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Disability-Adjusted Life Years

  1. Key messages
  2. Disability-Adjusted Life Years
  3. Read more

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
Estimates of projected non-fatal burden of 33 causes

1. Key messages

  • The Belgian national burden of disease study quantifies the health impact of 38 key diseases in terms of Disability-Adjusted Life Years (healthy life years lost due to morbidity and mortality).
  • In 2022, the considered diseases led to a loss of 2.5 million healthy life years.
  • In 2022, mental and substance use disorders, cancers, and musculoskeletal disorders were the leading causes of disease burden in Belgium.
  • The disease burden in 2022 attributable to premature mortality (55%) was higher compared to losses in quality of life (45%).
  • The total disease burden in 2022 was higher among men compared to women.
  • The largest share of the disease burden was borne by the people in their later life (65+).
  • The total disease burden was the highest in the Walloon Region, followed by the Brussels Capital Region, and Flemish Region.
  • Among EU-14 countries, Belgium ranks 4th worst in terms of total disease burden.

2. Disability-Adjusted Life Years

More than 2.5 millions healthy life years lost in Belgium in 2022

In 2022, the considered 38 key diseases led to a loss of 2,520,688 healthy life years (21,715 DALYs per 100,000). Mental and substance use disorders, cancers, and musculoskeletal disorders were the leading disease groups, accounting for 53% of the total disease burden. The top 5 specific causes for DALYs were depression (7.1%), lung cancer (6.2%), ischemic heart disease (6.2%), low back pain (6.1%), and alcohol use disorders (5.6%).

Distribution of Disability-Adjusted Life Years by disease, Belgium, 2022
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 (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).

Share of the fatal (YLL) and non-fatal (YLD) disease impact by disease group, Belgium, 2022
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 equaled 24,699 per 100,000 in 2022, of which 59% could be attributed to premature mortality, and 41% to reduced quality of life. The leading cause in men was ischemic heart disease with 1,980 DALYs per 100,000 men. Among women, the age-adjusted DALYs equaled 19,258 per 100,000 in 2022, 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 1,789 DALYs per 100,000 women.

Distribution of age-adjusted DALY rates by sex and disease group, Belgium, 2022
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 people in their later life. 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 28.0%. 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 (148,907 DALYs per 100,000) followed by the group of people with an age between 65 and 84 years old (93,606 DALYs per 100,000).  Among the group aged between 45 and 64 years, people living in Belgium suffered a total of 59,008 DALYs per 100,000, followed by a total of 55,743 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 neoplasms 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 neurological disorders in the elderly.

Distribution of DALY rates by age and disease group, Belgium, 2022
Source: Own calculations based on data from IMA, Intego, ERA, HIS, Belgian Cancer Registry and Statbel [1-6]

The highest burden is in the Walloon Region

After correcting for differences in population size and age structure, the disease burden is the highest in the Walloon Region (25,381 DALYs per 100,000), followed by the Brussels Capital Region (22,279 DALYs per 100,000), and the Flemish Region (19,690 DALYs per 100,000). In general, the leading disease groups do not differ across regions with mental and substance use disorders being the group with the highest impact in all regions, followed by cancers and musculoskeletal disorders.

Ranking of disease groups by age-adjusted DALY rates, Belgium and regions, 2022
Source: Own calculations based on data from IMA, Intego, ERA, HIS, Belgian Cancer Registry and Statbel [1-6]

After a peak in 2020 caused by COVID-19, the burden of disease decreases again over time

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 3,981 DALYs per 100,000 individuals in 2022. A similar trend is observed for cardiovascular disorders, for which the disease burden has decreased from 3,078 DALYs per 100,000 individuals in 2013 to 2,417 DALYs per 100,000 individuals in 2022. In contrast, the disease burden of mental and substance use disorder has increased from 4,360 DALYs per 100,000 in 2013 to 4,630 DALYs per 100,000 in 2022. The disease burden of musculoskeletal disorders was 2,665 DALYs per 100,000 in 2013 and increased to 2,962 DALYs per 100,000 in 2022. However, because of COVID-19 infectious diseases have increased between 2019 and 2020 from 692 DALYs per 100,000 individuals in 2019 to 3,084 DALYs per 100,000 individuals in 2020. In 2022, they have decreased again to 1,478 DALYs per 100,000 individuals.

Distribution of age-adjusted DALY rates by year and disease group, Belgium, 2013-2022
Source: Own calculations based on data from IMA, Intego, ERA, HIS, Belgian Cancer Registry and Statbel [1-6]

Belgium scores poorly among EU-14 countries

In 2021, according to the Global Burden of Disease 2021 study [7], the estimated total DALYs in Belgium was above the EU-14 countries mean, ranking the country 4th worst among the EU-14 countries after Greece, Germany and Portugal.

Age-adjusted DALY rate per 100,000 by country of residence (EU-14), 2021
Source: GBD 2021 study [7]

3. Read more

Belgian Burden of Disease visualization tool
Belgian National Burden of Disease Study. Guidelines for the calculation of Disability-Adjusted Life Years in Belgium, June 2025
Download Summary Table (.xlsx) 488 KB

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 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.

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 the EU-14 because these countries have similar socioeconomic conditions. Note: The United Kingdom is omitted since they have left the EU.
Age-standardized prevalence
The age-standardized prevalence is a weighted average of the individual age-specific prevalences using an external standard population. It is the prevalence that would be observed if the population had the age structure of the standard population. Since age has an important influence on the risk of diabetes, this standardization is necessary when comparing several populations that differ with respect to their age structure. Here, the Belgian 2018 mid-year population is used as standard population.

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 2021 (GBD 2021) Results. Seattle, United States: Institute for Health Metrics and Evaluation (IHME), 2022. Available from http://ghdx.healthdata.org/gbd-results-tool.

Please cite this page as: Sciensano. Burden of disease: Disability-Adjusted Life Years, Health Status Report, 26 June 2025, Brussels, Belgium, https://www.healthybelgium.be/en/health-status/burden-of-disease/disability-adjusted-life-years