Models for estimating and projecting global, regional and national prevalence and disease burden of asthma: protocol for a systematic review

1 Bhuia MR, e al. BMJ Open 2017;7:e015441. doi:10.1136/bmjopen-2016-015441 Open Access ABSTRACT In oduc ion Models ha ha e so a been used o es ima e and p ojec he p e alence and disease bu den o as hma a e in mos cases inadequa ely desc ibed and i ep oducible. We aim sys ema ically o desc ibe and c i ique he exis ing models in ela ion o hei s eng hs, limi a ions and ep oducibili y, and o de e mine he app op ia e models o es ima ing and p ojec ing he p e alence and disease bu den o as hma. Me hods We will sea ch he ollowing elec onic da abases o iden i y ele an li e a u e published om 1980 o 2017: Medline, Embase, WHO Lib a y and In o ma ion Se ices and Web o Science Co e Collec ion. We will iden i y addi ional s udies by sea ching he e e ence lis o all he e ie ed pape s and con ac ing expe s. We will include obse a ional s udies ha used models o es ima ing and/o p ojec ing p e alence and disease bu den o as hma ega ding human popula ion o any age and sex. Two independen e iewe s will assess he s udies o inclusion and ex ac da a om included pape s. Da a i ems will include au ho s’ names, publica ion yea , s udy aims, da a sou ce and ime pe iod, s udy popula ion, as hma ou comes, s udy me hodology, model ype, model se ings, s udy a iables, me hods o model de i a ion, me hods o pa ame e es ima ion and/ o p ojec ion, model i in o ma ion, key indings and iden i ied esea ch gaps. A de ailed c i ical na a i e syn hesis o he models will be unde aken in ela ion o hei s eng hs, limi a ions and ep oducibili y. A quali y assessmen checklis and sco ing amewo k will be used o de e mine he app op ia e models o es ima ing and p ojec ing he p e alence anddiseasebu den o as hma. E hics and dissemina ion We will no collec any p ima y da a o his e iew, and hence he e is no need o o mal Na ional Heal h Se ices Resea ch E hics Commi ee app o al. We will p esen ou indings a scien i ic con e ences and publish he indings in he pee - e iewed scien i ic jou nal. BACkgRound As hma is now one o he mos common long- e m condi ions in he wo ld, and i is esponsible o subs an ial mo bidi y and in some cases mo ali y.1 The o e all wo ldwide end in he p e alence o as hma appea s o ha e pla eaued in some pa s o he wo ld, while i is s ill inc easing in some coun ies.2 As hma has been anked as he 14 h mos impo an cause o yea s li ed wi h disabili y (YLDs) in he wo ld,3 and i accoun s o 1% o all disabili- y-adjus ed li e yea s (DALYs) los globally.4 The socie al and heal hca e cos s a ibu ed o as hma a e also high ac oss di e en wo ld egions: o ins ance, ac oss Eu ope, he cos o pe sis en as hma among hose aged 15–64 yea s was es ima ed in 2010 alues a abou €19.3 billion5; in Asia-Paci ic egion, he o al annual pe -pa ien soci- e al cos s o as hma a ied om US$184 in Vie nam o US$1189 in Hong Kong (2000 a es).6 Likewise, a na ional le els, as hma imposes conside able economic bu den o he heal hca e sys em besides i s nega i e impac on he quali y o li e o indi iduals and amilies.7 8 Fo example, ecen es ima es ound ha as hma cos s a leas £1.1 billion pe yea o UK and i s membe na ions,9 while in he USA he o al cos a ibu ed o as hma in 2007 was es i- ma ed a abou US$56 billion.10 Al hough a ying es ima es o as hma p e - alence and bu den a he na ional, egional and global le els ha e been epo ed in Models o es ima ing and p ojec ing global, egional and na ional p e alence and disease bu den o as hma: p o ocol o a sys ema ic e iew Mohammad Romel Bhuia,1 B igh I Nwa u,1,2 Ch is ophe J Wei ,3 Aziz Sheikh1 To ci e: BhuiaMR, Nwa uBI, Wei CJ, e al. Models o es ima ing and p ojec ing global, egional and na ional p e alence and disease bu den o as hma: p o ocol o a sys ema ic e iew. BMJ Open 2017;7:e015441. doi:10.1136/ bmjopen-2016-015441 ►P epublica ion his o y and addi ional ma e ial a e a ailable. To iew hese iles please isi he jou nal online (h p:// dx. doi. o g/ 10.1136/ bmjopen-2016-015441). Recei ed 4 Decembe 2016 Re ised 31 Janua y 2017 Accep ed 4 Ap il 2017 1As hma UK Cen e o Applied Resea ch, Cen e o Medical In o ma ics, Ushe Ins i u e o Popula ion Heal h Sciences and In o ma ics, The Uni e si y o Edinbu gh, Edinbu gh, UK 2School o Heal h Sciences, Uni e si y o Tampe e, Tampe e, Finland 3Edinbu gh Clinical T ials Uni , Ushe Ins i u e o Popula ion Heal h Sciences and In o ma ics, The Uni e si y o Edinbu gh, Edinbu gh, UK Co espondence o M . Mohammad Romel Bhuia; Mohammad- Romel. Bhuia@ ed. ac. uk P o ocol S eng hs and limi a ions o his s udy ►To he bes o ou knowledge, his is he i s sys ema ic e iew o syn hesise and c i ique exis ing models o es ima ing and/o p ojec ing he p e alence and diseasebu den o as hma o scope he ele an e idence base. ►The e is no geog aphical and language limi a ions. ►Comp ehensi e and highly sensi i e sea ch s a egies, iden i ica ion o s udies om leading medical and public heal h da abases, and in ol emen o a panel o expe will ensu e quali y o unde lying e idence base. ►Panel o expe s should be consul ed due o lack o s anda d guidelines o e alua ing models. g oup.bmj.com on May 29, 2017 - Published by h p://bmjopen.bmj.com/Downloaded om 2Bhuia MR, e al. BMJ Open 2017;7:e015441. doi:10.1136/bmjopen-2016-015441 Open Access he published li e a u e,3 11–16 almos all appea o ha e majo limi a ions in e ms o inadequacy o he analy ical app oach used and lack o ep oducibili y.17–19 The e is he e o e a need o gene a ing alid and ep oducible es ima es o disease p e alence and bu den o as hma o in o m e idence-based policy delibe a ions. De eloping anspa en p ocesses o gene a ing he na ional, egional and global es ima es o p e alence and disease bu den o as hma will hus enhance ep oducibili y ac oss se ings and will allow eliable p ojec ion o u u e es ima es. In heal hca e policy, a model can be de ined as a logical ma hema ical amewo k o analy ical me hodology ha in eg a es heo ies and da a o d aw in e ences ega ding pa ame e s o in e es o clinicians and decision make s.20 21 Models a e widely used o es ima e disease bu den,9 22–24 end in p e alence25 26 and u u e p ojec ions27 o di e en epidemiological cha ac e is ics o as hma. Al hough cu en p e alence o as hma can be es ima ed wi hou applying a model, many s udies15 17 28–31 es ima ed as hma p e alence applying modelling echniques, pa icula ly wi h he aim o adjus ing o ce ain popula ion cha - ac e is ics, such as age, sex, ime, geog aphy and o he con ex ual pa ame e s, which may a y ac oss s udies. Fo example, he In e na ional S udy o As hma and Alle gies in Childhood S ee ing Commi ee applied gene alised linea mixed model o es ima e he global p e alence o as hma in o de o adjus o wi hin-coun y and be ween- coun y a ia ions.15 Adeloye e al17 applied a non-linea model o es ima e egional (A ica) p e alence o as hma. The Global Bu den o Disease s udies also de eloped some compu e based disease modelling ools (such as DisMod, DisMod-MR) o es ima e he p e alence and bu den o a ious diseases.28 32 Howe e , exis ing models o es i- ma ing and p ojec ing p e alence and disease bu den o as hma a e in mos cases poo ly desc ibed, he eby limi ing he oppo uni y o assess hei ep oducibili y. In o de o gain a be e app ecia ion o he pe o mance o exis ing models and hei capaci y o ep oducibili y in es ima ing he bu den o as hma, a sys ema ic app aisal o he unde - lying e idence base is equi ed.33 objec i es The aims o his sys ema ic e iew a e o (1) sys ema ically desc ibe and c i ique he exis ing models o es ima ing and/o p ojec ing he global, egional and na ional p e - alence and disease bu den o as hma in ela ion o hei s eng hs, limi a ions and ep oducibili y, and (2) de e - mine he app op ia e models o es ima ing and p ojec ing he p e alence and disease bu den o as hma. MeThodS eligibili y c i e ia Types o s udies Any s udy ha de eloped models o es ima ing and/o p ojec ing p e alence and disease bu den o as hma will be included in his e iew. S udies ha es ima ed p e alence and disease bu den wi hou modelling will be excluded. Models ha es ima ed indi idual isk a he han popula ion bene i s, such as decision analy ic models and indi idual p ognos ic models, will be excluded. Mo eo e , s udies wi h models ha simply desc ibe animals, clinical se ies and cell lines will be excluded. Compa a i e in e en ion s udies will also be excluded. Po en ial sou ces o e idence such as o iginal esea ch a icles and e iew a icles, including sys ema ic e iews, me a-analyses and me a-syn heses o obse a ional s udies, will be included. Pa icipan s Eligible pa icipan s in his e iew will include human popula ions o any age and ei he sex. Yea s conside ed We will include s udies om Janua y 1980 o Ap il 2017. The s a da e has been se up om he ime when model- ling echniques s a ed o be applied b oadly o s udy he epidemic o non-communicable diseases.34 Se ing Resea ch a icles om any coun y and any se ing (u ban/ u al) will be included in his e iew. Language The e will be no language es ic ions and, whe e possible, we will ansla e he li e a u e published in languages o he han English. In o ma ion sou ces Da abase sea ches and o he sou ces o iden i y s udies We will conduc sea ches o iden i y bo h published and unpublished modelling s udies in he ollowing elec- onic da abases: Medline, Embase, WHO Lib a y and In o ma ion Se ices (lib a y ca alogue o books and epo s) and Web o Science Co e Collec ion. The e e - ence lis s o all he included pape s will be sea ched o addi ional s udies. We will also con ac a panel o expe s in an a emp o iden i y addi ional unpublished o in p og ess s udies. Sea ch s a egy A comp ehensi e li e a u e sea ch will be unde aken o iden i y bo h published and unpublished (g ey li e a u e) p ima y s udies as well as e iews. The sea ch s a egy has been de eloped o sea ching li e a u e in Medline and Embase (see online supplemen a y appendix) in consul- a ion wi h a senio medical lib a ian a The Uni e si y o Edinbu gh, and his will be adap ed in sea ching o he da abases. The sea ch e ms include he concep s o ‘modelling’, ‘p e alence and disease bu den’ and ‘as hma’. S udy eco ds Da a managemen The e ie ed eco ds om all da abases will be expo ed o EndNo e Lib a y, which will be used h oughou he e iew o s udy sc eening, deduplica ion and o e all managemen o he e ie ed eco ds. g oup.bmj.com on May 29, 2017 - Published by h p://bmjopen.bmj.com/Downloaded om 3 Bhuia MR, e al. BMJ Open 2017;7:e015441. doi:10.1136/bmjopen-2016-015441 Open Access Selec ion p ocess Two e iewe s will independen ly check and sc een he i les and abs ac s o iden i ied a icles agains he inclusion c i e ia. Full- ex copies o po en ially ele an s udies will be ob ained and assessed by wo independen e iewe s on he basis o hei eligibili y o inclusion. Any disc epancies will be esol ed by discussion, and disag ee- men s will be a bi a ed by a hi d e iewe . Da a ex ac ion A da a ex ac ion o m will be used o ex ac ele an da a om included s udies. We ha e de eloped a d a da a ex ac ion o m. Du ing he e iew p ocess, his d a will be e ined and he da a ex ac ion o m will be upda ed acco dingly. The da a ex ac ion o m will be p e-pilo ed p io o ull use in he e iew. Da a ex ac ion will be pe o med independen ly by wo e iewe s. da a i ems In o ma ion ega ding di e en componen s o he models will be eco ded o ge a comp ehensi e pic u e o he models. The ollowing da a i ems will be ex ac ed om each s udy: au ho s’ names; publica ion yea ; s udy aims; da a sou ce and ime pe iod; s udy popula ion; as hma ou comes (p e alence/disease bu den); s udy me hodology; model ype; model se ings; model o mu- la ion (s uc u e, speci ica ion, assump ions, me hods o model de i a ion, me hods o pa ame e es ima ion and/ o p ojec ion, heo e ical basis o he models) s udy a i- ables; a ailabili y o da a and codes; indings om he models; model i in o ma ion; key indings o he s udy; and iden i ied esea ch gaps. In o ma ion ega ding he model a ailabili y, anspa ency, sensi i i y analysis, model alida ion, add essing missing da a, policymake s’ in ol emen , dissemina ion and expe in ol emen , limi a ion discussed and ep oducibili y o he model will also be ex ac ed. Desc ip i e ables will be used o abu- la e hese i ems. The sys ema ic e iew will be epo ed ollowing he guidelines o he P e e ed Repo ing I ems o Sys ema ic e iew and Me a Analysis (PRISMA) check- lis (see online supplemen a y ma e ial).35 ou comes and p io i isa ion The ou comes ha a e o in e es include p e alence and disease bu den o as hma. The e a e a ious measu es a ailable o quan i y disease bu den. All he es ablished measu es o disease bu den will be conside ed in his e iew. P ima y and seconda y ou comes a e ca ego ised as ollows. P ima y ou comes 1. P e alence o as hma. 2. Di e en measu es o disease bu den o as hma. The measu es a e: DALYs, YLDs, mo ali y, heal hca e cos (cos o illness, d ug cos , hospi al cos /hospi alisa ion cos ), li e expec ancy, p ima y ca e, ambula o y ca e, eme gency isi , absen ees, yea s li e los , po en ial yea s o li e los , heal hy yea s o li e los , ac i e li e expec ancy, disabili y- ee li e expec ancy, disabili y-adjus ed li e expec ancy, heal hy li e expec ancy, and so on. Seconda y ou comes 1. Incidence o as hma. Risk o bias in indi idual s udies To he bes o ou knowledge, he e is no exis ing quali y app aisal ool o assess quali y o models. So we ha e d awn on i s p inciples and adap ed ele an sec ions om pe inen epo ing guidelines36 and o he guide- lines o good p ac ice in modelling s udies20 21 37 38 o de elop ou own model e alua ion amewo k. This will in ol e independen assessmen o he s eng hs and limi a ions o he models on he basis o model s uc u e, speci ica ion, assump ions, sensi i i y analysis, model alida ion, dealing wi h missing da a, heo e ical basis o he models, inco po a ion o con ounding ac o s and lag imes, and whe he po en ial me hodological limi a- ions a e desc ibed. Rep oducibili y o he model will be assessed on he basis o a ailabili y o he models, da a, codes and me hods o pa ame e es ima ion. To e alua e he models used in included s udies and o iden i y he bes models, we ha e p epa ed a check- lis o i ems and o mula ed a sco ing s a egy (see online supplemen a y appendix) ha we will use o hese pu poses. P io o use o he checklis , we plan o consul wi h a panel o expe s in he ield o modelling s udies o gain hei insigh s and c i icisms o he check- lis ; we will hen in eg a e eedback colla ed in p epa ing he inal e sion o he checklis o be used in ou s udy. da a syn hesis A abula summa y o he da a will be p esen ed o summa ise o e all e idence. A de ailed c i ical na a i e syn hesis o he models will be unde aken ega ding hei s eng hs, limi a ions and ep oducibili y. PRoToCol RegISTRATIon A de ailed p o ocol o he sys ema ic e iew will be egis e ed wi h he In e na ional P ospec i e Regis e o Sys ema ic Re iews p io o commencing he e iew acco ding o he PRISMA-P o ocols 2015 s a emen .39 ConCluSIonS To he bes o ou knowledge no e iew has been unde - aken ye o app aise he models o es ima ing and p ojec ing he global, egional and na ional p e alence and disease bu den o as hma. This sys ema ic e iew is he e o e he i s s udy o syn hesise exis ing models o es ima ing and p ojec ing p e alence and disease bu den o as hma. The e iew will also map he app op ia e models ha will subsequen ly be used o ob ain cu en es ima es and p ojec u u e end o global, egional and na ional p e alence and disease bu den o as hma. g oup.bmj.com on May 29, 2017 - Published by h p://bmjopen.bmj.com/Downloaded om 4Bhuia MR, e al. BMJ Open 2017;7:e015441. doi:10.1136/bmjopen-2016-015441 Open Access eThICS And dISSeMInATIon We will no collec any p ima y da a o his e iew, and hence he e is no need o o mal Na ional Heal h Se ice Resea ch E hics Commi ee e iew. This wo k is howe e subjec o Ins i u ional Re iew Boa d o e sigh by The Uni e si y o Edinbu gh’s Cen e o Popula ion Heal h Sciences. Findings om he e iew will be p esen ed a scien i ic con e ences and be published in he pee - e- iewed scien i ic jou nal. Acknowledgemen s We a e hank ul o Ma shall Dozie , Senio Liaison Lib a ian o he College o Medicine and Ve e ina y Medicine, The Uni e si y o Edinbu gh, o he suppo in de eloping he sea ch s a egies. We a ealso hank ul o D Susannah McLean o p o iding necessa y sugges ions and esou ces ega ding modelling s udies, D Niall Ande son o his sugges ions in de eloping sco ing amewo k o app aise he models, And ew S odda o sugges ing sea ch e ms ela ed o economic bu den o as hma, and he As hma UK Cen e o Applied Resea ch o p o iding pla o m o de elop his p o ocol. Con ibu o s AS concei ed he idea o his wo k. MRB d a ed he p o ocol unde he supe ision o AS, BIN and CJW. The d a was e ised acco ding o se e al ounds o c i ical commen s om AS, BIN and CJW. All he au ho s will be in ol ed in he sys ema ic e iew p ocess. Funding MRB is suppo ed by he College o Medicine & Ve e ina y Medicine, The Uni e si y o Edinbu gh, and he Fa Ins i u e, UK. BIN and AS a e also suppo ed by he Fa Ins i u e, UK. The Fa Ins i u e is unded by a conso ium o unde s led by he Medical Resea ch Council (MRC). Compe ing in e es s None decla ed. P o enance and pee e iew No commissioned; ex e nally pee e iewed. Open Access This is an Open Access a icle dis ibu ed in acco dance wi h he e ms o he C ea i e Commons A ibu ion (CC BY 4.0) license, which pe mi s o he s o dis ibu e, emix, adap and build upon his wo k, o comme cial use, p o ided he o iginal wo k is p ope ly ci ed. See: h p:// c ea i ecommons. o g/ licenses/ by/ 4. 0/ © A icle au ho (s) (o hei employe (s) unless o he wise s a ed in he ex o he a icle) 2017. All igh s ese ed. No comme cial use is pe mi ed unless o he wise exp essly g an ed. Re eRenCeS 1. Global As hma Ne wo k. The global as hma epo 2014. Auckland, New Zealand: Global As hma Ne wo k, 2014. 2. Anandan C, Nu ma o U, an Schayck OC, e al. Is he p e alence o as hma declining? sys ema ic e iew o epidemiological s udies. Alle gy 2010;65:152–67. 3. Vos T, Flaxman AD, Nagha i M, e al. Yea s li ed wi h disabili y (YLDs) o 1160 sequelae o 289 diseases and inju ies 1990-2010: a sys ema ic analysis o he Global Bu den o Disease S udy 2010. Lance 2012;380:2163–96. 4. 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