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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
7/29/2019 Final Presentation (National Burden of Skin Disease)
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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.
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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?
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Epidemiologic Transition
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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
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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
7/29/2019 Final Presentation (National Burden of Skin Disease)
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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
Melanoma and other skin cancers
Lichen planus
Vitiligo
Atopic DermatitisSeborrheic dermatitis
Psoriasis
Contact dermatitis
Others Diseases of the skin
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
Melanoma and other skin cancers
Lichen planus
Vitiligo
Atopic DermatitisSeborrheic dermatitis
Psoriasis
Contact dermatitis
Others Diseases of the skin
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
Melanoma and other skin cancers
Lichen planus
Vitiligo
Atopic DermatitisSeborrheic dermatitis
Psoriasis
Contact dermatitis
Others Diseases of the skin
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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