Burden of disease studies provide the means to measure the impact of morbidity and mortality on populations. Many studies have been performed within the EU28, examining a limited number of countries, diseases and risk factors (
Donovan et al 2018). The most comprehensive study of this kind, the Global Burden of Disease (GBD), has been undertaken by the World Health Organisation (WHO) and the Institute for Health, Metrics and Evaluation (IHME) ( GBD study 2017a). To facilitate the harmonization and comparability of burden of disease studies across Europe, the European Burden of Disease Network (EBoDN) ( WHO EBoDN), has been established in collaboration with the WHO and IHME. The GBD study currently encompasses 354 diseases and injuries for 195 countries with an assessment of 84 behavioural, environmental and occupational, and metabolic risks ( GBD study 2017b). The list of risks included evolves with each study to reflect the importance of major risk factors. A standard metric used in this, and other, studies is the disability adjusted life year (DALY), a measure of the years of healthy life lost. DALYs are estimated from the sum of years lost due to premature death (YLLs) and years lived with disability (YLDs).
Data from the Global Burden of Disease study is updated annually. Every effort is made to keep this chapter up to date. All current data (and uncertainty intervals) can be accessed at the Global Health Data Exchange ( GBD results tool).
The GBD 2017 study estimates that over 91% of deaths and almost 87% of DALYs in the EU are the result of non-communicable diseases (NCDs), of which approximately 61% and 46% respectively can be attributed to the risk factors assessed in the study. The largest burden, in terms of both deaths and DALYs, is from cardiovascular diseases and neoplasms, Table 1. While not responsible for significant portions of deaths, mental disorders and musculoskeletal disorders represent a large burden in terms of DALYs. Unhealthy diets, tobacco use, harmful use of alcohol and physical inactivity have been identified as the top risk factors for NCDs in the EU, all of which are, to a large extent, avoidable (
WHO 2014). Table 2 details the estimates obtained by GBD 2017 for deaths and DALYs from all NCDs that are attributable to these risk factors. The individual member state estimates for DALYs (expressed per 100,000 population) for these risk factors are further detailed in Table 3.
Table 1: Estimated percentage of deaths and disability-adjusted life years (DALYs) within the EU in 2017 from non-communicable diseases (NCDs)
Percent (%) contribution to total burden in the EU (2017)
Chronic respiratory diseases
Diabetes and kidney diseases
Other non-communicable diseases
Substance use disorders
Skin and subcutaneous diseases
Sense organ diseases
Table 2: Estimated deaths and disability-adjusted life years (DALYs) per 100,000 population from non-communicable diseases (NCDs) within the EU attributable to the risk factors listed (2017)
Deaths and DALYs per 100,000 population
Low physical activity
a Unhealthy diets due to the risk factors outlined in Table 4.
Table 3: Estimated disability-adjusted life years (DALYs)/100,000 attributable to dietary risks, low physical activity (PA), tobacco and alcohol use in the EU in 2017.
Please note these are summary measures. The differences between the countries could be affected by the different age structure of the populations.
DALYs per 100,000 population attributable to:
Dietary risk factors
United Kingdom 2395
The GBD 2017 study estimates that, in the European Union, over 950,000 deaths and over 16 million DALYs are attributable to dietary risks due to unhealthy diets. The individual member state estimates of these DALYs (expressed per 100,000 population) are detailed in Table 3. Of the deaths attributable to dietary risks, the GBD study estimates that all are the result of NCDs, mainly cardiovascular diseases (817,302), neoplasms (101,477) and diabetes and kidney diseases (32,009). Similarly, all DALYs attributable to dietary risks are estimated to be the result of NCDs, mainly cardiovascular diseases (12,285,330), diabetes and kidney diseases (1,902,235) and neoplasms (1,857,159).
The EU disease burden due to the dietary risk factors considered in the GBD study, and their definitions, are detailed in Table 4. The relative contributions of the individual dietary risk factors to specific disease burdens are shown in Table 5.
The 2017 GBD study estimates that, in the European Union, almost 153,000 deaths and over 2.1 million DALYs are attributable to low physical activity, which is defined as less than 8,000 metabolic equivalent (MET) minutes per week, with one MET being the energy spent while sitting quietly (
IHME 2018). The individual member state estimates of these DALYs (expressed per 100,000 population) are detailed in Table 3.
The GBD study estimates that all deaths attributable to low physical activity result from NCDs, distributed as follows: cardiovascular diseases (140,746), neoplasms (9,045) and diabetes and kidney diseases (3,075). Similarly, all DALYs attributable to low physical activity are estimated to result from NCDs as follows: cardiovascular diseases (1,799,919), neoplasms (160,040), and diabetes and kidney diseases (159,993).
The 2017 GBD study estimates that, in the European Union, over 810,000 deaths are attributable to smoking and almost 67,000 to second-hand smoke (passive smoking). Furthermore, the study estimates almost 19.8 million and over 1.6 million DALYs are attributable to smoking and second-hand smoke respectively. The individual member state estimates of these DALYs (expressed per 100,000 population) are detailed in Table 3.
Of the deaths attributable to smoking, approximately 784,000 result from NCDs, mainly neoplasms (388,279), cardiovascular diseases (222,947) and chronic respiratory diseases (103,515). Over 19.1 million DALYs attributable to smoking result from NCDs, as before, mainly neoplasms (7,922,504), cardiovascular diseases (4,964,460), chronic respiratory diseases (2,561,425) and musculoskeletal disorders (2,225,660).
Of the deaths attributable to second-hand smoking, approximately 59,000 result from NCDs, with more than 31,000 from cardiovascular diseases. Similarly, approximately 1.5 million DALYS attributable to second-hand smoking result from NCDs, with almost 600,000 from cardiovascular diseases.
The 2017 GBD study estimates that, in the European Union, over 300,000 deaths and 10 million DALYs are attributable to alcohol use. The individual member state estimates of these DALYs (expressed per 100,000 population) are detailed in Table 3.
Of the deaths attributable to alcohol use, almost 250,000 result from NCDs and a further 43,000 from injuries. The main NCDs attributable to alcohol use are neoplasms (124,469), digestive diseases (48,883) and cardiovascular diseases (48,663). Most injuries attributable to alcohol use are the result of self-harm and interpersonal violence (24,763).
Of the DALYs attributable to alcohol use, almost 7.5 million result from NCDs and over 2.2 million from injuries. The main NCDs contributing to DALYs from alcohol use are neoplasms (2,707,521), cardiovascular diseases (1,565,529), substance use disorders (1,556,951) and digestive diseases (1,335,641). DALYs due to injuries are mostly from self-harm and interpersonal violence (938,064) and unintentional injuries (932,165).
Donovan et al (2018) Burden of disease studies in the WHO European Region—a mapping exercise, The European Journal of Public Health, Vol. 28, No. 4, 773–778
GBD Study (2017a) Global, regional, and national incidence, prevalence, and years lived with disability for 354 diseases and injuries for 195 countries, 1990-2017: a systematic analysis for the Global Burden of Disease Study 2017. The Lancet (2017) Volume 390, Issue 10100, 16–22 September 2017, Pages 1211-1259
GBD Study (2017b) Global Burden of Disease Study, Global, regional, and national comparative risk assessment of 84 behavioural, environmental and occupational, and metabolic risks or clusters of risks, 1990–2017: a systematic analysis for the Global Burden of Disease Study 2017. Lancet (2018) 392-1923-94
IHME (2018), Institute for Health Metrics and Evaluation, Terms defined
WHO (2014) World Health Organization,Prevention and control of noncommunicable diseases in the European Region: a progress report
WHO EBoDN World Health Organization, European Burden of Disease Network