1992

-
(disability-adjusted life years-DALYs)

DALYs

DALYs DALYs
DALYs DALYs (YLLs-years of life l
ost)(YLDs-years lived with disability) DALYs
DALYs (time-based)
DALYs
DALYs (age-weighted)(disability-weighted)
(discounting)

evidence-based, empirical- based

DALYs

DALYs

()
DALYs ,

quantity
add years to lifequality(add life to years)

(outcome)
1960
(SMPH-summary
measures of population health)
Health expectancy = A + f(B) Health gap = C + g(B),

1. Health expectancy = A + f(B)

F fig1 A ,

(A)Disability-Free Life ExpectancyDFLE: 1

0 Active Life Expectancy, Independent Life Expectancy, Dementia-Free
Life Expectancy
(B)Life Expectancy With Disability Handicap
Expectancy, Severe Handicap Expectancy, Unhealthy Life
Expectancy Fig1: SMPH-summary measures of population health

Survivors (%)
100
90

80

70
60

50

(Full health)

40
30
20
10
0
0

10

20

30

40

50

60

70

80

90

100

Age (years)

Health-Adjusted Life Expectancy(HALE): utility weight

Disability-Adjusted Life Expectancy (DALE) : disability weight

Health gap = C + g(B),

G Fig1
(normative)IDEAL, NORM, GOA
L DALYs YLLs

YHLs(Years of Healthy Life) 1962 (Ghana)

QALYs(Quality-Adjusted Life Years)

1986 Klarmam, Torrance, Weinstein von-Neumann-Morgenstern Utility

Theory

HYEs(Healthy-Years Equivalent)

1989 Mehrez,Gafni QALYs

DALYs(Disability-Adjusted Life Years)

1992 Murray,Lopez DALYs=YLLs+YLDs QALYs

HeaLYs(Healthy Life-Years)

1998 Johns Hopkins Hyder Morrow years of healthy

life

3.DALYs
(Health outcome)
(Health outcome)

(Fairness )

(Egalitarian Principle)

>
0-4 5-14 15-44 4
5-59 60
ICD-9CM
:-

:
DALYs DALYs=YL
Ls+YLDs

x=+

DCxe -x e -r(x-a) dx
x=a

D=disability weight
r = 0.03 discount rate
= 0.04 age-weighting function
C=0.16243 age-weighting correction constant
a=age of onset
L=duration of disability

KCxe x (1 K )
K K 1 9 54

Fig2

Value of a Year of Life Lived at Different Ages

Relativ e Weight

1.5

0.5

0
0

10

15

20

25

30

35

40

45

Age

50

55

60

65

70

75

80

85

:
(Time preference)
1. 2
3.(discounting rate)
3 Fig3

Potential Years of Life Lost

Discounted and Undiscounted

Weight
80
70
60
50
40
30
20
10
0
0

10

15

20

25

30

35

40

45

50

55

60

65

70

75

Age
Fig3: (Age-Weight)(Discountin

Y e a r s lo s t d u e to a d e a th

90
M ale - undiscounted, no age weights

80

F emale - undiscounted, no age weights

70

M ale - age weighted and discounted

60

F emale - age weighted and discounted

50
40
30
20
10
0
0

20

40

60

80

100

120

Age

g), Fig4

1,

0.00 - 0.02

0.02 - 0.12

0.12 - 0.24

0.24 - 0.36

0.36 - 0.50

0.50 - 0.70

0.70 - 1.00

YLL(Years of life lose)

Dempsey 1947
years of life lost potentia
l years of life lost, period expected years of life lost, coho
rt expected years of life lost and standard expected years of life lost
DALYs Coale and Demeny Model Level 26

KCera
1 K
( r )( L a )
1 e rL
YLL
( r )( L a ) 1 e ( r ) a ( r )a 1
2 e
(r )
r
1999 ICD-9CM
DALYs 93.2% YLLs
YLD(Years lived with disability) DisMod <43>

YLD D

KCera
1 K
( r )( L a )
1 e rL
( r )( L a ) 1 e( r ) a ( r )a 1
2 e
(r )
r

DisMod
internal consistency
(static analysis)

 YLDs 1999 DALYs

54.5% YLDs DALYs

DALYs 2,512,765.4 YLLs 1,219,384 YLDs 1,293,382

67.7% 32.3%, 7.5%60.1%32.4%
72.36%
2 fig5
(YLLs)
77.6%YLDs , 75.77%
D
ALYs

72986.
86354

599456.
7587

138708.
9838

115236.
2554

910695.
1017

200000

400000

600000

675681.
4016

800000

1000000

1200000

1400000

1600000

1800000

15 44 18.13%
60 12.61% 3 fig6
fig7

DALYs

0-4

5-14 %

74,335

2.96%

1,451 0.06%

43,697

1.74%

53,472

15-44 %

60+

19,952

0.79%

115,236

8.91% 316,832 12.61%

910,695

8,239

17,937 0.71%

308,350 12.27%

223,879

2.13%

43,742 1.74%

455,548 18.13%

82,613

3.29%

40,306

1.60%

675,681

49,803

1.98%

1,068 0.04%

9,030

0.36%

3,231

0.13%

9,856

0.39%

72,987

34,620

1.38%

18,625 0.74%

193,817

7.71%

135,972

5.41% 216,422

8.61%

599,457

0.32%

12,406 0.49%

77,924

3.10%

22,182

0.88%

0.72%

138,709

263,953 10.50%

95,229 3.79% 1,055,928 42.02%

0.33%

DALYs

0.45%

8,025

11,260

45-59 %

18,172

476,116 18.95% 621,539 24.74% 2,512,765

DALYs,

60+
45-59

15-44
05-14

00-04

100000

200000

300000

400000

500000

600000

YLLs & YLDs

30,000

20,000

Y LD s
Y LLs

10,000
1

13 17 21 25 29 33 37 41 45 49 53

57 61 65 69 73 77 81

85 89 93 97

10.47(6.21)
(7.31)(16.63)(10.11)(11.78)

(DALYs)114.16(106.2)(141.
43)(162.36)(243.57)(128.33)
(606.64) 54.5%,

10

YLL/

YLLs/1000

YLDs/1000

DALYs/1000

etc

6.44

48.03

58.17

106.20

10.47

55.40

58.76

114.16

etc

6.21

61.41

66.92

128.33

etc

13.15

87.86

74.50

162.36

7.31

62.45

78.98

141.43

etc

11.78

105.23

79.14

184.36

16.84

122.77

82.87

205.64

16.63

153.19

90.38

243.57

10.11

151.21

95.39

246.60

26.08

477.51

129.13

606.64

etc
etc

:Botswana, Burundi, CentralAfricanRepublic, Congo, Cted'Ivoire, Democratic Republic Of

The Congo, Eritrea, Ethiopia, Kenya, Lesotho, Malawi, Mozambique, Namibia, Rwanda, SouthAfrica,
Swaziland, Uganda, UnitedRepublicofTanzania, Zambia, Zimbabwe
:Canada,UnitedStatesOfAmerica,Cuba
:Andorra, Austria, Belgium, Croatia, CzechRepublic, Denmark, Finland, France, Germany,
Greece, Iceland, Ireland, Israel, Italy, Luxembourg, Malta, Monaco, Netherlands, Norway,Portugal,
SanMarino, Slovenia, Spain,Sweden, Switzerland, UnitedKingdom
Albania, Armenia, Azerbaijan, BosniaAndHerzegovina, Bulgaria, Georgia,
Kyrgyzstan, Poland, Romania, Slovakia, Tajikistan, TheFormerYugoslavRepublicOfMacedonia,
Turkey, Turkmenistan, Uzbekistan, Yugoslavia
:Belarus,Estonia,Hungary,Kazakhstan,Latvia,Lithuania,
RepublicofMoldova,RussianFederation,Ukraine
Indonesia,SriLanka,Thailand
:Australia,Japan,BruneiDarussalam,NewZealand,Singapore
:Cambodia, China, LaoPeople'sDemocraticRepublic, Malaysia, Mongolia, Philippines,
RepublicOfKorea, VietNam

11


1.

,,

2.

DALYs YLL YLD

DALYs

3.

82.5 80

4. DALYs

DALYs

DALYs DALYs
DALYs DALYs

12