Viet Nam Burden of Disease and Injury Study 2008

Transcription

Viet Nam
Burden of Disease
and
Injury Study 2008
MEDICAL PUBLISHING HOUSE
HANOI - 2011
The VINE Project 2010-2011
AUTHORS
Nguyen Thi Trang Nhung, Hanoi School of Public Health, Vietnam
Tran Khanh Long, Hanoi School of Public Health Vietnam
Bui Ngoc Linh, Hanoi School of Public Health, Vietnam
Theo Vos, School of Population Health, the University of Queensland, Australia
Ngo Duc Anh, School of Population Health, the University of Queensland, Australia
Nguyen Thanh Huong, Hanoi School of Public Health, Vietnam
ACKNOWLEDGEMENT
Our sincere thanks are extended to The Atlantic Philanthropies for funding The Evidence
Base for Health Policy in Viet Nam Project (VINE Project). The Viet Nam Burden of Disease
and Injury Study 2008 was carried out as part of the VINE Project.
Hanoi School of Public Health
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TABLE OF CONTENTS
ABBREVIATIONS ........................................................................................................... viii
EXECUTIVE SUMMARY ................................................................................................. viii
1. INTRODUCTION ............................................................................................................ 1
2. OBJECTIVES ................................................................................................................. 4
2.1. GENERAL OBJECTIVE .........................................................................................................4
2.2. SPECIFIC OBJECTIVES.........................................................................................................4
3. METHOD ........................................................................................................................ 4
3.1. MORTALITY ESTIMATES....................................................................................................5
3.2. YEARS OF LIFE LOST (YLL)................................................................................................8
3.3. YEARS LIVED WITH DISABILITY (YLD)...........................................................................8
3.4. DISEASE CATEGORIES ........................................................................................................8
3.5. POPULATION.......................................................................................................................10
3.6. DISCOUNTING ....................................................................................................................10
3.7. DISABILITLY WEIGHTS ....................................................................................................11
3.8. AGE WEIGHTS ....................................................................................................................13
3.9. INCIDENCE AND DURATION............................................................................................13
4. OVERVIEW OF DISEASE AND INJURY MODELS..................................................... 15
4.1. TUBERCULOSIS ..................................................................................................................15
4.2. HIV/AIDS..............................................................................................................................16
4.3. DIARRHEA...........................................................................................................................17
4.4. RESPIRATORY INFECTIONS .............................................................................................17
4.5. CANCER ...............................................................................................................................17
4.6. DIABETES ............................................................................................................................18
4.7. MENTAL AND NEUROLOGICAL DISORDERS ................................................................19
Alcohol abuse........................................................................................................................19
Anxiety .................................................................................................................................19
Dementia...............................................................................................................................20
Depression ............................................................................................................................20
Drug dependence...................................................................................................................20
Epilepsy ................................................................................................................................20
Schizophrenia........................................................................................................................21
4.8. SENSE ORGAN DISORDERS ..............................................................................................21
Vision loss ............................................................................................................................21
Hearing loss ..........................................................................................................................22
4.9. ISCHEMIC HEART DISEASE..............................................................................................22
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4.10. STROKE..............................................................................................................................23
4.11. CHRONIC OBSTRUCTIVE PULMONARY DISEASE (COPD) ........................................24
4.12. OSTEOARTHRITIS ............................................................................................................24
4.13. INJURY ...............................................................................................................................25
5. RESULTS ..................................................................................................................... 25
5.1. DEATHS AND LIFE EXPECTANCY...................................................................................25
5.2. MORTALITY BURDEN IN VIETNAM (YLL).....................................................................26
5.3. YEARS LOST DUE TO DISABILITY (YLD).......................................................................31
5.4. DISABILITY ADJUSTED LIFE YEARS (DALYS)..............................................................36
5.5. AGE AND SEX PATTERNS OF DISEASE BURDEN .........................................................43
5.6. SPECIFIC DISEASE AND INJURY CATEGORIES.............................................................49
Infectious and respiratory diseases.........................................................................................50
Cancer...................................................................................................................................52
Diabetes Mellitus ..................................................................................................................54
Neuropsychiatric disorders ....................................................................................................55
Sense organ diseases .............................................................................................................57
Cardiovascular disease ..........................................................................................................58
COPD ...................................................................................................................................60
Musculoskeletal disorders .....................................................................................................61
Injuries ..................................................................................................................................62
DISCUSSION ................................................................................................................... 67
REFERENCE.................................................................................................................... 71
APPENDIX ....................................................................................................................... 76
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LIST OF TABLES
Table 1. VA interview cluster and the corresponding medical university .........................................7
Table 2. Top ten causes of death by sex.........................................................................................26
Table 3. Top 10 causes of YLL by sex ..........................................................................................31
Table 4. Top 10 causes of YLD by sex ..........................................................................................36
Table 5. Top 10 causes of DALYs by sex......................................................................................43
Table 6. Top 10 causes of DALYs among children below 15 years of age in both sexes. ...............44
Table 7. Top 10 causes of DALYs by sex in the 15-44 age group..................................................46
Table 8. Top 10 causes of DALYs by sex in the 45-69 age group..................................................47
Table 9. Top 10 causes of DALYs by sex in the 70+ age group.....................................................49
Table 10. Data sources for prevalence and incidence and quality issues for the main diseases .......70
LIST OF FIGURES
Figure 1. The Basic Disease Model Underlying DISMOD.............................................................14
Figure 2. General model for cancer YLD estimation......................................................................18
Figure 3. YLL by major disease groups, Viet Nam 2008 ...............................................................27
Figure 4. YLL by sex and major disease groups, Viet Nam 2008...................................................27
Figure 5. YLL by major disease categories in men, Viet Nam 2008...............................................28
Figure 6. YLL by major disease categories in women, Viet Nam 2008 ..........................................28
Figure 7. YLL by age and major disease groups in men, Viet Nam 2008.......................................29
Figure 8. YLL by age and major disease groups in women, Viet Nam 2008 ..................................29
Figure 9. YLL by age and disease categories in men, Viet Nam 2008............................................30
Figure 10. YLL by age and disease categories in women, Viet Nam 2008 .....................................30
Figure 11. YLD by major disease groups, Viet Nam 2008 .............................................................31
Figure 12. YLD by sex and major disease groups, Viet Nam 2008 ................................................32
Figure 13. YLD by major disease categories in men, Viet Nam 2008 ............................................33
Figure 14. YLD by major disease categories in women, Viet Nam 2008........................................33
Figure 15. YLD by age and major disease groups in men, Viet Nam 2008 ....................................34
Figure 16. YLD by age and major disease groups in women, Viet Nam 2008................................34
Figure 17. YLD by age and major disease categories in men, Viet Nam 2008 ...............................35
Figure 18. YLD by age and major disease categories in women, Viet Nam 2008...........................35
Figure 19. DALYs by major disease groups, Viet Nam 2008.........................................................37
Figure 20. YLL and YLD as proportion of total burden by sex, Viet Nam 2008 ............................37
Figure 21. DALYs by major disease categories, Viet Nam 2008 ...................................................38
Figure 22. DALYs by sex and major disease groups, Viet Nam 2008 ............................................38
Figure 23. DALYs by major disease categories in men, Viet Nam 2008 ........................................39
Figure 24. DALYs by major disease categories in women, Viet Nam 2008 ...................................39
Figure 25. DALYs by age and major disease groups in men, Viet Nam 2008 ................................40
Figure 26. DALYs by age and major disease groups in women, Viet Nam 2008............................41
Figure 27. DALYs by age and major disease categories in men, Viet Nam 2008 ...........................41
Figure 28. DALYs by age and major disease categories in women, Viet Nam 2008 ......................42
Figure 29. DALYs by major disease categories in the 0-14 age group, Viet Nam 2008..................43
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Figure 30. DALYs by major disease categories in the 15-44 age group in men,.............................45
Viet Nam 2008..............................................................................................................................45
Figure 31. DALYs by major disease categories in the 15-44 age group in women,
Viet Nam 2008..............................................................................................................................45
Figure 32. DALYs by major disease categories in 45-69 age groups in men, .................................46
Viet Nam 2008..............................................................................................................................46
Figure 33. DALYS by major disease categories in the 45-69 age group in women,
Viet Nam 2008..............................................................................................................................47
Figure 34. DALYs by major disease categories at ages 70+ in men, ..............................................48
Viet Nam 2008..............................................................................................................................48
Figure 35. DALYs by disease categories at ages 70+ in women, Vietnam 2008............................48
Figure 36. YLL and YLD by major disease categories, Viet Nam 2008.........................................49
Figure 37. The burden of specific infectious diseases by sex, Viet Nam 2008................................50
Figure 38. DALY rates (per 100,000 populations) for infectious diseases......................................51
by age in men, Viet Nam 2008 ......................................................................................................51
Figure 39. DALY rates (per 100,000 populations) for infectious diseases in women,
Viet Nam 2008..............................................................................................................................51
Figure 40. DALYs by sex of specific cancers, Viet Nam 2008 ......................................................52
Figure 41. DALY rates per 100,000 population for specific cancers in men,..................................53
Viet Nam 2008..............................................................................................................................53
Figure 42. DALY rates per 100,000 population for specific cancers in women, .............................53
Viet Nam 2008..............................................................................................................................53
Figure 43. DALYs for diabetes by sex, Viet Nam 2008 .................................................................54
Figure 44. DALY rates per 100,000 population for diabetes by age in men, ..................................54
Viet Nam 2008..............................................................................................................................54
Figure 45. DALY rates per 100,000 population for diabetes by age in women, Viet Nam 2008 .....55
Figure 46. DALYs by sex of specific neuropsychiatric disorders, Viet Nam 2008 .........................55
Figure 47. DALY rates per 100,000 populations of mental disorders in men, Viet Nam 2008........56
Figure 48. DALY rates per 100,000 population for mental disorders in women,............................56
Viet Nam 2008..............................................................................................................................56
Figure 49. DALYs by sex of sense organ diseases, Viet Nam 2008. ..............................................57
Figure 50. DALY rates per 100,000 populations for sense organ diseases by age in men,
Viet Nam 2008..............................................................................................................................57
Figure 51. DALY rates per 100,000 population for sense organ diseases by age in women,
Viet Nam 2008..............................................................................................................................58
Figure 52. DALYs by sex of cardiovascular diseases, Vietnam 2008.............................................58
Figure 53. DALY rates per 100,000 population for cardiovascular diseases in men by age,
Viet Nam 2008..............................................................................................................................59
Figure 54. DALY rates per 100,000 population for cardiovascular diseases by age in women,
Viet Nam 2008..............................................................................................................................59
Figure 55. The burden of disease of respiratory diseases by sex, Viet Nam 2008 ...........................60
Figure 56. DALY rates per 100,000 population for respiratory diseases by age in men,
Viet Nam 2008..............................................................................................................................60
Figure 57. DALY rates per 100,000 population for specific respiratory diseases by age in women,
Viet Nam 2008..............................................................................................................................61
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Figure 58. The burden of musculoskeletal disorders by sex, Viet Nam 2008..................................61
Figure 59. DALY rates per 100,000 population by age for musculoskeletal diseases in men,
Viet Nam 2008..............................................................................................................................62
Figure 60. DALY rates per 100,000 population by age for musculoskeletal diseases in women,
Viet Nam 2008..............................................................................................................................62
Figure 61. DALYs by sex of specific unintentional injuries, Viet Nam 2008. ................................63
Figure 62. The fatal and non-fatal burden of disease of unintentional injuries, Viet Nam 2008. .....63
Figure 63. DALY rates per 100,000 populations by age for unintentional injuries .........................64
in men, Viet Nam 2008. ................................................................................................................64
Figure 64. DALY rates per 100,000 populations by age for unintentional injuries .........................64
in women, Viet Nam 2008 ............................................................................................................64
Figure 65. DALYs by sex of intentional injuries, Viet Nam 2008..................................................65
Figure 66. DALY rates per 100,000 population by age for intentional injuries...............................65
in men, Viet Nam 2008 .................................................................................................................65
Figure 67. DALY rates per 100,000 population by age for intentional injuries in women,
Viet Nam 2008..............................................................................................................................66
LIST OF APPENDIX
Appendix 1. Diseases and injury categories and ICD-10................................................................76
Appendix 2. Disability Weights by disease and sequelae...............................................................79
Appendix 3. Deaths by sex, ages and causes in Vietnam 2008.......................................................88
Appendix 4. YLL by sex, ages and causes in Vietnam 2008..........................................................90
Appendix 5. YLD by sex, ages and causes in Vietnam 2008..........................................................92
Appendix 6. DALYs by sex, ages and causes in Vietnam 2008 .....................................................94
Appendix 7. YLD prevalence by sex, ages and causes in Vietnam 2008 ........................................96
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ABBREVIATIONS
AMI
Acute myocardial infection
AP
Angina pectoris
BoD
Burden of disease
CHS
Commune Health Station
COPCORD
Community-Oriented Program for the Control of Rheumatic
Disease
COPD
Chronic obstructive pulmonary disease
DALY
Disability adjusted life year
DW
Disability weight
GBD study
Global Burden of Disease Study
HF
Heart failure
HIV/AIDS
Human immunodeficiency virus/ Acquired immunodeficiency
syndrome
HLSS
Household Living Standard Survey
ICD
International Classification of Disease
IHD
Ischemic heart disease
MoH
Ministry of Health
NBD study
National Burden of Disease study
PCS
Population Change Survey
PTO method
Person Trade-Off method
TB
Tuberculosis
VA
Verbal autopsy
VINE Project
The Evidence Base for Health Policy in Viet Nam Project
VMIS
Viet Nam Multi-center Injury Survey
VNHS
Viet Nam National Health Survey
WHO
World Health Organization
YLD
Years lived with disability
YLL
Years of life lost
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EXECUTIVE SUMMARY
FATAL BURDEN IN 2008

Fatal diseases and injuries accounted for 4.1 million years of life lost (YLL) in men and
2.7 million YLL in women.

The main cause groups of YLL in 2008 were cardiovascular diseases (24%), cancer
(21%) and unintentional injuries (17%).

Stroke (14%), road traffic accidents (9%) and liver cancer (7%) were the main fatal
conditions, and leading causes of premature death in men.

Stroke (17%), road traffic accidents (4%) and pneumonia (4%) were the three main
causes for YLL in women.

The top ten causes of YLL contributed 58% to the total non-fatal burden in men and
51% in women.
NON-FATAL BURDEN IN 2008

Non-fatal diseases and injuries were responsible for 2.7 million years lost due to
disability (YLD) in men and 2.7 million YLD in women.

Neuropsychiatric conditions (33%), unintentional injuries (20%) and sense organ diseases
(8%) were the three main leading cause of the disability burden in men.

Neuropsychiatric conditions (41%), sense organ diseases (11%) and musculoskeletal diseases (10%) were the three main leading cause of the disability burden in women

Alcohol use disorders (14%), depression (11%) and road traffic accident (8%) were the
three main leading cause for disability burden in men while three leading causes in
women were depression (29%), vision loss (10%), osteoarthrtis (9%).

The top ten causes of YLD contributed 71% to the total non-fatal burden in men and
81% in women.
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TOTAL DISEASE BURDEN IN 2008

In 2008 the total burden of disease (BoD) and injury in Viet Nam was 12.3 million
disability-adjusted life years (DALYs). Men experienced 56% of the total burden.

Fifty-six per cent of the total BoD was due to premature death, with 60% in men and
50% in women.

Non-communicable diseases were responsible for 66% of the total burden in men and
77% in women.

Unintentional injuries (18%), cardiovascular disease (17%) and neuropsychiatric
disorders (14%) were the main cause groups in men while neuropsychiatric disorders
(22%), cardiovascular disease (18%) and cancer (12%) were the main cause groups
contributing to the BoD in women.

In men, stroke was the leading cause of the burden (10%) followed by road traffic
accidents (8%) and alcohol use disorders (5%).

In women, depression was a leading cause of the burden (12%), followed by stroke
(10%) and vision loss (4%).

Lower respiratory infection (pneumonia) was the main cause of the BoD in childhood,
making up 11% of the total burden.

Road traffic accidents and HIV/AIDS were responsible for a quarter of the total burden
in 15 - 44 year-old men. Depression and road traffic accidents accounted for 32% in
women in this age group.

Stroke was the main cause of burden contributing 14% in men and 9% in women aged
45 – 69 years; over age 70, stroke caused 22% of DALYs in men and 24% in women.
QUALITY OF DATA

Presently in Viet Nam, there is limited high quality epidemiology data available for calculating BoD.

There is concern around the consistency between and among surveys for each
disease.
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
All survey unit record data files should be submitted to a national health survey data
warehouse and be made available to bona fide researchers to allow further analysis
and scrutiny of data quality.

More investment is needed to improve vital registration and routine data from hospitals.
1. INTRODUCTION
The pressing demand for health services by growing populations pose a challenge for
governments around the globe. Limited resources require governments to respond to the
health needs of their citizens wisely. An inadequate evidence base to guide decisions on
health policies and resource allocation is a major obstacle to better policy development.
The formulation of sound decisions on resource allocation (based on health outcomes)
relies on the availability of accurate and comparable information. Researchers at Harvard
University and the World Health Organization (WHO) developed a comprehensive method
of quantifying loss of health in populations for the World Bank’s 1993 World Development
Report. Health loss was measured in disability-adjusted life years (DALYs) combining
mortality and morbidity due to disease and injury in a single indicator.
The DALY has an important advantage from a policy perspective: population health status
is estimated in a summary health-outcome measure combining both mortality and
morbidity. This greatly enhances comparisons of the size of different health problems and
comparisons of the cost-effectiveness of interventions addressing a particular health
problem or a wider range of diseases. The combined knowledge of the size of current and
future health problems, and knowledge of the ability of health services to respond to these
health challenges with cost-effective interventions, forms a powerful set of tools for
informed decision making.
The Viet Nam National Burden of Disease (NBD) Study assessed the burden attributable
to diseases and injuries. The study applied the methods developed for the Global Burden
of Disease (GBD) Study. This report provides the internally consistent epidemiological
estimates for a broad range of diseases and injuries in Viet Nam in 2008. A further
publication will follow on the BoD attributable to selected risk factors.
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The Viet Nam NBD Study is part of The Evidence Base for Health Policy Project (VINE
Project), a collaboration between the Ministry of Health (Viet Nam), the Hanoi Medical
School, the Hanoi School of Public Health and The University of Queensland, Australia.
Researchers from the Hanoi School of Public Health and The University of Queensland
were responsible for the NBD Study drawing upon information on causes of death
gathered in a companion verbal autopsy (VA) study. Results of these two studies are used
in cost-effectiveness analyses carried out as a third component of the VINE Project.
2. OBJECTIVES
2.1. GENERAL OBJECTIVE
The Viet Nam NBD Study aims to provide a comprehensive assessment of premature mortality and morbidity (non-fatal health outcomes) attributable to disease and injury in 2008.
2.2. SPECIFIC OBJECTIVES

To estimate cause-specific mortality by age and sex.

To provide internally consistent estimates of incidence, prevalence, case-fatality and
duration by age and sex for different causes of disease and injury.

To calculate the burden of premature mortality and morbidity (non-fatal health
outcome) in terms of DALYs.
3. METHOD
The Viet Nam NBD Study is largely based on the methods developed for the GBD Study.
The GBD Study began in the early 1990s with the objective to quantify the BoD and injury
of human populations and define the world’s main health challenges (1). The method
allows the quantification of all states of ill health into a universal indicator, the DALY.
DALYs for a disease or health condition are calculated as the sum of the years of life
lost due to premature mortality (YLL) in the population and the equivalent ‘healthy’
years lost due to disability (YLD) for incident cases of the health condition:
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DALY = YLL + YLD
The GBD DALYs are discounted at 3% and age weighted whereas DALYs in our Viet Nam
BoD Study are discounted but not age weighted. Age weighting was intended to capture a
greater social responsibility in young and mid-adult life for the very young and old in
society, but has been controversial (2).
The Viet Nam NBD Study used a combination of GBD disability weight (DW) and those
developed by Dutch researchers (3) with the latter providing greater detail by severity level.
3.1. MORTALITY ESTIMATES
Total and cause-specific mortality data were based on a nationally representative cause of
death survey using VA (verbal autopsy) methods implemented in 192 communes in 16
provinces, representing five socio-economic regions in Vietnam: Thai Nguyen, Hoa Binh,
Son La, Hanoi, Quang Ninh, Hai Duong, Thanh Hoa, Binh Dinh, Dac Lak, Khanh Hoa,
Thua Thien Hue, Binh Duong, Lam Dong, Ho Chi Minh city, Can Tho, Kien Giang. The
sample was drawn using a multi-stage stratified cluster sampling technique with provinces
as primary sampling units and households as listing units. The sample consisted of
668,142 households with an estimated 2,616,056 persons; representing approximately 3%
of the Vietnamese population.
Recording of Deaths
The list of deaths to have occurred between 1 January 2008 and 31 December 2008 was
compiled from three existing sources at the commune level: commune health station
(CHS) record, Commune People’s Committee’s report, and population collaborators’
report.
For each death, demographic information of the deceased (age, sex, date of
death) and household address was extracted into a separate file to help locate the
household for subsequent VA interviews to ascertain the cause of death.
Cause of death ascertainment
The second phase of the mortality data collection constituted a VA interview with the
principal caretaker of the deceased. In Viet Nam, VA was first applied to estimate maternal
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and infant mortality (4) and then cause-specific mortality in the adult population in Fila
Bavi, a demographic surveillance site about one hour outside of Hanoi (5, 6). For national
application of VA, the WHO standard VA questionnaire (7) was adapted to the Vietnamese
context, based on experience with VA in Fila Bavi. The questionnaire consisted of two
modules: one for deaths in neonates and children below 12 years; and the other for
adolescents and adults. The questionnaire captured information on (i) family background
and demographic characteristics; (ii) signs and symptoms using a check list; (iii)
open-ended questions to elicit information on the terminal illness leading to death; and (iv)
information on contacts with health services during illness preceding death.
The English version of the questionnaire was translated into Vietnamese, back-translated
and pilot-tested before being used in this study.
In each selected commune, two data collectors were recruited including one CHS staff member (nurse or midwife) and one population collaborator. Data collectors underwent three-day
intensive training on VA interviewing skills. The training emphasized desensitizing techniques
and communication skills to motivate the principal care taker of the deceased to participate in
the interview and give appropriate answers. Furthermore, training covered the specific content
of the questionnaire, the underlying intent of each question, and specific instructions for
coding responses. The training methods included lecture presentation, group discussions,
role-play, and hands-on practice. The potential bias arising from prior medical knowledge of
the data collectors was also addressed, with suitable instructions to ask and record each
question as per the protocol.
VA data collection was administered through five medical universities, including Thai Nguyen
and Hanoi in the North, Hue in the Centre, and Ho Chi Minh and Can Tho in the South. For
logistical convenience, 16 provinces were divided into five clusters (Table 1), corresponding
with the location of each medical university. Each participating medical university was
responsible for conducting VA data collection, reviewing the VA questionnaire to determine
the causes of death, and coding the causes of death identified in the respective cluster. VA
interviews were completed in six months from May to October 2009.
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Table 1. VA interview cluster and the corresponding medical university
No.
Medical University
Province
1
Ha Noi
Hanoi, Quang Ninh, Hai Duong, Thanh Hoa
2
Thai Nguyen
Thai Nguyen, Hoa Binh, Son La
3
Hue
Thua Thien Hue, Binh Dinh, Khanh Hoa
4
HCM
HCM, Lam Dong, Binh Duong
5
Can Tho
Can Tho, An Giang
A total of 9293 completed questionnaires were reviewed by a team of experienced medical
doctors at each medical university, who then assigned the causes of death with reference
to the standard death certification form (7).Underlying causes of death were selected and
coded using International Classification of Diseases Version 10 (ICD-10) by medical
doctors trained in ICD coding and who had a good command of English (i.e. they were
able to use the English version of the ICD-10 coding manual).
Statistical analysis
There are indirect methods like the Preston-Coale method (8) that assess the incompleteness of death registrations. When we used this method on deaths reported in the 2006
Population Change Survey by the General Statistics Office, it indicated an implausibly low
level of completeness (54% for female deaths and 69% for male deaths). Instead, we were
provided with estimates of childhood mortality and the probability of dying between ages
15 and 59 from the new Global Burden of Disease study (GBD study)(9, 10). The
estimates for Viet Nam in 2008 are based on regression methods on available mortality
data from all over the world since 1950. We believe this is currently the best available
estimate for Viet Nam. We use a GBD software program called ModMatch to extend the
childhood and adult mortality estimates into a full life table. The distribution by cause in
each age and sex category from the VA study was then imposed on the life table’s
all-cause mortality estimates for the whole country.
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3.2. YEARS OF LIFE LOST (YLL)
YLL are the mortality component of DALYs and are estimated against an ‘ideal’ standard
life expectancy at each age. YLL for deaths in each age and sex category are estimated
from the mean age at death in that age interval and the standard life expectancy figures at
the exact ages defining the age interval. The basic formula for calculating YLL is:
YLL = N * L
Where N is the age and sex-specific number of deaths and L is the age and sex-specific
standard life expectancy. With discounting at a rate of 3%, the formula becomes:
YLL = N * (1-e-0.03L) /0.03
3.3. YEARS LIVED WITH DISABILITY (YLD)
The loss of health due to non-fatal conditions requires estimation of the incidence of the
health condition (disease or injury) in the year of interest. For each new case, the number
of years of healthy life lost is obtained by multiplying the average duration of the condition
(to remission or death) by a severity weight that measures the loss of healthy life using an
average health state weight. The basic formula for calculating YLD is:
YLD = I * DW * L
Where I is the number of incident cases in the reference period, DW is the disability weight
and L is the average duration of disability (measured in years). With discounting at the rate
of 3%, the formula becomes:
YLD = I * DW * L*(1-e-0.03L) / 0.03
3.4. DISEASE CATEGORIES
One of the objectives of the GBD study was to develop a methodology for determining
internally consistent estimates of disease burden avoiding overestimation of the
contribution of a specific disease or injury through double counting. The approach adopted
was to define mutually exclusive categories for more than 100 conditions and 400
disabling consequences (sequelae) using the ICD-10 coding. For the Viet Nam study,
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diseases were classified into a comprehensive list of three major disease groups, 22
categories of disease and injuries and specific conditions following the structure of the
GBD list of conditions (Appendix 1).
The methods described in this report show how we calculated YLD for 42 diseases and
injuries and their disabling sequelae for which we have developed explicit estimates.
These conditions were chosen as they were expected to make significant contributions to
the total morbidity burden based on their ranking in the 1999 Thai BoD Study (11) and
availability of data. This list is not exhaustive and the remaining non-fatal conditions had to
be extrapolated.
In contrast, the analyses of the mortality burden are complete to the extent that it is
possible within the limitation of the death data collected. To complete the total burden
picture, we make the following assumptions regarding the residual morbidity not captured
by the explicit estimates for the 41 selected disease and injury categories:

For high mortality conditions, we assume morbidity in the residual category is
proportional to its mortality using the average YLD to YLL ratio of related categories for
which we developed explicit Vietnamese estimates;

YLD for some conditions in Viet Nam were estimated by applying the ratio of YLD to YLL
of the 1999 Thailand BoD study to YLL in Viet Nam. We used this extrapolation method
for nutritional deficiencies, endocrine disorder, rheumatic heart disease, hypertensive
heart disease, inflammatory heart disease, genitourinary diseases, and congenital
anomalies. For all digestive diseases, YLD in Viet Nam were calculated by the ratio YLD
to YLL for cirrhosis in Thailand. YLD for rest categories in each disease group such as
“other cardiovascular disease”, “other cancers”, “other perinatal conditions”, “other
maternal conditions” and “other infectious disease” were extrapolated by the YLD/YLL
ratio of the diseases that were explicitly estimated within those disease groups. YLD for
the neurological rest category were estimated from the YLD/YLL ratio of epilepsy and
dementia combined; and
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
For low mortality conditions, for which we did not make any explicit estimates for Viet Nam,
we made an assumption that YLD rates by age and sex from the 1999 Thai BoD study
applied. This method was used for skin diseases, gout, oral conditions and asthma.
3.5. POPULATION
Population estimates were based on the 1999 and the 2009 National Census projections.
The two censuses provided information on the number of persons and households
together with a range of their demographic characteristics.
3.6. DISCOUNTING
The DALY measures the future stream of healthy years of life lost due to each death or
incident case of disease or injury. It is thus an incidence-based measure rather than a
prevalence-based measure. The GBD study applied a 3% time discount rate to years of
life lost in the future to estimate the net present value of years of life lost. With this
discount rate, a year of healthy life gained in 10 year’s time is worth 24% less than one
gained now.
Discounting future benefits is standard practice in economic analysis and there are some
specific arguments for applying discounting to the DALY in measuring population health
(12). Arguments include:

To be consistent with measurement of health outcomes in cost-effectiveness
analyses;

To prevent giving excessive weight to deaths at younger ages (without age
weighting and discounting, a male death at age zero results in 44% more YLL than
a death at age 25 and 97% more than a death at age 40; with discounting at 3% an
infant death results in only 12% and 29% more YLL than a death at age 25 and age
40, respectively); and

The disease eradication/research paradox: assuming that investment in research or
disease eradication has a non-zero chance of succeeding, then without discounting,
Page 10
all current expenditure should be shifted to such investment because the future
stream of benefits is infinite.
Discounting has a profound effect on the estimated size of health outcomes. Discounting
alters the value attached to death at different ages. Thus the choice of a discount rate for
health outcomes, even if technically desirable, may result in morally unacceptable
allocations between generations. Because the discount rate issue is not easily resolved,
the GBD study published discounted and undiscounted estimates of the global burden.
A discount rate of 5% per annum has been standard in much health economic and other
social policy analyses for many years. Environmentalists and renewable energy analysts
have argued in recent decades for lower discount rates for social decisions. The World
Bank Disease Control Priorities Study and the Global Burden of Disease project (13, 14)
both used a 3% discount rate. The United States Panel on Cost-Effectiveness in Health
and Medicine recently recommended that a 3% real discount rate be used in health
economic analyses to adjust both costs and health outcomes (15) but that the sensitivity
of the results to the discount rate should be examined. In this study, a 3% discount rate
was applied to calculate the DALY.
3.7. DISABILITLY WEIGHTS
The DALY uses explicit preference values for different health states known as ‘disability
weights’ (DW). The DW quantifies societal preferences for different health states. These
weights do not represent the lived experience of any disability or health state, or imply any
societal value of the person in a disability or health state. Rather they quantify societal
preferences for health states in relation to the ‘ideal’ of optimal health. The weights for
DALY calculation are expressed on a scale from zero to one, with zero representing a
state of optimal health (no loss) and one representing a state equivalent to death.
Thus a weight for paraplegia of 0.57 does not mean that a person in this health state is
‘half dead’ or that society values them as a person less than anyone else. It means that,
on average, society judges a year with blindness (DW 0.43) to be preferable to a year with
paraplegia (DW 0.57), and a year with paraplegia to be preferable to a year with
Page 11
unremitting major depression (DW 0.76). It also means that, on average, society would
prefer a person to have a year in good health followed by death than a year with
paraplegia followed by death. Further, society would prefer a person to live three years
with paraplegia followed by death than live one year of good health followed by death (3x
(1-0.57) = 1.3 ‘healthy’ years is greater than 1 year of good heath).
The BoD DW are based on the Person Trade-Off (PTO) method, as this more directly attempts to measure social preferences for health states than other methods. Using this
method, the DW were derived from panels of health experts from around the world for 22
indicator conditions, followed by a deliberative process allowing members of the panel to
alter their initial valuations after hearing arguments from other panel members (16). It has
been argued that health state preferences would vary markedly between populations that
have different cultural beliefs, conceptualizations of health, and expectations for health and
well being. However, there is little evidence that this is the case (17). The GBD Study
carried out health state preference studies in over ten countries and found surprisingly
high levels of consistency between weights for the 22 indicator conditions spanning a wide
range of severity (16).
We used actual or derived weights from two sources: the GBD and the Dutch weights
applied in the Australian study (18, 19). The Dutch weights cover only a restricted range of
conditions, but they differentiate between different condition stages and severities.
Therefore they can be applied more directly to detailed disease models in estimating the
YLD. The Dutch weights also have the great advantage that they define each disease
stage or sequelae in terms of a standardized health state description using a variant of the
EuroQol classification, with six domains and three levels of severity for each domain. The
six domains are mobility, self-care, usual activities, pain, affect and cognition. Each
domain can be scored as having “no problems”, “some problems” or “severe problems”.
The GBD weights cover a wider range of conditions, but generally for less specific disease
and sequelae categories. The exception is injury, where the GBD has a much more
comprehensive set of weights for the short-term and long-term sequelae of 39 types of
injuries. The two sets of DW cannot be directly compared for most conditions because the
Page 12
disease categories in the Dutch study are more specific. Based on the correlation
coefficient (0.91) for these two sets of DW, and the line of best fit (a slope of 0.998 and an
intercept of 0.009) it is reasonably valid to use the GBD and Dutch weights in the
same study.
A list of all Dutch weights used in this study and their sources is presented in Appendix 2.
3.8. AGE WEIGHTS
The GBD study weighted a year of healthy life lived at young ages and older ages lower
than for other ages. However, there is no consensus that young and older ages should be
given less weight or, if one wishes to do so, on the relative magnitude of the differences.
The age weights are the single most controversial value choice built in the DALY.
Criticisms of the age weights have fallen into four categories (2, 20):

Age-weighting is unacceptable on equity grounds (every year of life is of equal
value a priori);

The age weights are arbitrary and have not been validated for large populations;

The age weights do not reflect social values; and

They add an extra level of complexity to the BoD analysis which obscures the
method and makes little overall difference to the rankings.
Conversely, there are arguments that age weights are not in themselves inequitable,
because everyone potentially lives through every age, and that they do reflect legitimate
societal priorities (21). The Viet Nam BoD study uses uniform age weights so that a year of
healthy life is valued equally at all ages.
3.9. INCIDENCE AND DURATION
The starting point for YLD calculation is to determine the number of new cases of a
particular condition in the year of interest and to estimate or model disease duration, and in
Page 13
some cases, progression through disease stages or severity levels. While for some conditions
it is possible to derive numbers of incident cases directly from disease registers, routine databases or epidemiological studies, for most only prevalence data are available. Additionally, it
is often necessary to estimate average duration from knowledge of the rates of remission or
death for a particular condition. For these conditions, we use a software program called DISMOD. The underlying model used by DISMOD is summarized below (Figure 1).
Population
m
without disease
Incidence
rate i
All other
mortality rate
Remission
rate
Deaths from
other causes
m
Cause
specific
Cases of disease
Case fatality
rate f
deaths
Figure 1. The Basic Disease Model Underlying DISMOD
The
epidemiology
of
a
disease
is
fully
described
by incidence, prevalence,
remission, duration, and some measure of mortality (relative risk, case fatality rate or
mortality rates). These variables differ in nature. For example, incidence and case fatality
express transition from one state to another, while prevalence is a proportion. All of these
variables can, in principle, be observed, but with a different degree of difficulty. Mortality,
for example, can be relatively easily observed, but, depending on the disease, can be
misclassified. Nevertheless, cause of death statistics usually constitute a more reliable
disease data source.
If three of the five disease parameters listed above are known, DISMOD can calculate
the missing two. Most commonly, there is information on prevalence, mortality and
some notion of remission. DISMOD estimates incidence and average duration by age
and sex that are consistent with the known parameters.
Page 14
While different assumptions regarding remission and case fatality affect the age
distribution of incident cases and YLD estimates, total YLD are relatively insensitive to
these assumptions if matched to a fixed prevalence distribution. This is because YLD
estimates are proportional to incidence multiplied by duration, which approximately equals
the prevalence of the condition. In other words, for most conditions, the combination of
incidence, case fatality and remission rates (and thus derived durations) used in the YLD
calculations makes relatively little difference to total YLD across age groups assuming the
same prevalence figures are used as the basis. The effect of discounting complicates this,
however, with low incidence and long duration conditions being more discounted than high
incidence but short duration conditions.
For sequelae of short duration (for example, the recovery time post surgery), we base our
assumptions regarding duration on findings reported in the literature or on advice from
experts rather than using DISMOD.
4. OVERVIEW OF DISEASE AND INJURY MODELS
4.1. TUBERCULOSIS
To calculate the incidence of tuberculosis (TB), we relied on the annual data on TB from 2002
to 2008 provided by the National Hospital of Lung Diseases that was sent to WHO for
contribution to the Global Tuberculosis Database. New AFB+ cases are the only ones for
which an age and sex pattern is provided. We imposed that pattern onto the overall figures of
new cases of pulmonary TB, which including AFB+ and AFB-, and extra-pulmonary TB.
YLD of TB were calculated for six different categories: treated and cured TB, treated and
relapsed TB, treated and not cured TB, untreated and fatal TB, untreated TB with
spontaneous recovery, and untreated TB resulting in chronic illness. According to a
population-based study from Viet Nam, 20% of TB cases were underreported(22). In the
absence of Vietnamese data, we made the same assumptions as in the Thai BoD study
that 70% of cases received treatment (11, 23). The duration of treated TB was assumed to
Page 15
be 10 months including 4 months of symptoms prior to treatment and 6 months on
treatment (24). Based on the data of the Viet Nam National Tuberculosis Prevention
Program, the cure rate of treated cases is 89%. The 8.6% who relapse were given an
average duration of 12 months (4 months delay to treatment and 8 months of
treatment)(25). The remaining 2.4% not cured were assumed to be on treatment with an
average duration of 18 months. For those receiving no treatment, we assumed 50% died,
18% become chronic TB sufferers and 32% recovered spontaneously (26).
Dutch DWs were used (0.29 for pulmonary TB and 0.30 for extra-pulmonary TB).
4.2. HIV/AIDS
We modeled HIV/AIDS in four stages: early asymptomatic HIV infection (Dutch DW 0.20),
then to symptomatic HIV infection stage (DW 0.31), then to AIDS (DW 0.56), and finally
the terminal stage of the illness (DW 0.95).
In the projection report for HIV in Viet Nam, the incidence rate in Viet Nam is about 39 per
million population (27). This report also provided the prevalence rate, sex ratio and number of
HIV infection cases in 2008 in Viet Nam. We subsequently applied the age and sex pattern
from the Vietnamese Ministry of Health’s (MoH) report on HIV patterns in 2008 (28).
Anti-retroviral treatment increases survival; the average duration of HIV/AIDS with treatment
was estimated to be 30 years in the Australian population (29). This is compared to a median
incubation period from HIV infection until development of AIDS of approximately 10 years in
untreated adults. Infectious disease experts estimate there are 59,000 people eligible for
treatment; that capacity to treat is 29,000 but only 20,000 are actually treated (30). From the
2008 report by the Vietnamese MoH, the effective coverage of anti-retroviral treatment in Viet
Nam is 45% (31). We therefore assumed that 27% of people have the longer durations
estimated for those treated in the Australian study and the remainder the shorter duration as
estimated in the era before treatment was available.
The mean duration from AIDS to death was based on applying the same estimate of 23%
effective treatment coverage with a duration of 5.5 years (18), assuming that the people
Page 16
untreated have an average duration of 1.3 years (as per the Thai HIV/AIDS projection
study (11)).
4.3. DIARRHEA
The incidence and duration of diarrhea was taken from the 2006 Viet Nam Standard
Household Survey. In this survey, household members reported on the duration and
levels of diarrhea, either mild, moderate, or severe. DW used for calculating YLD of
diarrhea is Dutch weight of 0.056 for uncomplicated episode (mild and moderate) and
0.402 for complicated episode (severe).
4.4. RESPIRATORY INFECTIONS
We used self-reported data from the 2002 Viet Nam National Health Survey (VNHS, 2002)
on cough in the last four weeks at 3 levels: mild, moderate, and severe. We assumed
severe disease reflected lower respiratory diseases at GBD study DW of 0.28. Mild
disease was assumed to be nasopharyngitis and moderate disease to be sinusitis or
tonsillitis (with Australian BoD DW based on regression model of Dutch weights of 0.014
and 0.061, respectively) at DW 0.061.
For employed adults, the average number of days off-work due per episode of respiratory
tract infection was around 0.5. The GBD study assumed an average duration of 3.5 days.
If we are using the self-report prevalence data, we probably include a considerable
number of minor infections with minimal disability. Hence we use days off work plus
additional half day on either side (1.5 days) as the average duration.
4.5. CANCER
We used site-specific incidence from six cancer registries (three from the North, one from
Centre, and two from the South of Viet Nam). The comparison between the cancer
incidence from those registries and cause-specific mortality from the cause of death study
using the VA method showed that mortality rates are higher than incidence rates for
almost all cancers for all age groups in both males and females. Consultation with cancer
experts from the Viet Nam National Cancer Hospital who are involved in collecting data
Page 17
revealed that the data obtained from the cancer registries is not complete due to limited
coverage of the register system and lack of human capacity to collect quality data. For the
sake of preserving consistency between mortality and morbidity estimates, we decided to
calculate site-specific incidence rates for cancers by multiplying mortality rates from the
mortality study with site specific incidence-to-mortality rate ratios from a study on the
regional estimates of cancer mortality and incidence by site (32).
Those surviving cancer for at least five years were assumed to be cured and have
disability for five years. For those who died, the survival time to death was assumed to
follow a Weibull distribution. Thus, the average survival time was estimated by applying
this distribution with relative five-year survival rates for developing countries obtained from
a study on the worldwide mortality from 25 cancers (33).
We estimated disability for cancers by adopting the models as per the Australian BoD
study (18) and application of the Dutch DW for each stage. The general model for cancers
is shown in Figure 2.
Incidence
Up to 5 years
12 months or less
Diagnosis and
primary therapy
DW 0.19-0.69
State after intentionally
curative primary therapy
DW 0.18-0.38
In remission
DW 0.18-0.47
Variable
Disseminated
DW 0.75-0.91
12 months
or less
Cure
Terminal
DW 0.19-0.93
Death
1 month
Figure 2. General model for cancer YLD estimation
4.6. DIABETES
YLD for diabetes were estimated for two categories: uncomplicated diabetes and
complicated diabetes. The prevalence of diabetes was derived from the survey
Page 18
“Epidemiology of diabetes in Vietnam, treatment methods and preventive measures” (34).
To calculate incidence rates and duration of diabetes, DISMOD2 (35) was used with zero
remission and relative risk of mortality in diabetics from the Asia-Pacific Cohort Studies
Collaboration (36). The ratio of YLD of diabetes complications to prevalent cases of
diabetes in the 1999 Thai study was used to estimate YLD for complications of diabetes of
Viet Nam. Dutch DW of 0.07 was used for uncomplicated diabetes.
4.7. MENTAL AND NEUROLOGICAL DISORDERS
We used the epidemiology clinical survey of ten common mental disorders by eight
ecological regions of Viet Nam in 2008 – 2009. The survey included a sample of 82,908
individuals. Data was available by age and sex.
Alcohol abuse
The incidence of alcohol abuse was computed using DISMOD2 from the prevalence
provided by the epidemiology survey and a remission of 0.24, based on an American
follow-up study of at-risk drinkers (37) and an elevated mortality risk of 1.8 in males and
3.84 in females (38). In the absence of local data, experts consulted agreed to use these
estimates. An average DW for alcohol abuse of 0.09 was adopted from the Australian BoD
study (18).
Anxiety
The epidemiology clinical survey reported 2085 cases of diagnosed anxiety. The remission
rate was assumed to be 4.3%, which is the combined estimate from four follow-up studies
of people with anxiety disorders (39). The standardized mortality ratio reported in the
meta-analysis of Harris and Barraclough ranged from no elevated risk for anxiety neurosis
to a risk of two for panic disorder (38). We assumed a relative risk for anxiety, and
DISMOD2 was used to ascertain incidence and duration. For DW we used assumptions
from the Australian BoD study taking into account average severity and a proportion of
time over the chronic course of anxiety disorders that is symptomatic.
Page 19
Dementia
We derived incidence and duration from DISMOD2 using prevalence, zero remission and
a relative mortality risk from Aguero-Torres study (3.6 and 4.5 for male and female 77-84
year olds (40); and 1.7 and 2.4 for males and females over age 85. We further used the
severity distribution from the Rotterdam study (minimal 13.8%, mild 41.3%, moderate
30.0% and severe dementia 15.0%) (35). This leads to an average DW of 0.52.
Depression
This epidemiology clinical survey reported 2653 cases of diagnosed depression. In the
absence of information on other depression parameters in Viet Nam, we decided to use
the GBD study 1990 estimates on duration for our current study. We assumed that the
average duration is 0.5 years with a corresponding remission of two years. A relative risk
of mortality of 1.36 was applied in DISMOD2.
Drug dependence
There were 369 cases of drug dependence in the mental health survey, males accounting
for 91%. The drug dependence definition used in that study included cocaine, heroin,
opium and cannabis. The survey found that heroine was the most used drug. The survey
also reported a prevalence of 0.0078 for the 10-19 age group. We assumed drug
dependence only occurs among 15 year or older age groups with the prevalence being
two times higher than that among the 10 – 19 age range.
Due to the absence of data on other drug dependence parameters in Viet Nam, we
decided to use a remission rate of 5% and a case fatality rate from overdose of 1% per
year as per Australian research (41). A DW of 0.27 was assumed similar to the Australian
BoD study
Epilepsy
As the prevalence of epilepsy by age in adults was somewhat erratic due to small
numbers, we modelled an adult prevalence combining data across adult age groups. We
used a midpoint mortality relative risk of 1.55 in range from 1.3 to 1.8 standardized
mortality ratios reported for epilepsy (42). At ten years after diagnosis, the probability of
Page 20
having no seizure and no medication for at least five years was 51% for those diagnosed
before 10 years of age, 40% for those diagnosed at ages 10 -19 years, 28% for those with
diagnosis at ages 20 to 59 and only 6% for those with diagnosis at 60 years or later. In
addition, the probability of relapse by 20 years after remission was 13% among those less
than nine years of age at diagnosis, 22% among those aged 10 - 19 years at diagnosis,
and 32% among those over age 20 years at diagnosis (43)). We subtract the relapse rate
from the remission rate to yield a net remission rate as an input to DISMOD2.
Schizophrenia
The National Mental Health Survey reported 348 cases of schizophrenia. We used a
median estimate of the standardized mortality ratio of 2.58 in people with schizophrenia
and a remission estimate of 0.0137 based on two meta-analysis of ten studies of Saha in
2005 and 2007 (44).
As in the Thai BoD study we assumed that 63% of time is spent at the GBD Study DW of
0.627 for untreated cases (that was the proportion of patients during two year follow-up in
WHO’s ten country study (45) who had remitted) and remainder of the time at 0.351 (GBD
study weight for treated cases) to give a composite weight of 0.453.
4.8. SENSE ORGAN DISORDERS
Vision loss
Vision loss includes all self-reported cases from the Household Living Standard Survey
(HLSS) 2006. Vision loss is divided into three categories: mild, moderate, and severe. In
the VNHS investigators asked whether survey participants experienced any visual
difficulty, including whether they wore glasses. The survey allowed for four potential
responses: no difficulty, a little difficult, very difficult, and completely blind. We categorized
the level of severity into none, mild, moderate, and severe corresponding to each of these
four items.
We used Dutch DW of 0.02 for mild, 0.17 for moderate and 0.43 for severe vision loss.
The DISMOD2 model was used to model incidence and duration of vision loss for each
level assuming no remission and no excess mortality.
Page 21
Hearing loss
Prevalence of hearing loss was also derived from the HLSS 2006. In this survey, people
reported either one of three levels of hearing loss: a little difficult, very difficult and
completely deaf. We then mapped into these responses mild, moderate and severe
hearing loss categories for which there were Dutch DW (0.02, 0.12 and 0.37, respectively).
Due to small survey numbers, the average DW for all prevalent cases of hearing loss
varied markedly with age but showed a bimodal pattern with higher values below age 45
(average 0.083) than for older ages (average 0.051).
DISMOD2 was used to model incident cases and duration of hearing loss, assuming no
remission and a relative risk or mortality equal to one.
4.9. ISCHEMIC HEART DISEASE
We made estimates for three disabling outcomes of ischemic heart disease (IHD): angina
pectoris (AP), acute myocardial infarction (AMI) and heart failure (HF). The incidence of
AP and AMI is based on hospital admission data from 200 health centers, provincial
hospitals, and national hospitals from throughout Viet Nam. We used incidence of IHD
from hospital admission data captured by the Administration of Medical Service of the MoH
As there are only two age groups in the hospital data (<14 and 15+) we imposed the age
pattern based on more detailed hospital admission data from Thailand.. Then, pursuant to
expert advice, we assumed that 70% of admissions over 60 years of age were first ever
admission cases for both AP and AMI and that 40% of AMI patients die outside of hospital
and thus would not be captured by hospital data.
Based on discussion with experts from the Viet Nam National Heart Hospital, we assumed
that case fatality rate in IHD in Viet Nam is 50% higher than in Australia. DISMOD2 was
used to derive average duration for all IHD incident events (combining AP and AMI)
assuming zero remission. The DISMOD2 incidence output was then apportioned to AP
and AMI based on ratio of AP to AMI admissions. We assumed that 15% of AMI leads to
HF and again we assumed the case fatality rate of HF in Viet Nam is 50% higher than
Australia.
Page 22
We assumed AP is associated with mild to moderate disability (DW 0.08) until the last 6
months at severe DW (0.57); and three months DW for AMI (GBD study DW 0.491
untreated and 0.395 treated) with estimation that it is about 50% treated so combined
weight is 0.443. For HF, we assumed 60% mild, 30% moderate and 10% severe disability
(DW 0.06, 0.35 and 0.65, respectively).
4.10. STROKE
YLD of stroke is estimated separately; those who die in 28 days and survivors after 28
days. Those who die in the first 28 days are assumed to have one week of disability at the
level of severe stroke (0.92 DW).
We imposed the age and sex pattern from Thai admission data on our overall admission
estimates of people discharged after a stroke with adjustment to reflect the partial
coverage of hospitals in the admission database as described in section above on IHD. In
Perth Australia, 22% of non fatal strokes were managed outside the hospital system (46).
We assumed a 50% higher proportion of cases do not present to hospitals in Viet Nam
and that this proportion is much higher in the 75+ age group (44%) than at younger ages
(17%).
Bonita (46) also noted that 69% of recorded strokes in Perth are first ever strokes. We
applied this proportion to incidence over age 60. In the Perth study about 22% of
strokes in males and 26% of strokes in females resulted in death within 28 days. Higher
case fatality rates were reported in cases of people older than 75 years (29%)
compared to cases less than 75 years (18%) (46). On the advice of experts from the
Heart Hospital we increased the case fatality rate by 50%.
According to linked data from Western Australia (47) on pre- and post-stroke levels of
disability amongst stroke survivors, mean DW amongst stroke survivors at four and
twelve months were estimated. These DW were calculated from absolute changes in
levels of disability after stroke in each individual and applied to all stroke survivors, not
just those with disability. We used the four month survivor DW in the first year and the
twelve-month disability after the first year.
Page 23
4.11. CHRONIC OBSTRUCTIVE PULMONARY DISEASE (COPD)
Our study utilised an epidemiological cross-sectional (national) study on COPD prevalence
that was carried out in Viet Nam between September 2006 and June 2007 (48). COPD in this
study is defined by the WHO GOLD definition in anyone who on spirometry testing has a
proportion of forced vital capacity exhaled in the first second less than 70% (FEV1/FVC < 0.7).
We assumed a progression from asymptomatic to mild-moderate and eventually severe.
We have DW for severe (III-IV) of 0.53 and for mild-moderate of 0.17. Gold II is more
inclusive (FEV1/FVC between 50 and 80%) than our definition of mild/moderate (50-70%
FEV1/FVC) for which the DW of 0.17 was determined. DISMOD2 was used to derive
average duration and incident for COPD assuming zero remission.
4.12. OSTEOARTHRITIS
We decided to use the estimated prevalence of osteoarthritis from the Viet Nam
Community-Oriented Program for the Control of Rheumatic Disease (COPCORD) study,
despite its small sample size (49). This was because it provided the prevalence of
radiographic osteoarthritis instead of self-reported osteoarthritis. This study was applied to
2119 urban subjects aged 16 years and over, using WHO-ILAR COPCORD core
questionnaires for reporting symptoms and radiographic and blood tests to classify
rheumatic disease categories (49). As the prevalence of osteoarthritis by sex only was
obtained from this study, the age distribution of patients who were diagnosed with
osteoarthritis in the Thai COPCORD study was imposed (11).
People with osteoarthritis have a higher risk of death than others, but it is thought that this is
due to an increased likelihood of significant co-morbidities (not related to the osteoarthritis),
and thus we assumed that case fatality in osteoarthritis is zero. We used DISMOD2 to
derive incidence and average duration with remission as inputs. Similar to both the
Australian (18) and Thai (11) BoD studies, we applied an average of Dutch weights,
assuming a severity distribution based on Kellgren and Lawrence radiological grades 2 and
3-4 for osteoarthritis from the Framingham study (50, 51).
Page 24
4.13. INJURY
The incidence of injury was taken from the Viet Nam Multi-center Injury Survey (VMIS)
(52) and the Survey of Children Injury in six provinces: Hai Phong, Hai Duong, Hue,
Quang Tri, Can Tho, and Dong Thap (Children Survey) (53). Injury cases in the two
surveys were classified into eight categories: burns, drowning, fall, homicide and violence,
poisoning, suicide, traffic accident, and other intentional injury. Compared to the Children
Survey, VMIS reported a higher incidence of all types of injury and also more
representative because of a larger sample size. Both surveys gave adequate information
on the type of injury (e.g. fall or road traffic accident). Unfortunately, neither of the two
surveys provided complete data on the nature of the injury (e.g. fractured leg or head
injury). Some information on the body part affected and additional information in the child
survey on whether the injury concerned a fracture was available. To extrapolate from the
limited survey information to estimate each of the 32 nature of injury categories we used
patterns of occurrence of injury types from the Thai BoD study. For instance, of all victims
of a road traffic accident in Thailand with an injury in the area of the face (the only
information provided in the Viet Nam adult survey), 67% had a fracture of face bones, 22%
a fractured skull and 11% an injury to the eye. We then applied those proportions to the
Viet Nam survey data for road traffic injuries where the face was the body part affected.
For each body part we made similar rules and borrowed detailed information from the Thai
BoD study. DW and duration for long term and short term injury were adapted from the
GBD study.
5. RESULTS
5.1. DEATHS AND LIFE EXPECTANCY
In Viet Nam in 2008, the number of deaths was estimated at 541,228; 54% in males and
46% in females. The leading cause of death in both sexes was stroke (Table 2). Liver
cancer and road traffic accident were the second and third leading causes in men while
COPD and pneumonia ranked second and third in women.
Page 25
Table 2. Top ten causes of death by sex
Male
Female
Rank
Disease category
Deaths
%
Disease category
Deaths
%
1
Stroke
53,217
18%
Stroke
56,771
23%
2
Liver cancer
19,915
7%
COPD
14,941
6%
3
Road traffic accidents
17,330
6%
Pneumonia
11,175
4%
4
Lung cancer
15,720
5%
11,015
4%
5
COPD
14,355
5%
Diabetes
9,858
4%
6
13,504
5%
Liver cancer
8,587
3%
7
Tuberculosis
11,450
4%
Lung cancers
7,869
3%
8
Pneumonia
9,470
3%
Tuberculosis
6,798
3%
9
HIV/AIDS
9,417
3%
5,750
2%
10
Stomach cancer
8,469
3%
Stomach cancer
5,470
2%
Total
290,624
Total
250,605
Life expectancy at birth in 2008 was 69.7 years in men and 77.7 years in women. The
crude death rate was 6.4 per 1,000. The probability of dying before age 5 was 15 per
1,000 in males and 12 per 1,000 in females. The probability of dying between ages 15 and
59 was 0.03 in males and 0.07 in females.
5.2. MORTALITY BURDEN IN VIETNAM (YLL)
The total YLL in the Viet Nam population in 2008 amounted to 6.8 million years. Almost
two thirds of YLL were due to non-communicable diseases (group II). Proportions of
mortality burden of communicable diseases, maternal and neonatal conditions (group I)
and injuries (group III) were both 16% of the total (Figure 3).
Page 26
16%
16%
Group I
Group II
Group III
68%
Figure 3. YLL by major disease groups, Viet Nam 2008
Premature mortality resulted in 4.1 million YLL in men and 2.7 million YLL in women. The
percentage of YLL in men and women varied by major disease groups. Group I conditions
and injuries (group III) contributed a greater burden to the total YLL in men than that in
women (Figure 4).
80%
75%
Proprotion of total YLL
70%
64%
60%
50%
40%
Male
30%
20%
17%
Female
19%
14%
11%
10%
0%
Group I
Group II
Group III
Figure 4. YLL by sex and major disease groups, Viet Nam 2008
YLL by sex
Cardiovascular diseases, cancer and unintentional injuries were the leading cause of premature death in men in 2008 (Figure 5). Infectious diseases also contributed a significant
proportion to total YLL. The four categories combined accounted for 74% of YLL in men.
Page 27
7%
2%
2%
2%
Cardiovas cular diseases
24%
Cancer
4%
Unintentional injuries
4%
Infectious diseases
Digestive dis eases
6%
Res piratory diseases
Res piratory infections
Intentional injuries
11%
21%
Congenital anomalies
Neuropsychiatric conditions
Other
17%
Figure 5. YLL by major disease categories in men, Viet Nam 2008
The pattern was similar in women. The leading causes of YLL in women were also
cardiovascular diseases, cancers, unintentional injuries and infectious diseases. The four
disease groups combined accounted for 69% of YLL in women (Figure 6).
10%
Cardiovas cular dis eas es
2%
Cancer
3%
31%
3%
Infectious dis eases
4%
Respiratory dis eases
4%
Respiratory infections
Diabetes mellitus
5%
Digestive dis eases
Neurops ychiatric conditions
7%
Perinatal conditions
9%
22%
Other
Figure 6. YLL by major disease categories in women, Viet Nam 2008
Page 28
YLL by age
Total YLL in men increased steadily from the lowest value in 5 to 14 age group to a peak
in 45 to 59 age group (Figure 7). The pattern in women is similar but at lower values than
seen in men (Figure 8). Injuries and infectious diseases largely affected the young while
non-communicable diseases are the dominant disease group among the elderly.
Millions
1.4
Group I
Group II
Group III
Years of Life Lost
1.2
1.0
0.8
0.6
0.4
0.2
0.0
0-4
5-14
15-29
3044
45-59
60-69
70-79
80+
Age groups
Figure 7. YLL by age and major disease groups in men, Viet Nam 2008
Millions
Group I
1.4
Group II
Group III
Years of Life Lost
1.2
1.0
0.8
0.6
0.4
0.2
0.0
0-4
5-14
15-29
3044
45-59
60-69
70-79
80+
Age groups
Figure 8. YLL by age and major disease groups in women, Viet Nam 2008
Page 29
Infectious diseases and perinatal conditions were the prominent causes of the mortality
burden in Vietnamese children. Before age 45, unintentional injuries and infectious diseases were the leading causes for YLL in both sexes in Viet Nam. After this age, cancer
and cardiovascular diseases were the major causes of YLL (Figures 9 and 10).
Millions
others
1.2
Years of Life Lost
1.0
0.8
0.6
Respiratory diseases
0.4
Digestive diseases
0.2
Infectious diseases
0.0
0-4
5-14
15-29
30-44
45-59
60-69
70-79
80+
Cancer
Cardiovascular diseases
Age groups
Figure 9. YLL by age and disease categories in men, Viet Nam 2008
Millions
1.2
Others
Years of Life Lost
1.0
0.8
Digestive dis eases
0.6
Diabetes mellitus
0.4
0.2
Infectious diseases
0.0
0-4
5-14
15-29
30-44
45-59
Age groups
60-69
70-79
80+
Cancer
Figure 10. YLL by age and disease categories in women, Viet Nam 2008
Page 30
YLL by cause
The main conditions causing YLL in both men and women were stroke and road traffic accidents. It is noted that liver cancer and lung cancer were important causes of the fatal
burden in men and women.
Table 3. Top 10 causes of YLL by sex
Male
Rank
Disease category
YLL
Female
%
Disease category
YLL
%
Stroke
453,357
17%
1
Stroke
579,115
14%
2
381,728
9%
121,629
4%
3
Liver cancer
300,877
7%
Pneumonia
118,805
4%
4
HIV/AIDS
238,430
6%
Liver cancer
117,215
4%
5
Lung cancer
201,595
5%
Ischaemic heart disease
110,197
4%
6
Pneumonia
157,546
4%
Diabetes mellitus
104,814
4%
7
150,223
4%
Lung cancer
97,558
4%
8
Tuberculosis
140,286
3%
COPD
96,738
4%
9
COPD
118,716
3%
Tuberculosis
83,496
3%
10
Drowning
118,503
3%
Stomach cancer
71,878
3%
5.3. YEARS LOST DUE TO DISABILITY (YLD)
Total of YLD in Viet Nam in 2008 amounted to 5.4 million years. Non-communicable
diseases contributed almost three quarters of the disability burden. Group I conditions and
injuries contributed to 10% and 15% of total YLD, respectively (Figure 11).
10%
15%
Group I
Group II
Group III
75%
Figure 11. YLD by major disease groups, Viet Nam 2008
Page 31
YLD by sex
Non-communicable disease accounted for 69% of the total YLD in men and 80% of the
total in women. Injuries contributed much more YLD in men than in women, 21% vs.10%
of total YLD (Figure 12).
90%
80%
80%
Proportion of the YLD
69%
70%
60%
50%
Female
40%
Male
30%
20%
21%
11% 10%
10%
10%
0%
Group I
Group II
Group III
Figure 12. YLD by sex and major disease groups, Viet Nam 2008
The leading causes of YLD were similar in men and women. Neuropsychiatric conditions
were the leading causes of the illness burden (Figures 13 and 14). In men, unintentional
injuries were the second main cause, followed by sense organ disorders (vision and
hearing loss). In women, sense organ disorders were the second leading cause followed
by musculoskeletal conditions.
Page 32
9%
2%
3%
4%
33%
Sense organ diseases
4%
5%
Musculoskeletal diseases
Nutritional deficiencies
Infectious diseases
6%
Diabetes mellitus
Cancer
6%
other
8%
20%
Figure 13. YLD by major disease categories in men, Viet Nam 2008
2%
3%
5%
4%
4%
5%
41%
6%
Cardiovascular diseas es
Diabetes mellitus
9%
Infectious dis eas es
Oral conditions
10%
11%
other
Figure 14. YLD by major disease categories in women, Viet Nam 2008
YLD by age
The pattern of YLD of men and women by age in Viet Nam in 2008 was similar. Non
communicable diseases dominated the majority of the disability burden in all age groups
and YLD increased gradually with age until reaching a peak in the 30-44 age group
(Figures 15 and 16).
Page 33
Millions
Years Live with Disabidity
0.8
0.7
0.6
0.5
Group III
0.4
Group II
0.3
Group I
0.2
0.1
0.0
0-4
5-14
15-29
30-44
45-59
60-69
70-79
80+
Age groups
Figure 15. YLD by age and major disease groups in men, Viet Nam 2008
Millions
Years Live with Disabidity
0.8
0.7
0.6
0.5
Group III
0.4
Group II
0.3
Group I
0.2
0.1
0.0
0-4
5-14
15-29
30-44
45-59
60-69
70-79
80+
Age groups
Figure 16. YLD by age and major disease groups in women, Viet Nam 2008
Most YLD in both sexes were due to non-communicable diseases in almost all age groups.
For males less than 5 years of age, YLD were mainly due to respiratory diseases and
unintentional injuries. Over a third of the total burden in age group from 14 onwards was
attributable to neuropsychiatric conditions and injuries. After age 60, YLD were mainly due
Page 34
to neuropsychiatric conditions and respiratory diseases. Moreover, from age 30 to age 60,
sense organ diseases also contributed significantly to the YLD in men (Figure 17).
Millions
Years Live with Disability
1.2
others
Cancer
1.0
Diabetes mellitus
0.8
Infectious diseases
0.6
0.4
0.2
0.0
0-4
5-14
15-29
30-44
45-59
60-69
70-79
80+
Age groups
Figure 17. YLD by age and major disease categories in men, Viet Nam 2008
Similar to men, YLD in women were mainly due to neuropsychiatric conditions. Besides
that sense organ diseases and musculoskeletal diseases were also the leading causes of
YLD in women. In girls, neuropsychiatric conditions, unintentional injuries, nutritional
disorders (largely anemia) and respiratory diseases (largely asthma) were the main
causes of YLD. From age 15, neuropsychiatric conditions, sense organ disorders and
musculoskeletal disease constituted the leading causes of the YLD among women (Figure 18).
Millions
Years Lived with Disability
1.2
Others
1.0
Oral conditions
Infectious diseases
0.8
0.6
Diabetes mellitus
0.4
0.2
0.0
0-4
5-14
15-29
30-44
45-59
60-69
70-79
80+
Age groups
Figure 18. YLD by age and major disease categories in women, Viet Nam 2008
Page 35
YLD by cause
The leading specific cause of YLD in men was alcohol use disorders, followed by
depression, road traffic accidents and vision loss. In women, depression was the leading
cause of the YLD, followed by vision loss, osteoarthritis and anxiety disorders. COPD,
falls, and drug use disorders appeared among the top ten causes of YLD in men but not in
women while dementia, hearing loss and schizophrenia were top ten causes of YLD in
women but not in men.
Table 4. Top 10 causes of YLD by sex
Male
Rank
Disease category
YLD
Female
%
Disease category
YLD
%
1
Alcohol use disorders
303,138
14%
Depression
638,658
29%
2
Depression
237,014
11%
Vision loss
223,711
10%
3
177,909
8%
Osteoarthritis
202,544
9%
4
Vision loss
164,032
8%
Anxiety disorders
146,254
7%
5
Stroke
135,817
6%
Dementia
129,578
6%
6
Osteoarthritis
120,839
6%
Diabetes
114,855
5%
7
COPD
114,966
5%
Stroke
109,144
5%
8
Falls
114,960
5%
91,075
4%
9
Drug use disorders
104,769
5%
Schizophrenia
74,926
3%
10
Diabetes
77,749
4%
Hearing loss
65,381
3%
5.4. DISABILITY ADJUSTED LIFE YEARS (DALYS)
In 2008 the total BoD in Viet Nam amounted to 12.3 million DALYs. Non-communicable
diseases were responsible for more than three-quarters of total disease burden. Injuries
contributed to 16% of the total burden (Figure 19).
Page 36
13%
16%
Group I
Group II
Group III
71%
Figure 19. DALYs by major disease groups, Viet Nam 2008
The burden due to premature death (YLL) in Vietnam 2008 is larger than the burden due to
illness (YLD) (Figure 20).
Millions
Total
56%
Female
50%
44%
50%
YLL
YLD
Male
60%
0
2
40%
4
6
8
10
12
14
Proportion of the total DALYs
Figure 20. YLL and YLD as proportion of total burden by sex, Viet Nam 2008
Neuropsychiatric conditions and cardiovascular disease were the leading cause groups for
disease burden in Viet Nam in 2008, each responsible for 18% of total DALYs. Unintentional injuries and cancers ranked third and fourth, accounting for 14% and 13% of total
DALYs, respectively (Figure 21).
Page 37
11%
18%
3%
Cardiovas cular diseas es
3%
4%
Cancer
Infectious diseases
4%
18%
5%
Sense organ diseas es
Musculos keletal dis eases
7%
Diabetes mellitus
13%
Other
14%
Figure 21. DALYs by major disease categories, Viet Nam 2008
DALYs by sex
The total number of DALYs in men was 6.8 million and 4.5 million in women. Noncommunicable diseases were the main cause for the total BoD in both men (77%) and
women (66%). The proportion of communicable diseases contributing to total DALYs in
men and women was almost similar. The contribution of injuries to total DALYs in men was
two times higher than that in women (Figure 22).
Proportion of the total DALYs
90%
77%
80%
66%
70%
60%
50%
40%
Female
30%
20%
20%
12% 14%
Male
10%
10%
0%
Group I
Group II
Group III
Disease groups
Figure 22. DALYs by sex and major disease groups, Viet Nam 2008
Page 38
In men, unintentional injuries were the leading cause of BoD contributing 18% of total
DALYs. Cardiovascular disease was responsible for 17% of the total, followed by
neuropsychiatric conditions and cancers both contributing 14% to the total. Together,
these four disease groups contributed approximately two thirds of the total BoD (Figure 23).
The leading cause of BoD in women was neuropsychiatric conditions (22%), followed by
cardiovascular diseases (18%), and then cancer and unintentional injuries (both 12%).
Together, the top four disease categories were responsible for two thirds of all DALYs in
women (Figure 24).
12%
18%
2%
3%
3%
Cancer
4%
Infectious diseases
5%
17%
Digestive diseases
8%
14%
14%
other
Figure 23. DALYs by major disease categories in men, Viet Nam 2008
13%
22%
3%
Cancer
4%
4%
5%
Infectious diseases
18%
5%
Diabetes m ellitus
5%
other
9%
12%
Figure 24. DALYs by major disease categories in women, Viet Nam 2008
Page 39
DALY by age
The lowest burden was experienced in the age group 5 to 14. After that the BoD in men
increased gradually with age, peaking in the 45 to 59 age group. The total BoD in early
childhood was predominantly due to communicable diseases. After age 15, noncommunicable diseases were leading causes though injuries also contributed significantly
to the BoD at ages 15 to 59 (Figure 25).
Millions
Disability Adjusted Life Years
1.8
1.6
1.4
1.2
Group III
1.0
Group II
0.8
Group I
0.6
0.4
0.2
0.0
0-4
5-14
15-29
30-44
45-59
60-69
70-79
80+
Age groups
Figure 25. DALYs by age and major disease groups in men, Viet Nam 2008
Before age of 14, the burden rose gradually with age groups in women. After that, the BoD
in women peaked again at age 79 due to non-communicable diseases (Figure 26).
Page 40
1.2
Millions
Group III
1.0
Group II
Group I
0.8
0.6
0.4
0.2
0.0
0-4
5-14
15-29
30-44
45-59
Age groups
60-69
70-79
80+
Figure 26. DALYs by age and major disease groups in women, Viet Nam 2008
Infectious and parasitic diseases were the main causes of the burden in males under 15 of
age. Between ages 15 and 44 unintentional injuries and neuropsychiatric conditions
dominated the BoD in men. Cardiovascular disease and cancer were the main causes of
burden in older men (Figure 27).
1.8
Millions
others
1.6
1.4
1.2
1.0
Digestive diseases
0.8
0.6
0.4
Infectious diseases
0.2
Cancer
0.0
0-4
5-14
15-29
30-44
45-59
Age groups
60-69
70-79
80+
Figure 27. DALYs by age and major disease categories in men, Viet Nam 2008
Page 41
The pattern of the burden in women under 45 years of age was different to men. Unintentional
injuries were the main cause in young girls. Neuropsychiatric conditions and injuries were the
most important causes of burden in young adult women. Similar to older men, cardiovascular
disease and cancer contributed most to the burden in older women (Figure 28).
1.2
Millions
Others
1.0
Diabetes mellitus
0.8
Infectious diseases
0.6
0.4
0.2
Cancer
0.0
0-4
5-14
15-29
30-44
45-59
Age groups
60-69
70-79
80+
Figure 28. DALYs by age and major disease categories in women, Viet Nam 2008
DALYs by cause
Stroke was the leading cause of DALYs in men, contributing 10% of total burden. For
women, depression was the leading cause of the burden, accounting for 12% of total burden. Road traffic accidents, alcohol use disorders, liver cancer and HIV/AIDS were the
next main causes in men. Stroke, vision loss, diabetes and road traffic accidents were the
next causes in women (Table 5). The top ten causes in both men and women were responsible for just under half of the total BoD.
Page 42
Table 5. Top 10 causes of DALYs by sex
Male
Rank
Disease category
1
Female
DALYs
%
Stroke
714,931
10%
2
559,637
3
4
Disease category
DALYs
%
Depression
638,658
12%
8%
Stroke
562,501
10%
315,841
5%
Vision loss
223,711
4%
Liver cancer
312,804
5%
Diabetes
219,669
4%
5
HIV/AIDS
285,748
4%
212,704
4%
6
Depression
237,014
3%
Osteoarthritis
209,452
4%
7
COPD
227,957
3%
Anxiety disorders
146,254
3%
8
Lung cancer
214,804
3%
Pneumonia
146,202
3%
9
Falls
185.372
3%
COPD
143,410
3%
10
Pneumonia
183,475
3%
Dementia
143,258
3%
5.5. AGE AND SEX PATTERNS OF DISEASE BURDEN
Children aged 0-14 years
In 2008 the total BoD in children 0-14 years in Viet Nam was 1.3 million DALYs, accounting for 11% of the total BoD. Unintentional injuries, congenital anomalies and respiratory
disease combined were responsible for half of the total of the burden in this age group
(Figure 29).
2%
6%
5%
22%
8%
8%
16%
Infectious dis eases
9%
Sens e organ diseases
11%
13%
Other
Figure 29. DALYs by major disease categories in the 0-14 age group, Viet Nam 2008
Page 43
Congenital anomalies and perinatal conditions were the leading specific causes of BoD in
children, followed by pneumonia and nutritional deficiencies. In addition, many types of
injuries such as drowning, fall and road traffic accidents appeared as the main causes of
BoD in children (Table 6).
Table 6. Top 10 causes of DALYs among children below 15 years of age in both
sexes
Rank
Disease category
Both sexes
DALYs
%
1
Pneumonia
150,228
11%
2
Drownings
89,853
7%
3
Falls
51,953
4%
4
37,009
3%
5
Epilepsy
23,073
2%
6
Hearing loss
19,718
1%
7
Diarrhea
16,639
1%
8
Depression
15,983
1%
9
Anxiety disorders
15,142
1%
10
Vision loss
8,450
1%
Males and Females aged 15 to 44 years
In men aged between 15 and 44 unintentional injuries were the leading BoD cause and
neuropsychiatric conditions ranked second. These two disease groups contributed about
half of the total BoD in this age range. Infectious diseases and cardiovascular diseases
were responsible for one fifth of total BoD in males of this age group. In women of a similar
age group, neuropsychiatric conditions, unintentional injuries, infectious diseases, and intentional injuries were the leading causes of the BoD (Figures 30 and 31).
Page 44
3%
6%
3%
3%
28%
3%
Infectious diseases
3%
Cancer
7%
7%
Digestive diseases
Other
23%
14%
Figure 30. DALYs by major disease categories in the 15-44 age group in men,
Viet Nam 2008
8%
2%
3%
4%
Infectious diseases
4%
40%
Cancer
4%
7%
Diabetes m ellitus
7%
Other
8%
13%
Figure 31. DALYs by major disease categories in the 15-44 age group in women,
Viet Nam 2008
Road traffic accidents were the leading specific cause of BoD in men aged 15 to 44, contributing
15% of the total of the burden. The next leading causes, HIV and alcohol use disorders,
combined, and accounted for 17% of the total of the burden. For women, depression was the
leading specific cause in this age group, responsible for 24% of the total burden, followed by
road traffic accidents (8%) and anxiety disorders (7%). HIV/AIDS ranks second in men, whilst it
ranks seventh in women. Liver cancer, falls and drug use disorders were top-ten causes of BoD
in men of this age group but not in women. Conversely, anxiety disorders, vision loss and diabetes were among top-ten BoD causes in women but not in men (Table 7).
Page 45
Table 7. Top 10 causes of DALYs by sex in the 15-44 age group
Male
Rank Disease category
Female
DALYs
%
Disease category
DALYs
%
1
384,885 15%
Depression
383,971
24%
2
HIV/AIDS
269,592 10%
124,518
8%
3
191,147
7%
Anxiety disorders
106,526
7%
4
Depression
149,309
6%
Osteoarthritis
100,193
6%
5
Stroke
130,827
5%
Schizophrenia
65,575
4%
6
Drug use disorders
106,600
4%
Vision loss
60,503
4%
7
Falls
87,370
3%
HIV/AIDS
52,278
3%
8
Liver cancer
68,872
3%
Diabetes
42,633
3%
9
Schizophrenia
67,610
3%
Stroke
37,838
2%
10
Osteoarthritis
65,382
2%
Tuberculosis
34,502
2%
Males and females aged 45 – 69 years
Cancer contributed 23% of the total burden in men and 18% of the total burden in women
aged 45 to 69 years. Cardiovascular diseases were the second leading cause in women
and the third leading cause of the BoD in men. Neuropsychiatric disorders were the
leading cause group in women in this age group, responsible for 19% of the total burden,
but ranked third in men accounting for 11% of the total BoD (Figures 32 and 33).
8%
3%
23%
3%
Cancer
4%
5%
Digestive diseases
5%
Sens e organ dis eases
Infectious diseases
5%
Congenital anom alies
22%
Diabetes m ellitus
other
11%
11%
Figure 32. DALYs by major disease categories in 45-69 age groups in men,
Viet Nam 2008
Page 46
8%
2%
3%
19%
3%
Cancer
6%
8%
18%
Diabetes m ellitus
Infectious diseases
8%
Digestive diseases
Other
8%
17%
Figure 33: DALYS by major disease categories in the 45-69 age group in women,
Viet Nam 2008
Stroke was the leading specific cause of BoD in both men and women in this age bracket.
The next three leading causes were liver cancer, road traffic accidents and lung cancer in
men, and COPD, lung cancer, and ischemic heart disease in women (Table 8).
Table 8. Top 10 causes of DALYs by sex in the 45-69 age group
Rank Disease category
Male
DALYs
%
Disease category
14% Depression
Female
DALYs
%
220,731
13%
1
Stroke
343,396
2
Liver cancer
191,497
8% Stroke
156,548
9%
3
139,243
6% Vision loss
107,214
6%
4
Lung cancer
127,657
5% Diabetes
100,593
6%
5
122,931
5% Osteoarthritis
97,719
6%
6
COPD
86,819
4% Liver cancer
68,525
4%
7
86,406
4% Road traffic injuries
63,393
4%
8
Vision loss
83,144
3% Ischaemic heart disease
59,551
3%
9
Depression
76,381
3% Dementia
52,119
3%
10
Diabetes
71,417
3% Lung cancer
49,956
3%
Adults aged 70+ years
Total burden at ages 70 and above was almost 2.5 million DALYs. Women accounted for
58% of the total of the DALYs in this age group. Cardiovascular diseases were the leading
Page 47
cause group in both sexes, contributing 40% to total BoD at this age. Cancers were the
next leading cause group, followed by neuropsychiatric disorders in women and respiratory disease in men (see Figures 34 and 35).
2%
2%
5%
3%
Cancer
4%
4%
40%
5%
Infectious and parasitic
diseases
Digestive diseases
5%
Diabetes m ellitus
10%
other
20%
Figure 34. DALYs by major disease categories at ages 70+ in men,
Viet Nam 2008
7%
3%
3%
Cancer
4%
4%
40%
Diabetes mellitus
5%
Infectious and parasitic diseases
5%
7%
Digestive diseases
9%
13%
Other
Figure 35. DALYs by disease categories at ages 70+ in women, Vietnam 2008
Stroke was the leading cause for both older men and women (Table 9), responsible for
22% of total BoD in men and 24% in women respectively. Other cardiovascular diseases
also ranked second in both sexes. COPD, lung cancer, and IHD were the next three leading causes in older men while dementia, COPD and diabetes held that position in women.
Page 48
Table 9. Top 10 causes of DALYs by sex in the 70+ age group
Rank
Male
Disease category
Disease category
DALYs
%
Stroke
Female
DALYs
%
367,039
24%
1
Stroke
234,042
22%
2
COPD
80,255
8%
Dementia
91,139
6%
3
Lung cancer
60,332
6%
COPD
82,857
5%
4
57,927
5%
Diabetes
76,443
5%
5
Liver cancer
51,568
5%
61,082
4%
6
Tuberculosis
41,848
4%
Pneumonia
52,691
3%
7
Stomach cancer
34,920
3%
Vision loss
52,359
3%
8
Diabetes
32,774
3%
Lung cancer
39,027
3%
9
Dementia
28,758
3%
Liver cancer
36,471
2%
10
Pneumonia
25,360
2%
Tuberculosis
32,762
2%
5.6. SPECIFIC DISEASE AND INJURY CATEGORIES
Most of the burden of cancer, cardiovascular disease, unintentional injuries, infectious and parasitic diseases was due to premature deaths. In contrast, the burden of sense organ disease,
mental disorder and, musculoskeletal disease was mainly caused by disability (Figure 36).
Other
Diabetes mellitus
YLL
Infectious diseases
YLD
Cancer
0%
5% 10% 15% 20% 25% 30% 35% 40% 45%
% of the total DALYs
Figure 36. YLL and YLD by major disease categories, Viet Nam 2008
Page 49
Infectious and respiratory diseases
Overall, the BoD caused by infectious diseases was higher in men than in women. DALYs
caused by HIV/AIDS in men were four times higher than in women. The burden of pneumonia was similar in both sexes (Figure 37).
Other respiratory infectious
Upper respiratory infectious
Pneumonia
Other infectious disease
Male
Female
Diarrhoea
HIV/AIDS
TB
0%
1%
2%
3%
4%
5%
Figure 27. The burden of specific infectious diseases by sex, Viet Nam 2008
Figure 38 presents the rate of disease burden as DALYs per 100,000. Pneumonia was the
main cause of the respiratory infection burden in young boys. In the next age range,
HIV/AIDS was the leading cause. The majority of the burden rate caused by infectious diseases in men at age 60 years (and above) was due to TB. Pneumonia and upper respiratory infections were important burden causes from age 70 onward.
Page 50
Thousands
DALYs per 100000 population
12
10
8
Pneumonia
6
Diarrhoea
4
HIV/AIDS
2
TB
0-4
5-14 15-29 30-44 45-59 60-69 70-79 80+
Age groups
Figure 38. DALY rates (per 100,000 populations) for infectious diseases
by age in men, Viet Nam 2008
Similar to men, the rate of the burden of infectious disease in women was dominated by
pneumonia in 0 to 4 and 70+ age groups (Figure 39). In early childhood, pneumonia made
up the bulk of the rate of burden. In adulthood, besides pneumonia, TB was the main
cause for a sharp rise in the rate of the burden. HIV/AIDS also contributed to the increase
with age in the burden rate.
Thousands
14
12
10
Pneumonia
8
6
Diarrhoea
4
HIV/AIDS
2
TB
0-4
5-14 15-29 30-44 45-59 60-69 70-79 80+
Age groups
Figure 39. DALY rates (per 100,000 populations) for infectious diseases in women,
Viet Nam 2008
Page 51
Cancer
The pattern of the burden of cancer differs between men and women. It was higher in men
for most cancers. This is particularly the case for lung, liver and mouth cancer, which were
almost twice as common in men. However, some cancers that exist common in women
such as ovary, uterus and breast cancer, also show significant percentages (Figure 40).
Other malignant neoplasms
Leukaemia
Lymphomas, multiple myeloma
Bladder cancer
Prostate cancer
Ovary cancer
Uterus cancer
Breast cancer
Male
Melanoma and other skin cancers
Female
Lung cancer
Pancreas cancer
Liver cancer
Bowel cancer
Stomach cancer
Oesophagus cancer
Mouth and oropharynx cancers
0.0%
0.5%
1.0%
1.5%
2.0%
2.5%
3.0%
3.5%
4.0%
4.5%
5.0%
Figure 40. DALYs by sex of specific cancers, Viet Nam 2008
The DALY rate for cancer increased steadily with age, up until 70 years, before declining.
Stomach, liver, and lung were the most common cancer types in both men and women
(Figure 41 and 42).
Page 52
Thousands
Leukaemia
16
14
Bladder cancer
12
Prostate cancer
10
Breast cancer
8
Lung cancer
6
Pancreas cancer
4
Liver cancer
Bowel cancer
2
Stomach cancer
-
Oesophagus cancer
0-4
5-14
15-29
30-44
45-59
60-69
70-79
80+
Age groups
Figure 41. DALY rates per 100,000 population for specific cancers in men,
Viet Nam 2008
Thousands
10
Leukaemia
9
8
Bladder cancer
7
Ovary cancer
6
Uterus cancer
Breast cancer
5
4
Lung cancer
3
Pancreas cancer
2
Liver cancer
Bowel cancer
1
Stomach cancer
0-4
5-14
15-29
30-44
45-59
Age groups
60-69
70-79
80+
Oesophagus cancer
Figure 42. DALY rates per 100,000 population for specific cancers in women,
Viet Nam 2008
Page 53
Diabetes Mellitus
The burden of diabetes mellitus amounted to 358,000 DALYs with a greater burden in
women than in men (Figures 43). Disability was the cause of 46% of DALYs from diabetes.
Male
Male
Female
Female
0%
1%
2%
3%
4%
5%
Figure 43. DALYs for diabetes by sex, Viet Nam 2008
DALY rates rose gradually to a peak at about 3.8 per 100,000 population in the 60-69 age
group in both sexes (Figures 44 and 45).
Thousands
4.0
3.0
2.0
Diabetes
1.0
0.0
0-4
5-14
15-29
30-44
45-59
60-69
70-79
80+
Age groups
Figure 44. DALY rates per 100,000 population for diabetes by age in men,
Viet Nam 2008
Page 54
Thousands
9.0
8.0
7.0
6.0
5.0
Diabetes
4.0
3.0
2.0
1.0
0.0
0-4
5-14
15-29
30-44
45-59
60-69
70-79
80+
Age groups
Figure 45. DALY rates per 100,000 population for diabetes by age in women,
Viet Nam 2008
Neuropsychiatric disorders
In 2008, neuropsychiatric disorders contributed more than 2.1 million DALYs to the BoD in
Viet Nam. Overall, the burden of mental disorders in women was higher than in men due
to a higher burden of depression, anxiety, dementia, and schizophrenia. Drug use disorder
and alcohol use disorder caused a greater burden in men than in women (Figure 46).
Other neuropsychiatric disorders
Drug use disorders
Dementia
Male
Epilepsy
Female
Schizophrenia
Anxiety disorders
Depression
0%
2%
4%
6%
8%
10%
12%
14%
Figure 46. DALYs by sex of specific neuropsychiatric disorders, Viet Nam 2008
Page 55
DALY rates for neuropsychiatric disorders in males rose sharply from age 5 to age 44. After that, there was a plateau in rates during ages 45 to 60 years. In young and middle aged
adult men, alcohol abuse disorder dominated the BoD, followed by depression. Dementia
made the largest contribution to the BoD in men over age 60 (Figure 47).
Thousands
10
9
8
Drug use disorders
7
Dementia
6
5
4
Epilepsy
3
Schizophrenia
2
Anxiety disorders
1
Depression
0-4
5-14 15-29 30-44 45-59 60-69 70-79 80+
Age groups
Figure 47. DALY rates per 100,000 populations of mental disorders in men,
Viet Nam 2008
DALY rates in women were higher compared to those in men (2739 vs. 2349 per 100,000)
despite having low rates of alcohol and drug use disorders. It increased steadily to a peak
at the oldest age group. This increase in the elderly was mainly due to dementia. Depression was the greatest contributor to BoD at ages 15 and 60 years (Figure 48).
Thousands
10
9
Drug use disorders
8
7
Dementia
6
5
Epilepsy
4
3
Schizophrenia
2
Anxiety disorders
1
Depression
0-4
5-14
15-29 30-44 45-59 60-69 70-79
80+
Age groups
Figure 48. DALY rates per 100,000 population for mental disorders in women,
Viet Nam 2008
Page 56
Overall, the burden of vision loss and hearing loss in women was higher than in men (Figure 49).
Hearing loss
Male
Female
Vision loss
0%
1%
2%
3%
4%
5%
Figure 49. DALYs by sex of sense organ diseases, Viet Nam 2008
Overall, the pattern of DALY rates for hearing loss and vision loss were similar in men and
women. During childhood, DALY rates reached a peak at ages 5 to 14 followed by a small
dip in early adulthood in both sexes, and then a steep rise with age. The contribution to the
burden of vision loss was much greater than that of hearing loss (Figures 50 and 51).
2,500
2,000
1,500
Hearing loss
1,000
Vision loss
500
0-4
5-14 15-29 30-44 45-59 60-69 70-79 80+
Age groups
Figure 50. DALY rates per 100,000 populations for sense organ diseases by age
in men, Viet Nam 2008
Page 57
3,500
3,000
2,500
Other sense organ
disorders
2,000
1,500
Hearing loss
1,000
Vision loss
500
0-4
5-14 15-29 30-44 45-59 60-69 70-79
80+
Age groups
Figure 51. DALY rates per 100,000 population for sense organ diseases by age
in women, Viet Nam 2008
Cardiovascular disease
In Viet Nam in 2008, cardiovascular disease was one of the largest contributors to the total
BoD. The contribution of stroke and IHD to the total cardiovascular disease burden was
similar among men and women while other cardiovascular diseases among men made up
a greater proportion (Figure 52).
Other
cardiovascular
diseases
Stroke
Male
Female
Ischaemic heart
disease
0%
2%
4%
6%
8%
10%
12%
Figure 52. DALYs by sex of cardiovascular diseases, Vietnam 2008
Page 58
DALY rates for cardiovascular diseases increased with age in both sexes with stroke being
the dominant cause of burden (Figures 53 and 54).
Thousands
40
Other
cardiovascular
diseases
30
Stroke
20
Ischaemic
heart disease
10
0-4
5-14
15-29 30-44 45-59 60-69 70-79
Age groups
80+
Figure 53. DALY rates per 100,000 population for cardiovascular diseases in men
by age, Viet Nam 2008
Thousands
40
Other
cardiovascular
diseases
30
Stroke
20
Ischaemic
heart disease
10
0-4
5-14
15-29
30-44 45-59
Age groups
60-69
70-79
80+
Figure 54. DALY rates per 100,000 population for cardiovascular diseases by age
Page 59
COPD
Compared to women, men made a greater contribution to the total burden due to COPD
(Figure 55). The number of DALYs, caused by COPD was also higher in men.
Other respiratory
diseases
Male
Female
COPD
0%
1%
1%
2%
2%
3%
3%
4%
Figure 55. The burden of disease of respiratory diseases by sex, Viet Nam 2008
DALY rates for COPD and other respiratory disease increased steadily with age in men
and women (Figures 56 and 57).
Thousands
Other respiratory diseases
12
10
COPD
8
6
4
2
0-4
5-14
15-29
30-44
45-59
60-69
70-79
80+
Age groups
Figure 56. DALY rates per 100,000 population for respiratory diseases by age
Page 60
Thousands
12
10
8
COPD
6
4
2
0-4
5-14
15-29
30-44
45-59
60-69
70-79
80+
Age groups
Figure 57. DALY rates per 100,000 population for specific respiratory diseases by
age in women, Viet Nam 2008
Musculoskeletal disorders
The contribution of osteoarthritis to the total burden in women was about two times higher
than in men (4% vs. 2%) (Figure 58). DALY rates per 100,000 population among women
were also almost doubled that among men (Figure 59, 60).
Other
musculoskeletal
disorders
Male
Female
Osteoarthritis
0%
1%
2%
3%
4%
5%
Figure 58. The burden of musculoskeletal disorders by sex, Viet Nam 2008
Page 61
1,500
Other musculoskeletal
disorders
1,200
900
Osteoarthritis
600
300
0-4
5-14 15-29 30-44 45-59 60-69 70-79 80+
Age group
Figure 59. DALY rates per 100,000 population by age for musculoskeletal diseases
3,000
2,500
2,000
disorders
1,500
1,000
Osteoarthritis
500
0-4
5-14
15-29 30-44 45-59 60-69 70-79
80+
Age group
Figure 60. DALY rates per 100,000 population by age for musculoskeletal diseases
Injuries
DALYs due to unintentional injuries were 2.5 times higher in men than in women (1.229 vs.
505). Road traffic accidents contributed most to the unintentional injury burden, with about 4%
Page 62
in women and 8% in men. Falls and drowning were two other significant causes in both sexes
(Figure 61). Unintentional injuries were among the leading causes of the BoD (14% of total
burden) (Figure 62). The largest proportion of the burden for unintentional injuries was from
premature death, particularly for road traffic accidents, drowning and poisoning.
Other unintentional injuries
Drownings
Fires
Falls
Male
Female
Poisonings
0%
1%
2%
3%
4%
5%
6%
7%
8%
9%
Figure 61. DALYs by sex of specific unintentional injuries, Viet Nam 2008
Other unintentional
injuries
Drownings
Fires
YLL
Falls
YLD
Poisonings
000
100
200
300
400
500
600
700
800
900
Thousands
Disability adjusted of Life Years
Figure 62. The fatal and non-fatal burden of disease of unintentional injuries,
Viet Nam 2008
Page 63
DALY rates in men for unintentional injuries showed a peak in young adults. In women the
rates peaked in young adults and again in the elderly. Drowning was the most common
cause of burden in young children of both sexes. Between ages 15 and 69 road traffic accidents dominated the DALY rates of both sexes. From age 70 years onwards falls are the
largest cause of burden (Figures 63 and 64). Notably, from age 60, the rates of burden
due to injuries in women increased steadily while the rates in men declined gradually.
4,500
4,000
3,500
Drownings
3,000
2,500
Fires
2,000
Falls
1,500
1,000
Poisonings
500
0-4
5-14
15-29
30-44
45-59
60-69
70-79
80+
Age groups
Figure 63. DALY rates per 100,000 populations by age for unintentional injuries
3,000
2,500
Drownings
2,000
Fires
1,500
1,000
Falls
500
Poisonings
0-4
5-14
15-29
30-44
45-59
60-69
70-79
80+
Age groups
Figure 64. DALY rates per 100,000 populations by age for unintentional injuries
Page 64
Intentional injuries contributed 1.5% to the total BoD in Viet Nam. Suicide was responsible
for most of the burden caused by this category (Figure 65).
Violence
Male
Female
Suicide
0%
0%
0%
1%
1%
1%
1%
Figure 65. DALYs by sex of intentional injuries, Viet Nam 2008
Similar to unintentional injuries, the burden in males was higher than that for females
for both causes of intentional injuries (Figures 66 and 67). DALY rates for intentional
injuries peaked in young adults and the elderly.
450
400
350
300
250
200
Violence
150
Suicide
100
50
0-4
5-14
15-29
30-44
45-59
60-69
70-79
80+
Age groups
Figure 66. DALY rates per 100,000 population by age for intentional injuries
Page 65
400
350
300
250
200
Violence
150
Suicide
100
50
0-4
5-14
15-29
30-44
45-59
60-69
70-79
80+
Age groups
Figure 67. DALY rates per 100,000 population by age for intentional injuries
Page 66
DISCUSSION
This study is significant: it is the first-ever attempt to provide a comprehensive estimate of
the patterns of the BoD and injury in Viet Nam. The results are based on the pool of data
on mortality, non-fatal health outcomes, and injury that was available for more than 50
disease and injury categories in a single measurement (DALYs) of the population’s health
status. Study findings constitute a valuable source of information to aid decision making
and priority setting in healthcare in the country. The mortality estimates were derived from
national VA studies, which allowed for the first time an understanding of the full picture of
causes of death. Attention given to accurate cause of death data hopefully will lead to
improvements in the death-certification process. Ultimately, this should reduce the need
for specific data collections in the future, such as through VA study.
A large number of estimates describing the epidemiology of the main diseases in Viet Nam
are now available, including incidence, prevalence, severity distribution and the risk of
disabling sequelae. These estimates will be very useful for health planners and policy
makers. For example, the prevalence figures in combination with health service usage
figures can give an indication of the coverage of health services. In turn, this will highlight
which health problems of Viet Nam may require more investment into health infrastructure
and service provision (and types of service provision).
The disease burden of Vietnam in 2008 was dominated by non-communicable diseases
causing 70% of health loss. Injuries were responsible for 16% and the remainder was due
to communicable diseases, maternal and neonatal conditions. Cardiovascular diseases,
particularly stroke, and unintentional injuries, especially road traffic accidents, were major
leading causes of burden among adult populations, whereas pneumonia was the leading
cause among children. This pattern of disease burden implies that efforts need to be made
to prevent emergent non-communicable diseases and injury while measures to control
infectious diseases remain important.
The use of DALYs as a summary measure of the population health allows meaningful
comparisons of health loss caused by different diseases, taking into account fatal and
non-fatal health outcomes. Thus, largely non-fatal health outcomes such as mental
Page 67
disorders, musculoskeletal disorders and sense organ disorders become apparent as
large health problems while with the traditional mortality-based measures they would have
been ignored. This information is of further import given it re-focuses public health
attention on the contribution chronic diseases have on the overall BoD in Viet Nam, with
further implications for national health policy, planning and health promotion.
Data quality
Findings from this study should be interpreted in conjunction with its limitations. First,
death reporting was found to be incomplete with substantial variations among different
regions throughout the country, particularly concerning deaths among children under 5
years of age. We relied on a 2008 life table for Viet Nam generated for the Global Burden
of Disease, update of which is currently being conducted by the University of Washington,
Harvard University, The University of Queensland, the World Health Organization and
Johns Hopkins University. The life table was created based on a statistical model of
available mortality data by country and year. As there was little data from Viet Nam
contributing to this statistical model, there is uncertainty about the validity of the estimates.
Second, causes of death were based on the VA method. While this is deemed an acceptable alternative in the absence of a valid vital registration system as is the case in Viet
Nam, its shortcomings in determining cause of death should be considered. VA studies
ought not to be a long term strategy to collect information on causes of death that are vital
to health planning. The ultimate goal has to be to improve the vital registration system.
This will require collaboration between the ministries and local government who are
currently involved in mortality data collection systems at the commune level. A single
registration system would need to be created at local level that pools and corrects all
information and provides an electronic record of each death with details on age, sex,
cause, place and date of death, and area of residence.
Third, data for non-fatal health outcomes were largely based on surveys of varying quality.
For mental disorders and diabetes there were major inconsistencies or implausible
consistency of age-specific estimates between successive surveys conducted in 2006 and
2008. Access to unit record data of surveys, apart from the national surveys conducted by
Page 68
the General Statistics Office is restricted and makes it difficult to make a judgment on the
quality of the data collected. As all of these surveys are funded by public or donor funds, it
is advisable that Government regulates that all survey unit record data files are submitted
to a national health survey data warehouse and be made available to bona fide
researchers leaving a reasonable amount of time following data collection (e.g. two years)
to allow the primary researchers time to publish data.
Incomplete information on hospitalizations (limitations of a largely paper-based recording
system of tabulations, e.g. lack of detail by age, sex and cause; as yet, incomplete
coverage of electronic records) meant we had to rely on additional information from the
more detailed hospital registration system in Thailand. Table 10 (located on the following
page) indicates the major quality issues for the main diseases.
For the calculation of the YLD from injuries we had limited data about the nature of injuries
from the injury surveys, indicating the location of the injury but not the type. We recommend
that in future injury survey greater detail on the nature of injuries is collected.
Despite limitations, this study can be considered as ground work for future BoD and mortality
investigations in Viet Nam. It also highlighted the weaknesses of available data collection
systems as well as the needs for strengthening the existing health information system in the
country. While there is considerable uncertainty around input data for the DALYs estimates,
results are considered a reasonable overall picture of health problems for Viet Nam to aid
health policy making. It certainly is a major improvement over having a collection of disparate
health statistics of unknown validity and completeness. However, there is considerable scope
to improve the accuracy of these estimates if routine data collection systems and surveys can
be improved based on the recommendations in this report.
Page 69
Table 10. Data sources for prevalence and incidence and quality issues
for the main diseases
Data source
Diseases
Issues
Hospital data
IHD, stroke
•
incomplete coverage
•
only two age groups: <5 and 5+
•
Assumed full coverage of TB cases in contact
with health services
•
Unknown undetected cases of TB
•
HIV/AIDS estimates from good quality
modeling study
•
Good surveys but incomplete information on
nature of injuries
•
Inconsistencies in child estimates between
surveys
•
Incomplete coverage
•
Coverage varies between register sites
•
Inconsistency between incidence and mortality
estimates
•
Representative, good quality self report data
mental disorders
•
No unit record data available
dementia
•
No information on severity
epilepsy
•
Sudden large increase in prevalence of
depression between mental health surveys of
2008 and 2006
•
Implausible replication of age and sex patterns
between successive surveys
•
Viet Nam part of survey
•
Good quality study
•
Good quality study
Disease notifications
TB
HIV/AIDS
Injury surveys
Cancer register
National Health Survey
injuries
cancers
diarrhea
respiratory infections
hearing loss
vision loss
Mental Health Survey
Multi country survey
COPD survey
Osteoarthritis
COPD
Page 70
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Page 75
APPENDIX
Appendix 1. Diseases and injury categories and ICD-10
Diseases and injuries
ICD-10 Code
I Communicable, maternal, perinatal and nutritional
A00-B99, G00-G02, N70-N73, J00-J06, J10J18, J20-J22, H65-H66, O00-O99, P00-P99,
E00-E02, E40-E46, E50, D50-D53, 55-D57, D80D89
A Infectious and parasitic diseases
A00-B99, G00, N70-N73
1 Tuberculosis
A15-A19, B90
2 HIV
B20-B24
3 Diarrheal diseases
A00-A04, A06-A09
B Respiratory infections
J00-J06, J10-J18, J20-J22, H65-H66
1 Lower respiratory infections
J10-J22
2 Upper respiratory infections
J00-J06
3 Otitis media
H65-H66
C Maternal conditions
O00-O99
D Conditions arising during the perinatal period
P00-P99
E Nutritional deficiencies
E00-E02, E40-E46, E51-E64, D50-D53
II Non-communicable diseases
C00-C97, D00-D48, D55-D80, E03-E07, E10E16, E20-E34, E65-E89, F00-F99, G03-G99,
H00-H61, H68-H95, I00-I99, J30-J99, K00-K99,
N00-N64, N75-N99, L00-L99, M00-M99, Q00Q99
A Malignant neoplasms
C00-C97
1 Mouth and oropharynx cancers
C00-C14
2 Oesophagus cancer
C15
3 Stomach cancer
C16
4 Colon and rectum cancers
C18-C21
5 Liver cancer
C22
6 Pancreas cancer
C25
7 Trachea, bronchus and lung cancers
C33-C34
8 Melanoma and other skin cancers
C43-C44
9 Breast cancer
C50
10 Cervix uteri cancer
C53
Page 76
11 Corpus uteri cancer
C54
12 Ovary cancer
C56
13 Prostate cancer
C61
14 Bladder cancer
C67
15 Lymphomas and multiple myeloma
C81-C87
16 Leukaemia
C91-C95
B Benign neoplasms
D00-D48
C Diabetes mellitus
E10-E14
D Endocrine disorders
D55-D80, E03-E07, E15-E16, E17-E34, E65-E89
E Neuropsychiatric conditions
F00-F69, F70-F99, G03-G99
1 Depression
F32-F33
2 Anxiety disorders
F40-F42
3 Schizophrenia
F20-F29
4 Epilepsy
G40-G41
5 Alcohol use/dependence
F10
6 Dementia
F00-F03, G30-G31
7 Drug use/dependence
F11-F16, F18-F19
F Sense organ diseases
H00-H61, H68-H95
G Cardiovascular diseases
I00-I99
1 Ischaemic heart disease
I20-I25
2 Stroke
I60-I69
H Respiratory diseases
1 Chronic obstructive pulmonary disease
J30-J99
J40-J44
I Digestive diseases
K20-K99
J Genito-urinary diseases
N00-N64, N75-N99
K Skin diseases
L00-L99
L Musculoskeletal diseases
M00-M99
1 Osteoarthritis
M15-M19
2 Other musculoskeletal
M00-M04, M07-M14, M20-M99
M Congenital anomalies
Q00-Q99
N Oral conditions
K00-K14
III Injuries
V01-Y98
A Unintentional injuries
V01-X59, Y40-Y98
Page 77
1 Road traffic accidents
V01-V89, Y85
2 Poisonings
X40-X49, Y14, Y16, Y17, Y18, Y19
3 Falls
W00-W19
4 Fires
X00-X09
5 Drownings
W65-W74
6 Other unintentional injuries
V90-V99, W20-W64, W75-W84, W85-W99, X10X39, X50-X59, Y40-Y84, Y86, Y88-Y91
B Intentional injuries
X60-Y09, Y35-Y36
1 Self-inflicted injuries (suicide)
X60-X84, Y87 0, Y87 1
2 Violence/homicide
X85-Y09
3 War
Y35-Y36
Page 78
Appendix 2. Disability Weights by disease and sequelae
Disease category and sequelae
Disability
Age/sex
weight
Comments
A Infectious and parasitic disease
1 Tuberculosis
Pulmonary tuberculosis
0.295
all
Dutch weight
Extra-pulmonary tuberculosis
0.300
all
Dutch weight
Early HIV
0.200
all
Dutch weight
Late HIV
0.310
all
Dutch weight
AIDS
0.560
all
Dutch weight
AIDS terminal phase
0.950
all
Dutch weight
Uncomplicated episode
0.056
all
Dutch weight for
uncomplicated episode
Complicated episode
0.402
all
Dutch weight for complicated
episode(50%) plus
uncomplicated episode(50%)
Pneumonia episode
0.280
all
GBD weoght
Acute nasopharyngitis
0.014
all
GBD weoght
Acute sinusitis
0.061
all
Australian study
Pharyngitis/tonsillitis
0.061
all
Australian study
Low grade malignancy, dissemination
stage I and II
0.190
all
Dutch disability weights
Low grade malignancy, dissemination
stage III and IV
0.610
all
Intermediate/high malignancy grade,
dissemination stage I
0.550
all
Intermediate/high malignancy grade,
dissemination stage II,III & IV
0.750
all
Temporary remission after treatment
0.190
all
Complete remission
0.190
all
Preterminal phase
0.750
all
Terminal phase
0.930
all
Dutch weight for end stage
2 HIV/AIDS
3 Diarrhoeal diseases
4 Respiratory infection
B Malignant neoplasms
Lymphomas, Multiple Myeloma
Page 79
Disability
Age/sex
weight
Comments
disease
Bladder
Diagnosis and primary therapy
0.270
all
Provisional weight based on
State after intentionally curative
primary therapy
0.180
all
Male survivors with
impotence/incontinence
0.200
all
WHO GBD 2000 study
In remission
0.180
all
Disseminated cancer
0.640
all
Terminal stage
0.930
all
disease
Diagnosis and primary therapy,
tumour <2 cm
0.260
all
Dutch disability weight
tumour 2-5 cm
0.690
all
tumour 5+ cm
0.810
all
primary therapy
0.260
all
Survivors with mastectomy
0.090
all
Weight taken from Global
Burden 2000 study
In remission
0.260
all
Disseminated cancer
0.790
all
Terminal stage
0.930
all
0.430
all
primary therapy
0.200
all
Survivors with hysterectomy
0.180
all
weight for infertility ages under
40
In remission
0.200
all
Disseminated cancer
0.750
all
Breast
Cervix uteri
Page 80
Terminal stage
Disability
Age/sex
weight
Comments
0.930
all
0.430
all
Dutch weight
primary therapy
0.200
all
Dutch weight
Survivors with stoma
0.210
all
WHO GBD 2000 weight
In remission
0.430
all
Dutch weight
Incompletely removed or
disseminated carcinoma
0.830
all
Dutch weight
Terminal stage
0.930
all
0.430
all
primary therapy
0.200
all
0.180
all
40
In remission
0.200
all
Disseminated cancer
0.750
all
Terminal stage
0.930
all
0.550
all
primary therapy
0.190
all
In remission
0.190
all
Preterminal cancer
0.750
all
Terminal stage
0.930
all
all
Provisional weight - Dutch
weight for colorectal cancer
Colon and Rectum cancer
Corpus Uteri
Leukemia
Liver cancer
0.430
Page 81
Disability
Age/sex
weight
Comments
a
primary therapy
0.200
all
In remission
0.200
all
Disseminated cancer
0.830
all
Terminal stage
0.930
all
Primary treatment, no evidence of
dissemination
0.190
all
No evidence of dissemination after
initial treatment
0.190
all
Primary treatment, lymph node but no
distant dissemination
0.430
all
In remission
0.190
all
Disseminated melanoma
0.810
all
Terminal stage
0.930
all
0.560
all
weight for oesophageal cancer
primary therapy
0.370
all
In remission
0.370
all
Disseminated cancer
0.900
all
Terminal stage
0.930
all
0.560
all
Dutch weight
primary therapy
0.370
all
Dutch weight
0.900
all
Dutch weight
Preterminal stage
0.930
all
Dutch weight
Terminal stage
0.930
all
Dutch weight
Melanoma
Mouth cancer
Oesophagus
Ovary
Page 82
Disability
Age/sex
weight
Comments
0.430
all
primary therapy
0.200
all
0.180
all
40
In remission
0.200
all
Disseminated cancer
0.750
all
Terminal stage
0.930
all
0.430
all
primary therapy
0.200
all
Disseminated cancer
0.830
all
Terminal stage
0.930
all
Diagnostic, primary therapy, localised
cancer
0.270
all
Clinically disease free after primary
therapy
0.180
all
Survivors with long term
impotence/incontinence
0.200
all
WHO GBD 2000 weight
In remission/watchful waiting
0.270
all
Hormone refractory cancer
0.640
all
Terminal stage
0.930
all
0.530
all
primary therapy
0.380
all
all
NOT APPLICABLE
all
Pancreas
Prostate
Stomach
Survivors with long term sequelae
0.730
Page 83
Terminal stage
Disability
Age/sex
weight
Comments
0.930
all
0.440
all
Disease free after primary therapy
0.470
all
Disseminated cancer
0.910
all
Terminal stage
0.930
all
0.070
all
GBD weight
Alcohol abuse
0.090
all
Australian study
Anxiety
0.098
Male
Australian study
0.093
Female
Australian study
Trachea, Bronchus and Lung
cancer
C Diabetes mellitus (IDDM and NIDDM)
D Mental Health
Dementia
0.520
Dutch weight
Depression
0.410
Male
Dutch weight
0.370
Female
Dutch weight
Drug dependence
0.270
Epilepsy
0.850
0-4 only
GBD weight
0.129
5 + age
GBD weight
Schizophrenia
Australian study
0.453
GBD weight
E Permanent disability
Mild hearing loss (25-34 dBHTL)
0.020
all
One half of Dutch disability
weight for mild hearing loss
Mild hearing loss (35-44 dBHTL)
0.040
all
Dutch weight
Moderate hearing loss
0.120
all
Dutch weight
Severe hearing loss
0.370
all
Dutch weight
Severe hearing loss (congenital or
early)
0.170
all
Dutch weight
Moderate vision loss
0.430
all
Dutch weight
Mild
0.080
all
Dutch weight
Severe
0.570
all
Dutch weight
F Ischemic Heart Disease
Angina pectoris
Page 84
Disability
Age/sex
weight
Comments
Acute myocardial infarction
Untreated
0.491
all
GBD weight
Treat
0.395
all
GBD weight
Mild
0.060
all
Dutch weight
Moderate
0.650
all
Dutch weight
Severe
0.350
all
Dutch weight
Heart failure
G Stroke
For first year survival
Male
0.33
< 65 age
0.37
74 age
0.27
75 + age
Western Australia follow up data
Female
0.20
< 65 age
0.27
65 – 74
age
0.39
75 + age
For subsequent years
0.59
Male
0.67
< 65 age
0.74
74 age
75 + age
0.67
Female
0.59
< 65 age
0.73
65 – 74
age
75 + age
H COPD
Mild to moderate COPD
0.17
all
Severe COPD
0.53
all
Grade 2 (radiological) hip or knee
0.01
all
Dutch disability weight for mild
ADL limitations in the elderly
Grade 2 symptomatic
0.14
all
Dutch disability weight for
Grade 2 (radiological)
Grade 3-4 asymptomatic
0.14
all
Grade 2 (radiological)
I OSTEOARTHRITIS
Page 85
Grade 3-4 symptomatic
Disability
Age/sex
weight
Comments
0.42
all
Grade 3-4 (radiological)
Skull-short term
0.431
all
GBD weight
Skull-long term
0.223
all
GBD weight
Vertebra column
0.266
all
GBD weight
Rib or sternum
0.199
all
GBD weight
Pelvis
0.247
all
GBD weight
Clavicle,scapula or humerus
0.153
all
GBD weight
Radius of ulna
0.180
all
GBD weight
Hand bone
0.100
all
GBD weight
Femur-short term
0.372
all
GBD weight
Femur-long term
0.272
all
GBD weight
Patella, tibia or fibula
0.271
all
GBD weight
Ankle
0.196
all
GBD weight
Foot bone
0.077
all
GBD weight
0.725
all
GBD weight
Shoulder, elbow or hip
0.074
all
GBD weight
Other dislocation
0.074
all
GBD weight
0.064
all
GBD weight
Short-term
0.359
all
GBD weight
Long-term
0.350
all
GBD weight
6 Internal injuries
0.208
all
GBD weight
7 Open wound
0.108
all
GBD weight
Short-term
0.108
all
GBD weight
Long-term
0.301
all
GBD weight
0.165
all
GBD weight
J Unintentional injuries
1 Fracture
2 Injured spinal cord
3 Dislocation
4 Sprains
5 Intracranial injuries
8 Injury to eye
9 Amputation
Thumb
Page 86
Disability
Age/sex
weight
Comments
Finger
0.102
all
GBD weight
Arm
0.257
all
GBD weight
Toe
0.102
all
GBD weight
Foot
0.300
all
GBD weight
Leg
0.300
all
GBD weight
10 Crushing
0.218
all
GBD weight
Less than 20% short-term
0.158
all
GBD weight
Less than 20% long-term
0.001
all
GBD weight
20% to 60% short-term
0.441
all
GBD weight
20% to 60% long-term
0.255
all
GBD weight
Greater than 60% short term
0.441
all
GBD weight
Greater than 60% long term
0.255
all
GBD weight
Short-term
0.064
all
GBD weight
Long-term
0.064
all
GBD weight
0.611
all
GBD weight
11 Burns
12 Injured nerves
13 Poisoning
Page 87
Appendix 3. Deaths by sex, ages and causes in Vietnam 2008
Males
Persons
Males
Females
0-4
5-14
15-29
30-44
45-59
60-69
70-79
80+
0-4
5-14
15-29
30-44
Females
45-59
60-69
70-79
80+
250,605
290,624
250,605
11,242
2,278
19,801
30,603
53,406
41,560
65,460
66,274
7,933
1,453
5,841
10,771
23,981
24,160
56,229
120,237
64,234
37,096
27,138
5,754
362
5,266
7,749
3,646
2,492
4,598
7,229
4,282
248
1,415
1,991
1,247
1,596
4,381
11,979
38,664
25,318
13,346
726
286
4,953
7,157
3,150
1,352
3,056
4,638
405
170
1,253
1,721
907
1,324
2,576
4,989
18,248
11,450
6,798
-
38
560
1,384
1,844
1,136
2,727
3,760
-
-
367
732
506
931
1,598
2,664
10,834
9,417
1,416
-
105
3,812
4,984
517
-
-
-
-
31
625
760
-
-
-
-
3,229
910
2,319
242
38
37
37
100
72
64
321
-
31
49
-
-
69
436
1,734
6,353
3,541
2,812
484
105
544
753
689
143
266
557
405
108
211
229
402
324
542
590
20,717
9,541
11,175
2,791
76
313
591
497
1,141
1,542
2,591
1,675
54
94
115
340
271
1,637
6,990
20,645
9,470
11,175
2,791
76
313
591
497
1,069
1,542
2,591
1,675
54
94
115
340
271
1,637
6,990
72
72
-
-
-
-
-
-
72
-
-
-
-
-
-
-
-
-
-
-
-
-
-
-
-
-
-
-
-
-
-
-
-
-
-
-
-
-
223
-
223
-
-
-
-
-
-
-
-
-
-
68
155
-
-
-
-
4,439
2,237
2,203
2,237
-
-
-
-
-
-
-
2,203
-
-
-
-
-
-
-
191
-
191
-
-
-
-
-
-
-
-
-
23
-
-
-
-
168
-
422,589
216,313
206,277
3,935
573
3,996
14,812
42,233
35,685
58,103
56,976
2,600
479
1,949
6,694
19,782
20,802
49,774
104,196
107,118
63,741
43,377
70
115
1,467
5,879
18,119
13,435
15,473
9,184
183
186
772
3,529
9,256
6,989
11,573
10,889
5,458
3,426
2,032
-
-
37
313
1,201
924
481
471
144
-
-
50
55
617
407
759
2,290
1,677
613
-
-
-
91
878
214
403
92
-
-
-
50
-
-
265
297
13,938
8,469
5,470
-
-
-
510
2,433
1,278
2,567
1,680
-
-
68
470
990
957
1,835
1,148
7,463
3,607
3,856
-
-
99
426
532
709
785
1,055
-
-
47
137
887
611
785
1,389
28,503
19,915
8,587
-
29
372
2,431
7,000
3,903
4,136
2,045
-
46
83
527
2,105
1,660
2,486
1,681
1,818
960
858
-
-
-
189
157
142
319
153
-
-
-
115
223
202
229
89
23,589
15,720
7,869
-
29
269
774
3,468
4,274
4,959
1,947
-
-
83
457
1,361
1,330
2,189
2,450
358
220
138
-
-
-
-
57
70
-
92
-
46
-
-
-
-
-
92
2,968
103
2,865
-
-
-
-
103
-
-
-
-
-
-
506
1,060
467
534
297
4,148
-
4,148
-
-
-
-
-
-
-
-
-
-
34
341
942
470
1,398
964
589
-
589
-
-
-
-
-
-
-
-
-
-
34
113
247
133
61
-
861
861
-
-
-
-
-
-
72
339
450
-
-
-
-
-
-
-
-
1,100
823
277
-
-
-
52
103
214
198
256
-
-
-
-
62
66
-
149
4,036
2,518
1,518
35
29
180
526
759
357
325
307
-
62
258
203
349
-
127
518
812
587
224
35
-
224
52
114
70
-
92
39
-
34
152
-
-
-
-
9,190
4,856
4,334
-
29
286
517
1,313
1,207
961
542
-
31
130
409
976
476
1,256
1,056
5,080
3,436
1,643
172
57
149
322
651
781
914
390
-
23
-
52
124
133
436
876
15,347
5,489
9,858
-
-
40
229
679
1,278
1,982
1,280
-
-
-
302
646
2,016
3,551
3,343
1,692
831
861
35
-
54
135
398
-
138
69
77
-
81
63
341
64
145
89
All Causes
I.
Communicable, mate rnal, pe rinatal and
nutritional conditions
A.
Infectious diseases
1
2
HIV/AIDS
3
Diarrhoea
4
B.
Other infectious diseases
1
Pneumonia
2
Upper respiratory infections
3
Other respiratory infections
C.
Maternal conditions
D.
E.
II.
Tuberculosis
Non-communicable diseases
A.
Malignant neoplasms
1
2
3
Mouth and oropharynx
cancers
Oesophagus cancer
Stomach cancer
4
Bowel cancer
5
Liver cancer
6
Pancreas cancer
7
Lung cancer
8
Melanoma and other skin
cancers
Breast cancer
9
10
Uterus cancer
11
Ovary cancer
12
Prostate cancer
13
Bladder cancer
14
15
16
Leukaemia
B.
Other neoplasms
C.
Diabetes mellitus
D.
Endocrine disorders
Males
Persons
E.
2
3
Other neuropsychiatric
disorders
70-79
80+
0-4
5-14
15-29
30-44
45-59
60-69
70-79
80+
12,994
4,736
8,258
242
286
476
732
690
568
670
1,072
-
85
473
227
525
399
558
5,989
-
-
-
-
-
-
-
-
-
-
-
-
-
-
-
-
-
-
-
-
-
-
-
-
-
-
-
-
-
-
-
-
-
-
-
-
-
-
534
211
323
-
-
-
49
98
-
64
-
-
-
-
-
111
69
-
143
2,133
1,073
1,060
-
105
318
204
241
72
64
69
-
31
330
113
238
197
61
89
600
600
-
-
-
37
245
247
70
-
-
-
-
-
-
-
-
-
-
3,480
600
2,880
-
-
-
-
-
72
138
390
-
-
-
-
-
-
145
2,735
216
216
-
6,031
2,036
3,995
89
-
-
-
-
-
-
81
135
-
-
-
-
-
-
-
-
-
-
-
-
242
181
40
98
103
354
404
612
-
54
143
115
177
133
352
3,021
89
-
-
-
-
-
-
-
-
-
-
-
-
-
-
-
89
-
-
-
-
-
-
-
-
-
-
-
-
-
-
-
-
-
-
-
-
-
-
-
-
-
-
-
-
-
-
-
-
-
-
-
89
-
89
-
-
-
-
-
-
-
-
-
-
-
-
-
-
-
89
194,436
93,933
100,503
551
-
705
4,366
13,996
14,570
28,893
30,852
-
31
164
1,674
6,652
7,920
25,706
58,356
24,519
13,504
11,015
-
-
77
758
2,224
2,541
4,174
3,730
-
-
-
176
1,674
1,146
2,794
5,225
109,988
53,217
56,771
-
-
517
2,578
9,051
8,810
16,231
16,030
-
-
130
657
2,914
3,978
15,517
33,576
59,930
27,212
32,718
551
-
111
1,029
2,722
3,219
8,489
11,092
-
31
34
842
2,064
2,795
7,396
19,555
39,022
19,554
19,468
207
29
260
225
1,744
2,633
5,949
8,506
222
-
-
177
634
1,362
3,432
13,641
29,296
14,355
14,941
172
-
74
139
795
1,851
4,626
6,698
-
-
-
-
341
883
2,454
11,263
9,726
5,199
4,527
35
29
186
86
949
782
1,323
1,808
222
-
-
177
293
479
978
2,378
24,023
15,069
8,953
140
29
317
2,481
5,056
1,780
2,328
2,938
260
54
115
126
615
936
2,002
4,845
8,133
3,678
4,454
-
29
267
234
453
426
1,074
1,196
-
-
198
442
755
729
972
1,359
1,346
472
874
-
-
54
41
54
72
-
251
-
-
49
102
119
-
229
375
8,177
2,324
5,853
-
-
-
82
249
142
681
1,170
-
23
-
-
62
255
1,169
4,344
1,896
554
1,342
-
-
-
-
108
70
69
306
-
-
-
-
-
-
252
1,090
6,281
1,770
4,511
-
-
-
82
141
72
612
864
-
23
-
-
62
255
917
3,254
4,981
2,897
2,084
2,517
29
204
49
98
-
-
-
1,858
77
96
-
54
-
-
-
152
152
-
-
-
-
37
46
-
-
69
-
-
-
-
-
-
-
-
54,405
37,215
17,190
1,554
1,343
10,539
8,042
7,526
3,383
2,759
2,068
1,051
725
2,477
2,086
2,952
1,762
2,074
4,062
47,339
32,682
14,657
1,554
1,316
9,137
6,595
6,765
2,970
2,335
2,010
1,051
725
1,846
1,587
2,506
1,306
1,783
3,852
23,081
17,330
5,750
34
306
6,104
3,761
4,278
1,390
908
549
-
112
1,324
1,289
1,670
523
556
277
1,624
1,296
327
-
-
270
417
417
134
-
58
-
-
-
109
-
65
-
154
8,578
4,678
3,899
34
30
517
853
636
676
833
1,099
72
-
81
-
116
262
656
2,713
243
148
95
-
-
75
-
-
72
-
-
36
-
-
-
59
-
-
-
6,488
4,561
1,927
1,259
817
1,084
571
510
140
123
58
322
531
228
141
168
131
195
210
7,326
4,669
2,658
227
164
1,087
993
924
558
470
246
622
82
213
48
493
326
376
498
7,066
4,532
2,533
-
27
1,402
1,447
761
413
425
58
-
-
631
499
445
456
291
210
5,573
3,206
2,366
-
-
711
1,161
629
346
302
58
-
-
584
499
445
391
236
210
1,432
1,265
167
-
27
691
286
132
67
62
-
-
-
47
-
-
65
55
-
-
-
-
-
-
-
-
-
-
-
-
-
-
-
-
-
-
-
-
Vision loss
Hearing loss
Other sense organ disorders
Stroke
3
Other cardiovascular diseases
1
2
COPD
Digestive diseases
Genitourinary diseases
Skin diseases
1
2
III.
60-69
Drug use disorders
3
2
L.
45-59
Dementia
2
1
K.
30-44
1
J.
15-29
Schizophrenia
Epilepsy
8
I.
5-14
Anxiety disorders
5
7
H.
Females
0-4
Depression
4
6
G.
Females
1
F.
Males
Osteoarthritis
disorders
M.
N.
Oral conditions
Injurie s
A.
1
2
3
Poisonings
Falls
4
Fires
5
Drownings
6
B.
1
2
3
Suicide
Violence
Other intentional injuries
Appendix 4. YLL by sex, ages and causes in Vietnam 2008
Males
Females
Persons
Males
Females
0-4
5-14
15-29
30-44
45-59
60-69
70-79
80+
0-4
5-14
15-29
30-44
45-59
60-69
70-79
80+
6,845,317
4,130,875
2,714,442
340,278
66,724
541,224
732,222
1,017,229
562,724
572,373
298,101
241,855
42,995
162,370
265,383
484,421
364,266
567,299
585,853
1,069,891
689,975
379,916
174,278
10,677
141,604
189,483
70,273
33,173
40,171
30,317
130,620
7,348
38,972
49,400
25,683
24,279
44,223
59,392
649,558
463,762
185,795
21,970
8,424
133,108
174,928
60,806
18,153
26,949
19,424
12,325
5,067
34,502
42,526
18,562
20,307
25,843
26,663
223,782
140,286
83,496
-
1,126
15,127
33,661
35,017
15,481
23,969
15,904
-
-
10,022
17,946
10,295
14,163
16,196
14,875
275,476
238,430
37,046
-
3,086
102,169
122,584
10,592
-
-
-
-
929
17,204
18,913
-
-
-
-
30,969
15,056
15,913
7,323
1,126
983
931
1,896
891
636
1,270
-
929
1,403
-
-
974
4,417
8,190
119,330
69,990
49,340
14,647
3,086
14,830
17,752
13,301
1,781
2,343
2,250
12,325
3,210
5,873
5,667
8,268
5,170
5,230
3,598
277,242
158,436
118,805
84,532
2,253
8,496
14,554
9,467
15,020
13,222
10,893
51,071
1,605
2,619
2,834
7,121
3,972
16,856
32,729
276,351
157,546
118,805
84,532
2,253
8,496
14,554
9,467
14,129
13,222
10,893
51,071
1,605
2,619
2,834
7,121
3,972
16,856
32,729
891
891
-
-
-
-
-
-
891
-
-
-
-
-
-
-
-
-
-
-
-
-
-
-
-
-
-
-
-
-
-
-
-
-
-
-
-
-
5,892
-
5,892
-
-
-
-
-
-
-
-
-
-
1,851
4,041
-
-
-
-
135,000
67,776
67,224
67,776
-
-
-
-
-
-
-
67,224
-
-
-
-
-
-
-
2,200
-
2,200
-
-
-
-
-
-
-
-
-
676
-
-
-
-
1,523
-
4,674,678
2,644,211
2,030,467
119,100
16,755
109,844
349,615
800,050
482,490
507,829
258,530
79,239
14,191
54,217
164,027
398,129
312,872
502,037
505,756
1,475,925
887,518
588,406
2,110
3,332
40,262
138,992
342,070
181,717
136,653
42,382
5,576
5,491
21,413
86,739
186,369
106,111
119,969
56,739
74,915
50,327
24,588
-
-
983
7,486
23,059
12,501
4,006
2,291
4,403
-
-
1,246
1,128
9,003
4,494
4,313
30,088
25,243
4,846
-
-
-
2,166
16,382
2,826
3,549
320
-
-
-
1,246
-
-
2,405
1,194
176,111
104,234
71,878
-
-
-
11,987
45,392
17,416
22,299
7,139
-
-
1,851
11,693
20,160
14,108
17,936
6,130
91,524
44,697
46,827
-
-
2,744
10,260
9,689
9,830
7,367
4,808
-
-
1,309
3,243
17,922
9,235
7,765
7,351
418,092
300,877
117,215
-
833
10,087
57,304
133,545
53,601
36,020
9,487
-
1,352
2,328
12,658
41,688
25,328
25,639
8,221
26,058
12,953
13,105
-
-
-
4,346
2,799
1,935
3,182
690
-
-
-
2,834
4,435
2,998
2,234
605
299,153
201,595
97,558
-
833
7,259
18,054
65,078
56,670
44,392
9,309
-
-
2,328
11,233
27,483
20,233
23,252
13,029
4,317
2,341
1,976
-
-
-
-
977
1,045
-
320
-
1,352
-
-
-
-
-
624
50,636
1,946
48,690
-
-
-
-
1,946
-
-
-
-
-
-
12,343
21,662
7,519
5,971
1,194
55,779
-
55,779
-
-
-
-
-
-
-
-
-
-
925
8,430
19,050
7,403
15,087
4,883
10,979
-
10,979
-
-
-
-
-
-
-
-
-
-
925
2,733
4,587
2,023
711
-
6,188
6,188
-
-
-
-
-
-
891
2,913
2,384
-
-
-
-
-
-
-
-
11,650
8,816
2,835
-
-
-
1,173
1,946
2,826
1,819
1,052
-
-
-
-
1,147
1,091
-
597
69,212
43,096
26,115
1,055
833
4,963
12,616
14,372
4,607
3,092
1,558
-
1,857
7,182
5,187
7,320
-
1,477
3,092
17,749
11,812
5,938
1,055
-
6,266
1,173
1,954
1,045
-
320
1,173
-
925
3,840
-
-
-
-
133,474
73,395
60,079
-
833
7,961
12,426
24,932
16,526
8,013
2,704
-
929
3,638
10,052
19,786
7,170
12,998
5,507
67,644
52,140
15,504
5,214
1,666
4,192
7,883
12,290
10,720
8,505
1,671
-
676
-
1,347
2,294
2,023
4,417
4,746
165,822
61,008
104,814
-
-
1,110
5,334
13,336
17,416
17,777
6,035
-
-
-
7,193
12,690
30,052
37,771
17,109
30,850
14,815
16,035
1,055
-
1,541
3,170
7,578
-
1,071
401
2,345
-
2,235
1,487
6,842
1,049
1,472
605
All Causes
I.
Communicable, maternal, perinatal and
A.
Infectious diseases
1
2
HIV/AIDS
3
Diarrhoea
4
B.
D.
E.
II.
1
Pneumonia
2
3
C.
Tuberculosis
Maternal conditions
A.
Malignant neoplasms
1
2
3
4
5
6
7
8
9
Mouth and oropharynx
cancers
Oesophagus cancer
Stomach cancer
Bowel cancer
Liver cancer
Pancreas cancer
Lung cancer
cancers
Breast cancer
10
Uterus cancer
11
Ovary cancer
12
13
Prostate cancer
Bladder cancer
14
Lymphomas, multiple
myeloma
15
Leukaemia
16
B.
Other neoplasms
C.
Diabetes mellitus
D.
Endocrine disorders
Males
Persons
E.
Males
Females
Females
0-4
5-14
15-29
30-44
45-59
60-69
70-79
80+
0-4
5-14
15-29
30-44
45-59
60-69
70-79
80+
7,323
8,424
13,119
17,433
13,270
7,741
5,758
4,833
-
2,533
13,242
5,566
10,561
6,070
5,838
26,742
-
-
-
-
-
-
-
-
-
-
-
-
-
-
-
-
1
2
148,453
77,900
70,553
-
-
-
Depression
Anxiety disorders
-
3
Schizophrenia
4
Epilepsy
5
6
7
-
7,550
3,645
3,905
-
-
-
1,119
1,889
-
636
-
-
-
-
-
2,357
974
-
574
45,641
23,557
22,084
-
3,086
8,807
4,958
4,779
891
636
401
-
929
9,220
2,733
4,815
3,072
711
605
12,703
12,703
-
-
-
983
5,946
4,730
1,045
-
-
-
-
-
-
-
-
-
-
17,312
3,632
13,680
-
-
-
-
-
891
1,071
1,671
-
-
-
-
-
-
1,472
12,208
5,389
5,389
-
59,857
28,973
30,884
Dementia
Drug use disorders
F.
disorders
-
-
2,219
3,170
-
-
-
-
-
-
-
-
-
-
-
-
7,323
5,339
1,110
2,239
1,872
4,915
3,414
2,762
-
1,605
4,022
2,834
3,390
2,023
3,655
13,355
8
1
Vision loss
2
Hearing loss
-
605
-
-
-
-
-
-
-
-
-
-
-
-
-
-
-
605
-
-
-
-
-
-
-
-
-
-
-
-
-
-
-
-
-
-
-
-
-
-
-
-
-
-
-
-
-
-
-
-
-
-
-
-
-
-
605
-
605
-
-
-
-
-
-
-
-
-
-
-
-
-
-
-
605
1,829,829
992,251
837,579
16,695
-
19,268
103,026
263,531
197,352
251,400
140,978
-
929
4,563
40,916
133,993
118,332
255,442
283,404
260,420
150,223
110,197
-
-
2,092
17,854
41,755
34,507
37,544
16,471
-
-
-
4,219
33,645
17,490
28,374
26,468
1,032,472
579,115
453,357
-
-
14,228
60,680
169,955
119,671
140,796
73,784
-
-
3,638
16,219
58,735
58,905
154,048
161,812
536,937
262,913
274,025
16,695
-
2,948
24,492
51,821
43,174
73,060
50,723
-
929
925
20,477
41,613
41,936
73,020
95,124
318,432
176,693
141,740
6,268
833
7,139
5,278
33,121
35,262
51,484
37,308
6,749
-
-
4,320
12,474
19,786
34,069
64,341
215,455
118,716
96,738
5,214
-
1,965
3,227
15,149
24,695
39,666
28,801
-
-
-
-
6,842
12,891
24,422
52,583
102,977
57,976
45,001
1,055
833
5,174
2,051
17,972
10,566
11,818
8,507
6,749
-
-
4,320
5,632
6,895
9,647
11,757
312,696
226,501
86,195
4,219
833
8,546
58,075
97,827
23,651
20,454
12,896
7,922
1,605
3,160
2,973
12,930
14,089
19,396
24,120
102,377
42,863
59,514
-
833
7,393
5,409
8,505
5,805
9,172
5,745
-
-
5,489
10,893
15,325
11,165
10,205
6,437
15,607
5,216
10,391
-
-
1,541
988
927
891
-
869
-
-
1,403
2,593
2,408
-
2,234
1,753
55,612
19,215
36,397
-
-
-
1,976
4,737
1,935
5,556
5,012
-
676
-
-
1,147
4,195
11,222
19,157
3
G.
Other sense organ
disorders
605
1
2
Stroke
3
H.
Other cardiovascular
diseases
1
2
COPD
I.
Digestive diseases
J.
K.
L.
Skin diseases
1
Osteoarthritis
III.
M.
disorders
N.
Oral conditions
11,723
4,815
6,908
-
-
-
-
1,855
1,045
535
1,381
-
-
-
-
-
-
2,285
4,623
43,889
14,400
29,489
-
-
-
1,976
2,882
891
5,020
3,631
-
676
-
-
1,147
4,195
8,936
14,534
148,525
85,789
62,736
76,215
833
5,733
1,119
1,889
-
-
-
56,647
2,281
2,712
-
1,096
-
-
-
2,301
2,301
-
-
-
-
931
969
-
-
401
-
-
-
-
-
-
-
-
1,100,748
796,689
304,059
46,901
39,292
289,776
193,125
146,906
47,061
24,373
9,254
31,997
21,456
69,182
51,956
60,608
27,115
21,039
20,706
951,548
698,287
253,260
46,901
38,515
251,388
158,223
132,105
41,279
20,824
9,053
31,997
21,456
51,657
39,447
51,438
19,929
17,842
19,495
503,357
381,728
121,629
1,022
8,947
168,141
90,847
83,538
19,052
7,682
2,500
-
3,295
37,013
31,948
33,997
7,971
5,742
1,662
32,106
27,737
4,369
-
-
7,326
9,993
8,226
1,991
-
201
-
-
-
2,685
-
1,067
-
617
100,659
70,412
30,248
1,022
876
14,148
19,961
11,915
9,858
7,631
5,001
2,172
-
2,235
-
2,358
3,845
6,365
13,274
2
Injuries
A.
1
2
Poisonings
3
Falls
4
Fires
5
Drownings
6
B.
5,113
2,930
2,183
-
-
2,030
-
-
900
-
-
1,086
-
-
-
1,097
-
-
-
162,539
118,503
44,035
37,986
23,928
29,918
13,470
10,152
1,896
953
201
9,773
15,712
6,444
3,570
3,423
1,993
1,910
1,211
147,773
96,977
50,797
6,871
4,764
29,825
23,952
18,275
7,583
4,558
1,150
18,966
2,449
5,966
1,243
10,563
5,053
3,826
2,731
149,200
98,402
50,799
-
778
38,388
34,902
14,801
5,782
3,549
201
-
-
17,524
12,510
9,171
7,186
3,197
1,211
114,810
67,028
47,782
-
-
19,441
27,988
12,015
4,787
2,596
201
-
-
16,215
12,510
9,171
6,120
2,556
1,211
33,914
30,897
3,017
-
778
18,947
6,914
2,786
995
477
-
-
-
1,309
-
-
1,067
640
-
-
-
-
-
-
-
-
-
-
-
-
-
-
-
-
-
-
-
-
1
2
3
Suicide
Violence
Appendix 5. YLD by sex, ages and causes in Vietnam 2008
All Causes
I.
Males
Females
0-4
5-14
15-29
5,423,142
2,714,126
2,709,016
161,751
208,526
626,877
731,221
560,759
270,756
290,003
35,903
46,980
71,430
166,510
97,182
69,328
5,090
1,923
37,819
Females
30-44
45-59
60-69
70-79
80+
0-4
5-14
15-29
60-69
70-79
80+
631,649
169,165
124,059
60,878
119,909
162,038
502,999
670,965
657,031
241,702
216,537
137,835
54,025
34,113
13,084
10,921
4,300
34,172
45,095
83,130
54,405
31,981
16,031
15,951
9,239
31,469
13,736
3,231
2,535
1,379
4,248
2,301
30,071
13,750
8,301
3,917
4,011
2,729
549
A.
B.
II.
Males
30-44
45-59
Persons
Infectious diseases
1
Tuberculosis
38,219
25,683
12,536
-
28
4,603
9,423
7,484
2,170
1,448
527
27
199
3,236
3,298
2,784
1,300
1,142
2
HIV/AIDS
64,529
47,318
17,211
418
-
28,319
16,520
1,863
129
63
6
181
289
11,270
4,890
480
62
35
4
3
Diarrhoea
21,520
10,577
10,943
3,475
983
2,140
1,840
1,199
586
188
166
2,080
723
1,384
1,718
2,050
801
916
1,273
4
42,242
13,605
28,637
1,198
912
2,758
3,685
3,190
346
837
680
1,959
1,090
14,180
3,845
2,987
1,754
1,919
902
86,308
45,301
41,007
6,528
13,425
9,779
7,205
5,315
1,494
1,242
314
3,639
7,476
9,114
7,951
6,621
2,249
2,161
1,796
1
Pneumonia
53,326
25,929
27,397
1,693
4,299
7,825
5,568
4,115
1,183
1,017
228
1,454
3,321
6,873
5,892
5,064
1,686
1,729
1,377
2
16,535
7,415
9,120
548
1,456
1,954
1,637
1,199
311
225
85
599
1,250
2,241
2,059
1,556
562
432
419
3
16,447
11,957
4,489
4,287
7,670
-
-
-
-
-
-
1,585
2,905
-
-
-
-
-
-
C.
Maternal conditions
9,664
-
9,664
-
-
-
-
-
-
-
-
-
-
4,659
5,005
-
-
-
D.
15,580
6,200
9,380
6,200
-
-
-
-
-
-
-
9,380
-
-
-
-
-
-
-
E.
282,697
122,072
160,625
18,084
31,632
23,831
15,351
15,062
8,359
7,144
2,608
16,906
35,318
39,287
27,698
17,059
9,866
9,778
4,714
4,046,588
1,885,970
2,160,618
97,246
86,098
358,672
530,428
504,190
148,307
106,254
54,774
71,359
82,635
356,296
552,882
568,024
214,176
188,759
126,486
A.
105,802
60,680
45,122
74
106
1,112
5,215
14,713
11,977
14,728
12,756
-
491
562
3,914
10,481
10,007
13,000
6,667
9,566
6,393
3,174
-
-
55
572
2,241
1,781
949
794
-
324
-
128
132
361
2,035
193
2,540
2,172
368
-
-
-
114
1,117
288
547
106
-
-
-
68
-
-
-
300
-
-
666
3,145
1,708
3,532
1,949
-
-
-
653
1,023
794
1,674
1,578
Malignant neoplasms
1
2
Oesophagus
cancer
3
Stomach cancer
16,723
11,000
5,722
-
4
Bowel cancer
12,193
7,069
5,124
-
-
188
847
1,074
1,457
1,685
1,817
-
-
83
-
1,417
1,373
1,301
950
5
Liver cancer
16,239
11,927
4,312
-
34
157
1,324
2,762
1,589
1,787
4,274
-
9
34
149
714
795
953
1,658
6
Pancreas cancer
1,387
788
599
1
1
4
148
122
119
293
100
-
-
2
38
167
100
185
107
18,467
13,209
5,258
-
17
131
521
2,389
3,521
4,570
2,060
-
-
41
230
1,151
1,090
2,026
720
692
580
113
-
-
-
-
160
192
-
228
-
-
113
-
-
-
-
-
7
8
Lung cancer
cancers
9
Breast cancer
10,295
-
10,295
-
-
-
1,241
3,582
3,121
2,045
306
10
Uterus cancer
6,097
-
6,097
-
-
-
461
1,386
1,389
2,119
742
11
Ovary cancer
955
-
955
-
-
-
138
103
496
219
-
12
Prostate cancer
713
713
-
13
Bladder cancer
2,090
1,830
260
-
14
4,501
3,168
1,333
38
15
Leukaemia
936
659
277
35
16
2,409
1,173
1,236
-
-
-
-
-
8
335
370
-
-
116
220
485
456
552
-
-
-
-
-
260
-
-
40
201
645
955
486
444
359
-
94
215
368
400
80
177
-
-
249
63
129
78
-
105
-
44
-
233
-
-
-
-
-
13
127
199
398
264
128
43
-
19
75
207
407
148
267
113
B.
Other neoplasms
1,034
767
266
6
4
25
66
174
234
230
29
-
4
-
32
51
44
80
54
C.
Diabetes mellitus
192,604
77,749
114,855
-
-
2,190
25,932
30,467
10,198
6,931
2,031
-
-
2,369
33,072
39,391
18,461
15,659
5,904
D.
Endocrine disorders
9,152
2,810
6,342
764
-
157
430
1,221
-
176
63
3,287
-
433
314
1,548
245
365
151
E.
F.
G.
H.
Males
Females
0-4
5-14
15-29
2,012,259
906,247
1,106,013
25,083
20,725
297,775
275,639
Females
30-44
45-59
60-69
70-79
80+
0-4
5-14
15-29
60-69
70-79
80+
201,972
47,690
27,652
9,711
19,882
32,335
306,290
315,355
239,676
83,542
62,945
45,988
1
Depression
875,673
237,014
638,658
-
4,707
58,383
90,925
62,099
14,282
5,323
1,295
-
11,276
150,834
233,137
176,198
44,532
17,764
4,916
2
Anxiety disorders
202,288
56,034
146,254
-
4,592
22,511
18,689
8,122
1,473
538
109
-
10,551
64,025
42,501
21,662
4,963
2,031
522
3
Schizophrenia
145,627
70,665
74,962
-
-
39,062
27,429
4,174
-
-
-
-
3,820
43,737
21,838
5,568
-
-
-
4
Epilepsy
25,178
12,199
12,979
3,809
6,451
1,462
343
100
19
11
6
3,769
5,030
3,092
746
308
24
7
2
5
333,482
303,138
30,345
-
-
51,201
133,017
104,149
13,007
1,285
478
-
-
9,330
12,813
7,520
452
142
87
6
Dementia
189,881
60,304
129,578
-
-
-
-
17,769
16,518
18,791
7,226
-
-
-
-
22,128
29,990
39,532
37,927
7
Drug use disorders
114,638
104,769
9,870
-
3,558
101,210
-
-
-
-
-
-
-
9,870
-
-
-
-
-
8
125,492
62,125
63,367
21,274
1,417
23,946
5,236
5,558
2,392
1,705
598
16,113
1,659
25,402
4,320
6,291
3,580
3,469
2,533
509,827
220,735
289,092
1,811
15,088
11,603
55,063
85,950
25,052
16,878
9,289
1,486
9,782
20,070
51,047
94,640
44,424
41,554
26,089
1
Vision loss
387,743
164,032
223,711
925
3,890
10,582
47,348
67,323
15,822
11,289
6,853
640
2,994
15,763
44,740
74,944
32,270
30,144
22,215
2
Hearing loss
122,084
56,703
65,381
886
11,198
1,021
7,715
18,627
9,230
5,589
2,436
846
6,787
4,307
6,307
19,696
12,154
11,410
3,874
3
-
-
2,906
5,374
21,134
42,783
51,088
19,148
21,609
12,057
221
918
4,984
17,437
32,552
19,566
37,015
30,100
49
176
1,316
4,861
7,624
2,520
2,501
1,412
8
31
316
2,581
5,790
2,626
3,454
2,786
5,198
19,635
36,282
39,858
13,913
13,467
5,995
213
862
4,614
13,369
24,399
14,509
29,490
21,689
318,893
176,100
142,793
1
38,049
20,458
17,591
2
Stroke
244,961
135,817
109,144
1,468
3
35,883
19,826
16,057
1,389
-
183
1,640
3,607
2,715
5,641
4,650
-
25
54
1,487
2,364
2,431
4,071
5,624
268,229
171,164
97,065
9,772
39,166
17,862
41,895
36,711
12,734
8,468
4,556
7,266
35,061
7,675
16,998
17,558
4,939
4,152
3,416
2,505
1
COPD
161,637
114,966
46,672
-
572
14,251
41,380
35,183
11,792
7,682
4,106
-
22
5,232
15,185
16,060
4,321
3,346
2
106,592
56,198
50,394
9,772
38,594
3,611
515
1,528
942
785
450
7,266
35,039
2,443
1,813
1,498
618
806
911
321
166
927
2,613
5,742
2,196
3,372
1,991
1,911
662
477
205
1,013
1,351
2,778
3,610
I.
Digestive diseases
29,332
17,325
12,006
J.
19,060
13,948
5,112
-
77
197
8,329
3,058
1,058
892
339
-
-
581
1,245
1,292
767
799
428
K.
Skin diseases
12,814
7,316
5,498
190
2,840
649
531
808
873
723
702
818
101
320
452
605
434
1,296
1,474
2,149
L.
III.
Males
30-44
45-59
Persons
402,500
143,526
258,974
232
350
982
68,184
55,682
13,344
3,823
930
720
950
8,355
106,677
107,862
24,692
7,569
1
Osteoarthritis
323,383
120,839
202,544
-
-
-
65,382
44,104
8,978
2,012
362
-
-
1,123
99,070
83,157
14,562
3,852
781
2
Other musculoskeletal disorders
79,117
22,688
56,430
232
350
982
2,802
11,578
4,366
1,810
568
720
950
7,232
7,607
24,705
10,130
3,718
1,368
M.
74,296
46,534
27,762
45,925
99
250
52
208
-
-
-
27,252
151
205
-
153
-
-
-
N.
Oral conditions
90,785
41,067
49,718
10,163
2,103
3,809
3,695
16,398
3,805
774
321
8,516
2,180
3,975
6,134
21,202
5,706
1,547
457
815,795
557,400
258,396
28,602
75,447
196,774
146,767
93,347
7,774
6,883
1,804
14,378
34,307
63,574
63,679
57,026
11,495
11,828
2,110
783,247
531,505
251,742
28,602
73,518
185,440
141,044
87,191
7,088
6,818
1,804
14,378
33,815
61,098
60,821
56,309
11,384
11,828
2,110
2,177
11,930
76,919
48,978
35,149
1,504
982
270
2,851
6,786
24,012
31,545
17,984
3,440
4,310
146
55
46
61
63
86
55
66
87
19
16
21
21
28
19
22
29
Injuries
A.
B.
1
268,984
177,909
91,075
2
Poisonings
695
519
176
3
Falls
177,057
114,960
62,098
11,174
22,647
29,573
23,688
20,814
2,418
3,592
1,055
5,957
8,105
11,994
6,521
17,879
4,364
5,516
1,761
4
Fires
10,604
7,886
2,718
1,530
1,479
2,455
1,460
773
115
63
11
870
482
587
395
201
96
48
39
5
Drownings
4,748
4,296
452
1,948
364
710
1,191
28
55
-
-
84
58
168
-
130
12
-
-
6
321,158
225,935
95,223
11,718
37,052
75,722
65,664
30,342
2,941
2,115
381
4,597
18,368
24,315
22,339
20,087
3,452
1,932
134
32,548
25,895
6,654
-
1,930
11,334
5,723
6,156
686
66
-
-
492
2,476
2,858
717
111
-
-
1
Suicide
214
128
87
-
21
75
24
-
7
-
-
-
-
12
20
54
-
-
-
2
Violence
32,334
25,767
6,567
-
1,908
11,259
5,699
6,156
679
66
-
-
492
2,464
2,837
662
111
-
-
3
-
-
-
Appendix 6. DALYs by sex, ages and causes in Vietnam 2008
Males
All Causes
I.
Males
Females
0-4
5-14
15-29
30-44
45-59
60-69
70-79
80+
0-4
5-14
15-29
30-44
45-59
60-69
70-79
80+
12,268,460
6,845,001
5,423,459
502,029
275,250
1,168,100
1,463,443
1,648,878
731,889
696,431
358,979
361,764
205,032
665,370
936,348
1,141,452
605,968
783,836
723,689
Communicable, maternal, perinatal
and nutritional conditions
A.
1,630,650
960,731
669,919
210,181
57,657
213,034
243,508
104,386
46,257
51,092
34,617
164,792
52,443
122,101
103,805
57,665
40,310
60,173
68,630
Infectious diseases
816,068
560,945
255,123
27,060
10,347
170,927
206,398
74,542
21,384
29,484
20,803
16,573
7,368
64,572
56,276
26,864
24,224
29,855
29,392
1
Tuberculosis
262,001
165,969
96,032
-
1,154
19,729
43,084
42,501
17,651
25,417
16,431
27
199
13,258
21,243
13,079
15,463
17,338
15,424
2
HIV/AIDS
340,005
285,748
54,257
418
3,086
130,488
139,104
12,455
129
63
6
181
1,218
28,475
23,803
480
62
35
4
3
Diarrhoea
Other infectious
diseases
52,490
25,633
26,856
10,798
2,110
3,123
2,772
3,095
1,477
824
1,436
2,080
1,651
2,787
1,718
2,050
1,775
5,333
9,463
161,572
83,595
77,977
15,845
3,998
17,587
21,438
16,491
2,128
3,180
2,930
14,284
4,300
20,052
9,512
11,255
6,924
7,149
4,501
363,550
203,738
159,812
91,060
15,677
18,275
21,759
14,782
16,513
14,464
11,206
54,709
9,081
11,732
10,784
13,742
6,221
19,017
34,525
1
329,677
183,475
146,202
86,225
6,552
16,321
20,122
13,582
15,312
14,239
11,121
52,525
4,926
9,491
8,726
12,185
5,658
18,585
34,106
17,426
8,306
9,120
548
1,456
1,954
1,637
1,199
1,201
225
85
599
1,250
2,241
2,059
1,556
562
432
419
16,447
11,957
4,489
4,287
7,670
-
-
-
-
-
-
1,585
2,905
-
-
-
-
-
-
4
B.
2
3
Pneumonia
Upper respiratory
infections
Other respiratory
infections
C.
Maternal conditions
15,556
-
15,556
-
-
-
-
-
-
-
-
-
-
6,509
9,046
-
-
-
D.
150,580
73,976
76,604
73,976
-
-
-
-
-
-
-
76,604
-
-
-
-
-
-
-
284,897
122,072
162,824
18,084
31,632
23,831
15,351
15,062
8,359
7,144
2,608
16,906
35,994
39,287
27,698
17,059
9,866
11,302
4,714
8,721,266
4,530,181
4,191,085
216,346
102,853
468,516
880,042
1,304,240
630,797
614,083
313,304
150,598
96,826
410,513
716,908
966,154
527,048
690,796
632,242
1,581,726
948,198
633,528
2,183
3,438
41,374
144,207
356,783
193,694
151,381
55,137
5,576
5,981
21,976
90,653
196,849
116,118
132,970
63,406
84,481
56,719
27,761
-
-
1,038
8,058
25,300
14,283
4,955
3,085
4,403
324
-
1,375
1,260
9,364
6,529
4,506
32,628
27,415
5,214
-
-
-
2,281
17,499
3,114
4,096
425
-
-
-
1,314
-
-
2,405
1,494
E.
II.
Females
Persons
A.
Malignant neoplasms
Mouth and orophar1
ynx cancers
2
Oesophagus cancer
3
Stomach cancer
192,834
115,234
77,600
-
-
-
12,654
48,537
19,124
25,832
9,088
-
-
1,851
12,346
21,183
14,902
19,610
7,708
4
Bowel cancer
103,717
51,766
51,950
-
-
2,932
11,107
10,763
11,287
9,052
6,626
-
-
1,392
3,243
19,339
10,609
9,066
8,301
5
Liver cancer
434,331
312,804
121,527
-
867
10,244
58,628
136,307
55,190
37,807
13,761
-
1,361
2,362
12,808
42,402
26,123
26,592
9,879
6
Pancreas cancer
27,445
13,741
13,704
1
1
4
4,494
2,922
2,054
3,475
790
-
-
2
2,872
4,602
3,098
2,419
712
7
317,620
214,804
102,816
-
850
7,390
18,575
67,467
60,190
48,963
11,369
-
-
2,369
11,464
28,633
21,323
25,277
13,749
8
Lung cancer
Melanoma and other
skin cancers
5,010
2,921
2,089
-
-
-
-
1,137
1,237
-
547
-
1,352
113
-
-
-
-
624
9
Breast cancer
60,931
1,946
58,985
-
-
-
-
1,946
-
-
-
-
-
-
13,584
25,244
10,641
8,016
1,500
10
Uterus cancer
61,875
-
61,875
-
-
-
-
-
-
-
-
-
-
925
8,891
20,437
8,792
17,206
5,624
11
Ovary cancer
11,934
-
11,934
-
-
-
-
-
-
-
-
-
-
925
2,871
4,690
2,519
929
-
12
Prostate cancer
6,900
6,900
-
-
-
-
-
-
899
3,248
2,754
-
-
-
-
-
-
-
-
13
13,740
10,646
3,095
-
-
-
1,289
2,166
3,311
2,276
1,604
-
-
-
-
1,147
1,351
-
597
14
Bladder cancer
Lymphomas, multiple
myeloma
73,713
46,265
27,448
1,093
873
5,164
13,261
15,327
5,093
3,536
1,917
-
1,951
7,397
5,554
7,720
80
1,654
3,092
15
Leukaemia
18,686
12,471
6,215
1,090
-
6,515
1,235
2,083
1,123
-
424
1,173
44
925
4,073
-
-
-
-
16
Other malignant
neoplasms
135,883
74,568
61,315
-
846
8,088
12,625
25,331
16,790
8,141
2,747
-
948
3,713
10,259
20,193
7,318
13,265
5,620
B.
Other neoplasms
68,678
52,908
15,770
5,220
1,671
4,216
7,949
12,465
10,954
8,735
1,699
-
680
-
1,379
2,345
2,068
4,497
4,801
C.
Diabetes mellitus
358,427
138,758
219,669
-
-
3,300
31,267
43,802
27,614
24,708
8,066
-
-
2,369
40,265
52,081
48,512
53,430
23,013
D.
Endocrine disorders
40,003
17,625
22,377
1,819
-
1,698
3,600
8,798
-
1,247
464
5,633
-
2,668
1,800
8,390
1,293
1,837
756
Males
Males
Females
0-4
5-14
15-29
30-44
45-59
60-69
70-79
80+
0-4
5-14
15-29
30-44
45-59
60-69
70-79
80+
2,160,712
984,147
1,176,566
32,406
29,149
310,894
293,071
215,241
55,430
33,410
14,544
19,882
34,869
319,532
320,922
250,237
89,612
68,783
72,730
1
Depression
875,673
237,014
638,658
-
4,707
58,383
90,925
62,099
14,282
5,323
1,295
-
11,276
150,834
233,137
176,198
44,532
17,764
4,916
2
Anxiety disorders
202,288
56,034
146,254
-
4,592
22,511
18,689
8,122
1,473
538
109
-
10,551
64,025
42,501
21,662
4,963
2,031
522
3
Schizophrenia
153,177
74,310
78,867
-
-
39,062
28,548
6,063
-
636
-
-
3,820
43,737
21,838
7,924
974
-
574
4
Epilepsy
70,820
35,756
35,063
3,809
9,536
10,269
5,301
4,879
909
647
406
3,769
5,959
12,312
3,479
5,123
3,096
718
607
5
346,185
315,841
30,345
-
-
52,184
138,963
108,879
14,051
1,285
478
-
-
9,330
12,813
7,520
452
142
87
6
Dementia
207,193
63,936
143,258
-
-
-
-
17,769
17,408
19,862
8,896
-
-
-
-
22,128
29,990
41,004
50,135
7
Drug use disorders
120,028
110,158
9,870
-
3,558
103,430
3,170
-
-
-
-
-
-
9,870
-
-
-
-
-
8
disorders
185,348
91,097
94,251
28,597
6,756
25,055
7,474
7,430
7,307
5,119
3,360
16,113
3,263
29,424
7,154
9,681
5,603
7,124
15,888
E.
510,432
220,735
289,697
1,811
15,088
11,603
55,063
85,950
25,052
16,878
9,289
1,486
9,782
20,070
51,047
94,640
44,424
41,554
26,694
1
Vision loss
387,743
164,032
223,711
925
3,890
10,582
47,348
67,323
15,822
11,289
6,853
640
2,994
15,763
44,740
74,944
32,270
30,144
22,215
2
Hearing loss
122,084
56,703
65,381
886
11,198
1,021
7,715
18,627
9,230
5,589
2,436
846
6,787
4,307
6,307
19,696
12,154
11,410
3,874
3
605
-
605
-
-
-
-
-
-
-
-
-
-
-
-
-
-
-
605
2,148,722
1,168,351
980,371
19,601
5,374
40,403
145,809
314,620
216,500
273,008
153,035
221
1,847
9,547
58,353
166,546
137,898
292,457
313,503
F.
G.
1
2
Stroke
3
H.
298,469
170,681
127,788
49
176
3,408
22,714
49,379
37,027
40,045
17,883
8
31
316
6,800
39,435
20,116
31,828
29,254
1,277,432
714,931
562,501
1,468
5,198
33,864
96,963
209,812
133,584
154,263
79,779
213
862
8,251
29,588
83,134
73,414
183,537
183,502
572,820
282,739
290,082
18,085
-
3,131
26,132
55,428
45,889
78,701
55,373
-
954
980
21,965
43,977
44,367
77,092
100,748
586,662
347,857
238,805
16,041
39,999
25,001
47,173
69,832
47,995
59,952
41,864
14,015
35,061
7,675
21,318
30,032
24,726
38,221
67,756
1
COPD
377,092
233,682
143,410
5,214
572
16,216
44,607
50,331
36,487
47,349
32,906
-
22
5,232
15,185
22,902
17,212
27,768
55,088
2
209,569
114,174
95,395
10,827
39,427
8,785
2,566
19,500
11,508
12,603
8,958
14,015
35,039
2,443
6,133
7,130
7,513
10,453
12,668
I.
Digestive diseases
342,027
243,826
98,201
4,540
999
9,473
60,687
103,568
25,846
23,826
14,887
9,833
2,266
3,638
3,178
13,944
15,440
22,174
27,729
J.
121,437
56,811
64,626
-
910
7,590
13,739
11,563
6,863
10,063
6,084
-
-
6,070
12,138
16,618
11,932
11,004
6,865
K.
Skin diseases
28,421
12,532
15,889
190
2,840
2,190
1,519
1,735
1,764
723
1,571
818
101
1,723
3,045
3,012
434
3,530
3,227
458,113
162,742
295,371
232
350
982
70,160
60,419
15,279
9,378
5,941
720
1,626
8,355
106,677
109,009
28,887
18,791
21,306
335,106
125,654
209,452
-
-
-
65,382
45,959
10,023
2,548
1,742
-
-
1,123
99,070
83,157
14,562
6,137
5,404
123,006
37,088
85,919
232
350
982
4,778
14,460
5,256
6,831
4,199
720
1,626
7,232
7,607
25,852
14,326
12,654
15,902
222,821
132,324
90,498
122,139
932
5,983
1,172
2,097
-
-
-
83,899
2,432
2,918
-
1,249
-
-
-
93,086
43,368
49,718
10,163
2,103
3,809
4,626
17,367
3,805
774
721
8,516
2,180
3,975
6,134
21,202
5,706
1,547
457
1,916,543
1,354,089
562,455
75,503
114,740
486,551
339,893
240,253
54,836
31,256
11,058
46,374
55,764
132,756
115,635
117,634
38,610
32,867
22,816
1,734,794
1,229,792
505,002
75,503
112,032
436,828
299,267
219,296
48,368
27,642
10,857
46,374
55,271
112,755
100,268
107,746
31,313
29,670
21,605
772,341
559,637
212,704
3,199
20,877
245,060
139,825
118,687
20,556
8,664
2,770
2,851
10,082
61,025
63,493
51,981
11,412
10,052
1,808
32,801
28,256
4,545
55
46
7,388
10,056
8,311
2,046
66
288
19
16
21
2,706
28
1,086
22
647
277,717
185,372
92,345
12,196
23,523
43,721
43,649
32,729
12,276
11,222
6,056
8,129
8,105
14,229
6,521
20,236
8,209
11,881
15,035
L.
1
2
III.
Females
Pe rsons
Osteoarthritis
disorders
M.
N.
Oral conditions
Injuries
A.
B.
1
2
Poisonings
3
Falls
4
Fires
15,717
10,816
4,901
1,530
1,479
4,485
1,460
773
1,015
63
11
1,956
482
587
395
1,298
96
48
39
5
Drownings
167,287
122,800
44,487
39,934
24,292
30,628
14,661
10,180
1,951
953
201
9,857
15,770
6,612
3,570
3,553
2,005
1,910
1,211
6
468,932
322,912
146,020
18,590
41,816
105,547
89,616
48,617
10,524
6,673
1,531
23,563
20,817
30,281
23,583
30,650
8,505
5,757
2,865
181,749
124,296
57,452
-
2,707
49,723
40,625
20,957
6,468
3,615
201
-
492
20,001
15,367
9,887
7,297
3,197
1,211
1
Suicide
115,024
67,156
47,869
-
21
19,516
28,012
12,015
4,793
2,596
201
-
-
16,227
12,530
9,225
6,120
2,556
1,211
2
Violence
66,248
56,664
9,584
-
2,686
30,206
12,613
8,942
1,675
542
-
-
492
3,774
2,837
662
1,178
640
-
3
-
-
-
-
-
-
-
-
-
-
-
-
-
-
-
-
-
-
-
Appendix 7. YLD prevalence by sex, ages and causes in Vietnam 2008
Males
Persons
Males
Females
0-4
5-14
Females
15-29
30-44
45-59
60-69
70-79
80+
0-4
5-14
15-29
30-44
45-59
60-69
70-79
80+
560
All causes
I.
A.
B.
Infectious diseases
1
Tuberculosis
56,361
40,116
16,245
-
358
8,497
14,885
10,806
2,931
1,930
709
51
345
4,962
4,442
3,296
1,405
1,183
2
HIV/AIDS
93,082
68,113
24,969
650
-
41,351
23,348
2,521
163
75
6
280
430
16,536
6,948
651
79
41
4
3
Diarrhoea
21,523
10,578
10,945
3,475
983
2,141
1,841
1,199
586
188
166
2,081
723
1,384
1,718
2,050
801
916
1,273
1
II.
C.
D.
2
Pneumonia
Maternal conditions
E.
15,820
7,416
8,404
548
1,456
1,954
1,637
1,200
311
225
85
537
1,124
2,053
1,896
1,444
530
409
412
53,348
25,940
27,408
1,693
4,301
7,828
5,570
4,117
1,184
1,018
228
1,455
3,323
6,875
5,894
5,067
1,687
1,730
1,378
200
Noncommunicable diseases
A.
Malignant neoplasms
1
9,909
6,621
3,287
-
-
57
592
2,322
1,845
983
823
-
336
-
133
137
374
2,107
2
Oesophagus cancer
2,595
2,219
376
-
-
-
117
1,141
294
559
108
-
-
-
69
-
-
-
307
3
Stomach cancer
17,059
11,222
5,837
-
-
-
680
3,208
1,742
3,603
1,989
-
-
-
666
1,044
810
1,708
1,610
4
Bowel cancer
12,489
7,240
5,249
-
-
193
868
1,100
1,493
1,725
1,860
-
-
85
-
1,452
1,407
1,332
973
5
Liver cancer
11,161
8,197
2,964
-
13
129
976
2,829
1,625
1,826
799
-
-
37
80
586
843
915
503
6
Pancreas cancer
1,322
747
575
-
-
-
147
118
111
263
107
-
-
-
38
166
98
158
115
7
20,716
15,362
5,354
-
31
213
752
3,325
4,313
5,060
1,669
-
-
42
235
1,172
1,110
2,063
734
8
Lung cancer
cancers
723
605
118
-
-
-
-
167
201
-
237
-
-
118
-
-
-
-
-
9
Breast cancer
10,646
-
10,646
-
-
-
1,283
3,703
3,227
2,115
317
10
Uterus cancer
6,321
-
6,321
-
-
-
478
1,439
1,441
2,196
768
11
Ovary cancer
987
-
987
-
-
-
142
106
513
226
-
12
Prostate cancer
2,139
2,139
-
13
Bladder cancer
2,158
1,889
269
-
14
4,614
3,248
1,367
39
15
Leukaemia
951
670
281
36
248,707
70,837
177,871
B.
Other neoplasms
C.
Diabetes mellitus
D.
Endocrine disorders
E.
-
-
-
-
-
201
913
1,025
-
-
120
228
502
472
567
-
-
-
-
-
269
-
-
41
206
661
980
498
455
368
-
97
221
377
410
82
181
-
-
253
64
132
80
-
106
-
45
-
237
-
-
-
-
-
-
440
13,033
28,607
14,808
11,549
2,400
-
-
225
13,471
38,285
42,640
62,167
21,083
1
Depression
827,681
229,989
597,692
-
3,897
54,390
89,477
60,447
14,673
5,692
1,412
-
9,311
137,105
220,003
163,682
43,804
18,490
5,297
2
Anxiety disorders
189,912
53,522
136,391
-
763
12,178
19,239
14,055
3,891
2,498
896
1
1,437
29,805
47,566
34,761
10,982
8,057
3,783
3
Schizophrenia
154,164
78,182
75,981
-
892
20,212
32,357
18,893
3,868
1,619
342
-
516
13,498
27,439
23,505
6,340
3,645
1,038
4
Epilepsy
31,688
15,678
16,010
982
5,939
5,549
2,204
776
132
71
24
1,026
5,137
5,807
2,440
1,103
253
172
73
5
291,000
261,672
29,328
-
2,226
59,916
114,673
74,096
8,414
1,724
623
-
498
6,314
12,416
8,715
1,041
231
114
6
Dementia
180,028
58,405
121,622
-
-
-
127
7,141
14,745
23,140
13,252
-
-
-
10
7,505
21,669
44,400
48,038
7
Drug use disorders
115,826
105,098
10,727
-
605
61,089
36,662
6,044
474
173
52
-
35
6,001
3,703
819
113
42
14
Males
F.
G.
H.
Males
Females
Females
0-4
5-14
15-29
30-44
45-59
60-69
70-79
80+
0-4
5-14
15-29
30-44
45-59
60-69
70-79
80+
1
Vision loss
360,743
140,795
219,948
371
1,513
6,855
17,513
44,204
21,070
25,743
23,525
229
1,008
7,563
16,264
43,226
33,551
54,991
63,117
2
Hearing loss
119,624
56,546
63,078
50
2,551
7,809
7,982
9,277
9,610
11,671
7,597
56
1,599
5,516
6,863
9,770
9,877
15,444
13,953
1
2
Stroke
61,709
33,106
28,603
49
177
2,735
6,433
10,103
4,973
5,101
3,535
8
31
622
2,276
5,988
4,708
7,342
7,627
347,965
192,502
155,462
2,183
7,685
28,589
51,531
55,164
18,984
18,964
9,402
336
1,345
7,007
19,450
33,740
19,371
40,743
33,471
150,976
106,414
44,562
-
44
3,971
19,478
37,743
18,866
17,528
8,785
-
1
1,069
6,459
14,831
8,028
8,369
5,806
1
III.
Persons
COPD
I.
Digestive diseases
J.
K.
Skin diseases
L.
292,467
114,874
177,593
-
66
986
14,358
42,370
27,654
20,247
9,193
-
89
1,499
9,566
71,763
37,719
35,660
21,297
292,467
114,874
177,593
-
66
986
14,358
42,370
27,654
20,247
9,193
-
89
1,499
9,566
71,763
37,719
35,660
21,297
M.
1
Osteoarthritis
N.
Oral conditions
431,697
280,915
150,782
4,642
23,184
132,838
72,146
44,999
1,765
1,062
280
6,713
14,600
45,453
50,149
24,858
4,123
4,729
156
695
519
176
55
46
61
63
86
55
66
87
19
16
21
21
28
19
22
29
289,777
187,837
101,941
24,124
44,852
50,162
34,437
26,592
2,793
3,797
1,080
13,938
17,571
22,781
10,335
24,275
5,110
6,088
1,844
25,067
14,989
10,078
-
-
14,657
-
-
332
-
-
8,803
-
-
-
1,275
-
-
-
8,924
8,119
805
4,355
666
1,196
1,805
34
64
-
-
191
113
311
-
177
14
-
-
569,311
393,209
176,102
26,309
77,667
138,971
103,021
40,966
3,533
2,339
404
11,168
41,853
49,077
38,022
29,274
4,343
2,221
143
Injuries
A.
1
Poisonings
2
Falls
3
Fires
4
Drownings
5
6
B.
1
Suicide
2
Violence
335
209
126
-
42
125
36
-
7
-
-
-
-
21
31
74
-
-
-
51,347
39,972
11,376
-
3,695
19,275
8,434
7,730
769
70
-
-
1,049
4,717
4,514
958
138
-
-

Viet Nam Burden of Disease and Injury Study 2008

Transcription

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