Meta-Data

What are DALYs?

One DALY can be thought of as one lost year of "healthy" life. The sum of these injury related DALYs across a population, or injury type, can be thought of as a measurement of the gap between current health status and an ideal health situation where the entire population lives to an advanced age, free of disability. DALYs for injury or disease are calculated as the sum of the Years of Life Lost (YLL) due to premature mortality in the population and the Years Lost due to Disability (YLD) for people living with the health condition or its consequences:

DALY = YLL + YLD

IDB-BOI Data Sources

The calculation of Injury DALYs requires five data sources:

  1. Non-admitted injury related emergency department attendances: Based on Minimum Data Set (IDB-MDS) submissions from member countries to the European Injury Data Base (IDB). Non-admitted injury related patients were identified using the ‘treatment and follow-up’ field in the IDB-MDS dataset. For further information on the IDB-MDS please refer to the IDB Operating Manual and IDB-MDS Data Dictionary.
  2. Injury related admissions to hospital: Admitted injury related patients were identified using the ‘treatment and follow-up’ field in the IDB-MDS dataset.
  3. Injury Deaths: Currently based on data submitted to the World Health Organisations (WHO) through the European Detailed Mortality Database (EDMD). In the future, we are planning to request data from member countries in a similar format to MDS. Injury deaths included all underlying causes of death in the ICD-10 codes V-Y, excluding Y40-Y84, Y88.
  4. Disability Weights (DWs): DWs are an indication of the severity of an injury and are required to calculate the YLD portion of a DALY. They range on a scale from 0 (which equates to perfect health) to 1 (which equates to death). DWs can be derived through several methods, and several classifications systems have been utilised in previous estimates. For this piece of work, DWs from the Injury VIBES Project were utilised. Further information about the Injury VIBES project can be found in Gabbe et als 2016 paper.
  5. Remaining years of life: Remaining years of life are required for the calculation of both YLDs and YLLs. Durations adopted in the recent 2013 Global Burden of Disease (GBD) study (see Table 1) were adopted in our calculations.

No age weighting was used in the IDB DALY calculations

Age Remaining Years of Life
0-4 85.01
5-9 78.76
10-14 73.79
15-19 68.83
20-24 63.88
25-29 58.94
30-34 54.00
35-39 49.09
40-44 44.23
45-49 39.43
50-54 34.72
55-59 30.10
60-64 25.55
65-69 21.12
70-74 16.87
75-79 12.89
80-84 9.32
85+ 5.05

Table 1: Remaining years of life lost used in the IDB DALY calculations

IDB-MDS Data included in IDB DALY Calculations

IDB DALY estimates were generated for countries and years where both non-fatal injury data (IDB-MDS) and fatal injury data (EDMD[6]) were available. Table 2 lists the availability of data in the IDB-MDS, WHO EDMD, and consequently data included in the IDB estimates.

Country IDB-MDS availability (years) EDMD availability (years) IDB DALY estimates (years included in IDB estimates)
Austria 2009-2014 2009-2014 2009 - 2014
Cyprus 2009 - 2010 2009 - 2013 2009-2010
Denmark 2009 - 2015 2009 - 2012 2009 - 2012
Estonia 2015 2009 - 2014
Finland 2010 - 2014 2009 - 2014 2010 - 2014
Germany 2011 - 2012 2009 - 2014 2011-2012
Iceland 2010 - 2013 2009
Italy 2011 2009 - 2012 2011
Lithuania 2013 - 2015 2009 - 2014 2013 - 2014
Luxembourg 2013 - 2015 2009 - 2014 2013 - 2014
Malta 2009 - 2013 2009 - 2014 2009 - 2013
Netherlands 2009 - 2014 2009 - 2013 2009 - 2013
Norway 2012 - 2014 2009 - 2014 2012 - 2014
Portugal 2011 - 2015 2009 - 2014 2011 - 2014
Romania 2013 2009 - 2014 2013
Slovenia 2011- 2015 2009 - 2010
Spain 2013 2009 - 2014 2013
Sweden 2009 - 2015 2009 - 2014 2009 - 2014
United Kingdom 2010 - 2015 2009 - 2013 2010 - 2013

Table 2: IDB-MDS and EDMD data availability, and subsequent data included in the IDB-BOI estimates

Disability weights

DWs generated in the Injury VIBES study (Gabbe et al 2016) were mapped across to MDS injury categories where possible. DWs are broken down into short-term (disability up to 12 months) and long term (disability 12 months post injury) for both hospitalised and non-hospitalised injuries. In several instances, where it was not possible to generate DWs for specific injuries, DWs for similar injuries were utilised. Further, as no DWs were generated for poisonings in the Injury VIBES study, poisoning DWs generated in the 2013 GBD study were utilised.

IDB DALY Calculations

The following acronyms will be used in the calculation steps below:

DALY Calculation steps:

  1. The first step involved mapping NHST DWs to non-admitted injury cases in the IDB-MDS using the VIBES DWs.
  2. The second step involved mapping NHLT DWs to non-admitted cases in the MDS. These weights were then multiplied by ‘remaining years of life lost’ (Table 1)
  3. NHYLD were calculated by adding NHST and NHLT together e.g.
    NHST + (NHLT x remaining years) = NHYLD
  4. HYLD were calculated in the same way as the above but for injury cases admitted to hospital e.g.
    HST + (HLT x remaining years) = HYLD
  5. YLDs were calculated by adding together NHYLD and HYLD e.g.
    NHYLD + HYLD = YLD
  6. YLL were calculated by assigning the ‘remaining years of life’ to each injury fatality.
  7. DALYs were calculated as follows:
    DALY = YLL +YLD
  8. DALYs, YLL and YLD’s were then assigned to one of 8 injury groups (see below). At present, it has only been possible to generate DALY estimates for one of the European Core Health Indicators 30b (accidental RTAs). The absence of location data in the WHO EDMD prevents the identification of injuries in the home and during leisure (ECHI 29b) and in the workplace (31), and thus the calculation of YLLs in these locations. However, there may be potential to generate estimates for ECHI 29b and 31 in the future for member countries who can provide location of death.
    • Road Traffic Accidents (ECHI 30b)
    • Accidental Falls
    • Accidental Poisonings
    • Accidental Burns and Scalds
    • Self-Harm
    • Assault
    • Undetermined/Unknown Intent
    • Other and Unknown

    Table 3 lists the MDS codes and ICD-10 codes assigned to the 8 injury groupings.

    Injury Cause MDS codes ICD-10 codes
    Road Traffic Accidents Intent = 1 and Mechanism = 1 V01-V99
    Accidental Falls Intent = 1 and Mechanism = 2 W00-W19
    Accidental Poisoning Intent = 1 and Mechanism = 4 X40-X49
    Accidental Burns and Scalds Intent = 1 and Mechanism = 5 X00-X19
    Self-harm Intent = 2 X60-X84
    Assault Intent = 3 X85-Y09
    Undetermined/Unknown Intent Intent = 9 Y10-Y34
    Other and Unknown Remaining MDS cases Remaining injury deaths

    Table 3: MDS codes and ICD-10 codes assigned to the 8 injury groupings

  9. Next a master table of DALYs, YLDs, and YLLs grouped by country, year, gender, age and injury type was created.
  10. As most IDB-MDS submissions are based on a sample of the national population, national populations were divided by IDB reference populations to obtain extrapolation factors by country, year, age and gender.
  11. YLDs were multiplied by the extrapolation factors to obtain national YLD estimates.
  12. New national level YLD and DALY estimates were generated and a final master results table was populated.
  13. To download the master results table containing all of the results utilised in this online tool, click here. The master table also contains additional information, including % of the national population included in the IDB sample, data warning flags and national population figures to enable the calculation of DALY rates.

Observations

The IDB-BOI estimates are between 2-10 times greater than national estimates generated in the Global Burden of Disease study. The increased IDB-BOI estimates are expected for several reasons however: