The burden of cancer in New Zealand: a comparison of incidence and DALY metrics and its relevance for ethnic disparities

Abstract

As cardiovascular disease incidence and mortality have steadily declined over the past 30-40 years, the relative burden of disease due to cancer has increased. In 2009, cancer was the leading cause of mortality in New Zealand (NZ) at ICD chapter level, accounting for about 30% of the total number of deaths.1 The age standardised rate for all cancer sites combined steadily increased post World War II, but is now stable (and possibly decreasing).2-4 However, there is notable heterogeneity by cancer sites (e.g. stomach cancer rates decreased over time and haemopoietic cancers increased). 2Burden of disease studies aim to estimate the burden of each major disease for a given country or region of the world at a given time using a composite measure of mortality and morbidity, the disability adjusted life year (DALY).5 A burden of disease study has previously been conducted in NZ for 1996, and found that cancers contributed 20% of the total burden of disease, second only to cardiovascular diseases at 24%. 6A DALY represents the loss of one year of healthy life, whether it is due to premature death or living in a state of less than full health, or a combination of both. In practice, they are calculated as the sum of years of life lost (YLLs) and years of life lived with disability (YLDs). YLLs capture life lost due to premature death from the disease. YLDs are equivalent to years of life lost as a result of living in health states other than full health, where disability weights (DW) are used to quantify the decremental loss of health.This paper aims to: estimate the burden of disease in DALYs arising from incident cancer cases diagnosed in 2006 for 27 cancer sites and show how the cancer DALY differences by sex and ethnicity vary from differences in incidence rates of cancer alone. MethodsWe modelled single year age groups (0-100 years), sex (males and females) and ethnicity (Māori and non-Māori) in terms of incidence, survival and background mortality. Due to the good quality of NZ cancer datasets, and the intended migration of this work into costeffectiveness modelling, a prospective method or incidence approach of calculating DALYs was used. That is, rather than estimating the cross-sectional burden for all prevalent cancer cases in 2006, we estimated the future burden arising from cancers diagnosed in 2006. respectively, sexes pooled).

Tuberculosis DALY-Gap: Spatial and Quantitative Comparison of Disease Burden Across Urban Slum and Non-slum Census Tracts

“…Much of the previous work using DALYs to identify health disparities within specific regions has focused on ethnic disparities. [19][20][21][22] However, DALY-gap in slum communities is different from income or indigenous health gap; it addresses disease burden of communities or neighborhoods, making it a metric easier to apply for resource allocation. Furthermore, the spatial analysis in our study showed that the TB burden differs greatly even across different slum and non-slum communities.…”

Prostate-specific antigen (PSA) screening and follow-up investigations in Māori and non-Māori men in New Zealand

“…Prostate cancer has been identified as the primary contributor to cancer burden in New Zealand men; with prostate cancer burden for Māori men being 50% higher compared with non-Māori men [ 1 ]. Māori men were reported to have higher mortality from prostate cancer, despite having lower incidence rates [ 2 – 4 ].…”

Burden of Disease Measured by Disability-Adjusted Life Years and a Disease Forecasting Time Series Model of Scrub Typhus in Laiwu, China

“…There were several reasons why DALYs were adopted rather than solely YLDs. Worldwide acceptance of DALYs and DALY rate enabled international comparisons or ranking of areas by disease burden [8] , [15] , [16] , [33] – [43] . DALYs represent unified summary estimate of disease burden that takes mortality as well as morbidity into consideration, i.e., DALYs and DALY rate would be more useful in comparing the disease burden among different diseases and different areas than other indexes.…”