Norwegian Burden of Disease Study 2017-2019: regional and socioeconomic patterns in Norway and Nordic comparison studies

Disease burden analyses illustrate how various diseases, injuries, and risk factors affect a population in terms of health loss and mortality. Disease burden analyses are comprehensive, as they include the burden from both fatal and non-fatal diseases on the population's health. Calculations can also be made for the proportion of disease burden that can be attributed to modifiable risk factors. The results from such analyses can be used to identify areas that should be prioritized in public health efforts and for preventive measures, clinical interventions, research, as well as health service capacity planning. The Global Burden of Disease project (GBD) is the leading initiative for calculating global disease burden. The project is coordinated by the Institute of Health Metrics and Evaluation (IHME) at the University of Washington, USA. However, there are several analyses that cannot be conducted within the GBD project, requiring national-level analyses. Here, the rich data infrastructure in Norway provides unique opportunities. The main goal of the Norwegian Research Council (NFR) project has been to expand and complement GBD's analyses of fatal and non-fatal health loss for Norway and the Nordic region. This includes detailed use of GBD's results for Norway and the Nordic countries and applying disease burden methodology to Norwegian and Nordic individual-level data. The project has had the following objectives: 1) Develop regional disease burden analyses in Norway; 2) Describe socio-economic gradients in disease burden in Norway; 3) Describe the disease burden in the Nordic countries; 4) Develop a data repository for Norwegian risk factor data. It has been essential for the project's implementation to further develop and strengthen the collaboration with IHME and the GBD project. We have also established a Nordic network of researchers working on disease burden analyses. This has provided access to new research questions, comparable analyses based on Nordic data, and the development of new expertise among project staff. In the project, we have worked with both Norwegian and Nordic primary data, as well as data produced by the GBD project. We have created a database where we have compiled data from various Norwegian health surveys and administrative registers and health registries. The project has resulted in 44 published scientific articles, several articles still in progress, and numerous media coverage. The results have been used as a knowledge base in the governments Public Health Plan (2022-2023) and in public health work in municipalities and counties. The project has contributed to increased knowledge about the distribution of disease burden in Norway and the Nordic region. Here are some key findings: 1) Through the project, Norwegian counties have been included as separate geographical units in GBD. The analyses show that differences between counties in life expectancy and disease burden have decreased from 1990 to 2019, with the most significant improvements seen in the counties that performed poorly in 1990. The increase in life expectancy can be attributed to the reduction in cardiovascular disease, cancer, and respiratory infections. There are no differences between counties for non-fatal health loss, but Troms and Finnmark had more years of life lost than the average for Norway. 2) Differences in life expectancy by income level increased from 2005 to 2015. The differences in life expectancy between the top and bottom percentiles in income are as large in Norway as in the USA. Income differences in life expectancy can largely be linked to deaths from cardiovascular diseases, cancers, COPD, and dementia in the older population, and substance use deaths and suicides in the younger population. 3) Comparisons of life expectancy and disease burden in the Nordic countries show that Icelandic women had the highest life expectancy, and Finnish men had the lowest in 2017. Differences in disease burden between countries could largely be linked to differences in causes contributing to years of life lost. Smoking and metabolic risk factors were important risk factors in all countries, but smoking and alcohol use contributed more to the disease burden in Finland and Denmark than in the other Nordic countries. The highest disease burden and the lowest life expectancy in the region were found among the population in Greenland.

- Styrket samarbeid med IHME og påvirkning i GBD prosjektet. - Etablering av en database for å utføre sykdomsbyrdeanalyser som ikke kan gjøres i GBD prosjektet, bla. sykdomsbyrde etter sosioøkonomisk status og nasjonale analyser av sykdomsbyrde etter risikofaktorer. - Etablering av et nordisk sykdomsbyrdenettverk som anvender sykdomsbyrdemetodikk på nordiske primærdata. I løpet av perioden har det vært avholdt 2 tre-dagers workshops (i Bergen og Stockholm), og et to dagers seminar (i Bergen). Det jobbes med nye prosjektsøknader, og vi har fått tilslag på såkornsmidler fra HOD for å jobbe mot å utvide sykdomsbyrdeanalyser til å inkludere urbefolkning i Arktis. - Problemstillingene i prosjektet er utvidet og videreført i andre nasjonale og internasjonale forskningsprosjekter, blant annet CHAIN (NFR prosjekt 288638), og Cost Action CA 18218 European Burden of Disease Network. - De vitenskapelige resultatene er tatt inn som viktige deler av kunnskapsgrunnlaget i blant annet Folkehelsemeldingen 2022-2023, og i folkehelsearbeidet på fylkes- og kommuninivå.

The Norwegian Institute of Public Health (NIPH) Burden of Disease (BoD) project and team was established in 2013 and as a Centre for Disease Burden in 2015. The project will build on and collaborate with the Global Burden of Disease (GBD). Burden of disease is measured as years of life lost (YLL) and years lived with disability (YLD). Unlike traditional mortality measures, disability-adjusted life years (DALYs=YLL+YLD) also capture disease burden caused by non-fatal chronic conditions and mental disorders, that may be assigned low weight in some priority settings. The project also estimates the disease burden caused by obesity, smoking, cardiovascular and a series of other risk factors. Results from a national burden of disease study should serve as important background information in the formation of national health polices and prevention strategies in public health. We aim to expand activities with a researcher and post-doc candidate that will focus on (1) analysis of burden of disease in the Nordic countries and other comparison countries based on estimates from GBD, (2) subnational BoD analyses in Norway, and (3) BoD in Norway by socioeconomic status. The project will also exploit the rich cohort data sources that exist in Norway to supplement and improve GBD estimates of the burden of major risk factors such as smoking, high blood pressure, physical activity, blood cholesterol, and body mass index. The researcher and postdoc and Norwegian Burden of Disease Centre will collaborate closely with the international GBD project that is lead from the Institute for Health Metrics and Evaluation (IHME) at the University of Washington. Collaboration will include above research questions, small-area distribution of life expectancy in Norway, trends in mortality compared to other high-income countries, and establishing a data repository for Norwegian risk factor data.