Gorasso Vanessa, Morgado Joana Nazaré, Charalampous Periklis, Pires Sara M, Haagsma Juanita A, Santos João Vasco, Idavain Jane, Ngwa Che Henry, Noguer Isabel, Padron-Monedero Alicia, Sarmiento Rodrigo, Pinheiro Vera, Von der Lippe Elena, Jakobsen Lea Sletting, Devleesschauwer Brecht, Plass Dietrich
Department of Epidemiology and Public Health, Sciensano, Brussels, Belgium.
Department of Public Health and Primary Care, Ghent University, Ghent, Belgium.
Arch Public Health. 2023 Jun 25;81(1):116. doi: 10.1186/s13690-023-01119-x.
Within the framework of the burden of disease (BoD) approach, disease and injury burden estimates attributable to risk factors are a useful guide for policy formulation and priority setting in disease prevention. Considering the important differences in methods, and their impact on burden estimates, we conducted a scoping literature review to: (1) map the BoD assessments including risk factors performed across Europe; and (2) identify the methodological choices in comparative risk assessment (CRA) and risk assessment methods.
We searched multiple literature databases, including grey literature websites and targeted public health agencies websites.
A total of 113 studies were included in the synthesis and further divided into independent BoD assessments (54 studies) and studies linked to the Global Burden of Disease (59 papers). Our results showed that the methods used to perform CRA varied substantially across independent European BoD studies. While there were some methodological choices that were more common than others, we did not observe patterns in terms of country, year or risk factor. Each methodological choice can affect the comparability of estimates between and within countries and/or risk factors, since they might significantly influence the quantification of the attributable burden. From our analysis we observed that the use of CRA was less common for some types of risk factors and outcomes. These included environmental and occupational risk factors, which are more likely to use bottom-up approaches for health outcomes where disease envelopes may not be available.
Our review also highlighted misreporting, the lack of uncertainty analysis and the under-investigation of causal relationships in BoD studies. Development and use of guidelines for performing and reporting BoD studies will help understand differences, avoid misinterpretations thus improving comparability among estimates.
The study protocol has been registered on PROSPERO, CRD42020177477 (available at: https://www.crd.york.ac.uk/PROSPERO/ ).
在疾病负担（BoD）方法的框架内，归因于风险因素的疾病和伤害负担估计值是疾病预防政策制定和优先级设定的有用指南。考虑到方法上的重要差异及其对负担估计的影响，我们进行了一项范围界定文献综述，以：（1）梳理欧洲各地进行的包括风险因素在内的BoD评估；（2）确定比较风险评估（CRA）和风险评估方法中的方法选择。
我们搜索了多个文献数据库，包括灰色文献网站和目标公共卫生机构网站。
共有113项研究纳入综述，并进一步分为独立的BoD评估（54项研究）和与全球疾病负担相关的研究（59篇论文）。我们的结果表明，在欧洲独立的BoD研究中，用于进行CRA的方法差异很大。虽然有些方法选择比其他方法更常见，但我们未观察到国家、年份或风险因素方面的模式。每种方法选择都可能影响国家之间和国家内部以及/或风险因素之间估计值的可比性，因为它们可能会显著影响可归因负担的量化。从我们的分析中我们观察到，对于某些类型的风险因素和结果，CRA的使用不太常见。这些包括环境和职业风险因素，对于这些因素，在可能没有疾病包络的健康结果方面，更可能使用自下而上的方法。
我们的综述还强调了BoD研究中存在报告错误、缺乏不确定性分析以及对因果关系研究不足的问题。制定和使用进行及报告BoD研究的指南将有助于理解差异、避免误解，从而提高估计值之间的可比性。
该研究方案已在PROSPERO上注册，注册号为CRD42020177477（可在https://www.crd.york.ac.uk/PROSPERO/获取）。
