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. 2024 May 22;24(1):1374.
doi: 10.1186/s12889-024-18529-3.

The state of health in the European Union (EU-27) in 2019: a systematic analysis for the Global Burden of Disease study 2019

João Vasco Santos  1   2   3 , Alicia Padron-Monedero  4 , Boris Bikbov  5 , Diana Alecsandra Grad  6   7 , Dietrich Plass  8 , Enkeleint A Mechili  9   10 , Federica Gazzelloni  11 , Florian Fischer  12 , Gerhard Sulo  13 , Che Henry Ngwa  14 , Isabel Noguer-Zambrano  4 , José L Peñalvo  15 , Juanita A Haagsma  16 , Katarzyna Kissimova-Skarbek  17 , Lorenzo Monasta  18 , Nermin Ghith  19 , Rodrigo Sarmiento-Suarez  4   20 , Rok Hrzic  21 , Romana Haneef  22 , Rónán O'Caoimh  23   24 , Sarah Cuschieri  25 , Stefania Mondello  26 , Zubair Kabir  27 ; GBD 2019 EU State of Health Collaborators; Alberto Freitas  28   29 , Brecht Devleesschauwer  30   31
Collaborators, Affiliations

The state of health in the European Union (EU-27) in 2019: a systematic analysis for the Global Burden of Disease study 2019

João Vasco Santos et al. BMC Public Health. .

Abstract

Background: The European Union (EU) faces many health-related challenges. Burden of diseases information and the resulting trends over time are essential for health planning. This paper reports estimates of disease burden in the EU and individual 27 EU countries in 2019, and compares them with those in 2010.

Methods: We used the Global Burden of Disease 2019 study estimates and 95% uncertainty intervals for the whole EU and each country to evaluate age-standardised death, years of life lost (YLLs), years lived with disability (YLDs) and disability-adjusted life years (DALYs) rates for Level 2 causes, as well as life expectancy and healthy life expectancy (HALE).

Results: In 2019, the age-standardised death and DALY rates in the EU were 465.8 deaths and 20,251.0 DALYs per 100,000 inhabitants, respectively. Between 2010 and 2019, there were significant decreases in age-standardised death and YLL rates across EU countries. However, YLD rates remained mainly unchanged. The largest decreases in age-standardised DALY rates were observed for "HIV/AIDS and sexually transmitted diseases" and "transport injuries" (each -19%). "Diabetes and kidney diseases" showed a significant increase for age-standardised DALY rates across the EU (3.5%). In addition, "mental disorders" showed an increasing age-standardised YLL rate (14.5%).

Conclusions: There was a clear trend towards improvement in the overall health status of the EU but with differences between countries. EU health policymakers need to address the burden of diseases, paying specific attention to causes such as mental disorders. There are many opportunities for mutual learning among otherwise similar countries with different patterns of disease.

Keywords: European Burden of Disease Network; European Union; Global Burden of Diseases; Health status; Population health.

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Conflict of interest statement

J Alonso reports grants or contracts from Instituto de Salud Carlos III, Spain MINDCOVID. COV20/0711, Instituto de Salud Carlos III, Spain PROMES-U. PI20/00006, and Departament de Salut, Generalitat de Catalunya, Spain. WEMWBS-CAT, SA-2021–741, as payments to their institution, outside the submitted work. R Ancuceanu reports consulting fees from Abbvie; payment or honoraria for lectures, presentations, speakers bureaus, manuscript writing or educational events from Abbive, B Braun, Sandoz, and Laropharm; support for attending meetings and/or travel from Abbive; all outside the submitted work. J Ärnlöv payment or honoraria for lectures, presentations, speakers bureaus, manuscript writing or educational events from AstraZeneca and Novartis; participation on Advisory Boards for AstraZeneca, Boehringer Ingelheim, and Astella; all outside the submitted work. T W Bärnighausen reports research grants from the European Union (Horizon 2020 and EIT Health), German Research Foundation (DFG), US National Institutes of Health, German Ministry of Education and Research, Alexander von Humboldt Foundation, Else-Kröner-Fresenius-Foundation, Wellcome Trust, Bill & Melinda Gates Foundation, KfW, UNAIDS, and the WHO; consulting fees for KfW on the OSCAR initiative in Vietnam; participation on a Data Safety Monitoring Board or Advisory Board with NIH-funded study “Healthy Options” (PIs: Smith Fawzi, Kaaya), Chair, Data Safety and Monitoring Board (DSMB), German National Committee on the “Future of Public Health Research and Education”, Chair of the scientific advisory board to the EDCTP Evaluation, Member of the UNAIDS Evaluation Expert Advisory Committee, National Institutes of Health Study Section Member on Population and Public Health Approaches to HIV/AIDS (PPAH), US National Academies of Sciences, Engineering, and Medicine’s Committee for the “Evaluation of Human Resources for Health in the Republic of Rwanda under the President’s Emergency Plan for AIDS Relief (PEPFAR)”, University of Pennsylvania (UPenn) Population Aging Research Center (PARC) External Advisory Board Member; leadership or fiduciary role in other board, society, committee or advocacy group, paid or unpaid as Co-chair of the Global Health Hub Germany (which was initiated by the German Ministry of Health). S Basu reports grants from the US National Institutes of Health and US Centers for Disease Control and Prevention; consulting fees from University of California San Francisco; patents planned, issued or pending, for a multi-modal patient outreach system; participation on an advisory board with La Scuola International School; leadership or fiduciary role on a board with Waymark, paid or unpaid; personal stock options in Collective Health and Waymark; all outside the submitted work. B Baune reports personal payment or honoraria for lectures, presentations, speakers bureaus, manuscript writing or educational events from Janssen Cilag and LivaNova, outside the submitted work. L Belo reports other financial or non-financial interests from the FCT in the scope of the project UIDP/04378/2020 and UIDB/04378/2020 of UCIBIO and the project LA/P/0140/2020 of i4HB. B Bikbov reports grants or contracts from the European Commission as personal payments, and from the Lombardy Region as payments to their institution; support for attending a meeting from the European Commission; leadership or fiduciary role, unpaid, in the Advocacy Working Group at the International Society of Nephrology; all outside the submitted work. D Buonsenso reports grants from Pfizer and Roche on long covid; support for attending meetings and/or travel from Pfizer for the ESPID meeting on covid vaccines; participation on a Data Safety Monitoring Board or Advisory Board from Pfizer for pneumococcal vaccines; all outside the submitted work. R Busse reports grants or contracts from the Innovation Fund (by Federal Joint Committee) as payments to their institution; consulting fees from Dresden hospitals and Paracelsus hospitals as personal payments; payment or honoraria for lectures, presentations, speakers bureaus, manuscript writing or educational events from Lilly, Abbvie and the Barmer Sickness Fund as personal payments; leadership or fiduciary role in other board, society, committee or advocacy group, paid or unpaid with the Government Commission on Hospital Reform; all outside the submitted work. M Carvalho reports other financial or non-financial interests from the FCT in the scope of the project UIDP/04378/2020 and UIDB/04378/2020 of UCIBIO and the project LA/P/0140/2020 of i4HB. J S Chandan reports grants or contracts from the National Institute for Health Research through College of Policing, the Youth Endowment Fund at the University of Birmingham and the Home Office. H Christensen reports grants or contracts from Veluxfonden, Novofonden, Helsefonden, Lundbeck fonden, and Tværsfonden; royalites and licenses from Gyldendals forlag (Medicinsk Kompendium); payment or honoraria for lectures, presentations, speakers bureaus, manuscript writing or educational events from Bayer and BMS; leadership or fiduciary role in the Action Plan for Stroke in Europe as Chair, (unpaid); all outside the submitted work. J Conde reports grants from the European Research Council Starting ERC-StG-2019–848325 (funding 1.5 M€) outside the submitted work. D Dias da Silva reports grants or contracts from faculty of Pharmacy of University of Porto as personal payment for lecturers and research activities, escola Superior de Saúde—Instituto Politécnico de Leiria as personal payment for lecturers, and Instituto Universitário de Ciências da Saúde (IUCS) as personal payment for lecturers; consulting fees from Albert Labs as personal payments and payments to their institution, Eurox Pharma as payments to their institution; payment or honoraria for lectures, presentations, speakers bureaus, manuscript writing or educational events from the Faculty of Pharmacy of University of Porto, Escola Superior de Saúde—Instituto Politécnico de Leiria, and Instituto Universitário de Ciências da Saúde (IUCS) all as personal payments for lectures; support to attend ICT 2022 – XVIth International Congress of Toxicology from Eurox Pharma; leadership or fiduciary role in the Portuguese Association of Forensic Sciences (APCF) as a member of the board; receipt of support to buy materials to research from Albert Labs and Eurox Pharma; all outside the submitted work. G Gazzard reports consulting fees from Alcon, Allergan, Belkin, Equinox, Genentech, Glaukos, Ivantis, McKinsey, Reichert, Ripple, Santen, Sight Sciences, Thea, Vialase, and Zeiss; payment or honoraria for lectures, presentations, speakers bureaus, manuscript writing or educational events from Alcon, Allergan, Belkin, Glaukos, Ivantis, Lumibird, McKinsey, Reichert, Sight Sciences, and Thea; leadership or fiduciary role in other board, society, committee or advocacy group, paid or unpaid, with the President UK & Ireland Glaucoma Society, and as an Advisor for Glaucoma UK Charity; al outside the submitted work. N Ghith reports support for the present manuscript from Novo Nordisk Foundation (NNF16OC0021856) as a grant to the research group. P S Gill reports leadership or fiduciary role in other board, society, committee or advocacy group, paid or unpaid, as NIHR senior investigator for the NIHR Department of Health and Social Care, UK, outside the submitted work. The views expressed are those of the author(s) and not necessarily those of the NHS, the NIHR or the Department of Health and Social Care. R Hrzic reports support for the present manuscript from the Department of International Health, Care and Public Health Research Institute – CAPHRI, Maastricht University, Maastricht, the Netherlands. J Jozwiak reports payment or honoraria for lectures, presentations, speakers bureaus, manuscript writing or educational events from Novartis and Adamed as personal fees, outside the submitted work. M AB Khan reports grants from G00003634- CMHS – NP-22–20 (80,000 AED), G00003569 NP-21–13 (80,000 AED), and 1976—SDG Research Program Grant (40,000 AED), outside the submitted work. M Klugar reports grants from Czech-Norwegian Collaboration on Meta-Research and Critical Thinking Education in Healthcare (EHP-CZ-ICP-2–009), Evidence Implementation in Clinical Practice (2020–1-DE01-KA203-005669), Towards an International Network for Evidence-based Research in Clinical Health Research in the Czech Republic (LTC20031), Strategic Partnership in Innovation and Development of Evidence-Based Healthcare (2019–1-CZ01-KA202-061350), all as payments to their institution; membership of Cochrane advisory board for Evidence Advocacy, unpaid; other non-financial interests as Director of Cochrane, JBI and GRADE centres of the Czech Republic; all outside the submitted work. H J Larson reports research grants to the London School of Hygiene and Tropical Medicine from the Janssen, Merck, and the MarcArthur Foundation; support for travel from Merrimon Honorary Lecture, UNC; all outside the submitted work. J V Lazarus reports grants AbbVie, Gilead Sciences, MSD, Roche Diagnostics as grants to ISGlobal; consulting fees from NovoVax; payment or honoraria for lectures, presentations, speakers bureaus, manuscript writing or educational events from AbbVie, Gilead Sciences, Intercept, Janssen, Novo Nordisk; unpaid participation on a Data Safety Monitoring Board or Advisory Board for a same-visit hepatitis C testing and treatment to accelerate cure among people who inject drugs (The QuickStart Study): a cluster randomised control trial – Australia; leadership or fiduciary role in other board, society, committee or advocacy group, unpaid, as a Member of EASL Public Health and Policy Committee, co-chair of HIV Outcomes, and SHARE Global Health Foundation; all outside the submitted work. G Logroscino reports payment or honoraria for lectures, presentations, speakers bureaus, manuscript writing or educational events from Roche Spa for a teaching course, outside the submitted work. S Lorkowski reports grants or contracts from Akcea Therapeutics Germany as payments made to their institution; consulting fees from Danone, Novartis Pharma, and Swedish Orphan Biovitrum (SOBI) as personal payments; payment or honoraria for lectures, presentations, speakers bureaus, manuscript writing or educational events from Akcea Therapeutics Germany, AMARIN Germany, Amedes Holding, AMGEN, Berlin-Chemie, Boehringer Ingelheim Pharma, Daiichi Sankyo Deutschland, Danone, Hubert Burda Media Holding, Janssen-Cilag, Lilly Deutschland, Novartis Pharma, Novo Nordisk Pharma, Roche Pharma, Sanofi-Aventis, and SYNLAB Holding Deutschland & SYNLAB Akademie, all as personal payments; support for attending meetings and/or travel from AMGEN and NOVO Nordisk Pharma as personal payments; participation on a Data Safety Monitoring Board or Advisory Board with Akcea Therapeutics Germany, AMGEN, Daiichi Sankyo Deutschland, Novartis, and Sanofi-Aventis as personal payments; all outside the submitted work. A M Madureira-Carvalho reports grants or contracts from Instituto Universitário de Ciências da Saúde (IUCS) as personal payments; consulting fees from Albert lab as personal and institutional payments and from Eurox Pharma as institutional payments; payment for lectures from Instituto Universitário de Ciências da Saúde (IUCS); support from Eurox Pharma to attend ICT 2022 – XVIth International Congress of Toxicology; leadership or fiduciary role, paid or unpaid, as Board Treasurer for the Portuguese Association of Forensic Sciences (APCF); receipt of support to buy materials for research from Albert Labs and Eurox Pharma; all outside the submitted work. A-F Mentis reports grants or contracts from ‘MilkSafe: A novel pipeline to enrich formula milk using omics technologies’, a research co financed by the European Regional Development Fund of the European Union and Greek national funds through the Operational Program Competitiveness, Entrepreneurship and Innovation, under the call RESEARCH—CREATE—INNOVATE (project code: T2EDK-02222), as well as from ELIDEK (Hellenic Foundation for Research and Innovation, MIMS-860) (both outside of the present manuscript); stock or stock options in a family winery; other financial or non-financial interest as a scientific officer with BGI Group; all outside the submitted work. S Mohammed reports support for the present manuscript from the Bill and Melinda Gates Foundation; a fellowship grant from the Alexander von Humboldt Foundation, outside the submitted work. A Otoiu reports grants or contracts from the Bucharest University for Economic Studies as personal payments, and from European Commission: Horizon 2020 as payments made to their institution; both outside the submitted work. R Palladino reports grants or contracts from the UK MS Society; consulting fees from Sanofi; payment or honoraria for lectures, presentations, speakers bureaus, manuscript writing or educational events from MSD; all outside the submitted work. C B Peterson reports grants or contracts from a consultancy with WHO Regional Office for Europe, focus on disability inclusion in health sectors as personal payments; consulting fees from the WHO Regional Office for Europe, outside the submitted work. M Pinheiro reports grants or contracts from Fundação para a Ciência e Tecnologia (FCT) (research grant) outside the submitted work. M J Postma reports stock or stock options Health-Ecore (Zeist, NL) and PAG BV (Groningen, NL), outside the submitted work. G Remuzzi reports consulting fees from Janssen, Otsuka Pharmaceuticals, Boehringher Ingheleim, Menarini Ricerche, BioCryst Pharmaceuticals, Alexion Pharmaceuticals; payment or honoraria for lectures, presentations, speakers bureaus, manuscript writing or educational events from Novartis Pharma as external expert: co-chair and speaker 59th ERA congress, and from AstraZeneca Pharmaceuticals; participation on a Data Safety Monitoring Board or Advisory Board from Silence Therapeutics, Omerois Corporation, and Alexion Pharmaceuticals; all outside the submitted work. A Riad reports grants and contracts from the Ministry of Education, Youth and Sports of the Czech Republic (MŠMT) “Systemic Risk Institute (SYRI) Project Number: LX22NPO5101”, from Masaryk University “MUNI/A/1402/2021”, and from Masaryk University “MUNI/IGA/1104/2021”, all outside the submitted work. S Sacco reports grants or contracts from Novartis, and Uriach; payment or honoraria for lectures, presentations, speakers bureaus, manuscript writing or educational events from Allergan-Abbvie, Abbott, Teva, Novartis, Lilly, Novonordisk, Pfizer, and Lundbeck; support for attending meetings and/or travel from Lilly, and Lundbeck; leadership or fiduciary role in other board, society, committee or advocacy group, paid or unpaid as President elect European Stroke Organisation, and Second vice president European headache Federation; receipt of equipment, materials, drugs, medical writing, gifts or other services from NovoNordisk; all outside the submitted work. N Scarmeas reports grants or contracts from EPAD as funding to their institution, and from NovoNordisk as funding to their institution; Participation as Chair of Data Safety Monitoring Board with the Albert Einstein College of Medicine funded by the NIH; outside the submitted work. V Shivarov reports one pending Bulgarian patent; stock or stock options in RSU from ICON plc; and other financial interest from PRAHS/ICON plc as salary; all outside the submitted work. S T Skou reports grants or contracts from the European Research Council as payment to their university, from the European Union's Horizon 2020 research innovation program (grant agreement No 801790), from the Region Zealand as payment to the hospital, program grant from Region Zealand (Exercise First); royalties from Munksgaard and TrustMe-Ed; payment or honoraria for one online presentations, from Nestlé Health Science; participation on as an Advisory Board Member as UK-based NIHR-funded trial PERFORM: Personalised Exercise-Rehabilitation FOR people with Multiple long-term conditions (multimorbidity, NIHR 202020); leadership or fiduciary role in other board, society, committee or advocacy group, paid, with JOSPT as associate editor; other non-financial interests as co-founder of GLA:D®, a not-for profit initiative hosted at University of Southern Denmark aimed at implementing clinical guidelines for osteoarthritis in clinical practice; all outside the submitted. J Sundstrom reports stock or stock options in Anagram kommunikation AB and Symptoms Europe AB, all outside the submitted work. J-D Zeitoun reports consulting fees from AbbVie, Takeda, Johnson & Johnson, and Boehringer Ingelheim; payment or honoraria for lectures, presentations, speakers bureaus, manuscript writing or educational events from Elsa and ALPTIS; stock in in approximately 30 medical startups and LP in 3 investment funds; all outside the submitted work. Other remaining authors do not have any competing interest.

Figures

Fig. 1
Fig. 1
Age-standardised death (A) and DALY (B) rates (per 100 000 inhabitants) by the Level 2 causes for the European Union and for each country in 2019. Footnote (to be included next to the figure)—Cells in green (or lighter grey) have a rate statistically significantly lower than EU, red (or darker) higher and yellow (or medium grey) without statistically significant differences
Fig. 2
Fig. 2
Disability adjusted life years (DALYs) per 100,000 inhabitants, split into Years of life lost (YLL) and Years lived with disability (YLD), by sex and age group in the European Union in 2019. The error bars indicate the 95% uncertainty interval around the DALYs estimates
Fig. 3
Fig. 3
Age-standardised YLL, YLD and DALY rates in 2019 (A), as well as changes (in %) between 2010 and 2019 (B) for the Level 2 causes in the European Union
See this image and copyright information in PMC

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