Biomedical Ethics Unit, McGill University, Montreal, Québec, Canada.
Department of Epidemiology, Biostatistics & Occupational Health, McGill University, Montreal, Québec, Canada.
PLoS One. 2018 Apr 17;13(4):e0195338. doi: 10.1371/journal.pone.0195338. eCollection 2018.
The Global Burden of Disease (GBD) project systematically assesses mortality, healthy life expectancy, and disability across 195 countries and territories, using the disability-adjusted life year (DALY). Disability weights in the DALY are based upon surveys that ask users to rate health states based on lay descriptions. We conducted an experimental study to examine whether the inclusion or removal of psychological, social, or familial implications from a health state description might affect individual judgments about disease severity, and thus relative disability weights.
We designed a survey consisting of 36 paired descriptions in which information about plausible psychological, social, or familial implications of a health condition was either present or absent. Using a Web-based platform, we recruited 1,592 participants, who were assigned to one of two experimental groups, each of which were asked to assign a value to the health state description from 0 to 100 using a slider, with 0 as the "worst possible health" and 100 as the "best possible health." We tested five hypotheses: (1) the inclusion of psychological, social, or familial consequences in health state descriptions will reduce the average rating of a health state; (2) the effect will be stronger for diseases with lower disability weights (i.e., less severe diseases); (3) the effect will vary across the type of additional information added to the health state description; (4) the impact of adding information on familial consequences will be stronger for female than male; (5) the effect of additional consequences on ratings of health state descriptions will not differ by levels of completed education and age.
On average, adding social, psychological, or familial consequences to the health state description lowered individual ratings of that description by 0.78 points. The impact of adding information had a stronger impact on ratings of the least severe conditions, reducing average ratings in this category by 1.67 points. Addition of information about child-rearing had the strongest impact, reducing average ratings by 2.09 points. We found little evidence that the effect of adding information on ratings of health descriptions varied by gender, education, or age.
Including information about health states not directly related to major functional consequences or symptoms, particularly with respect to child-rearing and specifically for descriptions of less severe conditions, can lead to lower ratings of health. However, this impact was not consistent across all conditions or types of information, and was most pronounced for inclusion of information about child-rearing, and among the least severe conditions.
全球疾病负担（GBD）项目系统地评估了 195 个国家和地区的死亡率、健康预期寿命和残疾情况，使用了伤残调整生命年（DALY）。DALY 中的残疾权重基于调查，调查要求用户根据一般描述对健康状况进行评级。我们进行了一项实验研究，以检验从健康状况描述中纳入或去除心理、社会或家庭影响是否会影响个体对疾病严重程度的判断，从而影响相对残疾权重。
我们设计了一项调查，其中包含 36 对配对描述，其中包含有关健康状况的可能心理、社会或家庭影响的信息。我们使用基于网络的平台招募了 1592 名参与者，将他们分配到两个实验组之一，每个实验组都被要求使用滑块将健康状况描述的分值从 0 到 100 进行赋值，0 表示“最差可能的健康状况”，100 表示“最好可能的健康状况”。我们检验了五个假设：（1）在健康状况描述中纳入心理、社会或家庭后果会降低对健康状况的平均评分；（2）这种影响在残疾权重较低的疾病中（即较不严重的疾病）更强；（3）这种影响会因添加到健康状况描述的附加信息类型而有所不同；（4）添加有关家庭影响的信息对女性的影响大于男性；（5）添加额外后果对健康状况描述的评分影响不因教育程度和年龄水平而异。
平均而言，在健康状况描述中添加社会、心理或家庭后果会使个体对该描述的评分降低 0.78 分。添加信息的影响对最不严重的疾病的评分影响更大，使该类别中的平均评分降低 1.67 分。添加关于育儿的信息的影响最大，使平均评分降低 2.09 分。我们几乎没有发现添加信息对健康描述评分的影响因性别、教育程度或年龄而异的证据。
纳入与主要功能后果或症状无直接关系的健康状况信息，特别是与育儿相关的信息，以及特定于较不严重疾病的信息，可能会导致对健康状况的评分降低。然而，这种影响并非在所有情况下或所有类型的信息中都一致，并且在纳入育儿信息和最不严重的疾病时最为明显。
