Health of the Big Apple: Measuring the burden of disease and injury in New York City using disability-adjusted life years (DALYs), 2005

Introduction: In the second application of this method at a local level, disability-adjusted life years (DALYs) were used to measure combined mortality and morbidity burden for nearly 100 conditions in New York City (NYC).

Methods: Years of life lost (YLL) were calculated using 2005 NYC mortality data, subtracting age at death from life expectancy, stratified by age, sex and race. Since we had limited local incidence data, we used national morbidity data for all conditions: years lived with disability (YLD) were calculated by 1) multiplying national YLD/YLL ratios by NYC YLL or 2) for conditions with high morbidity (national YLD/YLL >10), national rates were applied to the NYC population.

Results: Leading causes of DALYs were ischemic heart disease, depression, HIV, alcohol use and osteoarthritis. Compared with the nation, NYC had a lower burden of DALYs from road traffic accidents, lung cancer and COPD, and a larger burden from asthma, HIV and poisonings (including drug overdoses). Depression, post-traumatic stress disorder and panic disorder contributed a greater burden for women compared with men. Top 20 causes of DALYs for men included poisonings, self-inflicted injuries/deaths and falls, none of which were leading causes for women.

Conclusion: One limitation was that differences in national and NYC rankings of causes were driven primarily by mortality differences (due to unavailability of NYC incidence data). DALYs measure the often neglected impact of high morbidity/low mortality conditions, and should be considered when determining public health priorities and programming. Other jurisdictions can use this methodology to inform local planning.