The burden of disease in Germany at the national and regional level—results in terms of disability-adjusted life years (DALY) from the BURDEN 2020 study
Michael PorstElena von der LippeJanko LeddinAline AntonAnnelene WenglerJan BreitkreuzKatrin SchüsselGabriela BrücknerHelmut SchröderHeike GruhlDietrich PlaßBenjamin A. BarnesMarkus BuschSebastian HallerUlfert HapkeHannelore NeuhauserLukas ReitzleChrista Scheidt‐NaveAndreas SchlotmannHenriette SteppuhnJulia ThomThomas ZieseAlexander Rommel
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.Summary measures such as disability-adjusted life years (DALY) are becoming increasingly important for the standardized assessment of the burden of disease due to death and disability. The BURDEN 2020 pilot project was designed as an independent burden-of-disease study for Germany, which was based on nationwide data, but which also yielded regional estimates.DALY is defined as the sum of years of life lost due to death (YLL) and years lived with disability (YLD). YLL is the difference between the age at death due to disease and the remaining life expectancy at this age, while YLD quantifies the number of years individuals have spent with health impairments. Data are derived mainly from causes of death statistics, population health surveys, and claims data from health insurers.In 2017, there were approximately 12 million DALY in Germany, or 14 584 DALY per 100 000 inhabitants. Conditions which caused the greatest number of DALY were coronary heart disease (2321 DALY), low back pain (1735 DALY), and lung cancer (1197 DALY). Headache and dementia accounted for a greater disease burden in women than in men, while lung cancer and alcohol use disorders accounted for a greater disease burden in men than in women. Pain disorders and alcohol use disorders were the leading causes of DALY among young adults of both sexes. The disease burden rose with age for some diseases, including cardiovascular diseases, dementia, and diabetes mellitus. For some diseases and conditions, the disease burden varied by geographical region.The results indicate a need for age- and sex-specific prevention and for differing interventions according to geographic region. Burden of disease studies yield comprehensive population health surveillance data and are a useful aid to decision-making in health policy.Keywords:
Disability-adjusted life year
This report is the first of a series of publications about the Victorian Burden of
Disease Study. The study uses the methods developed for the Global Burden of
Disease Study adapted to the Victorian context. It provides a comprehensive
assessment of the amount of ill health, the ’burden of disease’, in Victoria in 1996
and projected to the year 2016. Mortality, disability and illness arising from over
130 diseases, injuries and risk factors are measured in Disability-Adjusted Life Years
(DALYs). The mortality component of the burden of disease, the Years of Life Lost
(YLLs), is the topic of this first report.
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Disability-adjusted life year
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Abstract Background Burden of disease describes the impact of living with and dying prematurely from different diseases or injuries. The Australian Burden of Disease Study (ABDS) 2018 estimated the health impact of 219 diseases and injuries on the Australian population. Methods Burden of disease measures years of healthy life lost from living with (non-fatal) and dying prematurely from (fatal) disease and injury. Fatal and non-fatal burden combined provides the total burden, measured in disability-adjusted life years (DALY). One DALY equals 1 year of healthy life lost. Disease burden was estimated for the years 2018, 2015, 2011 and 2003 for Australia. Results In 2018, 5.0 million years of healthy life were lost from disease and injury. Living with illness or injury caused more total disease burden than dying prematurely (52% vs 48%). Between 2003 and 2018, total burden decreased by 13%, driven by less premature deaths. Disease groups with the biggest absolute reductions in burden (DALY rate) were cardiovascular diseases and cancers. The five leading causes of burden were coronary heart disease, back pain, dementia, chronic obstructive pulmonary disease and lung cancer. Males experienced more burden than females for most age groups. Conclusions Overall burden of disease declined between 2003 and 2018, due to a large reduction in burden from dying prematurely. Living with the impact of chronic diseases contributed substantial burden in Australia in 2018. Key messages Living with illness or injury accounts for most of the disease burden in Australia. There have been improvements in fatal burden since 2003.
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Disease burden indicators assess the impact of disease on a population. They integrate mortality and disability in a single indicator. This allows setting priorities for health services and focusing resources.To analyze the burden of neurological diseases in Peru from 1990-2015.A descriptive study that used the epidemiological data published by the Institute for Health Metrics and Evaluation of Global Burden of Diseases from 1990 to 2015. Disease burden was measured using disability-adjusted life years (DALY) and their corresponding 95% uncertainty intervals (UIs), which results from the addition of the years of life lost (YLL) and years lived with disability (YLD).The burden of neurological diseases in Peru were 9.06 and 10.65%, in 1990 and 2015, respectively. In 2015, the main causes were migraine, cerebrovascular disease (CVD), neonatal encephalopathy (NE), and Alzheimer's disease and other dementias (ADD). This last group and nervous system cancer (NSC) increased 157 and 183% of DALY compared to 1990, respectively. Young population (25 to 44 years old) and older (>85 years old) were the age groups with the highest DALY. The neurological diseases produced 11.06 and 10.02% of the national YLL (CVD as the leading cause) and YLD (migraine as the main cause), respectively.The burden of disease (BD) increased by 1.6% from 1990 to 2015. The main causes were migraine, CVD, and NE. ADD and NSC doubled the DALY in this period. These diseases represent a significant cause of disability attributable to the increase in the life expectancy of our population among other factors. Priority actions should be taken to prevent and treat these causes.
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.Summary measures such as disability-adjusted life years (DALY) are becoming increasingly important for the standardized assessment of the burden of disease due to death and disability. The BURDEN 2020 pilot project was designed as an independent burden-of-disease study for Germany, which was based on nationwide data, but which also yielded regional estimates.DALY is defined as the sum of years of life lost due to death (YLL) and years lived with disability (YLD). YLL is the difference between the age at death due to disease and the remaining life expectancy at this age, while YLD quantifies the number of years individuals have spent with health impairments. Data are derived mainly from causes of death statistics, population health surveys, and claims data from health insurers.In 2017, there were approximately 12 million DALY in Germany, or 14 584 DALY per 100 000 inhabitants. Conditions which caused the greatest number of DALY were coronary heart disease (2321 DALY), low back pain (1735 DALY), and lung cancer (1197 DALY). Headache and dementia accounted for a greater disease burden in women than in men, while lung cancer and alcohol use disorders accounted for a greater disease burden in men than in women. Pain disorders and alcohol use disorders were the leading causes of DALY among young adults of both sexes. The disease burden rose with age for some diseases, including cardiovascular diseases, dementia, and diabetes mellitus. For some diseases and conditions, the disease burden varied by geographical region.The results indicate a need for age- and sex-specific prevention and for differing interventions according to geographic region. Burden of disease studies yield comprehensive population health surveillance data and are a useful aid to decision-making in health policy.
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This paper uses the Disability Adjusted Life Year (DALY) to estimate disease burden at a local level and relates this to programme budget (PB) data.We estimated DALY using the global burden of disease (GBD) template. For years of life lost, local mortality data were used and for years of life with disability, the GBD estimates from World Health Organization EURO A region (including the UK) were used. We used PB data to analyse how healthcare expenditure matched disease burden.In 2005 the burden of disease in Lambeth was estimated at 36,368 DALYs (13,515 DALYs lost per 100,000) and in Southwark was 34,196 DALYs (13,244 DALYs lost per 100,000). There were gender and area differences. The ranking is different when mortality and morbidity are combined compared with mortality alone. We estimated that the average spend per DALY lost in 2005 was 11,066 pounds in Lambeth and 9390 pounds in Southwark.We used a pragmatic approach to estimate overall disease burden providing a local, more comprehensive picture with important differences in spend by disease and health authority area. However, a more detailed approach to support decisions about prioritization based on modelling interventions that impact on avoidable burden of disease is recommended.
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Abstract Background The Scottish Burden of Disease (SBoD) Study monitors the contribution of over 100 diseases and injuries to the population health in Scotland. Providing robust estimates of the burden is important as recent evidence has highlighted stalling life expectancy and worsening trends in self-assessed general health and understanding the burden of disease is the first step in identifying areas of prevention which could have the biggest impact on health. Our aim was to estimate disability-adjusted life years (DALYs) for 2018, for all causes of disease and injury. Methods The SBoD 2016 study estimated the burden for 132 causes of injury and disease using routine data and patient-level record linkage. For this update, years lived with disability were estimated using 2016 age-sex-deprivation specific rates, assuming no change in disease prevalence from 2016, but taking account of changes to the population structure. Years of life lost were calculated from 2018 observed deaths and the application of the Global Burden of Disease aspirational life table. Results In 2018 the leading causes of burden were ischaemic heart disease, Alzheimer's/other dementias, lung cancer, drug-use disorders and cerebrovascular disease, representing over a quarter (27%) of the total DALYs in Scotland. Of the 10 leading causes of disease burden, four are wholly attributable to ill-health, demonstrating the added-value of considering DALYs in conjunction with traditional measures of mortality and morbidity. Conclusions Ischaemic heart disease continues to be the leading cause of burden of disease in Scotland, however recent years show an increase in burden of social causes and diseases primarily affecting the ageing population. These changes in leading causes demonstrate the importance of continuing to monitor the burden of disease in Scotland, to provide robust evidence for planning of local and national services. Key messages The study demonstrates the added-value of considering the burden of disease, in conjunction with traditional measures of morbidity and mortality. Ischaemic heart disease continues to be the leading cause of burden of disease in Scotland.
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The Global Burden of Disease concept, first published in 1996, constitutes the most comprehensive and consistent set of estimates of mortality and morbidity yet (Murray & Lopez 1996), and WHO regularly develops burden of disease estimates at regional and global level (WHO 2008) for more than 135 causes of disease and injury. The Global Burden of Disease Study uses a summary measure of population health, the disability-adjusted life year (DALY). Despite the technical and ethical, but also political and economic debates they provoke (Nygaard 2000; Bonneux 2002), DALYs are used by the World Bank and, increasingly, by researchers to quantify the burden of disease in a given area. The DALY combines information about mortality and morbidity in a single number and thus allows for describing the losses caused by disability and the losses caused by premature death in a single unit. A DALY is a function of years of life lost and of years lived with disability. One DALY equals the loss of 1 year of healthy life (Spiegel et al. 2008). According to the latest data available on the Global Burden of Disease (WHO 2008), the estimated burden of infectious and parasitic diseases was 160 million DALYs11 Standard DALYs with 3% discounting and age weights. in Africa; the burden of non-communicable diseases was estimated at 79 million DALYs. When, in addition, low- and middle-income countries22 Defined as countries with a gross national income per capita less than 10 066 US$ in 2004. from the Americas, Africa, the Eastern Mediterranean Region, South-East Asia and the Western Pacific are considered, these figures rise to 436 million DALYs for infectious and parasitic diseases and to 1.2 billion for non-communicable diseases. In all low- and middle-income countries worldwide, 2.9 DALYs owing to non-communicable diseases correspond to 1 DALY owing to infectious and parasitic diseases. The most relevant of these are tuberculosis, HIV/AIDS, diarrhoeal diseases, childhood infections such as measles or pertussis and malaria. The compilation provided by WHO neither includes infectious respiratory diseases nor maternal and perinatal conditions. Conditions such as malignant neoplasms, diabetes mellitus, neuropsychiatric disorders, sense organ disorders such as cataracts, cardiovascular diseases, respiratory non-infectious conditions and digestive diseases (peptic ulcer and others) are classified as non-communicable diseases. In Africa, non-communicable diseases account for half as many DALYs as infectious and parasitic diseases, but in low- and middle-income countries from all WHO regions, non-communicable diseases cause nearly three times as many DALYs as infectious and parasitic diseases. These alarming figures warrant urgent attention. In low- and middle-income countries, under-reporting in some areas and over-reporting in others, mainly owing to inadequate diagnostic resources, notoriously results in imprecision and inaccurate DALY estimates. However, it is conceivable, if not likely, that non-communicable diseases are under-reported more frequently than infectious and parasitic diseases as has been shown for patients with kidney injuries, for example (Cerdáet al. 2008). Many African health systems are ill-prepared for patients suffering from chronic diseases or even for the current transition to ageing populations (Nordberg 1997). The reason may be that health systems in low- and middle-income countries focus on acute and infectious disorders because these conditions have long been the prime causes of morbidity and mortality. But patterns of disease are changing because of the epidemiologic transition, changes in lifestyle and nutrition, among other factors. Low- and middle-income countries now experience the double burden of endemic infectious and parasitic diseases and steadily growing incidences of non-communicable diseases (Amuna & Zotor 2008). Interestingly, structural interventions to diagnose and prevent non-communicable diseases may be cost-effective and successfully integrated into primary healthcare systems (Beaglehole et al. 2007; Gaziano et al. 2007). WHO forecasts that by 2020 non-communicable diseases will account for roughly 75% of fatalities in the developing world (Kelishadi 2007). Nevertheless, Tropical Medicine research obstinately concentrates on infectious and parasitic diseases. In view of Global Burden of Disease data, this emphasis does not appear to be entirely justified. The preamble of the constitution of the International Federation for Tropical Medicine states that ‘… within the past decade developing countries and international organizations have redefined the health problems and priorities much more broadly to address additional major causes of death, disability and diseases in vulnerable groups.’ The broad and multidisciplinary nature of Tropical Medicine calls for substantial action beyond clinical, experimental and theoretical infectology. Infectious and parasitic diseases, in particular HIV/AIDS, tuberculosis and malaria, are indubitably significant determinants of morbidity and mortality in many low- and middle-income countries, and certainly research must not abate or neglect them. But Tropical Medicine research should recognize the data and integrate studies of non-communicable diseases effectively. Funding bodies, non-governmental institutions and researchers from low-, middle- and high-income countries should reconsider research priorities. More effort and funding are needed to scale up fundamental and applied non-communicable disease research in low- and middle-income countries. These endeavours will have to precede due changes in health policies and should eventually result in necessary adaptations of health systems to the pandemic of non-communicable diseases. Thus, researchers in Tropical Medicine and policy makers could bring more people closer to health, expansively defined by the WHO as: ‘… a state of complete physical, mental and social well-being and not merely the absence of disease or infirmity.’
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Indicators which help us evaluate the burden of a disease and its related health interventions include financial cost, mortality, and morbidity.1 Quality-adjusted life year (QALY) and disability-adjusted life year (DALY) are two indicators that quantify the total number of years lost because of illness.2 One DALY is equal to one year of healthy life lost, and disease burden is a measure of the gap between current health status and the ideal health status.3 These indicators help us compare disease burdens, and have also been used to forecast the possible impacts of health interventions.3 However, as a limitation, DALY is a generalization of a multifaceted reality, and consequently, provides a rough indication of health impact.4 The consideration of only DALY is not enough for policy makers to base health care plans upon. Policy makers pay the greatest attention to the highest DALYs; however, the presence of lower DALYs, as the major contributing factors of disease burden, should not be ignored. For instance, maternal death maintains a high disease burden, and prevention of coughs in infants does not receive enough financial support.4
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