Measurement of Adverse Health Burden Related to Sexual Behavior

Abstract:

As part of an analysis of the burden of disease and injury in the United States, we established a method to identify and quantify the incidence of adverse health events, deaths, and disability adjusted life years (DALY) attributed to unprotected sexual behavior (USB). Estimates for the incidence, morbidity and mortality from sexually transmitted diseases (STD) were derived from vital statistics, notifiable disease surveillance system, national surveys, outpatient and hospital discharge summaries, prevalence data from individuals attending health care services, the published literature, and expert opinion. Because many conditions for which USB is implicated as a cause have multifactorial causes, a major challenge is developing estimates for the attributable fraction of disease that is exclusively related to USB. For conditions with risk factors other than sexual behavior (e.g., HIV), or etiology (e.g., liver disease), sexual behavior-attributable fraction was estimated based on the literature or through expert consultations. Maternal and infant conditions related to unintended pregnancy and all voluntary abortions were considered as adverse outcomes of sexual behavior. A comprehensive estimation including morbidity, mortality, and summary measures such as DALYs can identify a larger burden related to sexual behavior and more profound disparities by gender than that can be captured by traditional measurement of mortality or morbidity alone. However, because epidemiology of health events related to sexual behavior varies by countries or regions, statistics such as attributable fractions should be developed based on these geographic units. Further, summary measures involve the synthesis of parameters considered objective and science-driven with culture-specific and value oriented inputs. Many countries have limited information regarding either of these topics and must develop estimates in this context. This chapter provides only a roadmap for such estimation.