Years of Life Lost to Death—A Comprehensive Analysis of Mortality in Germany Conducted as Part of the BURDEN 2020 Project

Abstract

Background: Knowing which diseases and causes of death account for most of the years of life lost (YLL) can help to better target appropriate prevention and intervention measures. The YLL in Germany for specific causes of death were estimated as part of the BURDEN 2020 project at the Robert Koch Institute.

Methods: Data from cause-of-death statistics were used for the analysis. ICD codes were grouped into causes of death categories at different levels of disaggregation. The YLL were estimated by combining each cause of death with the remaining life expectancy at the age of death. Deaths and YLL were compared by sex, age category, and regional distribution.

Results: Approximately 11.6 million years were estimated to be lost in Germany in 2017, of which 42.8% were lost by women and 57.2% by men. The largest number of YLL were due to (malignant) neoplasms (35.2%), followed by cardiovascular diseases (27.6%), gastrointestinal diseases (5.8%), and neurological diseases (5.7%). Deaths at younger ages had a greater impact on population health if expressed in YLL: the death share of persons under age 65 was 14.7%, but the years of life lost in this age group amounted to 38.3% of all YLL. The most common causes of death in this group include accidents, self-injury and violence, malignant neoplasms, and alcohol-related diseases.

Conclusion: A large proportion of YLL is borne by young and middle-aged persons. These findings emphasize the need to introduce preventive strategies early in life to reduce the YLL at younger ages, as well as to prevent risk factors for diseases in older ages.

Figure 1

Years of life lost (YLL) and deaths (expressed as proportions) by age group Source: BURDEN 2020 project, cause of death statistics 2017 (our own calculations)

Figure 2

Distribution of years of life lost (YLL) among cause of death categories by age group (level 2; see eTable 5) Source: BURDEN 2020 project, cause of death statistics 2017 (our own calculations; see eTable 5)

Figure 3

The top 20 causes of death in terms of years of life lost (YLL) and numbers of deaths (level 3)* *See eFigure 3 for women and eFigure 4 for menSource: BURDEN 2020 project, cause of death statistics 2017 (our own calculations); UI, uncertainty interval

Figure 4

The top 20 causes of death in terms of years of life lost (YLL) and numbers of deaths (level 3)* *See eFigure 5 for men and eFigure 6 for women 1) Leukemia; 2) epilepsy; 3) brain cancer; 4) alcohol use disorders; 5) sudden infant death; 6) endocrine disorders; 7) drowning; 8) transport injuries (other); 9) road injuries; 10) congenital disorders; 11) self-harm; 12) neonatal disorders; 13) chronic kidney disease; 14) chronic liver disease; 15) colon cancer; 16) hypertensive heart disease; 17) dementias; 18) chronic obstructive pulmonary disease (COPD); 19) stroke; 20) lung cancer; 21) breast cancer; 22) ischemic heart disease

Figure 5

Years of life lost (YLL), by spatial planning region a) per 100 000 inhabitants, b) per 100 000 inhabitants, age standardized Source: BURDEN 2020 project, Federal Statistical Office (our own calculations; see eTable 6); maps generated with ArcGIS (ESRI Inc.)

eFigure 1

Years of life lost (YLL) (absolute number) and YLL rates (per 100 000) by age and sex Source: BURDEN 2020 project, cause of death statistics 2017 (our own calculations)

eFigure 2

Years of life lost (YLL) with the same life expectancy (LE) for women and men and with sex-specific life expectancies Source: Federal Statistical Office, life tables 2016/2018 and deaths 2017 (our own calculations) [Authors’ note: Both for women and for men, there were fewer deaths at the age of 71 in 2017 than at the ages above and below 71 (see also Table 12613–003 in GENESIS-ONLINE with the deaths by age and sex for 2017); this explains the dip in the curves at this point. Because the LE of women is higher than that of men at all ages, if the LE is the same for both sexes this LE is used. For this reason there is only one curve for women in the graph.]