Burden Of Disease Study Research Articles

The Temporal Trend of Disease Burden Attributable to Metabolic Factors in China, 1990-2019, an Analysis of the Global Burden of Disease Study

The Temporal Trend of Disease Burden Attributable to Metabolic Factors in China, 1990-2019, an Analysis of the Global Burden of Disease Study

Burden of Mental and Substance Use Disorders Among Adolescents and Young Adults in Kenya: Results from the Global Burden of Disease Study 2019

Burden of Mental and Substance Use Disorders Among Adolescents and Young Adults in Kenya: Results from the Global Burden of Disease Study 2019

Colorado Burden of Disease, Injuries and Risk Factors, 1990-2019: A Sub-Analysis of the Global Burden of Disease Study.

(1) Background: Health disparities across the United States (U.S.) are increasing. Large variations in risk factors and health outcomes have been described among states from the U.S. (2) AIM. This study aims to describe health trends in morbidity, mortality, and risk factors from 1990 to 2019 in the State of Colorado. (3) Methods: We describe the measures of health loss for 286 causes of death, 369 diseases and injuries, and 87 risk factors for the state of Colorado from the Global Burden of Disease project estimates between 1990 to 2019. (4) Results: We found that 21,171 and 40,724 deaths were estimated in 1990 and 2019, respectively, in Colorado. The leading cause of death, in both sexes, in 1990 and 2019 was ischemic heart disease (IHD). The top leading disability-adjusted life years (DALY) diagnoses were IHD, followed by low back pain, chronic obstructive pulmonary disease, and opioid use disorder. In 2019, the top risk factors by DALYs in Colorado were smoking, drug use, high body mass index (BMI), alcohol use, high fasting plasma glucose, and high systolic blood pressure. (5) Conclusion: Non-communicable diseases and their related risk factors are the top leading causes of DALYs in Colorado. Findings support the need for policies to prevent non-communicable diseases, with special attention to musculoskeletal disorders and interventions to reduce tobacco, alcohol, and drug use.

Impact of Structural Ageism on Greater Violence Against Older Persons: A Cross-National Study of 56 Countries

Violence directed against older persons is recognized as a global health problem. However, structural drivers for violence remain under-studied. This country-level ecological study aimed to examine a previously unexplored link between structural ageism and violence against older persons. Following extensive structural stigma literature, structural ageism consisted of two components: (1) discriminatory national policies related to older persons’ economic, social, civil, and political rights, gathered from global databases including UN, WHO, and others; and (2) societal-level prejudicial social norms against older persons, measured by negative attitudes toward older persons by the World Values Survey. Two components were z scored and combined such that higher score indicated greater structural ageism. Prevalence rates of violence per 100,000 persons aged 70 and over in each country were drawn from the Global Burden of Diseases Study. Final analysis included 56 countries, representing 63% of the world’s aging population aged 60 and over across all six WHO regions. As predicted, structural ageism was significantly associated with the prevalence rates of violence in multivariate models (β =205.7, SE=96.3, P=.03), after adjusting for country-level sociodemographic and health covariates. Three sets of sensitivity analyses supported the robustness of our findings. That is, structural ageism did not predict other types of violence and other types of prejudice did not predict violence against older persons. Public health and population-based violence prevention policies may benefit from a targeted approach that tackles the harmful effects of structural ageism.

Magnitude, Temporal Trends, and Inequalities in the DALYs and YLDs of Nutritional Deficiency among Older Adults in the Western Pacific Region: Findings from the Global Burden of Disease Study 1990-2019.

The population in the Western Pacific region is aging rapidly. Nutritional deficiency is prevalent in older adults; however, information regarding nutritional deficiency in this population is scarce. Using the 2019 Global Burden of Disease (GBD) results, the age-standardized disability-adjusted life years (DALYs) and years of healthy life lost due to disability (YLDs) from nutritional deficiency were estimated between 1990 and 2019 for this population. Average annual percentage change (AAPC) was used to assess temporal trends, and linear mixed-effects models were used to examine socioeconomic and sex inequalities. From 1990 to 2019, the age-standardized DALYs of nutritional deficiency in this population decreased from 697.95 to 290.95 per 100,000, and their age-standardized YLDs decreased from 459.03 to 195.65 per 100,000, with the greatest declines seen in South Korea (AAPCs < −5.0). Tonga had the least decline in DALYs (AAPC = −0.8), whereas Fiji experienced an increase in YLDs (AAPC = 0.1). Being female and having a lower sociodemographic index score was significantly associated with higher age-standardized DALYs and YLDs. The magnitude and temporal trends of the nutritional deficiency burden among older adults varied across countries and sex in the region, indicating that health policies on nutritional deficiency among older adults must be crafted to local conditions.

Ultra-processed food consumption in adults across Europe

PurposeThe purpose of this study is to describe ultra-processed food and drinks (UPFDs) consumption, and associations with intake of total sugar and dietary fibre, and high BMI in adults across Europe.MethodsUsing food consumption data collected by food records or 24-h dietary recalls available from the European Food Safety Authority (EFSA) Comprehensive European Food Consumption Database, the foods consumed were classified by the level of processing using the NOVA classification. Diet quality was assessed by data linkage to the Dutch food composition tables (NEVO) and years lived with disability for high BMI from the Global Burden of Disease Study 2019. Bivariate groupings were carried out to explore associations of UPFDs consumption with population intake of sugar and dietary fibre, and BMI burden, visualised by scatterplots.ResultsThe energy share from UPFDs varied markedly across the 22 European countries included, ranging from 14 to 44%, being the lowest in Italy and Romania, while the highest in the UK and Sweden. An overall modest decrease (2–15%) in UPFDs consumption is observed over time, except for Finland, Spain and the UK reporting increases (3–9%). Fine bakery wares and soft drinks were most frequently ranked as the main contributor. Countries with a higher sugar intake reported also a higher energy share from UPFDs, as most clearly observed for UPF (r = 0.57, p value = 0.032 for men; and r = 0.53, p value = 0.061 for women). No associations with fibre intake or high BMI were observed.ConclusionPopulation-level UPFDs consumption substantially varied across Europe, although main contributors are similar. UPFDs consumption was not observed to be associated with country-level burden of high BMI, despite being related to a higher total sugar intake.

Smart Inhaler

As per the World Health Organization released during May 2018, 9 out of 10 individuals are believed to breathe air containing high levels of pollutants. Studies reveal, above 90% of air pollution-related deaths worldwide occur in low- and middle-income countries, especially in Asian and African countries, followed by low- and middle-income countries of the Eastern Mediterranean, European and the American regions. As per the University of Washington’s Global Burden of Disease study, 2018, COPD was the second-highest cause of death in India, leading to the death of almost 958,000. Inhalers are essential for observing the strict regimen required for these conditions, as they avoid the need for and the adverse effects associated with the use of injectables and oral drugs.Inhalers are used to treat chronic obstructive pulmonary disease (COPD), such as asthma, by delivering bronchodilator medication to the airway directly, without passing through the blood. ‘Smart’ inhalers are inhalers with extra digital features – they link to an app on the phone or tablet to help the patient and the doctor to manage asthma better.

Association between Gastric Cancer Mortality-to-Incidence Ratio and Human Development Index: Evidence from the Global Burden of Disease Study 2016

Gastric cancer has been one of the major causes of death in the past decades. It is the fifth most prevalent cancer and the third leading cause of neoplasm death worldwide. Thus, to know more about this health problem, assessing the burden of this cancer and its association with socioeconomic status of countries is of great importance. In this study, we aimed to evaluate the mean trend of gastric cancer mortality-to-incidence ratio (GCMIR) in different super regions defined by the Institute for Health Metrics and Evaluation (IHME) and investigate the relationship between GCMIR and Human Development Index (HDI) in the period 2000-2016. We used the data from the Global Burden of Disease (GBD) 2016 study to calculate GCMIR for 185 world countries in the period 2000-2016. We also extracted the HDI data for each year under study from the Updates of the UNDP website. To attain the analytic aims, marginal modeling and generalized estimating equations (GEE) were utilized. Sub-Saharan Africa was the only super region with a positive slope of GCMIR, and high-income countries had the greatest decreasing slope of GCMIR during the study period. Moreover, there was a negative association between GCMIR and HDI in these years. Our findings revealed that gastric cancer could be thought not only as a biological disease but also as a social event that will be more controllable with the improvement of economic status and other social determinants of health.

Abstract 11650: Global, Regional and National Time Trends in Mortality for Congenital Heart Disease, 1990-2019 an Age-Period-Cohort Analysis for the Global Burden of Disease Study 2019

Introduction: Congenital heart disease (CHD) is the leading birth defect worldwide. We report trends in CHD mortality in 204 countries and territories over the past 30 years, and associations with age, period, and birth cohort. Methods: Cause-specific CHD mortality estimates were derived from the Global Burden of Disease study 2019. We utilized an age-period-cohort model to estimate overall annual percentage change in mortality (net drifts), annual percentage change from 0-4 to 65-69 years (local drifts) and period (cohort) relative risks between 1990 and 2019. Results: Global CHD deaths in 2019 were 217,000 (95%UI: 177,000, 262,000). India, China, Pakistan and Nigeria were the top 4 countries accounting for 39.7% of deaths globally. The reduction in age-standardized mortality ranged from 66.3% in high-sociodemographic index (SDI) countries to 30.5% in low-SDI countries. Globally, there was an emerging transition in the age distribution of deaths from pediatric to adult population, except for an increasing trend of mortality in 10~34 years in Mexico and Pakistan. During 1990-2019, favorable mortality reductions were found in most high-SDI countries like South Korea (net drift = -4.0% per year) and United States (-2.3%), and also in many middle-SDI countries like Brazil (-2.7%) and a few low-SDI countries like Ethiopia (-2.3%). However, 52 out of 129 countries with at least 50 deaths had either increasing trends (net drifts≥0.0%) or stagnated reductions (≥-0.5%) in mortality. The relative risk of mortality generally showed improving trends over time and in successively younger birth cohorts among high- and high-middle SDI countries except Saudi Arabia and Kazakhstan. Fourteen middle-SDI countries such as Ecuador and Mexico, and sixteen low-middle-SDI countries like India and twenty low-SDI countries like Pakistan, had unfavorable or worsening risks for recent periods and birth cohorts. Conclusions: Improvements in the treatment of CHD should reduce the risk for successively younger cohorts and shift the risk for all age groups over time. Although there were gains in CHD mortality globally, unfavorable period and cohort effects were found in many countries, raising questions about adequacy of their health care for CHD patients across all age-groups.

Global, regional, and national burden of Guillain\u2013Barr\xe9 syndrome and its underlying causes from 1990 to 2019

BackgroundThis article presents the first detailed analysis of the prevalence and disability burden of Guillain–Barré syndrome (GBS) from 1990 to 2019 by cause, age, sex, and Socio-demographic Index (SDI) in 204 countries and territories.MethodsData from the Global Burden of Diseases Study (GBD) 2019 were used. GBD 2019 modelled the prevalence of GBS using hospital and claims data. Years lived with disability (YLDs) were estimated as the product of the GBS prevalence and the disability weight. This article also reported proportions in the age-standardised prevalence rate that were due to six underlying causes of GBS.ResultsIn 2019, there were 150,095 [95% uncertainty intervals (UI) 119,924 to 188,309] total cases of GBS worldwide, which resulted in 44,407 (95% UI 28,016 to 64,777) YLDs. Globally, there was a 6.4% (95% UI 3.6 to 9.5) increase in the age-standardised prevalence of GBS per 100,000 population between 1990 and 2019. High-income Asia Pacific [1.9 (95% UI: 1.5 to 2.4)] and East Asia [0.8 (95% UI: 0.6 to 1.0)] had the highest and lowest age-standardised prevalence rates (per 100,000), respectively, in 2019. Nationally, Japan [6.4 (95% UI: 5.3 to 7.7)] and China [0.8 (95% UI: 0.6 to 1.0)] had the highest and lowest age-standardised prevalence rates (per 100,000). The age-standardised burden of GBS increased with increasing age and was higher in males in all age groups. Furthermore, the age-standardised prevalence of GBS (per 100,000) had a positive association with the level of development, as measured by SDI, although this association was not strong. Upper respiratory infections and unknown causes accounted for the highest proportions of underlying causes.ConclusionsGlobally, the prevalence of GBS continues to increase. Geographical differences and strategies aimed at preventing infectious diseases should be considered in future health policy planning and decision-making processes. This study had several limitations, such as using the same disability weight for all causes and a reliance on hospital- and self-reported data, which should be addressed in future research.

EXPRESS: Prevalence, Incidence, and Survival of Pulmonary Arterial Hypertension: A Systematic Review for the Global Burden of Disease 2020 Study

Background: Pulmonary arterial hypertension (PAH) is characterized by increased resistance in the pulmonary arterioles as a result of remodeled blood vessels. We sought to establish the baseline level of PAH by assembling all available epidemiologic data on population-based prevalence, incidence, and one-year survival of PAH as part of the Global Burden of Disease Study. Methods: We performed a systematic review searching Global Index Medicus (GIM) for key words related to PAH between 1980 and 2021, and identified population-representative sources of prevalence, incidence, and mortality for clinically diagnosed PAH. Results: Of 6,772 identified we found 65 with population-level data: 17 for prevalence, 17 for incidence, and 58 reporting case fatality. Reported prevalence ranged from 0.37 cases/100,000 persons in a referral center of French children to 150 cases/100,000 persons in an Australian echocardiography study. Reported incidence ranged from 0.008 cases/100,000 person-years in a study of hospital discharge records in Finland, to 1.4 cases/100,000 person-years in a retrospective chart review at a clinic in Utah, USA. Reported one-year survival ranged from 67% to 99%. All studies with sex-specific estimates reported higher levels in females than males. Studies varied in their size, study design, diagnostic criteria, and sampling procedures. Conclusions: Reported PAH prevalence, incidence, and mortality varied by location and study. Prevalence ranged from 0.4 to 1.4 per 100,000 persons. Harmonization of methods for PAH registries would improve efforts at disease surveillance. Results of this search contribute to ongoing efforts to quantify the global burden of PAH.

Covid-19 Infection in Hematological Malignancies: Registry Data from India

Background: The impact of COVID-19 pandemic has been highly heterogeneous across the globe and different regions within the country. The differences in the outcome of these patients is related to their demographic profile, genetics, socio-economic conditions, and government health policies. Prior to the COVID-19 pandemic, the Healthcare Access and Quality (HAQ) Index for hematological malignancies (HAQ index <30) in a low-middle socio-demographic index(SDI) country like India was less than the mean HAQ index for all other diseases (HAQ index 41) with a significant regional disparity.(1)Several national and international registries from high socio-demographic Index (SDI) countries have reported worse short-term outcomes of coronavirus disease (COVID-19) in patients with hematologic as compared to other solid cancers. The outcomes of COVID-19 in patients with hematologic malignancies from a low-middle SDI country are yet unknown. The COVID-19 Hematologic Cancer registry of India reports these outcomes from India.Methods: Ten tertiary referral hospitals across India reported the demographic, clinical, laboratory, treatment, and outcomes of COVID-19 infection in patients with hematological malignancies. The registry was retrospective from March 21, 2020, and prospective from November 1, 2020, till March 20, 2021. Risk factors associated with severity and mortality were evaluated using the penalised logistic regression and Cox proportional hazards model.Findings: Data from 565 patients was included in this study. Among these, 429 (76%) patients were hospitalized, 186 (33%) patients had moderate/severe COVID-19.There were 116 (20.5%) non-survivors at a mean follow up of 147 (95% CI : 142-153) days. Age >60 years (HR 2·55, 1·23 - 5·27), diagnosis of acute myeloid leukemia (HR 2·85, 1·58 - 5·13), interruption or alteration of anticancer therapy (HR 2·78, 1·65 - 4·68), and post hematopoietic cell transplant status (HR 3·68, 1·82 - 7·45) predicted mortality. In contrast, increasing age [20-40 years (OR 2·54, 1·32 - 4·90), 41-60 years (OR 3·51, 1·84 - 6·71), >60 years (OR 6·04, 3·01 - 12·10), comorbidities such as diabetes mellitus (OR 1·89, 1·18 - 3·04), hypertension (OR 1·94, 1·17 - 3·19), diagnosis of AML (OR 3·70, 2·06 - 6·67), indolent non-hodgkin lymphoma (OR 3·20, 1·68 - 6·09), multiple myeloma (OR 2·88, 1·64 - 5·05), malignancy not being in remission (OR 1·71, 1·12 - 2·60)were significantly associated with severe COVID-19 on univariate analysis. Of these, only increasing age [20-40 years (OR 2·60 (1·31 - 5·15), 40-60 years (OR 3·44, 1.60 - 7·41), more than 60 years (OR 5·70, 2·43 - 13·35)] , AML (OR 2·73, 1·45 - 5·12), and malignancy not being in remission (OR 1·85, 1·18 - 2·89) were significantly associated with severe COVID-19 on multivariable analysisConclusion: The overall mortality from COVID-19 infection of the entire cohort was 20.5%; the mortality was 46.2% in patients who had moderate to severe disease COVID-19 illness. Similar to previous studies, age, diagnosis of acute myeloid leukemia and a post stem cell transplant status was associated with mortality. In addition, interruption or de-escalation of anticancer therapy during Covid-19 infection was identified as an important factor associated with higher mortality on follow up in the current study.

Global disease burden of uncorrected refractive error among adolescents from 1990 to 2019

BackgroundTo estimate the global disease burden of uncorrected refractive error (URE) among adolescents and assess the contributions of various risk factors to disability-adjusted life-years (DALYs) due to URE.MethodsGlobal, regional and country-level DALY numbers and rates due to URE among adolescents were acquired from the Global Burden of Disease Study 2019 database. Human Development Index (HDI), Socio-Demographic Index (SDI) and other country-level data were obtained from other open databases as potential indicators. Regression analysis was used to evaluate associations between DALY rates among adolescents and potential predictors.ResultsGlobal DALYs due to URE among adolescents rose by 8% between 1990 and 2019 but moderately decreased by 4.8% during this period after adjusting for population size. Female adolescents showed higher DALY rates. DALY rates sharply increased from 5 to 9 years of age, then rose more slowly, reaching a plateau before 20 years of age. Country-level DALY rates in 2019 were positively associated with HDI, SDI, and urbanization rates but negatively correlated with primary school dropout rates. Higher disease burden of adolescents visually impaired from URE was associated with lower primary school dropout rates (β = − 0.257, 95% CI − 0.376 to − 0.138, P < 0.001) and higher urbanization rates (β = 0.257, 95% CI 0.067 to 0.256, P = 0.001).ConclusionsHigher socioeconomic status, urbanization rates and education levels are associated with a heavier disease burden of URE among adolescents. The findings of this study can provide a reference for policy making on resource allocation for URE prevention and control in teenagers.

Cardiovascular disease and its management among Pacific people: a systematic review by ethnicity and place of birth

BackgroundPacific people experience a disproportionate burden of cardiovascular disease (CVD), whether they remain in their country of origin or migrate to higher-income countries, such as Australia, Aotearoa New Zealand or the United States of America. We sought to determine whether the CVD health needs of Pacific people vary according to their ethnicity or place of birth.MethodsWe conducted a systematic review of medical research databases and grey literature to identify relevant data published up to 2020. Texts were included if they contained original data stratified by Pacific-specific ethnicity or place of birth on the burden or management of CVD, and were assessed as having good quality using a National Heart, Lung, and Blood Institute quality assessment tool. The protocol for this review was registered with the Open Science Forum (https://doi.org/10.17605/OSF.IO/X7NR6).ResultsOf 3679 texts identified, 310 full texts were reviewed and the quality of 23 of these assessed, using the pre-defined search strategy. Six items (four reports, one article, one webpage) of good quality met the review eligibility criteria. All included texts provided data on epidemiology but only one reported on the management of CVD. Four texts were of Pacific populations in Pacific Island countries and two were of Pacific diaspora in other countries. Data from the Global Burden of Disease study, which provided estimates for the greatest number of Pacific countries, showed substantial differences in mortality rates between Pacific countries for every CVD type. For example, the mortality rate per 100,000 for ischemic heart disease (IHD) ranged from 103.41 in the Cook Islands to 430.35 in the Solomon Islands. A New Zealand-based report showed differences in CVD rates by Pacific ethnicity (e.g. the age-standardised prevalence of IHD per 1,000 population in Auckland ranged from 107.8 (Niuean) to 138 among Cook Islands Māori (p < 0.001)).ConclusionsThis review of published studies reveals that the epidemiology of CVD among Pacific people varies by specific ethnic groups, place of birth, and country of residence. There is a critical need for high-quality contemporary ethnic-specific Pacific data to respond to the diverse CVD health needs in these underrepresented groups.

The concept of Knowledge Translation in relation to Burden of Disease

Abstract The importance to bridge the gap between research and policy making has been widely recognised. Also, in the field of Burden of Disease, this gap exists. There are various terms used to define the dynamic process of synthesising, exchanging and applying generated knowledge into policy making. These are among other interchangeably used terms: knowledge translation, research utilization, implementation science, knowledge transfer or knowledge exchange, here referred to as knowledge translation (KT). The driver behind the systematic effort of KT is to bridge the gap between the generation of that knowledge and its application such as to improve public health. Among communication strategies to achieve KT include the engagement with policy and decision-makers for effective use of the findings into potential benefits for the health and wellbeing of the population. Other strategies, include the development of patient-public-involvement partnerships to communicate the findings with the public and create an open dialogue for further use of research results into practice. The focus of KT by researchers to date has mainly been on the ‘translation' of biomedical research, including findings from clinical trials, evidence from clinical practice guidelines, mixed-methods data on the development of implementation tools and other. However, similar findings on the translation of such evidence from burden of disease studies (BoD) have been non-existent. Potential reasons for this may have been challenges such as creating effective engagement strategies with appropriate stakeholders for the use of BoD findings, establishing a common methodological framework, difficulties in interpreting the findings for health-policy purposes, or miscommunication practices on the value and impact of BoD. Further, BoD methodological tools require specialist knowledge and interpretation of results into practice, hence, making KT even more challenging. Therefore, the prospect of developing a KT framework specifically for BoD remains an opportunity but also a pressing challenge.

5.H. Skills building seminar: Methodological choices in burden of disease studies: a literature review of European studies

Abstract Since the first Global Burden of Disease (GBD), the burden of disease (BoD) concept has been widely used to understand patterns of health and the causes of loss of health in populations. In particular, the use of Disability-Adjusted Life Years (DALYs) has become popular as a single numerical index representative of both morbidity and mortality. Over the years, the original GBD methodology has undergone numerous updates, and various weighting and discounting schemes have been used in the reporting of the result. In addition to the GBD estimates (produced by the World Health Organization and the Institute for Health Metrics and Evaluation), many other independent studies have been conducted with considerable variation in the use of discounting, age weighting, disability weights, reference life tables, incidence or prevalence measures, and in the use of methods handling missing or poorly coded mortality data. The European BoD network (COST Action CA18218) strives to integrate and strengthen the capacity and knowledge in BoD assessment across Europe and beyond. Within this context, a series of systematic literature reviews (SLR) was performed to explore key methodological choices and differences of European BoD studies. The reviews aimed to i) identify existing BoD studies; ii) provide an overview of the specific methodological choices for calculating disease burden; and iii) synthesize the current scope and quality of BoD assessments across Europe. The ultimate aim of the literature summary is to develop a checklist for BoD studies that used DALYs. Since the review has been a continuing collaboration with a large group of members who are part of the European BoD network (burden-eu), this workshop represents an opportunity to enlarge that collaboration. Within the workshop, we will first present our aims and objectives and SLR procedures. After having presented some preliminary results, we will offer some starting points for a discussion on the implications of our findings. In particular, the presentations will be structured as follows: Methods and preliminary results of the SLR focusing on non-communicable diseases, communicable diseases, and injuries; Methods and preliminary results of the SLR focusing risk factors; Discussion on the implications for researchers. The workshop is meant to be an occasion to share experiences on computational variations within BoD studies and to collect input for the quality and scope evaluation of the studies. Key messages Shedding light on methodological approaches and data sources that have been used over the years across European countries should help to evaluate effectively the comparability of the results. The development and use of key standardized guidelines for reporting BoD methodological choices may help decision-makers to draw national-level strategies based on more accessible BoD estimates.

9.B. Workshop: Burden of disease of COVID-19: strengthening the collaboration for national studies

The spread of coronavirus disease 2019 (COVID-19), caused by the severe acute respiratory syndrome coronavirus 2 (SARS-CoV-2), was categorized as a pandemic by the World Health Organization in March 2020. Since the outbreak was first identified in December 2019 in Wuhan, China, the public health impact of the disease globally has been enormous. Estimating the burden of the disease at national level is useful for comparing its impact with other diseases in the population and across populations. The disability-adjusted life year (DALY) is one of the most used summary measure of population health, and the key metric in the Global Burden of Disease study. The European Burden of Disease Network (burden-eu) was established in 2019 to act as a technical platform for integrating and strengthening capacity in burden of disease assessment across Europe and beyond. It is structured in technical and disease-focused working groups focus. Since the start of the pandemic, burden-eu has developed tools and started initiatives to support countries in estimating the national burden of COVID-19. These include developing and harmonizing methodologies, disseminating technical materials, launching a working group and online forum, exchanging experiences and supporting capacity building, and planning future studies. This workshop consists of four presentations. In the first, we present a consensus methodology, data requirements and solutions to data gaps to estimate national-level burden of COVID-1. Next, we present as examples results of studies conducted in Germany and Scotland, and the status of an international effort to harvest real-world data derived from the health systems' response across Europe and internationally during the pandemic. The fourth presentation describes burden-eu's activities to promote capacity building to estimate the burden of COVID-19, and discusses the importance, needs and lessons learned of sharing experience and of communicating COVID-19 data. The workshop will end with ample time for discussions on current approaches and opportunities for methodological developments, challenges, possible solutions and potential for collaborations to increase implementation and utility of studies of COVID-19 burden globally.Key messages National burden of disease studies offer a means of monitoring the direct population health impact of COVID-19 infection in countries.International initiatives have emerged to promote harmonization of methods, share knowledge and support international collaboration across countries and public health authorities worldwide.

1.H. Workshop: Health, risk factors and inequalities in the EU: insights from the Global Burden of Disease study

Abstract Since the 1990s, the Global Burden of Disease (GBD) study is providing a wealth of information on the health status of the world's population, at an increasing level of detail. The key metric of the GBD study is the Disability-Adjusted Life Year (DALY), which allows integrating the impact of morbidity and mortality into a single indicator, thereby providing a more comprehensive basis for evaluating, comparing and ranking the health impact of diseases, injuries, and risk factors. The GBD 2019 study, conducted by the Institute for Health Metrics and Evaluation, generated burden estimates for 369 diseases and injuries, and 87 risk factors, in 204 countries and territories, for the period 1990-2019. Leveraging the GBD 2019 study results, this workshop will paint a picture of the state of health in the European Union, focusing on the main causes of ill health, the main contributing risk factors, and the prevailing health inequalities. The workshop is organized by the European Burden of Disease Network (COST Action CA18218), which actively works to integrate and strengthen the capacity and knowledge in burden of disease assessment assessment across Europe and beyond. As a practical exercise in knowledge translation, the workshop will be an opportunity for participants to get familiar with the concept and importance of burden of disease, the GBD study, and the use of DALYs for population health monitoring and reporting. Key messages The Global Burden of Disease study provides comprehensive and comparable worldwide estimates of the population health impact of diseases, injuries, risk factors, and inequalities. Participants will receive a picture of the state of health in the European Union, including the main causes of ill health, the main contributing risk factors, and the prevailing health inequalities.

Burden 2020: The German Burden of Disease Study Informative, comprehensive, appealing and digital: Providing health data to users. Accessibility of scientific results in the burden context

Abstract The aim of the BURDEN 2020 project is to calculate the Burden of Disease for Germany at the national and regional level. Based on the methods of the Global Burden of Disease study, the results will assess the impact of diseases on population health thus providing a freely accessible information basis for policy making and health care planning. How can the transfer from science to society take place on a low-threshold basis? We will talk about our strategy reaching out to decision-makers within health care planning in Germany and Europe. In addition, it will be examined how we wanted our results to be accessible, which possibilities of publication we choose beyond scientific articles and what options we had when talking about research marketing. We will also have a closer look on our demands for data visualization and transparency. In an ongoing process, two things were at stake: how do we define our target groups and how we address them. It has been proven to be a good strategy to continuously build up (international) networks, to share our knowledge and implement feedback. When publishing scientific results, it has turned out to be helpful for the project to approach a well-known bi-lingual journal with a wide range of coverage. We aimed to present the pilot project online with an appealing data visualization and graphic formats. This type of presentation made it easier to approach members of the press. Also, the inclusion of current topics such as COVID-19 helped to increase the media response. There are plans to include the use of the data in media formats such as webinars. Burden of Disease assessments can be challenging in implementation and communication. Before the start, the use of the metrics for Germany had to be thoroughly explained to national stakeholders. Within the project, we had to discuss how our data should be communicated to the public, to explain strength and weaknesses, and to produce publication formats that suit different target groups.

An overview of burden of disease studies in Europe

Abstract Facing the considerable variation in the computation of disability-adjusted life years (DALY) in the numerous updates of the Global Burden of Disease (GBD) study and many independent studies, the European burden of disease network (burden-eu) launched a series of systematic literature reviews (SLR) to explore the key assumptions used in the European burden of disease (BoD) studies. The SLR will provide an overview of the existing BoD studies and the computational variations used and will also help identifying ways to harmonize the approaches enhancing the comparability of BoD estimates. The SLR was split in four parallel reviews: non-communicable diseases (NCDs), communicable diseases (CDs), injuries and risk factors. For the first three, the search strategy included terms describing the population (GBD area “European region”) and the BoD measures (years lived with disability, years of life lost, and DALYs). We included studies published between January 1990 and April 2020, without language restrictions. The search strategy was run in PubMed, Web of Science, Cochrane, and Embase. OpenGrey, OAIster, CABDirect, WHO and targeted public health agency websites were screened for grey literature. In addition, burden-eu members were asked to supplement the list of publications with any material available within their national public health institutes. Data extraction focused on methodological information. The title, abstract and full-text screening resulted in the final inclusion of 165 papers regarding NCDs, 189 with CDs, and 124 papers regarding injuries. The final list includes peer-reviewed articles and reports showing a variability in data sources used (e.g. patient medical records, disease registries, insurance claims sources) and model assumptions (e.g. use of multi-morbidity adjustments, use of disability weights). Further data extraction and analysis is in process, and will be presented during the workshop.