| Objective:To establish a comprehensive evaluation model of the burden of chronic diseases, and to explore its effectiveness on the burden of 10 common chronic diseases in Liuyang rural areas in Hunan province through empirical research.Methods:1. Reading documents and analytic hierarchy process (AHP) was used to create the comprehensive evaluation index system of burden of chronic diseases, and the Delphi method was adopted to select the evaluation index and determine its weight, then three comprehensive evaluation models were established by the virtue of AHP, RSR (rank sum ratio) and TOPSIS (technique for order preference by similarity to ideal solution).2. A study site was selected for this research of evaluation model of chronic diseases burden and an empirical study was implemented.(1) Selecting the Liuyang City in Hunan province as a research site. A cross-sectional investigation was conducted in the current situation to describe and identify the major 10 chronic diseases that their prevalences were on the top in the rural residents in 2006, which were served as the object of evaluation.(2) Calculating the indexes related to comprehensive evaluation of 10 major chronic diseases selected by the aboved method, including their morbidity rate, mortality, and loss of disability, life, quality of life and economy. (3) Using AHP, RSR and TOPSIS methods to establish the comprehensive evaluation model for the evaluation and sorting of the burden of the 10 major chronic diseases.(4) Comparing the results of the comprehensive evaluation with the DALYs for 10 major chronic diseases.Results:1. The comprehensive evaluation index system and models were created.(1) Based on the review of relevant literatures, a initial comprehensive evaluation index system framework of burden of chronic diseases was put forward through the analytic hierarchy process, which consisted of a level indicators (including five indexes: the characteristics of the development of diseases, loss of life due to diseases, loss of working capacity due to diseases, loss of quality of life due to diseases, economic loss of illness) and 24 secondary indicators.(2) After the implementation of the Delphi method, the enthusiasm coefficient of expert participation during the three round consultations were 92.3%,95.8% and 91.3%, respectively. The judgment coefficient of level indicators were between 0.70-0.90, the familiarity coefficients were between 0.55-0.75, and the authority coefficients of experts obtained from the above two coefficients were between 0.63-0.83. The judgment coefficient of secondary indicators were between 0.75-0.90, the familiarity coefficient were between 0.42-0.88, and the authority coefficients of experts obtained from the above two coefficients were between 0.60-0.89.(3) By selecting, the final form of comprehensive evaluation index system of the chronic diseases burden consisted of aboved 5 level indicators and 18 secondary indicators (prevalence, mortality, average age of onset, average duration, years of potential life lost, the incremental life expectancy due to the exclusion of cause of death, delayed working or studying time,working years of potential life lost, physical function, role-physical, bodily pain, general health, vitality, social function, role-emotional, mental health, direct economical loss of disease, indirect economical loss of disease). With weight of each index, the three comprehensive evaluation models were established by the way of AHP, RSR and TOPSIS methods.2. The empirical study of Comprehensive Evaluation models of the burden of chronic disease was conducted.(1) Based on the analysis according to disease systems, the prevalence of top five chronic diseases in rural areas of Liuyang city were followed by diseases of the circulatory system (5.74%), diseases of the digestive system (2.35%), diseases of the musculoskeletal system and connective tissue (2.23%), diseases of the genitourinary system (1.91%) and diseases of the respiratory system (1.48%), the total number of patients from five disease systems was 72.44% of total number of patients. There were different characteristics for the distribution of gender, age, occupation, education level and marital status from various chronic diseases. The lower level of education they were, the higher prevalence of chronic diseases they were. The prevalences of retired people and agriculture workers were higher and the prevalences of students and technical managers were lower.The prevalences of the widowed and married were higher than other marital status.Analysised by single disease, the prevalence of chronic diseases top 10 were:hypertension diseases (3.65%), urolithiasis (1.15%), rheumatoid arthritis (1.09%), chronic bronchitis (1.03%), chronic gastroenteritis (0.97%), ischaemic heart diseases (0.86%), other intervertebral disc disorders (0.72%), cerebrovascular diseases (0.68%), diabetes mellitus (0.52%), cholelithiasis and cholecystitis (0.49%).(2) In 2006, the total economical loss of 10 major chronic diseases were calculated from high to low as hypertension diseases (74.1691 million yuan), urolithiasis (54.4812 million yuan), other intervertebral disc disorders (34.1771 million yuan), cerebrovascular diseases (33.5409 million yuan), chronic bronchitis (31.7666 million yuan), rheumatoid arthritis (3137.88 million), cholelithiasis and cholecystitis (30.406 million yuan), diabetes mellitus (30.1652 million yuan), ischaemic heart diseases (2854.88 million yuan), chronic gastroenteritis (24.5635 million yuan). The total economic burden of 10 major chronic diseases in the rural was estimated to reach 373 million yuan.(3) The scores of eight dimension of quality of life from 10 major chronic diseases, including physical function (PF), role-physical (RP), bodily pain (BP), general health (GH), vitality (VT), social function (SF), role-emotional (RE), mental health (MH), were lower than healthy people (u-test, P values were<0.05). The scores of difference on the quality of life between the healthy people and various chronic diseases in each dimension were statistically significant (ANOVA, P values were<0.05).From the dimension of PF, the maximum of scores difference was between the cerebrovascular diseases and healthy population (25.3±8.3), the minimum was between urolithiasis and healthy population (8.2±2.6); from the dimension of RP, the maximum of scores difference was between diabetes mellitus and healthy people (63.8±22.4), the maximum was between cholelithiasis and cholecystitis and healthy population (33.1±11.7); from the dimension of BP, the maximum of scores difference was between other intervertebral disc disorders and healthy population, the maximum difference between healthy subjects (32.8±15.5), closely followed by rheumatoid arthritis (32.7±12.8), the minimum was between chronic bronchitis and healthy population (12.9±6.8); from the dimension of GH, the maximum of scores difference was between diabetes mellitus and healthy people (35.5±9.7), the minimum was between hypertension diseases and healthy people (23.3±8.2); from the dimension of VT, the maximum of scores difference was between diabetes mellitus and healthy people (18.3±4.2), the minimum was between hypertension diseases and healthy people (9.1±4.7); from the dimension of SF, the maximum of scores difference was between cerebrovascular diseases and healthy people (28.2±10.4), the minimum was between cholelithiasis and cholecystitis and healthy people (12.8±4.4); from the dimension of RE, the maximum of scores difference was between diabetes mellitus and healthy people(35.6±11.8), the minimum was between chronic bronchitis and healthy people (11.6±3.2); from the dimension of MH, the maximum of scores difference was between diabetes mellitus and healthy people (13.7±4.9), the minimum was between chronic gastroenteritis and healthy people (5.1±1.5).(4) In 2006, Liuyang City, the total mortality rate was 6.56‰. Among them, the male mortality rate was 7.20‰and female mortality rate was 5.87‰, the former was more than the latter. The highest crude death rate was 1.41‰, from cerebrovascular diseases. No death was due to other intervertebral other intervertebral disc disorders. In the 10 major chronic diseases, such as hypertension diseases, ischaemic heart diseases, cerebrovascular diseases, chronic bronchitis, urolithiasis, chronic gastroenteritis, their crude death rate in men were higher than women, but in rheumatoid arthritis, diabetes mellitus, cholelithiasis and cholecystitis, their crude mortality rate in women were higher than men. The average life expectancy in Liuyang city in 2006 was 74.4 years, and 72.7 years for men, women 76.3 years, respectively, which were higher than the national average over the same period. In the 10 majoe chronic diseases, the difference from average age of onset was statistically significant (Wilcoxon test, H=18.72, P<0.05), where the average age of onset of cerebrovascular diseases was the biggest, and the urolithiasis was the smallest. The longest average duration in patients was urolithiasis (36.87 years), the shortest was cerebrovascular diseases (6.20 years).(5) DALY loss of 10 major chronic diseases were followed by cerebrovascular diseases (12.986‰), chronic bronchitis (7.190‰), ischaemic heart diseases (5.581‰), hypertension diseases (1.196‰), rheumatoid arthritis (1.122‰), cholelithiasis and cholecystitis (0.883‰), diabetes mellitus (0.862%o), other intervertebral disc disorders (0.437%o), chronic gastroenteritis (0.379‰), urolithiasis (0.180‰). The diseases that their losses of DALY in men were greater than women were cerebrovascular disease, other intervertebral disc disorders, rheumatoid arthritis, urolithiasis, chronic gastroenteritis, the diseases that losses of DALY in women were greater than men were hypertension diseases, ischaemic heart diseases, chronic bronchitis, diabetes mellitus, cholelithiasis and cholecystitis.(6) Looking at the results from the evaluation, AHP method and TOPSIS method were exactly the same conclusions.10 major chronic diseases, the overall disease burden from high to low were cerebrovascular diseases, chronic bronchitis, hypertension diseases, ischaemic heart diseases, urolithiasis, diabetes mellitus, rheumatoid arthritis, other intervertebral disc disorders, cholelithiasis and cholecystitis, chronic gastroenteritis. The evaluation results from RSR method were cerebrovascular diseases, chronic bronchitis, diabetes mellitus, urolithiasis, hypertension diseases, ischaemic heart diseases, rheumatoid arthritis, chronic gastroenteritis, other intervertebral disc disorders, cholelithiasis and cholecystitis. (7) In the 10 major chronic diseases, the DALY loss from cerebrovascular diseases, chronic bronchitis, ischaemic heart diseases and hypertension diseases were among the top four. The results fully reflected that cerebrovascular diseases, chronic bronchitis, hypertension diseases and ischaemic heart diseases were currently the main source of the disease burden in Liuyang rural areas, regardless of the loss of life from the disease or from the other multifaceted impact.In additon, from a more general situation, the chronic disease with low mortality and prevalence, such as other intervertebral disc disorders, chronic gastroenteritis, cholelithiasis and cholecystitis, had lower burden of disease with its rank were at a later position even if considered in the evaluation of the ability to work, quality of life and economic effects, This also showed in some ways that the diseases with high prevalence, high mortality, and easy to be disable were major source of disease burden.(8) As a means of comprehensive evaluation, the proposed model not only considered the loss of life caused by the disease, such as the YPLL and the incremental life expectancy due to the exclusion of cause of death, but also took the loss of quality of life of patients into account, meanwhile it also included the loss of working capacity and the economic loss. Thus, the comprehensive evaluation model could reflect more complete information, and were more conducive to health policy. So, in theory, comprehensive evaluation model should be better than the DALY. In addition, the AHP and TOPSIS methods had obtained the consistent results, and reflected the better applicability.Conclusions:1. The prevalence and mortality of chronic diseases in rural areas in Liuyang city were 16.06%and 6.56‰, respectively. The prevalence was higher than the national rural average. 2. The financial burden of 10 major chronic diseases in Liuyang rural was estimated to reach 373 million yuan, the top three diseases were hypertension diseases (74.1691 million yuan), urolithiasis (54.4812 million yuan) and other intervertebral disc disorders (34.1771 million yuan), respectively.3.10 major chronic diseases greatly affected the quality of life and had different loss characteristics at different dimensions.4. The comprehensive evaluation model with 5 level indicators and 18 secondary indicators was first created and proved feasible and effective.5. The newly established comprehensive evaluation model was first applicated for the 10 common chronic diseases in rural areas of Liuyang. The result of burden of diseases in descending order was cerebrovascular diseases, chronic bronchitis, hypertension diseases, ischaemic heart diseases, urolithiasis, diabetes mellitus, rheumatoid arthritis, other intervertebral disc disorders, cholelithiasis and cholecystitis and chronic gastroenteritis.6. From the practical situation, the evaluation model used in chronic disease burden basically reflected the information and the harm of the current situation of chronic disease. The diseases with high prevalence, high mortality, and easy to be disable remained a major source of disease burden. Otherwise, the disease burden from the chronic disease with low prevalence and low mortality, even if considered in the evaluation of the ability to work, quality of life and economic impact, were relatively low.7. Comprehensive evaluation model created by our study should be better than the DALY. Among the three evaluation models, we recommend the use of AHP or TOPSIS methods for comprehensive evaluation of disease burden in applications.
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