INTRODUCTION Shifts in diabetes onset to earlier ages, globally and in Cuba, signify greater risk of early complications and premature death, with consequent economic and social repercussions for families and health systems.

OBJECTIVE Describe the trend in diabetes burden in Cuban children and adolescents in the period 1990 to 2010, in terms of disability-adjusted life years.

METHODS A descriptive epidemiological study was conducted of diabetes burden in Cuba, analyzing the years 1990, 1995, 2000, 2005 and 2010 for the age group 0–19 years. Disability-adjusted life years were obtained from the sum of potential years of life lost plus years lived with disability. The first is calculated based on total deaths in the country in which diabetes was recorded as underlying cause; the second from the product of severity, as assigned to diabetes in similar studies, and incidence and average duration, provided by the DISMOD II program, which estimates six internally consistent epidemiological indicators.

RESULTS Mortality indicators improved, with a decrease in the rate of potential years of life lost in boys from 21.9/100,000 population in 1990 to 0 in 2010, and in girls from 38.8/100,000 in 1990 to 4.9/100,000 in 2010 (1% of disability-adjusted life years in girls in 2010, corresponding to one death). In contrast, years lived with disability increased by 134.5% in boys and 156.4% in girls. The net result was that disability-adjusted life years increased by >100% in both sexes (from 137.2 to 321.9/100,000 in boys and from 157.3 to 403.3/100,000 in girls, increases of 102.3% and 108.1%, respectively).

CONCLUSIONS Disability-adjusted life years lost for diabetes in Cuban children and adolescents have increased, due to disability, while mortality has decreased.

KEYWORDS Diabetes mellitus, childhood, adolescence, disability-adjusted life years, potential years of life lost, years lived with disability, Cuba

INTRODUCCIÓN Los años de vida ajustados por discapacidad constituyen una medida compuesta que integra los componentes de morbilidad y mortalidad. Es un indicador útil de la carga global de la enfermedad y es particularmente útil para la evaluación de los resultados de las intervenciones en salud. En los casos de cáncer de mama y del sistema reproductor, estos también pueden afectar negativamente las oportunidades de maternidad en las mujeres jóvenes.

OBJETIVO Determinar los años de vida ajustados por discapacidad por cáncer de mama y del sistema reproductor de la mujer cubana en edades de 15–44 años durante el período 1990-2006.

MÉTODOS Se realizó un estudio epidemiológico nacional, que utilizó las estadísticas de enfermedad en Cuba para 1990, 1995, 2000 y 2006. Los años de vida ajustados por discapacidad en mujeres de 15–44 años se calcularon para el cáncer de mama y tres cánceres del sistema reproductor femenino (cervical, endometrial y de ovario) como la suma de los años de vida perdidos por mortalidad prematura y los años vividos con discapacidad. Los años de vida perdidos por mortalidad prematura se determinaron a partir de las estimaciones específicas de la esperanza de vida por edad. Los años vividos con discapacidad se calcularon como el producto de la severidad (proporcionada por el Estudio Global de Carga de la Enfermedad de la OMS referido al año 1990) y la incidencia y la duración promedio, ambas obtenidas a través del programa DISMOD II. Los datos introducidos en el programa incluyen las estadísticas nacionales de incidencia, prevalencia y mortalidad.

RESULTADOS El cáncer de mama y el cáncer de cuello uterino mostraron las mayores tasas de años potenciales de vida perdidos por muerte prematura, con los mayores incrementos en el período (de 139 a 206.5 y de 114.7 a 215.2 por 100 000, respectivamente). Las neoplasias de endometrio y ovario aumentaron más discretamente. Se observó un aumento en años vividos con discapacidad en tres de estos cuatro tipos de cáncer; solamente se produjo una disminución en el cáncer de cuello uterino (de 12.7 a 9 por 100 000). El cáncer de mama y el cáncer de cuello uterino presentaron los más altos niveles de años de vida ajustados por discapacidad en los cuatro años estudiados, con un aumento de 146.9 a 227.8 y de 127.4 a 224.2 por 100 000, respectivamente, entre 1990 y 2006 en mujeres en edad reproductiva.

CONCLUSIONES Se observó una tendencia desfavorable en los años de vida ajustados por discapacidad por cáncer de mama y de cuello uterino en mujeres cubanas en edad fértil entre 1990 y 2006.

PALABRAS CLAVE Años de vida ajustados por discapacidad, AVAD, DALY, años de vida perdidos por mortalidad prematura, años vividos con discapacidad, cáncer, mama, sistema reproductor femenino, fertilidad, Cuba

INTRODUCTION Disability-adjusted life years is a composite measure that integrates the components of mortality and morbidity. It is a useful indicator of overall disease burden and is particularly useful for evaluating health intervention outcomes. In the cases of breast and reproductive system cancers, these can also negatively affect childbearing opportunities for young women.

OBJECTIVE Determine disability-adjusted life years for breast and reproductive system cancers in Cuban women aged 15–44 years during the period 1990–2006.

METHODS A national epidemiological study was conducted using Cuba’s disease and vital statistics registry data for 1990, 1995, 2000 and 2006. Disability-adjusted life years in women aged 15–44 years were calculated for breast cancer and three female reproductive system cancers (cervical, endometrial and ovarian), by summing years of life lost due to premature mortality and years lived with disability. Years of life lost due to premature mortality were determined based on age-specific estimates of life expectancy. Years lived with disability were calculated as the product of severities (provided by the 1990 Global Burden of Disease study) and incidence and average duration, both obtained via the DISMOD II program. Data entered in the program include national statistics on incidence, prevalence, and mortality.

RESULTS Breast cancer and cervical cancer proved to have the highest rates of potential years of life lost due to premature mortality, with the sharpest increases in the period (from 139 to 206.5 and 114.7 to 215.2 per 100,000, respectively). Endometrial and ovarian neoplasms crept up more slowly. An increase in years lived with disability was seen in three of these four types of cancer; only cervical cancer saw a decline (from 12.7 to 9 per 100,000). Breast cancer and cervical cancer presented the highest levels of disability-adjusted life years for all four years studied, rising from 146.9 to 227.8 and 127.4 to 224.2 per 100,000, respectively between 1990 and 2006.

CONCLUSIONS An unfavorable trend in disability-adjusted life years was seen for breast and cervical cancer between 1990 and 2006 in Cuban women of childbearing age.

KEYWORDS Disability-adjusted life years, years of life lost due to premature mortality, years lived with disability, cancer, breast, female reproductive system, fertility, Cuba