across all cancers except mesothelioma. Differences in the composition of severity meant that most point-estimates of Scottish severity proportions were out-with the 95% uncertainty intervals. These differences resulted in overestimates of weighted-average DWs based on GBD 2016 worldwide SDs (17 out of 21 cancer types). The largest relative overestimates were for gallbladder and biliary tract cancer, oesophageal cancer and pancreatic cancer (71%, 32% and 31% higher respectively).
ConclusionThese findings illustrate a systematic bias introduced by using worldwide SDs. Current non-fatal BOD estimates should not be interpreted too precisely when comparing populations when they rely on data inputs from other countries. It is essential to ensure that any estimates are based upon country-specific data as far as possible.

Background: Providing infants with the 'best possible start in life' is a priority for the Scottish Government. This is reflected in policy and health promotion strategies to increase breast feeding, which gives the best source of nutrients for healthy infant growth and development. However, the rate of breast feeding in Scotland remains one of the lowest in Europe. Information is needed to provide a better understanding of infant feeding and its impact on child health. This paper describes the development of a unique population-wide resource created to explore infant feeding and child health in Scotland. Methods: Descriptive and multivariate analyses of linked routine/administrative maternal and infant health records for 731 595 infants born in Scotland between 1997 and 2009. Results: A linked dataset was created containing a wide range of background, parental, maternal, birth and health service characteristics for a representative sample of infants born in Scotland over the study period. There was high coverage and completeness of infant feeding and other demographic, maternal and infant records. The results confirmed the importance of an enabling environment—cultural, family, health service and other maternal and infant health-related factors—in increasing the likelihood to breast feed. Conclusions: Using the linked dataset, it was possible to investigate the determinants of breast feeding for a representative sample of Scottish infants born between 1997 and 2009. The linked dataset is an important resource that has potential uses in research, policy design and targeting intervention programmes.

BackgroundSBOD2015 was the first endeavour to produce burden of disease estimates in Scotland using linkage of routine health records. In 2017, the study highlighted disparities in burden due to morbidity and mortality with respect to age and gender for 132 conditions, diseases and injuries.
ObjectivesThe aim of SBOD2016 is to report on socioeconomic inequalities to provide further evidence to support preventable public health.
MethodsMorbidity estimates were estimated using an extensive range of administrative datasets to provide a transparent and systematic approach to describe non-fatal population health loss. Combining these estimates with the Global Burden of Disease 2016 study's relative assessment of severity and disability for each condition, we were able to calculate the Years Lived with Disability (YLD). Death registrations were used alongside life expectancy data to calculate the Years of Life Lost to premature mortality (YLL) as a measure of fatal burden.
FindingsPreliminary findings show a three-fold increase in the burden of disease between individuals living in the most deprived areas compared to the least deprived areas. The profile of diseases contributing the largest burden also varies between the most and least deprived areas.
ConclusionsBy combining information on fatal burden with the burden of living in less than ideal health (non-fatal burden), planners and policymakers have a better idea of the contribution that different diseases, conditions and injuries make to the total burden of disease and how this varies by levels of deprivation. This in turn provides information to support decisions about where prevention and service activity should be focused. It also provides a way of looking at the proportion of the burden that can be explained by a range of exposures in the population such as poverty or smoking.

BackgroundRecent evidence shows that after several decades of gains in life expectancy, Scotland has firmly entered a period of slow-down. Trend data show that the prevalence of morbidity continues to increase resulting in a frailer and more vulnerable population. Burden of Disease (BOD) studies measure the causes of health loss and their attribution to risk factor exposure and are essential to tackling current and future population needs for care workforce and services in an efficient manner.
AimTo assess the current and projected health loss in Scotland between 2019 and 2040, based on different scenarios for change in risk factors and the impact and cost-effectiveness of evidence-based interventions on those risk factors.
Methods and AnalysisEstimates of Years Lived with Disability (YLD), Years of Life Lost (YLL) and DALYs (Disability-adjusted Life Years) will be developed for 132 conditions for Scotland using routine data sources and linkage techniques. These estimates will be linked to risk factors using attributable fractions from the Global Burden of Disease (GBD) 2017 study. Scenario-modelling will be carried out based on three scenarios: continuation; worsening; and improvements of secular trends. Cost-effective interventions will be identified and their results will be assessed in the context of Scottish BOD estimates (current & projected) and evidence on the costs and potential impact of those interventions.
Dissemination Findings from Scottish BOD estimates along with information on costs and effectiveness will help direct resources to interventions and policies with the most potential to reduce disease burdens and improve population health. Results will be disseminated through pre-print publications, scientific publications, grey literature, social media and conference or workshop presentations both nationally and internationally throughout the European Burden of Disease Network and associated events.

ABSTRACT
ObjectivesThe gap between a population's actual and ideal health can be quantified by Disability-Adjusted Life Years (DALY). This metric combines the Years Lived with Disability (YLD) and Years of Life Lost (YLL). When supplemented by a Comparative Risk Assessment (CRA) it can depict the magnitude of disease burden and the effect that modifiable exposures contribute. We aim to utilise routine healthcare records to quantify the burden and potential reduction in DALY caused by stroke.
ApproachHospital stays involving a stroke diagnosis (ICD-9: 430-431, 433-34, 436; ICD-10: I60-61, I63-64) were identified through secondary care primary diagnoses from 1981-2013 and used to derive the incidence of acute stroke and the point-prevalence of chronic stroke. Disability weights for each health state of stroke sequelae were sourced from the Global Burden of Disease 2013 study and used to derive YLD. YLL for each death was calculated using Scotland-specific life tables for deaths where stroke was the underlying cause.
Eight waves of the Scottish Health Survey (SHES) from 1995-2012 were linked to secondary care and mortality records. Risk factors were identified from SHES then mapped to levels in the Dahlgren and Whitehead model and Population Attributable Fractions (PAFs) were calculated for each risk factor that was a significant casual risk of stroke from a Cox-proportional hazard regression model.
ResultsStroke was responsible for 47,836 DALY in Scotland during 2013 which was a reduction of 33.3% from 2000. The proportion of YLD contributing to DALY was 7.6% in 2000 rising to 14.4% in 2013. The main reasons for the changing profile of DALY are due to the large reduction in mortality and influence of the rising prevalence of chronic stroke. Stroke mortality reduced 34.3% during the period 2000-2013 from 7,013 deaths in 2000 to 4,610 in 2013, whilst chronic prevalence increased from 46,184 in 2000 to 59,367 in 2013.
Between 23.5 to 38.8% of excess first stroke incidence can be explained by education, social class and area deprivation, which were all significant predictors of stroke after adjusting for confounding. Altering the exposure distribution for each independent risk factor to its theoretical minimum risk exposure level could potentially reduce the DALY by between 9,615 to 15,882 in 2013.
ConclusionThis study highlights the benefit of using linked administrative health records to quantify the burden of stroke on the population and how public health interventions to tackle inequalities would be a method of reducing strokes in Scotland.

Erratum in: Wyper GMA, Assunção R, Cuschieri S, Devleesschauwer B, Fletcher E, Haagsma JA, Hilderink HBM, Idavain J, Lesnik T, Von der Lippe E, Majdan M, Milicevic MS, Pallari E, Peñalvo JL, Pires SM, Plaß D, Santos JV, Stockton DL, Thomsen ST, Grant I. Arch Public Health. 2020 Jun 18;78:57. doi:10.1186/s13690-020-00437-8. eCollection 2020. "[This corrects the article DOI:10.1186/s13690-020-00433-y.]." ; Background: Evidence has emerged showing that elderly people and those with pre-existing chronic health conditions may be at higher risk of developing severe health consequences from COVID-19. In Europe, this is of particular relevance with ageing populations living with non-communicable diseases, multi-morbidity and frailty. Published estimates of Years Lived with Disability (YLD) from the Global Burden of Disease (GBD) study help to characterise the extent of these effects. Our aim was to identify the countries across Europe that have populations at highest risk from COVID-19 by using estimates of population age structure and YLD for health conditions linked to severe illness from COVID-19. Methods: Population and YLD estimates from GBD 2017 were extracted for 45 countries in Europe. YLD was restricted to a list of specific health conditions associated with being at risk of developing severe consequences from COVID-19 based on guidance from the United Kingdom Government. This guidance also identified individuals aged 70 years and above as being at higher risk of developing severe health consequences. Study outcomes were defined as: (i) proportion of population aged 70 years and above; and (ii) rate of YLD for COVID-19 vulnerable health conditions across all ages. Bivariate groupings were established for each outcome and combined to establish overall population-level vulnerability. Results: Countries with the highest proportions of elderly residents were Italy, Greece, Germany, Portugal and Finland. When assessments of population-level YLD rates for COVID-19 vulnerable health conditions were made, the highest rates were observed for Bulgaria, Czechia, Croatia, Hungary and Bosnia and Herzegovina. A bivariate analysis indicated that the countries at high-risk across both measures of vulnerability were: Bulgaria; Portugal; Latvia; Lithuania; Greece; Germany; Estonia; and Sweden. Conclusion: Routine estimates of population structures and non-fatal burden of disease measures can be usefully combined to create composite indicators of vulnerability for rapid assessments, in this case to severe health consequences from COVID-19. Countries with available results for sub-national regions within their country, or national burden of disease studies that also use sub-national levels for burden quantifications, should consider using non-fatal burden of disease estimates to estimate geographical vulnerability to COVID-19. ; This research received no specific grant from any funding agency in the public, commercial or not-for-profit sectors. Journal open access publications fees upon acceptance of this article in a peer-reviewed journal will be reimbursed under the COST action CA18218 (European Burden of Disease Network) ; info:eu-repo/semantics/publishedVersion

Background: Evidence has emerged showing that elderly people and those with pre-existing chronic health conditions may be at higher risk of developing severe health consequences from COVID-19. In Europe, this is of particular relevance with ageing populations living with non-communicable diseases, multi-morbidity and frailty. Published estimates of Years Lived with Disability (YLD) from the Global Burden of Disease (GBD) study help to characterise the extent of these effects. Our aim was to identify the countries across Europe that have populations at highest risk from COVID-19 by using estimates of population age structure and YLD for health conditions linked to severe illness from COVID-19. Methods: Population and YLD estimates from GBD 2017 were extracted for 45 countries in Europe. YLD was restricted to a list of specific health conditions associated with being at risk of developing severe consequences from COVID-19 based on guidance from the United Kingdom Government. This guidance also identified individuals aged 70 years and above as being at higher risk of developing severe health consequences. Study outcomes were defined as: (i) proportion of population aged 70 years and above; and (ii) rate of YLD for COVID-19 vulnerable health conditions across all ages. Bivariate groupings were established for each outcome and combined to establish overall population-level vulnerability. Results: Countries with the highest proportions of elderly residents were Italy, Greece, Germany, Portugal and Finland. When assessments of population-level YLD rates for COVID-19 vulnerable health conditions were made, the highest rates were observed for Bulgaria, Czechia, Croatia, Hungary and Bosnia and Herzegovina. A bivariate analysis indicated that the countries at high-risk across both measures of vulnerability were: Bulgaria; Portugal; Latvia; Lithuania; Greece; Germany; Estonia; and Sweden. Conclusion: Routine estimates of population structures and non-fatal burden of disease measures can be usefully combined to create ...

Background: Evidence has emerged showing that elderly people and those with pre-existing chronic health conditions may be at higher risk of developing severe health consequences from COVID-19. In Europe, this is of particular relevance with ageing populations living with non-communicable diseases, multi-morbidity and frailty. Published estimates of Years Lived with Disability (YLD) from the Global Burden of Disease (GBD) study help to characterise the extent of these effects. Our aim was to identify the countries across Europe that have populations at highest risk from COVID-19 by using estimates of population age structure and YLD for health conditions linked to severe illness from COVID-19. Methods: Population and YLD estimates from GBD 2017 were extracted for 45 countries in Europe. YLD was restricted to a list of specific health conditions associated with being at risk of developing severe consequences from COVID-19 based on guidance from the United Kingdom Government. This guidance also identified individuals aged 70 years and above as being at higher risk of developing severe health consequences. Study outcomes were defined as: (i) proportion of population aged 70 years and above; and (ii) rate of YLD for COVID-19 vulnerable health conditions across all ages. Bivariate groupings were established for each outcome and combined to establish overall population-level vulnerability. Results: Countries with the highest proportions of elderly residents were Italy, Greece, Germany, Portugal and Finland. When assessments of population-level YLD rates for COVID-19 vulnerable health conditions were made, the highest rates were observed for Bulgaria, Czechia, Croatia, Hungary and Bosnia and Herzegovina. A bivariate analysis indicated that the countries at high-risk across both measures of vulnerability were: Bulgaria; Portugal; Latvia; Lithuania; Greece; Germany; Estonia; and Sweden. Conclusion: Routine estimates of population structures and non-fatal burden of disease measures can be usefully combined to create composite indicators of vulnerability for rapid assessments, in this case to severe health consequences from COVID-19. Countries with available results for sub-national regions within their country, or national burden of disease studies that also use sub-national levels for burden quantifications, should consider using non-fatal burden of disease estimates to estimate geographical vulnerability to COVID-19. ; peer-reviewed