Monitoring the burden of disease in Scotland and the contribution of risk factors

Abstract Background The Scottish Burden of Disease (SBoD) Study monitors the contribution of over 100 diseases and injuries to the population health in Scotland, in the context of disability-adjusted life years (DALYs). Providing robust estimates of burden is the first step in identifying areas of prevention which could have the biggest impact on health; including identification of modifiable risk factors and changes in the underlying risk factor prevalence. Our aim was to estimate DALYs for 2019, to describe the current burden in Scotland and as a baseline for future burden scenarios. Methods The SBoD 2016 study estimated the burden using routine data and patient-level record linkage. For this update, years lived with disability were estimated using 2016 age-sex-deprivation specific rates, assuming no change in disease prevalence from 2016, but taking account of changes to the population structure. Years of life lost were calculated from 2019 observed deaths and the application of the Global Burden of Disease (GBD) aspirational life table. Population attributable fractions (PAFs) were sourced from the GBD 2019 and risk factor prevalence from the Scottish Health Survey. Results In 2019 the leading causes of burden were ischaemic heart disease (IHD), Alzheimer's/other dementias, lung cancer, drug-use disorders and cerebrovascular disease, representing over a quarter (27%) of the total DALYs in Scotland. Application of PAFs shows that a proportion of the burden for each of these causes can be attributed to modifiable risk factors. Conclusions IHD continues to be the leading cause of health burden in Scotland in 2019. However recent years show an increase in burden of social causes and diseases affecting the ageing population. Application of PAFs demonstrate the importance of continuing to monitor both the burden of disease in Scotland and the prevalence of risk factors, to provide robust evidence for planning of local and national services. Key messages • The Scottish Burden of Disease continues to monitor the population health landscape of Scotland. • Ischaemic heart disease continues to be the leading cause of burden in Scotland.

In 2015 the German Prevention Act was implemented. The National Prevention Conference published the first National Prevention Report in 2019 to evaluate the health promotion activities. The second National Prevention Report is planned for 2023. Development of a harmonized prevention reporting system for the German Federal States is needed to form the basis for the contribution of the Federal States to the next National Prevention Report. A working group mandated from the sub-national health authorities has developed a harmonized prevention reporting system for the German Federal States since 2018. The Robert Koch Institute collaborated as representative of the national level during the process. Subject areas for indicators were selected based on a survey in which all 16 State Ministries of Health participated. Indicator subgroups developed indicators for each subject area based on predefined indicator selection criteria. Final set of indicators was adopted by indicator rating and majority voting process. The German Health Ministers Conference acknowledged the indicator system in June 2021. The conceptual framework is adapted from the health determinants model of Dahlgren and Whitehead. The indicator system is divided into 14 subject areas categorized into upstream, midstream and downstream level of prevention indicators. Seventy-three prevention indicators were included as a whole. The indicator short list consists of 32 Core indicators. An overview of the prevention indicator system will be given. First results of a pilot data collection will be shown. Health promotion and prevention reporting tools are needed to monitor prevention policies and evaluate health promotion measures. The prevention indicator system of the German Federal States will be used for the National Prevention Strategy in Germany of which one component is the next National Prevention Report 2023. Key messages: The prevention indicator system of the German Federal States is a useful tool to monitor prevention policies.
The indicator system will form the basis for the German Federal States' contribution to the National Prevention Report 2023.

Background:
The Scottish Burden of Disease (SBoD) Study monitors the contribution of over 100 diseases and injuries to the population health in Scotland, in the context of disabilityadjusted life years (DALYs). Providing robust estimates of burden is the first step in identifying areas of prevention which could have the biggest impact on health; including identification of modifiable risk factors and changes in the underlying risk factor prevalence. Our aim was to estimate DALYs for 2019, to describe the current burden in Scotland and as a baseline for future burden scenarios.

Methods:
The SBoD 2016 study estimated the burden using routine data and patient-level record linkage. For this update, years lived with disability were estimated using 2016 age-sex-deprivation specific rates, assuming no change in disease prevalence from 2016, but taking account of changes to the population structure. Years of life lost were calculated from 2019 observed deaths and the application of the Global Burden of Disease (GBD) aspirational life table. Population attributable fractions (PAFs) were sourced from the GBD 2019 and risk factor prevalence from the Scottish Health Survey.

Results:
In 2019 the leading causes of burden were ischaemic heart disease (IHD), Alzheimer's/other dementias, lung cancer, druguse disorders and cerebrovascular disease, representing over a quarter (27%) of the total DALYs in Scotland. Application of PAFs shows that a proportion of the burden for each of these causes can be attributed to modifiable risk factors.

Conclusions:
IHD continues to be the leading cause of health burden in Scotland in 2019. However recent years show an increase in burden of social causes and diseases affecting the ageing population. Application of PAFs demonstrate the importance of continuing to monitor both the burden of disease in Scotland and the prevalence of risk factors, to provide robust evidence for planning of local and national services. Key messages: The Scottish Burden of Disease continues to monitor the population health landscape of Scotland. Ischaemic heart disease continues to be the leading cause of burden in Scotland.