. 2023 Jul 28;22(1):140.

doi: 10.1186/s12939-023-01958-8.

Inequalities in the burden of non-communicable diseases across European countries: a systematic analysis of the Global Burden of Disease 2019 study

Carlos Alexandre Soares Andrade¹, Nour Mahrouseh¹, Jonila Gabrani², Periklis Charalampous³, Sarah Cuschieri⁴, Diana Alecsandra Grad^{5

6}, Brigid Unim⁷, Enkeleint A Mechili^{8

9}, José Chen-Xu^{10

11}, Brecht Devleesschauwer^{12

13}, Gaetano Isola¹⁴, Elena von der Lippe¹⁵, Carl Michael Baravelli¹⁶, Florian Fischer¹⁷, Nanna Weye^{16

18}, Mirza Balaj¹⁹, Romana Haneef²⁰, Mary Economou²¹, Juanita A Haagsma³, Orsolya Varga²²

Affiliations

¹ Department of Public Health and Epidemiology, Faculty of Medicine, University of Debrecen, 26 Kassai Street, 4028, Debrecen, Hungary.
² Faculty of Medicine, University of Basel, Basel, Switzerland.
³ Department of Public Health, Erasmus MC University Medical Center, Rotterdam, The Netherlands.
⁴ Faculty of Medicine and Surgery, University of Malta, Msida, Malta.
⁵ Department of Public Health, Babes-Bolyai University, Cluj-Napoca-Napoca, Romania.
⁶ RoNeuro Institute for Neurological Research and Diagnostic, Cluj-Napoca-Napoca, Romania.
⁷ Department of Cardiovascular, Endocrine-Metabolic Diseases and Aging, Istituto Superiore Di Sanità, Rome, Italy.
⁸ Department of Healthcare, Faculty of Health, University of Vlora, Vlora, Albania.
⁹ Clinic of Social and Family Medicine, School of Medicine, University of Crete, Crete, Greece.
¹⁰ Public Health Unit, Primary Healthcare Cluster Baixo Mondego, Coimbra, Portugal.
¹¹ National School of Public Health, NOVA University of Lisbon, Lisbon, Portugal.
¹² Department of Epidemiology and Public Health, Sciensano, Brussels, Belgium.
¹³ Department of Translational Physiology, Infectiology and Public Health, Ghent University, Merelbeke, Belgium.
¹⁴ Department of General Surgery and Surgical Medical Specialties, University of Catania, Catania, Italy.
¹⁵ Department of Epidemiology and Health Monitoring, Robert Koch Institute, Berlin, Germany.
¹⁶ Department of Disease Burden, Norwegian Institute of Public Health, Bergen, Norway.
¹⁷ Institute of Public Health, Charité - Universitätsmedizin Berlin, Berlin, Germany.
¹⁸ Department of Clinical Epidemiology, Aarhus University and Aarhus University Hospital, Aarhus, Denmark.
¹⁹ Department of Sociology and Political Science, Centre for Global Health Inequalities Research (CHAIN), Norwegian University of Science and Technology (NTNU), Trondheim, Norway.
²⁰ Department of Non-Communicable Diseases and Injuries, Santé Publique France, Saint-Maurice, France.
²¹ Department of Nursing, School of Health Sciences, Cyprus University of Technology, Limassol, Cyprus.
²² Department of Public Health and Epidemiology, Faculty of Medicine, University of Debrecen, 26 Kassai Street, 4028, Debrecen, Hungary. varga.orsolya@med.unideb.hu.

PMID: 37507733
PMCID: PMC10375608
DOI: 10.1186/s12939-023-01958-8

Inequalities in the burden of non-communicable diseases across European countries: a systematic analysis of the Global Burden of Disease 2019 study

Carlos Alexandre Soares Andrade et al. Int J Equity Health. 2023.

. 2023 Jul 28;22(1):140.

doi: 10.1186/s12939-023-01958-8.

Authors

Affiliations

¹ Department of Public Health and Epidemiology, Faculty of Medicine, University of Debrecen, 26 Kassai Street, 4028, Debrecen, Hungary.
² Faculty of Medicine, University of Basel, Basel, Switzerland.
³ Department of Public Health, Erasmus MC University Medical Center, Rotterdam, The Netherlands.
⁴ Faculty of Medicine and Surgery, University of Malta, Msida, Malta.
⁵ Department of Public Health, Babes-Bolyai University, Cluj-Napoca-Napoca, Romania.
⁶ RoNeuro Institute for Neurological Research and Diagnostic, Cluj-Napoca-Napoca, Romania.
⁷ Department of Cardiovascular, Endocrine-Metabolic Diseases and Aging, Istituto Superiore Di Sanità, Rome, Italy.
⁸ Department of Healthcare, Faculty of Health, University of Vlora, Vlora, Albania.
⁹ Clinic of Social and Family Medicine, School of Medicine, University of Crete, Crete, Greece.
¹⁰ Public Health Unit, Primary Healthcare Cluster Baixo Mondego, Coimbra, Portugal.
¹¹ National School of Public Health, NOVA University of Lisbon, Lisbon, Portugal.
¹² Department of Epidemiology and Public Health, Sciensano, Brussels, Belgium.
¹³ Department of Translational Physiology, Infectiology and Public Health, Ghent University, Merelbeke, Belgium.
¹⁴ Department of General Surgery and Surgical Medical Specialties, University of Catania, Catania, Italy.
¹⁵ Department of Epidemiology and Health Monitoring, Robert Koch Institute, Berlin, Germany.
¹⁶ Department of Disease Burden, Norwegian Institute of Public Health, Bergen, Norway.
¹⁷ Institute of Public Health, Charité - Universitätsmedizin Berlin, Berlin, Germany.
¹⁸ Department of Clinical Epidemiology, Aarhus University and Aarhus University Hospital, Aarhus, Denmark.
¹⁹ Department of Sociology and Political Science, Centre for Global Health Inequalities Research (CHAIN), Norwegian University of Science and Technology (NTNU), Trondheim, Norway.
²⁰ Department of Non-Communicable Diseases and Injuries, Santé Publique France, Saint-Maurice, France.
²¹ Department of Nursing, School of Health Sciences, Cyprus University of Technology, Limassol, Cyprus.
²² Department of Public Health and Epidemiology, Faculty of Medicine, University of Debrecen, 26 Kassai Street, 4028, Debrecen, Hungary. varga.orsolya@med.unideb.hu.

PMID: 37507733
PMCID: PMC10375608
DOI: 10.1186/s12939-023-01958-8

Abstract

Background: Although overall health status in the last decades improved, health inequalities due to non-communicable diseases (NCDs) persist between and within European countries. There is a lack of studies giving insights into health inequalities related to NCDs in the European Economic Area (EEA) countries. Therefore, the aim of the present study was to quantify health inequalities in age-standardized disability adjusted life years (DALY) rates for NCDs overall and 12 specific NCDs across 30 EEA countries between 1990 and 2019. Also, this study aimed to determine trends in health inequalities and to identify those NCDs where the inequalities were the highest.

Methods: DALY rate ratios were calculated to determine and compare inequalities between the 30 EEA countries, by sex, and across time. Annual rate of change was used to determine the differences in DALY rate between 1990 and 2019 for males and females. The Gini Coefficient (GC) was used to measure the DALY rate inequalities across countries, and the Slope Index of Inequality (SII) to estimate the average absolute difference in DALY rate across countries.

Results: Between 1990 and 2019, there was an overall declining trend in DALY rate, with larger declines among females compared to males. Among EEA countries, in 2019 the highest NCD DALY rate for both sexes were observed for Bulgaria. For the whole period, the highest DALY rate ratios were identified for digestive diseases, diabetes and kidney diseases, substance use disorders, cardiovascular diseases (CVD), and chronic respiratory diseases - representing the highest inequality between countries. In 2019, the highest DALY rate ratio was found between Bulgaria and Iceland for males. GC and SII indicated that the highest inequalities were due to CVD for most of the study period - however, overall levels of inequality were low.

Conclusions: The inequality in level 1 NCDs DALYs rate is relatively low among all the countries. CVDs, digestive diseases, diabetes and kidney diseases, substance use disorders, and chronic respiratory diseases are the NCDs that exhibit higher levels of inequality across countries in the EEA. This might be mitigated by applying tailored preventive measures and enabling healthcare access.

Keywords: DALY rate; European Economic Area; European Union; Global Burden of Disease; Health inequality; Non-communicable diseases.

PubMed Disclaimer

Conflict of interest statement

The authors declare no competing interests.

Figures

**Fig. 1**
Ratio of age-standardized level 1 NCDs DALY rates for EEA Member States by sex, 2019. Legend: blue color represents ratios closer to 1 (equality), and red color represents ratios further from 1 (inequality). Ratios in bold and underlined represent statistical difference between DALY rate of compared countries (95% UI not overlapping). Ratios for females are above the diagonal line, and for males are under the line

**Fig. 2**
Age-standardized level 1 NCDs DALY rates by EEA Member States and sex, 1990–2019. Legend: UI 95% for the overall highest (Bulgaria) and lowest (Iceland) DALY rate are shown in grey and blue shaded band, respectively. The order of the country lines within the graphs corresponds to the order of the country labels next to each graph

**Fig. 3**
Age-standardized level 1 NCDs DALY annual rate of change, 1990–2019

**Fig. 4**
Age-standardized DALY rate ratio by level 2 cause of disease between 1990 and 2019. Legend: Ratio is calculated for each NCD at level 2 by dividing the highest-ranking DALY rate by the lowest-ranking per year of the study period. NCDs: noncommunicable diseases and CVDs: cardiovascular diseases

**Fig. 5**
Gini coefficient of age-standardized NCDs DALY rate in EEA Member States, 1990–2019. Legend: NCDs: non-communicable diseases and CVDs: cardiovascular diseases

**Fig. 6**
Slope Index of Inequality of age-standardized NCDs DALY rate in EEA Member States, 1990–2019. Legend: NCDs: non-communicable diseases and CVDs: cardiovascular diseases

See this image and copyright information in PMC

References

1. Global Burden of Disease Collaborative Network, Global Burden of Disease Study 2019 (GBD 2019) Results (Institute for Health Metrics and Evaluation – IHME) https://vizhub.healthdata.org/gbd-results/.
1. NCD Data Portal - World Health Organization. https://ncdportal.org/Indicators.
1. Di Cesare M. Global trends of chronic non-communicable diseases risk factors. Eur J Public Health. 2019;29:ckz185–196. doi: 10.1093/eurpub/ckz185.196. - DOI
1. Budreviciute A, Damiati S, Sabir DK, Onder K, Schuller-Goetzburg P, Plakys G, et al. Management and prevention strategies for non-communicable diseases (NCDs) and their risk factors. Front Public Health. 2020;8:788. - PMC - PubMed
1. Sommer I, Griebler U, Mahlknecht P, Thaler K, Bouskill K, Gartlehner G, Mendis S. Socioeconomic inequalities in non-communicable diseases and their risk factors: an overview of systematic reviews. BMC Public Health. 2015;15:1–12. doi: 10.1186/s12889-015-2227-y. - DOI - PMC - PubMed

Publication types

Actions

MeSH terms

Actions
Actions
Actions
Actions
Actions
Actions
Actions
Actions
Actions
Actions

LinkOut - more resources

Full Text Sources
Miscellaneous
- NCI CPTAC Assay Portal

Save citation to file

Email citation

Add to Collections

Add to My Bibliography

Your saved search

Create a file for external citation management software

Your RSS Feed

Inequalities in the burden of non-communicable diseases across European countries: a systematic analysis of the Global Burden of Disease 2019 study

Affiliations

Inequalities in the burden of non-communicable diseases across European countries: a systematic analysis of the Global Burden of Disease 2019 study

Authors

Affiliations

Abstract

Conflict of interest statement

Figures

References

Publication types

MeSH terms

LinkOut - more resources

Full Text Sources

Miscellaneous