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The State of Health in New Mexico 2018

16. Disability-adjusted Life Years (DALYs)

A Comprehensive Measure of Health

What are DALYs?

Disability-Adjusted Life Years (DALYs) represent a new and innovative way of measuring health and disease burden at a state level. Traditionally, prioritizing conditions for state level health status improvement has been guided largely by mortality rates, where conditions with high mortality rates like heart disease and cancer are given higher priority than low-mortality conditions. However, there are many low-mortality health conditions that profoundly impact quality of life. DALYs combine a morbidity component (Years Lived with Disability) and a mortality component (Years of Life Lost due to a given cause of death or disability), to provide a more complete picture of the burden of disease and disability. DALYs are calculated with this equation:

DALY = Years of Life Lost due to premature mortality (YLL) + Years Lived with Disability (YLD)


The YLL is based on remaining life expectancy when compared with a reference standard life table at age of death, and the YLD is calculated by multiplying the prevalence of a disease or injury by its weighted level of severity. One DALY represents 1 year of healthy life lost. It is a measure of the gap between current health status and an ideal situation where everyone lives into old age free from disease and disability. DALYs are typically reported as a rate per 100,000 population.

Disability-Adjusted Life Years (DALYs) are widely available for the first time at a sub-national level. The DALYs calculations are part of the larger Global Burden of Disease (GBD) studies conducted by the World Health Organization and their partners. Data sources for DALYs are primarily meta-analyses of health status studies published in peer-reviewed journals.

DALYs Trends in New Mexico

From 1990-2010, total DALYs for New Mexico and the United States declined. This was from a high of 28,264 per 100,000 population for New Mexico in 1990 to a low of 25,841 in 2010 (Figure 1). This represents an 8.6% decrease. However, from 2010 to 2016 there was a slight increase in the total DALYs rate in New Mexico to the current level of 26,620 per 100,000 population (a 3% increase). New Mexico's total DALYs rates were very similar to the United States' rates in the 1990s. Since then, New Mexico has had higher rates compared to the U.S., with the current difference being approximately 2600 DALYs per 100,000 population.

The highest DALYs rates for New Mexico in 2016 were found for the following conditions (starting with the highest): drug use disorders, ischemic heart disease, low back and neck pain, road injuries, skin and subcutaneous diseases, depressive disorders, diabetes mellitus, self-harm, chronic obstructive pulmonary disease, and cerebrovascular disease (Figure 2). The highest ranked condition, drug use disorders, is an aggregate rate comprised of opioid, cocaine, amphetamine, cannabis, and other drug use disorders. For low mortality conditions such as low back and neck pain the DALYs rate is primarily comprised of the YLD, i.e., the morbidity component. For high mortality conditions such as ischemic heart disease, the DALYs rate is primarily comprised of the YLL, i.e., the mortality component (Figure 2). These top 10 DALYs rates can be compared directly to the DALYs rates for the same conditions in the United States for 2016 (Figure 3). For most of these conditions the DALYs rates for New Mexico are similar to those of the United States. However, for drug use disorders, road injuries, and self-harm the DALYs rates in New Mexico are significantly higher than those found in the U.S.

The conditions with the highest DALYs rates overlap with several conditions with the highest mortality rates such as heart disease (ranked #1), unintentional injuries (#3), chronic lower respiratory diseases (#4), and intentional self-harm (#9). Drug use disorders are not present in the top ten highest mortality rate conditions, however drug overdose death is the largest component of unintentional injury death. This is an excellent example of the value of including DALYs in assessing population health status over using mortality rates alone. Low-mortality conditions that greatly impact quality of life, such as low back/neck pain, skin diseases, and depressive disorders, may be neglected entirely in allocating health resources if focusing on mortality rates alone.

Assets and Resources

General information on DALYs can be found on the Metrics: Disability-Adjusted Life Year page on the World Health Organization website. The Institute for Health Metrics and Evaluation at the University of Washington is the primary WHO collaborator responsible for analyses and providing online tools for exploring the 2016 Global Burden of Disease study results. Resources available through the University of Washington include:
  • The complete list of online resources for the Global Burden of Disease 2016 study.
  • The GBD Compare tool provides several different data visualization tools for comparing DALYs, YLDs, and death rates across different geographic areas, time periods, age, and sex.
  • The GBD Results tool provides an easy way to query and download DALYs, YLDs, YLLs, death, prevalence, and incidence rates from GBD 2016 by geographic area, time period, age and sex.
  • The guidelines and methodology standards used in GBD 2016 can be found at the Guidelines for Accurate and Transparent Health Estimates Reporting (GATHER) website.

Summary

DALYs can be used in conjunction with other information, such as mortality and morbidity rates and health surveys, to arrive at a more complete picture of the burden of disease in New Mexico. Examination of levels and trends of DALYs facilitates quick comparison between different diseases and injuries across different geographies and time periods. The total DALYs rate for New Mexico has generally been trending downward since 1990 and tracking closely with the total U.S. rate, although in 2016 the New Mexico rate has increased, diverging from the U.S. rate. Three conditions with high DALYs in New Mexico, drug use disorders, road injuries, and self-harm, are significantly different from the U.S. rates for 2016. The inclusion of DALYs in state health assessment will help to emphasize low-mortality conditions that have great impact on citizens' quality of life. References

Figure 1. Total Disability-adjusted Life Years (DALYs) New Mexico and United States, 1990-2016 Total DALYs US vs. New Mexico 1990-2016, Age-Standardized Values have been age-standardized to the U.S. 2000 population.
Source: University of Washington Institute for Health Metrics & Evaluation
Figure 2. Leading Causes of Disability-adjusted Life Years by Disease/Condition, Years of Life Lost (YLL) versus Years Lived with Disability (YLD), New Mexico, 2016 Top 10 Disability-adjusted Life Years Conditions, YLLs versus YLDs, Age-Standardized, New Mexico, 2016 Values have been age-standardized to the U.S. 2000 population.
Source: University of Washington Institute for Health Metrics & Evaluation
Figure 3. Leading Causes of Disability-adjusted Life Years by Disease/Condition, New Mexico and United States, 2016 Top 10 Disability-Adjusted Life Years, New Mexico and United States, 2016 Values have been age-standardized to the U.S. 2000 population.
Source: University of Washington Institute for Health Metrics & Evaluation
The information provided above is from the New Mexico Department of Health's NM-IBIS web site (http://ibis.health.state.nm.us). The information published on this website may be reproduced without permission. Please use the following citation: "Retrieved Tue, 18 June 2019 from New Mexico Department of Health, Indicator-Based Information System for Public Health Web site: http://ibis.health.state.nm.us".

Content updated: Tue, 20 Mar 2018 15:16:58 MDT