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Small-area disability-adjusted life years : a new approach to the spatio-temporal analysis of public health surveillance data Lima, Viviane Dias

Abstract

When engaged in injury surveillance and regional health planning (e.g., the allocation and distribution of health services and prevention initiatives) it is essential that the health status of regions be monitored over time. The conventional approach to monitoring the health impact of injuries has been to summarize the spatial variation of each region using measures such as mortality and incidence rates. While the use of such measures yields important surveillance information, it does not directly quantify the overall (i.e., fatal and non-fatal) injury burden experienced by individual communities. Although measures of incidence and burden can be derived for small regions, they are often based on a low number of observed injury cases. These low counts are frequently associated with high degrees of chance variation. Recently developed model-based disease mapping methods reduce the influence of chance variation and in so doing yield more reliable estimates of the underlying variation in injury incidence and burden. In this thesis we describe how estimates of disability-adjusted life years (DALY) can be integrated into spatio-temporal Bayesian statistical methods to quantitatively describe how the burden of injuries varies between and within regions of British Columbia (BC) over time. As a demonstration, we examined administrative hospitalization data using the DALY methodology to calculate the incidence and burden of 13 external causes of injury at the provincial and health authority level from 1991-2000. To illustrate the small-area analysis of injury burden, we used the same data to describe the impact of road traffic accidents. Lastly, we examined injuries due to adverse events to demonstrate the usefulness of administrative database screening to describe region-specific impacts of these injuries in BC. Obtaining reliable small-area DALY estimates has the potential to dramatically improve our understanding of public health problems. As shown in this thesis, this methodology enables researchers to quantify the total number of healthy years lost for leading causes of injury. In addition to scientific gains, this information can be used to inform the setting of regional priorities related to the planning and delivery of health care and quantify the benefits of regional intervention programs in cost-effectiveness analyses.

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