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Levels of anchorage to local data and NBD Results:    

 
 
 
     
  Inputs from the Global Burden of Disease study (World Bank, 1993; Murray and Lopez, 1996) were used to generate the minimally anchored NBD estimates for Andhra Pradesh. The final results of the first global burden of disease study were published in 1996 - GBD96. By the time of this final revision, causes of death in urban areas of Maharashtra had been gathered by the Andhra Pradesh Burden of Disease Study, to approximate the mortality experience in urban areas of India. The urban cause of death data from Maharashtra was incorporated by the GBD96 study for the Indian estimates (Murray and Lopez, 1996 p139). In the present study, urban causes of death data remain the same while rural causes of death data have been a recent addition. The GBD96 study also had access to some preliminary insights from the pilot study on rural cause of death in Andhra Pradesh (Murray and Lopez, 1996 p140). Since the GBD96 study already incorporates a lot of local information on causes of death, it will be interesting to look at the first GBD estimates published in the World Development Report, 1993 (World Bank, 1993). Call this the WDR93. The WDR93 results used here for comparative purposes are the results taken for India directly from the World Development Report (1993, Appendix B). The GBD96 based estimates have been computed for Andhra Pradesh using the cause-specific mortality proportions, incidence, and duration data for India as used by the GBD96 study. The GBD96 disability weights are also used as such. These general demographic estimates are common inputs to the GBD96 based estimate and the intermediately anchored estimates for Andhra Pradesh.  
     
  Three intermediately anchored estimates are presented. The first one starts with the inputs used for the GBD96 based estimate, but with the cause-specific mortality proportions replaced by local estimates. The local cause-specific mortality proportions come from two studies. The rural cause of death study provided the cause-specific mortality proportions for the rural population of Andhra Pradesh. We call this the cause of death anchored (COD anchored) estimate. All other inputs are the same as in case of the GBD96 estimate. The second one starts with inputs for the COD anchored estimate and replaces the GBD96 disability weights with the APHSV-VAS weights. Call this the HSV-VAS anchored estimate. The third estimate uses APHSV99-Torrance-TTO disability weights instead of the APHSV99-VAS weights. Call this the HSV-Torrance-TTO estimate. The epidemiological parameters like incidence, duration and age at onset, remain same as in GBD96. The locally anchored estimates were computed separately for rural and urban areas of the state whereas the GBD96 estimate has been computed for the whole state population. The WDR93 and GBD96 are the two minimally anchored estimates. The three intermediately anchored estimates comprise of the COD anchored, and the two HSV anchored estimates.  
     
 

Overview of Burden of Disease Estimates for Andhra Pradesh with different levels of anchorage to local data.

Estimate Anchor to Local Data GBD Resource
WDR93 None GBD Regional estimate for India
GBD96 General demographic estimates for AP

Maharashtra urban cause of death data

Cause-specific mortality in India

Incidence, age at onset and duration

Disability weights
COD anchored As above, plus

Rural cause of death data from AP

Incidence, age at onset and duration.

Disability weights
HSV-VAS anchored As above, plus

Community-based health state valuation

Incidence, age at onset and duration
HSV-Torrance-TTO anchored As above, but HSV-VAS disability weights are transformed using power function estimated by Torrance (1976), relating VAS to TTO valuations. As above
 
     

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