Handbook of Disease Burdens and Quality of Life Measures

Abstract

Stroke is a major cause of death and disability in many countries. In Australia, as in many other parts of the world, the incidence of stroke will increase because of the aging population. The purpose of this chapter was to describe the disease burden attributable to stroke expressed as Disability Adjusted Life Years (DALYs) in Australia; and to provide an overview of public health programs that exist to reduce this disease burden. Methods of DALY estimation for stroke in Australia are outlined and compared. Despite some differences in methodologies and data sources, results were consistent. Public health programs to reduce the stroke burden include generic programs aimed at reducing common risk factors across a number of chronic diseases; and stroke specific programs to address unique aspects of stroke. Examples of these programs are provided. A simulation analysis is presented to demonstrate the potential impact of public health programs. This analysis is based on the concept of improving access to interventions that we already know are effective in preventing stroke and/or improving stroke outcomes in a representative year (2015) using local epidemiological data. DALYs saved were calculated for the additional cases that would benefit if current practice were improved to more closely reflect best-practice. Interventions included: blood pressure lowering; warfarin for atrial fibrillation; access to stroke care units; increased use of intravenous thrombolysis, cholesterol lowering and aspirin for ischemic events; and carotid endarterectomy. In present-value (2006) terms, this would result potentially in the recovery of more than 92,000 DALYs. Thus, improving access to effective prevention and treatment interventions should produce important health gains.