Severity weights for noise outcomes
|Moderator:Erkki Kuusisto (see all)|
For the purpose of burden-of-disease (DALY) calculations, what are the most widely accepted disability weights (or ranges thereof) for the presently known health effects of environmental noise?
- In case of unresolved disagreement regarding the appropriate weight for a particular outcome, what are the arguments stated for the justification of each of the values proposed?
NOTE: For transient effects (such as stroke or myocardial infarction), the severity weights refer to (a) defined stage(s) of the disease progression (e.g. the acute period requiring hospital care). Unfortunately, the definition, as well as data on the duration of the stage(s) in question are sometimes difficult to find, while essential for DALY calculations.
- de Hollander AEM, Melse JM, Lebret E, Kramers PGN (1999). An aggregate public health indicator to represent the impact of multiple environmental exposures. Epidemiology 10, p. 606-617.
- GBD (2008). The global burden of diseases, injuries, and risk factors study. Operations manual. Final draft. Jan 31, 2008
- Kempen EEM van (1998). Milieu-DALY’s: zieketelast die wordt veroorzaakt door blootstelling aan milieufactoren. Ontwikkeling van wegingsfactoren voor verschillende effecten van milieuverontreiniging en een schatting van de omvang van deze effecten. Universiteit van Maastricht, scriptie.
- Knol A, Staatsen B (2005). Trends in the environmental burden of disease in the Netherlands 1980 – 2020.
- Lopez AD, Mathers CD, Ezzati M,. Jamison DT, Murray CJL (eds.) (2006). Global Burden of Disease and Risk Factors. The World Bank and Oxford University Press
- Mathers CD, Vos T, Lopez AD, Salomon J, Ezzati M (ed.) (2001). National Burden of Disease Studies: A Practical Guide. Edition 2.0. Global Program on Evidence for Health Policy. Geneva: World Health Organization.
- Mathers CD, Bernard C, Moesgaard Iburg K, Inoue M, Ma Fat D, Shibuya K, Stein C, Tomijima N, Xu H (2004): Global Burden of Disease in 2002: data sources, methods and results. Global Programme on Evidence for Health Policy Discussion Paper No. 54. World Health Organization
- Stassen KR, Collier P, Torfs R (2008). Environmental burden of disease due to transportation noise in Flanders (Belgium). Transportation Research Part D: Transport and Environment. Vol. 13, 355-358. doi:10.1016/j.trd.2008.04.003
- WHO (2005). Quantifying burden of disease from environmental noise: Second technical meeting report. Bern, Switzerland, 15 – 16 December 2005.
- WHO (2009). Night noise guidelines for Europe
None (but generally speaking, values for severity weights may depend on the geographical area)
None (pure number).
|Outcome||Degree||Value||Source of original data||Page / Table||Comment|
|stroke||first-ever stroke cases||0.920 (global average)||Mathers et al 2004||Annex Table 5a|| "First-ever stroke according to WHO definition (includes subarachnoid haemorrhage but excludes transient ischaemic attacks, subdural haematoma, and haemorrhage or infarction due to infection or tumour)."
For recovery and mortality figures, see Mathers et al 2001, page 106.
NB! The duration of this state is defined in GBD 2008, p. 72:
"First-ever stroke: First-ever acute stroke event and period immediately following. Severe pain, unable to self-care or carry out usual activities, severe mobility limitations, likely cognitive and motor deficits. The average duration of this period for those who die within 28 days is around 6 days. Model this health state with duration of 6 days for all first strokes."
|stroke||long-term stroke survivors|| 0.259
|Mathers et al 2004||Annex Table 5a|| "Persons who survive more than 28 days after first-ever stroke."
NB! This state is defined in GBD 2008, p. 72:
"28-day stroke survivor: Persons who survive at least 28 days after first-ever stroke are estimated from incidence of first-ever stroke and measured 28-day case fatality rates. The model assumes that second and subsequent strokes are included in the average disability weight and mortality risk for this sequela. The model assumes approximately 50% of long-term stroke survivors have long-term disability and the disability weight for this sequela is an average across all survivors, disabled and not disabled."
Additional info from Mathers et al 2001 (page 106): "Half of men are symptom-free one year after a first episode of stroke. While the incidence of stroke is lower in women, they tend to have more severe disease (e.g. only about 1/3 symptom-free after a year). If not symptom-free at one year after stroke, permanent disability is assumed."
|annoyance||severe||0.12||van Kempen 1998|
|annoyance||severe||0.01||de Hollander 1999|
|annoyance||severe||0.02||Knol & Staatsen 2005||"Severe annoyance and sleep disturbance are hard to weigh, because there is little information on their relationship with quality of life measures. We have used a severity factor of 0.02, with a relatively large uncertainty interval (0.01-0.12 for annoyance, 0.01-0.10 for sleep disturbance). The minimum value (0.01) is based on De Hollander et al. (1999), who used a panel of environment-oriented physicians to attribute severity weights to various health states based on a protocol by Stouthard (1997). The maximum values (0.10 and 0.12) are based on Van Kempen (1998) who did a panel study with 13 medical experts, also based on a protocol by Stouthard. In that study, sleep disturbance and annoyance were weighted relatively high. Since the weight factors are so small, these variations have a relatively big impact on the outcomes."|
|annoyance||severe||0.01-0.12||WHO 2005||Page 5; Box 2 on p. 12|| "Celia Rodrigues (WHO) presented preliminary estimation of DALYs from annoyance using Eurostat survey data (2000). ... It was estimated that the DALYs for high annoyance from noise is 278,174 for disability weight 0.02, 139,087 for disability weight 0.01, for 1,669,041 for disability weight 0.12."
NOTE: 0.02 given as First choice in Box 2
|sleep disturbance||severe||0.1||van Kempen 1998|
|sleep disturbance||severe||0.01||de Hollander 1999|
|sleep disturbance||severe||0.02||Knol & Staatsen 2005||"Severe annoyance and sleep disturbance are hard to weigh, because there is little information on their relationship with quality of life measures. We have used a severity factor of 0.02, with a relatively large uncertainty interval (0.01-0.12 for annoyance, 0.01-0.10 for sleep disturbance). The minimum value (0.01) is based on De Hollander et al. (1999), who used a panel of environment-oriented physicians to attribute severity weights to various health states based on a protocol by Stouthard (1997). The maximum values (0.10 and 0.12) are based on Van Kempen (1998) who did a panel study with 13 medical experts, also based on a protocol by Stouthard. In that study, sleep disturbance and annoyance were weighted relatively high. Since the weight factors are so small, these variations have a relatively big impact on the outcomes."|
|sleep disturbance||severe||0.089||WHO 2005||Page 4.|| "Ruedi Müller-Wenk (Switzerland) presented the results from an original study on disability weight for sleep disturbance related to noise. It was questioned whether “noise-induced sleep disturbance” is compatible with “primary insomnia”. Primary insomnia is included in the global burden of disease estimation, however, it does not include insomnia from environmental factors by definition. Acknowledging this difference in the definition, a disability weight specific to noise-induced sleep disturbance was sought after. Based on consensus of the experts of Switzerland, Knoblauch/MüllerWenk proposed 0.089 (C.I. 0.060; 0.120). This value is slightly smaller than that of primary insomnia (0.089 versus 0.100), and can be used as the best estimate of disability weight for noise-induced sleep disturbance.
Celia Rodrigues (WHO) presented preliminary results of DALY estimation for noise-related sleep disturbance applying Miedema’s exposure-response relation... Three disability weights (0.02, 0.01, and 0.12) were considered. ...
The meeting agreed that the DALYs for noise-induced sleep disturbance will be estimated with disability weight as 0.089."
BUT see also the detailled discussion by Andreas Knoblauch and Ruedi Müller-Wenk on disability weights on pages 19-24, as well as further methodological discussion on pages 31-38.
|sleep disturbance|| severe
|0.07||WHO 2009||See entire Ch. 4.9.|| 4.9.4 CONCLUSIONS
"...The best estimate for a mean disability weight for self-reported sleep disturbance due to road traffic noise was 0.055 (CI: 0.039; 0.071) according to Müller-Wenk (2002), whilst our recheck based on a comparison with insomnia resulted in a disability weight of 0.09 (CI: 0.06; 0.12). The higher disability weight according to the second approach might be caused by the fact that in this second approach, there was a stronger focus on “the person’s condition during the day after the sleep-disturbed night”.
The above figures compare reasonably with a study published by van Kempen (1998), cited in Knol and Staatsen (2005:46), where a severity weight of 0.10 for severe sleep disturbance was found, based on the judgement of 13 medical experts according to the protocol of Stouthard et al. (1997). 96 EFFECTS ON HEALTH Nachtlaerm_2009_7:Nachtlaerm 31.08.2009 11:08 Uhr Seite 96NIGHT NOISE GUIDELINES FOR EUROPE In conclusion, a mean disability weight of 0.07 is proposed for self-reported sleep disturbance due to road noise or similar ambient noise. This disability weight can be used in connection with the equations of section 4.1 of this chapter for highly sleep- disturbed persons."
|hearing loss||severe NIHL (noise-induced hearing loss): Hearing loss >41 dB||0.25||WHO 2005||Box 2 on page 12|
|tinnitus||severely annoying (disabling) tinnitus||0.122||WHO 2005||Page 7. See also Box 2 on page 12|| "The group recommends two disability weights to match with whichever data is available for calculation: one for general tinnitus prevalence data, one for annoying (disabling) tinnitus.
For moderately to severely annoying tinnitus, the analogy is made with chronic pain. Chronic pelvic pain has a disability weight of 0.122 (global burden of disease 1990, WHO) whereas low back pain caused by chronic intervertebral disc has a disability weight of 0.121 (range 0.103- 0.125) (global burden of disease 1990, WHO). Primary insomnia have a disability weight of 0.100 while a mild depressive episode has a disability weight of 0.140. As tinnitus may induce in some cases any of these two consequences, an interpolation in those ranges seems reasonable. Thus, a disability weight of 0.120 is suggested. On could argue that this disability weight could be used for any annoying (disabling) tinnitus, including mildly annoying tinnitus.
For global prevalence of tinnitus without reference to its severity, a global disability weight of 0.012 is suggested as a majority of people declaring tinnitus in surveys will either have spontaneous remission or adapt easily. ... On the other hand, only a small proportion of persons reporting ever having tinnitus will be disabled. A disability weight of 0.012 was proposed based on an estimated 10% who become moderate to severe sufferers."
|tinnitus||tinnitus without reference to severity||0.012||WHO 2005||Page 7. See also Box 2 on page 12|
|hypertension||0.352||Stassen et al 2008||"The disability weight for hypertension and ischemic heart diseases is set at 0.352 (Mathers et al., 1999) and 0.35 (de Hollander et al., 1999)."|
|Mathers et al 2004||Annex Table 5a|
|hypertensive heart disease||cases|| 0.243
|Lopez et al 2006||Table 3A.6||Range: 0.201–0.300|
|hypertensive heart disease||cases, untreated||0.323||Lopez et al 2006||Table 3A.6||"Provisional disability weights based on GBD 1990 or Netherlands weights for comparable health states."|
|hypertensive heart disease||cases, treated||0.171||Lopez et al 2006||Table 3A.6||"Provisional disability weights based on GBD 1990 or Netherlands weights for comparable health states."|
|primary insomnia||0.1||Mathers et al 2004||Annex Table 5a|
|acute myocardial infarction|| 0.405
|Mathers et al 2004||Annex Table 5a||Case definition: "Definite and possible episodes of acute myocardial infarction according to MONICA study criteria"|
|acute myocardial infarction|| 0.437
|Lopez et al 2006||Table 3A.6|
|acute myocardial infarction||untreated 0.491, treated 0.395||Lopez et al 2006||Table 3A.6||These values are given in the "source" column, referring to "GBD 1990".|
|ischaemic heart disease (IHD)||hospital admission||0.35||de Hollander et al 1999||Table 2|
- disability weights
- burden of disease
- environmental noise
- health effect
- impact assessment