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MEASURING BURDEN
OF DISEASE
Introduction to DALYs

Dr. Susi Ari Kristina, M. Kes., Apt

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Important areas
• Cases
• Deaths
• Years of life lost (YLLs)
• Disability-adjusted life years (DALYs)
• Disability weight
• Discounting
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Reasons to measure burden of disease

• Assign priorities between different public health problems
• Compare strategies that a single public health problem in
terms of impact
• Choose health interventions that target different health
problems with different strategies
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Disability-adjusted life years (DALYs)

• Summary measure
• Take into account loss due to
• Death (Years of life lost, YLLs)
• Disability (Years lived with disability, YLDs)
• The equivalence is:
• Death = 100% disability
• Perfect health = 0% disability
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Disability-adjusted Life Years (DALYs)

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Concept of Years of life lost (YLL)

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Years of life lost to present deaths

• What is the number of years of life lost to AIDS in
Indonesia in 2016?
• Elements needed:
• 2016 AIDS death rates (N)
• Age distribution of death cases (Age)
• Life expectancy (LE) at the age of death

YLL =  N x (LE-Age)
Age groups
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The concept of disability (YLD)

• Life in a state of perfect health is lived to its full potential
• Life in case of disease is lived lived partially
• Disability weight
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Measuring death and disability

with the same metric
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The equivalence between

disability and death
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Calculating DALYs
• Calculate years of life lost through death
• Calculate years of life lived with disability
• Add the two
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DALYs lost to present conditions

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Estimation framework
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Attributable risk
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Population attributable fraction (PAF)

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Estimation framework (2)

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Data sources
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Example: COPD
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COPD YLD diagram

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COPD DALYs
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Example: Lung cancer burden

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Lung cancer YLD diagram

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Lung cancer YLD

• YLD male, preterminal stage
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• Lung cancer YLDs

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Lung cancer DALYs

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Discounting
• DALYs do not have the same value if lost
• Today (e.g., measles)
• Later (e.g., hepatitis B)
• Discounting rate
• Rate that discounts the value each year
• Apply to costs and effects
• E.g., 3%
• Subject to discussion
• Should DALYs be discounted?
• At what rate?
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Comparison between various

measures of burden
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Calculation of disease burden attributable to

tobacco
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COPD attibutable to smoking

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References
• Mathers CD, Vos T, Lopez AD, Salomon J, Ezzati M (ed.) 2001.
National Burden of Disease Studies: A Practical Guide. Edition 2.0.
Global Program on Evidence for Health Policy. Geneva: World Health
Organization.
• Murray CJL, Salomon JA, Mathers CD. 2000. A critical examination of
summary measures of population health. Bulletin of the World Health
Organization, 78(8): 981-994.
• Murray CJL, et al. 2002. Health gaps: an overview and critical
appraisal. In: Murray CJL, et al., eds. Summary measures of
population health: concepts, ethics, measurement and applications.
Geneva, World Health Organization, 231-242.