Accounting for multimorbidity can affect the estimation of the Burden of Disease: A comparison of approaches

被引：30
作者：
Hilderink H.B.M. [1 ]
Plasmans M.H.D. [1 ]
Snijders B.E.P. [1 ]
Boshuizen H.C. [1 ,2 ]
René Poos M.J.J.C. [1 ]
van Gool C.H. [1 ]
机构：
[1] National Institute for Public Health and the Environment (RIVM), P.O. Box 1, Bilthoven, BA
[2] Wageningen University and Research Centre, Wageningen
来源：
Archives of Public Health | / 74卷 / 1期
关键词：
Disability weights; Disease burden; Multimorbidity; Prevalence;
D O I：
10.1186/s13690-016-0147-7
中图分类号：
学科分类号：
摘要：
Background: Various Burden of Disease (BoD) studies do not account for multimorbidity in their BoD estimates. Ignoring multimorbidity can lead to inaccuracies in BoD estimations, particularly in ageing populations that include large proportions of persons with two or more health conditions. The objective of this study is to improve BoD estimates for the Netherlands by accounting for multimorbidity. For this purpose, we analyzed different methods for 1) estimating the prevalence of multimorbidity and 2) deriving Disability Weights (DWs) for multimorbidity by using existing data on single health conditions. Methods: We included 25 health conditions from the Dutch Burden of Disease study that have a high rate of prevalence and that make a large contribution to the total number of Years Lived with a Disability (YLD). First, we analyzed four methods for estimating the prevalence of multimorbid conditions (i.e. independent, independent age-and sex-specific, dependent, and dependent sex-and age-specific). Secondly, we analyzed three methods for calculating the Combined Disability Weights (CDWs) associated with multimorbid conditions (i.e. additive, multiplicative and maximum limit). A combination of these two approaches was used to recalculate the number of YLDs, which is a component of the Disability-Adjusted Life Years (DALY). Results: This study shows that the YLD estimates for 25 health conditions calculated using the multiplicative method for Combined Disability Weights are 5 % lower, and 14 % lower when using the maximum limit method, than when calculated using the additive method. Adjusting for sex-and age-specific dependent co-occurrence of health conditions reduces the number of YLDs by 10 % for the multiplicative method and by 26 % for the maximum limit method. The adjustment is higher for health conditions with a higher prevalence in old age, like heart failure (up to 43 %) and coronary heart diseases (up to 33 %). Health conditions with a high prevalence in middle age, such as anxiety disorders, have a moderate adjustment (up to 13 %). Conclusions: We conclude that BoD calculations that do not account for multimorbidity can result in an overestimation of the actual BoD. This may affect public health policy strategies that focus on single health conditions if the underlying cost-effectiveness analysis overestimates the intended effects. The methodology used in this study could be further refined to provide greater insight into co-occurrence and the possible consequences of multimorbid conditions in terms of disability for particular combinations of health conditions. © 2016 The Author(s).
引用
收藏
相关论文
共 34 条
  • [1] Devleesschauwer B., Maertens de Noordhout C., Smit G.S., Duchateau L., Dorny P., Stein C., Et al., Quantifying burden of disease to support public health policy in Belgium: opportunities and constraints, BMC Public Health, 14, (2014)
  • [2] Murray C.J., Quantifying the burden of disease: the technical basis for disability-adjusted life years, Bull World Health Organ, 72, 3, pp. 429-445, (1994)
  • [3] Murray C.J., Ezzati M., Flaxman A.D., Lim S., Lozano R., Michaud C., Et al., GBD 2010: design, definitions, and metrics, Lancet, 380, 9859, pp. 2063-2066, (2012)
  • [4] Schroeder S.A., Incidence, prevalence, and hybrid approaches to calculating disability-adjusted life years, Popul Health Metrics, 10, 1, (2012)
  • [5] Akker M., Buntinx F., Knottnerus J.A., Comorbidity or multimorbidity: What's in a name? A review of literature, Eur J Gen Pract, 2, 2, pp. 65-70, (1996)
  • [6] Mathers C.D., Iburg K.M., Begg S., Adjusting for dependent comorbidity in the calculation of healthy life expectancy, Popul Health Metrics, 4, (2006)
  • [7] Anand S., Hanson K., Disability-adjusted life years: a critical review, J Health Econ, 16, 6, pp. 685-702, (1997)
  • [8] Hoeymans N., Van Loon A.J.M., Van den Berg M., Harbers M.M., Hilderink H.B.M., Van Oers J.A.M., Et al., A healthier Netherlands: key findings from the Dutch 2014 Public Health Status and Foresight Report, (2014)
  • [9] Oostrom S.H., Picavet H.S., Bruin S.R., Stirbu I., Korevaar J.C., Schellevis F.G., Et al., Multimorbidity of chronic diseases and health care utilization in general practice, BMC Fam Pract, 15, (2014)
  • [10] Baal P.H., Hoeymans N., Hoogenveen R.T., Wit G.A., Westert G.P., Disability weights for comorbidity and their influence on health-adjusted life expectancy, Popul Health Metrics, 4, (2006)
1234