Other official information and services: www.belgium.be 
Discover the new page on cerebrovascular diseases.
The pages on general and premature mortality have been updated with 2023 data.
The page on diabetes has been updated with 2022 data.
All estimates can be consulted in more detail in our interactive online applications:
Estimated mortality and years of life lost attributed to tobacco use
In 2020, cigarette smoking was responsible for 9413 deaths, accounting for 7.4% of all deaths in Belgium.
Smoking is causally linked to the burden of 41 diseases including 19 types of cancer, 7 cardiovascular diseases, chronic obstructive pulmonary disease (COPD), and asthma. Lung cancer, COPD, and ischemic heart disease are the main causes of tobacco-related mortality, responsible for 3682, 1422, and 1305 deaths, respectively.
Overall, the main causes of tobacco-related mortality are similar across genders and regions. In the Flemish and Brussels-Capital regions, Alzheimer's and other dementias ranked eighth and sixth among smoking-related deaths, respectively. In the Walloon region, they ranked tenth. Women's rankings differed due to breast and cervical cancer, responsible for 49 and 53 deaths, respectively. For men, the ranking included aortic aneurysm, bladder, and liver cancer.
Most of the smoking-related deaths occurred in people aged 45 and older, especially in people over 65. Most of these deaths were due to cancer (neoplasms, 51%), heart disease (cardiovascular diseases, 23%), and lung disease (chronic respiratory diseases, 18%). The disease burden related to smoking was higher in men than in women, regardless of their age.
There has been an overall declining trend in the smoking attributable deaths rate by region since 2013. Despite a decrease, regional differences persist. The rate of smoking-related deaths was the highest in the Brussels-Capital Region (115.07 per 100,000), followed by the Walloon Region (105.28 per 100,000), both of which are 50% higher compared to the Flemish Region (66.09 per 100,000).
In 2021, according to the Global Burden of Disease 2021 study (Institute for Health Metrics and Evaluation (IHME), 2024) the estimated death rate in Belgium was above the EU-14 countries mean, ranking the country fifth worst among the EU-14.
Belgian National Burden of Disease visualization tool
Belgian National Burden of Disease Study. Patterns of tobacco use and sales in Belgium: a critical appraisal of available data sources
We aimed to quantify the health impact of tobacco use in Belgium by using representative data from the Belgian Health Interview Survey (BHIS). This survey was selected as the best available data source as it provides detailed insights into smoking behaviour [3]. We then constructed a time series on the BHIS data to have annual estimates from 2013 to 2020, that offer comprehensive insights into smoking behaviour trends across causes by age, sex, and region. This enabled us to estimate the contribution of smoking to the burden of disease through the Population Attributable Fraction (PAF) equation. Combining PAF percentages with total burden estimates, we calculated the attributable burden for each disease by age group, sex, and region. Additionally, we computed rates per 100,000 individuals and age-standardized rates (BSP) using population estimates from Statbel.
We used the Comparative Risk Assessment (CRA) method to calculate smoking-related deaths. It allows for the estimation of population attributable fractions (PAFs), quantifying the disease burden caused by exposure. The attributable burden (for example deaths) represents the share of the burden that can be linked to specific risk factor exposure, such as tobacco use, and would not have occurred without past exposure [4].
We calculate the attributable burden of tobacco use estimates by age, sex, region, year, and cause. The complete set of estimates can be explored via https://burden.sciensano.be/shiny/risk/
Primary data about tobacco use can be consulted on this page.
Please cite this page as: Sciensano. Burden of disease: Risk factor attributable burden - Tobacco attributable burden, Health Status Report, 31 May 2024, Brussels, Belgium, https://www.healthybelgium.be/en/health-status/burden-of-disease/risk-factor-attributable-burden/tobacco-use
All estimates can be consulted in more detail in our interactive online applications:
Estimates of mortality and years of life lost for 131 causes of death
Estimates of the non-fatal burden of 56 cancer types
Estimates of the burden of 38 key diseases
In 2021, the considered 38 key diseases led to a loss of 1,146,988 healthy life years (9,930 YLDs per 100,000) due to reduced quality of life (YLDs). Mental and substance use disorders, musculoskeletal disorders, and neurological disorders were the leading disease groups, accounting for more than 70% of the total disease burden due to reduced quality of life. The top 5 specific causes for YLDs were depression (16%), low back pain (13%), alcohol use disorders (11%), neck pain (8%) and drug use disorders (8%).
Men suffer a similar disease burden due to reduced quality of life compared to women. The age-adjusted YLDs equaled 9,831 per 100,000 men, and 9,904 per 100,000 women. In men, the three leading causes for YLDs were alcohol use (1,516 YLDs per 100,000), depression (1,326 YLDs per 100,000), and low back pain (1,202 YLDs per 100,000) whereas in women, the three leading specific causes were depression (1,789 YLDs per 100,000), low back pain (1,247 YLDs per 100,000), and neck pain (1,183 YLDs per 100,000).
In Belgium, the disease burden due to reduced quality of life is largely borne by the youngsters and adults. The majority (33%) of YLDs in the Belgian population are attributable to Belgians with an age between 15 and 44 years (52,515 YLDs per 100,000), followed by the group with an age between 45 and 64 years, where a total of 47,934 YLDs per 100,000, (33%) were lost in 2021. Among Belgians who are between 65 and 84 years old, 64,863 years were lost due to reduced quality of life per 100,000 (28%). The oldest group (85 years and older) accounted for 6% of the total amount of YLDs, while the youngest group (< 15 years) accounted for 1% of the total amount of YLDs. The leading specific causes with the highest impact in terms of YLDs per 100,000 were asthma and epilepsy in children with an age < 5 year, epilepsy and asthma in children aged between 5 to 14 years, depression and alcohol use disorders in youngsters and adults with an age between 15 to 44 year, depression and low back pain in adults with an age between 45 and 84, and low back pain and osteoarthritis in elderly with an age of 65 years and older.
After correcting for differences in population size and age structure, the disease burden in terms of reduced quality of life is the highest in the Walloon Region (11,724 YLDs per 100,000), followed by the Brussels Capital Region (10,642 YLDs per 100,000), and the Flemish Region (8,775 YLDs per 100,000). The leading cause groups are identical among regions.
Looking at trends over time after correcting for the population size and age structure, the disease burden due to reduced quality of life of the leading diseases has remained stable over the years. The disease burden of mental and substance use disorders went from 4,141 YLDs per 100,000 in 2013 to 4,374 YLDs per 100,000 in 2021. The disease burden of musculoskeletal disorders went from 2,558 YLDs per 100,000 in 2013 to 2,760 YLDs per 100,000 in 2020.
In 2019, according to the Global Burden of Disease 2019 study [7] the estimated total YLDs in Belgium was above the EU-14 countries mean, ranking the country 2nd worst among the EU-14.
Belgian Burden of Disease visualization tool
Belgian national burden of disease study. Guidelines for the calculation of DALYs in Belgium
Download Summary Table (.xlsx) 488 KB
What are the most important diseases in Belgium? Which risk factors contribute most to the overall disease burden? How is the burden of disease evolving over time, and how does it compare with neighboring countries? To address these basic questions, Sciensano conducts a national burden of disease study, in which the population impact for 38 key diseases in Belgium is evaluated.
The burden of disease in terms of reduced quality of life as a result of living with a disability is quantified using the Years Lived with Disability (YLD) metric. The YLD is a measure of the non-fatal disease burden in a specific population. YLDs are calculated by multiplying the number of prevalent cases with the (severity-weighted) disability weight, which reflects the relative reduction in quality of life lost due to living with the disease.
We calculate disease burden estimates by age, sex and region, allowing for a very detailed assessment of the state of health. The complete set of estimates can be explored via https://burden.sciensano.be/shiny/daly.
Please cite this page as: Sciensano. Burden of disease: Years Lived with Disability, Health Status Report, 04 July 2024, Brussels, Belgium, https://www.healthybelgium.be/en/health-status/burden-of-disease/years-lived-with-disability
All estimates can be consulted in more detail in our interactive online applications:
Estimates of mortality and years of life lost for 131 causes of death
Estimates of the non-fatal burden of 56 cancer types
Estimates of the burden of 38 key diseases
In 2021, the considered 38 key diseases led to a loss of 1,378,670 healthy life years (11,934 YLLs per 100,000) due to premature mortality. Cancer, cardiovascular diseases and infectious diseases were the leading disease groups, accounting for more than 60% of the total disease burden due to mortality. The top 5 specific causes for YLLs were COVID-19 (12%), lung cancer (11%), Ischemic heart disease (11%), cerebrovascular disease (7.5%), Alzheimer’s disease and other dementias (6.8%).
Men suffer a higher disease burden due to premature mortality compared to women. The age-adjusted YLLs equaled 15,314 per 100,000 among men, and 8,959 per 100,000 among women. In men, the three leading causes for YLLs were COVID-19 (1,918 YLLs per 100,000), ischemic heart disease (1,885 YLLs per 100,000), lung cancer (1,846 YLLs per 100,000), whereas, in women, the leading three causes were COVID-19 (962 YLLs per 100,000), lung cancer (838 YLLs per 100,000) Alzheimer’s disease and other dementias (822 YLLs per 100,000).
In Belgium, the disease burden due to premature mortality is largely borne by the elderly. The majority (67%) of YLLs in the Belgian population are attributable to the group of 65+ years (32,737 YLLs per 100,000 in people with an age between 65 and 84 years old and 88,472 YLLs per 100,000 in people aged 85 and older). In the group with an age between 45 and 64 years, Belgians suffered from 10,977 YLLs per 100,000 (24.5%), followed by a total of 12,534 YLLs per 100,000 in the group aged between 15 and 44 years (8%). The youngest group (< 15 years) accounted for less than 1% of the total amount of YLLs. The leading specific causes with the highest impact in terms of YLLs per 100,000 were road injuries and brain and nervous system cancer in children with an age < 5 years, brain and nervous system cancer, and road injuries in children with an age between 5 and 14 years, self-harm and road injuries in youngsters and adults with an age between 15 and 44 years, lung cancer and COVID-19 in adults with an age between 45 and 64, COVID-19 and lung cancer in elderly with an age between 65 and 84, and Alzheimer’s disease and other dementias and COVID-19 in people aged 85+.
After correcting for differences in population size and age structure, the disease burden in terms of premature mortality was the highest in the Walloon Region (14,003 YLLs per 100,000), followed by the Brussels Capital Region (12,609 YLLs per 100,000), and the Flemish Region (10,623 YLLs per 100,000). The leading causes were similar across regions except for the Brussels Region, where infectious disease is the most important group.
Looking at trends over time after correcting for the population size and age structure, the disease burden due to premature mortality has decreased for the top disorders. The disease burden of cancer has decreased from 4,255 YLLs per 100,000 individuals in 2013 to 3,606 YLLs per 100,000 individuals in 2021. A similar trend is observed for cardiovascular disorders, for which the disease burden has decreased from 2,808 YLLs per 100,000 individuals to 2,151 YLLs per 100,000 individuals in 2021. The number of YLLs caused by infectious diseases has increased because of COVID-19 between 2019 and 2020, rising from 691 YLLs per 100,000 individuals to 2,975 YLLs per 100,000 individuals. After which, the mortality-related burden dropped again to 1,867 YLLs in 2021.
In 2019, according to the Global Burden of Disease 2019 study [2] the estimated YLLs in Belgium was above the EU-14 countries mean, ranking the country third worst among the EU-14.
Belgian Burden of Disease visualization tool
Belgian national burden of disease study. Guidelines for the calculation of DALYs in Belgium
Download Summary Table (.xlsx) 488 KB
What are the most important diseases in Belgium? Which risk factors contribute most to the overall disease burden? How is the burden of disease evolving over time, and how does it compare with neighboring countries? To address these basic questions, Sciensano conducts a national burden of disease study, in which the population impact for 38 key diseases in Belgium is evaluated.
The burden of disease due to premature mortality is quantified using the Years of Life Lost (YLL) metric. YLLs are calculated by multiplying the number of deaths with the residual life expectancy at the age of death, thereby reflecting the number of years an individual has lost due to premature death.
We calculate disease burden estimates by age, sex and region, allowing for a very detailed assessment of the state of health. The complete set of estimates can be explored via https://burden.sciensano.be/shiny/daly.
Please cite this page as: Sciensano. Burden of disease: Years of Life Lost, Health Status Report, 04 Juli 2024, Brussels, Belgium, https://www.healthybelgium.be/en/health-status/burden-of-disease/years-of-life-lost
All estimates can be consulted in more detail in our interactive online applications:
Estimates of mortality and years of life lost for 131 causes of death
Estimates of the non-fatal burden of 56 cancer types
Estimates of the burden of 38 key diseases
In 2021, the considered 38 key diseases led to a loss of 2,525,658 healthy life years (21,864 DALYs per 100,000). Mental and substance use disorders, cancers, and musculoskeletal disorders were the leading disease groups, accounting for 52% of the total disease burden. The top 5 specific causes for DALYs were depression (7.1%), COVID-19 (6.7%), ischemic heart disease (6.2%), lung cancer (6.1%), and low back pain (5.6%).
Overall, DALYs could be attributed almost equally to premature mortality (55%) and to reduced quality of life (45%). Across disorders, there was a wide variety in the contribution of the mortality and morbidity impact: some disorders had almost entirely a morbidity impact (e.g., sense organ disorders), while others had almost entirely a mortality impact (e.g., injuries).
Men suffer a higher disease burden compared to women. Among men, the age-adjusted DALYs equaled 25,145 per 100,000 in 2021, of which 59% could be attributed to premature mortality, and 41% to reduced quality of life. The leading cause in men was COVID-19 with 1,990 DALYs per 100,000 men. Among women, the age-adjusted DALYs equaled 18,863 per 100,000 in 2021, of which 50% could be attributed to premature mortality, and 50% to reduced quality of life. The leading disease for DALYs in women was depression with 1,790 DALYs per 100,000 women.
The disease burden in Belgium is largely borne by the elderly. 37% of the total disease burden can be attributed to the group of people with an age between 65 and 84 years, followed by the group aged between 45 and 64 years with a contribution of 16.5%. The youngest group of people has smallest contribution with 1% of the total DALYs. When looking at specific ages, the highest burden per person was observed in the oldest group of people with an age of 85 years and older (142,667 DALYs per 100,000) followed by the group of people with an age between 65 and 84 years old (97,600 DALYs per 100,000). Among the group aged between 45 and 64 years, people living in Belgium suffered a total of 58,911 DALYs per 100,000, followed by a total of 55,049 DALYs per 100,000 among the group aged between 15 and 44 years. The leading disease groups with the highest impact in terms of DALYs per 100,000 were neurological disorders in children aged 5 years or less, neurological disorders in children aged between 5 to 14 years, mental and substance use disorders in youngsters and adults with an age between 15 to 64 years, musculoskeletal disorders in the group of people with an age between 65 and 84 years old, and cardiovascular diseases in the elderly.
After correcting for differences in population size and age structure, the disease burden is the highest in the Walloon Region (25,715 DALYs per 100,000), followed by the Brussels Capital Region (23,235 DALYs per 100,000), and the Flemish Region (19,394 DALYs per 100,000). In general, the leading disease groups do not differ across regions with mental and substance disorders being the group with the highest impact in all regions, followed by cancers. The third largest group in the Walloon Region is cardiovascular diseases, while in the Brussels Capital Region and the Flemish Region these are musculoskeletal disorders.
Looking at trends over time after correcting for the population size and age structure, the disease burden of cancer has decreased from 4,561 DALYs per 100,000 individuals in 2013 to 3,908 DALYs per 100,000 individuals in 2021. A similar trend is observed for cardiovascular disorders, for which the disease burden has decreased from 3,094 DALYs per 100,000 individuals in 2013 to 2,506 DALYs per 100,000 individuals in 2021. In contrast, the disease burden of mental and substance use disorder has increased from 4,339 DALYs per 100,000 in 2013 to 4,589 DALYs per 100,000 in 2021. The disease burden of musculoskeletal disorders was 2,567 DALYs per 100,000 in 2013 and 2,771 DALYs per 100,000 in 2021, remaining stable over time. However, because of COVID-10 infectious diseases have increased between 2019 and 2020 from 692 DALYs per 100,000 individuals in 2019 to 3,008 DALYs per 100,000 individuals in 2020. In 2021, they have decreased again to 1,939 DALYs per 100,000 individuals.
In 2019, according to the Global Burden of Disease 2019 study [7], the estimated total DALYs in Belgium was above the EU-14 countries mean, ranking the country 2nd worst among the EU-14 countries after Greece.
Belgian Burden of Disease visualization tool
Belgian National Burden of Disease Study. Guidelines for the calculation of Disability-Adjusted Life Years in Belgium, September 2023
Download Summary Table (.xlsx) 488 KB
What are the most important diseases in Belgium? Which risk factors contribute most to the overall disease burden? How is the burden of disease evolving over time, and how does it compare with neighboring countries? To address these basic questions, Sciensano conducts a national burden of disease study, in which the population impact for 38 key diseases in Belgium is evaluated.
The burden of disease is quantified using the Disability-Adjusted Life Year (DALY) metric. The use of DALYs allows to combine the years of healthy life lost due to reduced quality of life (Years Lived with Disability, YLD) and due to premature death (Years of Life Lost, YLL). It therefore permits a truly comparative ranking of the burden of various diseases, injuries and risk factors.
We calculate disease burden estimates by age, sex and region, allowing for a very detailed assessment of the state of health. The complete set of estimates can be explored via https://burden.sciensano.be/shiny/daly.
Please cite this page as: Sciensano. Burden of disease: Disability-Adjusted Life Years, Health Status Report, 11 July 2024, Brussels, Belgium, https://www.healthybelgium.be/en/health-status/burden-of-disease/disability-adjusted-life-years