Inequalities in the burden of noncommunicable diseases across European countries: a systematic analysis of the 2019 global burden of disease study
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Department of Public Health and Epidemiology, Faculty of Medicine, University of Debrecen Hungary
Department of Public Health and Epidemiology, Faculty of Medicine, University of Debrecen
Department of cardiovascular, endocrine-metabolic diseases and aging, Istituto Superiore di Sanità Italy
Faculty of Medicine & Surgery
Grad Department of Public Health, FSPAC, Babes-Bolyai University
Department of General Surgery and Surgical-Medical Specialties, School of Dentistry, University of Catania Italy
Norwergian Institute of Public Health Norway
Charité - Universitätsmedizin Berlin Germany
Department of Public Health; Erasmus MC University Medical Center Netherlands
Public Health Unit, Primary Healthcare Cluster NOVA National School of Public Health, Public Health Research Centre, Universidade NOVA de Lisboa, Lisbon Portugal
Department of Healthcare, Faculty of Health, University of Vlora, Vlora, Albania School of Medicine, University of Crete, Heraklion, Greece Albania
Department of Non-communicable diseases and injuries, Santé Publique France, Saint-Maurice France
Department of Clinical Epidemiology, Aarhus University and Aarhus University Hospital, Denmark Department of Disease Burden, Norwegian Institute of Public Health, Norway Denmark
Institute of Health and Society (IRSS), Université Catholique de Louvain Belgium
Health Analysis and Development Centre, National institute of public health Of Republic Slovenia, Ljubljana Slovenia
Robert Koch institute Germany
Erasmus MC University Medical Center Netherlands
Publication date: 2023-04-26
Popul. Med. 2023;5(Supplement):A1492
Background and objectives:
High disease burden due to non-communicable diseases (NCDs) and the associated health inequalities are major problems in Europe. This study aimed to assess health inequalities in NCDs by Disability-Adjusted Life Years (DALYs) rates across 30 member states of the European Economic Area (EEA) between 1990 and 2019.

The Global Burden of Disease (GBD) 2019 estimates were used for a descriptive longitudinal systematic analysis. Age-standardized DALYs rates and 95% Uncertainty Interval (UI 95%) were used. For inequality analysis, we performed DALYs rate ratios between all countries in 2019 by sex, ratio between highest and lowest-ranking country by year, annual rate-of-change between 1990 and 2019 by sex, Gini Coefficient (GC), and Slope Index of Inequality (SII).

In 2019, DALY rate of NCDs ranged from 24342 in Bulgaria (95%UI: 20406-28775) to 14845 in Iceland (95%UI: 12379-17682). The ratio between highest and lowest-ranking country in terms of NCD DALY rates was higher for males (1.90: Bulgaria/Iceland) compared to females (1.49: Bulgaria/Slovenia). The annual rate-of-change indicated DALY rate decrease in all countries between 1990 and 2019. For females it ranged from -0.12 in the Netherlands to -0.28 in Slovenia, while for males from -0.10 in Bulgaria to -0.40 in the Czech Republic. NCDs with highest GCs and ratios over the studied period were cardiovascular diseases (GC: 0.283; ratio: 5.89), digestive diseases (GC: 0.244; ratio: 6.29), diabetes and kidney diseases (GC: 0.194; ratio: 4.97), substance use disorders (GC: 0.224; ratio: 5.10), and chronic respiratory diseases (GC: 0.160; ratio: 3.45). The SII was 0.85 in 1990 and 0.59 in 2019.

Although the DALY rate of NCDs decreased between 1990 and 2019 in all EEA countries, the level of inequality between countries is not decreasing. Targeted policies can help tackle NCDs with particularly high levels of inequality in EEA countries.