Multiple-informant ranking of the disabling effects of different health conditions in 14 countries

Background The Global Burden of Disease study provided international statis tics on the burden of diseases, combining mortality and disability, that ca n be used for priority setting and policy making. However, there are concer ns about the universality of the disability weights used, We undertook a st udy to investigate the stability of such weighting in different countries a nd informant groups. Methods 241 key informants (health professionals, policy makers, people wit h disabilities, and their carers) from 14 countries were asked to rank 17 h ealth conditions from most disabling to least disabling. Kruskal-Wallis ANO VA was used to test for differences in ranking between countries or informa nt groups and Kendall tau-B correlations to measure association between dif ferent rank orders. Findings For 13 of 17 health conditions, there were significant (p<0.05) di fferences in ranking between countries; in the comparison of informant grou ps, there were significant differences for five of the 17 health conditions . The overall rank order in the present study was, however, almost identica l to the ranking of the Global Burden of Disease study, which used a differ ent method, Most. of the rank correlations between countries were between 0 .50 and 0.70 (average 0.61 [95% CI 0.59-0.64]). The average correlation of rank orders between different informant groups was 0.76. Interpretation Rank order of disabling effects of health conditions is rela tively stable across countries, informant groups, and methods. However, the differences are large enough to cast doubt: on the assumption of universal ity of experts' judgments at,out disability weights. Further studies are ne eded because disability weights are central to the calculation of disabilit y-adjusted life years.