Burden of oral disease among priority population groups in Australia Dr Mohammed Junaid BDS, MDS (Public Health Dentistry), MFDS RCPS (Glasg), DDPH RCS (Eng), AFHEA, PhD Senior Lecturer – Dental Public Health Image Source: Uni of Sydney: https://www.sydney.edu.au/news-opinion/news/2017/09/28/aboriginal-oral-health-care--double-the-services--half-the-cost.html Western Australian: https://thewest.com.au/politics/state-politics/homeless-crisis-was-number-of-rough-sleepers-more-than-doubles-making-it-hardest-hit-in-australia--c-10116449 ABC: https://www.abc.net.au/news/2023-03-13/disability-dental-care-hampered-by-cost-and-accessibility/102079462 https://www.oralhealthgroup.com/news/hamilton-hospital-launches-study-on-prevora-dental-treatment-for-high-risk-patients-1003973907/     **Dr Mohammed Junaid** BDS, MDS (Public Health Dentistry), MFDS RCPS (Glasg), DDPH RCS (Eng), AFHEA, PhD Senior Lecturer – Dental Public Health *Image Sources:* - *University of Sydney: https://www.sydney.edu.au/news-opinion/news/2017/09/28/aboriginal-oral-health-care--double-the-services--half-the-cost.html* - *The West Australian: https://thewest.com.au/politics/state-politics/homeless-crisis-was-number-of-rough-sleepers-more-than-doubles-making-it-hardest-hit-in-australia--c-10116449* - *ABC: https://www.abc.net.au/news/2023-03-13/disability-dental-care-hampered-by-cost-and-accessibility/102079462* - *Oral Health Group: https://www.oralhealthgroup.com/news/hamilton-hospital-launches-study-on-prevora-dental-treatment-for-high-risk-patients-1003973907/* Clinical photo: A caregiver in blue scrubs assists an elderly man in a wheelchair with oral hygiene (brushing teeth) while holding a glass of water, illustrating the concept of assisted daily living or care for priority populations such as the elderly or those with disabilities. Clinical photo: A close-up of a smiling young person with long red hair, raising their right fist in the air. The image illustrates the human element and potential for positive oral health outcomes within priority population groups. Clinical photo: A person in a red hoodie sitting on the ground next to water bottles and blankets, illustrating homelessness as a priority population group facing barriers to oral health care. Photograph: A smiling young girl in a yellow shirt is shown brushing the teeth of a green stuffed dinosaur toy with a large yellow toothbrush, illustrating oral health education. In the context of the slide's focus on 'priority population groups' and the source link regarding 'Aboriginal oral health care,' this image likely represents dental health promotion within Indigenous Australian communities. # Acknowledgement of country I would like to acknowledge the traditional custodians of the land, the Whadjuk Noongar people, in whose land, I have recorded this lecture and pay my respects to elder's past, present and emerging. Including to all those with Indigenous heritage who are listening to this recording. Image sourced from Department of Fire and Emergency services "Caring for the country" https://www.triple.com.au/story/local-noongar-artwork-transforms-fire-truck-99764  I would like to acknowledge the traditional custodians of the land, the Whadjuk Noongar people, in whose land, I have recorded this lecture and pay my respects to elder's past, present and emerging. Including to all those with Indigenous heritage who are listening to this recording. *Image sourced from Department of Fire and Emergency Services "Caring for the country": https://www.triple.com.au/story/local-noongar-artwork-transforms-fire-truck-99764* Indigenous artwork: A section of an Aboriginal dot painting featuring concentric circles, wavy blue and teal lines, and white branching patterns set against a background of reds, oranges, and browns, illustrating the 'Caring for the country' theme mentioned in the source text. # Learning outcomes 1. Understand the concept behind burden of disease. 2. Identify the priority population groups in Australia. 3. Understand the extent of burden of oral disease among these cohorts. 4. Enumerate and appreciate reasons behind the existing burden of disease among these groups of individuals. Image source: https://gifer.com/en/gifs/objective  1. Understand the concept behind burden of disease. 2. Identify the priority population groups in Australia. 3. Understand the extent of burden of oral disease among these cohorts. 4. Enumerate and appreciate reasons behind the existing burden of disease among these groups of individuals. *Image source: https://gifer.com/en/gifs/objective* > [!note] Lecturer — Lecture Structure > The lecture was recorded in three parts. > > - The first part introduces burden of disease, distinguishes it from incidence and prevalence, and explains disability-adjusted life years as a measurement method. > - The lecture introduces priority population groups identified by the Australian Institute of Health and Welfare and explains why they matter when planning public health activities. > - Subsequent recordings examine oral disease burden and the reasons for that burden among specific priority populations. Illustration: A 3D white humanoid figure stands next to a vertical checklist of four black boxes, each containing a red checkmark. The figure holds a red marker and appears to be ticking the third box from the top, visually representing the concept of completing learning outcomes or objectives. # Concept behind burden of disease The term **burden of disease** generally describes the total, cumulative consequences of a defined disease or a range of harmful diseases with respect to disabilities in a community. | Category | Cancer | Injury | Infant/congenital | Skin | Reproductive/maternal | Cardiovascular | Respiratory | Endocrine | Infections | Mental | Neurological | Oral | Gastrointestinal | Hearing/vision | Kidney/urinary | Blood/metabolic | | :--- | :--- | :--- | :--- | :--- | :--- | :--- | :--- | :--- | :--- | :--- | :--- | :--- | :--- | :--- | :--- | :--- | | **DALY** | 19% | 15% | 12% | 12% | 9% | 8% | 7% | | | | | | | | | | | **YLD** | 24% | 23% | | 12% | 7% | 6% | 4% | | | | | | | | | | | **YLL** | 34% | 23% | | | | 14% | | | | | | 6% | 5% | 4% | 4% | GBD 2021 Diseases and Injuries Collaborators. Global incidence, prevalence, years lived with disability (YLDs), disability-adjusted life-years (DALYs), and healthy life expectancy (HALE) for 371 diseases and injuries in 204 countries and territories and 811 subnational locations, 1990–2021: a systematic analysis for the Global Burden of Disease Study 2021. Lancet. 2024 May 18;403(10440):2133-2161. doi: 10.1016/S0140-6736(24)00757-8. Epub 2024. Image source: Australian Institute of Health and Welfare (2016) *Australian Burden of Disease Study: impact and causes of illness and death in Australia 2011*, AIHW, Australian Government, accessed 27 July 2024.  The term **burden of disease** generally describes the total, cumulative consequences of a defined disease or a range of harmful diseases with respect to disabilities in a community. | Category | Cancer | Injury | Infant/congenital | Skin | Reproductive/maternal | Cardiovascular | Respiratory | Endocrine | Infections | Mental | Neurological | Oral | Gastrointestinal | Hearing/vision | Kidney/urinary | Blood/metabolic | | :--- | :--- | :--- | :--- | :--- | :--- | :--- | :--- | :--- | :--- | :--- | :--- | :--- | :--- | :--- | :--- | :--- | | **DALY** | 19% | 15% | 12% | 12% | 9% | 8% | 7% | | | | | | | | | | | **YLD** | 24% | 23% | | 12% | 7% | 6% | 4% | | | | | | | | | | | **YLL** | 34% | 23% | | | | 14% | | | | | | 6% | 5% | 4% | 4% | *GBD 2021 Diseases and Injuries Collaborators. Global incidence, prevalence, years lived with disability (YLDs), disability-adjusted life-years (DALYs), and healthy life expectancy (HALE) for 371 diseases and injuries in 204 countries and territories and 811 subnational locations, 1990–2021: a systematic analysis for the Global Burden of Disease Study 2021. Lancet. 2024 May 18;403(10440):2133-2161. doi: 10.1016/S0140-6736(24)00757-8.* *Australian Institute of Health and Welfare (2016) Australian Burden of Disease Study: impact and causes of illness and death in Australia 2011, AIHW, Australian Government, accessed 27 July 2024.* > [!note] Lecturer — Burden Versus Frequency > Burden of disease is broader than incidence or prevalence: it considers not only how many people have a condition, but also its consequences. > > - Incidence refers to the number of new cases, whereas prevalence includes existing cases, both new and previously diagnosed. > - The impact includes effects on daily life, participation and contribution to society, interactions with society, and society more broadly. Chart: A stacked horizontal bar chart illustrating the percentage contribution of various disease groups to three burden of disease metrics: DALY (Disability-Adjusted Life Years), YLD (Years Lived with Disability), and YLL (Years of Life Lost). The legend identifies the color-coded categories, including Cancer, Injury, Mental, Musculoskeletal, Cardiovascular, Respiratory, Neurological, Gastrointestinal, Infant/congenital, Endocrine, Oral, Hearing/vision, Skin, Infections, Kidney/urinary, Blood/metabolic, and Reproductive/maternal. # Measuring burden of disease – introducing Disability Adjusted Life Years (DALY) One DALY represents the loss of the equivalent of one year of full health. DALYs for a disease or health condition are the sum of the years of life lost to due to premature mortality (YLLs) and the years lived with a disability (YLDs) due to prevalent cases of the disease or health condition in a population World Health Organisation, : https://www.who.int/data/gho/indicator-metadata-registry/imr-details/158 Image source: UK Health Security Agency https://ukhsa.blog.gov.uk/2015/09/15/the-burden-of-disease-and-what-it-means-in-england/  One DALY represents the loss of the equivalent of one year of full health. DALYs for a disease or health condition are the sum of the years of life lost due to premature mortality (YLLs) and the years lived with a disability (YLDs) due to prevalent cases of the disease or health condition in a population. *World Health Organization: https://www.who.int/data/gho/indicator-metadata-registry/imr-details/158* *UK Health Security Agency: https://ukhsa.blog.gov.uk/2015/09/15/the-burden-of-disease-and-what-it-means-in-england/* > [!example] Oral Cancer and DALYs > If a person is diagnosed with oral cancer at age 55, has a life expectancy of 85 years, and dies at age 65, they have lost approximately 20 years through premature mortality and lived with the disease and its consequences for approximately 10 years. This illustrates the components of a DALY, although the actual calculation is more precise and is performed at a population level. Labelled diagram illustrating the composition of a Disability Adjusted Life Year (DALY) as the sum of Years Lived with Disability (YLD) and Years of Life Lost (YLL). The graphic visually breaks down these components along a timeline from birth to expected life years, showing YLD as time spent with illness or injury and YLL as premature mortality. # Calculating DALY ## Calculating YLL and YLD ### The basic formula for calculating the YLL YLL = N x L where: - N = number of deaths. - L = standard life expectancy at age of death (in years) ### The basic formula for calculating the YLD YLD = I x DW x L where: - I = number of incident cases. - DW = disability weight. - L = average duration of disability (years) --- ## DALY **Disability Adjusted Life Years** is a measure of overall disease burden, expressed as the cumulative number of years lost due to ill-health, disability or early death YLD = Years Lived with Disability YLL = Years of Life Lost --- Source: https://www.publichealthnotes.com/daly-disability-adjusted-life-years/    #### Definition of DALY **Disability Adjusted Life Years (DALY)** is a measure of overall disease burden, expressed as the cumulative number of years lost due to ill-health, disability, or early death. - **YLD** = Years Lived with Disability - **YLL** = Years of Life Lost #### Calculating YLL and YLD ##### Basic Formula for Calculating YLL $$\text{YLL} = N \times L$$ Where: - $N$ = Number of deaths - $L$ = Standard life expectancy at age of death (in years) ##### Basic Formula for Calculating YLD $$\text{YLD} = I \times \text{DW} \times L$$ Where: - $I$ = Number of incident cases - $\text{DW}$ = Disability weight - $L$ = Average duration of disability (in years) *Public Health Notes: https://www.publichealthnotes.com/daly-disability-adjusted-life-years/* - ==DALYs capture the impact of a condition but do not measure its economic cost to society; economic burden is measured separately.== > [!note] Lecturer — YLL Life Expectancy > The relevant life expectancy in the YLL calculation is particularly the geographical life expectancy at death. For example, if a person dies in 2024 and the relevant life expectancy is 84 years, that life expectancy is used in the calculation. > [!note] Lecturer — Disability Weights > Disability weights are statistical measures provided by the World Health Organization and range from 0 to 1. > > - They represent the impact or “weight” of a disability on overall life. > - They differ according to the condition; a more disabling condition, such as cancer, may have a higher disability weight than dental caries. > - For population calculations, the duration of disability is generally expressed as an average duration. This labelled diagram illustrates the concept of Disability Adjusted Life Years (DALY) as a timeline of human life, visually defining it with the equation DALY = YLD + YLL. The graphic depicts 'Healthy life' transitioning into periods of 'Disease or Disability' and ending in 'Early death', which collectively fall short of the 'Expected life years'. Icon: A simple grey silhouette of a standing human figure, representing the individual subject in the context of calculating disease burden metrics like YLL and YLD. Iconographic illustration of a stylized human figure with a halo hovering above the head and dashed lines extending from the lower legs. **Most common cause of age-standardised DALY rates by location, all ages, both sexes, in 2021** COVID-19 Other COVID-19 pandemic-related outcomes HIV/AIDS Tuberculosis Diarrhoeal diseases Malaria Neonatal disorders Tracheal, bronchus, and lung cancer Ischaemic heart disease Stroke Depressive disorders Anxiety disorders Drug use disorders Diabetes mellitus Low back pain Road injuries Self-harm Interpersonal violence West Africa Eastern Mediterranean Northern Europe GBD 2021 Diseases and Injuries Collaborators. Global incidence, prevalence, years lived with disability (YLDs), disability-adjusted life-years (DALYs), and healthy life expectancy (HALE) for 371 diseases and injuries in 204 countries and territories and 811 subnational locations, 1990-2021: a systematic analysis for the Global Burden of Disease Study 2021. Lancet. 2024 May 18;403(10440):2133-2161. doi: 10.1016/S0140-6736(24)00757-8.       #### Most Common Causes of Age-Standardised DALY Rates by Location (All Ages, Both Sexes, 2021) ##### Leading Causes - COVID-19 - Other COVID-19 pandemic-related outcomes - HIV/AIDS - Tuberculosis - Diarrhoeal diseases - Malaria - Neonatal disorders - Tracheal, bronchus, and lung cancer - Ischaemic heart disease - Stroke - Depressive disorders - Anxiety disorders - Drug use disorders - Diabetes mellitus - Low back pain - Road injuries - Self-harm - Interpersonal violence ##### Illustrative Locations - West Africa - Eastern Mediterranean - Northern Europe *GBD 2021 Diseases and Injuries Collaborators. Global incidence, prevalence, years lived with disability (YLDs), disability-adjusted life-years (DALYs), and healthy life expectancy (HALE) for 371 diseases and injuries in 204 countries and territories and 811 subnational locations, 1990-2021: a systematic analysis for the Global Burden of Disease Study 2021. Lancet. 2024 May 18;403(10440):2133-2161. doi: 10.1016/S0140-6736(24)00757-8.* This choropleth world map illustrates the most common cause of age-standardised DALY rates by location for all ages and both sexes in 2021, with countries color-coded according to their leading disease or injury burden. The legend identifies the specific causes corresponding to each color: orange = COVID-19, light yellow = Other COVID-19 pandemic-related outcomes, dark red = HIV/AIDS, maroon = Tuberculosis, pinkish-red = Diarrhoeal diseases, light pink = Malaria, peach = Neonatal disorders, light blue = Tracheal, bronchus, and lung cancer, medium blue = Ischaemic heart disease, dark blue = Stroke, purple-grey = Depressive disorders, lavender = Anxiety disorders, grey-purple = Drug use disorders, dark purple = Diabetes mellitus, indigo = Low back pain, teal = Road injuries, green = Self-harm, and dark green = Interpersonal violence. Map: This choropleth map illustrates the most common cause of age-standardised DALY rates for the Caribbean and Central America region in 2021, with countries color-coded to correspond to specific diseases or injuries listed in the slide text (e.g., orange likely represents 'Other COVID-19 pandemic-related outcomes', green 'Road injuries', blue 'HIV/AIDS', and purple 'Tuberculosis'). Map: This figure displays a geographical map of the Arabian Peninsula, highlighting a specific subnational region in purple within the white-colored area of Saudi Arabia, surrounded by orange-colored neighboring territories and blue water. A choropleth map of the Balkan Peninsula region, illustrating the most common cause of age-standardised DALY rates by location in 2021. The countries are color-coded to represent different disease categories: orange indicates Ischaemic heart disease (covering Romania, Bulgaria, Serbia, Albania, North Macedonia, and Turkey), light blue represents Stroke (visible in Bosnia and Herzegovina, Greece, and Moldova), and dark purple signifies Depressive disorders (shown for Italy). This figure is a choropleth map of the Southeast Asia region, illustrating the most common cause of age-standardised DALY rates by location for the year 2021. The map uses different colors to represent specific diseases or injuries, which are defined in the slide's legend: dark blue corresponds to Stroke, light blue to Ischaemic heart disease, green to Tuberculosis, orange to Tracheal, bronchus, and lung cancer, and purple to Depressive disorders. This figure consists of three choropleth maps displaying geographic regions labeled 'West Africa', 'Eastern Mediterranean', and 'Northern Europe'. The maps use a color-coded system (orange, blue, purple, pink) to illustrate the most common cause of age-standardised DALY rates by location in 2021 for these specific areas, corresponding to the disease categories listed in the slide text. Lightweight text editor with a simple interface **Table** | Cause | YLDs 2021 | Percentage of all-cause YLDs | Count (millions) | Age-standardised rate (per 100 000) | Percentage change, 2010-21 YLD count | Percentage change, 2010-21 Age-standardised rate | |---|---|---|---|---|---|---| | 1 Low back pain | 7.7% (6.5 to 9.1) | 70.2 (50.2 to 94.1) | 832.2 (595.9 to 1115.3) | 19.4% (17.9 to 20.8) | -2.4% (-2.9 to -1.8) | | 2 Depressive disorders | 6.2% (5.0 to 7.8) | 56.3 (39.3 to 76.5) | 681.2 (475.3 to 924.0) | 36.5% (31.7 to 41.7) | 16.4% (11.9 to 21.3) | | 3 Headache disorders | 5.2% (1.2 to 10.4) | 48.0 (9.80 to 101) | 588.4 (117.6 to 1245.7) | 14.4% (12.7 to 17.8) | 0.3% (-1.1 to 1.4) | | 4 Age-related and other hearing loss | 4.9% (3.9 to 5.9) | 44.4 (30.7 to 62.0) | 525.9 (364.2 to 731.9) | 31.6% (30.0 to 33.1) | 2.5% (1.7 to 3.3) | | 5 Other musculoskeletal disorders | 4.8% (3.6 to 6.2) | 43.0 (29.6 to 59.2) | 507.2 (349.5 to 698.0) | 28.7% (26.7 to 30.8) | 6.3% (5.6 to 7.0) | | 6 Anxiety disorders | 4.7% (3.6 to 6.0) | 42.5 (29.4 to 57.7) | 524.3 (363.3 to 716.2) | 33.7% (30.7 to 37.0) | 16.7% (14.0 to 19.8) | | 7 Diabetes mellitus | 4.5% (3.9 to 5.2) | 41.2 (29.0 to 56.5) | 477.0 (336.1 to 653.3) | 62.9% (60.3 to 65.8) | 25.9% (24.0 to 28.1) | | 8 Dietary iron deficiency | 3.6% (2.8 to 4.2) | 32.3 (21.8 to 46.5) | 423.7 (285.3 to 611.0) | 3.2% (0.9 to 5.2) | -7.3% (-9.4 to -5.5) | | 9 Blindness and vision loss | 3.2% (2.4 to 4.4) | 29.2 (19.0 to 42.9) | 342.8 (224.2 to 503.6) | 32.9% (27.4 to 38.6) | 2.6% (-2.5 to 7.7) | | 10 Gynaecological diseases | 3.0% (2.5 to 3.7) | 27.4 (19.1 to 38.2) | 334.0 (232.7 to 467.5) | 15.3% (14.0 to 16.8) | 1.4% (0.6 to 2.3) | | 11 Falls | 2.7% (2.3 to 3.0) | 24.2 (16.8 to 32.8) | 288.6 (200.9 to 391.7) | 21.4% (19.2 to 23.3) | -3.5% (-4.7 to -2.6) | | 12 Oral disorders | 2.6% (1.7 to 3.6) | 23.2 (13.8 to 35.0) | 275.9 (164.2 to 416.8) | 25.1% (21.4 to 28.6) | 0.4% (-2.6 to 3.3) | | 13 Neonatal disorders | 2.4% (2.0 to 2.8) | 21.7 (15.7 to 27.3) | 282.7 (204.9 to 356.1) | 24.9% (13.8 to 35.3) | 13.5% (3.6 to 22.9) | | 14 Osteoarthritis | 2.3% (1.4 to 4.5) | 21.3 (10.2 to 42.9) | 244.5 (117.1 to 493.1) | 36.9% (35.2 to 38.5) | 2.4% (1.3 to 3.5) | | 15 Neck pain | 2.2% (1.7 to 2.9) | 20.4 (13.6 to 28.9) | 242.3 (162.6 to 342.8) | 22.0% (19.4 to 24.6) | 1.4% (1.0 to 1.9) | | 16 Stroke | 1.7% (1.3 to 2.0) | 15.2 (11.0 to 19.4) | 178.7 (128.9 to 227.6) | 29.1% (25.4 to 32.8) | -1.2% (-4.0 to 1.5) | | 17 COPD | 1.7% (1.3 to 2.1) | 14.9 (12.4 to 17.1) | 174.4 (145.5 to 201.0) | 29.1% (24.8 to 33.3) | -2.5% (-5.7 to 0.5) | | 18 Schizophrenia | 1.7% (1.2 to 2.2) | 14.8 (10.9 to 19.1) | 177.8 (131.6 to 228.9) | 16.3% (14.9 to 17.8) | 0.0% (-0.9 to 0.9) | | 19 COVID-19 | 1.6% (0.6 to 3.6) | 14.3 (5.14 to 33.7) | 176.4 (63.1 to 418.9) | -- | -- | | 20 Alzheimer's disease and other dementias | 1.3% (1.0 to 1.6) | 11.6 (7.96 to 15.3) | 141.9 (97.7 to 187.2) | 45.7% (44.1 to 47.2) | 2.6% (1.7 to 3.5) | | 21 Autism spectrum disorders | 1.3% (0.8 to 2.0) | 11.5 (7.84 to 16.3) | 147.6 (100.2 to 208.1) | 12.9% (11.9 to 13.7) | 0.7% (-0.2 to 1.4) | | 22 Alcohol use disorders | 1.2% (1.0 to 1.5) | 11.0 (7.68 to 15.3) | 132.3 (92.3 to 184.5) | 6.8% (3.4 to 10.5) | -8.1% (-10.8 to -5.4) | | 23 Asthma | 1.1% (0.9 to 1.4) | 10.2 (6.50 to 15.0) | 131.1 (84.0 to 194.7) | 2.1% (0.2 to 4.4) | -11.1% (-12.8 to -8.9) | | 24 Drug use disorders | 1.0% (0.8 to 1.3) | 9.23 (6.54 to 11.8) | 114.1 (80.9 to 145.5) | 26.2% (22.5 to 30.1) | 13.9% (10.9 to 17.2) | | 25 Other mental disorders | 1.0% (0.7 to 1.3) | 8.96 (5.72 to 13.5) | 106.6 (68.2 to 160.7) | 19.5% (18.4 to 21.0) | -0.2% (-0.8 to 0.2) | Data in parentheses are 95% uncertainty intervals. Count data are presented to three significant figures, and rates and percentage change data are presented to one decimal place. COPD=chronic obstructive pulmonary disease. YLDs=years lived with disability. Table: Top 25 leading Level 3 causes of global YLDs, ranked from 1 to 25, in 2021 across all ages, for both sexes combined, YLD counts, age-standardised rates, and percentage change between 2010 and 2021 GBD 2021 Disaactivity and Mortality Collaborators. Global incidence, prevalence, years lived with disability (YLDs), disability-adjusted life-years (DALYs), and healthy life expectancy (HALE) for 371 diseases and injuries in 204 countries and territories and 217 subnational locations: 1990-2021: a systematic analysis for the Global Burden of Disease Study 2021. Lancet. 2024 May 18;403(10440):2133-2161. doi:10.1016/S0140-6736(24)00578-6 #### Top 25 Leading Level 3 Causes of Global YLDs (2021) Top 25 leading Level 3 causes of global YLDs across all ages, for both sexes combined, including counts, age-standardised rates, and percentage change between 2010 and 2021: | Cause | Percentage of all-cause YLDs | Count (millions) | Age-standardised rate (per 100 000) | Percentage change, 2010–21 YLD count | Percentage change, 2010–21 Age-standardised rate | |---|---|---|---|---|---| | 1. Low back pain | 7.7% (6.5 to 9.1) | 70.2 (50.2 to 94.1) | 832.2 (595.9 to 1115.3) | 19.4% (17.9 to 20.8) | -2.4% (-2.9 to -1.8) | | 2. Depressive disorders | 6.2% (5.0 to 7.8) | 56.3 (39.3 to 76.5) | 681.2 (475.3 to 924.0) | 36.5% (31.7 to 41.7) | 16.4% (11.9 to 21.3) | | 3. Headache disorders | 5.2% (1.2 to 10.4) | 48.0 (9.80 to 101) | 588.4 (117.6 to 1245.7) | 14.4% (12.7 to 17.8) | 0.3% (-1.1 to 1.4) | | 4. Age-related and other hearing loss | 4.9% (3.9 to 5.9) | 44.4 (30.7 to 62.0) | 525.9 (364.2 to 731.9) | 31.6% (30.0 to 33.1) | 2.5% (1.7 to 3.3) | | 5. Other musculoskeletal disorders | 4.8% (3.6 to 6.2) | 43.0 (29.6 to 59.2) | 507.2 (349.5 to 698.0) | 28.7% (26.7 to 30.8) | 6.3% (5.6 to 7.0) | | 6. Anxiety disorders | 4.7% (3.6 to 6.0) | 42.5 (29.4 to 57.7) | 524.3 (363.3 to 716.2) | 33.7% (30.7 to 37.0) | 16.7% (14.0 to 19.8) | | 7. Diabetes mellitus | 4.5% (3.9 to 5.2) | 41.2 (29.0 to 56.5) | 477.0 (336.1 to 653.3) | 62.9% (60.3 to 65.8) | 25.9% (24.0 to 28.1) | | 8. Dietary iron deficiency | 3.6% (2.8 to 4.2) | 32.3 (21.8 to 46.5) | 423.7 (285.3 to 611.0) | 3.2% (0.9 to 5.2) | -7.3% (-9.4 to -5.5) | | 9. Blindness and vision loss | 3.2% (2.4 to 4.4) | 29.2 (19.0 to 42.9) | 342.8 (224.2 to 503.6) | 32.9% (27.4 to 38.6) | 2.6% (-2.5 to 7.7) | | 10. Gynaecological diseases | 3.0% (2.5 to 3.7) | 27.4 (19.1 to 38.2) | 334.0 (232.7 to 467.5) | 15.3% (14.0 to 16.8) | 1.4% (0.6 to 2.3) | | 11. Falls | 2.7% (2.3 to 3.0) | 24.2 (16.8 to 32.8) | 288.6 (200.9 to 391.7) | 21.4% (19.2 to 23.3) | -3.5% (-4.7 to -2.6) | | 12. Oral disorders | 2.6% (1.7 to 3.6) | 23.2 (13.8 to 35.0) | 275.9 (164.2 to 416.8) | 25.1% (21.4 to 28.6) | 0.4% (-2.6 to 3.3) | | 13. Neonatal disorders | 2.4% (2.0 to 2.8) | 21.7 (15.7 to 27.3) | 282.7 (204.9 to 356.1) | 24.9% (13.8 to 35.3) | 13.5% (3.6 to 22.9) | | 14. Osteoarthritis | 2.3% (1.4 to 4.5) | 21.3 (10.2 to 42.9) | 244.5 (117.1 to 493.1) | 36.9% (35.2 to 38.5) | 2.4% (1.3 to 3.5) | | 15. Neck pain | 2.2% (1.7 to 2.9) | 20.4 (13.6 to 28.9) | 242.3 (162.6 to 342.8) | 22.0% (19.4 to 24.6) | 1.4% (1.0 to 1.9) | | 16. Stroke | 1.7% (1.3 to 2.0) | 15.2 (11.0 to 19.4) | 178.7 (128.9 to 227.6) | 29.1% (25.4 to 32.8) | -1.2% (-4.0 to 1.5) | | 17. COPD | 1.7% (1.3 to 2.1) | 14.9 (12.4 to 17.1) | 174.4 (145.5 to 201.0) | 29.1% (24.8 to 33.3) | -2.5% (-5.7 to 0.5) | | 18. Schizophrenia | 1.7% (1.2 to 2.2) | 14.8 (10.9 to 19.1) | 177.8 (131.6 to 228.9) | 16.3% (14.9 to 17.8) | 0.0% (-0.9 to 0.9) | | 19. COVID-19 | 1.6% (0.6 to 3.6) | 14.3 (5.14 to 33.7) | 176.4 (63.1 to 418.9) | — | — | | 20. Alzheimer's disease and other dementias | 1.3% (1.0 to 1.6) | 11.6 (7.96 to 15.3) | 141.9 (97.7 to 187.2) | 45.7% (44.1 to 47.2) | 2.6% (1.7 to 3.5) | | 21. Autism spectrum disorders | 1.3% (0.8 to 2.0) | 11.5 (7.84 to 16.3) | 147.6 (100.2 to 208.1) | 12.9% (11.9 to 13.7) | 0.7% (-0.2 to 1.4) | | 22. Alcohol use disorders | 1.2% (1.0 to 1.5) | 11.0 (7.68 to 15.3) | 132.3 (92.3 to 184.5) | 6.8% (3.4 to 10.5) | -8.1% (-10.8 to -5.4) | | 23. Asthma | 1.1% (0.9 to 1.4) | 10.2 (6.50 to 15.0) | 131.1 (84.0 to 194.7) | 2.1% (0.2 to 4.4) | -11.1% (-12.8 to -8.9) | | 24. Drug use disorders | 1.0% (0.8 to 1.3) | 9.23 (6.54 to 11.8) | 114.1 (80.9 to 145.5) | 26.2% (22.5 to 30.1) | 13.9% (10.9 to 17.2) | | 25. Other mental disorders | 1.0% (0.7 to 1.3) | 8.96 (5.72 to 13.5) | 106.6 (68.2 to 160.7) | 19.5% (18.4 to 21.0) | -0.2% (-0.8 to 0.2) | *Note: Data in parentheses are 95% uncertainty intervals. Count data are presented to three significant figures, and rates and percentage change data are presented to one decimal place. COPD = chronic obstructive pulmonary disease. YLDs = years lived with disability.* *GBD 2021 Disaactivity and Mortality Collaborators. Global incidence, prevalence, years lived with disability (YLDs), disability-adjusted life-years (DALYs), and healthy life expectancy (HALE) for 371 diseases and injuries in 204 countries and territories and 217 subnational locations: 1990-2021: a systematic analysis for the Global Burden of Disease Study 2021. Lancet. 2024 May 18;403(10440):2133-2161. doi:10.1016/S0140-6736(24)00578-6.* ### YLD **Rank in 2023** | **Leading disease in 2023** | **% change since 2003** ---|---|--- **1** \[Yellow\] | Back pain and problems | 8.4 **2** \[Blue\] | Anxiety disorders | 33.2 **3** \[Grey\] | Depressive disorders | 11.4 **4** \[Green\] | Asthma | 10.4 **5** \[Yellow\] | Osteoarthritis | **27.3** **6** \[Purple\] | Autism spectrum disorders | 260.8 **7** \[Yellow\] | Rheumatoid arthritis | -35.4 **8** \[Green\] | COPD | -7.5 **9** \[Blue\] | Hearing loss | 14.1 **10** \[Grey\] | Dementia | -0.5 **11** \[Blue\] | Type 2 diabetes mellitus | 24.5 **12** \[Grey\] | Bipolar affective disorder | 33.1 **13** \[Purple\] | Eating disorders | 20.6 **14** \[Grey\] | Alcohol use disorders | -21.7 **15** \[Grey\] | Dental caries | 16.3 ### DALY **Rank in 2023** | **Leading disease in 2023** | **% change since 2003** ---|---|--- **1** \[Orange\] | Coronary heart disease | -58.2 **2** \[Yellow\] | Back pain and problems | 8.3 **3** \[Purple\] | Anxiety disorders | 33.2 **4** \[Purple\] | Depressive disorders | 11.2 **5** \[Green\] | Dementia | 39.8 **6** \[Green\] | Suicide and self-inflicted injuries | 16.6 **7** \[Blue\] | COPD | -12.9 **8** \[Blue\] | Asthma | 8.4 **9** \[Yellow\] | Lung cancer | -31.4 **10** \[Grey\] | Osteoarthritis | 26.7 Australian Institute of Health and Welfare (2023) **Australian Burden of Disease Study 2023**, AIHW, Australian Government, accessed 28 July 2024. https://www.aihw.gov.au/reports/burden-of-disease/australian-burden-of-disease-study-2023/contents/interactive-data-on-disease-burden/leading-causes-of-disease-burden #### Australian Burden of Disease (2023) ##### Leading Causes of Years Lived with Disability (YLD) | Rank in 2023 | Leading disease in 2023 | % change since 2003 | |---|---|---| | 1 [Yellow] | Back pain and problems | 8.4 | | 2 [Blue] | Anxiety disorders | 33.2 | | 3 [Grey] | Depressive disorders | 11.4 | | 4 [Green] | Asthma | 10.4 | | 5 [Yellow] | Osteoarthritis | 27.3 | | 6 [Purple] | Autism spectrum disorders | 260.8 | | 7 [Yellow] | Rheumatoid arthritis | -35.4 | | 8 [Green] | COPD | -7.5 | | 9 [Blue] | Hearing loss | 14.1 | | 10 [Grey] | Dementia | -0.5 | | 11 [Blue] | Type 2 diabetes mellitus | 24.5 | | 12 [Grey] | Bipolar affective disorder | 33.1 | | 13 [Purple] | Eating disorders | 20.6 | | 14 [Grey] | Alcohol use disorders | -21.7 | | 15 [Grey] | Dental caries | 16.3 | ##### Leading Causes of Disability-Adjusted Life Years (DALY) | Rank in 2023 | Leading disease in 2023 | % change since 2003 | |---|---|---| | 1 [Orange] | Coronary heart disease | -58.2 | | 2 [Yellow] | Back pain and problems | 8.3 | | 3 [Purple] | Anxiety disorders | 33.2 | | 4 [Purple] | Depressive disorders | 11.2 | | 5 [Green] | Dementia | 39.8 | | 6 [Green] | Suicide and self-inflicted injuries | 16.6 | | 7 [Blue] | COPD | -12.9 | | 8 [Blue] | Asthma | 8.4 | | 9 [Yellow] | Lung cancer | -31.4 | | 10 [Grey] | Osteoarthritis | 26.7 | *Australian Institute of Health and Welfare (2023) Australian Burden of Disease Study 2023, AIHW, Australian Government, accessed 28 July 2024. https://www.aihw.gov.au/reports/burden-of-disease/australian-burden-of-disease-study-2023/contents/interactive-data-on-disease-burden/leading-causes-of-disease-burden* # Bold text? Yes **Bold** # Central text **Centered** Slides can have // random // styles, similar to Word. Use a solid Regex approach that catches all types. ## Answers are surrounded by ####. Slide titles by ## Slide Titles ## Di bold or ***italicize*** your answers? Use 2 asterisks for bold and usually 1 for italicize. ## Answers should always be centered using #### • Disease Statistics • Side and Side statistics • Prevalence **bold text? Yes** Global prevelance of dental caries in children ages 0-1 years worldwide 1. ### 10%-49% ### *Global Burden of Disease Report 2016, World Health Organization*.  - Disease Statistics - Side and Side statistics - Prevalence Global prevalence of dental caries in children ages 0–1 years worldwide: **10%–49%** *Global Burden of Disease Report 2016, World Health Organization.* Chart: Four colored boxes display statistics on oral diseases: untreated tooth decay affects 2.5 billion people, complete tooth loss affects 350 million people, severe gum disease affects 1 billion people, and oral cancer affects 380,000 people. World map of disability-adjusted life year (DALY) for all oral conditions combined in 2015, both sexes. DALY rate (years per 1,000) 1.5 to 2 2 to 2.5 2.5 to 3 3 to 3.5 3.5 to 4 Source: Kassebaum NJ, Smith AGC, Bernabé E, Fleming TD, Reynolds AE, Vos T, Murray CJL, Marcenes W; GBD 2015 Oral Health Collaborators. Global, Regional, and National Prevalence, Incidence, and Disability-Adjusted Life Years for Oral Conditions for 195 Countries, 1990-2015: A Systematic Analysis for the Global Burden of Diseases, Injuries, and Risk Factors. J Dent Res. 2017 Apr;96(4):380-387. doi: 10.1177/0022034517693566.  World map of disability-adjusted life year (DALY) for all oral conditions combined in 2015, both sexes. DALY rate (years per 1,000): - 1.5 to 2 - 2 to 2.5 - 2.5 to 3 - 3 to 3.5 - 3.5 to 4 *Source: Kassebaum NJ, Smith AGC, Bernabé E, Fleming TD, Reynolds AE, Vos T, Murray CJL, Marcenes W; GBD 2015 Oral Health Collaborators. Global, Regional, and National Prevalence, Incidence, and Disability-Adjusted Life Years for Oral Conditions for 195 Countries, 1990-2015: A Systematic Analysis for the Global Burden of Diseases, Injuries, and Risk Factors. J Dent Res. 2017 Apr;96(4):380-387. doi: 10.1177/0022034517693566.* A world map choropleth illustrating the global distribution of disability-adjusted life year (DALY) rates for all oral conditions combined in 2015. Countries are color-coded according to a legend where dark blue represents the lowest rate (1.5 to 2 years per 1,000) and red represents the highest rate (3.5 to 4). The figure includes inset maps at the bottom to display data for smaller island nations and specific regions like the Caribbean and Balkan Peninsula. **Burden of oral disease in Australia – Recent findings** Source: Australian Institute of Health and Welfare (2023) Australian Burden of Disease Study 2023, AIHW, Australian Government, accessed 28 July 2024. https://www.aihw.gov.au/reports/burden-of-disease/australian-burden-of-disease-study-2023/contents/interactive-data-on-disease-burden/comparisons-over-time *Source: Australian Institute of Health and Welfare (2023) Australian Burden of Disease Study 2023, AIHW, Australian Government, accessed 28 July 2024. https://www.aihw.gov.au/reports/burden-of-disease/australian-burden-of-disease-study-2023/contents/interactive-data-on-disease-burden/comparisons-over-time* # Burden of oral disease in Australia – Recent findings Select from the following: Measure: DALY Choose sex view: Persons Start year: 2003 End year: 2023 Disease group: Oral disorders Disease/Injury: All causes **3.6% increase** in the age-standardised DALY rate in **Persons** between 2003 and 2023 for the disease/s selected **1.7% increase** in the age-standardised DALY rate in **Females** between 2003 and 2023 for the disease/s selected **5.5% increase** in the age-standardised DALY rate in **Males** between 2003 and 2023 for the disease/s selected DALY= Disability-adjusted life years; YLD= Years lived with disability; YLL= Years of life lost ## Comparison of age-standardised DALY rates, Persons | Year | Age-standardised rate | | :--- | :--- | | 2003 | 4 | | 2011 | 5 | | 2015 | 4 | | 2018 | 5 | | 2023 | 5 | Source: Australian Institute of Health and Welfare (2023) *Australian Burden of Disease Study 2023*, AIHW, Australian Government, accessed 28 July 2024. https://www.aihw.gov.au/reports/burden-of-disease/australian-burden-of-disease-study-2023/contents/interactive-data-on-disease-burden/comparisons-over-time  #### Study Parameters - **Measure:** DALY - **Sex view:** Persons - **Period:** 2003–2023 - **Disease group:** Oral disorders - **Disease/Injury:** All causes #### Changes in Age-Standardised DALY Rates (2003–2023) - **Persons:** 3.6% increase - **Females:** 1.7% increase - **Males:** 5.5% increase *DALY = Disability-adjusted life years; YLD = Years lived with disability; YLL = Years of life lost* #### Comparison of Age-Standardised DALY Rates (Persons) | Year | Age-standardised rate | | :--- | :--- | | 2003 | 4 | | 2011 | 5 | | 2015 | 4 | | 2018 | 5 | | 2023 | 5 | *Source: Australian Institute of Health and Welfare (2023) Australian Burden of Disease Study 2023, AIHW, Australian Government, accessed 28 July 2024. https://www.aihw.gov.au/reports/burden-of-disease/australian-burden-of-disease-study-2023/contents/interactive-data-on-disease-burden/comparisons-over-time* > [!note] Lecturer — All Oral Disorders > The Australian findings discussed were from the Australian Burden of Disease Study 2023. > > - The all-oral-disorders category excludes lip and oral cavity cancer and cleft lip and palate. > - It includes deciduous and permanent tooth caries, periodontal disease, tooth loss and other oral disorders. > [!note] Lecturer — DALY Burden > The increase in burden occurred despite a gradual decline in prevalence. The lecturer linked this largely to increased life expectancy, because people may live longer with the consequences of oral conditions. Chart: A bar chart titled 'Comparison of age-standardised DALY rates, Persons' that illustrates the burden of oral disease in Australia across five specific years (2003, 2011, 2015, 2018, and 2023). The vertical axis represents the 'Age-standardised rate', while the horizontal axis lists the years, with each bar showing a slight increase in the rate over time. Burden of oral disease in Australia – Recent findings Select from the following: Measure: DALY Choose sex view: Persons Start year: 2003 End year: 2023 Disease group: Oral disorders Disease/injury: Dental caries **16.4% increase** in the age-standardised DALY rate in **Persons** between 2003 and 2023 for the disease/s selected **19.9% increase** in the age-standardised DALY rate in **Females** between 2003 and 2023 for the disease/s selected **13.3% increase** in the age-standardised DALY rate in **Males** between 2003 and 2023 for the disease/s selected DALY= Disability-adjusted life years; YLD= Years lived with disability; YLL= Years of life lost Source: Australian Institute of Health and Welfare (2023) _Australian Burden of Disease Study 2023_, AIHW, Australian Government, accessed 28 July 2024. https://www.aihw.gov.au/reports/burden-of-disease/australian-burden-of-disease-study-2023/contents/interactive-data-on-disease-burden/comparisons-over-time  #### Study Parameters - **Measure:** DALY - **Sex view:** Persons - **Period:** 2003–2023 - **Disease group:** Oral disorders - **Disease/Injury:** Dental caries #### Changes in Age-Standardised DALY Rates (2003–2023) - **Persons:** 16.4% increase - **Females:** 19.9% increase - **Males:** 13.3% increase *DALY = Disability-adjusted life years; YLD = Years lived with disability; YLL = Years of life lost* *Source: Australian Institute of Health and Welfare (2023) Australian Burden of Disease Study 2023, AIHW, Australian Government, accessed 28 July 2024. https://www.aihw.gov.au/reports/burden-of-disease/australian-burden-of-disease-study-2023/contents/interactive-data-on-disease-burden/comparisons-over-time* - ==Dental caries was considered one of the oral conditions contributing to YLD and overall oral disease burden.== > [!note] Lecturer — Dental Caries Trends > The lecturer linked the burden findings to longer life expectancy and people retaining their teeth for longer, rather than interpreting them simply as increased prevalence. > > - The decline in severe tooth loss may indicate that treatment is effective and people are losing teeth later or less frequently. > - Dental caries prevalence has shown a temporal decline, particularly in developed parts of the world, associated with dental public health programs such as water fluoridation. Chart: A bar chart illustrating the comparison of age-standardised DALY rates for Persons over time, showing a progressive increase in the rate from 2003 to 2023. # Burden of oral disease in Australia – Recent findings Select from the following: - **Measure:** DALY - **Choose sex view:** Persons - **Start year:** 2003 - **End year:** 2023 - **Disease group:** Oral disorders - **Disease/injury:** Periodontal dise... **40.1% increase** in the age-standardised DALY rate in **Persons** between 2003 and 2023 for the disease/s selected **47.6% increase** in the age-standardised DALY rate in **Females** between 2003 and 2023 for the disease/s selected **34.8% increase** in the age-standardised DALY rate in **Males** between 2003 and 2023 for the disease/s selected DALY = Disability-adjusted life years; YLD = Years lived with disability; YLL = Years of life lost ### Comparison of age-standardised DALY rates, Persons Source: Australian Institute of Health and Welfare (2023) *Australian Burden of Disease Study 2023*, AIHW, Australian Government, accessed 28 July 2024. https://www.aihw.gov.au/reports/burden-of-disease/australian-burden-of-disease-study-2023/contents/interactive-data-on-disease-burden/comparisons-over-time  #### Study Parameters - **Measure:** DALY - **Sex view:** Persons - **Period:** 2003–2023 - **Disease group:** Oral disorders - **Disease/Injury:** Periodontal disease #### Changes in Age-Standardised DALY Rates (2003–2023) - **Persons:** 40.1% increase - **Females:** 47.6% increase - **Males:** 34.8% increase *DALY = Disability-adjusted life years; YLD = Years lived with disability; YLL = Years of life lost* #### Comparison of Age-Standardised DALY Rates (Persons) *Source: Australian Institute of Health and Welfare (2023) Australian Burden of Disease Study 2023, AIHW, Australian Government, accessed 28 July 2024. https://www.aihw.gov.au/reports/burden-of-disease/australian-burden-of-disease-study-2023/contents/interactive-data-on-disease-burden/comparisons-over-time* > [!note] Lecturer — Periodontal Disease Burden > The lecturer suggested that retaining teeth for longer can mean that people live longer with periodontal disease rather than losing affected teeth earlier. A decline in prevalence does not necessarily produce a decline in DALYs because DALYs also reflect life expectancy and the time people live with a condition. This figure is a vertical bar chart titled 'Comparison of age-standardised DALY rates, Persons' that illustrates the trend in the burden of oral disease over time. The x-axis displays five specific years (2003, 2011, 2015, 2018, and 2023), while the y-axis represents the 'Age-standardised rate' ranging from 0.0 to 1.5. Each bar corresponds to a year, showing a progressive increase in height from left to right, indicating a rise in the age-standardised DALY rate for persons between 2003 and 2023. Burden of oral disease in Australia – Recent findings Select from the following: Measure: DALY Choose sex view: Persons Start year: 2003 End year: 2023 Disease group: Oral disorders Disease/injury: Severe tooth loss **40.7%** decrease in the age-standardised DALY rate in **Persons** between 2003 and 2023 for the disease/s selected **43.2%** decrease in the age-standardised DALY rate in **Females** between 2003 and 2023 for the disease/s selected **37.2%** decrease in the age-standardised DALY rate in **Males** between 2003 and 2023 for the disease/s selected DALY= Disability-adjusted life years; YLD= Years lived with disability; YLL= Years of life lost Comparison of age-standardised DALY rates, Persons **2003** **2011** **2015** **2018** **2023** Age-standardised rate 12.0 11.5 11.0 10.5 10.0 9.5 9.0 8.5 8.0 7.5 7.0 6.5 6.0 5.5 5.0 4.5 4.0 3.5 3.0 2.5 2.0 1.5 1.0 0.5 0.0 Source: Australian Institute of Health and Welfare (2023) *Australian Burden of Disease Study 2023*, AIHW, Australian Government, accessed 28 July 2024. https://www.aihwww.gov.au/reports/burden-of-disease-australian-burden-of-disease-study-2023/contents/interactive-data-on-disease-burden/32012/  #### Study Parameters - **Measure:** DALY - **Sex view:** Persons - **Period:** 2003–2023 - **Disease group:** Oral disorders - **Disease/Injury:** Severe tooth loss #### Changes in Age-Standardised DALY Rates (2003–2023) - **Persons:** 40.7% decrease - **Females:** 43.2% decrease - **Males:** 37.2% decrease *DALY = Disability-adjusted life years; YLD = Years lived with disability; YLL = Years of life lost* #### Comparison of Age-Standardised DALY Rates (Persons) - Years: 2003, 2011, 2015, 2018, 2023 - Age-standardised rate scale: 0.0 to 12.0 *Source: Australian Institute of Health and Welfare (2023) Australian Burden of Disease Study 2023, AIHW, Australian Government, accessed 28 July 2024. https://www.aihwww.gov.au/reports/burden-of-disease-australian-burden-of-disease-study-2023/contents/interactive-data-on-disease-burden/32012/* > [!note] Lecturer — Severe Tooth Loss > The substantial decline in severe tooth loss may indicate that people are receiving treatment and retaining their teeth for longer. It may also help explain the increased periodontal-disease burden, because people may live longer with periodontal disease rather than losing teeth earlier. This bar chart illustrates the decline in age-standardised DALY rates for severe tooth loss among persons in Australia across five specific years: 2003, 2011, 2015, 2018, and 2023. The visual form is a vertical bar graph where the height of each bar corresponds to the rate value on the y-axis, showing a consistent downward trend from the highest point in 2003 to the lowest in 2023. Burden of oral disease in Australia – Recent findings Select from the following: Measure: DALY Choose sex view: Persons Start year: 2003 End year: 2023 Disease group: Cancer and other... Disease/injury: Lip and oral cavit... **21.1% decrease** in the age-standardised DALY rate in **Persons** between 2003 and 2023 for the disease/s selected **20.9% decrease** in the age-standardised DALY rate in **Females** between 2003 and 2023 for the disease/s selected **20.6% decrease** in the age-standardised DALY rate in **Males** between 2003 and 2023 for the disease/s selected DALY= Disability-adjusted life years; YLD= Years lived with disability; YLL= Years of life lost Comparison of age-standardised DALY rates, Persons Source: Australian Institute of Health and Welfare (2023) *Australian Burden of Disease Study 2023*, AIHW, Australian Government, accessed 28 July 2024. https://www.aihw.gov.au/reports/burden-of-disease/australian-burden-of-disease-study-2023/contents/interactive-data-on-disease-burden/comparisons-over-time  #### Study Parameters - **Measure:** DALY - **Sex view:** Persons - **Period:** 2003–2023 - **Disease group:** Cancer and other neoplasms - **Disease/Injury:** Lip and oral cavity cancer #### Changes in Age-Standardised DALY Rates (2003–2023) - **Persons:** 21.1% decrease - **Females:** 20.9% decrease - **Males:** 20.6% decrease *DALY = Disability-adjusted life years; YLD = Years lived with disability; YLL = Years of life lost* #### Comparison of Age-Standardised DALY Rates (Persons) *Source: Australian Institute of Health and Welfare (2023) Australian Burden of Disease Study 2023, AIHW, Australian Government, accessed 28 July 2024. https://www.aihw.gov.au/reports/burden-of-disease/australian-burden-of-disease-study-2023/contents/interactive-data-on-disease-burden/comparisons-over-time* - ==Lip and oral cavity cancer is reported under neoplasms rather than in the general oral-disorder category, so it must be considered separately when assessing the complete burden of oral disease.== > [!note] Lecturer — Oral Cancer Trends > The lecturer suggested that anti-tobacco legislation may have contributed to the decline in lip and oral cavity cancer burden. Measures concerning cigarette advertising were mentioned as one possible influence on oral-cancer prevalence and burden. Chart: A bar chart titled 'Comparison of age-standardised DALY rates, Persons' displaying the trend in disease burden for lip and oral cavity cancer from 2003 to 2023. The vertical axis represents the Age-standardised rate ranging from 0.0 to 0.5, while the horizontal axis marks specific years (2003, 2011, 2015, 2018, 2023) with corresponding colored bars indicating a general decrease over time. # **Burden of oral disease in Australia – Recent findings** Select from the following: | Measure: | D A L Y | |---|---| | Choose sex view: | P e r s o n s | | Start year: | 2 0 0 3 | | End year: | 2 0 2 3 | | Disease group: | I n f a n t a n d c o n g e … | | Disease/injury: | C l e f t l i p a n d / o r p … | **19.8% increase** in the age-standardised DALY rate in **Persons** between 2003 and 2023 for the disease/s selected **19.1% decrease** in the age-standardised DALY rate in **Females** between 2003 and 2023 for the disease/s selected **80.4% increase** in the age-standardised DALY rate in **Males** between 2003 and 2023 for the disease/s selected DALY= Disability-adjusted life years; YLD= Years lived with disability; YLL= Years of life lost **Comparison of age-standardised DALY rates, Persons** Age-standardised rate 0.020 0.015 0.010 0.005 0.000 2003 2011 2015 2018 2023 Source: Australian Institute of Health and Welfare (2023) *Australian Burden of Disease Study 2023*, AIHW, Australian Government, accessed 28 July 2024. https://www.aihw.gov.au/reports/burden-of-disease/australian-burden-of-disease-study-2023/contents/interactive-data-on-disease-burden/comparisons-over-time  #### Study Parameters - **Measure:** DALY - **Sex view:** Persons - **Period:** 2003–2023 - **Disease group:** Infant and congenital disorders - **Disease/Injury:** Cleft lip and/or palate #### Changes in Age-Standardised DALY Rates (2003–2023) - **Persons:** 19.8% increase - **Females:** 19.1% decrease - **Males:** 80.4% increase *DALY = Disability-adjusted life years; YLD = Years lived with disability; YLL = Years of life lost* #### Comparison of Age-Standardised DALY Rates (Persons) - Years: 2003, 2011, 2015, 2018, 2023 - Age-standardised rate scale: 0.000 to 0.020 *Source: Australian Institute of Health and Welfare (2023) Australian Burden of Disease Study 2023, AIHW, Australian Government, accessed 28 July 2024. https://www.aihw.gov.au/reports/burden-of-disease/australian-burden-of-disease-study-2023/contents/interactive-data-on-disease-burden/comparisons-over-time* - ==Cleft lip and palate is reported under congenital conditions rather than in the general oral-disorder category, so it should be considered separately when assessing overall oral-disease burden.== > [!note] Lecturer — Cleft Lip and Palate > The increase in burden may reflect changes in diagnosis and identification, including more frequent capture of syndromic conditions. A genuine rise in prevalence was also presented as a possibility, but not as a confirmed explanation. Chart: A bar chart displaying the age-standardised DALY (Disability-adjusted life years) rates for persons over five specific time points: 2003, 2011, 2015, 2018, and 2023. The vertical axis represents the 'Age-standardised rate' ranging from 0.000 to 0.020, illustrating a trend where the rate decreased from 2003 to 2018 before rising significantly in 2023. **Prevalence of oral disease is disproportionate !** # Prevalence of oral disease is disproportionate ! <!--CAPTIONS_JSON_START--> {"BOX_A": "Figure 2: Proportion of children aged 6–14 who have experienced decay in permanent teeth by selected population groups, 2012–14"} <!--CAPTIONS_JSON_END--> | | | | :--- | :--- | | | | | Indigenous | Australia | | status | Indigenous | | | Non-Indigenous | | Remoteness | Major cities | | | Inner regional | | | Outer regional | | | Remote/very remote | | Household income | Low | | | Medium | | | High | | | 0 5 10 15 20 25 30 35 40 45 | | | Per cent | Source: National Child Oral Health Study 2012–14, published in Ha et al. 2016. Australian Institute of Health and Welfare (2023) *Oral health and dental care in Australia*, AIHW, Australian Government, accessed 15 January 2024.  *Figure 2: Proportion of children aged 6–14 who have experienced decay in permanent teeth by selected population groups, 2012–14* #### Population Breakdown - **Indigenous Status:** Australia, Indigenous, Non-Indigenous - **Remoteness:** Major cities, Inner regional, Outer regional, Remote/very remote - **Household Income:** Low, Medium, High *Source: National Child Oral Health Study 2012–14, published in Ha et al. 2016.* *Australian Institute of Health and Welfare (2023) Oral health and dental care in Australia, AIHW, Australian Government, accessed 15 January 2024.* > [!note] Lecturer — Unequal Disease Burden > A general decline in oral disease does not mean that every population group is experiencing the same decline. > > - Some groups continue to experience a high burden because of social, economic, geographic or health-related circumstances. > - Population-level averages should not be interpreted as representing the experience of all groups. Chart: A horizontal bar chart illustrating the proportion of children aged 6–14 who have experienced decay in permanent teeth, categorized by Indigenous status, remoteness, and household income. The x-axis represents percentages from 0 to 45, showing that Indigenous children and those in remote areas or low-income households experience higher rates of decay compared to the national average. # Strategic approach to population oral health - Whole population approach - Targeted population approach - High risk individual approach - Proportionate universalism Source: Ivor G Chestnutt, *Dental Public Health at a Glance*, John Wiley & Sons, Inc., 2016. - Whole population approach - Targeted population approach - High risk individual approach - Proportionate universalism *Source: Ivor G Chestnutt, Dental Public Health at a Glance, John Wiley & Sons, Inc., 2016.* > [!note] Lecturer — Funding and Approaches > Population oral health planning is shaped by limited funding, because public dental schemes are largely government funded and oral conditions may be viewed as less severe than conditions addressed by mental health or cardiovascular programs. > > - The whole-population approach aims to influence everyone; water fluoridation was given as an example, although population-wide interventions can require substantial funding and may not be feasible for every condition. > - The targeted-population approach focuses services on a defined group; school dental services were given as an example because children may be more susceptible to preventable oral conditions. > - The high-risk approach focuses on people with particular risk factors; smoking cessation was given as an example, although measured risk may not fully reflect a person’s need for care. > - Need can include both objective and subjective aspects, including whether a person considers that they require care. > [!note] Lecturer — Proportionate Universalism > Proportionate universalism aims to improve oral health across the entire population while directing additional priority to people with the greatest needs. > > - The approach was associated with the Marmot report in the United Kingdom, its adoption across most OECD countries including Australia, and the National Oral Health Plan. > - It avoids treating the whole population as if every group has the same level of need by making resources and services proportionate to need. > [!note] Lecturer — Common Risk Factors > Oral health should be integrated with broader health because risk factors for oral conditions may also contribute to other health complications. > > - Sugar was given as an example because it contributes to dental caries, diabetes and other conditions. > - Integrating oral health programs with other health programs may improve opportunities for funding and improve oral health outcomes. # Common risk factor approach in dental public health **Figure 21.1** Common-risk factor approach. Source: Watt 2005. Reproduced with permission from World Health Organisation.Originally adapted from Sheiham and Watt 2000 with permission from John Wiley & Sons. | | Risk factors | | | | | Risk factors | | | Risk factors | | | | :--- | :--- | :--- | :--- | :--- | :--- | :--- | :--- | :--- | :--- | :--- | | **School** | Diet | | Obesity | | Cancer | | Heart disease | | Respiratory disease | | Dental caries | | Peridontal diseases | | Trauma | | Workplace | | | Stress | | | | | Tobacco | | Alcohol | | Exercise | | Injuries | | Housing | | **Policy** | | Control | | | | | Physical environment | | | Social environment | | Political environment | Source: Ivor G Chestnutt, _Dental Public Health at a Glance_, John Wiley & Sons, Inc., 2016.  *Figure 21.1: Common-risk factor approach. Source: Watt 2005. Reproduced with permission from World Health Organisation. Originally adapted from Sheiham and Watt 2000 with permission from John Wiley & Sons.* #### Key Components and Environments - **Settings & Contexts:** School, Workplace, Housing, Policy - **Broader Environments:** Physical environment, Social environment, Political environment - **Risk Factors:** Diet, Stress, Tobacco, Alcohol, Exercise, Control - **Conditions & Outcomes:** Obesity, Cancer, Heart disease, Respiratory disease, Dental caries, Periodontal diseases, Trauma, Injuries *Source: Ivor G Chestnutt, Dental Public Health at a Glance, John Wiley & Sons, Inc., 2016.* Labelled diagram: The Common-risk factor approach, illustrating how shared risk factors (Diet, Stress, Control, Hygiene, Tobacco, Alcohol, Exercise, Injuries) link to multiple diseases (Obesity, Cancer, Heart disease, Respiratory disease, Dental caries, Periodontal diseases, Trauma). It further shows that these elements are influenced by upstream determinants including the School, Workplace, Housing, Policy, Political environment, Physical environment, and Social environment. # Priority populations as outlined by the National Oral Health Plan (2015-24) ## Priority populations 1. People who are socially disadvantaged or on low incomes 2. Aboriginal and Torres Strait Islander people 3. People living in regional and remote Australia 4. People with additional and/or specialised health care needs Source: Australian Institute of Health and Welfare (2023) **Oral health and dental care in Australia**, AIHW, Australian Government, accessed 28 July 2024. https://www.aihw.gov.au/reports/dental-orl-health/oral-health-and-dental-care-in-australia/contents/priority-populations 1. People who are socially disadvantaged or on low incomes 2. Aboriginal and Torres Strait Islander people 3. People living in regional and remote Australia 4. People with additional and/or specialised health care needs *Source: Australian Institute of Health and Welfare (2023) Oral health and dental care in Australia, AIHW, Australian Government, accessed 28 July 2024. https://www.aihw.gov.au/reports/dental-orl-health/oral-health-and-dental-care-in-australia/contents/priority-populations* > [!note] Lecturer — Priority Group Details > The priority populations include more specific groups and access concerns than the broad categories listed in the plan. > > - Social disadvantage includes culturally and linguistically diverse people, people experiencing substantial economic disadvantage, and people who are homeless. > - Aboriginal and Torres Strait Islander people were also referred to as First Nations people. > - People with additional or specialised healthcare needs include geriatric populations, people living in aged care, and people living with disability. > - People in regional and remote areas may experience difficulty accessing dental care. 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