Global burden of disease.

Assessing the health situation in populations has traditionally been carried out on the basis of mortality data, and where available, on the prevalence and/or incidence of disease. A new approach to quantifying the burden of disease has been developed which simultaneously considers both premature death as well as the non-fatal health consequences of disease and injury. The burden of disease approach is based on an incidence perspective and provides an estimate of the number of years of life lost due to premature death (in 1990), and the number of years of life lived with a disability arising from new cases of disease or injury in 1990. These two components constitute the total number of disability-adjusted life years (DALYs) due to disease or injury incurred in 1990. The results of this approach were first utilized in the World development report 1993: investing in health. The following four articles present, for the first time, details about the methods, assumptions and findings of the global burden of disease methodology. The first article summarizes the principles and properties of the DALY measure. The detailed set of age, sex, cause-specific mortality rates used to estimate the years of life lost from premature death are presented in the second paper. The third article gives details about the estimated years of life lived with a disability, reflecting the likelihood of progressing from disease incidence to disability, the duration of disability, and its severity. The fourth paper provides a summary of the DALYs arising from both components and shows that the results are relatively insensitive to assumptions about parameter values used in the calculation. This article also provides an overview of how the method might be applied to assist countries with their own health situation assessment.