The Georgia Burden of Disease Study
Smith, Colin Keith
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The Georgia Burden of Disease Study (GBDS) is a pioneering study aimed at conducting the first known state-specific burden of disease (BOD) analysis in the United States. BOD analyses result in the creation of the population health summary measure Disability-Adjusted Life Years (DALYs) which combine mortality and morbidity sources into a total burden of disease for a given series of disease and injury conditions. These conditions can then be rank ordered to assist in public health planning and prioritization; and, when combined with program services data, be used in cost-effectiveness analysis (CEA). The GBDS is based on the work done by the 1996 U.S. Burden of Disease and Injury (USBODI) study and other international BOD studies. The GBDS used the unmodified estimates for disease age at onset, duration, and disability weights from the USBODI study. However, the GBDS used a population proportional distribution method, based on the USBODI, to create 2002-2006 Georgia disease prevalence and incidence estimates. WHO DISMODII software was utilized for internal consistency checks, and the results were found to not be statistically different (α-level = 0.10). Rank ordering of causes in Georgia was found to be different than was observed in the USBODI. This was attributed both to the different racial composition of the population observed in the two studies, and improvement in mortality and morbidity outcomes among Black in Georgia from 1996 to 2006. Diabetes mellitus DALYs were found to be significantly higher in Georgia for the entire population; nephritis/nephrosis DALYs were higher among Black Females; and hypertension/hypertensive heart disease was observed to be higher among Black Males (p < 0.10). Black Males were also observed to have significantly lower DALYs in the GBDS when compared to the USBODI for: HIV, homicide, motor vehicle accidents, lung cancer, and stroke (p < 0.10). Policy and future research recommendations were made based on the process and outcome findings. Example recommendations included: training of Georgia health policy-makers on the use of DALYs; and application of the GBDS model to the 18 public health districts in Georgia.