The Burden of Disease in Germany at the National and Regional Level—Results in Terms of Disability-Adjusted Life Years (DALY) from the BURDEN 2020 Study

Abstract

Background: .Summary measures such as disability-adjusted life years (DALY) are becoming increasingly important for the standardized assessment of the burden of disease due to death and disability. The BURDEN 2020 pilot project was designed as an independent burden-of-disease study for Germany, which was based on nationwide data, but which also yielded regional estimates.

Methods: DALY is defined as the sum of years of life lost due to death (YLL) and years lived with disability (YLD). YLL is the difference between the age at death due to disease and the remaining life expectancy at this age, while YLD quantifies the number of years individuals have spent with health impairments. Data are derived mainly from causes of death statistics, population health surveys, and claims data from health insurers.

Results: In 2017, there were approximately 12 million DALY in Germany, or 14 584 DALY per 100 000 inhabitants. Conditions which caused the greatest number of DALY were coronary heart disease (2321 DALY), low back pain (1735 DALY), and lung cancer (1197 DALY). Headache and dementia accounted for a greater disease burden in women than in men, while lung cancer and alcohol use disorders accounted for a greater disease burden in men than in women. Pain disorders and alcohol use disorders were the leading causes of DALY among young adults of both sexes. The disease burden rose with age for some diseases, including cardiovascular diseases, dementia, and diabetes mellitus. For some diseases and conditions, the disease burden varied by geographical region.

Conclusion: The results indicate a need for age- and sex-specific prevention and for differing interventions according to geographic region. Burden of disease studies yield comprehensive population health surveillance data and are a useful aid to decision-making in health policy.

Figure 1

Total burden of disease (DALY per 100 000 population [pop]) for selected causes of burden of disease by sex (Level 3, Germany), error bars correspond to the 95% UI; source: BURDEN 2020; YLL: cause of death statistics 2017 (31), Federal Statistical Office of Germany 2018 (32); YLD: eTable 3; our own calculations; only 17 ranks each are presented here since no DALY were calculated for prostate cancer in women and breast cancer in men, and the residual category “Other transport injuries” is not shown (eTable 1, eTable 2); data limitations must be taken into account when making a direct comparison of DALY (etable 3); COPD, chronic obstructive pulmonary disease; DALY, disability-adjusted life years; RI, road injuries; YLL, years of life lost due to death; YLD, years lived with disability

Figure 2

Relative contribution of YLL and YLD to the total burden of disease (absolute DALY) for the selected causes of burden of disease (level 3, Germany, both sexes) Source: BURDEN 2020; YLL: Cause of death statistics 2017 (31), Federal Statistical Office of Germany 2018 (32); YLD: eTable 3; own calculations; the residual category “Other transport injuries” is excluded (eTable 1, eTable 2); COPD, chronic obstructive pulmonary disease; DALY, disability-adjusted life years; IHD, coronary heart disease; YLL, years of life lost due to death; YLD, years lived with disability

Figure 3

Total burden of disease (age-standardized DALY per 100 000 population) at the spatial planning regions level (level 3, both sexes) for the sum of all causes of burden of disease (Map I), and for IHD (Map II), COPD (Map III) and depressive disorders (Map IV); range in brackets Source: BURDEN 2020; YLL: Cause of death statistics 2017 (31), Federal Statistical Office of Germany 2018 (32); YLD: eTable 3; our own calculations; spatial planning regions, see Federal Institute for Research on Building, Urban Affairs and Spatial Development (BBSR) (34); Map I total burden of disease. Excluded from Map I are pain disorders and alcohol use disorders due to the lack of spatial data resolution (eTable); COPD, chronic obstructive pulmonary disease; DALY, disability-adjusted life years; IHD, ischemic heart disease; YLL, years of life lost due to death; YLD, years lived with disability

eFigure 1

Total burden of disease (DALY per 100 000 population [pop]) of the selected causes of burden of disease by sex (level 4, Germany), error bars correspond to the 95% UI Source: BURDEN 2020; YLL: Cause of death statistics 2017 (31), Federal Statistical Office of Germany 2018 (32); YLD: (etable 3); our own calculations; only 26 ranks each are presented here because no DALY were calculated for prostate cancer in women and breast cancer in men, and the residual category “Other transport injuries” is not shown (eTable 1, eTable 2); data limitations must be taken into account when making a direct comparison of DALY (etable 3); COPD, chronic obstructive pulmonary disease; DALY, disability-adjusted life years; RI, Road injuries; YLL, years of life lost due to death; YLD, years lived with disability

eFigure 2

Burden of disease (DALY per 100 000 population by YLL and YLD) for road injuries with increasing age and according to sex (level 3, Germany) Source: BURDEN 2020; YLL: Cause of death statistics 2017 (31), Federal Statistical Office of Germany 2018 (32); YLD: eTable 3; our own calculations; DALY, disability-adjusted life years; YLL, years of life lost due to death; YLD, years lived with disability