Haagsma Juanita A, Polinder Suzanne, Cassini Alessandro, Colzani Edoardo, Havelaar Arie H
Department of Public Health, Erasmus Medical Center, Rotterdam, 3000 CA, The Netherlands.
Office of the Chief Scientist, European Centre for Disease Prevention and Control, Stockholm, SE-171 83, Sweden.
Popul Health Metr. 2014 Aug 23;12:20. doi: 10.1186/s12963-014-0020-2. eCollection 2014.
The disability-adjusted life year (DALY) is widely used to assess the burden of different health problems and risk factors. The disability weight, a value anchored between 0 (perfect health) and 1 (equivalent to death), is necessary to estimate the disability component (years lived with disability, YLDs) of the DALY. After publication of the ground-breaking Global Burden of Disease (GBD) 1996, alternative sets of disability weights have been developed over the past 16 years, each using different approaches with regards to the panel, health state description, and valuation methods. The objective of this study was to review all studies that developed disability weights and to critically assess the methodological design choices (health state and time description, panel composition, and valuation method). Furthermore, disability weights of eight specific conditions were compared.
Disability weights studies (1990¿2012) in international peer-reviewed journals and grey literature were identified with main inclusion criteria being that the study assessed DALY disability weights for several conditions or a specific group of illnesses. Studies were collated by design and methods and evaluation of results.
Twenty-two studies met the inclusion criteria of our review. There is considerable variation in methods used to derive disability weights, although most studies used a disease-specific description of the health state, a panel that consisted of medical experts, and nonpreference-based valuation method to assess the values for the majority of the disability weights. Comparisons of disability weights across 15 specific disease and injury groups showed that the subdivision of a disease into separate health states (stages) differed markedly across studies. Additionally, weights for similar health states differed, particularly in the case of mild diseases, for which the disability weight differed by a factor of two or more.
In terms of comparability of the resulting YLDs, the global use of the same set of disability weights has advantages, though practical constraints and intercultural differences should be taken into account into such a set.
伤残调整生命年（DALY）被广泛用于评估不同健康问题和风险因素的负担。伤残权重是一个介于0（完美健康）和1（等同于死亡）之间的值，用于估算DALY中的伤残部分（伤残生存年数，YLD）。在具有开创性意义的《1996年全球疾病负担》（GBD）发布之后，在过去16年里又开发出了其他几套伤残权重，每套权重在专家组、健康状态描述和估值方法方面都采用了不同的方法。本研究的目的是回顾所有开发伤残权重的研究，并严格评估方法学设计选择（健康状态和时间描述、专家组构成以及估值方法）。此外，还对八种特定疾病的伤残权重进行了比较。
在国际同行评审期刊和灰色文献中识别1990年至2012年的伤残权重研究，主要纳入标准是该研究评估了多种疾病或特定疾病组的DALY伤残权重。通过设计、方法和结果评估对研究进行整理。
22项研究符合我们综述的纳入标准。尽管大多数研究使用针对特定疾病的健康状态描述、由医学专家组成的专家组以及基于非偏好的估值方法来评估大多数伤残权重的值，但用于得出伤残权重的方法存在相当大的差异。对15个特定疾病和损伤组的伤残权重进行比较后发现，不同研究中疾病细分为不同健康状态（阶段）的方式存在显著差异。此外，相似健康状态的权重也不同，尤其是在轻度疾病的情况下，其伤残权重相差两倍或更多。
就所产生的YLD的可比性而言，全球使用同一套伤残权重具有优势，不过在制定这样一套权重时应考虑实际限制和文化差异。
