{"status":"ok","message-type":"work","message-version":"1.0.0","message":{"indexed":{"date-parts":[[2026,5,4]],"date-time":"2026-05-04T23:37:27Z","timestamp":1777937847220,"version":"3.51.4"},"reference-count":16,"publisher":"SAGE Publications","issue":"2","license":[{"start":{"date-parts":[[2021,7,2]],"date-time":"2021-07-02T00:00:00Z","timestamp":1625184000000},"content-version":"unspecified","delay-in-days":0,"URL":"https:\/\/creativecommons.org\/licenses\/by-nc\/4.0\/"}],"content-domain":{"domain":["journals.sagepub.com"],"crossmark-restriction":true},"short-container-title":["Scand J Public Health"],"published-print":{"date-parts":[[2023,3]]},"abstract":"<jats:p>Recent estimates have reiterated that non-fatal causes of disease, such as low back pain, headaches and depressive disorders, are amongst the leading causes of disability-adjusted life years (DALYs). For these causes, the contribution of years lived with disability (YLD) \u2013 put simply, ill-health \u2013 is what drives DALYs, not mortality. Being able to monitor trends in YLD closely is particularly relevant for countries that sit high on the socio-demographic spectrum of development, as it contributes more than half of all DALYs. There is a paucity of data on how the population-level occurrence of disease is distributed according to severity, and as such, the majority of global and national efforts in monitoring YLD lack the ability to differentiate changes in severity across time and location. This raises uncertainties in interpreting these findings without triangulation with other relevant data sources. Our commentary aims to bring this issue to the forefront for users of burden of disease estimates, as its impact is often easily overlooked as part of the fundamental process of generating DALY estimates. Moreover, the wider health harms of the COVID-19 pandemic have underlined the likelihood of latent and delayed demand in accessing vital health and care services that will ultimately lead to exacerbated disease severity and health outcomes. This places increased importance on attempts to be able to differentiate by both the occurrence and severity of disease.<\/jats:p>","DOI":"10.1177\/14034948211024478","type":"journal-article","created":{"date-parts":[[2021,7,2]],"date-time":"2021-07-02T10:07:28Z","timestamp":1625220448000},"page":"296-300","update-policy":"https:\/\/doi.org\/10.1177\/sage-journals-update-policy","source":"Crossref","is-referenced-by-count":7,"title":["The increasing significance of disease severity in a burden of disease framework"],"prefix":"10.1177","volume":"51","author":[{"ORCID":"https:\/\/orcid.org\/0000-0003-2854-5822","authenticated-orcid":false,"given":"Grant M.A.","family":"Wyper","sequence":"first","affiliation":[{"name":"Place and Wellbeing Directorate, Public Health Scotland, UK"}]},{"given":"Ricardo","family":"Assuncao","sequence":"additional","affiliation":[{"name":"National Institute of Health Dr Ricardo Jorge, Portugal"}]},{"given":"Eilidh","family":"Fletcher","sequence":"additional","affiliation":[{"name":"Data Driven Innovation Directorate, Public Health Scotland, UK"}]},{"given":"Michelle","family":"Gourley","sequence":"additional","affiliation":[{"name":"Burden of Disease and Mortality Unit, Australian Institute of Health and Welfare, Australia"}]},{"given":"Ian","family":"Grant","sequence":"additional","affiliation":[{"name":"Data Driven Innovation Directorate, Public Health Scotland, UK"}]},{"given":"Juanita A.","family":"Haagsma","sequence":"additional","affiliation":[{"name":"Department of Public Health, Erasmus MC, University Medical Centre Rotterdam, The Netherlands"}]},{"given":"Henk","family":"Hilderink","sequence":"additional","affiliation":[{"name":"National Institute for Public Health and the Environment (RIVM), The Netherlands"}]},{"ORCID":"https:\/\/orcid.org\/0000-0003-1240-3344","authenticated-orcid":false,"given":"Jane","family":"Idavain","sequence":"additional","affiliation":[{"name":"National Institute for Health Development, Estonia"}]},{"given":"Tina","family":"Lesnik","sequence":"additional","affiliation":[{"name":"National Institute of Public Health, Slovenia"}]},{"given":"Elena","family":"von der Lippe","sequence":"additional","affiliation":[{"name":"Department of Epidemiology and Health Monitoring, Robert Koch Institute, Germany"}]},{"given":"Marek","family":"Majdan","sequence":"additional","affiliation":[{"name":"Faculty of Health Sciences and Social Work, Trnava University, Slovakia"}]},{"given":"Gerry","family":"Mccartney","sequence":"additional","affiliation":[{"name":"Place and Wellbeing Directorate, Public Health Scotland, UK"}]},{"given":"Milena","family":"Santric-Milicevic","sequence":"additional","affiliation":[{"name":"Institute of Social Medicine, Centre School of Public Health and Health Management, Faculty of Medicine University of Belgrade, Serbia"}]},{"given":"Elena","family":"Pallari","sequence":"additional","affiliation":[{"name":"MRC Clinical Trials and Methodology Unit, University College London, UK"}]},{"given":"Sara M.","family":"Pires","sequence":"additional","affiliation":[{"name":"National Food Institute, Technical University of Denmark, Denmark"}]},{"given":"Dietrich","family":"Plass","sequence":"additional","affiliation":[{"name":"Section Exposure Assessment and Environmental Health Indicators, German Environment Agency, Germany"}]},{"given":"Michael","family":"Porst","sequence":"additional","affiliation":[{"name":"Department of Epidemiology and Health Monitoring, Robert Koch Institute, Germany"}]},{"ORCID":"https:\/\/orcid.org\/0000-0003-4696-1002","authenticated-orcid":false,"given":"Jo\u00e3o V.","family":"Santos","sequence":"additional","affiliation":[{"name":"MEDCIDS, Department of Community Medicine, Information and Health Decision Sciences, Faculty of Medicine, University of Porto, Portugal"},{"name":"CINTESIS, Centre for Health Technology and Services Research, Portugal"},{"name":"Public Health Unit, ACES Grande Porto VIII \u2013 Espinho\/Gaia, ARS Norte, Portugal"}]},{"given":"Maria Teresa","family":"de Haro Moro","sequence":"additional","affiliation":[{"name":"Data Driven Innovation Directorate, Public Health Scotland, UK"}]},{"given":"Diane L.","family":"Stockton","sequence":"additional","affiliation":[{"name":"Clinical and Protecting Health Directorate, Public Health Scotland, UK"}]},{"given":"Brecht","family":"Devleesschauwer","sequence":"additional","affiliation":[{"name":"Department of Epidemiology and Public Health, Sciensano, Belgium"},{"name":"Department of Veterinary Public Health and Food Safety, Faculty of Veterinary Medicine, Ghent University, Belgium"}]}],"member":"179","published-online":{"date-parts":[[2021,7,2]]},"reference":[{"key":"bibr1-14034948211024478","volume":"396","author":"GBD","year":"2020","journal-title":"Lancet"},{"key":"bibr2-14034948211024478","unstructured":"Institute for Health Metrics and Evaluation. 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