Abstract
BackgroundFor accurate estimation of the future burden of communicable diseases, the dynamics of the population at risk – namely population growth and population ageing – need to be taken into account. Accurate burden estimates are necessary for informing policy-makers regarding the planning of vaccination and other control, intervention, and prevention measures. Our aim was to qualitatively explore the impact of population ageing on the estimated future burden of seasonal influenza and hepatitis B virus (HBV) infection in the Netherlands, in the period 2000–2030.MethodsPopulation-level disease burden was quantified using the disability-adjusted life years (DALY) measure applied to all health outcomes following acute infection. We used national notification data, pre-defined disease progression models, and a simple model of demographic dynamics to investigate the impact of population ageing on the burden of seasonal influenza and HBV. Scenario analyses were conducted to explore the potential impact of intervention-associated changes in incidence rates.ResultsIncluding population dynamics resulted in increasing burden over the study period for influenza, whereas a relatively stable future burden was predicted for HBV. For influenza, the increase in DALYs was localised within YLL for the oldest age-groups (55 and older), and for HBV the effect of longer life expectancy in the future was offset by a reduction in incidence in the age-groups most at risk of infection. For both infections, the predicted disease burden was greater than if a static demography was assumed: 1.0 (in 2000) to 2.3-fold (in 2030) higher DALYs for influenza; 1.3 (in 2000) to 1.5-fold (in 2030) higher for HBV.ConclusionsThere are clear, but diverging effects of an ageing population on the estimated disease burden of influenza and HBV in the Netherlands. Replacing static assumptions with a dynamic demographic approach appears essential for deriving realistic burden estimates for informing health policy.
Highlights
For accurate estimation of the future burden of communicable diseases, the dynamics of the population at risk – namely population growth and population ageing – need to be taken into account
The disability-adjusted life years (DALY) measure is the simple sum of two components: years of life lost (YLL) due to premature death and years of life lost due to disability (YLD)
Considering infection in the year 2000 only, in males the greatest disease burden of 136 DALYs occurred in the age group with the highest incidence (Figure 3), but a relatively high burden is apparent for the 20–24 years age group, mainly due to high YLL (116 DALYs for males, 86 DALYs for females)
Summary
For accurate estimation of the future burden of communicable diseases, the dynamics of the population at risk – namely population growth and population ageing – need to be taken into account. According to forecasts by Statistics Netherlands (CBS), in 2050 there will be 4.5 million people in the Netherlands aged 65 years and over [2] – representing 25% of the projected total population – a substantial increase over the 15% of the total population represented by this age category in 2008. Demographic changes such as population ageing have an impact on estimates of the disease burden (i.e., mortality and morbidity) over time. When projecting population-based disease burden into the future, the dynamics of demographic processes such as birth, mortality, and migration that influence the agedistribution of the population need to be taken into account
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