Wyper Grant M A, Grant Ian, Fletcher Eilidh, Chalmers Neil, McCartney Gerry, Stockton Diane L
Public Health Science Directorate, NHS Health Scotland, Meridian Court, 5 Cadogan Street, Glasgow, Scotland G2 6QE.
2Information Services Division, NHS National Services Scotland, Gyle Square, 1 South Gyle Crescent, Edinburgh, Scotland EH12 9EB.
Arch Public Health. 2020 Jan 9;78:3. doi: 10.1186/s13690-019-0385-6. eCollection 2020.
Severity distributions are a means of summarising the range of health loss suffered to disease which enables estimates of disease occurrence to be paired with disability weights to estimate Years Lost to Disability (YLD) in burden of disease studies. There is a lack of current data exploring severity distributions, which has led to the Global Burden of Disease (GBD) study relying on using the same severity distributions across countries and regions across the world. This is also largely true for some national studies, although there are exceptions. Recent evidence has raised concerns that severity distributions are unlikely to be generalisable as major differences arise when using country-specific data to develop severity distributions. These issues raise uncertainties over interpreting YLD estimates, particularly if they are being used to develop and influence policies and to determine priorities across diseases and populations. It is clear that GBD researchers and those carrying out national studies need to work towards ensuring that estimates are based upon country-specific data, and, if possible, that the impact of assumptions are fully tested and understood. There is a lack of strategy about if, where, and how, this could be achieved, particularly around how efforts should be prioritised. This commentary advocates and presents a possible strategic approach to better understanding how efforts may be best placed.
严重程度分布是总结疾病所导致的健康损失范围的一种方式，它能使疾病发生率的估计与残疾权重相结合，以在疾病负担研究中估算残疾调整生命年（YLD）。目前缺乏探索严重程度分布的数据，这导致全球疾病负担（GBD）研究依赖于在世界各国和各地区使用相同的严重程度分布。一些国家的研究在很大程度上也是如此，不过也有例外。最近的证据引发了人们的担忧，即严重程度分布不太可能具有普遍性，因为在使用特定国家的数据来制定严重程度分布时会出现重大差异。这些问题给YLD估计值的解释带来了不确定性，尤其是当这些估计值被用于制定和影响政策以及确定不同疾病和人群的优先事项时。显然，GBD研究人员和开展国家研究的人员需要努力确保估计值基于特定国家的数据，并且如果可能的话，要充分测试和理解假设的影响。关于是否、在何处以及如何实现这一点，缺乏相关策略，特别是在如何确定工作重点方面。本评论主张并提出一种可能的战略方法，以更好地理解如何最好地开展工作。
