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; Nour Mahrouseh; Jonila Gabrani; Periklis Charalampous; Sarah Cuschieri; Diana Alecsandra Grad; Brigid Unim; Enkeleint A Mechili; José Chen-Xu; Brecht Devleesschauwer; Gaetano Isola; Elena von der Lippe; Carl Michael Baravelli; Florian Fischer; Nanna Weye; Mirza Balaj; Romana Haneef; Mary Economou; Juanita A Haagsma; Orsolya Varga

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

Int J Equity Health. 2023 Jul 28;22(1):140. doi: 10.1186/s12939-023-01958-8.

Authors

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.

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.

Publication types

Research Support, Non-U.S. Gov't

MeSH terms

Cardiovascular Diseases* / epidemiology
Female
Global Burden of Disease
Global Health
Humans
Life Expectancy
Male
Noncommunicable Diseases* / epidemiology
Quality-Adjusted Life Years
Respiratory Tract Diseases* / epidemiology