title: Health status of 'Ruhr-City' in 2025--predicted disease burden for the metropolitan Ruhr area in North Rhine-Westphalia.
abstract: BACKGROUND
  Demographic change is a driving force of disease burden. The German population is aging and simultaneously shrinking, due to a rising life expectancy and a declining fertility rate. North Rhine-Westphalia (NRW) is the most populous federal state of Germany including the Ruhr metropolitan area. The NRW population is expected to shrink by 2.5% until 2025, the population of the Ruhr area by 9.5%. At the same time, the population forecast predicts a growth of 30% in the age group > or =55 years for NRW.
  
  
  METHODS
  The 'burden of disease' approach of the World Health Organisation (WHO) summarizes the health status of populations. This approach was used to predict the regional disease burden in 2025 by calculating disability adjusted life years (DALY) as the sum of life years lost due to premature death and years lived with disability due to selected diseases. Our projection included selected tumours, myocardial infarction (MI) and dementia.
  
  
  RESULTS
  For the Ruhr area, increases in DALYs are expected for all causes studied, i.e. selected tumours (20%), MI (17%) and dementia (36%). The increase in the Ruhr area was estimated to be proportionally lower than in NRW in total, but the disease burden per inhabitant is higher.
  
  
  CONCLUSIONS
  The population shrinking is no cure for 'Ruhr City'. The projection of disease burden shows that health status will decrease due to the demographic change. DALY estimates show the potential health gains, which can be won by implementing measures to reduce premature deaths and to prevent new cases.
authors.affiliation: NRW Institute of Health and Work (LIGA.NRW), Westerfeldstrasse 35-37, Bielefeld, Germany. claudia.terschueren@liga.nrw.de
authors.forename: Claudia
authors.initials: C
authors.lastname: Terschüren
authors.forename: Odile C L
authors.initials: OC
authors.lastname: Mekel
authors.forename: Reinhard
authors.initials: R
authors.lastname: Samson
authors.forename: Thomas K D
authors.initials: TK
authors.lastname: Classen
authors.forename: Claudia
authors.initials: C
authors.lastname: Hornberg
authors.forename: Rainer
authors.initials: R
authors.lastname: Fehr
mesh_terms: D000293:Adolescent; D000328:Adult; D017677:Age Distribution; D000368:Aged; D000369:Aged, 80 and over; D002648:Child; D002675:Child, Preschool; D003704:Dementia / Q000453:epidemiology*; D005260:Female; D005858:Germany / Q000453:epidemiology; D006304:Health Status; D006306:Health Surveys; D006801:Humans; D007223:Infant; D007231:Infant, Newborn; D008017:Life Expectancy / Q000639:trends; D008297:Male; D008875:Middle Aged; D009203:Myocardial Infarction / Q000453:epidemiology*; D009369:Neoplasms / Q000453:epidemiology*; D011157:Population Dynamics; D017678:Sex Distribution; D014505:Urban Population / Q000706:statistics & numerical data; D055815:Young Adult