Attributable burden, life expectancy and income loss to non-communicable diseases in Ireland: from evidence to policy-making
University College Cork
Introduction: This thesis is devoted, primarily, to the study of the burden of non-communicable diseases in the Republic of Ireland. Four major NCDs – cancer, cardiovascular disease (CVD), diabetes and Chronic Obstructive Pulmonary Disease (COPD) – are chosen and their risk factors as well as socio-economic impact is analysed. Burden of disease studies utilize the evidence base and quantify the health scenario and trends over time. Such estimates are relevant for a country’s policy makers to allocate the limited resources to the areas that require more attention. The Global Burden of Disease study was the most comprehensive study of its kind to draw attention to the diseases and risk factors in any country which require more attention than the others. We seek to do the same for Ireland with a special focus for NCDs. NCDs contributed to approximately 71% of deaths worldwide in 2016 (WHO). NCDs lead to early deaths, morbidities and long-term health effects. It was observed that life expectancies have increased in Ireland. It is critically important to determine whether people are living these additional years in good health or not. NCDs also contribute to considerable economic loss. These considerations form the motivating factors for this study, whose primary objectives are as follows: 1. To estimate NCD burden and attributable burden, including LE and HALE- 1990 to 2017 2. To investigate the main drivers of NCD burden changes in 1990-2017 3. To estimate the national economic loss to NCD burden 4. To estimate the future NCD burden- 2040 5. To carry out Internal validation exercises Methods: This work uses methods similar to that of the GBD study. The metrics used to quantify the burden are Disability Adjusted Life Years (DALYs), number of deaths, Years of Life Lost (YLLs) and Years Lived with Disability (YLDs). DALYs quantify the burden due to premature mortality and disability. They enable comparisons across nations, thus allowing benchmarking. Decomposition analysis is used to separate the effects of population ageing, population growth and changes in the risk factor scenario. We also quantified Gross Domestic Product (GDP) per capita lost to DALYs in Ireland in 2017 using the WHO model for projecting the Economic Costs of Ill-Health (WHO--EPIC model). Each DALY amounts to a loss of 1 to 3 units of GDP per capita (in international dollars). The burden of disease in 2030 was projected for Ireland using GBD’s forecasting methods, and the potential and avertable YLLs were calculated. The GBD study results were also validated against some national level estimates. This is done to ascertain whether, and to what extent, the data from GBD would be an appropriate evidence base to formulate national level policy decisions. The estimates were also validated using different standard populations by checking if the results varied significantly. Main Findings: This study analyzed data from GBD as well as some national level databases, and the following are some of the main findings of the analysis. Ireland ranks 11th best in the NCD related age-standardized DALYs, 2nd in the age-standardized deaths and 3rd in the age-standardized YLDs within the EU. This clearly shows that, while Ireland performs well in terms of number of deaths and YLDs, there is still a lot to be done when it comes to DALYs. Life Expectancy in the ROI has increased during 1990 and 2017, however the Healthy life expectancy (HALE) has not increased at the same pace. This means that the additional years are lived in less than ideal health. It was found that diabetes, ischemic heart disease (IHD) and stroke related death rate attributable to diets high in processed meat and sodium have increased during 1990 and 2017. Cancer and diabetes YLDs attributed to alcohol consumption have increased significantly (from 2.4 per 100,000 to 37.6 for diabetes and 15.9 per 100,000 to 25.4 for cancer). On disentangling the drivers of burden change, it was observed that except diabetes, the other three NCDs have shown more improvements in the risk factor scenario. We estimated that Ireland lost about 75.6 million international dollars (I$) in GDP per capita from all causes in 2017. An alarming result here is that, of the 75.6 million mention above, cancer alone contributed to 15 million I$. A part of this study also focused on forecasting the burden in 2040. The model predicts that IHD will be the leading cause of deaths in 2040, whereas smoking is on its way to becoming the leading cause for YLLs. In all the above-mentioned analyses, estimates based on national level data agreed with those obtained from the analysis of the GBD data. On using different standard populations the DALYs varied. Conclusion: To the best of our knowledge, this is the first comprehensive epidemiologic and economic profile of NCD burden in Ireland. It was observed that the YLDs are on the rise and diabetes is the most neglected NCD in terms of effective population interventions. In terms of the risk factors, alcohol was found to be the leading cause of NCD morbidity. It should also be mentioned that, even though estimates obtained from GBD were in agreement with the national burden estimates, this study cannot be a replacement for a sub-national BOD study.
Irish burden , Non communicable diseases , Drivers of change , Economic impact , Burden of disease
Chakraborty, S. 2020. Attributable burden, life expectancy and income loss to non-communicable diseases in Ireland: from evidence to policy-making. PhD Thesis, University College Cork.