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Burden of
Major Diseases
and Risk
Factors
Book list
1
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Lopez; Colin D
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Jamison; Christopher J
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Murray

2
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Understanding Global Health
Lange Publication

4
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Definition of Disease Burden
Burden of disease: Burden of disease (BOD) is a general term used in public health and epidemiological literature to
identify the cumulative effect of a broad range of harmful disease consequences on a community, including the health,
social and economic costs to individual and to society
...

Burden: It includes –
•
•
•
•

Frequency: Incidence or prevalence
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Consequences such as health, social and economic
...
g
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Impairment: Loss or abnormality of psychological, physiological or anatomical structure or function is called
impairment
...

Handicap: Disadvantage resulting from impairment or disability that limits or prevents the fulfilment of a role that is
normal depending on age, sex, social and cultural factors is called handicap
...
Subsequent national and reginal studies, risk facts or studies were conducted
...
A systematic scientific effort to quantify the comparative magnitude of health loss for
187 countries from 1990 to 2010
...
Covering 291 diseases
and injuries, 1160 resulting effects of these disease and injuries, and 67 risk factors or clusters of risk factors
...
Summary papers published in a dedicated triple
issue of the Lancet December 15th, 2012
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4
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Cause of death transition: Fraction of deaths or years of life lost shifting from communicable, maternal,
neonatal and nutritional to non – communicable diseases and injuries despite the HIV epidemic
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Risk transition: Shift from risks related to poverty to behavioral risks in risk transition
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2
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Prioritizing actions in health and the environment
Planning for preventive action
Assessing performance of healthcare systems

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6
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Comparing action and health gain
Identifying high-risk populations
Planning for future needs
Setting priorities in health research

Applications of burden of disease analysis:
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In this application,
burden of disease may be considered analogous to national income and product accounts
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Debating the appropriate values for, say, disability weights or for years of life lost at different ages helps clarify
values and objectives of national health policy
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Identifying national control priorities: Many countries now identify a relatively short list of interventions
whose full implementation becomes an explicit priority for national political and administrative attention
...
Because political attention and high-level administrative capacity are in relatively
fixed and short supply, the benefits from using those resources will be maximized if they are directed toward
interventions that are both cost-effective and aimed at problems associated with a high disease burden
...

Creating knowledge: Medical schools offer a fixed number of instructional hours, and training programs for
other levels and types of health workers are similarly limited
...
This implies allocating time to training for
interventions where the disease burden is high and cost-effective interventions exist
...
In particular, whenever a fixed effort will have a benefit proportional not only to
the size of that effort, but also to the size of the problem being addressed, estimates of the disease burden
becomes essential for formulating and implementing research and development priorities
...

Allocating resource across health interventions: A key task for priority-setting analysis n health is to create
the evidence base to stimulate the reallocation of resources to interventions that, at the margin, will generate
the greatest reduction in health loss
...
Similarly, major fixed costs may be associated with the universalization (or major
expansion) of an intervention and, if so, the cost-effectiveness of the expansion will depend in part on the size
of the burden
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Central objectives:
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2
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To undertake the quantification of health problems in time-based units that can also be used in
economic appraisal
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Specific objectives:
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2
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3

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To analyze the contribution of this burden of major physiological, behavioral and social risk factors by
age, sex and region
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Types of disease burden:
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Disability burden: Disability burden of disease is estimated by DALY
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Disease burden perspectives:
•
•
•

Individual
Family
Social, national and global

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2
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Risk: Risk is the probability of an event among those experiencing the event divided by the number who could
experience it (at risk)
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Risk conditions: Risk conditions are conditions such as overweight/obesity, which are not behaviors but that
nonetheless contribute to diseases, disability or death
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Risk exposures: Risk exposures are things that happen to a person that may have negative impacts on health and are
outside of his/control – physical or psychological abuse, for example, developing respiratory disease as a result of
indoor air pollution or becoming infected with Schistosoma haematobium from contact with contaminated water
...
A risk factors is a characteristic, condition or behavior that increases the likelihood of getting a disease
or injury
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They often coexist
and interact with one another
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Together, these significantly increase the chance of developing chronic heart disease and
other health related problems
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There is a risking demand for healthcare, placing the sector under increasing budget pressure which is not always met
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Types of risk factors: In general, risk factors can be categorized into the following groups:
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3
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They can
therefore, be eliminated or reduced through lifestyle or behavioral choices
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They may be
influenced by a combination of genetic, lifestyle and other broad factors
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• Being overweight or obese
• High blood pressure
• High blood cholesterol
• High blood sugar (glucose)
Demographic: Demographic risk factors are those that relate to the overall population
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Examples include:
• Access to clean water and sanitation
• Risks in the workplace
• Air pollution
• Social settings
Genetic risk factors: Genetic risk factors are based on an individual’s genes
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Many other diseases such
as asthma or diabetes, reflect the interaction between the genes of the individual and environmental factors
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Modifiable: These include:
• Smoking
• High blood pressure
• Diabetes
• Physical inactivity
• Being overweight
• High blood cholesterol
Nonmodifiable: Nonmodifiable risk factors are:
• Age: The older one is, the more likely he/she to develop coronary heart disease or to have a cardiac
event
...
Also, people from African Caribbean backgrounds
have a higher than average risk of developing high blood pressure
...
g risk of coronary heart disease
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It is generally characterized by insulin resistance, where the body does not fully respond to insulin
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For some people with type 2 diabetes
this can eventually exhaust the pancreas, resulting in the body producing less and less insulin, causing even higher
blood sugar levels (hyperglycaemia)
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The cornerstone of type 2 diabetes management is a healthy diet, increased physical activity and maintaining a healthy
body weight
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Risk factors: Several risk factors have been associated with type 2 diabetes and include:
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3
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5
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Family history of diabetes
Overweight
Unhealthy diet
Physical inactivity
Increasing age
High blood pressure
Ethnicity
Impaired glucose tolerance (IGT)*
History of gestational diabetes
Poor nutrition during pregnancy

6

*Impaired glucose tolerance (IGT) is a category of higher than normal blood glucose, but below the threshold for
diagnosing diabetes
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Importance of measuring risk factors:
1
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3
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Identifying individuals/groups at risk: Ability to predict future disease in individual patients is very limited
even for well-established risk factors e
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cholesterol and CHD
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Prevention: To remove causative agent and prevent disease
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Tobacco use

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Physical inactivity

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High cholesterol

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0

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Alcohol use

3
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Indoor smoke from solid fuels

3
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Different people and perspectives may assess risk differently
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The
assessment of risk also depends on time: Is the impact of an activity on current or future health (the adolescent may
significantly discount the future impact of tobacco use)
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If you are a 10th grader, other high school students are your
peers
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When you are on par with someone, you are
their peer
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]
Probability: Probability may be defined as the relative frequency or probable chance of occurrence with which an event
is expected to occur on an average such as of giving birth to a baby in the first pregnancy, chances of one drug being
better than the other etc
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Odds: It is the probability of an event divided by the probability of the event not happening
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61
Odds ratio: An odds ratio (OR) is a measure of association between an exposure and an outcome
...
Odds ratios are most commonly used in case control studies
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PAR:
Proportion of Incidence Attributable to Exposure (Proportional Attributable Risk)
=
=

𝐼𝑛𝑐𝑖𝑑𝑒𝑛𝑐𝑒 𝑖𝑛 𝑒𝑥𝑝𝑜𝑠𝑒𝑑 𝑔𝑟𝑜𝑢𝑝−𝐼𝑛𝑐𝑖𝑑𝑒𝑛𝑐𝑒 𝑖𝑛 𝑛𝑜𝑛𝑒𝑥𝑝𝑜𝑠𝑒𝑑 𝑔𝑟𝑜𝑢𝑝
𝐼𝑛𝑐𝑖𝑑𝑒𝑛𝑐𝑒 𝑖𝑛 𝑒𝑥𝑝𝑜𝑠𝑒𝑑 𝑔𝑟𝑜𝑢𝑝
𝐼𝐴𝑅
𝐼𝑛𝑐𝑖𝑑𝑒𝑛𝑐𝑒 𝑖𝑛 𝑒𝑥𝑝𝑜𝑠𝑒𝑑 𝑔𝑟𝑜𝑢𝑝

Example:

IAR = 28
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4
10
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0−17
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379
= 37
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Odds: It is the ratio of the probability of having an event to the probability of not having the event
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Example: 1 out of 5 patients suffer a stroke
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Interpretation of relative risk or risk ratio (RR):
•
•
•

RR = 1 suggests that, Risk in exposed is equal to risk in non-exposed
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Interpretation of ODDs ratio
•
•
•

OR =

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