Abstract
BackgroundThe East/West gradient in health across Europe has been described often, but not using metrics as comprehensive and comparable as those of the Global Burden of Disease 2000 and Comparative Risk Assessment studies.MethodsComparisons are made across 3 epidemiological subregions of the WHO region for Europe – A (very low child and adult mortality), B (low child and low adult mortality) and C (low child and high adult mortality) – with populations in 2000 of 412, 218 and 243 millions respectively, and using the following measures: 1. Probabilities of death by sex and causal group across 7 age intervals; 2. Loss of healthy life (DALYs) to diseases and injuries per thousand population; 3. Loss of healthy life (DALYs) attributable to selected risk factors across 3 age ranges.ResultsAbsolute differences in mortality are most marked in males and in younger adults, and for deaths from vascular diseases and from injuries. Dominant contributions to east-west differences come from the nutritional/physiological group of risk factors (blood pressure, cholesterol concentration, body mass index, low fruit and vegetable consumption and inactivity) contributing to vascular disease and from the legal drugs – tobacco and alcohol.ConclusionThe main requirements for reducing excess health losses in the east of Europe are: 1) favorable shifts in all amenable vascular risk factors (irrespective of their current levels) by population-wide and personal measures; 2) intensified tobacco control; 3) reduced alcohol consumption and injury control strategies (for example, for road traffic injuries). Cost effective strategies are broadly known but local institutional support for them needs strengthening.
Highlights
The East/West gradient in health across Europe has been described often, but not using metrics as comprehensive and comparable as those of the Global Burden of Disease 2000 and Comparative Risk Assessment studies
The Global Burden of Disease project for the year 2000 (GBD2000) [5] and the associated Comparative Risk Assessment (CRA) Project [6], use common metrics and comparable methodology to address the burden of disease and injuries and their risk factors
We have identified three risk factor/disease clusters as leading modifiable causes of excess health losses in Europe B and C: first, in order of importance, is the 'nutritional/physiological' group of risk factors contributing primarily to very large absolute differences in vascular disease burdens; second, and largely because of its important multiplier effect on vascular risks, is tobacco; and third is the role of alcohol and other contributors to injuries as major sources of differences in health experiences of adult males
Summary
The East/West gradient in health across Europe has been described often, but not using metrics as comprehensive and comparable as those of the Global Burden of Disease 2000 and Comparative Risk Assessment studies. An important aspect of such comparative analyses is the use of a consistent and comparable metric of lost healthy life and the attribution of such losses either to diseases or injuries or to the risk factors for those diseases and injuries. The Global Burden of Disease project for the year 2000 (GBD2000) [5] and the associated Comparative Risk Assessment (CRA) Project [6], use common metrics and comparable methodology to address the burden of disease and injuries and their risk factors. The results are presented for 3 epidemiologically-defined subregions of the WHO region for Europe
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