BURDEN 2020—Burden of disease in Germany at the national and regional level

Rommel, Alexander; Lippe, Elena von der; Plaß, Dietrich; Wengler, Annelene; Anton, Aline; Schmidt, Christian Gortázar; Schüssel, Katrin; Brückner, Gabriela; Schröder, Helmut; Porst, Michael; Leddin, Janko; Tobollik, Myriam; Baumert, Jens; Scheidt‐Nave, Christa; Ziese, Thomas

doi:10.1007/s00103-018-2793-0

Cited by 31 publications

(24 citation statements)

References 19 publications

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“…Researchers from independent national studies have been left with either: using the same approach as the GBD study; or developing their own country-specific severity distributions for all, or a subset of, causes. Pivotal examples of this are found in South Korea and Germany, where researchers have opted to develop country-specific severity distributions [3,4]. In Scotland, we have been fortunate in developing severity distributions for cancers, epilepsy and cirrhosis, but have currently used GBD data to infer severity distributions for all other causes due to limited study resources.…”

Section: Heterogeneity Of Approachesmentioning

confidence: 99%

Prioritising the development of severity distributions in burden of disease studies for countries in the European region

et al. 2020

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Severity distributions are a means of summarising the range of health loss suffered to disease which enables estimates of disease occurrence to be paired with disability weights to estimate Years Lost to Disability (YLD) in burden of disease studies. There is a lack of current data exploring severity distributions, which has led to the Global Burden of Disease (GBD) study relying on using the same severity distributions across countries and regions across the world. This is also largely true for some national studies, although there are exceptions. Recent evidence has raised concerns that severity distributions are unlikely to be generalisable as major differences arise when using country-specific data to develop severity distributions. These issues raise uncertainties over interpreting YLD estimates, particularly if they are being used to develop and influence policies and to determine priorities across diseases and populations. It is clear that GBD researchers and those carrying out national studies need to work towards ensuring that estimates are based upon country-specific data, and, if possible, that the impact of assumptions are fully tested and understood. There is a lack of strategy about if, where, and how, this could be achieved, particularly around how efforts should be prioritised. This commentary advocates and presents a possible strategic approach to better understanding how efforts may be best placed.

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Section: Heterogeneity Of Approachesmentioning

confidence: 99%

Prioritising the development of severity distributions in burden of disease studies for countries in the European region

et al. 2020

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“…The GBD study produces country-specific modelled estimates of prevalence for each non-fatal cause of disease, but the allocation of sequelae prevalence is largely defined using the same severity distributions in each country. This has prompted the development of country-specific severity distributions [5–7], although the impact of using these in favour of GBD severity distributions has not yet been evaluated.…”

Section: Introductionmentioning

confidence: 99%

“…There is a growing appetite for BOD studies to provide more granular estimates for regions within countries in both the GBD study [8–10] and independent national studies, particularly in Europe [5, 6, 11, 12], to influence local policy development. This raises further questions about the utility of worldwide severity distributions in sub-national calculations.…”

Section: Introductionmentioning

confidence: 99%

The impact of worldwide, national and sub-national severity distributions in Burden of Disease studies: A case study of cancers in Scotland

et al. 2019

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Background Increasingly Burden of Disease (BOD) measures are being used to influence policy decisions because they summarise the complete effects of morbidity and mortality in an equitable manner. An important element of producing non-fatal BOD estimates are severity distributions. The Global Burden of Disease (GBD) study use the same severity distributions across countries due to a lack of available country-specific data. In the Scottish BOD (SBOD) study we developed national severity distributions for cancer types. The main aim of this study was to consider the extent to which the use of worldwide severity distributions in BOD studies are influencing cross-country comparisons, by comparing weighted-average disability weights (DW) based on GBD severity distributions with nationally derived severity distributions in Scotland for cancer types. Methods We obtained individual records from the Scottish Cancer Registry for 21 cancer types and linked these to registered deaths. We estimated prevalent cancer cases for 2016 and assigned each case to sequelae using GBD 2016 study definitions. We compared the impact of using severity distributions based on GBD 2016, a Scotland-wide distribution, and distributions specific to deprivation strata in Scotland, on the weighted-average DW for each cancer type. Results The relative difference in point estimates of weighted-average DW based on GBD 2016 worldwide severity distributions compared with Scottish national severity distributions resulted in overestimates in the majority of cancers (17 out of 21 cancer types). The largest overestimates were for gallbladder and biliary tract cancer (70.8%), oesophageal cancer (31.6%) and pancreatic cancer (31.2%). Furthermore, the use of weighted-average DW based on Scottish national severity distributions rather than sub-national Scottish severity distributions stratified by deprivation quintile overestimated weighted-average DW in the least deprived areas (16 out of 18 cancer types), and underestimated in the most deprived areas (16 out of 18 cancer types). Conclusion Our findings illustrate a bias in point estimates of weighted-average DW created using worldwide severity distributions. This bias would have led to the misrepresentation of non-fatal estimates of the burden of individual cancers, and underestimated the scale of socioeconomic inequality in this non-fatal burden. This highlights the importance of not interpreting non-fatal estimates of burden of disease too precisely, especially for sub-national estimates and those comparing populations when relying on data inputs from other countries. It is essential to ensure that any estimates are based upon country-specific data as far as possible.

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“…While advances in the development of the granularity of disease and sequelae have been made, they have not been matched by the development of country-specific severity distributions [2]. This has prompted the development of country-specific severity distributions [5][6][7], although the impact of using these in favour of GBD severity distributions has not yet been evaluated.…”

Section: Introductionmentioning

confidence: 99%

“…There is a growing appetite for BOD studies to provide more granular estimates for regions within countries in both the GBD study [8][9][10] and independent national studies [5,6,11], to influence local policy development. This raises further questions about the utility of worldwide severity distributions in sub-national calculations.…”

Section: Introductionmentioning

confidence: 99%

The impact of worldwide, national and sub-national severity distributions in Burden of Disease studies: a case study of individual cancer types in Scotland

Wyper

Grant

Fletcher

et al. 2019

Preprint

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AimThe main aim of this study was to consider the extent to which the use of worldwide severity distributions in Burden of Disease studies are influencing cross-country comparisons, by comparing Global Burden of Disease distributions with nationally derived severity distributions in Scotland for cancer types. MethodsWe obtained individual records from the Scottish Cancer Registry for 21 cancer types and linked these to registered deaths. We estimated prevalent cancer cases for 2016 and assigned each case to sequelae using Global Burden of Disease (GBD) 2016 study definitions. We compared the impact of using severity distributions based on GBD 2016, a Scotland-wide distribution, and a distribution specific to deprivation strata in Scotland, on the weighted-average disability weights for each cancer type in Scotland. ResultsThe relative difference in point estimates of weighted-average disability weights based on GBD 2016 worldwide severity distributions compared with Scottish national severity distributions resulted in overestimates in the majority of cancers (17 out of 21 cancer types). The largest overestimates were for gallbladder and biliary tract cancer (70.8%), oesophageal cancer (31.6%) and pancreatic cancer (31.2%). Furthermore, the use of weighted-average disability weights based on Scottish national severity distributions rather than sub-national Scottish severity distributions stratified by deprivation quintile overestimated weighted-average disability weights in the least deprived areas (16 out of 18 cancer types), and underestimated in the most deprived areas (16 out of 18 cancer types). ConclusionOur findings illustrate a bias in point estimates of weighted-average disability weights created using worldwide severity distributions. This bias would have led to the misrepresentation of non-fatal estimates of the burden of individual cancers, and underestimated the scale of socioeconomic inequality in this non-fatal burden. This highlights the importance of not interpreting non-fatal estimates of burden of disease too precisely, especially for sub-national estimates and those comparing populations when relying on data inputs from other countries. It is essential to ensure that any estimates are based upon the best available country-specific data at the lowest granularity.

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BURDEN 2020—Burden of disease in Germany at the national and regional level

Abstract: The Burden 2020 study will provide the results of a new, health-related data processing system to the public. This includes a noninterest-guided presentation of the burden of disease (DALY) in Germany at the national and regional level.

Cited by 31 publications

References 19 publications

Prioritising the development of severity distributions in burden of disease studies for countries in the European region

Prioritising the development of severity distributions in burden of disease studies for countries in the European region

The impact of worldwide, national and sub-national severity distributions in Burden of Disease studies: A case study of cancers in Scotland

The impact of worldwide, national and sub-national severity distributions in Burden of Disease studies: a case study of individual cancer types in Scotland

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