The burden of disease in Spain: results from the global burden of disease study 2010

Haro et al. BMC Medicine 2014, 12:236 http://www.biomedcentral.com/1741-7015/12/236 Medicine for Global Health RESEARCH ARTICLE Open Access The burden of disease in Spain: results from the global burden of disease study 2010 Josep Maria Haro1,2*, Stefanos Tyrovolas1,2, Noe Garin1,2, Cesar Diaz-Torne3, Loreto Carmona4, Lidia Sanchez-Riera5,6, Fernando Perez-Ruiz7 and Christopher JL Murray8 Abstract Background: We herein evaluate the Spanish population? s trends in health burden by comparing results of two Global Burden of Diseases, Injuries, and Risk Factors Studies (the GBD studies) performed 20 years apart. Methods: Data is part of the GBD study for 1990 and 2010. We present results for mortality, years of life lost (YLLs), years lived with disability, and disability-adjusted life years (DALYs) for the Spanish population. Uncertainty intervals for all measures have been estimated. Results: Non-communicable diseases accounted for 3,703,400 (95% CI 3,648,270? 3,766,720) (91.3%) of 4,057,400 total deaths, in the Spanish population. Cardiovascular and circulatory diseases were the main cause of mortality among non-communicable diseases (34.7% of total deaths), followed by neoplasms (27.1% of total deaths). Neoplasms, cardiovascular and circulatory diseases, and chronic respiratory diseases were the top three leading causes for YLLs. The most important causes of DALYs in 2010 were neoplasms, cardiovascular and circulatory diseases, musculoskeletal disorders, and mental and behavioral disorders. Conclusions: Mortality and disability in Spain have become even more linked to non-communicable diseases over the last years, following the worldwide trends. Cardiovascular and circulatory diseases, neoplasms, mental and behavioral disorders, and neurological disorders are the leading causes of mortality and disability. Specific focus is needed from health care providers and policy makers to develop health promotion and health education programs directed towards non-communicable disorders. Keywords: Disability-adjusted life years, Global Burden of Diseases, Injuries, and Risk Factors Studies, Spain, Mortality, Years lived with disability, Years of life lost Background The impact of diseases and injures on population health is usually assessed with measures of mortality and non-fatal health outcomes [1]. These estimates are used to signal the most relevant public health problems, allow comparison between different populations and different health conditions, and assess changes over time. The only comprehensive effort to date to estimate summary measures of the global population health, by cause and by world * Correspondence: 1 Parc Sanitari Sant Joan de D?u, Universitat de Barcelona, Fundaci? Sant Joan de D?u. Dr Antoni Pujades, 42, 08830 Sant Boi de Llobregat, Barcelona, Spain 2 Instituto de Salud Carlos III, Centro de Investigaci?n Biom?dica en Red de Salud Mental CIBERSAM, Dr. Esquerdo 46, 28007 Madrid, Spain Full list of author information is available at the end of the article region, is the ongoing Global Burden of Diseases, Injuries, and Risk Factors (GBD) initiative [2,3]. The first GBD study analyzed data from 1990 [4] and was published in 1993. Since then, a number of updates have been published [5]. The Global Burden of Diseases, Injuries, and Risk Factors Study 2010 (GBD 2010) has updated and expanded previous efforts to include 1,160 diseases and injury sequelae from the previous analysis, which included 483 diseases. The most important limitation of previous GBD studies is that results were not estimated with uncertainty [6]. Specifically, uncertainty can come from many sources, including heterogeneity in the empirical data that are available and uncertainty in the indirect estimation models used to make predictions for populations with little or no data. However, this ? 2014 Haro et al.; licensee BioMed Central Ltd. This is an Open Access article distributed under the terms of the Creative Commons Attribution License (http://creativecommons.org/licenses/by/4.0), which permits unrestricted use, distribution, and reproduction in any medium, provided the original work is properly credited. The Creative Commons Public Domain Dedication waiver (http://creativecommons.org/publicdomain/zero/1.0/) applies to the data made available in this article, unless otherwise stated. Haro et al. BMC Medicine 2014, 12:236 http://www.biomedcentral.com/1741-7015/12/236 limitation has been solved in the recent analysis of the GBD 2010 study. The GBD initiative uses disability-adjusted life years (DALYs) and mortality as the summary measurements of the impact of health conditions on population health. The DALY combines the years of life lost (YLLs) due to premature mortality and the years lived with disability (YLDs). The use of DALYs as measure of impact, the inclusion of a large number of communicable and non-communicable conditions, the analysis of the impact of health conditions stratified by gender and age, and the effort to use comparable methodologies across countries and regions make the GBD project an excellent tool to understand the determinants of health and their variability across time and regions. According to previous reported global results, in 1990, 47% of DALYs were attributed to communicable, maternal, neonatal, and nutritional disorders, 43% to noncommunicable diseases, and 10% to injuries, while in 2010, this had reversed to 35%, 54%, and 11%, respectively [5]. Besides clear differences among countries with different socioeconomic conditions, heterogeneity is also present when analyzing and comparing countries with more similar socioeconomic conditions. For example, in the United Kingdom (UK), mortality and disability as well as overall health has improved in absolute terms between 1990 and 2010. However, according to Murray et al. [7], the UK performed worse than other EU countries in age-standardized mortality, YLLs, and life expectancy rates. The UK age-standardized DALY rates for chronic obstructive pulmonary disease, disorders of drug use, lower respiratory infections, breast cancers, and preterm birth complications were significantly higher compared to the mean of the EU-15 area countries [7]. Spain is a southern European country with distinct sociodemographic and health characteristics; while in former years large proportions of the population adhered to a Mediterranean diet, dietary habits are changing rapidly with alarming rates of obesity and smoking and alcohol drinking are still highly prevalent in the country despite public health efforts to reduce consumption. Nevertheless, the, until recently, universal coverage of the National Health System also facilitates good health care levels and the implementation of some preventive actions. Until now, to the best of our knowledge, only two studies have tried to assess the burden of disease in Spain. Genova-Maleras et al. [8] estimated the impact of different diseases using DALYs. According to the resea (...truncated)