David Banham, Jonathan Karnon, Alex Brown, David Roder, John Lynch
{"title":"诊断后生命损失年数（FLYLAD）：以人为中心的癌症负担指标。","authors":"David Banham, Jonathan Karnon, Alex Brown, David Roder, John Lynch","doi":"10.1186/s12963-023-00314-w","DOIUrl":null,"url":null,"abstract":"<p><strong>Background: </strong>Cancer control initiatives are informed by quantifying the capacity to reduce cancer burden through effective interventions. Burden measures using health administrative data are a sustainable way to support monitoring and evaluating of outcomes among patients and populations. The Fraction of Life Years Lost After Diagnosis (FLYLAD) is one such burden measure. We use data on Aboriginal and non-Aboriginal South Australians from 1990 to 2010 to show how FLYLAD quantifies disparities in cancer burden: between populations; between sub-population cohorts where stage at diagnosis is available; and when follow-up is constrained to 24-months after diagnosis.</p><p><strong>Method: </strong>FLYLAD<sub>cancer</sub> is the fraction of years of life expectancy lost due to cancer (YLL<sub>cancer</sub>) to life expectancy years at risk at time of cancer diagnosis (LYAR) for each person. The Global Burden of Disease standard life table provides referent life expectancies. FLYLAD<sub>cancer</sub> was estimated for the population of cancer cases diagnosed in South Australia from 1990 to 2010. Cancer stage at diagnosis was also available for cancers diagnosed in Aboriginal people and a cohort of non-Aboriginal people matched by sex, year of birth, primary cancer site and year of diagnosis.</p><p><strong>Results: </strong>Cancers diagnoses (N = 144,891) included 777 among Aboriginal people. Cancer burden described by FLYLAD<sub>cancer</sub> was higher among Aboriginal than non-Aboriginal (0.55, 95% CIs 0.52-0.59 versus 0.39, 95% CIs 0.39-0.40). Diagnoses at younger ages among Aboriginal people, 7 year higher LYAR (31.0, 95% CIs 30.0-32.0 versus 24.1, 95% CIs 24.1-24.2) and higher premature cancer mortality (YLL<sub>cancer</sub> = 16.3, 95% CIs 15.1-17.5 versus YLL<sub>cancer</sub> = 8.2, 95% CIs 8.2-8.3) influenced this. Disparities in cancer burden between the matched Aboriginal and non-Aboriginal cohorts manifested 24-months after diagnosis with FLYLAD<sub>cancer</sub> 0.44, 95% CIs 0.40-0.47 and 0.28, 95% CIs 0.25-0.31 respectively.</p><p><strong>Conclusion: </strong>FLYLAD described disproportionately higher cancer burden among Aboriginal people in comparisons involving: all people diagnosed with cancer; the matched cohorts; and, within groups diagnosed with same staged disease. The extent of disparities were evident 24-months after diagnosis. This is evidence of Aboriginal peoples' substantial capacity to benefit from cancer control initiatives, particularly those leading to earlier detection and treatment of cancers. FLYLAD's use of readily available, person-level administrative records can help evaluate health care initiatives addressing this need.</p>","PeriodicalId":51476,"journal":{"name":"Population Health Metrics","volume":"21 1","pages":"14"},"PeriodicalIF":3.2000,"publicationDate":"2023-09-13","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://www.ncbi.nlm.nih.gov/pmc/articles/PMC10500871/pdf/","citationCount":"0","resultStr":"{\"title\":\"The fraction of life years lost after diagnosis (FLYLAD): a person-centred measure of cancer burden.\",\"authors\":\"David Banham, Jonathan Karnon, Alex Brown, David Roder, John Lynch\",\"doi\":\"10.1186/s12963-023-00314-w\",\"DOIUrl\":null,\"url\":null,\"abstract\":\"<p><strong>Background: </strong>Cancer control initiatives are informed by quantifying the capacity to reduce cancer burden through effective interventions. Burden measures using health administrative data are a sustainable way to support monitoring and evaluating of outcomes among patients and populations. The Fraction of Life Years Lost After Diagnosis (FLYLAD) is one such burden measure. We use data on Aboriginal and non-Aboriginal South Australians from 1990 to 2010 to show how FLYLAD quantifies disparities in cancer burden: between populations; between sub-population cohorts where stage at diagnosis is available; and when follow-up is constrained to 24-months after diagnosis.</p><p><strong>Method: </strong>FLYLAD<sub>cancer</sub> is the fraction of years of life expectancy lost due to cancer (YLL<sub>cancer</sub>) to life expectancy years at risk at time of cancer diagnosis (LYAR) for each person. The Global Burden of Disease standard life table provides referent life expectancies. FLYLAD<sub>cancer</sub> was estimated for the population of cancer cases diagnosed in South Australia from 1990 to 2010. Cancer stage at diagnosis was also available for cancers diagnosed in Aboriginal people and a cohort of non-Aboriginal people matched by sex, year of birth, primary cancer site and year of diagnosis.</p><p><strong>Results: </strong>Cancers diagnoses (N = 144,891) included 777 among Aboriginal people. Cancer burden described by FLYLAD<sub>cancer</sub> was higher among Aboriginal than non-Aboriginal (0.55, 95% CIs 0.52-0.59 versus 0.39, 95% CIs 0.39-0.40). Diagnoses at younger ages among Aboriginal people, 7 year higher LYAR (31.0, 95% CIs 30.0-32.0 versus 24.1, 95% CIs 24.1-24.2) and higher premature cancer mortality (YLL<sub>cancer</sub> = 16.3, 95% CIs 15.1-17.5 versus YLL<sub>cancer</sub> = 8.2, 95% CIs 8.2-8.3) influenced this. Disparities in cancer burden between the matched Aboriginal and non-Aboriginal cohorts manifested 24-months after diagnosis with FLYLAD<sub>cancer</sub> 0.44, 95% CIs 0.40-0.47 and 0.28, 95% CIs 0.25-0.31 respectively.</p><p><strong>Conclusion: </strong>FLYLAD described disproportionately higher cancer burden among Aboriginal people in comparisons involving: all people diagnosed with cancer; the matched cohorts; and, within groups diagnosed with same staged disease. The extent of disparities were evident 24-months after diagnosis. This is evidence of Aboriginal peoples' substantial capacity to benefit from cancer control initiatives, particularly those leading to earlier detection and treatment of cancers. FLYLAD's use of readily available, person-level administrative records can help evaluate health care initiatives addressing this need.</p>\",\"PeriodicalId\":51476,\"journal\":{\"name\":\"Population Health Metrics\",\"volume\":\"21 1\",\"pages\":\"14\"},\"PeriodicalIF\":3.2000,\"publicationDate\":\"2023-09-13\",\"publicationTypes\":\"Journal Article\",\"fieldsOfStudy\":null,\"isOpenAccess\":false,\"openAccessPdf\":\"https://www.ncbi.nlm.nih.gov/pmc/articles/PMC10500871/pdf/\",\"citationCount\":\"0\",\"resultStr\":null,\"platform\":\"Semanticscholar\",\"paperid\":null,\"PeriodicalName\":\"Population Health Metrics\",\"FirstCategoryId\":\"3\",\"ListUrlMain\":\"https://doi.org/10.1186/s12963-023-00314-w\",\"RegionNum\":2,\"RegionCategory\":\"医学\",\"ArticlePicture\":[],\"TitleCN\":null,\"AbstractTextCN\":null,\"PMCID\":null,\"EPubDate\":\"\",\"PubModel\":\"\",\"JCR\":\"Q2\",\"JCRName\":\"PUBLIC, ENVIRONMENTAL & OCCUPATIONAL HEALTH\",\"Score\":null,\"Total\":0}","platform":"Semanticscholar","paperid":null,"PeriodicalName":"Population Health Metrics","FirstCategoryId":"3","ListUrlMain":"https://doi.org/10.1186/s12963-023-00314-w","RegionNum":2,"RegionCategory":"医学","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":null,"EPubDate":"","PubModel":"","JCR":"Q2","JCRName":"PUBLIC, ENVIRONMENTAL & OCCUPATIONAL HEALTH","Score":null,"Total":0}
The fraction of life years lost after diagnosis (FLYLAD): a person-centred measure of cancer burden.
Background: Cancer control initiatives are informed by quantifying the capacity to reduce cancer burden through effective interventions. Burden measures using health administrative data are a sustainable way to support monitoring and evaluating of outcomes among patients and populations. The Fraction of Life Years Lost After Diagnosis (FLYLAD) is one such burden measure. We use data on Aboriginal and non-Aboriginal South Australians from 1990 to 2010 to show how FLYLAD quantifies disparities in cancer burden: between populations; between sub-population cohorts where stage at diagnosis is available; and when follow-up is constrained to 24-months after diagnosis.
Method: FLYLADcancer is the fraction of years of life expectancy lost due to cancer (YLLcancer) to life expectancy years at risk at time of cancer diagnosis (LYAR) for each person. The Global Burden of Disease standard life table provides referent life expectancies. FLYLADcancer was estimated for the population of cancer cases diagnosed in South Australia from 1990 to 2010. Cancer stage at diagnosis was also available for cancers diagnosed in Aboriginal people and a cohort of non-Aboriginal people matched by sex, year of birth, primary cancer site and year of diagnosis.
Results: Cancers diagnoses (N = 144,891) included 777 among Aboriginal people. Cancer burden described by FLYLADcancer was higher among Aboriginal than non-Aboriginal (0.55, 95% CIs 0.52-0.59 versus 0.39, 95% CIs 0.39-0.40). Diagnoses at younger ages among Aboriginal people, 7 year higher LYAR (31.0, 95% CIs 30.0-32.0 versus 24.1, 95% CIs 24.1-24.2) and higher premature cancer mortality (YLLcancer = 16.3, 95% CIs 15.1-17.5 versus YLLcancer = 8.2, 95% CIs 8.2-8.3) influenced this. Disparities in cancer burden between the matched Aboriginal and non-Aboriginal cohorts manifested 24-months after diagnosis with FLYLADcancer 0.44, 95% CIs 0.40-0.47 and 0.28, 95% CIs 0.25-0.31 respectively.
Conclusion: FLYLAD described disproportionately higher cancer burden among Aboriginal people in comparisons involving: all people diagnosed with cancer; the matched cohorts; and, within groups diagnosed with same staged disease. The extent of disparities were evident 24-months after diagnosis. This is evidence of Aboriginal peoples' substantial capacity to benefit from cancer control initiatives, particularly those leading to earlier detection and treatment of cancers. FLYLAD's use of readily available, person-level administrative records can help evaluate health care initiatives addressing this need.
期刊介绍：
Population Health Metrics aims to advance the science of population health assessment, and welcomes papers relating to concepts, methods, ethics, applications, and summary measures of population health. The journal provides a unique platform for population health researchers to share their findings with the global community. We seek research that addresses the communication of population health measures and policy implications to stakeholders; this includes papers related to burden estimation and risk assessment, and research addressing population health across the full range of development. Population Health Metrics covers a broad range of topics encompassing health state measurement and valuation, summary measures of population health, descriptive epidemiology at the population level, burden of disease and injury analysis, disease and risk factor modeling for populations, and comparative assessment of risks to health at the population level. The journal is also interested in how to use and communicate indicators of population health to reduce disease burden, and the approaches for translating from indicators of population health to health-advancing actions. As a cross-cutting topic of importance, we are particularly interested in inequalities in population health and their measurement.
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