Person: Plaß, Dietrich
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Veröffentlichung The increasing significance of disease severity in a burden of disease framework(2021) Wyper, Grant M.A.; Assunção, Ricardo; Fletscher, Eilidh; Plaß, DietrichRecent estimates have reiterated that non-fatal causes of disease, such as low back pain, headaches and depressive disorders, are amongst the leading causes of disability-adjusted life years (DALYs). For these causes, the contribution of years lived with disability (YLD) - put simply, ill-health - is what drives DALYs, not mortality. Being able to monitor trends in YLD closely is particularly relevant for countries that sit high on the socio-demographic spectrum of development, as it contributes more than half of all DALYs. There is a paucity of data on how the population-level occurrence of disease is distributed according to severity, and as such, the majority of global and national efforts in monitoring YLD lack the ability to differentiate changes in severity across time and location. This raises uncertainties in interpreting these findings without triangulation with other relevant data sources. Our commentary aims to bring this issue to the forefront for users of burden of disease estimates, as its impact is often easily overlooked as part of the fundamental process of generating DALY estimates. Moreover, the wider health harms of the COVID-19 pandemic have underlined the likelihood of latent and delayed demand in accessing vital health and care services that will ultimately lead to exacerbated disease severity and health outcomes. This places increased importance on attempts to be able to differentiate by both the occurrence and severity of disease. © Author(s) 2021Veröffentlichung Redistributing ill-defined causes of death - a case study from the BURDEN 2020-project in Germany(2021) Wengler, Annelene; Gruhl, Heike; Plaß, DietrichBackground The cause of death statistics in Germany include a relatively high share (26% in 2017) of ill-defined deaths (IDD). To make use of the cause of death statistics for Burden of Disease calculations we redistribute those IDD to valid causes of death. Methods The process of proportional redistribution is described in detail. It makes use of the distribution of the valid ICD-codes in the cause of death data. We use examples of stroke, diabetes, and heart failure to illustrate how IDD are reallocated. Results The largest increases in the number of deaths for both women and men were found for lower respiratory infections, diabetes mellitus, and stroke. The numbers of deaths for these causes more than doubled after redistribution. Conclusion This is the first comprehensive redistribution of IDD using the German cause of death statistics. Performing a redistribution is necessary for burden of disease analyses, otherwise there would be an underreporting of certain causes of death or large numbers of deaths coded to residual or unspecific codes. © The Author(s). 2021Veröffentlichung Verlorene Lebensjahre durch Tod(2021) Wengler, Annelene; Gruhl, Heike; Rommel, Alexander; Plaß, DietrichHintergrund: Die Kenntnis darüber, welche Erkrankungen und Todesursachen erheblich zu den durch Sterblichkeit verlorenen Lebensjahren ("years of life lost", YLL) beitragen, kann zur besseren Fokussierung entsprechender Präventions- und Versorgungsprogramme beitragen. Im Rahmen des Projekts BURDEN 2020 am Robert Koch-Institut wurden die YLL deutschlandweit für spezifische Todesursachen ermittelt. Methode: Für die Analyse wurden die Daten der Todesursachenstatistik genutzt. ICD-10-Codes wurden auf unterschiedlichen Ebenen zu Todesursachen gruppiert und Sterbefälle todesursachenspezifisch über die Restlebenserwartung im Alter des Todes in YLL transformiert. Sterbefälle und YLL wurden differenziert nach Alter, Geschlecht und regionaler Verteilung miteinander verglichen. Ergebnisse: Im Jahr 2017 gab es in Deutschland rund 11,6 Millionen YLL, 42,8 % entfielen auf Frauen, 57,2 % auf Männer. Die größten Anteile wiesen (bösartige) Neubildungen (35,2 %), kardiovaskuläre Erkrankungen (27,6 %), Verdauungserkrankungen (5,8 %) und neurologische Störungen (5,7 %) auf. Sterbefälle in jüngerem Alter wirken sich auf die Bevölkerungsgesundheit, gemessen in YLL, verhältnismäßig stärker aus: Nur 14,7 % der Sterbefälle entfielen auf die unter 65-Jährigen, dies entspricht aber 38,3 % der verlorenen Lebensjahre. Häufige Sterbeursachen waren in dieser Gruppe unter anderem Unfälle, Selbstschädigung und Gewalt, bösartige Neubildungen sowie alkoholassoziierte Erkrankungen. Schlussfolgerung: Ein bedeutender Teil der YLL entfiel auf jüngere und mittlere Altersgruppen. Die Ergebnisse unterstreichen daher die Notwendigkeit, früh im Lebensverlauf mit Präventionsangeboten anzusetzen, um verlorene Lebenszeit in jüngeren Jahren wie auch Risikofaktoren altersassoziierter Erkrankungen zu reduzieren. Quelle: www.aerzteblatt.deVeröffentlichung Quantifying the environmental burden of disease for children and adolescents in Germany(2023) Kienzler, Sarah; Plaß, Dietrich; Tobollik, Myriam; Wintermeyer, DirkVeröffentlichung Burden of infectious disease studies in Europe and the United Kingdom: a review of methodological design choices(2023) Charalampous, Periklis; Haagsma, Juanita A.; Jakobsen, Lea S.; Plaß, DietrichThis systematic literature review aimed to provide an overview of the characteristics and methods used in studies applying the disability-adjusted life years (DALY) concept for infectious diseases within European Union (EU)/European Economic Area (EEA)/European Free Trade Association (EFTA) countries and the United Kingdom. Electronic databases and grey literature were searched for articles reporting the assessment of DALY and its components. We considered studies in which researchers performed DALY calculations using primary epidemiological data input sources. We screened 3053 studies of which 2948 were excluded and 105 studies met our inclusion criteria. Of these studies, 22 were multi-country and 83 were single-country studies, of which 46 were from the Netherlands. Food- and water-borne diseases were the most frequently studied infectious diseases. Between 2015 and 2022, the number of burden of infectious disease studies was 1.6 times higher compared to that published between 2000 and 2014. Almost all studies (97%) estimated DALYs based on the incidence- and pathogen-based approach and without social weighting functions; however, there was less methodological consensus with regards to the disability weights and life tables that were applied. The number of burden of infectious disease studies undertaken across Europe has increased over time. Development and use of guidelines will promote performing burden of infectious disease studies and facilitate comparability of the results. Quelle:© The Author(s)Veröffentlichung Estimating the morbidity related environmental burden of disease due to exposure to PM2.5, NO2 and O3 in outdoor ambient air(European Topic Centre on Human health and the environment, 2022) Kienzler, Sarah; Soares, Joana; Ortiz, Alberto González; Plaß, DietrichVeröffentlichung Health Risk Assessment of Air Pollution: assessing the environmental burden of disease in Europe in 2021(ETC-HE, 2023) Soares, Joana; Kienzler, Sarah; Plaß, DietrichThis report presents the results of the environmental burden of disease (EBD) assessment related to air pollution in 2021 for the 27 Member States of the European Union and an additional 14 European countries (Albania, Andorra, Bosnia and Herzegovina, Iceland, Kosovo under UNSCR 1244/99, Liechtenstein, Monaco, Montenegro, North Macedonia, Norway, San Marino, Serbia, Switzerland, and Türkiye). The estimations differentiate the EBD by three individual pollutants, fine particulate matter (PM2.5), nitrogen dioxide (NO2), and ozone (O3), considering all-cause mortality as well as cause-specific mortality and morbidity. For the analyses, various burden of disease indicators were used, such as attributable deaths (AD), years of life lost (YLL), years lived with disability (YLD), disability-adjusted life years (DALY) and attributable hospitalisation cases. In 2021, long-term exposure to concentration levels above the WHO Air Quality Guideline levels of PM2.5 and NO2, resulted in 293 000 and 69 000 AD from all natural causes, respectively. There were 27 000 AD related to short-term exposure to O3. For EU27, the number of AD is 253 000, 52 000 and 22 000, respectively. When considering both the number of deaths and the age at which it occurs, the YLL (YLL per 100 000 inhabitants) is 2 936 000 (618) for long-term exposure to PM2.5 and 740 000 (132) to NO2, and 299 000 (54) due to short-term exposure to O3. For EU27, YLL (YLL per 100 000 inhabitants) are 2 584 000 (584), 532 000 (120), 234 000 (53), respectively. When comparing long-term exposure, both all-cause and cause-specific analyses point to PM2.5 as the pollutant with the highest burden. The cause-specific analyses resulted in 2 528 363 DALY in all countries or 2 310 387 DALY in the EU27. The burden attributable to NO2 was considerably lower, with 634 721 DALY and 403 788 DALY in all countries and in the EU27, respectively. Looking at the single disease entities, ischemic heart disease contributed the most to the overall burden of PM2.5, with 759 303 DALY in all countries and 704 525 DALY in the EU27. The lowest burden was related to Asthma (children), with 25 932 and 23 969 DALY in all countries and the EU27, respectively. For NO2, the highest disease burden was associated with diabetes mellitus (314 574 DALY; EU27: 197 031 DALY) and the lowest with asthma (adults) (all countries: 115 425 DALY; EU27: 62 460 DALY). No corresponding indicators were calculated for O3, yet short-term exposure to O3 was associated with 15 986 attributable hospital admissions in the selected European countries. When comparing the results, it is important to note that different age groups (i.e. children, adults, and elderly) were considered in the estimates, according to the relevant concentration-response functions. © European Topic Centre on Human Health and the Environment, 2023Veröffentlichung COVID-19-Krankheitslast in Deutschland im Jahr 2020(2021) Rommel, Alexander; Lippe, Elena von der; Plaß, DietrichHintergrund: Die SARS-CoV-2-Pandemie hat im Jahr 2020 das Gesundheitswesen vor große Herausforderungen gestellt. Die COVID-19-Krankheitslast lässt sich durch den Verlust an Lebensjahren durch Krankheit oder Tod ausdrücken. Dabei gehen beispielsweise durch Versterben im Alter von 40 Jahren deutlich mehr Lebensjahre verloren als bei Tod mit 80 Jahren. Methode: Auf Basis laborbestätigter SARS-CoV-2-Meldefälle im Jahr 2020 (Datenstand 18. Januar 2021) werden durch Tod verlorene Lebensjahre ("years of life lost", YLL) und durch gesundheitliche Einschränkungen verlorene Lebensjahre ("years lived with disability", YLD) zur Krankheitslast insgesamt ("disability-adjusted life years", DALY) aufsummiert. Die Methodik ist angelehnt an die â€ÌGlobal Burden of Diseaseâ€Ì-Studie. Bestehende Vorerkrankungen werden bei der Berechnung der YLL nicht berücksichtigt. Die angelegte Restlebenserwartung berücksichtigt aber ein mittleres altersspezifisches Niveau an Morbidität. Ergebnisse: Im Jahr 2020 gingen in Deutschland 305 641 Lebensjahre durch COVID-19 verloren. Bei Männern entfielen 34,8 % der DALY auf Personen unter 70 Jahre, bei Frauen 21,0 %. 99,3 % dieser Krankheitslast machten verlorene Lebensjahre durch Versterben aus (YLL). Die durch COVID-19 im Tagesmittel entstandene Krankheitslast durch Versterben lag unter der für wichtige nichtübertragbare Erkrankungen. Eine verstorbene Person verlor im Mittel etwa 9,6 Lebensjahre, Personen unter 70 Jahre verloren 25,2 Lebensjahre. Männer hatten durch Tod einen größeren Verlust an Lebenszeit als Frauen (11,0 versus 8,1 Jahre). Schlussfolgerung: Die Auswirkungen von COVID-19 auf die Bevölkerungsgesundheit lassen sich mit den Indikatoren der Krankheitslast verdeutlichen. Die Methode liefert damit zusätzliche Erkenntnisse, die für künftige Ausbrüche frühzeitig genutzt werden sollten. Quelle: www.aerzteblatt.deVeröffentlichung Daten und Fakten zu Braun- und Steinkohlen(Umweltbundesamt, 2021) Baumgarten, Corinna; Beckers, Rolf; Bretschneider, Wolfgang; Briem, Sebastian; Frauenstein, Jörg; Gibis, Claudia; Gniffke, Patrick; Herbstritt, Caren; Grimm, Sabine; Juhrich, Kristina; Kahrl, Andreas; Kosmol, Jan; Kuhs, Gunter; Langner, Marcel; Lewandrowski, Dmitri; Lünenbürger, Benjamin; Mohaupt, Volker; Pfeiffer, David; Plaß, Dietrich; Plickert, Sebastian; Rechenberg, Jörg; Reißmann, Daniel; Sandau, Fabian; Straff, Wolfgang; Timme, Stephan; Weiß, Jan; Wintermeyer, DirkUm die weitere Ausgestaltung des Kohleausstiegs besteht weiterhin ein hoher Diskussion- und Entscheidungsbedarf. Um diesen gesellschaftlichen Diskussionsprozess zu begleiten, setzt das Umweltbundesamt mit diesem aktualisierten Hintergrundpapier seine Veröffentlichungsreihe "Daten und Fakten zu Braun- und Steinkohlen" fort. Die Publikation beleuchtet die aktuelle und perspektivische Rolle der Kohlen als Energieträger aus energiewirtschaftlicher, umweltpolitischer und ökonomischer Sicht (wie steigende Preise für CO2-Emissionszertifikate). Quelle: https://www.umweltbundesamt.deVeröffentlichung Population vulnerability to COVID-19 in Europe: a burden of disease analysis(2020) Wyper, Grant M.A.; Assunção, Ricardo; Cuschieri, Sarah; Plaß, DietrichBackground Evidence has emerged showing that elderly people and those with pre-existing chronic health conditions may be at higher risk of developing severe health consequences from COVID-19. In Europe, this is of particular relevance with ageing populations living with non-communicable diseases, multi-morbidity and frailty. Published estimates of Years Lived with Disability (YLD) from the Global Burden of Disease (GBD) study help to characterise the extent of these effects. Our aim was to identify the countries across Europe that have populations at highest risk from COVID-19 by using estimates of population age structure and YLD for health conditions linked to severe illness from COVID-19. Methods Population and YLD estimates from GBD 2017 were extracted for 45 countries in Europe. YLD was restricted to a list of specific health conditions associated with being at risk of developing severe consequences from COVID-19 based on guidance from the United Kingdom Government. This guidance also identified individuals aged 70 years and above as being at higher risk of developing severe health consequences. Study outcomes were defined as: (i) proportion of population aged 70 years and above; and (ii) rate of YLD for COVID-19 vulnerable health conditions across all ages. Bivariate groupings were established for each outcome and combined to establish overall population-level vulnerability. Results Countries with the highest proportions of elderly residents were Italy, Greece, Germany, Portugal and Finland. When assessments of population-level YLD rates for COVID-19 vulnerable health conditions were made, the highest rates were observed for Bulgaria, Czechia, Croatia, Hungary and Bosnia and Herzegovina. A bivariate analysis indicated that the countries at high-risk across both measures of vulnerability were: Bulgaria; Portugal; Latvia; Lithuania; Greece; Germany; Estonia; and Sweden. Conclusion Routine estimates of population structures and non-fatal burden of disease measures can be usefully combined to create composite indicators of vulnerability for rapid assessments, in this case to severe health consequences from COVID-19. Countries with available results for sub-national regions within their country, or national burden of disease studies that also use sub-national levels for burden quantifications, should consider using non-fatal burden of disease estimates to estimate geographical vulnerability to COVID-19. © 2020 BioMed Central Ltd.