View source for Burden of disease, health and population data

{{ebode}}
{{study|moderator=Pauli|stub=Yes}}
[[Category:EBoDE]]

For this project, the harmonized health statistics database as held by the World Health Organization was used. This database provides health data specific for each country, health endpoint as defined by the Environmental Burden of Disease -programme, age group and gender. We used data (deaths and DALYs) for the year 2004 (WHO, 2009b; more detailed data available on request)(World Health Organization. The global burden of disease: 2004 update. Geneva: World Health Organization; 2009. Available at: http://www.who.int/healthinfo/global_burden_disease/2004_report_update/en/index.html).

The data were obtained in discounted/age-weighted and undiscounted/un-age-weighted format.

Depending on the type of calculation (see section 2.1), different data were needed. For calculations according to methods 1A and 2A (Table 3-19 shows which methods were used for which calculation), the total YLL and YLD were needed per age group and country. The WHO database provides data for pre-defined age categories (e.g. 0–4; 5–14, etc). Age-specific values were derived assuming an equal distribution of people within the age categories in the WHO data. Table 3-15 shows a sample of the burden of disease as available from the WHO database, aggregated over all ages and for a selection of health endpoints only.

For calculations according to method 2B (see section 2.1 and Table 3-19), no background health data was applied; the incidences were calculated using a unit risk model and the burden of disease was estimated using the WHO disability weights and duration estimates. For these calculations (IQ loss and HTD from lead), no age-weighing was applied due to the lack of information on the age distribution of the effects; however, the impact of the simplification was estimated to be small and to affect only the discounted results. Table 3-16 shows the disability weights and durations that were used.

We have carried out preliminary calculations to investigate the potential effect of lag times on the discounted estimates. The lag times used per health endpoint are provided in Table 3-17.

Population data (number of people in 2004) were used to calculate numbers of DALYs per million people and are provided in Table 3-18.
<ref name="EBoDe">Otto Hänninen, Anne Knol:  European Perspectives on Environmental Burden of Disease: Esimates for Nine Stressors in Six European Countries, 
Authors and National Institute for Health and Welfare (THL), Report 1/2011 [http://www.thl.fi/thl-client/pdfs/b75f6999-e7c4-4550-a939-3bccb19e41c1]</ref>

{|{{prettytable}}
|+ TABLE 3-15. WHO burden of disease data (total undiscounted, not-age-weighted DALYs) in 2004 (sample of health endpoints; aggregated over all ages).
! rowspan="2" | Health endpoint
! rowspan="2" | YLL/ YLD
! colspan="6" | Burden of disease data (WHO) – discounted (3%) and age-weighted
|-----
| Belgium
| Finland
| France
| Germany
| Italy
| Netherlands
|-----
| rowspan="2" | Total mortality (non-violent)
Total morbidity
| YLL
| 1 137 042
| 520 755
| 5 904 337
| 9 261 877
| 5 780 589
| 1 585 775
|-----
| YLD
| 930 436
| 460 350
| 5 219 164
| 7 283 809
| 4 838 018
| 1 360 245
|-----
| rowspan="2" | Total cancer
| YLL
| 413 390
| 154 033
| 2 447 205
| 3 193 738
| 2 215 606
| 622 914
|-----
| YLD
| 34 945
| 12 796
| 198 478
| 254 086
| 172 230
| 50 271
|-----
| rowspan="2" | Leukaemia
| YLL
| 15 490
| 5 586
| 99 669
| 119 106
| 93 212
| 22 131
|-----
| YLD
| 487
| 167
| 3 222
| 3 845
| 2 859
| 689
|-----
| rowspan="2" | Lung cancers
| YLL
| 103 461
| 27 142
| 514 569
| 653 118
| 465 809
| 154 443
|-----
| YLD
| 2 125
| 583
| 9 473
| 12 740
| 10 014
| 3 031
|-----
| rowspan="2" | Otitis media
| YLL
| n/a
| n/a
| n/a
| n/a
| n/a
| n/a
|-----
| YLD
| 1 184
| 611
| 7 447
| 8 038
| 5 469
| 2 004
|-----
| rowspan="2" | Ischemic heart disease
| YLL
| 178 793
| 115 258
| 478 408
| 1 624 841
| 841 741
| 177 269
|-----
| YLD
| 21 764
| 13 676
| 56 462
| 188 782
| 98 850
| 22 340
|-----
| rowspan="2" | Cardiopulmonary disease
| YLL
| 385 102
| 203 063
| 1 222 063
| 3 067 603
| 1 861 658
| 425 443
|-----
| YLD
| 147 553
| 58 363
| 502 501
| 1 003 277
| 559 717
| 189 275
|-----
| rowspan="2" | Chronic bronchitis
| YLL
| 47 784
| 9 982
| 69 644
| 239 985
| 134 312
| 55 767
|-----
| YLD
| 66 091
| 14 949
| 125 272
| 404 043
| 151 689
| 83 814
|-----
| rowspan="2" | Asthma induction/ aggravation
| YLL
| 4 632
| 935
| 17 794
| 31 851
| 9 902
| 1 882
|-----
| YLD
| 13 818
| 9 264
| 99 867
| 100 872
| 60 658
| 31 209
|-----
| rowspan="2" | Lower respiratory infections
| YLL
| 30 003
| 13 331
| 97 589
| 168 799
| 78 505
| 44 596
|-----
| YLD
| 629
| 361
| 1 981
| 3 721
| 2 317
| 1 072
|-----
| rowspan="3" | Sum of all above
| YLL
| 2 313 816
| 2 313 816
| 2 313 816
| 2 313 816
| 2 313 816
| 2 313 816
|-----
| YLD
| 1 220 913
| 1 220 913
| 1 220 913
| 1 220 913
| 1 220 913
| 1 220 913
|-----
| DALY
| 3 534 729
| 3 534 729
| 3 534 729
| 3 534 729
| 3 534 729
| 3 534 729
|}


{|{{prettytable}}
|+ TABLE 3-16. Input parameters for calculating the burden of disease (method 2B).
! Stressor
! Health endpoint
! Disability Weight
! Duration (yrs)
|-----
| rowspan="2" | Lead
| Mild mental retardation
| 0.36
| 77.6
|-----
| Hypertensive disease
| 0.2
| 3.6
|-----
| Road traffic noise
| High sleep disturbance (HSD)
| 0.07<sup>a)</sup>
| 1
|-----
| Railway noise
| High sleep disturbance (HSD)
| 0.07<sup>a)</sup>
| 1
|-----
| Aircraft noise
| High sleep disturbance (HSD)
| 0.07<sup>a)</sup>
| 1
|-----
| rowspan="3" | Ozone
| Minor restricted activity days
| 0.07<sup>b)</sup>
| 0.00274 (= 1 day)
|-----
| Cough days, children
| 0.07<sup>b)</sup>
| 0.00274 (= 1 day)
|-----
| LRS days in children (excl cough)
| 0.099<sup>c)</sup>
| 0.00274 (= 1 day)
|-----
| PM<sub>2.5</sub>
| Restricted activity days (RAD)
| 0.099<sup>c)</sup>
| 0.00274 (= 1 day)
|}

<small><sup>a)</sup> Disability weight proposed by the WHO working group for noise impact assessment (confidence intervals 0.04–0.09).

<sup>b)</sup> Disability weight for pharyngitis.

<sup>c)</sup> Disability weight for lower respiratory infections (chronic sequelae)</small>


{|{{prettytable}}
|+ TABLE 3-17: Crude estimated lag times (time between exposure to the onset of the disease) as used in the lag-time model (author estimates in years).
! Environmental stressor
! Health endpoint
! Crude estimated lag time (author judgement)
years
|-----
| Benzene
| Leukaemia
| 3
|-----
| Dioxins
| Total cancer incidence
| 10
|-----
| rowspan="6" | SHS
| Tracheas, bronchus and lung cancers in non smokers
| 30
|-----
| Ischemic heart disease
| 3
|-----
| Asthma induction, adults (>21 yr)
| 1
|-----
| Asthma induction, children (<14 yr)
| 1
|-----
| Lower respiratory infections (<2 yr)
| 0
|-----
| Otitis media (<3yr)
| 0
|-----
| Formaldehyde
| Asthma aggravation (children)
| 0
|-----
| rowspan="2" | Lead
| IQ loss
| 3
|-----
| Hypertensive disease
| 1
|-----
| rowspan="2" | Transport noise
| High sleep disturbance (HSD)
| 0
|-----
| Ischemic heart disease (IHD)
| 3
|-----
| rowspan="4" | Ozone
| Total mortality (non-violent)
| 1
|-----
| Minor restricted activity days
| 0
|-----
| Cough days, children
| 0
|-----
| LRS days in children
| 0
|-----
| rowspan="5" | PM<sub>2.5</sub>
| Cardiopulmonary mortality *
| 3
|-----
| Lung cancer mortality *
| 30
|-----
| Total mortality (non-violent) *
| 3
|-----
| Chronic bronchitis
| 1
|-----
| Restricted activity days (RAD)
| 0
|-----
| rowspan="2" | PM<sub>10</sub>
| LRS symptoms days, children
| 0
|-----
| LRS symptom days, adults
| 0
|-----
| Radon
| Lung cancer
| 30
|}

<small> * Overlapping end-points.</small>


{|{{prettytable}}
|+ TABLE 3-18. Population sizes (in 2004; millions) in the defined target population groups (WHO, 2009b: Reference populations and live births).
! Populations (in millions)
! Belgium
! Finland
! France
! Germany
! Italy
! Netherlands
! Total
|-----
| All
| 10.2
| 5.2
| 60.6
| 82.5
| 58.2
| 16.3
| 233.1
|-----
| Infants (<2 yr)
| 0.229
| 0.113
| 1.530
| 1.452
| 1.090
| 0.399
| 4.8
|-----
| Toddlers (<3 yr)
| 0.345
| 0.169
| 2.296
| 2.197
| 1.629
| 0.603
| 7.2
|-----
| Children (0-4 yr)
| 0.58
| 0.28
| 3.83
| 3.69
| 2.71
| 1.02
| 12.1
|-----
| School children (5–14 yr)
| 1.23
| 0.63
| 7.39
| 8.35
| 5.51
| 2.00
| 25.1
|-----
| Children (<14 yr)
| 1.7
| 0.851
| 10.5
| 11.2
| 7.7
| 2.8
| 34.6
|-----
| Adults (>15 yr)
| 8.4
| 4.3
| 49.4
| 70.5
| 50.0
| 13.3
| 195.8
|-----
| Adults (>15 yr) with chronic LRS *
| 2.5
| 1.3
| 14.8
| 21.1
| 15.0
| 4.0
| 58.8
|-----
| Non-smoking adults (>15 yr)
| 6.3
| 3.2
| 35.3
| 50.0
| 38.2
| 8.8
| 141.9
|-----
| Adults (>21 yr)
| 7.7
| 3.9
| 44.7
| 64.7
| 46.4
| 12.1
| 179.6
|-----
| Adults (>27 yr)
| 6.9
| 3.5
| 40.0
| 58.9
| 42.2
| 10.9
| 162.5
|-----
| Adults (>30 yr)
| 6.5
| 3.3
| 37.8
| 56.1
| 39.8
| 10.3
| 153.8
|-----
| Adults (15-64 yr)
| 6.7
| 3.5
| 39.5
| 55.4
| 38.7
| 11.0
| 154.7
|-----
| Working age (18–64 yr)
| 6.3
| 3.3
| 37.1
| 52.5
| 37.0
| 10.4
| 146.7
|}

<small>* Adults with chronic respiratory symptoms estimated in CAFE to be 30% (Watkiss et al, 2005).</small>

==References==
<references/>