Regional years of life lost, years lived with disability, and disability-adjusted life-years for severe mental disorders in Guangdong Province, China: a real-world longitudinal study

Abstract

Background: To understand the magnitude and spatial-temporal distribution of the regional burden attributable to severe mental disorders is of great essential and high policy relevance. The study aimed to address the burden of severe mental disorders by evaluating the years of life lost, years lived with disability, and disability-adjusted life-years (DALYs) in Guangdong, China.

Methods: We undertook a longitudinal study based on a multicenter database established by the Health Commission of Guangdong, involving a total of 21 prefectures and four economic regions in the Guangdong province. A total of 520,731 medical records from patients with severe mental disorders were collected for 2010-2020. Data were analyzed via an integrated evaluation framework by synthesizing prevalence estimates, epidemiological adjustment as well as comorbidity assessment to develop internally consistent estimates of DALY. DALY changes during 2010-2020 were decomposed by population growth and aging and further grouped by Socio-demographic Index (SDI). DALYs were projected to 2030 by the weighted median annualized rate of change in 2010-2020.

Results: In 2010-2020, the average DALYs for severe mental disorders reached 798,474 (95% uncertainty interval [UI]: 536,280-1,270,465) person-years (52.2% for males, and 47.8% for females). Severe mental disorders led to a great amount of disease burden, especially in Guangzhou, Shenzhen, and Foshan cities. Schizophrenia and mental retardation with mental disorders were the two leading sources of the burden ascribed to severe mental disorders. Population growth and aging could be accountable for the increasing burden of severe mental disorders. Economic regions with higher SDI carried a greater burden but had lower annualized rates of change in DALYs. The overall burden of severe mental disorders is projected to rise modestly over the next decade.

Conclusions: The findings urge prioritization of initiatives focused on public mental health, prevention strategies, health resources reallocation, and active involvement of authorities to effectively address the anticipated needs.

Keywords: Burden of disease; Comorbidity; Disability-adjusted life-years; Severe mental disorders; Socio-demographic index.

Fig. 1

Weighted median annualized rates of change (a) and change of logarithm of values (b) in disability-adjusted life-years (DALYs) for patients with severe mental disorders in Guangdong, China, during 2010–2020, by SDI group. Notes: SDI = Socio-demographic Index. SDI groups were generated by calculating quintiles at the set of percentiles p = {0, 0.2, 0.4, 0.6, 0.8, 1.0}, in which five categories of SDI were yielded (namely, low SDI < 0.11, Low-middle SDI < 0.14, Middle SDI < 0.24, high-middle SDI < 0.52, and High SDI ≥ 0.56). In (a), the median of SDI during 2010–2020 was plotted, whereas the blue line reflects the linear relationship between estimated SDI and weighted median annualized rates of change in DALYs ascribed to severe mental disorders. In (b), the logarithm of DALYs across 21 prefecture cities was further aggregated by the median for the four economic regions. Arrows indicate the direction of change in the logarithm of DALY, where comorbidity-adjusted values were reported

Fig. 2

Temporal trends (a–c) for age-standardized DALY^a rates and forecasts (d) for absolute DALYs ascribed to severe mental disorders in Guangdong, China, during 2010–2030, by economic region. ^aDALY: disability-adjusted life-years, for which comorbidity-adjusted estimates were reported. Age-standardized rates were calculated based on the Chinese population reported by the GBD 2019 [31]. Notes: In (a–c), region-specific patterns of age-standardized DALYs ascribed to severe mental disorders during 2010–2030 were depicted. The Greater Bay Area refers to Guangzhou(1), Foshan(2), Zhaoqing(5), Shenzhen(3), Dongguan(4), Huizhou(6), Zhuhai(7), Zhongshan(8), Jiangmen(9). The North Guangdong region refers to Shaoguan(10), Qingyuan(11), Meizhou(12), and Heyuan(13). The West Guangdong region refers to Zhanjiang(14), Yangjiang(15), Maoming(16) and Yunfu(17). Finally, the East Guangdong region refers to Chaozhou(18), Shantou(19), Jieyang(20), and Shanwei(21). In panel (D), temporal trends between 2010 and 2030 were shown, for four economic regions of Guangdong. Uncertainty intervals of forecasts for DALYs were presented in shaded colors