The relation between funding by the National Institutes of Health and the burden of disease

Background. The Institute of Medicine has proposed that the amount of disea se-specific research funding provided by the National Institutes of Health (NIH) be systematically and consistently compared with the burden of diseas e for society. Methods. We performed a cross-sectional study comparing estimates of diseas e-specific funding in 1996 with data on six measures of the burden of disea se. The measures were total mortality, years of life lost, and number of ho spital days in 1994 and incidence, prevalence, and disability-adjusted life -years (one disability-adjusted life-year is defined as the loss of one yea r of healthy life to disease) in 1990. With the use of these measures as ex planatory variables in a regression analysis, predicted funding was calcula ted and compared with actual funding. Results. There was no relation between the amount of NIH funding and the in cidence, prevalence, or number of hospital days attributed to each conditio n or disease (P = 0.82, P = 0.23, and P = 0.21, respectively). The numbers of deaths (r = 0.40, P = 0.03) and years of life lost (r = 0.42, P = 0.02) were weakly associated with funding, whereas the number of disability-adjus ted life-years was strongly predictive of fundi ng (r = 0.62, P < 0.001). W hen the latter th ree measures were used to predict expected funding, the c onclusions about the appropriateness of funding for some diseases varied ac cording to the measure used. However, the acquired immunodeficiency syndrom e, breast cancer, diabetes mellitus, and dementia all received relatively g enerous funding, regardless of which measure was used as the basis for calc ulating support. Research on chronic obstructive pulmonary disease, perinat al conditions, and peptic ulcer was relatively underfunded. Conclusions. The amount of NIH funding for research on a disease is associa ted with the burden of the disease; however, different measures of the burd en of disease may yield different conclusions about the appropriateness of disease-specific funding levels. (N Engl J Med 1999;340:1881-7). (C) 1999, Massachusetts Medical Society.