6. Incorporating Deaths Near the Time of Birth into Estimates of the Global Burden of Disease
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Editors/Authors: Dean T. Jamison, Sonbol A. Shahid-Salles, Julian Jamison, Joy E. Lawn, and Jelka Zupan
Disease / Condition
Adolescent & Childhood Diseases
Maternal & Neonatal Conditions
Many countries maintain vital registration systems that provide data on deaths by cause, sex, and age, and some also report years of life lost because of premature mortality (YLL) resulting from each cause. The tracking of stillbirths, however, is often incomplete and variable.
In the early 1990s, no estimates of YLL were available for many developing countries or regions. In 1993, the World Bank initiated an effort to generate estimates that have subsequently been used to guide resource allocation in the health sector. Nevertheless, the global burden of disease literature provides little insight into the importance of deaths near the time of birth.
In 2001, 10.6 million children died before their fifth birthday. Of these, 3.9 million deaths occurred in the neonatal period, under the age of 28 days. Another 3.3 million stillborn children remained outside the vital registration systems of most countries. With stillbirths included, about half of all deaths of children under age five occur under the age of 28 days.
There are limitations in the use of disability-adjusted life years (DALYs) as a formulation when dealing with events around the time of birth. The DALY can be extended by modeling a concept of gradual acquisition of life potential (ALP) based on two judgments: that an individual life acquires value as it acquires self-awareness and that it acquires additional value as it interacts with others. A mechanism is proposed to allow for the use of gradual ALP in DALY modeling.
In the standard DALY formulation, the ratio of YLL for a death at age 20 versus a death at birth is approximately one. ALP allows us to vary this ratio, and in particular we propose a variant that yields a value of about three for this number.
Click on the links below to read the full text.
- Stillbirths and Neonatal Mortality in the Context of the Global Burden Of Disease
- The Burden of Disease Resulting from Events Near the Time of Birth
- Annex 6A: Flexible Functional Forms for the Acquisition of Life Potential
- Annex 6B: Supplementary Tables
- Annex 6C: Causes of Neonatal Mortality: Comparison of Numbers from the Global Burden of Disease with those from the Child Health Epidemiology Reference Group
- 6.1 Age Distribution of Deaths of Children under Five in Low-band Middle-Income Countries, 2001
- 6.2 ALP, Traditional DALYs, and DALYs (3,0,.54)
- 6.3 Ratio of DALYs Lost at Age 20 to Age 0 as a Function of Age Weighting
- 6.4 YLL for Deaths at Different Ages
- 6.A1 Relationship between Time to Complete ALP and Life Potential at Age 0 for Several Values of A
- 6.A2 Ratio of DALYs Lost at Age 20 to Age 0 as a Function of A
Population Totals and Numbers of Births, 2001
Age Distribution of Deaths under Age 5, 2001
Estimated Death Rates under Age 5, by Country Income Level, 2001
Probability of dying in the x years following age y (xqy), expressed per thousand live births
- 6.4 Deaths by Age and Cause, 2001 (thousands)
- 6.5 Values of Selected ALP Functions
- 6.6 Discounted YLL at Different Ages of Death for Several DALY Formulations
- 6.7 Disease Burden at Different Ages Using Different Measures, Low- and Middle-Income Countries, 2001
- 6.8 Disease Burden from Selected Groups of Causes Using Different Measures, Low- and Middle-Income Countries, 2001
- 6.B1 Deaths (Excluding Stillbirths) from Selected Causes, by Age, 2001 (thousands)
- 6.B2 YLL(3,0) from Selected Causes, by Age, 2001 (thousands)
- 6.B3 YLD from Selected Causes, by Age, 2001 (thousands)
- 6.B4 The Burden of Disease—DALYs(3,0) from Selected Causes, by Age, 2001 (Excluding Stillbirths) (thousands)
- 6.B5 YLLSB(3,0,1) Calculated to Include Stillbirths (Valued the Same as Newborn Deaths) (thousands)
- 6.B6 The Burden of Disease—DALYsSB(3,0,1). Calculated to Include Stillbirths (Valued the Same as Newborn Deaths) (thousands)
- 6.B7 YLLSB(3,0,.54) Calculated to Include Stillbirths and Gradual ALP (in thousands)
- 6.B8 The Burden of Disease—DALYsSB(3,0,.54). Calculated to Include Stillbirths and Gradual ALP (A = .54) (thousands)
- 6.C1 Causes of Neonatal Mortality, Worldwide in 2001 (thousands)