Limits...
Aging, transition, and estimating the global burden of disease.

Seligman BJ, Cullen MR, Horwitz RI - PLoS ONE (2011)

Bottom Line: By contrast, estimated survival past sixty decreased over the same period.These results show that the GBD mortality model did not accurately estimate survival at older ages as developed countries transitioned in the twentieth century and may be similarly flawed in developing countries now undergoing transition.Estimates of the size of older-age populations and their attributable disease burden should be reconsidered.

View Article: PubMed Central - PubMed

Affiliation: Stanford University School of Medicine, Palo Alto, California, United States of America. bensel1@stanford.edu

ABSTRACT

Background: The World Health Organization's Global Burden of Disease (GBD) reports are an important tool for global health policy makers, however the accuracy of estimates for countries undergoing an epidemiologic transition is unclear. We attempted to validate the life table model used to generate estimates for all-cause mortality in developing countries.

Methods and results: Data were obtained for males and females from the Human Mortality Database for all countries with available data every ten years from 1900 to 2000. These provided inputs for the GBD life table model and served as comparison observed data. Above age sixty model estimates of survival for both sexes differed substantially from those observed. Prior to the year 1960 for males and 1930 for females, estimated survival tended to be greater than observed; following 1960 for both males and females estimated survival tended to be less than observed. Viewing observed and estimated survival separately, observed survival past sixty increased over the years considered. For males, the increase was from a mean (sd) probability of 0.22 (0.06) to 0.46 (0.1). For females, the increase was from 0.26 (0.06) to 0.65 (0.08). By contrast, estimated survival past sixty decreased over the same period. Among males, estimated survival probability declined from 0.54 (0.2) to 0.09 (0.06). Among females, the decline was from 0.36 (0.12) to 0.15 (0.08).

Conclusions: These results show that the GBD mortality model did not accurately estimate survival at older ages as developed countries transitioned in the twentieth century and may be similarly flawed in developing countries now undergoing transition. Estimates of the size of older-age populations and their attributable disease burden should be reconsidered.

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This figure shows box-and-whisker plots of the ratio of GBD model estimated survival from age 60 to 80 to the observed survival for each year in the set of life tables for males (top) and females (bottom).
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pone-0020264-g002: This figure shows box-and-whisker plots of the ratio of GBD model estimated survival from age 60 to 80 to the observed survival for each year in the set of life tables for males (top) and females (bottom).

Mentions: Box plots showing the ratio of estimated to observed survival rates from age 60 to age 80 (20l60) from 1900 to 2000 are displayed in Figure 2; the year of the data is given along the x-axis and the ratio of the model-estimated to HMD-observed survival probability is given along the y-axis. As this figure shows, the GBD model substantially over-estimates survival probabilities among males in the first half of the 20th century, whereas for females it performs reasonably well. However, in the latter half of the century, the model overestimates mortality for both males and females, with ever increasing deviation from observed mortality over time.


Aging, transition, and estimating the global burden of disease.

Seligman BJ, Cullen MR, Horwitz RI - PLoS ONE (2011)

This figure shows box-and-whisker plots of the ratio of GBD model estimated survival from age 60 to 80 to the observed survival for each year in the set of life tables for males (top) and females (bottom).
© Copyright Policy
Related In: Results  -  Collection

Show All Figures
getmorefigures.php?uid=PMC3101233&req=5

pone-0020264-g002: This figure shows box-and-whisker plots of the ratio of GBD model estimated survival from age 60 to 80 to the observed survival for each year in the set of life tables for males (top) and females (bottom).
Mentions: Box plots showing the ratio of estimated to observed survival rates from age 60 to age 80 (20l60) from 1900 to 2000 are displayed in Figure 2; the year of the data is given along the x-axis and the ratio of the model-estimated to HMD-observed survival probability is given along the y-axis. As this figure shows, the GBD model substantially over-estimates survival probabilities among males in the first half of the 20th century, whereas for females it performs reasonably well. However, in the latter half of the century, the model overestimates mortality for both males and females, with ever increasing deviation from observed mortality over time.

Bottom Line: By contrast, estimated survival past sixty decreased over the same period.These results show that the GBD mortality model did not accurately estimate survival at older ages as developed countries transitioned in the twentieth century and may be similarly flawed in developing countries now undergoing transition.Estimates of the size of older-age populations and their attributable disease burden should be reconsidered.

View Article: PubMed Central - PubMed

Affiliation: Stanford University School of Medicine, Palo Alto, California, United States of America. bensel1@stanford.edu

ABSTRACT

Background: The World Health Organization's Global Burden of Disease (GBD) reports are an important tool for global health policy makers, however the accuracy of estimates for countries undergoing an epidemiologic transition is unclear. We attempted to validate the life table model used to generate estimates for all-cause mortality in developing countries.

Methods and results: Data were obtained for males and females from the Human Mortality Database for all countries with available data every ten years from 1900 to 2000. These provided inputs for the GBD life table model and served as comparison observed data. Above age sixty model estimates of survival for both sexes differed substantially from those observed. Prior to the year 1960 for males and 1930 for females, estimated survival tended to be greater than observed; following 1960 for both males and females estimated survival tended to be less than observed. Viewing observed and estimated survival separately, observed survival past sixty increased over the years considered. For males, the increase was from a mean (sd) probability of 0.22 (0.06) to 0.46 (0.1). For females, the increase was from 0.26 (0.06) to 0.65 (0.08). By contrast, estimated survival past sixty decreased over the same period. Among males, estimated survival probability declined from 0.54 (0.2) to 0.09 (0.06). Among females, the decline was from 0.36 (0.12) to 0.15 (0.08).

Conclusions: These results show that the GBD mortality model did not accurately estimate survival at older ages as developed countries transitioned in the twentieth century and may be similarly flawed in developing countries now undergoing transition. Estimates of the size of older-age populations and their attributable disease burden should be reconsidered.

Show MeSH