Disease burden in the Nordic region. Results from the Global Burden of Disease Study 2017 (GBD 2017)

Abstract

Abstract Background The Nordic countries - Norway, Sweden, Finland, Iceland, Denmark - combine liberal and open-market economies with public welfare and universal health services. As separate countries with differences in culture and lifestyle, important health differences may exist between them. The aim of this study was to compare life expectancy and disease burden by causes and risk factors in the Nordic countries, including Greenland as constituent country under Denmark. Methods Age-standardised overall, cause-, and risk factor-specific estimates of disability-adjusted life-years (DALYs), along with life expectancy, were analysed in the Global Burden of Diseases, Injuries and Risk Factors Study 2017 (GBD 2017). Sex and country specific estimates were compared with Nordic regional estimates. Results Males and females in Denmark (males: 78.8 years, 95% uncertainty interval 78.1-79.5; females: 82.7 years, 81.9-83.4), and males in Finland (78.6 years, 77.8-79.2) had lower life expectancy than the other countries. The lowest life expectancy and highest DALY rates were found among males and females in Greenland. Variation in DALY rates between the countries was primarily due to differences in mortality-related causes, including ischaemic heart disease, chronic obstructive pulmonary disease, lung cancer, alcohol use disorder, and self-harm. These causes dominated male DALYs. There was little country-wise variation in DALYs due to non-fatal diseases, which were dominant causes among females. Smoking and metabolic risk factors were important risk factors across countries, but contributed most to DALYs among males and females in Denmark, and males in Finland (alcohol use only). Conclusions The GBD framework facilitates within-region comparisons for benchmarking exercises and can guide policy development. The comparison of disease burden in the Nordic countries illustrates how differences in risk factors may drive life expectancy and disease burden differences in high-income settings. Key messages Diseases and injuries associated with mortality are important causes of disease burden among males, while non-fatal diseases dominates disease burden among females in the Nordic region. Risk factors differences may drive disease burden differences between the Nordic countries.