Measuring burden of disease in two inner London boroughs using Disability Adjusted Life Years

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Abstract
This paper uses the Disability Adjusted Life Year (DALY) to estimate disease burden at a local level and relates this to programme budget (PB) data. We estimated DALY using the global burden of disease (GBD) template. For years of life lost, local mortality data were used and for years of life with disability, the GBD estimates from World Health Organization EURO A region (including the UK) were used. We used PB data to analyse how healthcare expenditure matched disease burden. In 2005 the burden of disease in Lambeth was estimated at 36 368 DALYs (13 515 DALYs lost per 100 000) and in Southwark was 34 196 DALYs (13 244 DALYs lost per 100 000). There were gender and area differences. The ranking is different when mortality and morbidity are combined compared with mortality alone. We estimated that the average spend per DALY lost in 2005 was £11 066 in Lambeth and £9390 in Southwark. We used a pragmatic approach to estimate overall disease burden providing a local, more comprehensive picture with important differences in spend by disease and health authority area. However, a more detailed approach to support decisions about prioritization based on modelling interventions that impact on avoidable burden of disease is recommended.