title: The impact of infection on population health: results of the Ontario burden of infectious diseases study.
abstract: BACKGROUND
  Evidence-based priority setting is increasingly important for rationally distributing scarce health resources and for guiding future health research. We sought to quantify the contribution of a wide range of infectious diseases to the overall infectious disease burden in a high-income setting.
  
  
  RESULTS
  We used health-adjusted life years (HALYs), a composite measure comprising premature mortality and reduced functioning due to disease, to estimate the burden of 51 infectious diseases and associated syndromes in Ontario using 2005-2007 data. Deaths were estimated from vital statistics data and disease incidence was estimated from reportable disease, healthcare utilization, and cancer registry data, supplemented by local modeling studies and national and international epidemiologic studies. The 51 infectious agents and associated syndromes accounted for 729 lost HALYs, 44.2 deaths, and 58,987 incident cases per 100,000 population annually. The most burdensome infectious agents were: hepatitis C virus, Streptococcus pneumoniae, Escherichia coli, human papillomavirus, hepatitis B virus, human immunodeficiency virus, Staphylococcus aureus, influenza virus, Clostridium difficile, and rhinovirus. The top five, ten, and 20 pathogens accounted for 46%, 67%, and 75% of the total infectious disease burden, respectively. Marked sex-specific differences in disease burden were observed for some pathogens. The main limitations of this study were the exclusion of certain infectious diseases due to data availability issues, not considering the impact of co-infections and co-morbidity, and the inability to assess the burden of milder infections that do not result in healthcare utilization.
  
  
  CONCLUSIONS
  Infectious diseases continue to cause a substantial health burden in high-income settings such as Ontario. Most of this burden is attributable to a relatively small number of infectious agents, for which many effective interventions have been previously identified. Therefore, these findings should be used to guide public health policy, planning, and research.
authors.affiliation: Institute for Clinical Evaluative Sciences, Toronto, Canada. jeff.kwong@utoronto.ca
authors.forename: Jeffrey C
authors.initials: JC
authors.lastname: Kwong
authors.forename: Sujitha
authors.initials: S
authors.lastname: Ratnasingham
authors.forename: Michael A
authors.initials: MA
authors.lastname: Campitelli
authors.forename: Nick
authors.initials: N
authors.lastname: Daneman
authors.forename: Shelley L
authors.initials: SL
authors.lastname: Deeks
authors.forename: Douglas G
authors.initials: DG
authors.lastname: Manuel
authors.forename: Vanessa G
authors.initials: VG
authors.lastname: Allen
authors.forename: Ahmed M
authors.initials: AM
authors.lastname: Bayoumi
authors.forename: Aamir
authors.initials: A
authors.lastname: Fazil
authors.forename: David N
authors.initials: DN
authors.lastname: Fisman
authors.forename: Andrea S
authors.initials: AS
authors.lastname: Gershon
authors.forename: Effie
authors.initials: E
authors.lastname: Gournis
authors.forename: E Jenny
authors.initials: EJ
authors.lastname: Heathcote
authors.forename: Frances B
authors.initials: FB
authors.lastname: Jamieson
authors.forename: Prabhat
authors.initials: P
authors.lastname: Jha
authors.forename: Kamran M
authors.initials: KM
authors.lastname: Khan
authors.forename: Shannon E
authors.initials: SE
authors.lastname: Majowicz
authors.forename: Tony
authors.initials: T
authors.lastname: Mazzulli
authors.forename: Allison J
authors.initials: AJ
authors.lastname: McGeer
authors.forename: Matthew P
authors.initials: MP
authors.lastname: Muller
authors.forename: Abhishek
authors.initials: A
authors.lastname: Raut
authors.forename: Elizabeth
authors.initials: E
authors.lastname: Rea
authors.forename: Robert S
authors.initials: RS
authors.lastname: Remis
authors.forename: Rita
authors.initials: R
authors.lastname: Shahin
authors.forename: Alissa J
authors.initials: AJ
authors.lastname: Wright
authors.forename: Brandon
authors.initials: B
authors.lastname: Zagorski
authors.forename: Natasha S
authors.initials: NS
authors.lastname: Crowcroft
mesh_terms: D001424:Bacterial Infections / Q000453:epidemiology* / Q000382:microbiology / Q000401:mortality; D002423:Cause of Death / Q000639:trends; D005260:Female; D006291:Health Policy; D006801:Humans; D008297:Male; D009864:Ontario / Q000453:epidemiology; D019057:Quality-Adjusted Life Years; D012042:Registries; D012307:Risk Factors; D012737:Sex Factors; D012959:Socioeconomic Factors; D016019:Survival Analysis; D014777:Virus Diseases / Q000453:epidemiology* / Q000401:mortality / Q000821:virology