Global Burden Of Disease Methodology Research Articles

Abstract P100: Global Burden of Atrial Fibrillation and Atrial Flutter and Its Trend From 1990-2019 in G20 Countries: Results From the GBD 2019

Background: Atrial Fibrillation and Atrial Flutter (Afib) ranks 6th in mortality and 7th in disability amongst all cardiovascular disease the G20 nations. Method: We employed 2019 Global Burden of Disease methodology. Afib and Flutter, non-fatal health outcomes, such as incidence and prevalence, were estimated using the Bayesian meta-regression tool (DisMod MR 2.1). Fatal health outcomes were assessed using the Cause of Death Ensemble Model (CODEm), considering factors like age, gender, year, and location throughout the G20 from 1990 to 2019. Results: From 1990 to 2019, prevalence rose from 23.2 million (95%UI: 17.6-29.7) to 48.9 million (37.5-61.6). The annual percentage change (APC) in incidence surged by 102% (1.8-3.8 million), DALYs by 119% (3-6 million), and deaths by 168% (93,864-251,272). Despite these increases, the age-standardized rate per 100,000 person-years declined over the past three decades. In 2019, the U.S. reported the highest age-standardized incidence rate at 109.52 (88.97-131.92) per 100,000, while Sweden had the top mortality rate of 8.63 (4-10.32) per 100,000. The age group 65-69 had the peak incidence count of 700,768 (362,032-1,158,177). Meanwhile, the highest death count was in the 85-89 age bracket with 59,325 (48,618-70,077), and the most DALYs were in the 80-84 age group with 1,083,488 (882,995-1,323,533) in 2019. Males consistently faced a higher burden than females over this period. Conclusion: AFib and AF accounted for 1.88% deaths amongst all cardiovascular casualties in 2019. Clinicians in the G20 countries must prioritize early detection and intervention for Afib and flutter, especially in males and the elderly, given its escalating prevalence and its ranking as a major cause of death and disability. Public health strategies in the G20 nations should focus on targeted awareness and interventions to combat the rising burden of atrial fibrillation, with countries like the United States and Sweden requiring heightened attention due to their notably high incidence and mortality rates.

TRENDS OF INFLAMMATORY BOWEL DISEASE BURDEN IN THE UNITED STATES (1990-2019), PROJECTIONS OF DEATHS TO 2040: INSIGHTS FROM THE 2019 GLOBAL BURDEN OF DISEASE STUDY

Abstract BACKGROUND Inflammatory Bowel Disease (IBD) ranks as the 9th primary cause of deaths and 7th for disabilities among all digestive diseases, affecting over 3 million Americans with a continuous upsurge. METHOD Utilizing the Global Burden of Disease methodology, we evaluated the prevalence, incidence, mortality, and Disability Adjusted Life Years (DALYs) of IBD from 1990 to 2019 in the U.S. based on age, sex, and year via a standardized statistical model. Furthermore, we forecasted deaths and Years of Life Lost (YLLs) up to 2040 through a regression framework. RESULTS IBD prevalence showed a decline from 982,981 (95%UI: 846,832-1,129,782) in 1990 to 762,889 (712,356-813,653) in 2019. From 1990-2019, the total annual incidence reduced by 12% (4-18), while deaths surged by 172% (81-199), and DALYs increased by 16% (2-34) (Figure 1). The Age-Standardized Rate (ASR) for mortality rose from 0.62 (0.60-0.82) per 100,000 cases in 1990 to 1.02 (0.8-1.11) in 2019. In raw counts, Nevada saw the most significant rise in incidence (87%), deaths (486%), and DALYs (174%) from 1990-2019. Based on ASR, West Virginia and Kentucky led in mortality increases with 87% and 83% respectively (Figure 2). In 2019, the age group 80-84 reported the highest deaths (848), while ages 25-29 saw the most significant incidence (8429), and ages 60-64 the highest DALYs (20933). Comparing genders, females had a steeper increase in DALYs (17% vs. 13% for males), whereas males saw a higher rise in deaths (181% vs. 167% for females) between 1990-2019. By 2040, IBD-related age-standardized mortality rates are predicted to climb by 0.9 per 100,000. CONCLUSION In 2019, IBD was responsible for 4.56% of all digestive disease deaths. Highlighting a comprehensive challenge for the U.S. healthcare, IBD's impact is not just clinical or economic but also profoundly psychosocial. Emphasizing early detection, cutting-edge treatments, and comprehensive patient support is crucial to lessen the severe implications of IBD in the U.S.

Statewide Burden and Trends of Acute Myeloid Leukemia Attributable to Smoking in the United States of America from 1990-2019: A Benchmarking and Comparative Analysis

Background: Smoking has long been associated with an increased risk of various cancers, and it plays a significant role in deaths related to Acute Myeloid Leukemia (AML), accounting for 1.69% of all cancer-related deaths in the United States of America (USA). Additionally, among all other risk factors contributing to AML development, smoking is responsible for a staggering 77.2% of AML-related deaths. However, there is a large statewide variation within the USA concerning AML burden. Comparable and consistent state-level measures of total AML burden have not been produced previously. Method: Using the Global Burden of Disease methodology “AML attributable to smoking” mortality, and disability-adjusted life years (DALYs) were analyzed by age group, sex and year from 1990-2019 for all residents in the USA using standardized approaches for data processing and statistical modeling. Results were produced in total number and age-standardized rate. The findings were reported both in absolute numbers and age- standardized rates. Results: The total number of deaths attributed to AML due to smoking showed an increase from 2,230 (95% uncertainty interval (UI): 1,159-3,275) in 1990 to 3,918 (95% UI: 1,833- 6,003) in 2019. Similarly, the DALYs (Disability-Adjusted Life Years) associated with AML increased from 52,843 (95% UI: 30,918-75,041) in 1990 to 81,356 (95% UI: 43,328-121,964) in 2019. However, the age-standardized mortality rate (ASMR) remained relatively stable, with no major difference observed (0.7 deaths per 100,000 95% UI: 0.38-1.02) in 1990 compared to 0.7 (95% UI: 0.35-1.05) in 2019. In contrast the age-standardized DALYs rate (ASDALR) decreased from 17.51 to 15.3 per 100,000 from 1990 to 2019. Regarding the highest annual percentage of change (APC) in total number of deaths due to AML, Nevada observed the greatest increase at 275% followed by Alaska at 236% and Arizona at 179% from 1990 to 2019. In contrast, the District of Columbia was the only state that showed a decrease in APC for total deaths with a decline of 6%. Analyzing ASMR, Indiana, and West Virginia observed the highest APC at 28% each, followed by Kentucky at 23%. Conversely, California experienced the highest decrease in ASMR APC, showing a decline of 30% from 1990 to 2019. Regarding age groups, the 95+ age group observed the highest APC increase in ASMR and ASDALR at 363% and 356%, respectively, followed by the 90-94 age group, which had an ASMR APC increase of 307% and ASDALR APC increase of 305%. Moreover, males exhibited a higher APC increase in the total number of deaths compared to females, with percentages of 85% and 62%, respectively, from 1990 to 2019. Conclusion: Large disparities in the total burden of AML attributable to smoking persist between US states despite marked improvements in management. Our findings show that a substantial proportion of AML cases in the United States are attributed to smoking, making it a modifiable risk factor for this aggressive hematologic malignancy. Healthcare professionals and policymakers should utilize this evidence to reinforce anti-smoking initiatives and raise public awareness about the link between smoking and AML.

Statewide Burden and Trends of Acute Myeloid Leukemia in the United States between 1990-2019: A Benchmarking Analysis for the Global Burden of Disease Study 2019

Background: Acute myeloid leukemia (AML) ranks as the 15th leading cause of death, accounting for 1.75% of all cancer-related deaths in the United States of America (USA) in 2019, following Myeloma. Despite its significance, statewide disparities in AML burden have not been previously studied. Thus, this research aimed to assess the burden and trends of AML across the USA over the last three decades, spanning from 1990 to 2019. Method: Employing the Global Burden of Disease methodology, we evaluated AML prevalence, incidence, mortality, and disability-adjusted life years (DALYs) using standardized approaches and statistical modeling. The results were presented in absolute counts and age-standardized rates (per 100,000 person-years). Results: The total number of AML prevalence cases rose from 10,124 (95% uncertainty interval (UI): 9,259-11,482) in 1990 to 21,370 (95% UI: 17,759-24,830) in 2019. Correspondingly, deaths increased from 6,849 (95% UI: 6,301-7,724) in 1990 to 13,620 (95% UI: 11,632-14,664) in 2019, while DALYs increased from 185,960 (95% UI: 171,985-210,122) in 1990 to 301,526 (95% UI: 268,606-323,608) in 2019. The age-standardized incidence rate (ASIR) rose from 2.75 (95% UI: 2.52-3.09) to 3.23 (95% UI: 2.71-3.73) cases per 100,000 from 1990 to 2019. Similarly, the age-standardized mortality rate (ASMR) increased from 2.20 (95% UI: 2.03-2.48) to 2.54 (95% UI: 2.19-2.72) cases per 100,000 during the same period. In 2019, the greatest AML incidence was observed in California (1,677), followed by Florida (1,268) and Texas (1,155), while the lowest incidence was observed in the District of Columbia (24). Regarding the annual percentage of change (APC), the highest percentage increase in deaths was observed in Nevada (328%), followed by Alaska (224%), while the District of Columbia had the lowest APC (6%) from 1990 to 2019. In terms of incidence, Nevada (332%) and Arizona (227%) had the highest APC during the same period. The age group of 70-74 years had the highest number of deaths (2,264) and incidence (2,665), as well as DALYs (43,918) in 2019. Notably, the older age groups exhibited the highest APC in deaths and incidence. Males had a higher burden of AML compared to females. Conclusion: Our study underscores significant disparities in AML burden across different states in the USA from 1990 to 2019. We have also identified that males and elderly individuals face a higher likelihood of AML burden. Consequently, policymakers must prioritize enhancing healthcare systems, advancing early diagnosis and treatment approaches, and promoting health education to reduce individual exposures to relevant risk factors.

Global Burden and Trends of Multiple Myeloma in High-Income North America Countries between 1990-2019, with Projections of Deaths to 2040: A Benchmarking Analysis for the Global Burden of Disease Study 2019

Background: Multiple myeloma (MM), a malignant neoplasm originating from plasma cells, imposes a considerable health burden in high-income North America (HINA). It ranks as the 14th leading cause of cancer-related deaths and disability in HINA countries. This study aims to assess the epidemiological aspects of MM, including its incidence, prevalence, mortality rates, and non-fatal health outcomes across HINA countries over the last three decades (1990-2019) with projections of deaths up to 2040. Methods: Using the Global Burden of Disease methodology, we evaluated MM prevalence, incidence, mortality, and disability-adjusted life years (DALYs) based on age group, sex, and year across HINA from 1990 to 2019, utilizing standardized approaches and statistical modeling. We employed a regression framework to forecast MM deaths through 2040, and the results were presented in absolute counts and age-standardized rates (per 100,000 person-years). Results: The absolute prevalence of MM increased from 42,637 (95% uncertainty interval (UI): 35,449-44,970) in 1990 to 101,994 (95% UI: 86,889-127,309) in 2019. Similarly, deaths increased from 11,200 (95% UI: 9,435-11,633) to 19,941 (95% UI: 18,012-22,919) during 1990-2019, and DALYs increased from 235,334 (95% UI: 194,820-244,361) in 1990 to 388,955 (95% UI: 360,494-478,317) in 2019. The age-standardized incidence rate (ASIR) increased from 4.32 (95% UI: 3.62-4.5) to 4.8 (95% UI: 4.12-5.87) cases per 100,000 persons from 1990-2019. However, the annual percentage of change (APC) in age-standardized mortality rate (ASMR) and age-standardized DALY rate (ASDALR) decreased by 1% and 8%, respectively, from 1990-2019. Among HINA countries, Canada observed the highest APC increase in total deaths (111%), followed by Greenland (110%) and the United States (75%) during 1990-2019. In terms of age groups, the 70-74 age group observed the highest number of incidences (5,257), deaths (3,336), and DALYs (67,310) in 2019. The 80+ age group exhibited the highest APC in total deaths, incidence, and DALYs from 1990-2019. Furthermore, males experienced a higher burden compared to females over the last three decades. The projected number of MM deaths in HINA is expected to reach 28,904 (95% UI: 22,690-37,300) by 2040. Conclusion: This study reveals the secular trend of MM burden in HINA, indicating a significant increase in MM cases and its impact on public health. MM accounted for 2.295% of deaths among all cancer-related deaths in HINA in 2019. The burden of MM has been on the rise in general from 1990 to 2019 and is predicted to continue increasing over the next two decades. Notably, there is a noticeable disparity in MM burden, with higher prevalence in males compared to females. Age and cohort effects appear to play a significant role, with elevated risk observed among elderly individuals and those from earlier-born cohorts. Nonetheless, continuous surveillance, data collection, and research efforts are crucial to monitor evolving epidemiological trends and inform evidence-based policies aimed at mitigating the impact of multiple myeloma on individuals and society in the region.

Abstract 19042: Statewide Burden of Ischemic Heart Disease Attributable to Dietary Risk Factors From 1990-2019 in United States: A Systematic and Comparative Benchmarking Study

Introduction: Ischemic Heart Disease (IHD) is the 1 st leading cause of deaths among all causalities in United states (US). However, there is a large statewide variation within the US due to IHD attributable to dietary risk factors. Comparable and consistent state-level burden of total IHD attributable to dietary risk factors have not been produced previously. Methods: Using Global Burden of Disease methodology, deaths, and disability adjusted life years (DALYs) due to IHD attributable to dietary risk factors were analyzed by age group, sex, year, and location across the US from 1990-2019. Results were presented in all age counts and age standardized rate per 100,000 person years. Results: The annual percentage of change (APC) in total DALYs increased by 32% for IHD attributable to a high sodium diet, followed by a 10% increase for a diet high in sugar-sweetened beverages and a 2% increase for a diet low in vegetables. In terms of total deaths, the highest APC increase was observed in Nevada (142%), followed by Alaska (98%) and Arizona (65%). Conversely, the District of Columbia and Nebraska had the lowest APC increases in total DALYs and deaths. Regarding age groups, the highest APC increase in the total number of deaths was seen in the 95+ year group (97%), followed by the 90-94 age (44%), 55-59 age (10%), and 50-54 age (3%). Conclusions: Statewide disparities of IHD attributable to dietary risk factors in the US is significant and calls for comprehensive public health strategies. By addressing the root causes and promoting healthier dietary habits, it is possible to reduce the burden of IHD, improve population health outcomes, and alleviate the strain on healthcare systems and the economy.

Abstract 18555: Global Burden of Congenital Heart Disease and Its Trend From 1990-2019 in 38 OECD Countries: A Benchmarking Analysis for the Global Burden of Disease Study

Introduction: Congenital heart disease (CHD) is the 1st leading cause of deaths among all deaths associated with congenital birth defects in (Organization for Economic Cooperation and Development) OECD countries, constituting a significant health concern that imposes a substantial burden on healthcare systems and society. Methods: Using the Global Burden of Disease methodology, this study assesses the prevalence, incidence, mortality, and disability-adjusted life years (DALYs) associated with CHD in 38 OECD countries by sex, year, and location, covering the period from 1990 to 2019. The results are presented in both all age counts and age standardized rates (ASR) per 100,000 person-years. Results: From 1990 to 2019, the total number of prevalent cases of CHD increased from 1,469,128 (95%UI: 1,292,909-1,671,743) to 1,590,654 (1,387,114-1,815,338). In contrast, CHD-related deaths decreased from 37,291 (31,629-47,869) in 1990 to 13,886 (10,668-16,919) in 2019. The annual percentage of change (APC) in age-standardized mortality (ASMR) decreased by 60%, while the ASIR showed almost no change but decreased by 3%. Notably, the highest APC in ASIR was observed in Czechia (27%), Sweden (21%), Hungary (18%), and the United States (11%), while Turkey (28%) and Canada (21%) had the lowest APC increases. The highest APC increase in ASIR among females was observed in France (29%) Conclusions: Despite a decrease in the burden of CHD over the last three decades, it remains a significant concern in OECD countries. The impact of CHD is felt by individuals, families, healthcare systems, and the economy, emphasizing the ongoing need for comprehensive strategies to address this burden.

Abstract P404: Statewide Burden Of Ischemic Heart Disease Attributable To High Blood Pressure In United States From 1990-2019: A Benchmarking And Comparative Analysis For The Gbd 2019

Background: Ischemic Heart Disease (IHD) is the 1 st leading cause of death across the United States accounting for 18.9% of all casualties. The burden of IHD due to hypertension (HTN) in the United States is significant and multifaceted. Method: Using Global Burden of Disease methodology, deaths and disability adjusted life years (DALY) were assessed by age, sex and year across the US from 1990-2019. Results: Total number of deaths due to IHD attributable to HTN decreased from 343,151 in 1990 to 252,093 in 2019, DALYs decreased from 5,877,382 to 4,115,645 from 1990-2019. The age standardized death rate (ASMR) decreased from 102 to 41 per 100,000 person year 1990-2019. The highest annual percentage change (APC) increase in deaths observed in Nevada 88% (1217-2,283) followed by Alaska, Arizona from 1990-2019. Conclusion: IHD due to HTN found to be the leading cause of deaths across the US. Despite significant advancements in the management of IHD, the burden of IHD attributable to HTN remains a major health concern across the United States.

Abstract P131: Global Burden Of Stroke Attributable To High Systolic Blood Pressure In 38 Oecd Countries: A Systematic Analysis For The Global Burden Of Disease Study 2019

Background: High blood pressure (HBP) emerges as the primary leading cause of death and disability among all risk factors for stroke in Organization for Economic Cooperation and Development (OECD) countries. Method: This study employed the Global Burden of Disease methodology to evaluate mortality, DALY (Disability Adjusted Life Years) and YLD (Years Lived with Disability) associated with stroke attributable to HBP by age group, sex, year across the 38 OECD countries from 1990-2019. Results: The annual percentage change (APC) of deaths due to stroke attributable to HBP decreased by 22% (557,114-436,389) between 1990-2019, while DALY decreased by 26% (10,970,202-8,087,473) and YLD increased by 19% (1,451,842- 1,727,949). Among the OECD countries, Turkey exhibited the highest APC in deaths at 113% (11,476- 24,440). The highest APC in deaths was observed in the 95+ age group reaching 170% (13,578- 36,655) between 1990-2019. Conclusion: Despite a decreasing burden of stroke due to HBP, OECD countries continue to face significant mortality and DALY rates, necessitating ongoing efforts to reduce the burden.

Abstract P372: Global Burden Of Chronic Kidney Disease Due To Hypertension In 38 Oecd Countries: A Benchmarking Analysis For The Global Burden Of Disease Study 2019

Background: Chronic Kidney Disease (CKD) due to hypertension (HTN) ranks as the leading cause of death among all types of CKD in Organization for Economic Cooperation and Development (OECD) countries. Method: Using the Global Burden of Disease methodology, CKD due to HTN prevalence, incidence, deaths, Disability adjusted life years were analyzed by age, sex, year across the 38 OECD countries between 1990-2019. Results: Total prevalence of CKD due to HTN doubled from 4933515 (95%UI4543,520-5382155) in 1990 to 10871399 (95%UI10055175-11754447) in 2019. Age-standardized incidence rate (ASIR) increased from 21/100000 in 1990 to 25/100000 in 2019. The highest ASMR was observed in Mexico (16/100000), ASIR in Turkey (36/100000) in 2019. The highest annual percentage of change (APC) increased in ASMR observed in Estonia 341% (0.8-3.6) per 100000 from 1990-2019. Conclusion: CKD due to HTN has remained a leading cause of deaths in OECD countries. The escalating prevalence of CKD due to HTN underscores the urgency for proactive strategies aimed at prevention, early detection, and effective management of HTN.

Cardiovascular disease burden attributable to non-optimal temperature: analysis of the 1990-2019 global burden of disease.

Extreme temperatures are increasingly experienced as a result of climate change. Both high and low temperatures, impacted by climate change, have been linked with cardiovascular disease (CVD). Global estimates on non-optimal temperature-related CVD are not known. The authors investigated global trends of temperature-related CVD burden over the last three decades. The authors utilized the 1990-2019 global burden of disease methodology to investigate non-optimal temperature, low temperature- and high temperature-related CVD deaths, and disability-adjusted life years (DALYs) globally. Non-optimal temperatures were defined as above (high temperature) or below (low temperature) the location-specific theoretical minimum-risk exposure level or the temperature associated with the lowest mortality rates. Analyses were later stratified by sociodemographic index (SDI) and world regions. In 2019, non-optimal temperature contributed to 1 194 196 (95% uncertainty interval [UI]: 963 816-1 425 090) CVD deaths and 21 799 370 (95% UI: 17 395 761-25 947 499) DALYs. Low temperature contributed to 1 104 200 (95% UI: 897 783-1 326 965) CVD deaths and 19 768 986 (95% UI: 16 039 594-23 925 945) DALYs. High temperature contributed to 93 095 (95% UI: 10 827-158 386) CVD deaths and 2 098 989 (95% UI: 146 158-3 625 564) DALYs. Between 1990 and 2019, CVD deaths related to non-optimal temperature increased by 45% (95% UI: 32-63%), low temperature by 36% (95% UI: 25-48%), and high temperature by 600% (95% UI: -1879-2027%). Non-optimal temperature- and high temperature-related CVD deaths increased more in countries with low income than countries with high income. Non-optimal temperatures are significantly associated with global CVD deaths and DALYs, underscoring the significant impact of temperature on public health.

Burden of cardiovascular disease attributable to particulate matter pollution in the eastern Mediterranean region: analysis of the 1990-2019 global burden of disease.

Particulate matter pollution is the most important environmental mediator of global cardiovascular morbidity and mortality. Air pollution evidence from the Eastern Mediterranean Region (EMR) is limited, owing to scarce local studies, and the omission from multinational studies. We sought to investigate trends of particulate matter (PM2.5)-related cardiovascular disease (CVD) burden in the EMR from 1990 to 2019. We used the 1990-2019 global burden of disease methodology to investigate total PM2.5, ambient PM2.5, and household PM2.5-related CVD deaths and disability-adjusted life years (DALYs) and cause-specific CVD mortality in the EMR. The average annual population-weighted PM2.5 exposure in EMR region was 50.3 μg/m3 [95% confidence interval (CI):42.7-59.0] in 2019, which was comparable with 199 048.1 μg/m3 (95% CI: 36.5-65.3). This was despite an 80% reduction in household air pollution (HAP) sources since 1990. In 2019, particulate matter pollution contributed to 25.67% (95% CI: 23.55-27.90%) of total CVD deaths and 28.10% (95% CI: 25.75-30.37%) of DALYs in the region, most of which were due to ischaemic heart disease and stroke. We estimated that 353 071 (95% CI: 304 299-404 591) CVD deaths in EMR were attributable to particulate matter in 2019, including 264 877 (95% CI: 218 472-314 057) and 88 194.07 (95% CI: 60 149-119 949) CVD deaths from ambient PM2.5 pollution and HAP from solid fuels, respectively. DALY's in 2019 from CVD attributable to particulate matter was 28.1% when compared with 26.69% in 1990. The age-standardized death and DALY rates attributable to air pollution was 2122 per 100 000 in EMR in 2019 and was higher in males (2340 per 100 000) than in females (1882 per 100 000). The EMR region experiences high PM2.5 levels with high regional heterogeneity and attributable burden of CVD due to air pollution. Despite significant reductions of overall HAP in the past 3 decades, there is continued HAP exposure in this region with rising trend in CVD mortality and DALYs attributable to ambient sources. Given the substantial contrast in disease burden, exposures, socio-economic and geo-political constraints in the EMR region, our analysis suggests substantial opportunities for PM2.5 attributable CVD burden mitigation.

The burden of musculoskeletal disorders in Belgium: a national population-based study

Abstract Background According to WHO, approximately one in three people worldwide live with a chronic, painful musculoskeletal (MSK) disorder. Low back pain (LBP), neck pain (NKP), osteoarthritis (OST) and rheumatoid arthritis (RHE) are among the most disabling MSK disorders. According to the Global Burden of Disease (GBD) study, LBP was the leading global cause in terms of years lived with disability and OST showed an increase in prevalence and is predicted to be one of the leading future causes. Our study aimed to analyse the burden of these MSK disorders in Belgium, providing a summary of morbidity and mortality outcomes from 2013 to 2018. Methods Prevalence and disability-adjusted life years (DALY) were computed using data from the Belgian health interview surveys from 2013 and 2018, the INTEGO database (Belgian registration network for general practitioners) and GBD study 2019. Mortality data was retrieved from the Belgian statistical office for people dying from RHE. Following GBD methodology, LBP, NKP and OST were assumed to not generate any deaths. Results The prevalence of MSK disorders increased from 2013 to 2018 with OST being the disorder with the highest number of cases (1.7 million cases in 2018). The burden was higher in women and the gender disparities increased with age. Women died also more frequently due to RHE compared to men. In total MSK disorders contributed to 180,746 comorbidity-adjusted DALYs for female and 116,063 comorbidity-adjusted DALYs for men in 2018, with LBP being the largest contributor (140,031 DALY). Conclusions The burden of MSK disorders has increased over the years. In 2018, 2.5 million Belgians were affected by at least one MSK disorder that resulted in almost 300,000 DALY. Our study provides valuable information of a part of the health burden that is known to have a great impact on the total burden of disease but that is sometimes disregarded by public health institutions. Key messages • MSK disorders represent a major health problem in Belgium. • Acting on risk factors associated to these disorders is crucial to mitigate their burden.

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.

Global Burden of Orofacial Clefts and the World Surgical Workforce.

Orofacial clefts are one of the most common congenital anomalies, but this disease burden is unevenly distributed worldwide. The authors hypothesize that this burden falls disproportionately on the countries with the smallest surgical workforce or lowest Socio-Demographic Index, rather than those with the highest prevalence of disease. The authors estimated the prevalence and disease burden of orofacial clefting from 1990 to 2017 in 195 countries using the Global Burden of Disease methodology. Prevalence and disability-adjusted life-years were compared geographically, temporally, and against the size of the national surgical workforce, Socio-Demographic Index, and income status. Linear and logarithmic regressions were performed. In 2017, the prevalence of orofacial clefting was estimated to be 10.8 million people, representing a disease burden of 652,084 disability-adjusted life-years, with most of this disease burden experienced by low- and middle-income countries (94.1%). From 1990 to 2017, there was a decrease in disease burden (-70.2%) and prevalence (-4.9%). There was negative logarithmic association between surgical workforce size and disease burden, with a surgical workforce of greater than six providers per 100,000 population (3.6 disability-adjusted life-years versus 22.4 disability-adjusted life-years per 100,000 population; p < 0.0001). Burden of orofacial clefting has a strong negative association with the size of the surgical workforce, suggesting that strengthening the surgical workforce will help alleviate this burden. Epidemiologic data on countries and regions with inadequate surgical workforces and high disease burden should guide future research efforts and allocation of resources, and guide the treatment and educational goals of international charitable organizations.

The greatest health problem of the Middle Ages? Estimating the burden of disease in medieval England

ObjectiveTo identify the major health problems of the Middle Ages. Bubonic plague is often considered the greatest health disaster in medieval history, but this has never been systematically investigated. MaterialsWe triangulate upon the problem using (i) modern WHO data on disease in the modern developing world, (ii) historical evidence for England such as post-medieval Bills of Mortality, and (iii) prevalences derived from original and published palaeopathological studies. MethodsSystematic analysis of the consequences of these health conditions using Disability Adjusted Life Years (DALYs) according to the Global Burden of Disease methodology. ResultsInfant and child death due to varied causes had the greatest impact upon population and health, followed by a range of chronic/infectious diseases, with tuberculosis probably being the next most significant one. ConclusionsAmong medieval health problems, we estimate that plague was probably 7th–10th in overall importance. Although lethal and disruptive, it struck only periodically and had less cumulative long-term human consequences than chronically endemic conditions (e.g. bacterial and viral infections causing infant and child death, tuberculosis, and other pathogens). SignificanceIn contrast to modern health regimes, medieval health was above all an ecological struggle against a diverse host of infectious pathogens; social inequality was probably also an important contributing factor. LimitationsMethodological assumptions and use of proxy data mean that only approximate modelling of prevalences is possible. Suggestions for further researchProgress in understanding medieval health really depends upon understanding ancient infectious disease through further development of biomolecular methods.

The global burden of atopic dermatitis: lessons from the Global Burden of Disease Study 1990-2017.

The Global Burden of Disease (GBD) Study provides an annually updated resource to study disease-related morbidity and mortality worldwide. Here we present the burden estimates for atopic dermatitis (AD), including data from inception of the GBD project in 1990 until 2017. Data on the burden of AD were obtained from the GBD Study. Atopic dermatitis (AD) ranks 15th among all nonfatal diseases and has the highest disease burden among skin diseases as measured by disability-adjusted life-years (DALYs). Overall, the global DALY rate for AD in 1990 was 121 [95% uncertainty interval (UI) 65·4-201] and remained similar in 2017 at 123 (95% UI 66·8-205). The three countries with the highest DALY rates of AD were Sweden (327, 95% UI 178-547), the UK (284, 95% UI 155-478) and Iceland (277, 95% UI 149-465), whereas Uzbekistan (85·1, 95% UI 45·2-144), Armenia (85·1, 95% UI 45·8-143) and Tajikistan (85·1, 95% UI 46·1-143) ranked lowest. The global prevalence rate of AD has remained stable from 1990 to 2017. However, the distribution of AD by age groups shows a bimodal curve with the highest peak in early childhood, decreasing in prevalence among young adults, and a second peak in middle-aged and older populations. We also found a moderate positive correlation between a country's gross domestic product and disease burden. GBD data confirm the substantial worldwide burden of AD, which has remained stable since 1990 but shows significant geographical variation. Lifestyle factors, partially linked to affluence, are likely important disease drivers. However, the GBD methodology needs to be developed further to incorporate environmental risk factors, such as ultraviolet exposure, to understand better the geographical and age-related variations in disease burden.

Burden of cardiovascular diseases in the region of Monastir (Tunisia)

Abstract Background Cardiovascular disease (CVD) is the leading cause of death in Tunisia. The aim of this study was to analyze CVD burden from 2002 to 2013 in the region of Monastir. Methods Using the Global Burden of Disease methodology, cardiovascular disease mortality and disability-adjusted life years (DALYs) were analyzed by age group and sex for all admissions at the university hospital of Monastir, using standardized approaches for data processing and statistical modeling. Data were retrieved from the regional register of hospital morbidity in Monastir and were analyzed from January 2002 to December 2013. Results CVDs caused 519 in-hospital deaths during the study period, accounting for 43.3 % (CI 95%: 40.6-46.1%) of all in-hospital non-communicable diseases-related mortality (n = 1197). The crude mortality rate of CVDs was 8.81 per 100,000 inh. The highest rate was recorded among patients aged ≥ 60 years-old. The age-standardized mortality rate was 11/100,000 PY (14 in men and 8 in women). CVD DALY per 100,000 was 176.4 (199.4 in men and 152.7 in women). The highest CVD DALY was in the age groupe of 60 years and older (929.7/100,000). The leading causes of DALYs for both sexes are coronary heart diseases and stroke with DALY rate of 112.6 and 47.4 per 100,000 inh, respectively. Conclusions The CVD burden was heavy in the study population, in particular in the elderly and in men. Prevention and control of modifiable risk factors should be taken actively to improve health for Tunisian adults. Key messages CVD burden was heavy in the region of Monastir. More efforts are needed to improve cardiovascular health in Tunisian adults.

The power of administrative data in national studies: experiences from the Scottish Burden of Disease study

Abstract In 2013, the Scottish Burden of Disease Study (SBoD) study set out with an ambitious aim of comprehensively estimating the burden of 132 causes of ill-health and mortality. The study utilised the rich and widespread data which is recorded as a by-product of individual encounters across the universally available and free at point-of-contact healthcare services in Scotland, and other long-standing survey initiatives. It was carried out as an independent national burden of disease study, but used Global Burden of Disease methodology for disability weights. In 2017, our first report outlined the contribution of causes of disease and injury of DALYs. This was followed up in a 2018, with a further report highlighting the effect of socioeconomic inequalities in DALYs. In this presentation we will show the key steps involved in undertaking the SBoD study drawing on available data sources in Scotland. From the Scottish experience we will highlight important issues in knowledge translation for national burden of diseases studies to consider when specific choices are made on the methodological inputs into calculations for both YLL and YLD, specifically: (i) the differential impact between different life tables; (ii) the impact of differences in severity distributions; and (iii) the impact of using different standard populations when directly standardising rates.

Burden of disease due to hip, knee, and unspecified osteoarthritis in the Peruvian social health insurance system (EsSalud), 2016

Introduction: Since its introduction by the World Health Organization (WHO), the concept of burden of disease has been evolving. The current method uses life expectancy projected to 2050 and does not consider age-weighting and time-discounting. Our aim is to estimate the burden of disease due to hip, knee, and unspecified osteoarthritis using this new method in the Peruvian Social Health Insurance System (EsSalud) during 2016. Methods: We followed the original 1994 WHO study and the current 2015 Global Burden of Disease (GBD) methods to estimate disability adjusted life years (DALY) due to osteoarthritis, categorized by sex, age, osteoarthritis type, and geographical area. We used disability weights employed by the Peruvian Ministry of Health, and the last update issued by WHO. Results: Overall, EsSalud reported 17.9 new cases of osteoarthritis per 1000 patients per year. Annual incidence was 23.7/1000 among women, and 72.6/1000 in people above 60 years old. Incidence was 5.6/1000 for knee osteoarthritis and 1.1/1000 for hip. According to the 1994 WHO method, there were 399,884 DALYs or 36.6 DALYs/1000 patients per year due to osteoarthritis. 12.4 and 2.2 DALYs/1000 patients per-year were estimated for knee and hip osteoarthritis, respectively. Using the 2015 GBD method, there were 1,037,865 DALYs or 94.9 DALYs/1000 patients per year. 31.4 and 5.3 DALYs/1000 patients per year were calculated for knee and hip osteoarthritis, respectively. Conclusions: In the Peruvian social health insurance subsystem, hip, knee, and unspecified osteoarthritis produced a high burden of disease, especially among women and patients over 60. The 2015 GBD methodology yields values almost three times higher than the original recommendations.