Disability-adjusted life years (DALY) reflects the burden of disease in the population, by measuring a combination of years of life lost due to premature mortality, and years lived with disability (any short-term or long term health loss). According to the Singapore Burden of Disease Study, nearly 400 thousand DALYs were lost due to premature deaths and ill health in Singapore in 2010. One DALY can be thought of as one lost year of ‘healthy’ life in the population. Ischaemic heart disease, diabetes and stroke were the top three contributors of DALYs.
Between 2004 and 2010, there was a 10% increase in total disease burden: 15% increase in disability burden and 5% increase in premature mortality burden. However, the age standardised overall burden per head of population decreased by 8%.
10. SchizophreniaThe mental disorder burden is significant in Singapore, with one in ten having a psychiatric condition. Although schizophrenia is not actually within the most common mental health issues in Singapore (Major depressive disorder, alcohol abuse and obsessive compulsive disorder were the top three most common), it has led to the greatest disease burden by having the greatest effect on DALYs.
9. Breast cancerBreast cancer is the most common form of cancer for women, and leads to a disproportionately high rate of disability compared to other forms of cancer. Breast cancer leads to 2.1% of all disability due to disease, compared to 0.5% due to lung cancer. For breast cancer, causes of years of healthy life lost to disability include side effects during and after treatment (for example, after radiotherapy, chemotherapy or hormonal therapies), potential changes in menopause, the effects of lymphoedema and the psychosocial differences in ‘life after therapy’.
8. Lower respiratory tract infectionPneumonia is actually the second highest cause of death in Singapore, accounting for 19% of all causes of death, after cancer. It is the fifth most common cause of admission to hospitals. Its contribution to disease burden is mainly as an acute illness, leading to significant death.
7. Adult onset hearing lossIncreasing numbers of young Singaporeans are at risk of losing their hearing. Statistics from the Changi General Hospital (CGH) show that 40 per cent of those diagnosed with hearing loss are younger than 40 years old, which is an increase by two times compare to figures five to eight years ago. This increase has been attributed to increased exposure to loud noises from night entertainment outlets and audio devices.
6. Lung cancerBetween 2010 and 2014, on average 1370 people in Singapore were diagnosed with lung cancer yearly. Lung cancer is the second most common cancer among men in Singapore, and the third among women. However, its leads to a disproportionately higher mortality rate, being the top cause of death from cancer in men, and the second highest cause of death from cancer in women.
5. Alzheimer's and other dementiasOne in 10 people aged 60 and above in Singapore has dementia, according to the Well-being of the Singapore Elderly (WiSE) study published in 2015. IMH experts attribute the rise in prevalence to a rapidly ageing population and increasing prevalence of stroke, obesity, diabetes and hypertension that are risk factors for dementia. Caregivers of those with dementia also report significantly higher levels of distress and psychological problems compared to other caregivers.
4. Vision disordersEye diseases related to ageing such as cataracts, glaucoma, age-related macular degeneration and diabetic retinopathy are a significant cause of ocular morbidity in the elderly population. They cause substantial disease burden due to the disability associated with visual loss, which can cause decreased mobility and physical performance as well as an increase in hip fractures, depression, morbidity and mortality. It has been observed that many people fear blindness more than death, and would be willing to trade a significant proportion of their lifespan for optimal vision.
3. StrokeAccording to an MOHH study, the number of strokes in Singapore has increased from 2009 to 2013. However, after adjusting for age, the study found that the age-standardised incidence rate was stable. In this study, Malays had the highest overall age-standardised incidence followed by Indians and Chinese. This could be due to the higher risk factors for stroke among Malays, such as hypertension and hyperlipidemia.
2. Diabetes mellitusDiabetes mellitus made headlines in Singapore in April 2016, when Minister for Health Gan Kim Yong ‘waged a war on diabetes’, and pledged to implement a multi-year action plan to fight diabetes in Singaporeans. According to the Ministry of Health, there are now 440,000 residents 18 years and older with diabetes. This number is projected to rise to 670,000 by 2030, and nearly 1 million by 2050.
Diabetes mellitus causes 10.4% of DALYs, also leading to 2% of hospital admissions and 9.8% of polyclinic attendances. It cost Singapore more than $1 billion in 2010, which was 0.35% of SIngapore’s GDP or 10% of healthcare spending. Although diabetes caused significant disability as measured by DALYs, diabetes itself did not directly lead to a significant proportion of death, except as a risk factor of other conditions such as ischemic heart disease, cerebrovascular disease and kidney disease.
1. Ischemic heart diseaseAnd finally, we see that ischemic heart disease creates the highest disease burden of all for Singaporeans. For this disease, much of the disease burden is due to its high rate of mortality.
In the Global Burden of Disease study, ischemic heart disease led to the highest number of years of life lost due to disease (at 19.9% vs stroke, the next highest cause at 9.3%). However, it is useful to note that the figures in the Global Burden of Disease Study separated the various types of cancer (e.g. breast cancer vs lung cancer) into separate categories, rather than lumping cancers as a whole. In studies where all types of cancer were lumped as a whole, single entity, cancers led to the highest mortality. However, in this study, where the cancers were separated by type (e.g. breast cancer and lung cancer), ischemic heart disease took the top spot.
Cardiovascular disease (heart disease and stroke) also accounted for almost a third of all deaths in Singapore, with 15 people dying from cardiovascular disease every day in 2014. MIMS