1. Update on “Disease Burden Attributable to Risk Factors in the US” Project Armineh Zohrabian, CDC IAWG on Summary and Outcome Measures of Health July 12, 2006

2. Presentation Outline Overview of the specific activities of CDC/Harvard University current Burden of Disease (BOD) project Brief mention of CDC’s Health Related Quality of Life Surveillance Program Overview of the specific activities of CDC/Harvard University current Burden of Disease (BOD) project Brief mention of CDC’s Health Related Quality of Life Surveillance Program

3. BOD Project CDC/Harvard University cooperative agreement $325,000 over 3 years (2004-2007) CDC/Harvard University cooperative agreement $325,000 over 3 years (2004-2007)

4. BOD Objectives Update 1996 disease burden estimates to the year for which most recent data are available (2001) Estimate distributions and trends of total and risk-factor attributable disease burden by age, sex, race and geography Update 1996 disease burden estimates to the year for which most recent data are available (2001) Estimate distributions and trends of total and risk-factor attributable disease burden by age, sex, race and geography

5. Specific Activities Inputs for estimating disease burden attributable to risk factors are: Risk factor exposure Uses risk assessment module from the Comparative Risk Assessment (CRA) Project, WHO Risk factor hazard Estimates will be based on systematic review of epi literature Burden of disease Will use Disability Adjusted Life Years (DALYs) Inputs for estimating disease burden attributable to risk factors are: Risk factor exposure Uses risk assessment module from the Comparative Risk Assessment (CRA) Project, WHO Risk factor hazard Estimates will be based on systematic review of epi literature Burden of disease Will use Disability Adjusted Life Years (DALYs)

6. Collation of data sources and development of methods to re-distribute ill-defined causes of death in the US (completed) estimate unbiased overweight and obesity trends from self-reported data (completed) estimate unbiased trends for other risk factors from self- reported data (initiated) estimate sub-national risk factor exposure and trends in risk factor exposure (ongoing) Development of new algorithms to update 1996 US burden of disease estimates to the year 2000 or 2001(ongoing) Collation of data sources and development of methods to re-distribute ill-defined causes of death in the US (completed) estimate unbiased overweight and obesity trends from self-reported data (completed) estimate unbiased trends for other risk factors from self- reported data (initiated) estimate sub-national risk factor exposure and trends in risk factor exposure (ongoing) Development of new algorithms to update 1996 US burden of disease estimates to the year 2000 or 2001(ongoing) Specific Activities (continued)

7. Contribution to scientific literature Ezzati M, Martin H, Skjold S,Vander Hoorn S, Murray CJ. Trends in National and State-Level Obesity in the USA after correction for self-reported bias. JR Soc Med. 2006 May; 99(5):250-7. Erratum in: J R Soc Med. 2006 Jun;99(6):280. Christopher J.L. Murray, Sandeep C. Kulkarni and Majid Ezzati. Understanding the Coronary Heart Disease Versus Total Cardiovascular Mortality Paradox: A Method to Enhance the Comparability of Cardiovascular Death Statistics in the United States. Circulation 2006;113;2071-2081 Ezzati M, Martin H, Skjold S,Vander Hoorn S, Murray CJ. Trends in National and State-Level Obesity in the USA after correction for self-reported bias. JR Soc Med. 2006 May; 99(5):250-7. Erratum in: J R Soc Med. 2006 Jun;99(6):280. Christopher J.L. Murray, Sandeep C. Kulkarni and Majid Ezzati. Understanding the Coronary Heart Disease Versus Total Cardiovascular Mortality Paradox: A Method to Enhance the Comparability of Cardiovascular Death Statistics in the United States. Circulation 2006;113;2071-2081

8. CDC's Health-Related Quality of Life Surveillance Program Housed in the Division of Adult and Community Health, National Center for Chronic Disease Prevention and Health Promotion Its purpose is to learn about unmet health needs; recognize trends, disparities, and determinants of health in the population It uses the Healthy Days surveillance measures in summary measures of population health Housed in the Division of Adult and Community Health, National Center for Chronic Disease Prevention and Health Promotion Its purpose is to learn about unmet health needs; recognize trends, disparities, and determinants of health in the population It uses the Healthy Days surveillance measures in summary measures of population health

9. Resources on Healthy Days Measures Moriarty DG, Zack MM, Kobau R, Zahran HS. Tracking Health-Related Quality of Life in the United States 1993-2004. Presented at the Institute of Medicine Committee to Evaluate Measures of Health Benefits for Environmental, Health, and Safety Regulation. Washington, DC, December 1, 2004. See PowerPoint slides @ http://www.iom.edu/subpage.asp?id=23875 http://www.iom.edu/subpage.asp?id=23875 Klementiev A. Chapter 5 -- An Alternative Measure of Years of Healthy Life, from:Estes RJ (Ed). Social Indicators Research Series, 2006; 29 ISBN: 1-4020-5099-2 [In press, available November 15, 2006]. For additional information, including copies of the measures, annual state-based HRQOL prevalence data from 1993 and later, and references to research based on the measures, please see the CDC HRQOL Website at http://www.cdc.gov/hrqol.http://www.cdc.gov/hrqol Moriarty DG, Zack MM, Kobau R, Zahran HS. Tracking Health-Related Quality of Life in the United States 1993-2004. Presented at the Institute of Medicine Committee to Evaluate Measures of Health Benefits for Environmental, Health, and Safety Regulation. Washington, DC, December 1, 2004. See PowerPoint slides @ http://www.iom.edu/subpage.asp?id=23875 http://www.iom.edu/subpage.asp?id=23875 Klementiev A. Chapter 5 -- An Alternative Measure of Years of Healthy Life, from:Estes RJ (Ed). Social Indicators Research Series, 2006; 29 ISBN: 1-4020-5099-2 [In press, available November 15, 2006]. For additional information, including copies of the measures, annual state-based HRQOL prevalence data from 1993 and later, and references to research based on the measures, please see the CDC HRQOL Website at http://www.cdc.gov/hrqol.http://www.cdc.gov/hrqol