The burden of disease

Burden of disease studies provide the means to measure the impact of morbidity and mortality on populations. Many studies have been performed within the EU Member States, examining a limited number of countries, diseases and risk factors ( Donovan et al 2018 ) and often using different methodologies across countries (Charalampous et al 2022). The most comprehensive study of this kind, the Global Burden of Disease (GBD), has been undertaken by the World Health Organisation (WHO) and the Institute for Health, Metrics and Evaluation (IHME) ( GBD study 2019a ). To facilitate the harmonization and comparability of burden of disease studies across Europe, the European Burden of Disease Network (EBoDN) ( WHO EBoDN ), has been established in collaboration with the WHO and IHME. The GBD study currently encompasses 369 diseases and injuries for 204 countries with an assessment of 87 risk factors and combinations of risk factors ( GBD study 2019b ). A standard metric used in this, and other studies is the disability adjusted life year (DALY), a measure of the years of healthy life lost. DALYs are estimated from the sum of years lost due to premature death (YLLs) and years lived with disability (YLDs).

Risk factors

The GBD 2019 study estimates that over 91% of deaths and more than 87% of DALYs in the EU in 2019 are the result of non-communicable diseases (NCDs), of which approximately 62% and 46% respectively can be attributed to the risk factors assessed in the study (GBD Results). The largest burden, in terms of both deaths and DALYs, is from cardiovascular diseases and neoplasms (Table 1). While not responsible for significant portions of deaths, mental disorders and musculoskeletal disorders represent a large burden in terms of DALYs (GBD Results). In the EU, tobacco and alcohol use, unhealthy diets, physical inactivity, hypertension, obesity and environmental factors have been identified as responsible for two thirds of the premature deaths caused by four major NCDs (cardiovascular disease -CVD-, diabetes, cancers and chronic respiratory diseases) (WHO/EURO 2016). Table 2 details the estimates obtained by GBD 2019 for deaths and DALYs from all NCDs that are attributable to these risk factors. The individual member state estimates for DALYs (expressed per 100 000 population) for these risk factors are further detailed in Table 3.

Table 1: Estimated percentage of deaths and DALYs / EU 2019 from NCDs

Table 2: Estimated deaths and DALYs per 100 000 population from NCDs / EU 2019 - risk factors

Table 3: Estimated DALYs/100 000 - dietary risks, low physical activity, tobacco and alcohol EU 2019

View visualisation: DALYs chart 

View visualisation: Mortality chart 

Diets

The GBD study estimates that, in the European Union in 2019, over 800 000 deaths and over 14 million DALYs are attributable to dietary risks due to unhealthy diets (GBD Results). This disease burden corresponds exclusively to NCDs. Most deaths attributable to dietary risks are due to the following NCDs: cardiovascular diseases (672 923), neoplasms (96 132) and diabetes and kidney diseases (45 512). Similarly, DALYs attributable to dietary risks are mainly due to cardiovascular diseases (10 430 894), diabetes and kidney diseases (2 078 943) and neoplasms (1 823 700). The individual member state estimates of these DALYs (expressed per 100 000 population) are detailed in Table 3. 

The EU disease burden due to the dietary risk factors considered in the GBD study, and their definitions, are detailed in Table 4. The relative contributions of the individual dietary risk factors to specific disease burdens are shown in Table 5.

Table 4: Estimated DALYs/100 000 - GBD diet-related risk factors EU 2019

Table 5: Estimated percentage of DALYs by disease - diet-related risk factors EU 2019

Physical inactivity

The GBD study estimates that, in the European Union in 2019, almost 125 000 deaths and almost 2 million DALYs are attributable to low physical activity (GBD Results), which is defined as less than 8 000 metabolic equivalent (MET) minutes per week, with one MET being the energy spent while sitting quietly ( IHME definitions ). The individual member state estimates of these DALYs (expressed per 100 000 population) are detailed in Table 3.

The GBD study estimates that all deaths attributable to low physical activity result from NCDs, distributed as follows: cardiovascular diseases (92 473), neoplasms (18 520) and diabetes and kidney diseases (13 981). Similarly, all DALYs attributable to low physical activity are estimated to result from NCDs as follows: cardiovascular diseases (1 078 076), neoplasms (286 291), and diabetes and kidney diseases (533 421) (GBD Results).

Tobacco use

The GBD study estimates that, in the European Union, in 2019, over 850 000 deaths are attributable to smoking and over 73 000 to second-hand smoke (passive smoking) (GBD Results). Furthermore, the study estimates over 21 million and over 1.7 million DALYs are attributable to smoking and second-hand smoke respectively. The individual member state estimates of these DALYs (expressed per 100 000 population) are detailed in Table 3.

Of the deaths attributable to smoking, approximately 826 378 result from NCDs, mainly neoplasms (416 262), cardiovascular diseases (232 576) and chronic respiratory diseases (127 135). Almost 20.5 million DALYs attributable to smoking result from NCDs, as before, mainly neoplasms (8 794 199), cardiovascular diseases (5 254 890), chronic respiratory diseases (3 023 515) and musculoskeletal disorders (1 867 836) (GBD Results).

Of the deaths attributable to second-hand smoking, approximately 64 500 result from NCDs, with almost 33 000 from cardiovascular diseases. Similarly, approximately 1.6 million DALYS attributable to second-hand smoking result from NCDs, with almost 650 000 from cardiovascular diseases (GBD Results).

Alcohol use

The GBD study estimates that, in the European Union, in 2019, almost 320 000 deaths and almost 10 million DALYs are attributable to alcohol use (GBD Results). The individual member state estimates of these DALYs (expressed per 100 000 population) are detailed in Table 3.

Of the deaths attributable to alcohol use, over 260 000 result from NCDs and a further 32 000 from injuries. The main NCDs linked to alcohol use are neoplasms (97 451 deaths), digestive diseases (84 781 deaths) and cardiovascular diseases (60 253). Most deaths from injuries attributable to alcohol use are the result of self-harm and interpersonal violence (18 172).

Of the DALYs attributable to alcohol use, more than 7.8 million result from NCDs and 1.6 million from injuries. The main NCDs contributing to DALYs from alcohol use are digestive diseases (2 212 417), neoplasms (2 190 296), substance use disorders (1 995 236) and cardiovascular diseases (1 262 819). DALYs due to injuries are mostly from self-harm and interpersonal violence (718 390) and unintentional injuries (609 164).

References

Overview of the references to this brief