Robert Koch Institute, Department 2, Epidemiology and Health Monitoring, Berlin; AOK Research Institute (WIdO), Berlin; German Federal Environment Agency, Department II 1 Environmental Hygiene, Berlin; Robert Koch Institute, Department 3, Infectious Disease Epidemiology, Berlin.
Dtsch Arztebl Int. 2022 Nov 18;119(46):785-792. doi: 10.3238/arztebl.m2022.0314.
.Summary measures such as disability-adjusted life years (DALY) are becoming increasingly important for the standardized assessment of the burden of disease due to death and disability. The BURDEN 2020 pilot project was designed as an independent burden-of-disease study for Germany, which was based on nationwide data, but which also yielded regional estimates.
DALY is defined as the sum of years of life lost due to death (YLL) and years lived with disability (YLD). YLL is the difference between the age at death due to disease and the remaining life expectancy at this age, while YLD quantifies the number of years individuals have spent with health impairments. Data are derived mainly from causes of death statistics, population health surveys, and claims data from health insurers.
In 2017, there were approximately 12 million DALY in Germany, or 14 584 DALY per 100 000 inhabitants. Conditions which caused the greatest number of DALY were coronary heart disease (2321 DALY), low back pain (1735 DALY), and lung cancer (1197 DALY). Headache and dementia accounted for a greater disease burden in women than in men, while lung cancer and alcohol use disorders accounted for a greater disease burden in men than in women. Pain disorders and alcohol use disorders were the leading causes of DALY among young adults of both sexes. The disease burden rose with age for some diseases, including cardiovascular diseases, dementia, and diabetes mellitus. For some diseases and conditions, the disease burden varied by geographical region.
The results indicate a need for age- and sex-specific prevention and for differing interventions according to geographic region. Burden of disease studies yield comprehensive population health surveillance data and are a useful aid to decision-making in health policy.
.由于死亡和残疾导致的疾病负担，残疾调整生命年（DALY）等综合衡量指标变得越来越重要。BURDEN 2020 试点项目是一项针对德国的独立疾病负担研究，该研究基于全国范围的数据，但也产生了区域估计值。
DALY 定义为因死亡（YLL）和因残疾（YLD）而损失的生命年的总和。YLL 是疾病导致的死亡年龄与该年龄剩余预期寿命之间的差异，而 YLD 则量化了个体因健康受损而度过的年数。数据主要来自死因统计数据、人口健康调查以及健康保险公司的索赔数据。
2017 年，德国约有 1200 万 DALY，即每 10 万人中有 14584 个 DALY。导致 DALY 数量最多的疾病是冠心病（2321 DALY）、下背痛（1735 DALY）和肺癌（1197 DALY）。头痛和痴呆症在女性中的疾病负担比男性更大，而肺癌和酒精使用障碍在男性中的疾病负担比女性更大。疼痛障碍和酒精使用障碍是男女青年 DALY 的主要原因。对于某些疾病，包括心血管疾病、痴呆症和糖尿病，疾病负担随着年龄的增长而增加。对于某些疾病和状况，疾病负担因地理位置而异。
结果表明，需要针对特定年龄和性别的预防措施，并根据地理位置采取不同的干预措施。疾病负担研究提供了全面的人口健康监测数据，是卫生政策决策的有用辅助工具。
