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1. Key messages

  • The Belgian national burden of disease study quantifies the health impact of 37 key diseases in terms of Disability-Adjusted Life Years (healthy life years lost due to morbidity and mortality).
  • In 2018, the considered diseases led to a loss of 2.3 million health life years.
  • Mental and substance use disorders, cancers, and musculoskeletal disorders are the leading causes of disease burden in Belgium.
  • The disease burden is almost equally attributable to premature mortality (52%) as to losses in quality of life (48%).
  • The total disease burden is higher among men compared to women.
  • The largest share of the disease burden is borne by the elderly (65+).
  • The total disease burden is the highest in the Walloon Region, followed by the Brussels Capital Region, and Flemish Region.
  • Among EU-14 countries, Belgium ranks worst in terms of total disease burden.

2. Background

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 37 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.

3. Belgium

In 2018, the considered 37 key diseases led to a loss of 2,315,500 healthy life years (20,330 DALYs per 100,000). Mental and substance use disorders, cancers, and musculoskeletal disorders were the leading disease groups, accounting for more than 50% of the total disease burden. The top 5 specific causes for DALYs were depression (7.6%), ischemic heart disease (6.8%), lung cancer (6.6%), low back pain (6.2%), and alcohol use (6.0%).

Distribution of Disability-Adjusted Life Years by disease, Belgium, 2018
Source: Own calculations based on data from IMA, Intego, ERA, HIS, Belgian Cancer Registry and Statbel [1-6]

Overall, DALYs could be attributed almost equally to premature mortality (53%) and to reduced quality of life (47%). Across disorders, there was 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).

Share of the fatal (YLL) and non-fatal (YLD) disease impact by disease group, Belgium, 2018
Source: Own calculations based on data from IMA, Intego, ERA, HIS, Belgian Cancer Registry and Statbel [1-6]

Men suffer a higher disease burden compared to women. Among men, the age-adjusted DALYs equalled 23,200 per 100,000 in 2018, of which 56% could be attributed to premature mortality, and 44% to reduced quality of life. Among women, the age-adjusted DALYs equalled 17,859 per 100,000 in 2018, of which 48% could be attributed to premature mortality, and 52% to reduced quality of life. In men, the leading disease for DALYs was ischemic heart disease (2,009 DALYs per 100,000), whereas in women, the leading disease was depression (1,782 DALYs per 100,000).

Distribution of age-adjusted DALY rates by sex and disease group, Belgium, 2018
Source: Own calculations based on data from IMA, Intego, ERA, HIS, Belgian Cancer Registry and Statbel [1-6]

The disease burden in Belgium is largely borne by the elderly. The majority (48%) of DALYs in the Belgian population are attributed to the group of 65+ years (120,418 DALYs per 100,000). Among the group aged between 45 and 64 years, the Belgians suffered a total of 23,249 DALYs per 100,000 (31%), followed by a total of 10,954 DALYs per 100,000 among the group aged between 15 and 44 years (20%). The youngest group (< 15 years) accounted for less than 1% of the total DALYs. The leading disease groups with the highest impact in terms of DALYs per 100,000 were infectious diseases in children with an age < 5 year, cancer in children aged between 5 to 15 years, mental health and substance use disorders in youngsters and adults with an age between 15 to 64 year, and cardiovascular diseases in elderly with an age higher than 65 years.

Distribution of DALY rates by age and disease group, Belgium, 2018
Source: Own calculations based on data from IMA, Intego, ERA, HIS, Belgian Cancer Registry and Statbel [1-6]

4. Regional differences

After correcting for differences in population size and age structure, the disease burden is the highest in the Walloon Region (23,618 DALYs per 100,000), followed by the Brussels Capital Region (20,614 DALYs per 100,000), and the Flemish Region (18,494 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 but the Flemish Region, where cancer is the leading disease group. Cancer is the second largest disease group among all regions, except for the Flemish Region, where mental and substance disorders is the second largest group. The third largest group among all regions is musculoskeletal disorders.

Ranking of disease groups by age-adjusted DALY rates, Belgium and regions, 2018
Source: Own calculations based on data from IMA, Intego, ERA, HIS, Belgian Cancer Registry and Statbel [1-6]

5. International comparison

In 2018, 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 1st worst among the EU-14 countries.

Age-adjusted DALY rate per 100,000 by country of residence (EU-14), 2018
Source: GBD 2019 study [7]

6. Read more

Belgian Burden of Disease visualization tool
Belgian national burden of disease study. Guidelines for the calculation of DALYs in Belgium
Download Summary Table (.xlsx)231.31 KB

Definitions

DALY
The Disability-Adjusted Life Year or DALY in short is a population-level measure of the disease or disability burden in a specific population. DALYs are calculated by combining measures of life expectancy as well as the adjusted quality of life during a burdensome disease or disability for a population. More specifically the DALY reflects the sum of years of life lost (YLL) due to premature mortality and years of life lost due to disability (YLD) for a specific disease or condition.
YLD
The Years Lived with Disability or YLDs in short 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.
YLL
The Years of Life Lost or YLLs in short is a measure of the fatal disease burden in a specific population. 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.
EU-14
The EU-14 corresponds to all countries that belonged to the European Union between 1995 and 2004: Austria, Belgium, Denmark, Finland, France, Germany, Greece, Ireland, Italy, Luxembourg, the Netherlands, Portugal, Spain, and Sweden. We compare the Belgian health status to that of the EU-14 because these countries have similar socioeconomic conditions. Note: The United Kingdom is not included since they have left the EU.

References

  1. Intermutualistic Agency (IMA). https://aim-ima.be/
  2. Intego, KU Leuven. https://intego.be/
  3. Renal Database, European Renal Association (ERA). https://www.era-online.org/en/registry/
  4. Health Interview Survey (HIS), Sciensano. https://www.sciensano.be/en/projects/health-interview-survey
  5. Belgian Cancer Registry (BCR). https://kankerregister.org/
  6. Statistics Belgium (Statbel). https://statbel.fgov.be/en
  7. Global Burden of Disease Collaborative Network. Global Burden of Disease Study 2019 (GBD 2019) Results. Seattle, United States: Institute for Health Metrics and Evaluation (IHME), 2020. Available from http://ghdx.healthdata.org/gbd-results-tool.