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9. Recurrent effects
The direct health loss method of equations 1-4 is not readily applicable to recurrent effects. It may also be possible to represent effects that can recur multiple times a year, by adapting the inputs to the calculation, e.g. by expressing intake not as the level of intake but as the frequency of intakes in the current year that exceed an effect level, setting the probability of effect to 1, and making the duration of the effect (YLD) and, if appropriate, its severity (the DALY or QALY weight) functions of the intake measure (i.e. of the number of episodes of the disease in the year).
As the direct health loss method only considers effects that begin in the current year, the calculations do not require consideration of recurrence in future years. However, the probability, magnitude and severity of recurrent events in future years (which are represented in the calculation by individuals of older ages) would be dependent on whether effects occurred in the current year. The existence of such dependencies is not considered in the direct health loss model and, where relevant, must be taken into account when evaluating unquantified uncertainties affecting results (see section 15.1).