Centre for International Health, Curtin Health Innovation Research Institute, Curtin University of Technology, Perth, WA, Australia.
Int J Stroke. 2010 Aug;5(4):269-77. doi: 10.1111/j.1747-4949.2010.00439.x.
The disability-adjusted life year index is used extensively to compare disease burden among diseases and locations, but difficulties remain in accurately estimating the nonfatal stroke burden in years lived with disability.
To improve stroke-related years lived with disability estimates in Western Australia for 2000, by improving the accuracy of component inputs: nonfatal (28-day survivor) incidence, disease duration and disability (severity) weights.
Nonfatal stroke incidence and the mortality difference between prevalent cases and the general population were estimated from linked hospital and mortality data using the Western Australian Data Linkage System. dismod software used these inputs to model disease duration. Disability weights were estimated from population-based stroke survey data, using indirect health valuation methods and adjusting for prestroke disability. Years lived with disability were calculated from the three components.
The annual age-standardised nonfatal incidence (n=1985) was higher in males (121/100,000) than females (96/100,000). The duration varied between 35.8 (females 15-24 years) and 3.4 years (males 85+ years). The mean pre-stroke-adjusted disability weight was higher at 4-months (0.38) than at 12-months (0.31). The age-standardised rate of nonfatal burden in males (302/100,000; 95% CI 290-314) was significantly higher than that in females (250/100,000; 95% CI 240-260). The nonfatal proportion of stroke burden (males 45%; females 37%) was higher than estimated in previous studies.
This study illustrates that previous reports most likely underestimated disability burden as a contributor to the total stroke burden in Australia. Methodological refinements will contribute to burden of disease studies elsewhere.
残疾调整生命年指数广泛用于比较疾病和地点的疾病负担，但在准确估计失能年数方面仍存在困难。
通过改进非致命性（28 天幸存者）发病率、疾病持续时间和残疾（严重程度）权重等组成部分的输入，提高西澳大利亚州 2000 年与卒中相关的失能年数的估计值。
利用西澳大利亚州数据链接系统，从关联的医院和死亡率数据中估计非致命性卒中发病率和现患病例与一般人群之间的死亡率差异。使用 dismod 软件，这些输入来模拟疾病持续时间。使用基于人群的卒中调查数据，采用间接健康估值方法并调整发病前残疾情况，估计残疾权重。失能年数由这三个组成部分计算得出。
年标准化非致命性发病率（n=1985）男性（121/100,000）高于女性（96/100,000）。男性（15-24 岁）和女性（85 岁以上）的疾病持续时间分别为 35.8 年和 3.4 年。发病前调整后的残疾权重在 4 个月时（0.38）高于 12 个月时（0.31）。男性（302/100,000；95%CI 290-314）的标准化非致命性负担率显著高于女性（250/100,000；95%CI 240-260）。卒中负担的非致命性比例（男性 45%；女性 37%）高于以往研究中的估计值。
本研究表明，以前的报告可能低估了残疾负担，使其在澳大利亚总卒中负担中的贡献被低估。方法上的改进将有助于其他地方的疾病负担研究。
