Burden Of Disease Research Articles

The role of preventive medicine in reducing chronic disease Burden in the USA: A Systematic Review

Chronic diseases, including cardiovascular disease, diabetes, cancer, and respiratory illnesses, are the leading causes of morbidity and mortality in the United States, placing a significant burden on individuals, healthcare systems, and the economy. Preventive medicine, encompassing primary, secondary, and tertiary strategies, plays a crucial role in mitigating this burden by focusing on disease prevention and health promotion. This systematic review aims to evaluate the effectiveness of preventive medicine in reducing the chronic disease burden in the USA. Through a comprehensive search of peer-reviewed studies, we explore the impact of screening programs, early detection, lifestyle interventions, and health policies designed to prevent chronic diseases. The review highlights the success of preventive measures in decreasing disease incidence, improving health outcomes, and reducing healthcare costs. However, challenges such as disparities in access to care, patient adherence, and the integration of preventive services into the broader healthcare system remain significant barriers. The review concludes by discussing policy implications, recommending strategies to overcome implementation challenges, and outlining future research directions to enhance the role of preventive medicine in combating chronic diseases in the USA.

Practice guideline of influenza vaccination and antiviral drugs use in children(2024 editon)

Influenza is the most common acute respiratory infectious diseases among children in China. The annual seasonal influenza outbreak has a significant impact on children's health, poses a significant disease and socioeconomic burden, and arouses a wide public concern. In recent years, a number of new influenza vaccines and influenza antivirals have been approved for use in children, expanding the choices for prevention and treatment of influenza. Pediatric Infection Group, Chinese Society of Infectious Diseases of Chinese Medical Association and Infection Group, Pediatric Expert Committee of National Health Commission Capacity Building and Continuing Education, and China Clinical Practice Guidelines Alliance Methodology Committee organized a multidisciplinary guideline development group (GDG) consisting of experts in pediatrics, infectious diseases,epidemiologists,health policy,and guideline methodology proposed eight key issues concerning influenza vaccination and antiviral use from a practice perspective. Through research question construction, evidence retrieval and synthesis, evidence appraisal and evidence-to-decision discussion, recommendations and implementation suggestions were formulated. This guideline is intended to provide guidance for pediatricians at different facility levels and healthcare providers engaged in vaccination services,and institutional professionals dealing with prevention and control of infectious diseases.

Health care utilization at the end of life in Parkinson’s disease: a population-based register study

BackgroundKnowledge of health care utilization at the end of life in Parkinson’s disease (PD) is sparse. This study aims to investigate end of life health care utilization, characterized by emergency room (ER) visits, receipt of specialized palliative care (SPC), and acute hospital deaths in a Swedish population-based PD cohort.MethodsWe conducted a retrospective cohort study on deceased patients (≥ 18 years) with a PD diagnosis during their last year of life (n = 922), based on health care-provider data from Region Stockholm´s data warehouse, for the study period 2015–2021. Univariable and multivariable logistic regression analyses tested associations and adjusted Odds ratios (aORs) were calculated.ResultsDuring the last month of life, approx. half of the cohort had emergency room (ER) visits and risk of frailty (measured by Hospital Frailty Risk Score) significantly predicted these visits (aOR, 3.90 (2.75–5.55)). In total, 120 people (13%) received SPC during their last three months of life, which positively associated with risk for frailty, (aOR, 2.65 (1.43–4.94, p = 0.002). In total, 284 people (31%) died in acute hospital settings. Among community-dwellers, male gender and frailty were strongly associated with acute hospital deaths (aOR, 1.90 (1.15–3.13, p = 0.01) and 3.70 (1.96–6.98, p < 0.0001)).ConclusionsRates of ER visits at end of life and hospital deaths were relatively high in this population-based cohort. Considering a high disease burden, referral to SPC at end of life was relatively low. Sex-specific disparities in health care utilization are apparent. Identifying people with high risk for frailty could assist the planning of optimal end-of-life care for people with PD.

3.A. Round table: Towards a research agenda for burden of disease studies

Abstract What are the most relevant diseases in a country? Which risk factors are the strongest contributors to disease and death? How is the impact of different diseases evolving over time, and how does it compare between countries and within subnational units? As the need for prioritising the use of available resources constantly increases, a timely, sound and comprehensive answer to these fundamental questions is more than ever needed to inform public health decision-making. Driven by the impact of the Global Burden of Disease study, several researchers and national and international health institutes have adopted the burden of disease approach to address these questions. The complexity of the burden of disease approach however resulted in major disparities in research capacity across Europe. Furthermore, the current burden of disease landscape remains scattered, and researchers struggle to translate their findings to decision makers. The European Burden of Disease Network (COST Action CA18218) addresses these challenges by acting as a technical platform for integrating and strengthening capacity in burden of disease assessment across Europe and beyond. The different activities of the Network have helped to improve the quality and comparability of burden of disease estimates and increase their use in policy and practice. However, still many challenges remain. As a way of looking into the future applications of the burden of disease metrics, the European Burden of Disease Network took the initiative of developing a research agenda based on barriers and weaknesses identified within the activities of the network and input from researchers working regularly with burden of disease. As an initial step, a series of systematic literature review was carried to identify barriers and weaknesses in the computation of burden of disease estimates. These highlighted the differences in methodological choices that could hamper the comparability of results. This point was later identified as a key element of future development (abstract one). Secondly, the members of the network were consulted. Online questionnaires and structured consultations led to the identification of four main pillars of the future research agenda: transparency and availability, refining current methods, new applications, and prioritization of topics. In this workshop, we will present different activities within and outside the Network that correspond to the four pillars above described (abstract 2-4) and start the reflection on the future of burden of disease estimated. Key messages • Despite the wide use of the burden of disease approach, many challenges were identified in the replication of the methods and the need for further developments. • A new research agenda for burden of disease estimates will formalize a way to strengthen methodologies, interpretations and applications.

10.E. Scientific session: Confronting the hidden risks: unveiling the disease burden of chemicals in Europe

Abstract With increasing industrialization and globalization, Europe faces a complex landscape of chemical hazards, ranging from persistent organic pollutants like PFAS to foodborne chemicals and beyond. Understanding the extent of these exposures and their associated population health risks is crucial for environmental and health policy making across Europe. The burden of disease methodology, particularly through metrics such as Disability-Adjusted Life Years (DALYs), combined with economic costs, plays a crucial role in assessing and addressing the impacts of chemicals on population health. DALYs provide a comprehensive measure that quantifies both the years of life lost due to premature death and the years lived with disability, offering a holistic understanding of the disease burden caused by chemical exposures. Additionally, incorporating economic costs into the analysis enables the evaluation of the financial burden imposed by chemical-related illnesses on healthcare systems, productivity, and societal well-being. By leveraging the burden of disease methodology, stakeholders can make evidence-based decisions to protect health of populations and allocate resources effectively, ultimately promoting healthier environments and communities. Several global and European initiatives provide platforms for evidence generation, knowledge-sharing, and action to address the disease burden of chemicals. At the global level, the Foodborne Disease Burden Epidemiology Reference Group of the World Health Organization (WHO/FERG) has estimated the global burden of foodborne diseases, including those caused by chemical contaminants in foods. At European level, the health impact of PFAS and other chemicals of high concern is being spearheaded by the European Environment Agency’s European Topic Centre on Human Health and the Environment, and the European Partnership on the Assessment of Risks from Chemicals (PARC). Furthermore, the Organisation for Economic Cooperation and Development has established a project of an unprecedented scale to measure the economic value of the effects of chemicals on human health. Complementary to these international initiatives, various countries have started to unravel the burden of chemicals based on local data and contextual insights. In this workshop, we will present the state-of-the-art of the disease burden of chemicals, by bringing together insights from key international and national burden of disease initiatives, emphasizing the imperative of addressing the cost of policy inaction in safeguarding public health. We will also show how burden of disease estimates for chemicals can help to monitor the trends towards relevant environment and health goals such as those described in the EU’s zero pollution ambition. Through collaborative discussions and knowledge-sharing, we aspire to identify actionable strategies for policymakers, researchers, and stakeholders to effectively address these challenges and promote a healthier future for all. Key messages • Understanding the vital importance of chemical risks for European health, the utilization of DALY and economic costs reveals their true burden, guiding evidence-based policies. • Global, regional and national initiatives are examining the impacts of chemicals worldwide, contributing to evidence gathering and policy shaping.

The Cardiovascular Disease Burden Associated with secondhand smoke, 1990-2019: an age-period-cohort analysis of the Global Burden of Disease study

Abstract Background Over the past three decades, global regions have shown significant differences in the burden of cardiovascular disease (CVD), and secondhand smoke is a major risk factor contributing to this burden. Nevertheless, a comprehensive understanding of the global trends and associations between second-hand smoke and cardiovascular disease is lacking. Methods Using data from the Global Burden of Disease (GBD) study 1990-2019, an age-period-cohort (APC) analysis was conducted to investigate trends in cardiovascular disease-related mortality in populations affected by secondhand smoke globally over the past 30 years and its association with age, period, and birth cohort. Results Over the past 30 years, the number of cardiovascular deaths caused by secondhand smoke has increased significantly worldwide, from 432.6 thousand in 1990 (95% UI: 357.4-508.3) to 598.5 thousand in 2019 (95% UI: 489.7-713.5), an increase of 38.4% (95% UI: 26.8%-49.5%). In 2019, cardiovascular disease accounted for 45.9% of all deaths attributable to secondhand smoke in both men and women globally. Among cardiovascular diseases, ischemic heart disease became the main component, accounting for 66.4% compared with stroke. The gender composition of cardiovascular deaths due to secondhand smoke is slightly lower in men (46.5%) than in women (53.5%). Longitudinal analyses using age-time-cohort models show that global CVD-related mortality from secondhand smoke has improved overall over the past three decades, but there are differences between regions, genders, and CVD subtypes. It is worth noting that the higher the socio-demographic index (SDI) level, the greater the reduction in mortality, with a staggering 39.1% reduction in high SDI areas (95% UI: 35.6%-42.3%), in sharp contrast to virtually no change in mortality in low SDI areas (0.1% (95% UI: -52.4%-62.2%)). During the period 2003-2007, cardiovascular disease-related mortality decreased significantly, with an average annual percentage change of -1.48%. Conclusion The study highlights the importance of using secondhand smoke as a modifiable risk factor for the global burden of cardiovascular disease. Further research is vital to understand the factors that lead to differences in countries and regions at different levels of development, gender differences and differences in cardiovascular disease subtypes.

Burden of inflammatory bowel disease in Belgium, 2020

Abstract Inflammatory bowel disease (IBD) comprises digestive disorders resulting from non-infectious inflammation of the colon and gastrointestinal tract. With its global prevalence on the rise, IBD poses significant challenges to healthcare systems. There is a need for more accurate disease burden estimates to guide decision-making processes within the health sector. As a part of the Belgian national burden of disease study (BeBOD), this study aims to estimate the burden of IBD in Belgium based on locally available data. We estimated the Belgian IBD burden in 2020 in terms of mortality, prevalence, years of life lost (YLLs) due to premature death, years lived with disability (YLDs), and disability-adjusted life years (DALYs). As there is no single comprehensive data source on prevalence of IBD in Belgium, a critical appraisal of existing local and national data sources was conducted. Prevalence data were combined with disability weights to yield YLDs. YLLs were calculated using the most recent Global Burden of Disease (GBD) 2019 reference life table and the number of deaths caused by non-infective IBD (ICD-10 K50-52). Cause of death data were extracted from Statbel, the Belgian statistical office. The best available data source to estimate the IBD prevalence in Belgium was a widespread network of general practitioners. The prevalence of IBD was 1.5% in 2020. The prevalence-based YLD for IBD was 220 YLDs per 100 000, while the YLL rate was 11.5 per 100 000. We estimated 26 276 DALYs caused by IBD in 2020. Of the total DALYs caused by IBD, 5% were due to YLLs and 95% were due to YLDs. Our burden estimates for IBD in Belgium were however higher than those of the GBD study. IBD imposes a low fatal burden, whereas the burden of morbidity is more prominent. Our findings could be useful for policy makers to justify and prioritize resource allocation. Integrating the current research in BeBOD will allow monitoring the burden of IBD over time. Key messages • Inflammatory bowel disease is characterized by a substantial non-fatal burden due to chronic relapsing and persistent symptoms. • National inflammatory bowel disease burden estimates are useful to guide decision-making within the health sector.

Rapid health technology assessment to inform policy: a case study with respiratory syncytial virus

Abstract Background Respiratory syncytial virus (RSV) can cause severe acute respiratory tract infection in infants and older adults. However, until recently, no immunisation interventions were available to reduce the burden of RSV disease in the general population. New health technologies have now been authorised in Europe for infants (a long-acting monoclonal antibody (nirsevimab) and a maternal vaccine (RSVpreF)), and two vaccines for adults aged ≥60 years (RSVPreF3 and RSVpreF). A rapid health technology assessment (HTA) was requested by the Irish Department of Health to support an interim decision on RSV immunisation. Methods The rapid HTA commenced in January 2024, and comprised description of technology, a summary of international practice, national and international epidemiology and burden of disease, and a costing analysis. The summary of international practice (including underpinning evidence) was undertaken rather than a systematic review of effectiveness and safety due to the rapidly changing evidence base and short timeline within which information was required. Results While new recommendations regarding immunisation against RSV are emerging internationally in response to recently authorised technologies, implementation and funding strategies are not currently widespread. Compared with a full HTA, a rapid HTA enabled an efficient and flexible approach to producing a high quality evidence synthesis to inform a temporary policy decision, taking approximately 6 months to complete rather than 12 months or longer. A full HTA is planned to inform long-term decision-making on this topic, but would not have been feasible to inform an interim decision. Conclusions This rapid HTA will inform a temporary decision on immunisation policy for a single RSV season in Ireland. Conducting a rapid HTA prior to a full HTA has enabled timely decision-making, with implications for Ireland’s national healthcare system and people at risk of severe RSV-related disease. Key messages • Innovations in immunisation against RSV are leading to changes in policy across Europe. • Rapid HTA can support timely, evidence-based public health decision-making in a fast-evolving field.

Burden of disease due to road traffic noise in Flanders, Belgium

Abstract This study estimates the disease burden of ischemic heart disease (IHD), stroke and diabetes mellitus attributable to road traffic noise in the Flemish Region (Belgium) for the year 2020, expressed in disability-adjusted life years (DALYs). The research proposes an approach to stratify population exposure to noise according to age and sex, which allows to examine internal differences in noise burden related to both varying risk and baseline burden. Stratification of population exposure to noise is achieved by (1) linking modelled noise exposure to age- and sex-stratified population data at small area-level, (2) dividing the prevalence in each exposure class proportionally over the strata, and (3) aggregating the small areas to a Flemish total per stratum. Annual day-evening-night level exposure is translated into the fraction of attributable burden relying on relative risks (RR) from the WHO’s Environmental Noise Guidelines and more recent studies. Baseline burden for the three outcomes is sourced from the Belgian National Burden of Disease Study. The lower and upper bound of the RR’s 95% confidence interval (CI) are used to calculate the uncertainty range on the burden estimates. The total noise DALYs estimated are 1092 (95% CI: 135, 2061) for IHD, 761 (379, 1017) for stroke, and 671 (486, 918) for diabetes. Noise burden rates rise steeply with age for all outcomes, although the wide CIs on the IHD estimates prevent to ascertain a significant trend. The IHD burden is twice as high in men as in women, while both sexes are almost equal for the other outcomes. The variations between age and sex groups are largely explained by differences in baseline burden, as exposure is fairly constant across strata. This study estimates age- and sex-stratified disease burden attributable to noise traffic in Flanders, Belgium. As differential exposure between the population subgroups is limited, any variation in noise DALYs is mainly related to stratum-specific baseline burden. Key messages • Road traffic noise is responsible for hundreds of healthy life years lost in Flanders, Belgium. • The noise burden for stroke and diabetes rises sharply with age, and the burden for ischemic heart disease is twice as high in men as in women.

Assessing the adequacy and sustainability of the Northern Territory health workforce with respect to burden of disease and injury, 2009-2021: an analysis of administrative data.

To assess the adequacy of the Northern Territory health workforce with respect to population size and burden of disease, overall and by selected health specialties; to assess its sustainability by investigating changes in workforce numbers. Analysis of Australian Health Practitioner Regulation Agency (AHPRA) health workforce data (2013-2021) and burden of disease data (disability-adjusted life-years, DALYs) drawn from national and NT burden of disease studies (and projected for 2019-2021). NT and Australian health workforces, 2009-2021. Adequacy of the NT health workforce, assessed as the ratio of the mean annual numbers of NT health workers per 1000 population or health workers per 1000 DALYs (2009-2013 and 2014-2018) to those of the Australian workforce (2013 and 2018); sustainability of the NT health workforce, defined as the number of health workers per 1000 population or per 1000 DALYs increasing between 2013 and 2021. The number of health workers per 1000 population was slightly higher in the NT than for Australia in both time periods (2009-2013 v 2013: 23.30 v 21.79 per 1000 population, 6.9% larger; 2014-2018 v 2018: 25.79 v 23.47 per 1000 population, 9.9% larger); however, it was smaller with respect to burden of disease (2009-2013 v 2013: 82.6 v 107.4 health workers per 1000 DALYs, 23.1% fewer; 2014-2018 v 2018: 91.5 v 117.1 per 1000 DALYs, 21.8% fewer). In particular, 464 more nurses and midwives (11.4% more than the mean for 2013-2021), 196 more physiotherapists (115%), 189 more psychologists (102%), 152 more pharmacists (79%), and 144 more dentists (106%) are needed in the NT to match the corresponding numbers of health workers by disease burden for Australia as a whole. The number of Aboriginal health practitioners per 100 000 DALYs fell during the study period. Health worker population density alone does not reliably assess health workforce needs; burden of disease information is important for workforce planning that meets population health needs. The NT health workforce needs to be increased by about 28% to reflect the population burden of disease and injury. Shortages in the NT health workforce must be eliminated to close health gaps between Indigenous and non-Indigenous Australians.

Estimation of Environmental Burden of Disease related to Arsenic exposure in European Populations

Abstract Background Arsenic (As) exposure poses significant health risks to exposed populations, with exposure occurring predominantly via diet for the general population as recently referred by the European Food Safety Authority. This study assesses the environmental burden of disease (EBD) for three cancer types related to arsenic, across Europe. Methods A literature review was conducted to 1) identify the dose-response function (DRF) to assess the cancer risk in European populations, and 2) define EBD approaches applicable to the available data. Country-specific data (Belgium, Denmark, Portugal) for EBD calculation (exposure, socioeconomic status, health outcomes) were gathered. Disability-Adjusted Life Years (DALY) estimations were performed by calculating attributable cases (AC). Results Two main references are used for DRF: the United States Food and Drug Administration DRF for assessing bladder and lung cancer risks, and the United States Environmental Protection Agency DRF for skin cancer. Preliminary results for Belgium indicate that inorganic arsenic dietary exposure ranges from 0.084 [0.080 - 0.088] to 0.102 [0.097 - 0.107] µg/kg body weight per day, varying with education level. Stratified estimates suggest that individuals with higher educational attainment (ISCED levels 5 &amp; 6) have a marginally higher average daily intake of arsenic compared to those with lower educational attainment (ISCED levels 0, 1 &amp; 2). DALY attributable to inorganic arsenic exposure follow the same trend as exposure levels, i.e. individuals with a higher education level bear a higher burden of disease than individuals of the low education stratum. This concerns the three studied cancers. Conclusions This study quantifies DALY related to inorganic arsenic from dietary exposure for different European countries. Our findings will contribute to better target public health policies and interventions for arsenic risk mitigation. Key messages • Exposure to inorganic arsenic is confirmed in European countries. • EBD studies guide action priorities to tackle chemical risk factors.

Exploring Burden of Disease Metrics in EU legislation: A Systematic Analysis

Abstract Background The burden of disease (BoD) methodology is a valuable tool for evidence-based policymaking. However, there is currently no systematic analysis available regarding its use in the European Union (EU) legislation framework. This study aims to describe the implementation of BoD methodology in EU legislation. Methods A search was conducted on EUR-Lex, the official and most comprehensive platform to access EU legal documents. The main inclusion criteria in the analyses were date of publication (between 2004 and 2023, accounting for EU-25) and inclusion of BoD metrics (years of life lost - YLL, years lived with disability - YLD or disability-adjusted life years - DALY). Descriptive and network analysis were conducted to analyse the legislation content. Results Out of 2592 documents, 191 met the set criteria. Ten were legally binding, and 69% were published after 2018. The European Commission (n = 152) was the most regular issuing institution. BoD was mainly used as an argument (n = 93) and for impact assessment (n = 50). The metrics were commonly presented in the main text (n = 122) and in the annex (n = 48). EuroVoc domains like environment and social questions prevailed. The most frequent EuroVoc terms were climate change policy (n = 45), EU environmental policy (n = 32) and pollution control measures (n = 32). Discussion Despite the growing recognition of BoD metrics in supporting policymaking, only 191 documents published over the past 20 years within the EU legislation make reference to this methodology. Greater efforts in knowledge dissemination and directing research towards specific policy uptake may increase the application of BoD studies in EU policies. By advocating for increased awareness, promoting collaboration between researchers and policymakers, and targeting research efforts towards specific policy needs, a more comprehensive integration of BoD methodologies into EU legislation can be achieved, contributing for evidence-informed policies. Key messages • There were only 191 documents of the EU legislative documents published in the past 20 years mention burden of disease metrics, mainly addressing environmental and social issues. • There is a need to increase EU policy uptake from BoD studies, by conducting policy-oriented research, and building capacity among researchers and policymakers on BoD methodology.

Improving transparency: Development of reporting guidelines for burden of disease studies

Abstract The burden of disease (BOD) approach, originating with the Global Burden of Disease (GBD) study in the 1990s, has become a cornerstone for population health monitoring. Despite the widespread use of the Disability-Adjusted Life Year (DALY) metric, variations in methodological approaches and reporting inconsistencies hinder comparability across studies. To tackle this issue, we set out to develop guidelines for reporting DALY calculation studies to improve the transparency and comparability of BOD estimates. The development of the STROBOD statement began within the European Burden of Disease Network, evolving from initial concepts discussed in workshops and training sessions focused on critical analysis of BOD studies. In 2021, a working group was formed to refine the preliminary version into the final Standardised Reporting of Burden of Disease studies (STROBOD) statement, consisting of 28 items structured across six main sections. These sections cover the title, abstract, introduction, methods, results, discussion, and open science, aiming to ensure transparency and standardization in reporting BOD studies. Notably, the methods section of the STROBOD checklist encompasses aspects such as study setting, data inputs and adjustments, DALY calculation methods, uncertainty analyses, and recommendations for reproducibility and transparency. A pilot phase was conducted to test the efficacy of the STROBOD statement, highlighting the importance of providing clear explanations and examples for each reporting item. The inaugural STROBOD statement offers a crucial framework for standardizing reporting in BOD research, with plans for ongoing evaluation and potential revisions based on user feedback. While the current version focuses on general BOD methodology, future iterations may include specialized checklists for distinct applications such as injury or risk factor estimation, reflecting the dynamic nature of this field.

Addressing Regional Health Disparities: Estonia’s Approach to Burden of Disease Studies

Abstract Background Estonia, a small country defined by NUTS2 regions, faces challenges in assessing health disparities across its different counties when using global health data such as the Global Burden of Disease (GBD). Recognizing this limitation, Estonia initiated independent burden of disease studies in Estonia since 2013, with the findings being biennially published through the health statistics database of the National Institute for Health Development. The objective of this research is to assess the strengths and limitations inherent in various methods when calculating the years of life lost due to premature mortality (YLLs). Methods The approach to assess the burden of disease in Estonia differs somewhat from the Global Burden of Disease (GBD) methodology. One key distinction lies in our utilization of a national life expectancy table and our presentation of results at the LAU1 regional level. These burden of disease studies utilize region-specific life tables supplied by Statistics Estonia, categorized by county and gender, to compute Years of Life Lost (YLLs), offering an opportunity to pinpoint and tackle regional health issues. Results Since the calculation of YLL (Years of Life Lost) in these past studies has relied upon Estonia’s regionalized life tables, categorized by county and gender, the results exhibit substantial disparities when juxtaposed with the Global Burden of Disease study conducted by the Institute for Health Metrics and Evaluation (IHME). Conclusions This research aims to delve deeper into these variations, examining the challenges related to methodology, the availability, and the quality of data, and most importantly, knowledge translation. Our own burden of disease studies empowers us to formulate informed policy recommendations precisely tailored to the distinctive needs of each county, thereby facilitating targeted interventions, and driving improvements in overall public health outcomes.

The burden of cirrhosis and other chronic liver disease in the middle east and North Africa (MENA) region over three decades

BackgroundCirrhosis comprises a significant health challenge in the Middle East and North African (MENA) region impacting healthcare systems and communities. This study sought to investigate trends in the burden of cirrhosis and other chronic liver disease, different etiologies, deaths, and the disability burden utilizing data from the Global Burden of Disease (GBD) database.MethodsAnalyzing epidemiological trends from 1990 to 2021 across 21 MENA countries, this research utilized data on age-standardized incidence rates (ASIR), age-standardized death rates, and age-standardized disability-adjusted life years (DALYs) to evaluate the burden of cirrhosis and other chronic liver disease. The study also examined national variations and sociodemographic relationships.ResultsThe study identified a 114.9% increase in cirrhosis and other chronic liver disease incidence within the MENA region between 1990 and 2021, with 7,344,030 incident cases reported in 2021. The ASIR showed a steeper rise in females (9.6%) compared to males (7.0%). Etiology-specific analysis revealed an increase in the ASIR for MASLD related cirrhosis and other chronic liver disease by 22.2%, while those due to alcohol as well as hepatitis B and C decreased by 28.1%, 59.3%, and 30%, respectively. Despite the rising incidence, overall age-standardized death rates across all etiologies decreased by 54.3%, with DALYs showing a 51.4% decrease during the same period. Country-specific trends varied significantly, with Oman recording the highest annual ASIR increase (0.64%), and Qatar observing the most substantial annual reduction in age-standardized death rates (-2.88%).ConclusionThe study highlights evolving trends in cirrhosis and other chronic liver disease within the MENA region, emphasizing the necessity for comprehensive, etiology, and gender-specific interventions. Despite an increasing incidence, the observed improvements in mortality rates and age-standardized disability burden indicate progress in public health efforts to mitigate cirrhosis’s impact. These findings point to the complex nature of cirrhosis outcomes and the urgent need for tailored strategies to manage its increasing burden effectively.

Burden of disease and socioeconomic deprivation in Germany – regional patterns and variations

Abstract Within the scope of the BURDEN 2020 project (Burden of disease in Germany at the National and Regional Level) carried out by Robert Koch Institute (RKI) in collaboration with the German Environmental Agency and AOK Scientific Institute, burden of disease estimates for Germany and its regions become available for the first time. The national estimates of YLL, YLD and DALY are provided not only stratified by age and sex, but also by detailed regional level (96 spatial planning regions). The regional estimates provide valuable information and support the evidence-based decisions in health policies aiming at reducing the burden of disease in the country. To facilitate further the interpretation and usability of these estimates, the provided indicators were linked to the regional information on deprivation. For this purpose, the German index of socioeconomic deprivation (GISD) was used. The index was developed at the RKI and the last revised version was published in 2022. It is based on nine indicators which reflect the three subdimensions of deprivation: education, employment, and income. That is why GISD is a very suitable index for evaluating regional health disparities. Connecting both informations on BoD and deprivation, gives deeper insides in the regional differences within the country. Some diseases exhibit east/west differences, while others show north/south patterns or rural/urban distinctions. These differences reflect the variation in the prevention and health care needs for the different diseases in Germany. The results underline the necessity to study the regional inequalities separately for each disease. Different health conditions are connected to variations in settings and outline different needs in intervention programs and allocation of means.

Applying knowledge translation for an effective use of Burden of Disease

Abstract Burden of disease, expressed in disability-adjusted life years, is a very powerful metric to assess population health. It combines both mortality, i.e. years of life lost, and morbidity, i.e. years lost due to disability and is increasingly used within public health policy making. However, the substantial demand for (good quality) data, the involved methodological choices and the complexity of the concept make it also challenge to calculate Burden of Disease and to have the results properly used, e.g. in the policy making process. The concept of Knowledge translation provides a systematic way of dealing with the synthesis, dissemination, and application of research findings to improve health outcomes and inform policymaking. Understanding the burden of disease is fundamental to effective knowledge translation, as it helps prioritize research efforts, target interventions to address the most significant health challenges, and allocate resources efficiently. The four different models of knowledge translation, i.e. the push, pull exchange and integrated model, provide a sound theoretical basis to strengthen the use of burden of disease in policy making. To have an effective way of knowledge translation, the following basic facets are important: timing of providing results, having policy-relevant results, for whom are the results relevant and in what way to get the results to a potential user. This presentation will focus on how to deal with these different aspects, building on experiences of burden of disease studies throughout Europe.

Burden of disease due to ambient particulate matter pollution in Germany from 2010 to 2021

Abstract Background Worldwide, according to the global burden of disease (GBD) study, around 118 million disability-adjusted life years (DALYs) were attributable to ambient particulate matter (PM2.5) in 2019. Further, 97% of Europe’s urban population are exposed to annual average levels of PM2.5 above the World Health Organization’s guideline value of 5 µg/m³. In Germany, considerable efforts have been made to reduce PM2.5-emissions, which resulted in a continuous decrease of exposure. We estimated the burden of disease attributable to PM2.5-exposure in Germany for a time series from 2010 to 2021. Methods We used the environmental burden of disease (EBD) methodology developed by the WHO. For the exposure assessment we combined annual average measured and modelled PM2.5-concentrations with information on population density at a 2-by-2 km² grid. Using the exposure-response functions from GBD 2019, we estimated the EBD for chronic obstructive pulmonary diseases, type 2 diabetes mellitus, lung cancer, stroke and ischemic heart diseases (IHD). National surveys and register data were used to estimate the baseline burden of disease. Results In total, we estimated 232,863 (95%-CI: 153,716-314,882) DALYs attributable to PM2.5 in 2021. We observed a reduction of about 50% compared to 2010. The highest attributable burden was estimated for IHD with 70,197 (95%-CI: 42,609-101,785) DALYs, which is about 8% of the overall IHD-burden. The mortality-to-morbidity ratio revealed that years lost due to death (YLLs) had a higher share (69.9%) of overall DALYs with 162,561 (95%-CI: 106,918-222,567) YLLs. Discussion Despite a decreasing trend of the EBD for PM2.5 in Germany since 2010, our results show that there is still a long way to a pollutant free environment as envisaged by the EU’s zero pollution ambition. Using EBD as a standardized methodology and the DALYs as the core measure allows to have a comprehensive and comparable overview of the impact of PM2.5 on population health. Key messages • Ambient particulate matter pollution is an important environmental risk factor in Germany. • The decreasing trends is encouraging but there is still a long way to go to meet the objectives of the EU’s zero pollution ambition.

2.P. Scientific session: Improving health impact assessment in the context of EU policy cycle

Abstract The European Commission (EC) is responsible for planning, preparing and proposing better and simpler new policies, avoiding unnecessary burdens, and involving citizens and any interested stakeholders in the decision-making process. The EC is also responsible for evaluating existing European laws and proposing improvements where necessary. In achieving these goals, the EC has defined its “Better regulation” (BR) policy, governed by a set of common principles and established procedures, including the assessment of the most significant impacts on the economic, environmental, and social domains, among others. These assessments should be based on the best available evidence, which refers to multiple sources of data, information and knowledge, including quantitative (e.g. statistics and measurements) and qualitative data (e.g. opinions, stakeholder input, scientific and expert advice). BR’s principles and procedures also ensure the implementation of more effective, coherent, relevant and efficient initiatives, improving the transparency, participation, learning and accountability. With this approach, the EC also seeks to guarantee that all legislative proposals contribute to the 2030 sustainable development agenda, and to better planetary health. As stated in the EU Treaty (Article 168 TFEU), “a high level of human health protection shall be ensured in the definition and implementation of all Union policies and activities”. Therefore, assessment of any potential health impacts should be addressed during the policy cycle. Health gains and health losses can be direct or indirect, and particular attention should be given to specific population groups that may be disproportionally affected by the intervention (e.g., children, persons with disabilities, pregnant women, the elderly, low-income groups). The design and improvement of healthy public policies was precisely the ultimate goal for which the WHO proposed in 1999 the Health impact assessment (HIA) approach. HIA practice is grounded in the WHO’s health definition, which encompasses physical, mental and social health and well-being, and it is closely linked to the social determinants of health framework and to Health in All Policy strategy. Several quantitative methods are available to estimate health impacts within HIA applied to policies. The environmental burden of disease (EBD) is one of them aiming at quantifying the impact of a health problem as measured by avoidable mortality/morbidity, financial cost, or other indicators attributed to environmental factors (e.g. exposure to chemicals). EBD approach allows policy actions to be based on estimated health gains, rather than on “safe environmental levels” of the risk factor alone. The main aim of this session will be to analyses different quantitative approaches and provide some recommendations and good practice on how epidemiological evidence can support the policy cycle, improving data collection, evaluation and reporting suitable to such context. Key messages • Refining epidemiologic data recording and reporting, especially uncertainty characterisation, is necessary to improve weight-of-evidence evaluations for a better regulation process. • Environmental burden of disease, as a tool for quantifying health impacts, provides crucial information to policy makers on how to regulate for better protecting population health.

Developing survey instruments for low back and neck pain to improve disease severity estimates for burden of disease assessment

Abstract Two people living with the same disease can have very different experiences; one has little consequence, whilst the other struggles with much more debilitating consequences that impacts how they live their lives day-to-day. A growing body of research highlights the need for better estimates of disease severity to facilitate better estimation of the non-fatal burden of disease (BOD). Routine data does not always offer solutions because it’s often not coded at a granular enough level to map to individual health states. Data offering solutions are scarce and therefore not available across time or space. Most commentators have quantified the problem of assuming the same proportional severity splits to fill data gaps; a problem common to the Global Burden of Disease (GBD) study and independent BOD studies. However, whilst the need for highlighting the problems associated with this assumption remains, there are other positive steps that can be taken to overcome it. We propose how reproducible approaches can be developed, and present how they can be used to develop disease severity estimates. This involves developing a survey instrument to estimate the overall and health state prevalence of back pain and neck pain, basing health state definitions from the GBD non-fatal disease models, where the classification of cases by severity is based on the combination of respondent’s answers. Furthermore, we discuss how self-assessed severity estimates allow for internal validity checks, but also more widely offer opportunities to appraise the appropriateness of GBD non-fatal disease models. The development, and publication, of survey instruments can assist both independent studies and the GBD study to improve estimates of disease severity, as well as retaining important opportunities for cross-country comparability. Understanding the spectrum of severity is important for understanding how disease impacts populations and can inform healthcare provision and expenditure strategies.