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Title: Alcohol-attributable harm to health in urban Europe : disability-adjusted life years in a policy context
Author: Higgerson, James
Awarding Body: University of Manchester
Current Institution: University of Manchester
Date of Award: 2013
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Introduction: The majority of the European population live in urban areas (UAs). Policy making in urban areas is complex and the use of summary and aggregate measures for public health are important tools. Disability-Adjusted Life Years (DALYs) are important for national and international comparison. However, DALYs have not been calculated at urban level. Alcohol is an important European urban public health problem. Therefore the aim of this study was to calculate urban level DALYs attributable to alcohol consumption in Europe(AA-DALYs) and years of life lost (AA-YLL). This work was one of the deliverables of the European Urban Health Indicator System Part II (EURO-URHIS 2), a European Commission funded project. Methodology Design: This is a cross sectional study with four components to be able to calculate comparable DALYs. The boundary study determined the denominator to ensure comparability and facilitate identification of the UAs to be included in the study. The systematic review and national level DALY calculations were used to develop the methodology for calculating AA-DALYs, including AA-YLL. The main methodology was to calculate AA-DALYs and AA-YLL were calculated for comparison between UAs, but also to measure the relationship between alcohol policy strength (measured using the Alcohol Policy Index) and harms to health. Results: It was possible to calculate urban level AA-DALY and AA-YLL for males and females and for different age groups in 20 different UAs. There was no association at either national (p=0.15) or urban level with AA-DALYs and AA-YLL and API score. Clustering of the countries by European region may have influenced the lack of association as well as the need for further refinements of the API to include enforcement. Mean male (female) AA-YLL was 12.75 (3.23) per 1000 population (p<0.0001). Mean male (female) AA-DALYs was 18.85 (3.88) per 1000 population (p<0.0001). There were significant differences between mean male and female AA-DALYs and AA-YLL which were not present when the protective indicators were removed from the calculation. The mean effect size between all ages and the 15-79 year age groups were significant for AA-DALYs and AA-YLLs (p<0.0001).Conclusions: Comparable AA-DALYs and AA-YLL can be calculated at urban level. National level DALYs mask the intra-national differences observed within cities. AA-DALYs and AA-YLL can be used as a summary measure to help policy makers determine the outcomes of their alcohol policy strategies in cities of Europe. Morbidity data availability undermines AA-DALY estimates, but AA-YLL estimates were based on robust data on causes of death at the urban level. Future work will replicate this method for more risk factors for YLL.
Supervisor: Verma, Arpana; De Vocht, Frank; Van Ameijden, Erik Sponsor: European Commission
Qualification Name: Thesis (Ph.D.) Qualification Level: Doctoral
EThOS ID:  DOI: Not available
Keywords: Disability-Adjusted Life Years ; Alcohol policy ; Urban health