국제질병부담연구의 복합질환 고려 위한 방법론 고찰

초록

Objectives: As the prevalence of multimorbidity, the simultaneous presence of two or more diseases in the same individual, is increasing with the aging of the population, technological advances, and improvements in medical care and public policy, accounting for multimorbidity in the calculation of disease burden is becoming more important. Methods: This study reviewed advances in methods to adjust for multimorbidity in the Global Burden of Disease (GBD) study. Results: The first GBD study introduced a single measure to quantify the burden of diseases called disability-adjusted life year (DALY), which is a sum of years of life lost (YLL) and years lived with disability (YLD). The approaches for GBD study have been improved continuously, and since 2010 the GBD study adopted a prevalence based approach rather than an incidence based approach to calculate the YLDs, and the YLDs have been adjusted for comorbidity. To adjust for multimorbidity, GBD 2010 study ran a Monte Carlo simulation of 20,000 individuals based on the assumptions of independent probability and the multiplicative function for the combined disability weight. To capture uncertainty, 1000 different micro-simulations were run. The combined disability weight was distributed proportionately to all comorbid sequelae, and the average of these adjusted values across all simulants with a particular sequela produced the adjusted YLDs. The number of simulants has increased to 40,000 since GBD 2013 study to produce more stable values. Conclusion: More research to incorporate dependent comorbidity into the simulation and reduce uncertainty from disability weight should be conducted to adjust for multimorbidity more accurately.

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