Method generation v2 · CDC WONDER 2020–2022 · CDC PLACES 2024 · IHME GBD 2021 · US-2000 standard population · Sergey Soshnikov, MD PhD
This analysis quantifies the disease burden of Wayne County (which contains Detroit) as Disability-Adjusted Life Years (DALYs) across seven condition groups: cancer, cardiovascular disease, chronic lower respiratory disease (COPD), stroke, diabetes, substance-use disorder, and a mental-health group. A DALY is one lost year of healthy life; it is the sum of Years of Life Lost to premature death (YLL) and Years Lived with Disability (YLD).
It uses the v2 age-standardized method, an upgrade over the crude method used for this site's smaller rural counties. The three upgrades: (a) YLL is computed age-specifically from a GBD reference life table rather than against one fixed benchmark age; (b) rates are age-standardized to the US-2000 population so counties with very different age structures can be compared fairly; (c) substance-use and mental-health mortality are directly observed by age, because Wayne is large enough that these counts are not statistically suppressed.
Deaths by cause × ten-year age group, Wayne County (FIPS 26163), 2020–2022 pooled, from the CDC WONDER Underlying Cause of Death, 2018–2024, Single Race database. The five chronic causes are the aggregate 113-cause-list rows: malignant neoplasms (C00–C97), diseases of heart (I00–I09, I11, I13, I20–I51), chronic lower respiratory (J40–J47), cerebrovascular (I60–I69), and diabetes (E10–E14). Substance use is the sum of drug-induced and alcohol-induced causes; the mental-health mortality proxy is intentional self-harm/suicide (X60–X84).
Age-adjusted adult prevalence for each condition from the CDC PLACES county dataset (Socrata swc5-untb), which also supplies the adult (18+) population denominator. PLACES has no substance-use measure (see §4).
Disability weights are the IHME GBD 2021 values, reused unchanged across all counties (they are population-independent). Age-specific remaining life expectancy for YLL comes from the GBD 2019 reference life table (the same standard IHME uses), interpolated to each age group's midpoint.
Population by county × age group is drawn from the CDC WONDER Single-Race Population Estimates 2020–2022 (the Census Bureau's Population Estimates Program — the same denominators CDC uses for official age-adjusted death rates). We sum 2020, 2021 and 2022 to obtain person-years matching the 3-year pooled deaths, then annualize. Five-year population bands are collapsed to the ten-year mortality bands.
Michigan GDP per capita $62,000 (BEA) for the human-capital method; income-adjusted HHS value of a statistical life $10.5M for the VSL method. Comorbidity correction factor 0.949 (Gaussian-copula net-YLD correction), reused from the Isabella pipeline.
DALY = YLL + YLD, no age-weighting and no time discounting, following the WHO Global Health Estimates convention.
For each cause i and ten-year age group a with midpoint age ma:
where RLE(m_a) is the remaining life expectancy at age ma interpolated from the GBD 2019 reference table. Pooled deaths are annualized (÷3). This replaces the crude method's single fixed 89.1-year benchmark, so a death at 40 and a death at 80 correctly lose different amounts of life.
Prevalence is the PLACES age-adjusted value; DW the IHME disability weight; CF the 0.949 comorbidity factor. For the mental-health group, prevalence is PLACES depression × 0.50 (remission adjustment). PLACES provides no age-specific prevalence, so YLD carries no age structure (see §4).
The cross-county comparison metric is the age-standardized YLL rate: the age-specific YLL rate per 100,000 in each band, weighted by the US-2000 standard population.
Standard weights are normalized over the ten age bands present (the <1 band is folded into 1–4 to match the population banding, and weights re-sum to 1). Wayne's age-standardized YLL rate is 14,177 per 100,000 — about 1.7× Ann Arbor's 8,251.
Unlike small rural counties, Wayne's substance-use and suicide deaths are numerous enough to be reported by age rather than suppressed, so both are observed directly rather than modeled from proxies. Wayne's substance-use mortality (1,107 deaths/yr) is a defining feature of its burden.
CDC WONDER suppresses cell counts of 1–9. Suppressed chronic-disease cells at young ages (<45), where the true count is near zero, are imputed at 1; suppressed substance-use/suicide cells are imputed at the midpoint 5. A 0-to-9 sensitivity band brackets the choice; in a county this large the swing on the total is well under ±1%.
Human-capital: DALYs × $62,000. VSL: annual deaths × $10.5M (mortality only). Both are planning-grade, not audited fiscal figures.
| Condition | Deaths/yr | YLL | YLD | DALYs |
|---|---|---|---|---|
| CVD (heart disease) | 5,531 | 111,087 | 33,017 | 144,104 |
| Cancer | 3,502 | 75,346 | 24,296 | 99,641 |
| Substance use | 1,107 | 46,729 | 30,032 | 76,762 |
| COPD | 736 | 13,460 | 20,390 | 33,850 |
| Mental health | 224 | 9,993 | 22,951 | 32,944 |
| Stroke | 1,017 | 16,576 | 15,668 | 32,244 |
| Diabetes | 642 | 14,124 | 8,582 | 22,706 |
| Total | 12,759 | 287,315 | 154,936 | 442,251 |
Age-standardized YLL rate 14,177/100k · crude YLD rate 8,738/100k · crude DALY rate 24,943/100k · population 1,773,082 (2020–22 average). Rows use unrounded estimates, so YLL + YLD may differ from the DALY column by ±1.
The pipeline (Python) parses the raw CDC WONDER exports, applies the formulas above, and writes a machine-readable results file. An independent agent re-parsed the raw death files and re-implemented the engine from scratch, reproducing all 56 cause × county × metric cells and every total to the integer. Two suppression-sensitivity runs (0 and 9) bracket the central estimate. Data vintages: CDC WONDER 2020–2022, CDC PLACES 2024, CDC Single-Race Population Estimates 2020–2022, IHME GBD 2021.