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Cirera L, Bañón RM, Maeso S, Molina P, Ballesta M, Chirlaque MD, Salmerón D. Territorial gaps on quality of causes of death statistics over the last forty years in Spain. BMC Public Health 2024; 24:361. [PMID: 38310211 PMCID: PMC10837971 DOI: 10.1186/s12889-023-17616-1] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/03/2023] [Accepted: 12/29/2023] [Indexed: 02/05/2024] Open
Abstract
BACKGROUND The quality of the statistics on causes of death (CoD) does not present consolidated indicators in literature further than the coding group of ill-defined conditions of the International Classification of Diseases. Our objective was to assess the territorial quality of CoD by reliability of the official mortality statistics in Spain over the years 1980-2019. METHODS A descriptive epidemiological design of four decades (1980-, 1990-, 2000-, and 2010-2019) by region (18) and sex was implemented. The CoD cases, age-adjusted rates and ratios (to all-cause) were assigned by reliability to unspecific and ill-defined quality categories. The regional mortality rates were contrasted to the Spanish median by decade and sex by the Comparative Mortality Ratio (CMR) in a Bayesian perspective. Statistical significance was considered when the CMR did not contain the value 1 in the 95% credible intervals. RESULTS Unspecific, ill-defined, and all-cause rates by region and sex decreased over 1980-2019, although they scored higher in men than in women. The ratio of ill-defined CoD decreased in both sexes over these decades, but was still prominent in 4 regions. CMR of ill-defined CoD in both sexes exceeded the Spanish median in 3 regions in all decades. In the last decade, women's CMR significantly exceeded in 5 regions for ill-defined and in 6 regions for unspecific CoD, while men's CMR exceeded in 4 and 2 of the 18 regions, respectively on quality categories. CONCLUSIONS The quality of mortality statistics of causes of death has increased over the 40 years in Spain in both sexes. Quality gaps still remain mostly in Southern regions. Authorities involved might consider to take action and upgrading regional and national death statistics, and developing a systematic medical post-grade training on death certification.
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Affiliation(s)
- Lluís Cirera
- Department of Epidemiology, Regional Health Council, IMIB-Arrixaca. Ronda de Levante 11, 30008, Murcia, Spain
- Spanish Consortium for Research On Epidemiology and Public Health (CIBERESP), Calle de Melchor Fernández Almagro, 3, 28029, Madrid, Spain
- Department of Health and Social Sciences, University of Murcia, IMIB-Arrixaca, 32. 30120, Buenavista, Spain
| | - Rafael-María Bañón
- Medico-Legal Advisor. Ministry of Justice. Calle San Bernardo, 21. 28071, Madrid, Spain
| | - Sergio Maeso
- National Centre for Epidemiology, Carlos III Institute of Health (ISCIII), Avenida Monforte de Lemos 5, 28029, Madrid, Spain
| | - Puri Molina
- SGAIPE. Departament de Salut, Generalitat de Catalunya. Travessera de Les Corts, 131. 08028, Barcelona, Spain
| | - Mónica Ballesta
- Department of Epidemiology, Regional Health Council, IMIB-Arrixaca. Ronda de Levante 11, 30008, Murcia, Spain
- Department of Health and Social Sciences, University of Murcia, IMIB-Arrixaca, 32. 30120, Buenavista, Spain
| | - María-Dolores Chirlaque
- Department of Epidemiology, Regional Health Council, IMIB-Arrixaca. Ronda de Levante 11, 30008, Murcia, Spain
- Spanish Consortium for Research On Epidemiology and Public Health (CIBERESP), Calle de Melchor Fernández Almagro, 3, 28029, Madrid, Spain
- Department of Health and Social Sciences, University of Murcia, IMIB-Arrixaca, 32. 30120, Buenavista, Spain
| | - Diego Salmerón
- Spanish Consortium for Research On Epidemiology and Public Health (CIBERESP), Calle de Melchor Fernández Almagro, 3, 28029, Madrid, Spain.
- Department of Health and Social Sciences, University of Murcia, IMIB-Arrixaca, 32. 30120, Buenavista, Spain.
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Ebeling M, Mühlichen M, Talbäck M, Rau R, Goedel A, Klüsener S. Disease incidence and not case fatality drives the rural disadvantage in myocardial-infarction-related mortality in Germany. Prev Med 2024; 179:107833. [PMID: 38145875 DOI: 10.1016/j.ypmed.2023.107833] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 09/18/2023] [Revised: 12/11/2023] [Accepted: 12/20/2023] [Indexed: 12/27/2023]
Abstract
OBJECTIVE Demographic and infrastructural developments might compromise medical care provision in rural regions, particularly for acute health conditions. Studying the case of myocardial infarction (MI), we investigated how MI-related mortality at ages 65+ varies between rural and urban regions in Germany and to what extent differences are driven by varying case fatality and disease incidence. METHODS The study relies on data containing all hospitalizations, cause-specific deaths and population counts for the total German population between years 2012-2018 and ages 65+. MI-related mortality, MI incidence and case fatality are compared between urban and rural regions in a population-wide analysis. The impacts of changing incidence and case fatality on rural-urban MI-related mortality differences are assessed using a counterfactual approach. RESULTS Rural regions in Germany show systematically higher MI-related death rates and MI incidence at ages 65+ compared to urban regions. Higher mortality is primarily the result of higher MI incidence in rural regions, while case fatality is largely similar. The rural excess in MI-related death rates would be nullified and 1 out of 6 MI-related deaths in rural regions could be prevented if rural regions in Germany would have at least the median MI incidence of urban regions. CONCLUSIONS MI incidence and not case fatality drives the rural disadvantage in MI-related mortality in Germany. Higher MI incidence points towards potential regional variation in the effectiveness of disease prevention. The findings highlight that improving disease prevention at the patient level carries larger opportunities for reducing regional MI-related mortality inequalities in Germany.
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Affiliation(s)
- Marcus Ebeling
- Max Planck Institute for Demographic Research, Rostock, Germany; Karolinska Institute, Stockholm, Sweden; Federal Institute for Population Research (BiB), Wiesbaden, Germany.
| | | | | | - Roland Rau
- Max Planck Institute for Demographic Research, Rostock, Germany; University of Rostock, Rostock, Germany
| | - Alexander Goedel
- Karolinska Institute, Stockholm, Sweden; Technical University of Munich, Munich, Germany
| | - Sebastian Klüsener
- Federal Institute for Population Research (BiB), Wiesbaden, Germany; University of Cologne, Cologne, Germany; Vytautas Magnus University, Kaunas, Lithuania
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Devleesschauwer B, Scohy A, De Pauw R, Gorasso V, Kongs A, Neirynck E, Verduyckt P, Wyper GMA, Van den Borre L. Investigating years of life lost in Belgium, 2004-2019: A comprehensive analysis using a probabilistic redistribution approach. Arch Public Health 2023; 81:160. [PMID: 37626403 PMCID: PMC10464430 DOI: 10.1186/s13690-023-01163-7] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/18/2023] [Accepted: 07/27/2023] [Indexed: 08/27/2023] Open
Abstract
INTRODUCTION Information on years of life lost (YLL) due to premature mortality is instrumental to assess the fatal impact of disease and necessary for the calculation of Belgian disability-adjusted life years (DALYs). This study presents a novel method to reallocate causes of death data. MATERIALS AND METHODS Causes of death data are provided by Statistics Belgium (Statbel). First, the specific ICD-10 codes that define the underlying cause of death are mapped to the GBD cause list. Second, ill-defined deaths (IDDs) are redistributed to specific ICD-10 codes. A four-step probabilistic redistribution was developed to fit the Belgian context: redistribution using predefined ICD codes, redistribution using multiple causes of death data, internal redistribution, and redistribution to all causes. Finally, we used the GBD 2019 reference life table to calculate Standard Expected Years of Life Lost (SEYLL). RESULTS In Belgium, between 2004 and 2019, IDDs increased from 31 to 34% of all deaths. The majority was redistributed using predefined ICD codes (14-15%), followed by the redistribution using multiple causes of death data (10-12%). The total number of SEYLL decreased from 1.83 to 1.73 million per year. In 2019, the top cause of SEYLL was lung cancer with a share of 8.5%, followed by ischemic heart disease (8.1%) and Alzheimer's disease and other dementias (5.7%). All results are available in an online tool https://burden.sciensano.be/shiny/mortality2019/ . CONCLUSION The redistribution process assigned a specific cause of death to all deaths in Belgium, making it possible to investigate the full mortality burden for the first time. A large number of estimates were produced to estimate SEYLL by age, sex, and region for a large number of causes of death and every year between 2004 and 2019. These estimates are important stepping stones for future investigations on Disability-Adjusted Life Years (DALYs) in Belgium.
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Affiliation(s)
- Brecht Devleesschauwer
- Service Health Information, Department of Epidemiology and Public Health, Sciensano, Rue Juliette Wytsman 14, Brussels, 1050, Belgium.
- Department of Translational Physiology, Infectiology and Public Health, Ghent University, Merelbeke, Belgium.
| | - Aline Scohy
- Service Health Information, Department of Epidemiology and Public Health, Sciensano, Rue Juliette Wytsman 14, Brussels, 1050, Belgium
| | - Robby De Pauw
- Service Health Information, Department of Epidemiology and Public Health, Sciensano, Rue Juliette Wytsman 14, Brussels, 1050, Belgium
- Department of Rehabilitation Sciences, Ghent University, Ghent, Belgium
| | - Vanessa Gorasso
- Service Health Information, Department of Epidemiology and Public Health, Sciensano, Rue Juliette Wytsman 14, Brussels, 1050, Belgium
- Department of Public Health and Primary Care, Ghent University, Ghent, Belgium
| | - Anne Kongs
- Department of Care, Flemish Public Administration, Brussels, Belgium
| | | | - Peter Verduyckt
- Brussels-Capital Health and Social Observatory, Brussels, Belgium
| | - Grant M A Wyper
- Place and Wellbeing Directorate, Public Health Scotland, Glasgow, UK
- School of Health & Wellbeing, University of Glasgow, Glasgow, UK
| | - Laura Van den Borre
- Service Health Information, Department of Epidemiology and Public Health, Sciensano, Rue Juliette Wytsman 14, Brussels, 1050, Belgium
- Interface Demography, Department of Sociology, Vrije Universiteit Brussel, Brussels, Belgium
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Porst M, von der Lippe E, Leddin J, Anton A, Wengler A, Breitkreuz J, Schüssel K, Brückner G, Schröder H, Gruhl H, Plaß D, Barnes B, A. Busch M, Haller S, Hapke U, Neuhauser H, Reitzle L, Scheidt-Nave C, Schlotmann A, Steppuhn H, Thom J, Ziese T, Rommel A. The Burden of Disease in Germany at the National and Regional Level. DEUTSCHES ARZTEBLATT INTERNATIONAL 2022; 119:785-792. [PMID: 36350160 PMCID: PMC9902892 DOI: 10.3238/arztebl.m2022.0314] [Citation(s) in RCA: 6] [Impact Index Per Article: 3.0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Received: 05/01/2022] [Revised: 05/01/2022] [Accepted: 08/29/2022] [Indexed: 11/11/2022]
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.
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Affiliation(s)
- Michael Porst
- Robert Koch Institute, Department 2, Epidemiology and Health Monitoring, Berlin
| | - Elena von der Lippe
- Robert Koch Institute, Department 2, Epidemiology and Health Monitoring, Berlin
| | - Janko Leddin
- Robert Koch Institute, Department 2, Epidemiology and Health Monitoring, Berlin
| | - Aline Anton
- Robert Koch Institute, Department 2, Epidemiology and Health Monitoring, Berlin
| | - Annelene Wengler
- Robert Koch Institute, Department 2, Epidemiology and Health Monitoring, Berlin
| | | | | | | | | | - Heike Gruhl
- German Federal Environment Agency, Department II 1 Environmental Hygiene, Berlin
| | - Dietrich Plaß
- German Federal Environment Agency, Department II 1 Environmental Hygiene, Berlin
| | - Benjamin Barnes
- Robert Koch Institute, Department 2, Epidemiology and Health Monitoring, Berlin
| | - Markus A. Busch
- Robert Koch Institute, Department 2, Epidemiology and Health Monitoring, Berlin
| | - Sebastian Haller
- Robert Koch Institute, Department 3, Infectious Disease Epidemiology, Berlin
| | - Ulfert Hapke
- Robert Koch Institute, Department 2, Epidemiology and Health Monitoring, Berlin
| | - Hannelore Neuhauser
- Robert Koch Institute, Department 2, Epidemiology and Health Monitoring, Berlin
| | - Lukas Reitzle
- Robert Koch Institute, Department 2, Epidemiology and Health Monitoring, Berlin
| | | | | | - Henriette Steppuhn
- Robert Koch Institute, Department 2, Epidemiology and Health Monitoring, Berlin
| | - Julia Thom
- Robert Koch Institute, Department 2, Epidemiology and Health Monitoring, Berlin
| | - Thomas Ziese
- Robert Koch Institute, Department 2, Epidemiology and Health Monitoring, Berlin
| | - Alexander Rommel
- Robert Koch Institute, Department 2, Epidemiology and Health Monitoring, Berlin
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Monasta L, Alicandro G, Pasovic M, Cunningham M, Armocida B, Ronfani L, Naghavi M, Monasta L, Alicandro G, Pasovic M, Cunningham M, Armocida B, Albano L, Beghi E, Beghi M, Bosetti C, Bragazzi NL, Carreras G, Castelpietra G, Catapano AL, Cattaruzza MS, Collatuzzo G, Conti S, Damiani G, Ferrara P, Fornari C, Gallus S, Giampaoli S, Golinelli D, Isola G, Lauriola P, La Vecchia C, Leonardi M, Magnani FG, Minelli G, Moccia M, Pedersini P, Perico N, Raggi A, Remuzzi G, Sanmarchi F, Sattin D, Unim B, Villafañe JH, Violante FS, Murray CJL, Ronfani L, Naghavi M. Redistribution of garbage codes to underlying causes of death: a systematic analysis on Italy and a comparison with most populous Western European countries based on the Global Burden of Disease Study 2019. Eur J Public Health 2022; 32:456-462. [PMID: 35061890 PMCID: PMC9159332 DOI: 10.1093/eurpub/ckab194] [Citation(s) in RCA: 3] [Impact Index Per Article: 1.5] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/29/2022] Open
Abstract
Background The proportion of reported causes of death (CoDs) that are not underlying causes can be relevant even in high-income countries and seriously affect health planning. The Global Burden of Disease (GBD) study identifies these ‘garbage codes’ (GCs) and redistributes them to underlying causes using evidence-based algorithms. Planners relying on vital registration data will find discrepancies with GBD estimates. We analyse these discrepancies, through the analysis of GCs and their redistribution. Methods We explored the case of Italy, at national and regional level, and compared it to nine other Western European countries with similar population sizes. We analysed differences between official data and GBD 2019 estimates, for the period 1990–2017 for which we had vital registration data for most select countries. Results In Italy, in 2017, 33 000 deaths were attributed to unspecified type of stroke and 15 000 to unspecified type of diabetes, these making a fourth of the overall garbage. Significant heterogeneity exists on the overall proportion of GCs, type (unspecified or impossible underlying causes), and size of specific GCs among regions in Italy, and among the select countries. We found no pattern between level of garbage and relevance of specific GCs. Even locations performing below average show interesting lower levels for certain GCs if compared to better performing countries. Conclusions This systematic analysis suggests the heterogeneity in GC levels and causes, paired with a more detailed analysis of local practices, strengths and weaknesses, could be a positive element in a strategy for the reduction of GCs in Italy.
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Affiliation(s)
- Lorenzo Monasta
- Institute for Maternal and Child Health–IRCCS “Burlo Garofolo”, Trieste, Italy
| | - Gianfranco Alicandro
- Department of Pathophysiology and Transplantation, Università degli Studi di Milano, Milan, Italy
- Cystic Fibrosis Center, Fondazione IRCCS Ca' Granda Ospedale Maggiore Policlinico, Milan, Italy
| | - Maja Pasovic
- Institute for Health Metrics and Evaluation, University of Washington, Seattle, WA, USA
| | - Matthew Cunningham
- Institute for Health Metrics and Evaluation, University of Washington, Seattle, WA, USA
| | - Benedetta Armocida
- Institute for Maternal and Child Health–IRCCS “Burlo Garofolo”, Trieste, Italy
| | - Luca Ronfani
- Institute for Maternal and Child Health–IRCCS “Burlo Garofolo”, Trieste, Italy
| | - Mohsen Naghavi
- Institute for Health Metrics and Evaluation, University of Washington, Seattle, WA, USA
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Haneef R, Schmidt J, Gallay A, Devleesschauwer B, Grant I, Rommel A, Wyper GM, Van Oyen H, Hilderink H, Ziese T, Newton J. Recommendations to plan a national burden of disease study. ACTA ACUST UNITED AC 2021; 79:126. [PMID: 34233754 PMCID: PMC8262070 DOI: 10.1186/s13690-021-00652-x] [Citation(s) in RCA: 6] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/23/2021] [Accepted: 06/27/2021] [Indexed: 11/17/2022]
Abstract
Background The InfAct (Information for Action) project is a European Commission Joint Action on Health Information which has promoted the potential role of burden of disease (BoD) approaches to improve the current European Union-Health Information System (EU-HIS). It has done so by raising awareness of the concept, the methods used to calculate estimates and their potential implications and uses in policymaking. The BoD approach is a systematic and scientific effort to quantify and compare the magnitude of health loss due to different diseases, injuries, and risk factors with estimates produced by demographic characteristics and geographies for specific points in time. Not all countries have the resources to undertake such work, and may therefore start with a more restricted objective, e.g., a limited number of diseases, or the use of simple measures of population health such as disease prevalence or life expectancy. The main objective to develop these recommendations was to facilitate those countries planning to start a national burden of disease study. Results These recommendations could be considered as minimum requirements for those countries planning to start a BoD study and includes following elements: (1) Define the objectives of a burden of disease study within the context of your country, (2) Identify, communicate and secure the benefits of performing national burden of disease studies, (3) Secure access to the minimum required data sources, (4) Ensure the minimum required capacity and capability is available to carry out burden of disease study, (5) Establish a clear governance structure for the burden of disease study and stakeholder engagement/involvement, (6) Choose the appropriate methodological approaches and (7) Knowledge translation. These were guided by the results from our survey performed to identify the needs of European countries for BoD studies, a narrative overview from four European countries (Belgium, Germany, The Netherlands and Scotland) and the summary of a comparative study of country health profiles with national health statistics. Conclusions These recommendations as minimum requirements would facilitate efforts by those European countries who intend to perform national BoD studies. Supplementary Information The online version contains supplementary material available at 10.1186/s13690-021-00652-x.
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Affiliation(s)
- Romana Haneef
- Department of Non-Communicable Diseases and Injuries, Santé Publique France, 12 rue du Val d'Osne, 94415, Saint-Maurice Cedex, France.
| | | | - Anne Gallay
- Department of Non-Communicable Diseases and Injuries, Santé Publique France, 12 rue du Val d'Osne, 94415, Saint-Maurice Cedex, France
| | - Brecht Devleesschauwer
- Department of Epidemiology and Public Health, Sciensano, Brussels, Belgium.,Department of Veterinary Public Health and Food Safety, Ghent University, Merelbeke, Belgium
| | - Ian Grant
- Public Health Scotland, Edinburgh, Scotland, UK
| | - Alexander Rommel
- Department of Epidemiology and Health Monitoring, Robert Koch-Institute, Berlin, Germany
| | | | - Herman Van Oyen
- Department of Epidemiology and Public Health, Sciensano, Brussels, Belgium.,Department of Veterinary Public Health and Food Safety, Ghent University, Merelbeke, Belgium
| | - Henk Hilderink
- Centre for Public Health Forecasting, National Institute for Public Health and the Environment (RIVM), Bilthoven Utrecht, Utrecht, The Netherlands
| | - Thomas Ziese
- Department of Epidemiology and Health Monitoring, Robert Koch-Institute, Berlin, Germany
| | - John Newton
- Health Improvement, Public Health England, London, UK
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Rommel A, von der Lippe E, Plass D, Ziese T, Diercke M, an der Heiden M, Haller S, Wengler A. The COVID-19 Disease Burden in Germany in 2020—Years of Life Lost to Death and Disease Over the Course of the Pandemic. DEUTSCHES ARZTEBLATT INTERNATIONAL 2021; 118:145-151. [PMID: 33958032 PMCID: PMC8212397 DOI: 10.3238/arztebl.m2021.0147] [Citation(s) in RCA: 36] [Impact Index Per Article: 12.0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Received: 10/06/2020] [Revised: 10/06/2020] [Accepted: 02/03/2021] [Indexed: 11/27/2022]
Abstract
BACKGROUND The SARS-CoV-2 pandemic presented major challenges to the health sector in 2020. The burden of disease arising from COVID-19 can be expressed as the number of years of life lost to disease or death. For example, death at age 40 involves a loss of far more years of life than death at age 80. METHODS The disability-adjusted life years (DALY) lost to COVID-19 were calculated as the sum of the years of life lost through death (YLL) and the number of years lived with disability (YLD), on the basis of laboratory-confirmed notifiable cases of SARS-CoV-2 infection in Germany in 2020 (documented as of 18 January 2021). The methodology was based on that used in the Global Burden of Disease Study. Pre-existing diseases do not enter into the determination of YLL; rather, the residual life expectancy that is applied in this calculation corresponds to a mean age-specific level of morbidity. RESULTS 305 641 years of life were lost to COVID-19 in Germany in 2020. The percentage of DALY lost by persons under 70 was 34.8% in men and 21.0% in women. 99.3% of the COVID-19 disease burden was accounted for by death (YLL). The daily average years of life lost due to death was lower for COVID-19 than for the major non-communicable diseases. Persons who died of COVID-19 lost a mean of 9.6 years of life; those who were under 70 when they died lost a mean of 25.2 years of life. Men lost more years of life than women (11.0 vs. 8.1 years). CONCLUSION The effects of COVID-19 on public health can be expressed through the burden of disease indicators. This method yields additional information that should be put to use early in the course of future outbreaks.
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Affiliation(s)
- Alexander Rommel
- Department 2, Epidemiology and Health Monitoring, Robert Koch Institute, Berlin
| | - Elena von der Lippe
- Department 2, Epidemiology and Health Monitoring, Robert Koch Institute, Berlin
| | - Dietrich Plass
- Department II 1 Environmental Hygiene, German Environment Agency, Berlin
| | - Thomas Ziese
- Department 2, Epidemiology and Health Monitoring, Robert Koch Institute, Berlin
| | - Michaela Diercke
- Department 3, Infectious Disease Epidemiology, Robert Koch Institute, Berlin
| | | | - Sebastian Haller
- Department 3, Infectious Disease Epidemiology, Robert Koch Institute, Berlin
| | - Annelene Wengler
- Department 2, Epidemiology and Health Monitoring, Robert Koch Institute, Berlin
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