Application of Summary Measures of Population Health to Measure Healthy Life Expectancy and Assess the Burden of Cancer in Taiwan

• Main Authors: Ling-Yu Liang, 梁玲郁
• Other Authors: Chung-Fu Lan
• Format: Others
• Language: zh-TW
• Published: 2005
• Online Access: http://ndltd.ncl.edu.tw/handle/43604449447470294862

博士 === 國立陽明大學 === 公共衛生研究所 === 93 === Background: Information on non-fatal health outcomes of disease and injury has been neglected in studies using mortality as the primary indicator in the past year. It is necessary to combine fatal and non-fatal health outcomes in the same study to objectively reflect life loss. One major objectives of this study was therefore to analyze non-fatal health outcomes in terms of Disability-Free Life Expectancy (DFLE) and Disability Adjusted Life Years (DALYs). We also applied disability adjusted life expectancy to estimate the burden of cancer. Specifically, we compared the relationships of year of life lost (YLLs) and years lived with disability (YLDs) to mortality, medical care utilization rate, and incidence. Objectives: 1. Measured the trends in disability free life expectancy from 1998 to 2002 in Taiwan to assess whether it is relative or absolute expansion or compression. . 2. Estimated the burden of cancer by age and gender in 2003 in Taiwan. 3.Analyzed the relationship between DALYs, YLLs, YLDs, mortality, incidence and medical care utilization in association with medical care expenditure (MCE). Materials and Methods Five data files were used in the study including vital registrations, catastrophe file, handicap file and National Health Insurance claim data (including inpatient and outpatient). We applied Sullivan and DALYs methods, which are the summation of YLLs and YLDs, to analyze the data mentioned above. The association between any of two variables related to relevant indicators was measured by correlation coefficients and regression coefficients using simple linear regression model. Results From 1998 to 2002, inpatient-free life expectancy is with relative expansion of morbidity, catastrophe-free life expectancy is absolute expansion of morbidity and handicap-free life expectancy is with absolute compression of morbidity. The total burden of cancer in Taiwan in 2003 was estimated to be 18.6 DALYs lost per 1,000 population. Cancer DALYs account for 14.7% of total DALYs. Cancer MCE account for 6.1% of total MCE. YLLs and YLDs account for 83.8% and 16.2%, respectively, of total cancer DALYs. Male and female DALYs account for 63.1% and 36.9% of the total cancer DALYs, respectively. The top five leading cancers of burden are liver cancer, lung cancer, oral cancer, colorectal and breast cancer; The top five YLLs are liver cancer, lung cancer, oral cancer, colorectal cancer and stomach cancer. The top five YLDs are breast cancer, oral cancer, liver cancer, colorectal cancer and lung cancer. The percent of cancer DALYs of total DALYs is similar to those of established market economics(EME) countries. The YLLs per death in Taiwan are higher than that of EME countries, due to leukemia, oral cancer, esophageal cancer, corpus of uterus and liver cancer. The YLDs per 1,000 population in Taiwan is the highest among other 14 regions in the world, attributed to cancers of mouth, esophageal, stomach, liver and pancreas. The associations among YLLs, YLDs , DALYs, mortality, medical care utilization rate some were significant. The highest correlation coefficients(r=0.99, p<0.0001) were exhibited by the DALYs and YLLs. The lowest correlation coefficients(r=0.38, p=0.1392 ) were exhibited by the medical care utilization rate and YLLs. The simple regression analysis identified the YLDs (R2=0.773), DALYs((R2=0.674), YLLs(R2=0.597), incidence(R2=0.583), mortality (R2=0.498), outpatients medical care utilization rate(R2=0.409) as the main determinants of total cancer MCE. The result showed the YLLs correlation to MCE is clear than that of mortality. DALYs correlation to MCE is clear than that of YLLs. YLDs correlation to for MCE is clear than that of DALYs. Conclusions The life expectancy of inpatient-free and catastrophe-free is subject to the expansion of morbidity whereas the handicap-free life expectancy is explained by the compression of morbidity. These findings account for a declining trend in healthy life expectancy although life expectancy has been increasing. The cause of expansion of morbidity is unknown and need to be clarified in further study. YLDs are the most predictor for accounting for MCE, and can account for 77.3% MCE which contains the expenditure of treatment, rehabilitation and prevent death and is similar to DALYs which combins fatal and non-fatal health outcome. The health resources allocation is a multiple-directional issue. It’s not satisfied the demand and the expectation of population by purely knowledge or politics aspect. The application of scientific DALYs is not the issue but how to apply this DALYs technology to the explanation burden is the most important issue. Resources allocation is a value judgments, the DALYs is not the only technical method of health resource allocation.