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DALYs: the age-weights on balance
J J Barendregt1, L Bonneux, P J Van der Maas
1Department of Public Health, Erasmus University, Rotterdam, Netherlands.
Bulletin of the World Health Organization
|January 1, 1996
Summary
The disability-adjusted life year (DALY) methodology weights life years by age. However, the DALY
Area of Science:
- Public Health
- Epidemiology
- Health Economics
Background:
- The disability-adjusted life year (DALY) was developed by Murray et al. for the 1993 World Development Report.
- DALY methodology incorporates age-weighting to value life years differently across age groups.
- Murray's proposed equation weights life years between ages 9-54 greater than unity, and outside this range less than unity.
Purpose of the Study:
- To examine the impact of age-weighting within the DALY methodology.
- To compare the effects of age-weighting on life expectancies.
- To analyze the combined effect of DALY age-weighting and expected years of life lost (EYLL) calculations.
Main Methods:
- Analysis of the DALY methodology's age-weighting component.
- Comparison of age-weighted versus unweighted age-specific life expectancies.
- Evaluation of the EYLL calculation as an inherent age-weighting system.
Main Results:
- The age range emphasized by DALY age-weighting is actually 0-27 years, not 9-54 years.
- The EYLL calculation itself acts as an age-weighting system, prioritizing younger ages.
- Combining DALY age-weighting with EYLL results in a disproportionately strong emphasis on younger life years.
Conclusions:
- The combined age-weighting systems in DALY and EYLL create an unintended, amplified focus on younger ages.
- This amplified emphasis on the young may differ from the intended application of the DALY methodology.
- While unlikely to significantly alter Global Burden of Disease study outcomes, the findings suggest a need for re-evaluation of the age-weighting approach.