The relation between funding by the National Institutes of Health and the burden of disease

Background. The Institute of Medicine has proposed that the amount of disease-specific research funding provided by the National Institutes of Health (NIH) be systematically and consistently compared with the burden of disease for society. Methods. We performed a cross-sectional study comparing estimates of disease-specific funding in 1996 with data on six measures of the burden of disease. The measures were total mortality, years of life lost, and number of hospital days in 1994 and incidence, prevalence, and disability-adjusted life-years (one disability-adjusted life-year is defined as the loss of one year of healthy life to disease) in 1990. With the use of these measures as explanatory variables in a regression analysis, predicted funding was calculated and compared with actual funding. Results. There was no relation between the amount of NIH funding and the incidence, prevalence, or number of hospital days attributed to each condition or disease (P = 0.82, P = 0.23, and P = 0.21, respectively). The numbers of deaths (r = 0.40, P = 0.03) and years of life lost (r = 0.42, P = 0.02) were weakly associated with funding, whereas the number of disability-adjusted life-years was strongly predictive of fundi ng (r = 0.62, P < 0.001). When the latter th ree measures were used to predict expected funding, the conclusions about the appropriateness of funding for some diseases varied according to the measure used. However, the acquired immunodeficiency syndrome, breast cancer, diabetes mellitus, and dementia all received relatively generous funding, regardless of which measure was used as the basis for calculating support. Research on chronic obstructive pulmonary disease, perinatal conditions, and peptic ulcer was relatively underfunded. Conclusions. The amount of NIH funding for research on a disease is associated with the burden of the disease; however, different measures of the burden of disease may yield different conclusions about the appropriateness of disease-specific funding levels. (N Engl J Med 1999;340:1881-7). (C) 1999, Massachusetts Medical Society.