Development of methodology for disability-adjusted life years (DALYs) calculation based on real-life data.
BACKGROUND
Disability-Adjusted Life Years (DALYs) have the advantage that effects on total health instead of on a specific disease incidence or mortality can be estimated. Our aim was to address several methodological points related to the computation of DALYs at an individual level in a follow-up study.


METHODS
DALYs were computed for 33,507 men and women aged 20-70 years when participating in the EPIC-NL study in 1993-7. DALYs are the sum of the Years Lost due to Disability (YLD) and the Years of Life Lost (YLL) due to premature mortality. Premature mortality was defined as death before the estimated date of individual Life Expectancy (LE). Different methods to compute LE were compared as well as the effect of different follow-up periods using a two-part model estimating the effect of smoking status on health as an example.


RESULTS
During a mean follow-up of 12.4 years, there were 69,245 DALYs due to years lived with a disease or premature death. Current-smokers had lost 1.28 healthy years of their life (1.28 DALYs 95%CI 1.10; 1.46) compared to never-smokers. The outcome varied depending on the method used for estimating LE, completeness of disease and mortality ascertainment and notably the percentage of extinction (duration of follow-up) of the cohort.


CONCLUSIONS
We conclude that the use of DALYs in a cohort study is an appropriate way to assess total disease burden in relation to a determinant. The outcome is sensitive to the LE calculation method and the follow-up duration of the cohort.
Julius Center for Health Sciences and Primary Care, University Medical Center Utrecht, Utrecht, The Netherlands ; National Institute for Public Health and the Environment (RIVM), Bilthoven, The Netherlands.
Ellen A
EA
Struijk
Anne M
AM
May
Joline W J
JW
Beulens
G Ardine
GA
de Wit
Jolanda M A
JM
Boer
N Charlotte
NC
Onland-Moret
Yvonne T
YT
van der Schouw
H Bas
HB
Bueno-de-Mesquita
Jeljer
J
Hoekstra
Petra H M
PH
Peeters
D000328:Adult; D000368:Aged; D006233:Persons with Disabilities; D005260:Female; D006304:Health Status; D006801:Humans; D008017:Life Expectancy; D008297:Male; D008875:Middle Aged; D009026:Mortality; D019057:Quality-Adjusted Life Years; D055815:Young Adult