Burden of non-communicable disease studies in Europe: a systematic review of data sources and methodological choices

Abstract

Background: Assessment of disability-adjusted life years (DALYs) resulting from non-communicable diseases (NCDs) requires specific calculation methods and input data. The aims of this study were to (i) identify existing NCD burden of disease (BoD) activities in Europe; (ii) collate information on data sources for mortality and morbidity; and (iii) provide an overview of NCD-specific methods for calculating NCD DALYs.

Methods: NCD BoD studies were systematically searched in international electronic literature databases and in grey literature. We included all BoD studies that used the DALY metric to quantify the health impact of one or more NCDs in countries belonging to the European Region.

Results: A total of 163 BoD studies were retained: 96 (59%) were single-country or sub-national studies and 67 (41%) considered more than one country. Of the single-country studies, 29 (30%) consisted of secondary analyses using existing Global Burden of Disease (GBD) results. Mortality data were mainly derived (49%) from vital statistics. Morbidity data were frequently (40%) drawn from routine administrative and survey datasets, including disease registries and hospital discharge databases. The majority (60%) of national BoD studies reported mortality corrections. Multimorbidity adjustments were performed in 18% of national BoD studies.

Conclusion: The number of national NCD BoD assessments across Europe increased over time, driven by an increase in BoD studies that consisted of secondary data analysis of GBD study findings. Ambiguity in reporting the use of NCD-specific BoD methods underlines the need for reporting guidelines of BoD studies to enhance the transparency of NCD BoD estimates across Europe.

Figure 1

Flowchart of the search of existing burden of disease studies in the ‘Global Burden of Disease’ European region countries

Figure 2

Number of existing burden of disease assessments per European country. *Please note that the number of the identified studies refers to BoD assessments performed between the January 1990 and April 2020 period

Figure 3

Total number of existing burden of disease assessments by year of publication. *Please note that the number of the identified studies refers to BoD assessments performed between January 1990 and April 2020. **There were no studies published in 2010 that met our eligibility criteria

Figure 4

Data input sources for morbidity (left) and mortality (right) in the single-country burden of disease studies (N = 96) performed in 22 European countries. *Adm: Administrative data; GBD: Global Burden of Disease; GP: General Practitioner. **Please note that the size and the colour of each circle correspond to the amount of burden of disease studies for each European country in each data source for morbidity (left) and mortality (right). The bigger (and lighter) the circle, the higher the number of BoD studies