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Can global or national disability weights represent provincial level?

Qin He1, Maigeng Zhou2, Peng Yin2

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|March 10, 2023
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Disability weights (DWs) from China show cultural variations compared to global data. Similar cultural regions had smaller DW differences, highlighting the need for culturally relevant standards in disease burden assessments.

Keywords:
Cross-cultural comparisonsDisability weightHealth statePaired comparisonProbit regression model

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Area of Science:

  • Public Health
  • Epidemiology
  • Health Economics

Background:

  • Universal disability weights (DWs) are primarily based on North American, Australian, and European data, with limited Asian representation.
  • The representativeness and cultural relevance of universal DWs remain debated, as subjective evaluations of pain can vary across cultures.
  • Existing DWs may impact the accuracy of disease burden magnitude and ranking, necessitating region-specific data.

Purpose of the Study:

  • To derive disability weights (DWs) representative of the general population in China's Anhui Province.
  • To explore variations in DWs by comparing Anhui's DWs with those from similar cultural backgrounds and cross-cultural contexts.
  • To assess the implications of cultural differences on disability weight estimations.

Main Methods:

  • A web-based survey was conducted in 2020 to estimate DWs for 206 health states in Anhui Province.
  • Paired comparison (PC) data were analyzed using probit regression and loess modeling.
  • Anhui's DWs were compared with those from other Chinese provinces, the Global Burden of Disease (GBD) study, and Japan.

Main Results:

  • The proportion of health states with at least a two-fold difference in DWs varied from 1.94% (Henan) to 11.17% (Sichuan) within China, and was 19.88% in Japan and 21.51% in GBD 2013.
  • In Asian regions, top-ranked DWs were predominantly for mental, behavioral, and substance use disorders, contrasting with GBD's focus on infectious diseases and cancer.
  • Smaller differences in DWs were observed between neighboring Chinese provinces compared to more geographically distant regions or countries.

Conclusions:

  • Disability weight (DW) responses showed general consistency across diverse settings, but cultural exceptions warrant attention.
  • Differences in DWs were smaller among similar cultural regions than cross-cultural regions.
  • There is a clear need for the development and adoption of culturally relevant gold standards for disability weight estimation.