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PLoS ONE. The Impact of Infection on Population Health: Results of the Ontario Burden of Infectious Diseases Study

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  • PLoS ONE. The Impact of Infection on Population Health: Results of the Ontario Burden of Infectious Diseases Study

    [Source: PLoS ONE, full text: (LINK). Abstract, edited.]
    The Impact of Infection on Population Health: Results of the Ontario Burden of Infectious Diseases Study


    Jeffrey C. Kwong<SUP>1</SUP><SUP>,</SUP><SUP>2</SUP><SUP>,</SUP><SUP>3</SUP><SUP>,</SUP><SUP>4</SUP><SUP>*</SUP>, Sujitha Ratnasingham<SUP>1</SUP>, Michael A. Campitelli<SUP>1</SUP>, Nick Daneman<SUP>1</SUP>, Shelley L. Deeks<SUP>2</SUP><SUP>,</SUP><SUP>3</SUP>, Douglas G. Manuel<SUP>1</SUP><SUP>,</SUP><SUP>11</SUP>, Vanessa G. Allen<SUP>2</SUP><SUP>,</SUP><SUP>6</SUP>, Ahmed M. Bayoumi<SUP>1</SUP><SUP>,</SUP><SUP>5</SUP><SUP>,</SUP><SUP>7</SUP><SUP>,</SUP><SUP>9</SUP>, Aamir Fazil<SUP>14</SUP>, David N. Fisman<SUP>3</SUP>, Andrea S. Gershon<SUP>1</SUP>, Effie Gournis<SUP>3</SUP><SUP>,</SUP><SUP>10</SUP>, E. Jenny Heathcote<SUP>7</SUP>, Frances B. Jamieson<SUP>2</SUP><SUP>,</SUP><SUP>6</SUP>, Prabhat Jha<SUP>3</SUP><SUP>,</SUP><SUP>8</SUP>, Kamran M. Khan<SUP>5</SUP><SUP>,</SUP><SUP>7</SUP><SUP>,</SUP><SUP>9</SUP>, Shannon E. Majowicz<SUP>12</SUP><SUP>,</SUP><SUP>13</SUP>, Tony Mazzulli<SUP>2</SUP><SUP>,</SUP><SUP>6</SUP><SUP>,</SUP><SUP>7</SUP>, Allison J. McGeer<SUP>3</SUP><SUP>,</SUP><SUP>6</SUP>, Matthew P. Muller<SUP>7</SUP>, Abhishek Raut<SUP>3</SUP>, Elizabeth Rea<SUP>3</SUP><SUP>,</SUP><SUP>10</SUP>, Robert S. Remis<SUP>3</SUP>, Rita Shahin<SUP>10</SUP>, Alissa J. Wright<SUP>15</SUP>, Brandon Zagorski<SUP>1</SUP>, Natasha S. Crowcroft<SUP>2</SUP><SUP>,</SUP><SUP>3</SUP><SUP>,</SUP><SUP>6</SUP>
    <SUP></SUP>
    1 Institute for Clinical Evaluative Sciences, Toronto, Canada, 2 Public Health Ontario, Toronto, Canada, 3 Dalla Lana School of Public Health, University of Toronto, Toronto, Canada, 4 Department of Family and Community Medicine, University of Toronto, Toronto, Canada, 5 Department of Health Policy, Management, and Evaluation, University of Toronto, Toronto, Canada, 6 Department of Laboratory Medicine and Pathobiology, University of Toronto, Toronto, Canada, 7 Department of Medicine, University of Toronto, Toronto, Canada, 8 Centre for Global Health Research, St Michael's Hospital, Toronto, Canada, 9 Centre for Research on Inner City Health, The Keenan Research Centre, Li Ka Shing Knowledge Institute, St Michael's Hospital, Toronto, Canada, 10 Toronto Public Health, Toronto, Canada, 11 Ottawa Hospital Research Unit, Ottawa, Canada, 12 Department of Population Medicine, University of Guelph, Guelph, Canada, 13 Department of Health Studies and Gerontology, University of Waterloo, Waterloo, Canada, 14 Public Health Agency of Canada, Guelph, Canada, 15 Department of Medicine, University of British Columbia, Vancouver, Canada


    Abstract

    Background

    Evidence-based priority setting is increasingly important for rationally distributing scarce health resources and for guiding future health research. We sought to quantify the contribution of a wide range of infectious diseases to the overall infectious disease burden in a high-income setting.


    Methodology/Principal Findings

    We used health-adjusted life years (HALYs), a composite measure comprising premature mortality and reduced functioning due to disease, to estimate the burden of 51 infectious diseases and associated syndromes in Ontario using 2005?2007 data. Deaths were estimated from vital statistics data and disease incidence was estimated from reportable disease, healthcare utilization, and cancer registry data, supplemented by local modeling studies and national and international epidemiologic studies. The 51 infectious agents and associated syndromes accounted for 729 lost HALYs, 44.2 deaths, and 58,987 incident cases per 100,000 population annually. The most burdensome infectious agents were: hepatitis C virus, Streptococcus pneumoniae, Escherichia coli, human papillomavirus, hepatitis B virus, human immunodeficiency virus, Staphylococcus aureus, influenza virus, Clostridium difficile, and rhinovirus. The top five, ten, and 20 pathogens accounted for 46%, 67%, and 75% of the total infectious disease burden, respectively. Marked sex-specific differences in disease burden were observed for some pathogens. The main limitations of this study were the exclusion of certain infectious diseases due to data availability issues, not considering the impact of co-infections and co-morbidity, and the inability to assess the burden of milder infections that do not result in healthcare utilization.


    Conclusions/Significance

    Infectious diseases continue to cause a substantial health burden in high-income settings such as Ontario. Most of this burden is attributable to a relatively small number of infectious agents, for which many effective interventions have been previously identified. Therefore, these findings should be used to guide public health policy, planning, and research.



    Citation: Kwong JC, Ratnasingham S, Campitelli MA, Daneman N, Deeks SL, et al. (2012) The Impact of Infection on Population Health: Results of the Ontario Burden of Infectious Diseases Study. PLoS ONE 7(9): e44103. doi:10.1371/journal.pone.0044103

    Editor: Paula Braitstein, Indiana University and Moi University, United States of America

    Received: April 16, 2012; Accepted: July 30, 2012; Published: September 4, 2012

    Copyright: ? 2012 Kwong et al. This is an open-access article distributed under the terms of the Creative Commons Attribution License, which permits unrestricted use, distribution, and reproduction in any medium, provided the original author and source are credited.

    Funding: This study was funded by Public Health Ontario (PHO) and was supported by the Institute for Clinical Evaluative Sciences (ICES), both of which are funded by annual grants from the Ontario Ministry of Health and Long-Term Care (MOHLTC). JCK was supported by a MOHLTC Career Scientist Award and a University of Toronto Department of Family and Community Medicine Clinician Scientist Award. ND was supported by a Canadian Institutes of Health Research (CIHR) Clinician Scientist Award. AMB was supported by a CIHR/Ontario MOHLTC Applied Chair in Health Services and Policy Research. KMK was supported by a CIHR New Investigator Award. DGM was supported by a Chair in Applied Public Health from the CIHR and the Public Health Agency of Canada. The study sponsors were involved in the conception and design of the study, data interpretation, revision of the paper for important intellectual content, and the decision to publish.

    Competing interests: The authors have read the journal's policy and the following authors wish to report these potential conflicts. DNF has previously received research funding and/or served as a consultant to Novartis, Sanofi-Pasteur, and GlaxoSmithKline on issues related to vaccination. AJM has received research honoraria from Gilead Biosciences, Hoffman-Laroche, GlaxoSmithKline, Pfizer, Merck, Sanofi-Pasteur, and Wyeth. This does not alter the authors' adherence to all the PLoS ONE policies on sharing data and materials. The remaining authors declare that they have no conflict of interest.


    * E-mail: jeff.kwong@utoronto.ca
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