The estimated disease burden of acute COVID-19 in the Netherlands in 2020, in disability-adjusted life-years

Abstract

The impact of COVID-19 on population health is recognised as being substantial, yet few studies have attempted to quantify to what extent infection causes mild or moderate symptoms only, requires hospital and/or ICU admission, results in prolonged and chronic illness, or leads to premature death. We aimed to quantify the total disease burden of acute COVID-19 in the Netherlands in 2020 using the disability-adjusted life-years (DALY) measure, and to investigate how burden varies between age-groups and occupations. Using standard methods and diverse data sources (mandatory notifications, population-level seroprevalence, hospital and ICU admissions, registered COVID-19 deaths, and the literature), we estimated years of life lost (YLL), years lived with disability, DALY and DALY per 100,000 population due to COVID-19, excluding post-acute sequelae, stratified by 5-year age-group and occupation category. The total disease burden due to acute COVID-19 was 286,100 (95% CI: 281,700-290,500) DALY, and the per-capita burden was 1640 (95% CI: 1620-1670) DALY/100,000, of which 99.4% consisted of YLL. The per-capita burden increased steeply with age, starting from 60 to 64 years, with relatively little burden estimated for persons under 50 years old. SARS-CoV-2 infection and associated premature mortality was responsible for a considerable direct health burden in the Netherlands, despite extensive public health measures. DALY were much higher than for other high-burden infectious diseases, but lower than estimated for coronary heart disease. These findings are valuable for informing public health decision-makers regarding the expected COVID-19 health burden among population subgroups, and the possible gains from targeted preventative interventions.

Keywords: COVID-19; Disability-adjusted life-years; Disease burden; Netherlands; Pandemic.

Fig. 1

Estimated cumulative incidence of symptomatic infection (SI) per 5-year age-group with 95% CIs, 27 February through 31 December 2020

Fig. 2

Estimated DALY (split into YLD and YLL) per 5-year age-group with 95% CIs, 27 February through 31 December 2020. Inset zooms in on the age-groups < 1 year to 30–34 years

Fig. 3

Estimated disease burden per 5-year age-group as DALY per 100,000 population, 27 February through 31 December 2020

Fig. 4

Estimated absolute disease burden (in DALY) per occupation category and 5-year age-group, 27 February through 31 December 2020. Inset zooms in on the age-groups 20–24 years through 40–44 years

Fig. 5

Estimated disease burden per occupation category and 5-year age-group (as DALY per 10,00,000 persons in each category within each age-group), 27 February through 31 December 2020, and shown for the age range 20–69 years only