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Disability-Adjusted Life Years

  1. Key messages
  2. Disability-Adjusted Life Years
  3. Read more

All estimates can be consulted in more detail in our interactive online applications:
Estimates of mortality and years of life lost for 131 causes of death
Estimates of the non-fatal burden of 56 cancer types
Estimates of the burden of 38 key diseases

1. Key messages

  • The Belgian national burden of disease study quantifies the health impact of 38 key diseases in terms of Disability-Adjusted Life Years (healthy life years lost due to morbidity and mortality).
  • In 2020, the considered diseases led to a loss of 2.5 million healthy life years.
  • In 2020, mental and substance use disorders, cancers, and infectious diseases were the leading causes of disease burden in Belgium.
  • The disease burden in 2020 was almost equally attributable to premature mortality (57%) as to losses in quality of life (43%).
  • The total disease burden in 2020 was higher among men compared to women.
  • The largest share of the disease burden was borne by the elderly (65+).
  • The total disease burden was the highest in the Walloon Region, followed by the Brussels Capital Region, and Flemish Region.
  • Among EU-14 countries, Belgium ranks 2nd worst in terms of total disease burden.

2. Disability-Adjusted Life Years

More than 2.5 millions healthy life years lost in Belgium in 2020

In 2020, the considered 38 key diseases led to a loss of 2,509,328 healthy life years (21,807 DALYs per 100,000). Mental and substance use disorders, cancers, and infectious diseases were the leading disease groups, accounting for 50% of the total disease burden. The top 5 specific causes for DALYs were COVID-19 (11%), depression (7%), lung cancer (6%), ischemic heart disease (6%) and low back pain (6%).

Distribution of Disability-Adjusted Life Years by disease, Belgium, 2020
Source: Own calculations based on data from IMA, Intego, ERA, HIS, Belgian Cancer Registry and Statbel [1-6]

Overall, DALYs could be attributed almost equally to premature mortality (57%) and to reduced quality of life (43%). Across disorders, there was a wide variety in the contribution of the mortality and morbidity impact: some disorders had almost entirely a morbidity impact (e.g., sense organ disorders), while others had almost entirely a mortality impact (e.g., injuries).

Share of the fatal (YLL) and non-fatal (YLD) disease impact by disease group, Belgium, 2020
Source: Own calculations based on data from IMA, Intego, ERA, HIS, Belgian Cancer Registry and Statbel [1-6]

Men suffer a higher disease burden compared to women. Among men, the age-adjusted DALYs equaled 25,357 per 100,000 in 2020, of which 61% could be attributed to premature mortality, and 39% to reduced quality of life. Among women, the age-adjusted DALYs equaled 18,815 per 100,000 in 2020, of which 53% could be attributed to premature mortality, and 47% to reduced quality of life. In both sexes, the leading disease for DALYs was COVID-19 (men: 3,134 DALYs per 100,000; women : 1,884 DALYs per 100,000).

Distribution of age-adjusted DALY rates by sex and disease group, Belgium, 2020
Source: Own calculations based on data from IMA, Intego, ERA, HIS, Belgian Cancer Registry and Statbel [1-6]

The disease burden in Belgium is largely borne by the elderly. The majority (53%) of DALYs in the Belgian population are attributed to the group of 65+ years (603,753 DALYs per 100,000). Among the group aged between 45 and 64 years, the Belgians suffered a total of 90,430 DALYs per 100,000 (28%), followed by a total of 64,886 DALYs per 100,000 among the group aged between 15 and 44 years (19%). The youngest group (< 15 years) accounted for less than 1% of the total DALYs. The leading disease groups with the highest impact in terms of DALYs per 100,000 were chronic respiratory diseases in children aged 5 years or less, neurological disorders in children aged between 5 to 14 years, mental and substance use disorders in youngsters and adults with an age between 15 to 64 years and infectious diseases in the elderly.

Distribution of DALY rates by age and disease group, Belgium, 2020
Source: Own calculations based on data from IMA, Intego, ERA, HIS, Belgian Cancer Registry and Statbel [1-6]

The highest burden is in the Walloon Region

After correcting for differences in population size and age structure, the disease burden is the highest in the Walloon Region (26,224 DALYs per 100,000), followed by the Brussels Capital Region (25,013 DALYs per 100,000), and the Flemish Region (19,016 DALYs per 100,000). In general, the leading disease groups do not differ across regions with mental and substance disorders being the group with the highest impact in all regions except the Flemish Region, where cancer is the leading disease group.  Cancer is the second largest disease group in the Walloon Region, mental and substance disorders are the second most important group in the Flemish Region, and infectious diseases are in second place in the Brussels-Capital Region. The third largest group in the Walloon Region is infectious diseases, while in Brussels this is cancer, and in the Flemish Region these are musculoskeletal disorders. 

Ranking of disease groups by age-adjusted DALY rates, Belgium and regions, 2020
Source: Own calculations based on data from IMA, Intego, ERA, HIS, Belgian Cancer Registry and Statbel [1-6]

The burden of disease decreases over time but COVID-19 has increased the burden of infectious diseases

Looking at trends over time after correcting for the population size and age structure, the disease burden of cancer has decreased from 4,507 DALYs per 100,000 individuals in 2013 to 3,770 DALYs per 100,000 individuals in 2020. A similar trend is observed for cardiovascular disorders, for which the disease burden has decreased from 3,026 DALYs per 100,000 individuals in 2013 to 2,225 DALYs per 100,000 individuals in 2020. In contrast, the disease burden of mental and substance use disorder has increased from 4,095 DALYs per 100,000 in 2013 to 4,260 DALYs per 100,000 in 2020. The disease burden of musculoskeletal disorders was 2,664 DALYs per 100,000 in 2013 and 2,724 DALYs per 100,000 in 2020, remaining stable over time. However, infectious diseases have increased between 2019 and 2020. They have risen from 681 DALYs per 100,000 individuals in 2019 to 2,967 DALYs per 100,000 individuals in 2020. This is mainly due to the appearance of Covid-19.

Distribution of age-adjusted DALY rates by year and disease group, Belgium, 2013-2020
Source: Own calculations based on data from IMA, Intego, ERA, HIS, Belgian Cancer Registry and Statbel [1-6]

Belgium scores poorly among EU-14 countries

In 2019, according to the Global Burden of Disease 2019 study [7], the estimated total DALYs in Belgium was above the EU-14 countries mean, ranking the country 2nd worst among the EU-14 countries after Greece.

Age-adjusted DALY rate per 100,000 by country of residence (EU-14), 2019
Source: GBD 2019 study [7]

3. Read more

Belgian Burden of Disease visualization tool
Belgian National Burden of Disease Study. Guidelines for the calculation of Disability-Adjusted Life Years in Belgium, September 2023
Download Summary Table (.xlsx) 488 KB

Background

What are the most important diseases in Belgium? Which risk factors contribute most to the overall disease burden? How is the burden of disease evolving over time, and how does it compare with neighboring countries? To address these basic questions, Sciensano conducts a national burden of disease study, in which the population impact for 38 key diseases in Belgium is evaluated.

The burden of disease is quantified using the Disability-Adjusted Life Year (DALY) metric. The use of DALYs allows to combine the years of healthy life lost due to reduced quality of life (Years Lived with Disability, YLD) and due to premature death (Years of Life Lost, YLL). It therefore permits a truly comparative ranking of the burden of various diseases, injuries and risk factors.

We calculate disease burden estimates by age, sex and region, allowing for a very detailed assessment of the state of health. The complete set of estimates can be explored via https://burden.sciensano.be/shiny/daly.

Definitions

DALY
The Disability-Adjusted Life Year or DALY in short is a population-level measure of the disease or disability burden in a specific population. DALYs are calculated by combining measures of life expectancy as well as the adjusted quality of life during a burdensome disease or disability for a population. More specifically the DALY reflects the sum of years of life lost (YLL) due to premature mortality and years of life lost due to disability (YLD) for a specific disease or condition.
YLD
The Years Lived with Disability or YLDs in short is a measure of the non-fatal disease burden in a specific population. YLDs are calculated by multiplying the number of prevalent cases with the (severity-weighted) disability weight, which reflects the relative reduction in quality of life lost due to living with the disease.
YLL
The Years of Life Lost or YLLs in short is a measure of the fatal disease burden in a specific population. YLLs are calculated by multiplying the number of deaths with the residual life expectancy at the age of death, thereby reflecting the number of years an individual has lost due to premature death.
EU-14
The EU-14 corresponds to all countries that belonged to the European Union between 1995 and 2004: Austria, Belgium, Denmark, Finland, France, Germany, Greece, Ireland, Italy, Luxembourg, the Netherlands, Portugal, Spain, and Sweden. We compare the Belgian health status to that of the EU-14 because these countries have similar socioeconomic conditions. Note: The United Kingdom is not included since they have left the EU.

References

  1. Intermutualistic Agency (IMA). https://aim-ima.be/
  2. Intego, KU Leuven. https://intego.be/
  3. Renal Database, European Renal Association (ERA). https://www.era-online.org/en/registry/
  4. Health Interview Survey (HIS), Sciensano. https://www.sciensano.be/en/projects/health-interview-survey
  5. Belgian Cancer Registry (BCR). https://kankerregister.org/
  6. Statistics Belgium (Statbel). https://statbel.fgov.be/en
  7. Global Burden of Disease Collaborative Network. Global Burden of Disease Study 2019 (GBD 2019) Results. Seattle, United States: Institute for Health Metrics and Evaluation (IHME), 2020. Available from http://ghdx.healthdata.org/gbd-results-tool.

Please cite this page as: Sciensano. Burden of disease: Disability-Adjusted Life Years, Health Status Report, 18 Sept 2023, Brussels, Belgium, https://www.healthybelgium.be/en/health-status/burden-of-disease/disability-adjusted-life-years