Disability Adjusted Life Years

Violent injury devastates urban underserved populations, but the impact over a lifetime is not well characterized. The disability-adjusted life year (DALY) measures the burden of disability and is used widely to describe the long-term impact of a particular disease or injury. The objective of this study was to calculate DALYs and lost wages attributable to violence and its consequences on physical and mental health.

In this retrospective case series analysis, we conducted an in-depth review of 102 clients in our violence prevention (VP) program. We calculated DALYs using data from our trauma registry and VP program database and disability weights from the WHO. Using data on unemployment and salaries obtained from the Bureau of Labor Statistics, we estimated the earnings lost over a lifetime secondary to disability from violent injury.

The mean age was 20 years. 39% had evidence of PTSD post-injury. Violent injury accounted for 165 years of healthy life lost. Disability weight for mental illness accounted for an 18% DALY increase. See figure for lost wages. When mental illness is included in disability, lost wages increases to $767,579 per person.

Other studies have shown that in African American men, violent injury accounts for more DALYs than heart disease. In a population already suffering from high unemployment and high incidence of chronic disease, the physical and mental impact of violent injury creates another threat to this population's health and economic wellbeing. Violence prevention is necessary to save lives and livelihoods.