final presentation (national burden of skin disease)

7/29/2019 Final Presentation (National Burden of Skin Disease)

1/24

National burden of skin

diseases in Iran in 2003

Abbass Entezari

Skin Research Center (SRC)

Shaheed Beheshti University of Medical sciences


2/24

Clinical Data

Information

Knowledge

Apropriate

Decision Making

Improve Outcomes

For Patient

(clinical benefits)

Improve Use of

Resources

(economic Benefits)

Community

Health Promotion

Individual

Health PromotionHealth

Promotion

Service

Research

education


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Necesity of priority setting

When resources are scarce and they

always are we need methods to define

what is most important.


4/24

Two public health questions:

1. What is the total impact of disease and

injury in the population?

2. How do we compare the impacts ofdifferent diseases, risk factors, and

interventions that affect different

populations?


5/24

Epidemiologic Transition


6/24

Burden of disease study

The purpose of the burden-of-disease

concept is to provide a comprehensive

assessment of health challenges to inform

public debate on the priorities for health

action.


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Ultimate Measure of Ill-health?

Death is most common

Easy to determine

Commonly tabulated

Deaths + Illness = ?


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Disability Adjusted Life Year (DALY)

DALY = YLL + YLD

Years of Lost Life (due to mortality)

Years Lost to Disability(due to injury & illness)

The only differences in the rating of a death

or disability should be due to age and sex,

not to income, culture, location, social

class.

Everyone in the world has right to best life expectancy in world


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(C4 needs)Combined mortality and morbidity

Complete

Much of the world unrepresented Many important disabilities unaccounted

Consistent definitions of disease states

CoherentDeaths by disease add to total

Statistics match by age and sex


10/24

Needs for DALY calculation

1. Prevalence of skin disaeses by type

2. Incidence of skin disaeses by type

3. Age of onset & duration of skin disaeses by type

4. Mortality of skin disaeses by type

5. Remission rate of skin disaeses by type

6. Case fatality of skin disaeses by type

7. RR mortality

plus

Total population of Iran

Total Mortality of iran


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problem

There are no complete

and consistant data


12/24

WHO recommendation

Use of Disease Modeling concept and

DISMOD software for production of

consistant data


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National BOD

study method

Research on current knowledge

of the disease

Construct Diagram of the Natural

History of the Disease

A clear knowledge of the state-of-art of the disease.

Enough information to construct a diagram of the natural history of the

disease. If there is not enough information, consult experts (preferablyopinion leaders) to put up assumptions necessary to fill in the gaps

Identify the epidemiological

indicators to be estimated

Yes

No

Apply estimates to

calculate Burden

DISMOD Output Data:

A consistent set of epidemiological estimates of the disease.

All the necessary parameters for calculating the burden of disease

and injury.

The burden of the disease measured

Check internal consistency of the

estimates

A list of the most important epidemiological indicators needed to construct

the diagram of the natural history of the disease.

A list with the most relevant epidemiological data available.

Define (or redefine) best

estimates

A set of the most reliable epidemiological and

representative indicators of the disease.

A clear delineation of the case-definition, as well as epidemiologicalrelationships between the disease determinants, outcomes and sequelae

of the disease.

Are the estimates

consistent?

Review the published and non-

published epidemiological data

available

STEPS OUTPUT

Research on current knowledge

of the disease

Construct Diagram of the Natural

History of the Disease

A clear knowledge of the state-of-art of the disease.

Enough information to construct a diagram of the natural history of the

disease. If there is not enough information, consult experts (preferablyopinion leaders) to put up assumptions necessary to fill in the gaps

Identify the epidemiological

indicators to be estimated

Yes

No

Apply estimates to

calculate Burden

DISMOD Output Data:

A consistent set of epidemiological estimates of the disease.

All the necessary parameters for calculating the burden of disease

and injury.

The burden of the disease measured

Check internal consistency of the

estimates

A list of the most important epidemiological indicators needed to construct

the diagram of the natural history of the disease.

A list with the most relevant epidemiological data available.

Define (or redefine) best

estimates

A set of the most reliable epidemiological and

representative indicators of the disease.

A clear delineation of the case-definition, as well as epidemiologicalrelationships between the disease determinants, outcomes and sequelae

of the disease.

Are the estimates

consistent?

Review the published and non-

published epidemiological data

available

STEPS OUTPUT


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Methods

1. Collection of all published & unpublished

epidemiologic data of skin disaeses by

type

all universities

national & international articles

2. Review of all data in expert panel

3. Define the best estimation by expert

opinion


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Methods

4. Checked internal consistency of all data

by disease modeling and DISMOD

software

5. Creat all necessary index for DALY

calculation by DISMOD

6. Checked all DISMOD outputs in expert

panel

7. DALY Calculation


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World health report 2004

46.8

41.0

12.2

0.0 5.0 10.0 15.0 20.0 25.0 30.0 35.0 40.0 45.0 50.0

Injuries

Communicable diseases,maternal and perinatal

conditions and

nutritional deficiencies

Noncommunicable

conditions


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Burden of skin disease in the world (2004)

0.1

0.3

0.50.5

1.0

1.1

1.8

2.0

3.13.7

4.7

5.1

9.9

13.0

0.0 2.0 4.0 6.0 8.0 10.

0

12.

0

14.

0

Other neoplasms

Skin diseasesOral diseases

Nutritional/endocrine disorders

Diseases of the genitourinary systemDiabetes mellitus

Congenital abnormalities

Musculoskeletal diseases

Digestive diseasesRespiratory diseases

Sense organ disorders

Malignant neoplasmsCardiovascular diseases

Neuropsychiatric disorders


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Burden of non communicable skin

disease in Iran

250.3

396.31552.7

7993.8

9416.6

26466.5

26637.0

27825.0

32638.9

36702.2

41380.2

149289.4

Pemphigus

pilonidal cyst

Alopecia Areata

Melanoma and other skin cancers

Lichen planus

Vitiligo

Atopic Dermatitis

Seborrheic dermatitis

Psoriasis

Contact dermatitis

Others Diseases of the skin

Acne Vulgaris


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Burden of non communicable skin

disease in Iran

0.07

0.11

0.43

2.22

2.61

7.34

7.397.72

9.05

10.18

11.48

41.41

0.00 5.00 10.0

0

15.0

0

20.0

0

25.0

0

30.0

0

35.0

0

40.0

0

45.0

0

Pemphigus

pilonidal cyst

Alopecia Areata


Lichen planus

Vitiligo

Atopic DermatitisSeborrheic dermatitis

Psoriasis

Contact dermatitis


Acne Vulgaris


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YLL of non communicable skin disaese

130.40.0

0.0

5129.9

0.0

0.0

0.0

0.0

0.0

0.0

19.3

0.0

0.0 1000.

0

2000.

0

3000.

0

4000.

0

5000.

0

6000.

0

Pemphiguspilonidal cyst

Alopecia Areata


Lichen planus

Vitiligo


Psoriasis

Contact dermatitis


Acne Vulgaris


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YLD of non communicable skin

disease

119.9

396.3

1552.7

2863.9

9416.6

26466.5

26637.027825.0

32638.9

36702.2

41360.8

149289.4

0.0 2000

0.0

4000

0.0

6000

0.0

8000

0.0

1000

00.0

1200

00.0

1400

00.0

1600

00.0

Pemphigus

pilonidal cyst

Alopecia Areata


Lichen planus

Vitiligo


Psoriasis

Contact dermatitis


Acne Vulgaris


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Burden of communicable skin disease

in Iran

482.5

5.5

1.4

0.0 100.0 200.0 300.0 400.0 500.0 600.0

Leishmaniasis

Leprosy

Anthrax


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Special thanks

Dr.P.Tousi

Dr.M.Shahidi

Dr.H.Morravej

Dr.N.Tehranchi

Dr.L.Nabaei

Dr.M.Naghavi

Dr.N.Gafari

Dr.S.Vaseghi

Dr.F.Abolhasani


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final presentation (national burden of skin disease)

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