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Section C: Morbidity Coding Systems, Part
2
Adnan Hyder, MD, PhD
Global Burden of Disease Study

Causes of deaths and disabilities
Group 1
Group 2
Group 3
Source: Murray, C. J. (1997).
Communicable diseases,
maternal, perinatal, and
nutritional disorders
Noncommunicable
diseases
Intentional and
unintentional injuries
3
Summary Measures of Population Health: 1



Combines mortality and disability impact of diseases on
population
Measures impact in terms of time lost from premature
mortality and disability
Time expressed as loss of healthy life (in state of perfect
health)
4
Summary Measures of Population Health: 2





Disability-Adjusted Life Years (DALY)
Healthy Life-Years (HeaLY)
Years Lived with Disabilities (YLD)
Disability-Adjusted Life Expectancy (DALE)
Quality-Adjusted Life Years (QALY)
5
Global Burden of Disease Study

Estimated DALYs by disease group
Causes
Group
1990 DALYs
%
2020 DALYs
%
Group 1
Communicable
diseases,
maternal,
perinatal, and
nutritional
disorders
43.9
20.1
Group 2
Noncommunicable
diseases
40.9
59.7
Group 3
Intentional and
unintentional
injuries
15.2
20.1
Source: Murray, C. J. (1997).
6
DALYs by Cause Globally, 2000
Neuropsychiatric
conditions (12%)
Cardiovascular (10%)
Others (61%)
Cancer (5%)
Injuries (12%)
Source: WHR. (2001).
7
Injury DALYs by Specific Cause Globally, 2000
War (6%)
Interpersonal
violence (9%)
Others (23%)
Self-inflicted
violence (11%)
Drowning (7%)
Road traffic
injuries (22%)
Fires (6%)
Falls
(11%)
Source: WHR. (2001).
Poisoning
(5%)
8
HeaLYs/1000/year
Loss of Healthy Life-Years in Ghana, by
Disease (1981)
128.4
140
120
100
80
60
40
20
0
M
97.46
a
ia
r
la
M
82.5
l
s
ls e
ea
85.19
el
c
e
S
B
h
ir t
j
in
it
r
u
at
rie
u
l
k
ic
s
81.18
y
em
r
P
Source: Hyder, A. A. (February 1998). American Journal of Public Health, 88, 2, 196–202.
60.85
78.67
TB
60.21
s
j
In
ie
r
u
ld
i
h
c
I
R
L
A
9
s
n
29.91
io
ns
rte
pe
Hy
di
r th
Bi
Source: Hyder, A. A. (August 2000). American Journal of Public Health, 90, 8, 1235–1240.
31.94
rie
ld
hi
Ic
LT
R
33.13
ju
35.74
In
36.76
se
as
es
38.95
TB
45
40
35
30
25
20
15
10
5
0
re
n
HeaLYs/1000/year
Healthy Life-Years Lost in Pakistan (1990)
10
Causes of Years Lived with Disability (YLDs)—
1990
Disease or injury
  Unipolar major depression
  Anemias
  Falls
  Alcohol use
  Chronic obstructive
pulmonary disease
Source: WHO Injuries and the World Health Report 1999.
Thousands
  50,810
  21,987
  21,949
  15,770
  14,692
11
Percentage Distribution of YLDs by Causes
(1990)
84.2
90
80
Percentage
70
54.8
60
50
Developed countries
Developing countries
40
27.8
30
17.4
20
10
9.5
6.3
0
Communicable
diseases
Source: Murray, C. J. (1997).
Noncommunicable
diseases
Injuries
12
Healthy Life Expectancy Rankings



Based on the World Health Organization's Disability Adjusted
Life Expectancy (DALE)
Disability Adjusted Life Expectancy (DALE) summarizes the
expected number of years to be lived in what might be
termed the equivalent of “full health”
To calculate DALE, the years of ill-health are weighted
according to severity and subtracted from the expected
overall life expectancy to give the equivalent years of healthy
life
13
DALE
DALE in Years
Rank
WHO Member
State
Overall
Male
Female
1
Japan
74.5
71.9
77.2
2
Australia
73.2
70.8
75.5
3
France
73.1
69.3
76.9
4
Sweden
73.0
71.2
74.9
5
Spain
72.8
69.8
75.7
14
QALY Losses Due to Unintentional Injuries
QALYs

For children ages 0 to 19 in the United States, 1996
1,287,000
1,400,000
1,200,000
1,000,000
800,000
600,000
400,000
200,000
0
957,000
412,000
Fatal Injuries
Source: Miller, T. R. (2000). The Future of Children, 3, 138–263.
Hospital Admitted
Injuries
Other Injuries
15
Percentage of QALY Loss

Due to unintentional injuries to children ages 0 to 19 in the
United States, 1996
Fatal Injuries
16%
Other Injuries
48%
Hospital-Admitted
Injuries
36%
Source: Miller, T. R. (2000). The Future of Children, 3, 138–263.
16