142nd APHA Annual Meeting and Exposition

Annual Meeting Recordings are now available for purchase

Tuberculosis DALY-gap: Quantifying health disparities

142nd APHA Annual Meeting and Exposition (November 15 - November 19, 2014): http://www.apha.org/events-and-meetings/annual
Monday, November 17, 2014 : 12:30 PM - 12:50 PM

Mariel Marlow, PhD, MPH , Division of Infectious Diseases and Vaccinology, School of Public Health, University of California, Berkeley, Berkeley, CA
Ethel Leonor Noia Maciel, PhD , Federal University of Espírito Santo, Vitória, Brazil
Regina Daumas, PhD , National School of Public Health, Oswaldo Cruz Foundation – FIOCRUZ, Rio de Janeiro, Brazil
Robert Snyder, MPH , Division of Epidemiology, School of Public Health, University of California, Berkeley, Berkeley, CA
Lee Riley, MD , Division of Infectious Diseases and Vaccinology, School of Public Health, University of California, Berkeley, Berkeley, Brazil
Background Policy makers use disability-adjusted life years (DALYs) data to allocate resources and define public health priorities. These estimates can be disaggregated to compare disease burden in subpopulations within nations. Here, we propose a new health metric called “DALY-gap” to compare tuberculosis (TB) disease burden in populations residing in and outside of urban slums in Rio de Janeiro, Brazil.

Methods Residence in an informal settlement, defined as aglomerados subnormais (AGSN), was determined for all TB cases in Rio reported to the Brazilian Information System for Notifiable Diseases (SINAN) in 2005 and 2010. DALYs were calculated as the sum of years of life lost (YLLs) and years lived with disability (YLDs) based on the 2010 Global Burden of Disease methodology. DALY-gap was calculated as the difference between age-adjusted TB DALYs in residents of AGSN vs non-AGSN.

Results The total DALY for TB in Rio de Janeiro in 2010 was 16,731 (265.58 DALYs/100,000 population). DALYs were higher in AGSN census tracts (306.41 vs 236.37 DALYs/100,000), resulting in a DALY-gap of 70.04 DALYs/100,000. Attributable DALY fraction for living in an AGSN was 25.4%. Highest burden was found in AGSN census tracts with <60% electricity, sanitation, and water accessibility, and <70% solid waste disposal service.

Conclusion TB DALY-gap calculation allowed a quantitative assessment of disparity that was not evident from traditional comparison of incidence or mortality between subpopulations. DALY-gap determination to compare disease burden could be used to design focused interventions and resource allocation.

Learning Areas:

Conduct evaluation related to programs, research, and other areas of practice
Protection of the public in relation to communicable diseases including prevention or control
Public health or related public policy
Public health or related research

Learning Objectives:
Define a new metric called DALY-gap. Compare and quantitatively assess health disparity due to disease burden (DALYs) in slum versus non-slum communities.

Keyword(s): Underserved Populations, Poverty

Presenting author's disclosure statement:

Qualified on the content I am responsible for because: I am currently a NIH/FIC Global Health Equity Scholar based in Rio de Janeiro, Brazil. My work here focuses on creating community health indicators (such as the DALY-gap to be presented in the current abstract) in the slums, or "favelas", of Rio.
Any relevant financial relationships? No

I agree to comply with the American Public Health Association Conflict of Interest and Commercial Support Guidelines, and to disclose to the participants any off-label or experimental uses of a commercial product or service discussed in my presentation.