Z-Score Burden Metric: A Method for Assessing Burden of Injury and Disease

Wolff CS, Naumann RB, Golightly YM, Wiebe DJ, Ranapurwala SI, Marshall SW. Z-Score Burden Metric: A Method for Assessing Burden of Injury and Disease. Am J Prev Med. 2022 Aug;63(2):e65-e72. doi: 10.1016/j.amepre.2022.03.029. Epub 2022 Jun 18. PMID: 35725600.


Introduction: Traditional methods of summarizing burden of disease have limitations in terms of identifying communities within a population that are in need of prevention and intervention resources. This paper proposes a new method of burden assessment for use in guiding these decisions.

Methods: This new method for assessing burden utilizes the sum of population-weighted age-specific z-scores. This new Z-Score Burden Metric was applied to firearm-related deaths in North Carolina counties using 2010‒2017 North Carolina Violent Death Reporting System data. The Z-Score Burden Metric consists of 4 measures describing various aspects of burden. The Z-Score Burden Metric Overall Burden Measure was compared with 2 traditional measures (unadjusted and age-adjusted death rates) for each county to assess similarities and differences in the relative burden of firearm-related death.

Results: Of all 100 North Carolina counties, 73 met inclusion criteria (≥5 actual and expected deaths during the study period in each age strata). Ranking by the Overall Burden Measure produced an ordering of counties different from that of ranking by traditional measures. A total of 8 counties (11.0%) differed in burden rank by at least 10% when comparing the Overall Burden Measure with age-adjusted and unadjusted rates. All the counties with large differences between the measures were substantially burdened by firearm-related death.

Conclusions: The use of the Z-Score Burden Metric provides an alternative way of measuring realized community burden of injury while still facilitating comparisons between communities with different age distributions. This method can be used for any injury or disease outcome and may help to prioritize the allocation of resources to communities suffering high burdens of injury and disease.