GBD

What does DALY stand for & what is it

Disability-Adjusted Life Years - one lost year of healthy life

DALY formula

DALYs = Years of life lost due to premature mortality (YLLs) + Years of life lived with any short- or long-term health loss (YLDs)

Calculate the DALYs for this population of 100,000 people.

Deaths this year: 20 deaths, average age at death = 70.

Remaining life expectancy at 70 = 15 years

Prevalence: 60 people under treatment

DW = 0.30

DALYs = YLL+YLD

Step 1 : YLL

YLL = deaths × remaining life expectancy

= 20 × 15 = 300 YLL

Step 2 :YLD

YLD = DW × prevalence

= 0.30 × 60 = 18 YLD

Step 3 : DALY

DALY = YLL + YLD = 300 + 18 = 318 DALYs per 100,000 (in2024, for colorectal cancer)

What is the GBD study

Global Burden of Diseases study is the single largest and most detailed scientific effort ever

conducted to quantify levels and trends in health

What does GBD study

Quantifies trends in health by comparing the magnitude of health loss due to specific diseases, injuries, and risk factors across age groups, sexes, countries, regions, and time.

In what year did the GBD begin

1990

Name & explain 5 Limitations of the GBD

Per 100,000 what is considered a good/bad rate of DALY

Regions with best health outcomes = rate of DALYs was under 20,000 per 100,000 people

Regions with worse health outcomes = rate of DALYs over 60,000 per 100,000 people

Top 3 causes for DALYs worldwide

Top 3 specific causes of DALYs in Ireland in 2023

Cancer

Cardiovascular diseases

Mental disorders

Top 3 specific causes of DALYs in Africa in 2023

Neonatal disorders

Resp infections / TB

Malaria & neglected tropical diseases

What is double burden of disease

The double burden of disease means that the development of a country leads to a rise in non-communicable diseases (NCDs) such as CVD, cancer and diabetes, while infectious diseases such as TB remain major health problems at the same time.

(the development of the country is adding to the problem (e.g. increased air pollution & sedentary lifestyles) while also the country is still trying to deal with the communicable diseases not seen as much in fully developed countries)

Where can the double burden of disease be seen

South-East Asia

Why is it helpful to standardise health metrics for age?

Age standardisation provide better comparison between populations with different age structures and allow us to interpret underlying risk to see how mortality and morbidity vary without age differences

Which of these would you use crude vs age-standardised rates

Plan the number of cardiovascular beds/services needed next year?

Estimate future demand for cardiovascular services in an ageing population?

Identify whether one region has a higher underlying risk of stroke than another?

Assess whether cardiovascular risk has fallen over time despite population ageing?

Plan the number of cardiovascular beds/services needed next year? Crude

Estimate future demand for cardiovascular services in an ageing population? Crude

Identify whether one region has a higher underlying risk of stroke than another? Age Std

Assess whether cardiovascular risk has fallen over time despite population ageing? Age Std

The WHO has identified 29 measures called “best buys” that countries can use to prevent and manage major NCDs. Give an example of a WHO "Best Buy" Implemented in Ireland

Alcohol Harm Reduction: Minimum unit pricing introduced via the Public Health (Alcohol) Act (2018), along with structural separation of alcohol in stores, broadcast advertising restrictions, and health labelling on products

Explain the Urban Heat Island effect

Daytime: During the day urban surfaces (like roads & buildings) absorb solar radiation, storing thermal energy & raising local temperatures.

Night time: The heat stored in urban areas is released slowly at night. So it results in elevated night time temperatures compared to the surrounding rural areas → Urban Heat Island effect

Give some examples of how climate change & Extreme heat can destabilise pre-existing NCDs

• Cardiovascular: skin vasodilation + dehydration → ↓ circulating volume, ↑ heart rate and cardiac workload → myocardial ischaemia, arrhythmia, stroke and heart failure.

• Renal/metabolic: dehydration and reduced renal perfusion → Acute Kidney Injury, electrolyte disturbance and worsening chronic kidney disease; people with diabetes are also at increased risk of heat-related morbidity and mortality.

• Respiratory/neurological/mental health: heat can exacerbate COPD/asthma and is associated with increased neurological and mental-health morbidity.

• Medication matters: diuretics may increase dehydration; some antihypertensives and psychotropic/anticholinergic drugs can impair physiological responses to heat; NSAIDs may increase renal risk during dehydration

What is the leading cause of child mortality in WHO African region (2023)

Malaria

Burden of Disease is calculated using what formula

Burden of Disease = Mortality (YLLs) + Morbidity (YLDs) (expressed as DALYs)