Research articleAssessing the Burden of Disease in the United States Using Disability-Adjusted Life Years
Section snippets
Background
Mortality data are the most widely used source of information for identifying most important health problems for a population.1, 2 However, during the 20th century, death rates in economically developed countries have fallen substantially. Correspondingly, many persons live many years with serious illness and disability. Therefore, causes of deaths are increasingly viewed as inadequate measures of the health of a population.3 Assessments that include more than mortality data to measure
Methods
The calculation of DALYs requires estimates for the age-specific incidence, prevalence, and duration of disability associated with nonfatal health outcomes, and the age at death due to individual diseases and injuries. The conceptual and computational details of how these parameters are estimated and then combined to generate DALYs for individual conditions have been presented elsewhere.8 A more detailed presentation on the specific analytic methods, data sources, consultations, and data sets
Results
In 1996, there were 2.3 million deaths in the United States that contributed to over 33 million DALYs (Table 3, Table 4). The greatest number of deaths and DALYs were attributed to chronic disease conditions that occur in adulthood. The leading source of DALYS for both males and females was ischemic heart disease. Other chronic diseases, such as cerebrovascular disease, cancer, and dementias, dominated the list of major causes. Injuries from road traffic events and violence were also prominent
Discussion
In the mid-1990s, the leading sources of premature death and disability in the United States, as measured by DALYs, were chronic diseases such as cardiovascular conditions, cancers (especially breast and lung), depression, osteoarthritis, diabetes mellitus, and alcohol use and abuse. In addition, motor vehicle-related injuries and the HIV epidemic exacted a substantial toll on the health status of the U.S. population. The use of DALYs to enumerate the impact of health conditions produced
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