BACKGROUND Previous research has focused on the mortality associated with armed conflict as the primary measure of the population health effects of war. However, mortality only demonstrates part of the burden placed on a population by conflict. Injuries and resultant disabilities also have long-term effects on a population and are not accounted for in estimates that focus solely on mortality. Our aim was to demonstrate a new method to describe the effects of both lives lost, and years of disability generated by a given conflict, with data from the US-led 2003 invasion and subsequent occupation of Iraq. METHODS AND FINDINGS Our data come from interviews conducted in 2014 in 900 Baghdad households containing 5,148 persons. The average household size was 5.72 persons. The majority of the population (55.8%) were between the ages of 19 and 60. Household composition was evenly divided between males and females. Household sample collection was based on methodology previously designed for surveying households in war zones. Survey questions were answered by the head of household or senior adult present. The questions included year the injury occurred, the mechanism of injury, the body parts injured, whether injury resulted in disability and, if so, the length of disability. We present this modeling study to offer an innovative methodology for measuring "years lived with disability" (YLDs) and "years of life lost" (YLLs) attributable to conflict-related intentional injuries, using the Global Burden of Disease (GBD) approach. YLDs were calculated with disability weights, and YLLs were calculated by comparing the age at death to the GBD standard life table to calculate remaining life expectancy. Calculations were also performed using Iraq-specific life expectancy for comparison. We calculated a burden of injury of 5.6 million disability-adjusted life years (DALYs) lost due to conflict-related injuries in Baghdad from 2003 to 2014. The majority of DALYs lost were attributable to YLLs, rather than YLDs, 4.99 million YLLs lost (95% uncertainty interval (UI) 3.87 million to 6.13 million) versus 616,000 YLDs lost (95% UI 399,000 to 894,000). Cause-based analysis demonstrated that more DALYs were lost to due to gunshot wounds (57%) than any other cause. Our study has several limitations. Recall bias regarding the reporting and attribution of injuries is possible. Second, we have no data past the time of the interview, so we assumed individuals with ongoing disability at the end of data collection would not recover, possibly counting more disability for injuries occurring later. Additionally, incomplete data could have led to misclassification of deaths, resulting in an underestimation of the total burden of injury. CONCLUSIONS In this study, we propose a methodology to perform burden of disease calculations for conflict-related injuries (expressed in DALYs) in Baghdad from 2003 to 2014. We go beyond previous reports of simple mortality to assess long-term population health effects of conflict-related intentional injuries. Ongoing disability is, in cross section, a relatively small 10% of the total burden. Yet, this small proportion creates years of demands on the health system, persistent limitations in earning capacity, and continuing burdens of care provision on family members.

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2003-2014 年伊拉克巴格达与冲突相关的故意伤害：计算冲突中伤害负担的模型研究和建议方法。

背景 先前的研究主要关注与武装冲突相关的死亡率，将其作为战争对人口健康影响的主要衡量标准。然而，死亡率只是冲突给人口带来的部分负担。伤害和由此导致的残疾也对人口产生长期影响，在仅关注死亡率的估计中没有考虑在内。我们的目的是展示一种新方法来描述特定冲突造成的生命损失和多年残疾的影响，数据来自美国领导的 2003 年入侵和随后占领伊拉克的数据。方法和结果 我们的数据来自 2014 年对 900 个巴格达家庭（包含 5,148 人）进行的访谈。平均家庭人数为 5.72 人。大多数人口 (55.8%) 年龄在 19 至 60 岁之间。家庭构成在男性和女性之间平均分配。家庭样本收集基于以前为战区家庭调查而设计的方法。调查问题由在场的户主或老年人回答。问题包括伤害发生的年份、伤害的机制、受伤的身体部位、伤害是否导致残疾，如果是，残疾的持续时间。我们提出了这项建模研究，以提供一种创新的方法，用于使用全球疾病负担 (GBD) 方法来衡量与冲突相关的故意伤害导致的“残疾年限”(YLD) 和“丧失的生命年数”(YLL)。YLD 是用残疾权重计算的，YLLs 是通过将死亡年龄与 GBD 标准寿命表进行比较来计算剩余预期寿命来计算的。还使用伊拉克特定的预期寿命进行计算以进行比较。我们计算了 2003 年至 2014 年巴格达因冲突相关伤害而损失的 560 万伤残调整生命年 (DALY) 的伤害负担。 损失的大部分 DALY 归因于 YLL，而不是 YLD，损失了 499 万 YLL（ 95% 的不确定性区间 (UI) 387 万至 613 万）与 616,000 年损失（95% UI 399,000 至 894,000）。基于原因的分析表明，由于枪伤 (57%) 损失的 DALY 比任何其他原因都多。我们的研究有一些局限性。关于伤害报告和归因的回忆偏见是可能的。其次，我们没有超过采访时间的数据，因此，我们假设在数据收集结束时持续残疾的个人将无法康复，可能会将更多的残疾计算为以后发生的伤害。此外，不完整的数据可能会导致对死亡的错误分类，从而导致对伤害总负担的低估。结论 在本研究中，我们提出了一种方法来计算 2003 年至 2014 年巴格达与冲突相关的伤害（以 DALYs 表示）的疾病负担。我们超越了先前关于简单死亡率的报告，以评估冲突对人口的长期健康影响- 相关的故意伤害。从横截面来看，持续性残疾仅占总负担的 10% 相对较小。然而，这一小部分对卫生系统造成了多年的需求，收入能力的持续限制，