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BMC Med Res Methodol. 2012; 12: 125.
Published online Aug 17, 2012. doi:  10.1186/1471-2288-12-125
PMCID: PMC3490831
Estimating and validating disability-adjusted life years at the global level: a methodological framework for cancer
Isabelle Soerjomataram,corresponding author1,2,3 Joannie Lortet-Tieulent,3 Jacques Ferlay,3 David Forman,3 Colin Mathers,4 D Maxwell Parkin,5 and Freddie Braycorresponding author3
1Department of Public Health, Erasmus MC, Rotterdam, the Netherlands
2Department of Global Health and Population, Harvard School of Public Health, Boston, USA
3Section of Cancer Information, International Agency for Research on Cancer, 150 Cours Albert Thomas, Lyon, 69372, France
4World Health Organization, Geneva, Switzerland
5Clinical Trial Service Unit and Epidemiological Studies Unit, University of Oxford, Oxford, UK
corresponding authorCorresponding author.
Isabelle Soerjomataram: soerjomatarami/at/iarc.fr; Joannie Lortet-Tieulent: tieulentj/at/iarc.fr; Jacques Ferlay: FerlayJ/at/iarc.fr; David Forman: formand/at/iarc.fr; Colin Mathers: mathersc/at/who.int; D Maxwell Parkin: max.parkin/at/ctsu.ox.ac.uk; Freddie Bray: brayf/at/iarc.fr
Received September 14, 2011; Accepted May 18, 2012.
Abstract
Background
Disability-adjusted life years (DALYs) link data on disease occurrence to health outcomes, and they are a useful aid in establishing country-specific agendas regarding cancer control. The variables required to compute DALYs are however multiple and not readily available in many countries. We propose a methodology that derives global DALYs and validate variables and DALYs based on data from various cancer registries.
Methods
We estimated DALYs for four countries (Norway, Bulgaria, India and Uganda) within each category of the human development index (HDI). The following sources (indicators) were used: Globocan2008 (incidence and mortality), various cancer registries (proportion cured, proportion treated and duration of disease), treatment guidelines (duration of treatment), specific burden of disease studies (sequelae and disability weights), alongside expert opinion. We obtained country-specific population estimates and identified resource levels using the HDI, DALYs are computed as the sum of years of life lost and years lived with disabilities.
Results
Using mortality:incidence ratios to estimate country-specific survival, and by applying the human development index we derived country-specific estimates of the proportion cured and the proportion treated. The fit between the estimates and observed data from the cancer registries was relatively good. The final DALY estimates were similar to those computed using observed values in Norway, and in WHO’s earlier global burden of disease study. Marked cross-country differences in the patterns of DALYs by cancer sites were observed. In Norway and Bulgaria, breast, colorectal, prostate and lung cancer were the main contributors to DALYs, representing 54% and 45%, respectively, of the totals. These cancers contributed only 27% and 18%, respectively, of total DALYs in India and Uganda.
Conclusions
Our approach resulted in a series of variables that can be used to estimate country-specific DALYs, enabling global estimates of DALYs and international comparisons that support priorities in cancer control.
Keywords: Years of life live with disability, Years of life lost, Disability-adjusted life years, Cancer, Global estimates
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