title: Disability-adjusted life years lost due to diabetes in France, Italy, Germany, Spain, and the United Kingdom: a burden of illness study.
abstract: OBJECTIVE
  To compare the burden of disease (BoD) attributable to diabetes expressed in disability-adjusted life years (DALYs) for five European countries in 2010.
  
  
  METHODS
  DALYs lost to diabetes as the sum of years of life lost and years lived with disability were estimated by sex and age using country-specific epidemiological data and global disability weights. Data from various secondary sources were combined to estimate health loss due to diabetes for France, Germany, Italy, Spain, and the UK. National statistical databases were used and if necessary, community studies were used to derive the prevalence of diabetes by sex and age group, which were weighted proportionately for a national population burden of disease estimate. All identified data were adapted to the Global Burden of Disease methodology (2010) to calculate the burden attributable to diabetes. No age weighting and discounting was applied. Sensitivity to different sources of variation was examined. Germany and Italy lost the largest number of DALYs due to diabetes, with 5.9 and 5.8 per 1,000 inhabitants, respectively, followed by Spain (4.4), France (3.7), and the UK (2.9). The highest burden was caused by mortality due to diabetes, with the exception of the UK, for which the burden due to disability of diabetes was higher. Mean DALYs lost were higher for women in Germany, Italy, and Spain and shown to increase with age for all countries. Sensitivity analysis in variation in disability weights and uncertainty in epidemiological data were shown to have effects on DALYs lost.
  
  
  CONCLUSIONS
  In spite of data limitations, the estimates reported here show that DALY loss due to diabetes imposes a substantial burden on countries. Cross-national variation in disease epidemiology was the largest source of variation in the burden of diabetes between countries.
authors.affiliation: Department of Economics, University of Barcelona, Barcelona, Spain.
authors.forename: Josep
authors.initials: J
authors.lastname: Darbà
authors.affiliation: Department of Health Economics, BCN Health Economics and Outcomes Research SL, Barcelona, Spain.
authors.forename: Lisette
authors.initials: L
authors.lastname: Kaskens
authors.affiliation: Department of Health Economics, CEMKA-EVAL, Bourg-la-Reine, France.
authors.forename: Bruno
authors.initials: B
authors.lastname: Detournay
authors.affiliation: Department of Endocrinology, Endokrinologikum, Center for Hormone and Metabolism, Ulm, Germany.
authors.forename: Werner
authors.initials: W
authors.lastname: Kern
authors.affiliation: Department of Endocrinology, Mario Negri Sud Foundation, Santa Maria Imbaro, Italy.
authors.forename: Antonio
authors.initials: A
authors.lastname: Nicolucci
authors.affiliation: Department of Family Medicine, University Miguel Hernández, Alicante, Spain.
authors.forename: Domingo
authors.initials: D
authors.lastname: Orozco-Beltrán
authors.affiliation: Department of Health Economics, EU-HEOR Novo Nordisk, Madrid, Spain.
authors.forename: Antonio
authors.initials: A
authors.lastname: Ramírez de Arellano
keywords: DALY; life expectancy; mortality; prevalence
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