NIH Disease Funding Levels and Burden of Disease

Citation: Gillum LA, Gouveia C, Dorsey ER, Pletcher M, Mathers CD, et al. ( NIH Disease Funding Levels and Burden of Disease Leslie A. Gillum 0 Christopher Gouveia 0 E. Ray Dorsey 0 Mark Pletcher 0 Colin D. Mathers 0 Charles E. 0 McCulloch 0 S. Claiborne Johnston 0 Joseph Ross, Yale University School of Medicine, United States of America 0 1 Department of Neurology, University of California San Francisco , San Francisco , California, United States of America, 2 Department of Epidemiology and Biostatistics, University of California San Francisco , San Francisco , California, United States of America, 3 Department of Neurology, Johns Hopkins University Medical Center , Baltimore , Maryland, United States of America, 4 Department of Health Statistics and Informatics, World Health Organization , Geneva , Switzerland Background: An analysis of NIH funding in 1996 found that the strongest predictor of funding, disability-adjusted life-years (DALYs), explained only 39% of the variance in funding. In 1998, Congress requested that the Institute of Medicine (IOM) evaluate priority-setting criteria for NIH funding; the IOM recommended greater consideration of disease burden. We examined whether the association between current burden and funding has changed since that time. Methods: We analyzed public data on 2006 NIH funding for 29 common conditions. Measures of US disease burden in 2004 were obtained from the World Health Organization's Global Burden of Disease study and national databases. We assessed the relationship between disease burden and NIH funding dollars in univariate and multivariable log-linear models that evaluated all measures of disease burden. Sensitivity analyses examined associations with future US burden, current and future measures of world disease burden, and a newly standardized NIH accounting method. Results: In univariate and multivariable analyses, disease-specific NIH funding levels increased with burden of disease measured in DALYs (p = 0.001), which accounted for 33% of funding level variation. No other factor predicted funding in multivariable models. Conditions receiving the most funding greater than expected based on disease burden were AIDS ($2474 M), diabetes mellitus ($390 M), and perinatal conditions ($297 M). Depression ($719 M), injuries ($691 M), and chronic obstructive pulmonary disease ($613 M) were the most underfunded. Results were similar using estimates of future US burden, current and future world disease burden, and alternate NIH accounting methods. Conclusions: Current levels of NIH disease-specific research funding correlate modestly with US disease burden, and correlation has not improved in the last decade. - Funding: This work was supported by NIH/NCRR/OD UCSF-CTSI grant KL2 RR024130. The funders had no role in study design, data collection and analysis, decision to publish, or preparation of the manuscript. Competing Interests: The authors have declared that no competing interests exist. The National Institutes of Health (NIH) is the largest public funder of biomedical research worldwide [1,2], with a budget that has grown from $11.9 billion in 1996 to $28.5 billion in 2006 [3]. In the mid-1990s, Congress and the public raised concerns that disease-specific funding allocations by the NIH failed to adequately reflect burden of disease and incorporate public input [4]. In response, Congress requested that the Institute of Medicine (IOM) assess the NIH funding apportionment processes. In its 1998 report, Scientific Opportunities and Public Needs: Improving Priority Setting and Public Input at the National Institutes of Health, the IOM recommended improved tracking of disease-specific funding and development of a new priority-setting process [4]. A landmark study comparing disease burden to NIH funding levels was published in 1999 [5]. For 29 common conditions, the study examined a variety of measures of societal burden, recognizing that none by itself completely captures relative impacts of diseases. Disease incidence and prevalence were unrelated to funding, while mortality and years of life lost (YLLs) weakly correlated with funding. Disability-adjusted life years (DALYs)a measure that estimates the equivalent number of healthy years lost due to disability or early death [6,7]were more strongly predictive. Using DALYs as the best single predictor, only 39% of the variance in NIH funding could be explained. The prior analysis was limited to evaluation of univariate predictors, and did not attempt to evaluate whether funding aligned with other measures of disease burden. The NIH Reform Act of 2006 reemphasized the NIHs role in identifying research to meet public health challenges, and mandated submission of a biennial report to Congress regarding disease-specific funding amounts [8]. There has been no recent comprehensive study of US disease burden and NIH funding, and an analysis of only one of its institutes has been performed [9]. To determine whether the NIH has developed processes that better align funding with burden, we assessed the correlation between NIH funding and burden of disease, and compared results with those reported 10 years ago [5]. We also considered other potential predictors of funding and assessed the association of NIH funding with estimates of future and global disease burden. In a cross-sectional study, we compared measures of US and world disease burden and sociopolitical factors from 2004 to NIH funding levels in 2006. The study design was modeled on methods previously established [5], which used 1994 burden data and 1996 NIH funding to reflect an expected lag in availability of data on disease burden. Each disease was defined using pre-specified sets of International Classification of Diseases, 9th revision, Clinical Modification (ICD-9) codes, which were applied to public sources of information on disease burden [10]. Data Sources Amounts of NIH funding for disease categories were obtained directly from the NIH for the year 2006 (Table 1). These estimates were annually consolidated from figures supplied by individual NIH Institutes and Centers (http://www.nih.gov/news/ fundingresearchareas.htm) [11]. In 2006 and prior years, NIH Institutes and Centers categorized spending in a variety of manners to satisfy diverse reporting requirements, and calculated condition-specific total funds in a non-mutually exclusive manner. Thus, funding for a particular trial or biomarker could have been attributed to multiple conditions. Data denoting disease burden were collected from multiple sources (Table 1). First, world and North American disease-specific data were obtained from the Global Burden of Disease (GBD) Project the World Health Organization (WHO) [12,13,14]. We used GBDs North American data for US estimates. The GBD systematically collects timely disease-specific epidemiologic information and models missing data to estimate a variety of measures of burden [15,16]. We used 2004 GBD estima (...truncated)