Estimating the burden of disease in one Swiss canton: what do disability adjusted life years (DALY) tell us?
BACKGROUND
Examining life expectancy and general mortality rates, the health of the population of Geneva can be described as one of the best in the world. However, in some areas Geneva fares worse than the rest of Switzerland or Europe. To re-appraise the current health priorities of the Genevan population, we analysed the relative importance of specific diseases and injuries calculating DALYs.


METHODS
We followed the procedures developed for the Global Burden of Disease (GBD) study to ensure comparability. Some adaptations were made for mortality coding. Disability was estimated based on data for countries classified as Established Market Economies (EME) in the GBD study.


RESULTS
Non-communicable diseases accounted for 79% of the disability adjusted life years (DALY), injuries represented 12%, and communicable diseases and other disorders 9%. Ischaemic heart disease was the largest single contributor to DALY, followed by unipolar major depression. Neuropsychiatric disorders and mental health accounted for more than 23% of DALY.


CONCLUSIONS
Some of the most important problems identified-depression, osteoarthritis and alcohol abuse-would have been overlooked in an analysis based solely on mortality data. The most striking finding is the importance of mental health problems. The main limitation is the lack of morbidity data for Geneva.
Schopper
D
D
Institut de médecine sociale et préventive, Faculté de médecine, Université de Genève, 1211 Geneva 4, Switzerland. dschopper@geneva.msf.org
Pereira
J
J
Torres
A
A
Cuende
N
N
Alonso
M
M
Baylin
A
A
Ammon
C
C
Rougemont
A
A
D000293:Adolescent; D000328:Adult; D017677:Age Distribution; D000368:Aged; D000369:Aged, 80 and over; D006233:Persons with Disabilities / Q000706:statistics & numerical data*; D004812:Epidemiologic Methods; D005260:Female; D006304:Health Status; D006801:Humans; D008297:Male; D008875:Middle Aged; D009026:Mortality; D011159:Population Surveillance / Q000379:methods*; D019057:Quality-Adjusted Life Years; D017678:Sex Distribution; D013557:Switzerland / Q000453:epidemiology