Department of Global Public Health and Primary Care, Bergen Centre for Ethics and Priority Setting (BCEPS), University of Bergen, Bergen, Norway.
Department of Addiction Medicine, Haukeland University Hospital, Bergen, Norway.
PLoS One. 2020 Jul 14;15(7):e0235955. doi: 10.1371/journal.pone.0235955. eCollection 2020.
At any point in time, a person's lifetime health is the number of healthy life years they are expected to experience during their lifetime. In this article we propose an equity-relevant health metric, Health Adjusted Age at Death (HAAD), that facilitates comparison of lifetime health for individuals at the onset of different medical conditions, and allows for the assessment of which patient groups are worse off. A method for estimating HAAD is presented, and we use this method to rank four conditions in six countries according to several criteria of "worse off" as a proof of concept.
For individuals with specific conditions HAAD consists of two components: past health (before disease onset) and future expected health (after disease onset). Four conditions (acute myeloid leukemia (AML), acute lymphoid leukemia (ALL), schizophrenia, and epilepsy) are analysed in six countries (Ethiopia, Haiti, China, Mexico, United States and Japan). Data from 2017 for all countries and for all diseases were obtained from the Global Burden of Disease Study database. In order to assess who are the worse off, we focus on four measures: the proportion of affected individuals who are expected to have HAAD<20 (T20), the 25th and 75th percentiles of HAAD for affected individuals (Q1 and Q3, respectively), and the average HAAD (aHAAD) across all affected individuals.
Even in settings where aHAAD is similar for two conditions, other measures may vary. One example is AML (aHAAD = 59.3, T20 = 2.0%, Q3-Q1 = 14.8) and ALL (58.4, T20 = 4.6%, Q3-Q1 = 21.8) in the US. Many illnesses, such as epilepsy, are associated with more lifetime health in high-income settings (Q1 in Japan = 59.2) than in low-income settings (Q1 in Ethiopia = 26.3).
Using HAAD we may estimate the distribution of lifetime health of all individuals in a population, and this distribution can be incorporated as an equity consideration in setting priorities for health interventions.
在任何时候，一个人的终生健康是指他们在一生中预计会经历的健康寿命年数。在本文中，我们提出了一个与公平相关的健康衡量标准，即死亡时健康调整年龄（HAAD），该标准便于比较不同医疗条件下个体的终生健康，并能够评估哪些患者群体的情况更差。提出了一种估计 HAAD 的方法，并使用该方法根据“更差”的几个标准对六个国家的四种情况进行排名，以此作为概念验证。
对于患有特定疾病的个体，HAAD 由两部分组成：过去的健康（疾病发作前）和未来预期的健康（疾病发作后）。分析了六个国家（埃塞俄比亚、海地、中国、墨西哥、美国和日本）的四种疾病（急性髓系白血病（AML）、急性淋巴细胞白血病（ALL）、精神分裂症和癫痫）。所有国家和所有疾病的数据均来自全球疾病负担研究数据库。为了评估谁的情况更差，我们关注四个指标：预计 HAAD<20（T20）的患者比例、受影响个体的 HAAD 的第 25 和 75 百分位数（分别为 Q1 和 Q3）以及所有受影响个体的平均 HAAD（aHAAD）。
即使在两个条件的 aHAAD 相似的情况下，其他指标也可能不同。AML（aHAAD=59.3，T20=2.0%，Q3-Q1=14.8）和 ALL（58.4，T20=4.6%，Q3-Q1=21.8）在美国就是一个例子。许多疾病，如癫痫，在高收入环境中的终生健康状况较好（日本的 Q1=59.2），而在低收入环境中较差（埃塞俄比亚的 Q1=26.3）。
使用 HAAD，我们可以估计人群中所有个体的终生健康分布，并且可以将该分布作为在确定健康干预措施优先级时的公平考虑因素之一。
