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• Cirrhosis^[1]

• Proposed Changes The first proposed change would be to remove the second figure present within the Complications section of the article, which outlines the global DALY rates for cirrhosis per 100,000 inhabitants. The second proposed change would be to add a third paragraph to the Epidemiology section with the following three sentences: “Globally, age-standardized disability-adjusted life year (DALY) rates have decreased from 1990 to 2017, with the values going from 656.4 years per 100,000 people to 510.7 years per 100,000 people.^[2] Breaking this down into sex demographics, age-standardized DALY rates in males have decreased from 903.1 years per 100,000 population in 1990, to 719.3 years per 100,000 population in 2017, while in females the DALY rates have decreased from 415.5 years per 100,000 population in 1990, to 307.6 years per 100,000 population in 2017.^[2] However, the total number of DALYs have increased globally by 10.9 million from 1990 to 2017, reaching the value of 41.4 million DALYs.^[2]”
• Rationale for Proposed Changes The rationale behind the first proposed change is the outdated data used for the graph included in the article. Global DALY rates for cirrhosis is a crucial component of identifying the burden of disease presented by cirrhosis. It also ensures that international data is provided in the context of the disease, and is not solely centered around North American or European data. However, the graph presented in the article uses statistics from 2004, more than 15 years ago. This questions its relevancy and applicability in today’s context. The graph is also placed under the Complications section of the article describing various medical conditions connected to cirrhosis, which is unrelated to the graph’s contents. Additionally, the figure is not referenced anywhere within the article, emphasizing its rationale for removal. The rationale behind the second proposed change is the importance of discussing DALY rates within the article. Removing the graph does not mean its information should not be available to readers, considering the value of acknowledging global health and burden of disease. Adding this change into the Epidemiology section of the article is a more applicable location for the information, and supplements the existing information regarding cirrhosis prevalence and mortality. The current Epidemiology section is inadequate in its discussion about the global burden of disease presented by cirrhosis and how global statistics have changed over the years. I also felt that ensuring the DALY rates adjusted for age factors and represented the numerical differences between men and women was integral in including other variables to the data. It provides readers with a bigger picture into which demographics have a greater burden of disease, as well as the trends with DALY rates over the last three decades. The current Epidemiology section also includes information about prevalence rates between males and females, so complimenting this information with data on DALY rates for these specific populations is important. There are no identified controversies with the above two proposed changes. DALYs are an internationally respected statistical value used by organizations such as the World Health Organization (WHO), and help researchers compare the effects of various diseases on population health. Including this information in the article would supplement the existing Epidemiology section and provide specific numerical data. The reference used for the above changes is included below:
  • 1.     GBD 2017 Cirrhosis Collaborators (2020). The global, regional, and national burden of cirrhosis by cause in 195 countries and territories, 1990-2017: a systematic analysis for the Global Burden of Disease Study 2017. The lancet. Gastroenterology & hepatology, 5(3), 245–266. https://doi.org/10.1016/S2468-1253(19)30349-8'
• Critique of Source Overall, I believe this source has good validity and reliability. I chose this source because it is a systematic analysis published in a reputable peer-reviewed medical journal (The Lancet). It was published very recently in January 2020, pools together data from the Global Burden of Diseases, Injuries, and Risk Factors Study (GBD) 2017, vital registrations, and verbal autopsies, and strives for significant statistical analysis. Finally the study is also compliant with the Guidelines for Accurate and Transparent Health Estimates Reporting. These factors contributed to my choice in resource, however there are some smaller critiques that may be of concern when looking at the published information. Firstly in order to make mortality estimates, the resource collected data through vital registrations and verbal autopsies from 195 countries, mostly using the WHO mortality database. However there were instances where zero data points were available for a certain year and age group, which could affect the data significantly. The resource describes using a Bayesian noise-reduction algorithm to compensate for this, however to be as accurate as possible I did not utilize the mortality data in my proposed changes. Secondly, although the resource collected a significant amount of prevalence and DALY data based on geographic region and country, there does not seem to be any indication for challenges met at collecting this data. It is important to recognize and account for the fact that not all countries will have accurate systems in place for collecting cirrhosis-related data in every region of their country. Low availability and low quality of data, as well as a dependence on hospital and claims data in specific countries can create poor validity in the study. It is crucial to identify these barriers and where these challenges were most commonly met, so that readers can evaluate the data from specific countries with caution. For this reason I have chosen to not include information comparing DALY rates to a country’s Socio-demographic index (SDI), as these region-specific data points are more likely to be statistically skewed than total global population numbers. Finally, the grand nature of this research and its extensive financial supports causes the study to have a fairly long Declaration of Interests list. Reported financial grants and personal fees come from Alab Laboratoria, Sanofi Pasteur, Akcea Therapeutics, and Unilever. Non-financial support has also come from Preventicus, Microlife, Superpharm, Medicover, and more. These affiliations could have possible conflicts of interest unknowing to the reader of the resource.

• This will also be covered on Nov 23rd in class. Your group should use the below template to share an outline of your proposed improvements (including your new wording and citations). Article talk pages are not places to share your assignment answers. The Wikipedia community will be more interested in viewing your exact article improvement suggestions including where you plan to improve the article (which section), what wording you suggest, and the exact citation (Note: all citations must meet WP:MEDRS)
• You will not be able to paste citations directly from your sandbox to talk pages (unless you are interested in editing/learning Wiki-code in the "source editing" mode). We suggest re-adding your citations on the talk page manually (using the cite button and populating the citation by pasting in the DOI, website, or PMID). You will have to repeat this process yet again when you edit the actual article live.
• Talk Page Template: Wikipedia:CARL Medical Editing Initiative/Fall 2020/Talk Page Template