Sensitivity analysis in summary measure of population health in France.
BACKGROUND
The aim of this study is to provide estimates of the French burden of disease, using the WHO Global Burden of Disease methodology and to perform sensitivity analysis on different set of mortality data.


METHODS
The burden of disease is measured by disability-adjusted life years (DALYs) that take into account both mortality and morbidity data. Results were obtained using French mortality data for the years 2000 and 2001 and morbidity data estimated by WHO for France. Sensitivity analyses were conducted using different mortality data sets and various life tables as mortality norms. Calculations were also performed with and without discounting and age-weighting.


RESULTS
In France, the annual burden of disease was about 12.4 million DALYs. Depending on the mortality data set and the choice of social values used for calculation, results could be quite different. The use of WHO estimates for mortality resulted in an underestimation of 2.6% of total DALYs with respect to French data. Changes of the mortality norm imply changes in the number of years of life lost (YLLs), whereas the use of discounting and age-weighting mainly modifies the ranking of diseases.


CONCLUSIONS
DALYs constitute a summary measure of population health, which is a powerful tool for the grading of health problems, allowing to compare fatal and non-fatal diseases. Nevertheless, the validity of results obtained depends primarily on the validity of the input data. Collecting morbidity data (mainly incidence) at the national level is hence an important step in order to assess more accurately the specific burden of diseases in France.
Inserm U822/Service de Santé Publique, France. lapostol@vjf.inserm.fr
Annabelle
A
Lapostolle
Agnès
A
Lefranc
Isabelle
I
Gremy
Alfred
A
Spira
D002423:Cause of Death / Q000639:trends; D017281:Cost of Illness; D006233:Persons with Disabilities / Q000145:classification / Q000706:statistics & numerical data*; D005260:Female; D005602:France / Q000453:epidemiology; D006801:Humans; D015993:Life Tables; D008297:Male; D011634:Public Health; D019057:Quality-Adjusted Life Years; D012737:Sex Factors