The state of health in the European Union (EU-27) in 2019: a systematic analysis for the Global Burden of Disease study 2019

João Vasco Santos; Alicia Padron-Monedero; Boris Bikbov; Diana Alecsandra Grad; Dietrich Plass; Enkeleint A. Mechili; Federica Gazzelloni; Florian Fischer; Gerhard Sulo; Che Henry Ngwa; Isabel Noguer-Zambrano; José L. Peñalvo; Juanita A. Haagsma; Katarzyna Kissimova-Skarbek; Lorenzo Monasta; Nermin Ghith; Rodrigo Sarmiento-Suarez; Rok Hrzic; Romana Haneef; Rónán O’Caoimh; Sarah Cuschieri; Stefania Mondello; Zubair Kabir; Alberto Freitas; Brecht Devleesschauwer

doi:10.1186/s12889-024-18529-3

The state of health in the European Union (EU-27) in 2019: a systematic analysis for the Global Burden of Disease study 2019

João Vasco Santos^*, Alicia Padron-Monedero, Boris Bikbov, Diana Alecsandra Grad, Dietrich Plass, Enkeleint A. Mechili, Federica Gazzelloni, Florian Fischer, Gerhard Sulo, Che Henry Ngwa, Isabel Noguer-Zambrano, José L. Peñalvo, Juanita A. Haagsma, Katarzyna Kissimova-Skarbek, Lorenzo Monasta, Nermin Ghith, Rodrigo Sarmiento-Suarez, Rok Hrzic, Romana Haneef, Rónán O’CaoimhSarah Cuschieri, Stefania Mondello, Zubair Kabir, Alberto Freitas, Brecht Devleesschauwer

^*Corresponding author for this work

Research output: Contribution to journal › Article › Academic › peer-review

Abstract

Background: The European Union (EU) faces many health-related challenges. Burden of diseases information and the resulting trends over time are essential for health planning. This paper reports estimates of disease burden in the EU and individual 27 EU countries in 2019, and compares them with those in 2010. Methods: We used the Global Burden of Disease 2019 study estimates and 95% uncertainty intervals for the whole EU and each country to evaluate age-standardised death, years of life lost (YLLs), years lived with disability (YLDs) and disability-adjusted life years (DALYs) rates for Level 2 causes, as well as life expectancy and healthy life expectancy (HALE). Results: In 2019, the age-standardised death and DALY rates in the EU were 465.8 deaths and 20,251.0 DALYs per 100,000 inhabitants, respectively. Between 2010 and 2019, there were significant decreases in age-standardised death and YLL rates across EU countries. However, YLD rates remained mainly unchanged. The largest decreases in age-standardised DALY rates were observed for “HIV/AIDS and sexually transmitted diseases” and “transport injuries” (each -19%). “Diabetes and kidney diseases” showed a significant increase for age-standardised DALY rates across the EU (3.5%). In addition, “mental disorders” showed an increasing age-standardised YLL rate (14.5%). Conclusions: There was a clear trend towards improvement in the overall health status of the EU but with differences between countries. EU health policymakers need to address the burden of diseases, paying specific attention to causes such as mental disorders. There are many opportunities for mutual learning among otherwise similar countries with different patterns of disease.

Original language	English
Article number	1374
Journal	BMC Public Health
Volume	24
Issue number	1
DOIs	https://doi.org/10.1186/s12889-024-18529-3
Publication status	Published - 1 Dec 2024

Keywords

European Burden of Disease Network
European Union
Global Burden of Diseases
Health status
Population health

Access to Document

10.1186/s12889-024-18529-3Licence: CC BY

Cite this

Santos, J. V., Padron-Monedero, A., Bikbov, B., Grad, D. A., Plass, D., Mechili, E. A., Gazzelloni, F., Fischer, F., Sulo, G., Ngwa, C. H., Noguer-Zambrano, I., Peñalvo, J. L., Haagsma, J. A., Kissimova-Skarbek, K., Monasta, L., Ghith, N., Sarmiento-Suarez, R., Hrzic, R., Haneef, R., ... Devleesschauwer, B. (2024). The state of health in the European Union (EU-27) in 2019: a systematic analysis for the Global Burden of Disease study 2019. BMC Public Health, 24(1), Article 1374. https://doi.org/10.1186/s12889-024-18529-3

@article{927fece0f59b461fb22299cfd0d2f7d1,

title = "The state of health in the European Union (EU-27) in 2019: a systematic analysis for the Global Burden of Disease study 2019",

abstract = "Background: The European Union (EU) faces many health-related challenges. Burden of diseases information and the resulting trends over time are essential for health planning. This paper reports estimates of disease burden in the EU and individual 27 EU countries in 2019, and compares them with those in 2010. Methods: We used the Global Burden of Disease 2019 study estimates and 95% uncertainty intervals for the whole EU and each country to evaluate age-standardised death, years of life lost (YLLs), years lived with disability (YLDs) and disability-adjusted life years (DALYs) rates for Level 2 causes, as well as life expectancy and healthy life expectancy (HALE). Results: In 2019, the age-standardised death and DALY rates in the EU were 465.8 deaths and 20,251.0 DALYs per 100,000 inhabitants, respectively. Between 2010 and 2019, there were significant decreases in age-standardised death and YLL rates across EU countries. However, YLD rates remained mainly unchanged. The largest decreases in age-standardised DALY rates were observed for “HIV/AIDS and sexually transmitted diseases” and “transport injuries” (each -19%). “Diabetes and kidney diseases” showed a significant increase for age-standardised DALY rates across the EU (3.5%). In addition, “mental disorders” showed an increasing age-standardised YLL rate (14.5%). Conclusions: There was a clear trend towards improvement in the overall health status of the EU but with differences between countries. EU health policymakers need to address the burden of diseases, paying specific attention to causes such as mental disorders. There are many opportunities for mutual learning among otherwise similar countries with different patterns of disease.",

keywords = "European Burden of Disease Network, European Union, Global Burden of Diseases, Health status, Population health",

author = "Santos, {Jo{\~a}o Vasco} and Alicia Padron-Monedero and Boris Bikbov and Grad, {Diana Alecsandra} and Dietrich Plass and Mechili, {Enkeleint A.} and Federica Gazzelloni and Florian Fischer and Gerhard Sulo and Ngwa, {Che Henry} and Isabel Noguer-Zambrano and Pe{\~n}alvo, {Jos{\'e} L.} and Haagsma, {Juanita A.} and Katarzyna Kissimova-Skarbek and Lorenzo Monasta and Nermin Ghith and Rodrigo Sarmiento-Suarez and Rok Hrzic and Romana Haneef and R{\'o}n{\'a}n O{\textquoteright}Caoimh and Sarah Cuschieri and Stefania Mondello and Zubair Kabir and Alberto Freitas and Brecht Devleesschauwer",

note = "Funding Information: The authors would like to acknowledge the networking support from COST Action CA18218 (European Burden of Disease Network), supported by COST (European Cooperation in Science and Technology).\u00A0This article was supported by National Funds through FCT - Funda\u00E7\u00E3o para a Ci\u00EAncia e a Tecnologia,I.P., within CINTESIS, R&D Unit (reference UIDB/4255/2020). GBD 2019 EU State of Health Collaborators Jo\u00E3o Vasco Santos, MD,1,2 Alicia Padron-Monedero, PhD,3 Boris Bikbov, MD,4 Diana Alecsandra Grad, BA,5,6 Dietrich Plass, DrPH,7 Enkeleint A Mechili, PhD,8,9 Federica Gazzelloni, BSc,10 Florian Fischer, PhD,11 Gerhard Sulo, PhD,12 Che Henry Ngwa, MSc,13 Prof Isabel Noguer-Zambrano, PhD,3 Prof Jos\u00E9 L Pe\u00F1alvo, PhD,14,15 Juanita A Haagsma, PhD,16 Katarzyna Kissimova-Skarbek, PhD,17 Lorenzo Monasta, DSc,18 Nermin Ghith, PhD,19 Prof Rodrigo Sarmiento-Su\u00E1rez, MPH,20,3 Rok Hrzic, MSc,21 Romana Haneef, PhD,22 R\u00F3n\u00E1n O'Caoimh, PhD,23,24 Sarah Cuschieri, PhD,25 Prof Stefania Mondello, NA,26 Zubair Kabir, PhD,27 Cristiana Abbafati, PhD,28 Hassan Abolhassani, PhD,29,30 Victor Adekanmbi, PhD,31 Keivan Ahmadi, PhD,32 Sepideh Ahmadi, PhD,33 Prof Adel Al-Jumaily, PhD,34,35 Prof Fran\u00E7ois Alla, PhD,36 Jordi Alonso, MD,37,38 Prof Robert Ancuceanu, PhD,39 Catalina Liliana Andrei, PhD,40 Prof Tudorel Andrei, PhD,41 Sofia Androudi, PhD,42 Prof Josep M Ant\u00F3, MD,43,44 Seth Christopher Yaw Appiah, PhD,45,46 Olatunde Aremu, PhD,47 Benedetta Armocida, MSc,48 Prof Johan \u00C4rnl\u00F6v, PhD,49,50 Ashokan Arumugam, PhD,51,52 Sameh Attia, MSc,53 Avinash Aujayeb, MBBS,54 Prof Marcel Ausloos, PhD,55,41 Prof Jose L Ayuso-Mateos, PhD,56,57 Prof Maciej Banach, PhD,58,59 Prof Till Winfried B\u00E4rnighausen, MD,60,61 Francesco Barone-Adesi, PhD,62 Sandra Barteit, PhD,63 Sanjay Basu, PhD,64,32 Prof Bernhard T Baune, PhD,65,66 Massimiliano Beghi, MD,67 Luis Belo, PhD,68,69 Derrick A Bennett, PhD,70 Prof Antonio Biondi, PhD,71 Mahdi Bohluli, PhD,72,73 Israel J\u00FAnior Borges do Nascimento, MD,74,75 Nicola Luigi Bragazzi, PhD,76 Tasanee Braithwaite, PhD,77,78 Prof Hermann Brenner, MD,79 Danilo Buonsenso, MD,80,81 Prof Reinhard Busse, PhD,82 Prof Daniela Calina, PhD,83 Giulia Carreras, PhD,84 M\u00E1rcia Carvalho, PhD,85,69 Giulio Castelpietra, PhD,86,87 Prof Alberico L Catapano, PhD,88,89 Maria Sofia Cattaruzza, PhD,90 Joht Singh Chandan, MFPH,91 Periklis Charalampous, MSc,16 Vijay Kumar Chattu, MD,92,93 Simiao Chen, DSc,60 Prof Rajiv Chowdhury, PhD,94,95 Prof Hanne Christensen, DMSci,96 Sheng-Chia Chung, PhD,97,98 Joao Conde, PhD,99 Barbara Corso, PhD,100 Prof Nat\u00E1lia Cruz-Martins, PhD,101,102 Giovanni Damiani, MD,103,104 Alejandro de la Torre-Luque, PhD,105 Andreas K Demetriades, MD,106,107 Nikolaos Dervenis, MD,108,109 Mostafa Dianatinasab, MSc,110,111 Prof Diana Dias da Silva, PhD,112,69 Abdel Douiri, PhD,113 Prof David Edvardsson, PhD,114,115 Luchuo Engelbert Bain, PhD,116 Francesco Esposito, MD,117 Adeniyi Francis Fagbamigbe, PhD,118,119 Carla Sofia e S\u00E1 Farinha, MSc,120,121 Seyed-Mohammad Fereshtehnejad, PhD,49,122 Jo\u00E3o C Fernandes, PhD,123 Pietro Ferrara, MD,124 Peter Andras Gaal, PhD,125,126 Silvano Gallus, DSc,127 Lucia Galluzzo, MA,48 Mariana Gaspar Fonseca, PhD,128 Prof Gus Gazzard, MD,129,130 Alessandro Gialluisi, PhD,131 Simona Giampaoli, MD,132 Prof Paramjit Singh Gill, DM,133 James C Glasbey, MSc,134 Giuseppe Gorini, MD,135 Prof Michal Grivna, PhD,136,137 Abdul Hafiz, PhD,138,139 Josep Maria Haro, MD,140,141 Prof Jan Hartvigsen, PhD,142,143 Prof Simon I Hay, FMedSci,144,145 Behzad Heibati, PhD,146 David Hillus, MD,147 Mehdi Hosseinzadeh, PhD,148,149 Mihaela Hostiuc, PhD,150 Sorin Hostiuc, PhD,151,152 Salman Hussain, PhD,153,154 Prof Gaetano Isola, PhD,155 Olatunji Johnson, PhD,156 Prof Jost B Jonas, MD,157,158 Tamas Joo, PhD,125,159 Jacek Jerzy Jozwiak, PhD,160 Mikk J\u00FCrisson, PhD,161 Marina Karanikolos, PhD,162,163 Joonas H Kauppila, MD,164,165 Moien AB Khan, MSc,166,167 Khaled Khatab, PhD,168,169 Miloslav Klugar, PhD,153,170 Ai Koyanagi, MD,171,172 Om P Kurmi, PhD,173,174 Dian Kusuma, DSc,175,176 Prof Carlo La Vecchia, MD,177 Ben Lacey, PhD,70,178 Demetris Lamnisos, PhD,179 Prof Heidi Jane Larson, PhD,180,144 Prof Anders O Larsson, PhD,181,182 Savita Lasrado, MS,183 Paolo Lauriola, MD,184 Prof Jeffrey V Lazarus, PhD,185 Caterina Ledda, PhD,186 Paul H Lee, PhD,187 Mall Leinsalu, PhD,188,189 Matilde Leonardi, MD,190 Miriam Levi, PhD,191,192 An Li, PhD,193,194 Christine Linehan, PhD,195 Prof Giancarlo Logroscino, PhD,196,197 Prof Stefan Lorkowski, PhD,198,199 Joana A Loureiro, PhD,200,201 Prof Ronan A Lyons, MD,202 \u00C1urea M Madureira-Carvalho, PhD,112,203 Prof Azeem Majeed, MD,204 Alexander G Mathioudakis, PhD,205,206 Colm McAlinden, PhD,207 Prof John J McGrath, MD,208,209 Prof Ritesh G Menezes, MD,210 Alexios-Fotios A Mentis, MD,211 Atte Meretoja, MD,212,213 Tuomo J Meretoja, MD,214,215 Tomislav Mestrovic, PhD,216,144 Junmei Miao Jonasson, PhD,217 Bartosz Miazgowski, MD,218,219 Prof Tomasz Miazgowski, MD,220 Andreea Mirica, PhD,41 Shafiu Mohammed, PhD,221,82 Ali H Mokdad, PhD,144,145 Prof Ute Mons, PhD,222 Joana Morgado-da-Costa, MSc,223 Francesk Mulita, PhD,224,225 Prof Christopher J L Murray, DPhil,144,145 Ionut Negoi, PhD,226,227 Ruxandra Irina Negoi, PhD,228,229 Serban Mircea Negru, MD,230 Evangelia Nena, MD,231 Nurulamin M Noor, MRCP,232,233 George Ntaios, PhD,234 Prof Bogdan Oancea, PhD,235 Frank B Osei, PhD,236,237 Adrian Otoiu, PhD,41 Raffaele Palladino, MD,238,204 Songhomitra Panda-Jonas, MD,239 Prof Shahina Pardhan, PhD,240 Jay Patel, NA,241,242 Prof Mihaela Paun, PhD,243,244 Paolo Pedersini, MSc,245 Umberto Pensato, MD,246 Renato B Pereira, PhD,247 Prof Jorge P\u00E9rez-G\u00F3mez, PhD,248 Norberto Perico, MD,249 Ionela-Roxana Petcu, PhD,41 Carrie B Peterson, PhD,250 Marina Pinheiro, PhD,247 Prof Maarten J Postma, PhD,251,252 Alberto Raggi, PhD,190 Amir Masoud Rahmani, PhD,253 Chythra R Rao, MD,254 Prof Salman Rawaf, MD,204,255 Reza Rawassizadeh, PhD,256 Prof Giuseppe Remuzzi, MD,249 Abanoub Riad, DDS,257,153 Prof Simona Sacco, MD,258 Prof Mohammad Reza Saeb, PhD,259 Brijesh Sathian, PhD,260,261 Davide Sattin, PsyD,262 Prof Nikolaos Scarmeas, PhD,263,264 Prof Falk Schwendicke, PhD,265 Rahman Shiri, PhD,266 Velizar Shivarov, PhD,267,268 Kibrom T Sibhatu, PhD,269 Prof Biagio Simonetti, PhD,270,271 Prof S\u00F8ren T Skou, PhD,142,272 Prof Joan B Soriano, MD,273,274 Ireneous N Soyiri, PhD,275 Prof Nicholas Steel, PhD,276,277 Simona C\u0103t\u0103lina \u0218tefan, PhD,278 Fridolin Steinbeis, MD,147 Paschalis Steiropoulos, MD,231 Leo Stockfelt, PhD,279 Prof Saverio Stranges, MD,280,281 Prof Johan Sundstr\u00F6m, PhD,181,282 Prof Rafael Tabar\u00E9s-Seisdedos, PhD,283,284 Arulmani Thiyagarajan, MPH,285 Roman Topor-Madry, PhD,286,287 Marcos Roberto Tovani-Palone, PhD,288,289 Nikolaos Tsilimparis, PhD,290 Brigid Unim, PhD,48 Marco Vacante, PhD,71 Jef Van den Eynde, BSc,291 Prof Tommi Juhani Vasankari, MD,292,293 Prof Massimiliano Veroux, PhD,294 Jorge Hugo Villafa\u00F1e, PhD,245 Prof Francesco S Violante, MD,295,296 Yanzhong Wang, PhD,113 Ronny Westerman, DSc,297 Prof Charles D A Wolfe, MD,113,298 Grant M A Wyper, MSc,299 Prof Sanni Yaya, PhD,300,301 Prof Vesna Zadnik, PhD,302 Jean-David Zeitoun, PhD,303,304 Prof Alimuddin Zumla, PhD,305,306 Alberto Freitas, PhD,307,1 Prof. Brecht Devleesschauwer, PhD.308,309 Affiliations 1CINTESIS@RISE, MEDCIDS, Faculty of Medicine,\u00A0University of Porto, Porto, Portugal; 2Public Health Unit, ULS Santo Ant\u00F3nio,\u00A0Porto, Portugal; 3National School of Public Health, Institute of Health Carlos III, Madrid, Spain; 4Scientific-Tools.Org, Bergamo, Italy; 5Research Department, RoNeuro Institute for Neurological Research and Diagnostic, Cluj-Napoca, Romania; 6Department of Public Health, Babes-Bolyai University, Cluj-Napoca, Romania; 7Department for Exposure Assessment and Environmental Health Indicators, German Environment Agency, Dessau-Ro\u00DFlau, Germany; 8Department of Healthcare, University of Vlora, Vlora, Albania; 9Clinic of Social and Family Medicine, University of Crete, Heraklion, Greece; 10Independent researcher; 11Institute of Gerontological Health Services and Nursing Research, Ravensburg-Weingarten University of Applied Sciences, Weingarten, Germany; 12Department of Disease Burden, Norwegian Institute of Public Health, Bergen, Norway; 13\u00A0Department of Epidemiology and Population Health, Faculty of Health Sciences, American University of Beirut, Beirut, Lebanon; 14National Center for Epidemiology, Instituto de Salud Carlos III, Madrid, Spain; 15The Gerald J. and Dorothy R. Friedman School of Nutrition Science and Policy, Tufts University, Boston, MA, USA; 16Department of Public Health, Erasmus University Medical Center, Rotterdam, Netherlands; 17Department of Health Economics and Social Security, Jagiellonian University Medical College, Krakow, Poland; 18Clinical Epidemiology and Public Health Research Unit, Burlo Garofolo Institute for Maternal and Child Health, Trieste, Italy; 19Research group for Childhood Cancer, Danish Cancer Institute, Danish Cancer Society, Copenhagen, Denmark; 20Department of Health and Society, Faculty of Medicine, University of Applied and Environmental Sciences, Bogota, Colombia; 21Department of International Health, Maastricht University, Maastricht, Netherlands; 22Department of Non-communicable Diseases and Injuries, Sant\u00E9 Publique France (Public Health France), Saint-Maurice, France; 23Department of Medicine, University College Cork, Cork, Ireland; 24Department of Geriatric Medicine, Mercy University Hospital, Cork, Ireland; 25Anatomy Department, University of Malta, Msida, Malta; 26Department of Biomedical and Dental Sciences and Morphofunctional Imaging, Messina University, Messina, Italy; 27School of Public Health, University College Cork, Cork, Ireland; 28Department of Juridical and Economic Studies, La Sapienza University, Rome, Italy; 29Research Center for Immunodeficiencies, Tehran University of Medical Sciences, Tehran, Iran; 30Department of Biosciences and Nutrition, Karolinska University Hospital, Huddinge, Sweden; 31Department of Obstetrics & Gynecology, University of Texas, Galveston, TX, USA; 32School of Public Health, Imperial College London, London, UK; 33School of Advanced Technologies in Medicine, Shahid Beheshti University of Medical Sciences, Tehran, Iran; 34School of Computing, Mathematics and Engineering, Charles Sturt University, Wagga Wagga, NSW, Australia; 35Information and Communication Sciences and Technologies Pole, Mathematics, Algorithms and Decision Team, ENSTA Bretagne, Brest, France; 36Bordeaux School of Public Health, University of Bordeaux, Bordeaux, France; 37Research Program of Epidemiology and Public Health, Pompeu Fabra University, Barcelona, Spain; 38Department of Experimental and Health Sciences, Biomedical Research Networking Center in Epidemiology and Public Health (CiberESP), Madrid, Spain; 39Faculty of Pharmacy, Carol Davila University of Medicine and Pharmacy, Bucharest, Romania; 40Cardiology Department, Carol Davila University of Medicine and Pharmacy, Bucharest, Romania; 41Department of Statistics and Econometrics, Bucharest University of Economic Studies, Bucharest, Romania; 42Department of Medicine, University of Thessaly, Volos, Greece; 43Non-Communicable Diseases & Environment Programme, Barcelona Institute for Global Health, Barcelona, Spain; 44Department of Experimental and Health Sciences, Pompeu Fabra University, Barcelona, Spain; 45Department of Sociology and Social Work, Kwame Nkrumah University of Science and Technology, Kumasi, Ghana; 46Center for International Health, Ludwig Maximilians University, Munich, Germany; 47Department of Public Health, Birmingham City University, Birmingham, UK; 48Department of Cardiovascular, Endocrine-metabolic Diseases and Aging, National Institute of Health, Rome, Italy; 49Department of Neurobiology, Care Sciences and Society, Karolinska Institute, Stockholm, Sweden; 50School of Health and Social Studies, Dalarna University, Falun, Sweden; 51Department of Physiotherapy, University of Sharjah, Sharjah, United Arab Emirates; 52Department Community Medicine and Rehabilitation, Ume\u00E5 University, Umea, Sweden; 53Oral and Maxillofacial Surgery, Justus Liebig University of Giessen, Giessen, Germany; 54Northumbria HealthCare NHS Foundation Trust, National Health Service (NHS) Scotland, Newcastle upon Tyne, UK; 55School of Business, University of Leicester, Leicester, UK; 56Department of Psychiatry, Autonomous University of Madrid (Universidad Aut\u00F3noma de Madrid), Madrid, Spain; 57CIBERSAM, Institute of Health Carlos III, Madrid, Spain; 58Department of Hypertension, Medical University of Lodz, Lodz, Poland; 59Polish Mothers' Memorial Hospital Research Institute, Lodz, Poland; 60Heidelberg Institute of Global Health (HIGH), Heidelberg University, Heidelberg, Germany; 61T.H. Chan School of Public Health, Harvard University, Boston, MA, USA; 62Department of Translational Medicine, University of Eastern Piedmont, Novara, Italy; 63Heidelberg Institute of Global Health (HIGH), Heidelberg University Hospital, Heidelberg, Germany; 64Center for Primary Care, Harvard University, Boston, MA, USA; 65Department of Psychiatry, University of M\u00FCnster, M\u00FCnster, Germany; 66Department of Psychiatry, Melbourne Medical School, Melbourne, VIC, Australia; 67Department of Mental Health, AUSL Romagna, Ravenna, Italy; 68Biological Sciences Department, University of Porto, Porto, Portugal; 69Research Unit on Applied Molecular Biosciences (UCIBIO), University of Porto, Porto, Portugal; 70Nuffield Department of Population Health, University of Oxford, Oxford, UK; 71Department of General Surgery and Medical-Surgical Specialties, University of Catania, Catania, Italy; 72Department of Computer Science and Information Technology, Institute for Advanced Studies in Basic Sciences, Zanjan, Iran; 73Department of Research and Innovation, Petanux Research GmBH, Bonn, Germany; 74School of Medicine and University Hospital, Federal University of Minas Gerais, Belo Horizonte, Brazil; 75Division of Country Health Policies and Systems, World Health Organization (WHO), Denmark, Denmark; 76University of Genoa, Genoa, Italy; 77Ophthalmology Department, Moorfields Eye Hospital NHS Foundation Trust, London, UK; 78International Centre for Eye Health, London School of Hygiene & Tropical Medicine, London, UK; 79Division of Clinical Epidemiology and Aging Research, German Cancer Research Center, Heidelberg, Germany; 80Department of Woman and Child Health and Public Health, Agostino Gemelli University Polyclinic IRCCS (Fondazione Policlinico Universitario A. Gemelli IRCCS), Roma, Italy; 81Global Health Research Institute, Universit\u00E0 Cattolica del Sacro Cuore (Catholic University of Sacred Heart), Roma, Italy; 82Department of Health Care Management, Technical University of Berlin, Berlin, Germany; 83Clinical Pharmacy, University of Medicine and Pharmacy of Craiova, Romania, Craiova, Romania; 84Institute for Cancer Research, Prevention and Clinical Network, Florence, Italy; 85Faculty of Health Sciences, University Fernando Pessoa, Porto, Portugal; 86Department of Medicine, University of Udine, Udine, Italy; 87Department of Mental Health, Healthcare Agency \{"}Friuli Occidentale\{"}, Pordenone, Italy; 88Department of Pharmacological and Biomolecular Sciences, University of Milan, Milan, Italy; 89MultiMedica, IRCCS, Sesto S. Giovanni, Italy; 90Department of Public Health and Infectious Diseases, La Sapienza University, Rome, Italy; 91Institute of Applied Health Research, University of Birmingham, Birmingham, UK; 92Faculty of Medical Sciences, University of the West Indies, St Augustine, Trinidad and Tobago; 93Independent Consultant, Athens, Greece; 94Florida International University, Florida International University, Miami, FL, USA; 95Department of Epidemiology, University of Bern, Bern, Switzerland; 96Bispebjerg Hospital, University of Copenhagen, Copenhagen, Denmark; 97Department of Health Informatics, University College London, London, UK; 98Health Data Research UK, London, UK; 99Nova Medical School, Nova University of Lisbon, Lisbon, Portugal; 100Institute of Neuroscience, National Research Council, Pisa, Italy; 101Therapeutic and Diagnostic Technologies, Cooperativa de Ensino Superior Polit\u00E9cnico e Universit\u00E1rio (Polytechnic and University Higher Education Cooperative), Gandra, Portugal; 102Institute for Research and Innovation in Health, University of Porto, Porto, Portugal; 103IRCCS Istituto Ortopedico Galeazzi (Galeazzi Orthopedic Institute IRCCS), University of Milan, Milan, Italy; 104Department of Dermatology, Case Western Reserve University, Cleveland, OH, USA; 105Department of Legal Medicine, Psychiatry and Pathology, Complutense University of Madrid (Universidad Complutense de Madrid), Madrid, Spain; 106Department of Neurosurgery, University of Edinburgh, Edinburgh, UK; 107Department of Neurosurgery, National Health Service (NHS) Scotland, Edinburgh, UK; 108St Paul's Eye Unit, Royal Liverpool University Hospital, Liverpool, UK; 109Department of Ophthalmology, Aristotle University of Thessaloniki, Thessaloniki, Greece; 110Department of Epidemiology, Maastricht University, Maastricht, Netherlands; 111Department of Epidemiology, Shiraz University of Medical Sciences, Shiraz, Iran; 112Toxicology Research Unit (TOXRUN), Cooperativa de Ensino Superior Polit\u00E9cnico e Universit\u00E1rio (CESPU) (University Polytechnic Higher Education Cooperative), Gandra, Portugal; 113School of Population Health and Environmental Sciences, King's College London, London, UK; 114School of Nursing and Midwifery, La Trobe University, Melbourne, VIC, Australia; 115Department of Nursing, Ume\u00E5 University, Umea, Sweden; 116Lincoln International Institute for Rural Health, University of Lincoln, Lincoln, UK; 117Dipartimento di Scienze Biomediche e Neuromotorie (Department of Biomedical and Neuromotor Sciences), University of Bologna, Bologna, Italy; 118Department of Epidemiology and Medical Statistics, University of Ibadan, Ibadan, Nigeria; 119Institute of Applied Health Sciences, University of Aberdeen, Aberdeen, UK; 120Dissemination Division, National Institute of Statistics, Lisbon, Portugal; 121Activity Planning and Control Unit, Directorate-General of Health\u00A0(DGS), Lisbon, Portugal; 122Division of Neurology, University of Ottawa, Ottawa, ON, Canada; 123Center for Biotechnology and Fine Chemistry, Catholic University of Portugal, Porto, Portugal; 124Research Center on Public Health, University of Milan Bicocca, Monza, Italy; 125Health Services Management Training Centre, Semmelweis University, Budapest, Hungary; 126Department of Applied Social Sciences, Sapientia Hungarian University of Transylvania, T\u00E2rgu-Mure\u015F, Romania; 127Department of Environmental Health Sciences, Mario Negri Institute for Pharmacological Research, Milan, Italy; 128National Health Service, London, UK; 129Institute of Ophthalmology, University College London, London, UK; 130Moorfields Eye Hospital NHS Foundation Trust, London, UK; 131Department of Epidemiology and Prevention, IRCCS Neuromed, Pozzilli, Italy; 132Department of Cardiovascular Endocrine-metabolic Diseases and Aging, Istituto Superiore di Sanit\u00E0, Rome, Italy; 133Warwick Medical School, University of Warwick, Coventry, UK; 134NIHR Global Health Research Unit on Global Surgery, University of Birmingham, Birmingham, UK; 135Oncological Network, Prevention and Research Institute, Institute for Cancer Research, Prevention and Clinical Network, Florence, Italy; 136College of Medicine and Health Sciences, United Arab Emirates University, Al Ain, United Arab Emirates; 137Department of Public Health and Preventive Medicine, Charles University, Prague, Czech Republic; 138College of Medicine, Umm AL Qura University, Makkah, Saudi Arabia; 139MSc Epidemiology Programme, London School of Hygiene & Tropical Medicine, London, UK; 140Research Unit, University of Barcelona, Barcelona, Spain; 141Biomedical Research Networking Center for Mental Health Network (CiberSAM), Barcelona, Spain; 142Department of Sports Science and Clinical Biomechanics, University of Southern Denmark, Odense, Denmark; 143Research Department, Nordic Institute of Chiropractic and Clinical Biomechanics, Odense, Denmark; 144Institute for Health Metrics and Evaluation, University of Washington, Seattle, WA, USA; 145Department of Health Metrics Sciences, School of Medicine, University of Washington, Seattle, WA, USA; 146Research Unit of Population Health, University of Oulu, Oulu, Finland; 147Department of Infectious Diseases and Respiratory Medicine, Charit\u00E9 Medical University Berlin, Berlin, Germany; 148Institute of Research and Development, Duy Tan University, Da Nang, Viet Nam; 149Department of Computer Science, University of Human Development, Sulaymaniyah, Iraq; 150Internal Medicine Department, Carol Davila University of Medicine and Pharmacy, Bucharest, Romania; 151Department of Legal Medicine and Bioethics, Carol Davila University of Medicine and Pharmacy, Bucharest, Romania; 152Clinical Legal Medicine Department, National Institute of Legal Medicine Mina Minovici, Bucharest, Romania; 153Czech National Centre for Evidence-based Healthcare and Knowledge Translation, Masaryk University, Brno, Czech Republic; 154Institute of Biostatistics and Analyses, Masaryk University, Brno, Czech Republic; 155Department of General Surgery and Surgical-Medical Specialties, University of Catania, Catania, Italy; 156Department of Mathematics, University of Manchester, Manchester, UK; 157Institute of Molecular and Clinical Ophthalmology Basel, Basel, Switzerland; 158Department of Ophthalmology, Heidelberg University, Mannheim, Germany; 159Hungarian Health Management Association, Budapest, Hungary; 160Department of Family Medicine and Public Health, University of Opole, Opole, Poland; 161Institute of Family Medicine and Public Health, University of Tartu, Tartu, Estonia; 162European Observatory on Health Systems and Policies, London School of Hygiene & Tropical Medicine, London, UK; 163Department of Health Services Research and Policy, London School of Hygiene & Tropical Medicine, London, UK; 164Surgery Research Unit, University of Oulu, Oulu, Finland; 165Department of Molecular Medicine and Surgery, Karolinska Institute, Stockholm, Sweden; 166Family Medicine Department, United Arab Emirates University, Al Ain, United Arab Emirates; 167Primary Care Department, NHS North West London, London, UK; 168Faculty of Health and Wellbeing, Sheffield Hallam University, Sheffield, UK; 169College of Arts and Sciences, Ohio University, Zanesville, OH, USA; 170Institute for Health Information and Statistics of the Czech Republic, Prague, Czech Republic; 171Biomedical Research Networking Center for Mental Health Network (CIBERSAM), San Juan de Dios Sanitary Park, Sant Boi de Llobregat, Spain; 172Catalan Institution for Research and Advanced Studies (ICREA), Barcelona, Spain; 173Faculty of Health and Life Sciences, Coventry University, Coventry, UK; 174Department of Medicine, McMaster University, Hamilton, ON, Canada; 175Department of Health Services Research and Management, City University of London, London, UK; 176Faculty of Public Health, University of Indonesia, Depok, Indonesia; 177Department of Clinical Sciences and Community Health, University of Milan, Milan, Italy; 178National Institute for Health Research (NIHR) Oxford Biomedical Research Centre, Oxford, UK; 179Department of Health Sciences, European University Cyprus, Nicosia, Cyprus; 180Department of Infectious Disease Epidemiology, London School of Hygiene & Tropical Medicine, London, UK; 181Department of Medical Sciences, Uppsala University, Uppsala, Sweden; 182Department of Clinical Chemistry and Pharmacology, Uppsala University Hospital, Uppsala, Sweden; 183Department of Otorhinolaryngology, Father Muller Medical College, Mangalore, India; 184International Society Doctors for the Environment, Arezzo, Italy; 185Barcelona Institute for Global Health, Barcelona, Spain; 186Clinical and Experimental Medicine, University of Catania, Catania, Italy; 187Department of Health Sciences, University of Leicester, Leicester, UK; 188School of Social Sciences, S\u00F6dert\u00F6rn University, Huddinge, Sweden; 189Department of Epidemiology and Biostatistics, National Institute for Health Development, Tallinn, Estonia; 190UO Neurologia, Salute Pubblica e Disabilit\u00E0, Fondazione IRCCS Istituto Neurologico Carlo Besta (Neurology, Public Health and Disability Unit, Carlo Besta Neurological Institute), Milan, Italy; 191Department of Prevention, USL Tuscany Center, Firenze, Italy; 192Department of Health Sciences, University of Florence, Florence, Italy; 193Center for Dentistry and Oral Hygiene, University of Groningen, Groningen, Netherlands; 194Stomatological Hospital, Southern Medical University, Guangzhou, China; 195UCD Centre for Disability Studies, University College Dublin, Dublin, Ireland; 196Department of Basic Medical Sciences, Neuroscience and Sense Organs, University of Bari Aldo Moro, Bari, Italy; 197Department of Clinical Research in Neurology, Fondazione Cardinale Giovanni Panico Hospital, Tricase, Italy; 198Institute of Nutritional Sciences, Friedrich Schiller University Jena, Jena, Germany; 199Competence Cluster for Nutrition and Cardiovascular Health (nutriCARD), Jena, Germany; 200Laboratory for Process Engineering, Environment, Biotechnology and Energy (LEPABE), University of Porto, Porto, Portugal; 201School of Health, Polytechnic Institute of Porto, Portugal; 202School of Medicine, Swansea University, Swansea, UK; 203Laborat\u00F3rio de Farmacognosia (LAQV) (Associated Laboratory for Green Chemistry, University of Porto, Porto, Portugal; 204Department of Primary Care and Public Health, Imperial College London, London, UK; 205Division of Infection, Immunity and Respiratory Medicine, University of Manchester, Manchester, UK; 206North West Lung Centre, Manchester University NHS Foundation Trust, Manchester, UK; 207Department of Ophthalmology, Singleton Hospital, Swansea, UK; 208Queensland Brain Institute, The University of Queensland, Brisbane, QLD, Australia; 209National Centre for Register-based Research, Aarhus University, Aarhus, Denmark; 210Forensic Medicine Division, Imam Abdulrahman Bin Faisal University, Dammam, Saudi Arabia; 211International Dx Department, BGI Genomics, Copenhagen, Denmark; 212Neurology Unit, Helsinki University Hospital, Helsinki, Finland; 213School of Health Sciences, University of Melbourne, Melbourne, VIC, Australia; 214Breast Surgery Unit, Helsinki University Hospital, Helsinki, Finland; 215University of Helsinki, Helsinki, Finland; 216University Centre Varazdin, University North, Varazdin, Croatia; 217School of Public Health and Community Medicine, University of Gothenburg, Gothenburg, Sweden; 218Center for Innovation in Medical Education, Pomeranian Medical University, Szczecin, Poland; 219Pomeranian Medical University, Szczecin, Poland; 220Department of Propedeutics of Internal Diseases & Arterial Hypertension, Pomeranian Medical University, Szczecin, Poland; 221Health Systems and Policy Research Unit, Ahmadu Bello University, Zaria, Nigeria; 222Faculty of Medicine and University Hospital Cologne, University of Cologne, Cologne, Germany; 223University Hospital Center of Porto, University of Porto, Porto, Portugal; 224Department of Surgery, General University Hospital of Patras, Patras, Greece; 225Medical School, University of Thessaly, Larissa, Greece; 226Department of General Surgery, Carol Davila University of Medicine and Pharmacy, Bucharest, Romania; 227Department of General Surgery, Emergency Hospital of Bucharest, Bucharest, Romania; 228Department of Anatomy and Embryology, Carol Davila University of Medicine and Pharmacy, Bucharest, Romania; 229Department of Cardiology, Cardio-Aid, Bucharest, Romania; 230Department of Oncology, Victor Babes University of Medicine and Pharmacy, Timisoara, Romania; 231Department of Medicine, Democritus University of Thrace, Alexandroupolis, Greece; 232Medical Research Council Clinical Trials Unit, University College London, London, UK; 233Department of Gastroenterology, Cambridge University Hospitals, Cambridge, UK; 234Department of Internal Medicine, University of Thessaly, Larissa, Greece; 235Department of Applied Economics and Quantitative Analysis, University of Bucharest, Bucharest, Romania; 236Faculty of Geo-Information Science and Earth Observation, University of Twente, Enschede, Netherlands; 237Department of Mathematics and Statistics, University of Energy and Natural Resources, Sunyani, Ghana; 238Department of Public Health, University of Naples Federico II, Naples, Italy; 239Privatpraxis, Heidelberg, Germany; 240Vision and Eye Research Institute, Anglia Ruskin University, Cambridge, UK; 241Global Health Governance Programme, University of Edinburgh, Edinburgh, UK; 242School of Dentistry, University of Leeds, Leeds, UK; 243Department of Bioinformatics and Biostatistics, National Institute of Research and Development for Biological Sciences, Bucharest, Romania; 244Department of Statistics and Cybernetics, University of Bucharest, Bucharest, Romania; 245Clinical Research Department, IRCCS Fondazione Don Carlo Gnocchi, Milan, Italy; 246Department of Neurology, IRCCS Humanitas Research Hospital, Milan, Italy; 247Department of Chemistry, University of Porto, Porto, Portugal; 248Departamento de Did\u00E1ctica de la Expresi\u00F3n Musical, Pl\u00E1stica y Corportal, University of Extremadura, C\u00E1ceres, Spain; 249Mario Negri Institute for Pharmacological Research, Bergamo, Italy; 250Independent Consultant, Copenhagen, Denmark; 251University Medical Center Groningen, University of Groningen, Groningen, Netherlands; 252Center of Excellence in Higher Education for Pharmaceutical Care Innovation, Universitas Padjadjaran (Padjadjaran University), Bandung, Indonesia; 253Future Technology Research Center, National Yunlin University of Science and Technology, Yunlin, Taiwan; 254Department of Community Medicine, Manipal Academy of Higher Education, Manipal, India; 255Academic Public Health England, Public Health England, London, UK; 256Department of Computer Science, Boston University, Boston, MA, USA; 257Department of Public Health, Masaryk University, Brno, Czech Republic; 258Department of Neurology, University of L'Aquila, L'Aquila, Italy; 259Department of Polymer Technology, Independent Consultant, Gdansk, Poland; 260Geriatric and Long Term Care Department, Hamad Medical Corporation, Doha, Qatar; 261Faculty of Health & Social Sciences, Bournemouth University, Bournemouth, UK; 262IRCCS Istituti Clinici Scientifici Maugeri (IRCCS Maugeri Scientific Clinical Institute), Milan, Italy; 263Department of Neurology, National and Kapodistrian University of Athens, Athens, Greece; 264Department of Neurology, Columbia University, New York, NY, USA; 265Oral Diagnosis, Digital Health and Health Services Research, Charit\u00E9 University Medical Center Berlin, Berlin, Germany; 266Finnish Institute of Occupational Health, Helsinki, Finland; 267Clinical Immunology and Hematology, Sofiamed University Hospital, Sofia, Bulgaria; 268Department of Genetics, Sofia University \{"}St. Kliment Ohridiski\{"}, Sofia, Bulgaria; 269Department of Agricultural Economics and Rural Development, University of G\u00F6ttingen, G\u00F6ttingen, Germany; 270Department of Law, Economics, Management and Quantitative Methods, University of Sannio, Benevento, Italy; 271WSB University in Gda\u0144sk, Gda\u0144sk, Poland; 272Department of Physiotherapy and Occupational Therapy, N\u00E6stved-Slagelse-Ringsted Hospitals, Slagelse, Denmark; 273Hospital Universitario de La Princesa (Princess University Hospital), Autonomous University of Madrid, Madrid, Spain; 274Centro de Investigaci\u00F3n Biom\u00E9dica en Red Enfermedades Respiratorias (CIBERES) (Center for Biomedical Research in Respiratory Diseases Network), Madrid, Spain; 275Hull York Medical School, University of Hull, Hull City, UK; 276Department of Primary Care and Public Health, University of East Anglia, Norwich, UK; 277Public Health England, London, UK; 278Management Department, Bucharest University of Economic Studies, Bucharest, Romania; 279Occupational and Environmental Medicine Department, University of Gothenburg, Gothenburg, Sweden; 280Department of Epidemiology & Biostatistics, The University of Western Ontario, London, ON, Canada; 281Department of Population Health, Luxembourg Institute of Health, Strassen, Luxembourg; 282The George Institute for Global Health, Sydney, NSW, Australia; 283Department of Medicine, University of Valencia, Valencia, Spain; 284Institute of Health Carlos III, Biomedical Research Networking Center for Mental Health Network (CiberSAM), Madrid, Spain; 285Clinical Epidemiology, Leibniz Institute for Prevention Research and Epidemiology, Bremen, Germany; 286Institute of Public Health, Jagiellonian University Medical College, Krak\u00F3w, Poland; 287Agency for Health Technology Assessment and Tariff System, Warsaw, Poland; 288Saveetha Dental College and Hospitals, Saveetha Institute of Medical and Technical Sciences (SIMATS), Chennai, India; 289Modestum LTD, Eastbourne, UK; 290Department of Vascular Surgery, Ludwig Maximilians University, Munich, Germany; 291Department of Cardiovascular Sciences, Katholieke Universiteit Leuven, Leuven, Belgium; 292UKK Institute, Tampere, Finland; 293Faculty of Medicine and Health Technology, Tampere University, Tampere, Finland; 294Department of Medical and Surgical Sciences and Advanced Technologies, University of Catania, Catania, Italy; 295Department of Medical and Surgical Sciences, University of Bologna, Bologna, Italy; 296Occupational Health Unit, Sant'Orsola Malpighi Hospital, Bologna, Italy; 297Competence Center of Mortality-Follow-Up of the German National Cohort, Federal Institute for Population Research, Wiesbaden, Germany; 298NIHR-Biomedical Research Centre (NIHR-BRC), Guy's and St. Thomas' Hospital and Kings College London, London, UK; 299School of Health and Wellbeing, University of Glasgow, Glasgow, UK; 300School of International Development and Global Studies, University of Ottawa, Ottawa, ON, Canada; 301The George Institute for Global Health, Imperial College London, London, UK; 302Epidemiology and Cancer Registry Sector, Institute of Oncology Ljubljana, Ljubljana, Slovenia; 303Centre of Clinical Epidemiology, H\u00F4tel Dieu Hospital, Assistance Publique H\u00F4pitaux de Paris (Public Hospitals of Paris), Paris, France; 304Gastroenterology and Nutrition, Saint-Antoine Hospital, Assistance Publique H\u00F4pitaux de Paris (Public Hospitals of Paris), Paris, France; 305Department of Infection, University College London, London, UK; 306NIHR-Biomedical Research Centre (NIHR-BRC), University College London Hospitals, London, UK; 307Department of Community Medicine, Information and Health Decision Sciences, University of Porto, Porto, Portugal; 308Department of Epidemiology and Public Health, Sciensano, Brussels, Belgium; 309Department of Translational Physiology, Infectiology and Public Health, Ghent University, Ghent, Belgium. Only secondary data was used for this study. Funding Information: T W B\u00E4rnighausen was supported by the Alexander von Humboldt Foundation through the Alexander von Humboldt Professor award, funded by the German Federal Ministry of Education and Research. L Belo acknowledges the support from FCT in the scope of the project UIDP/04378/2020 and UIDB/04378/2020 of UCIBIO and the project LA/P/0140/2020 of i4HB. D A Bennett is supported by the UK Medical Research Council Population Health Research Unit at the University of Oxford. M Carvalho acknowledges the support from FCT in the scope of the project UIDP/04378/2020 and UIDB/04378/2020 of UCIBIO and the project LA/P/0140/2020 of i4HB. A L Catapano is supported in part by the Ministero della Salute ricerca corrente. J S Chandan acknowledges the National Institute of Health Research. J Conde would like to acknowledge the European Research Council Starting Grant (ERC-StG-2019\u2013848325). D Dias da Silva acknowledges the projects UIDP/04378/2022 and UIDB/04378/2022 of the Research Unit on Applied Molecular Biosciences UCIBIO; the project LA/P/ 0140/2022 of the Associate Laboratory Institute for Health and Bioeconomy i4HB; and IINFACTS-Institute of Research and Advanced Training in Health Sciences and Technologies (project PsiloPharm) and TOXRUN Toxicology Research Unit, University Institute of Health Sciences, IUCS-CESPU, Portugal. A Douiri acknowledges support by King\u2019s Health Partners/Guy\u2019s and St Thomas Charity \u201CMLTC Challenge Fund\u201D (grant number EIC180702) and the NIHR Applied Research Collaboration (ARC) South London at King\u2019s College Hospital NHS Foundation Trust. The views expressed are those of the authors and not necessarily those of the NIHR or the Department of Health and Social Care. J C Fernandes acknowledges support from Funda\u00E7\u00E3o para a Ci\u00EAncia e Tecnologia (FCT) with funding for UID/Multi/50016/2019. G Gazzard acknowledges support from NIHR Biomedical Research Centre at Moorfields Eye Hospital NHS Foundation Trust, London, UK and Institute of Ophthalmology, University College London, UK. P S Gill acknowledges being NIHR senior investigator for the NIHR Department of Health and Social Care. The views expressed are those of the author(s) and not necessarily those of the NHS, the NIHR or the Department of Health and Social Care. J C Glasbey is supported by a UK National Institute of Health Research Doctoral Research Fellowship (NIHR300175). S Hussain was supported from Operational Programme Research, Development and Education \u201CProject, Postdoc2MUNI\u201D (No.CZ.02.2.69/0.0/0.0/18_053/0016952). M AB Khan acknowledges support as recipient of research grants G00003634- CMHS \u201CNP-22\u201320 80, 000 AED (2021), G00003569 NP-21\u201313 80,000 AED, and 1976\u2014SDG Research Program Grant 40,000 AED. B Lacey acknowledges support from UK Biobank, which is funded largely by the UK Medical Research Council and Wellcome. J A Loureiro was supported by National Funds through Funda\u00E7\u00E3o para a Ci\u00EAncia e Tecnologia (FCT) under the Scientific Employment Stimulus\u2019 Institutional Call\u2014[CEECINST/00049/2018]. S Lorkowski acknowledges institutional support from the Competence Cluster for Nutrition and Cardiovascular Health (nutriCARD) Halle-Jena-Leipzig (Germany; German Federal Ministry of Education and Research; grant agreement number 01EA1808A). A G Mathioudakis acknowledges support by the National Institute for Health and Care Research Manchester Biomedical Research Centre (NIHR Manchester BRC) and by an NIHR Clinical Lectureship in Respiratory Medicine. J J McGrath was supported by the Danish National Research Foundation (Niels Bohr Professorship) and is employed by The Queensland Centre for Mental Health Research, which receives core funding from the Queensland Health. S Mohammed reports fellowship grant from Alexander von Humboldt Foundation, outside the submitted work. L Monasta received support from the Italian Ministry of Health, through the contribution given to the Institute for Maternal and Child Health IRCCS Burlo Garofolo, Trieste, Italy (RC 34/2017). P Pedersini was supported and funded by the Italian Ministry of Health\u2014Ricerca Corrente 2021. M Pinheiro thanks FCT for funding through program DL 57/2016 Norma transita. A Raggi acknowledges support by the Italian Ministry of Health (RRC). A Riad was supported by the project of the Ministry of Education, Youth and Sports of the Czech Republic (Systemic Risk Institute \{"}SYRI\{"}: LX22NPO5101) and the projects of Masaryk University (MUNI/A/1402/2021 and MUNI/IGA/1104/2021). S T Skou is currently funded by a grant from Region Zealand (Exercise First) and two grants from the European Union\u2019s Horizon 2020 Research and Innovation Program, one from the European Research Council (MOBILIZE, grant agreement No 801790) and the other under grant agreement No 945377 (ESCAPE). J B Soriano is supported by Centro de Investigacion Biomedica en Red de Enfermedades Respiratorias, Instituto de Salud Carlos III, Madrid, Spain. L Stockfelt was funded by the Swedish state under the agreement between the Swedish government and the country councils, the ALF-agreement. Johan Sundstr\u00F6m acknowledges stock ownership in Anagram kommunikation AB and Symptoms Europe AB. R Tabares-Seisdedos is supported by the Spanish Ministry of Science and Innovation, Institute of Health Carlos III, CIBERSAM, INCLIVA (PID2021-129099OB-I00). M R Tovani-Palone acknowledges Saveetha Institute of Medical and Technical Sciences (SIMATS) for its support. J H Villafa\u00F1e was supported and funded by the Italian Ministry of Health\u2014Ricerca Corrente 2021. A Zumla acknowledges grant support from the Pan-African Network for Rapid Research, Response, Relief and Preparedness for Infectious Diseases Epidemics (PANDORA-ID-NET) ONE-HEALTH (Europe-Africa) consortium funded by the European and Developing Countries Clinical Trials Partnership, which is supported by Horizon 2020, the EU's Framework Programme for Research and Innovation. Funding Information: The authors would like to acknowledge the networking support from COST Action CA18218 (European Burden of Disease Network), supported by COST (European Cooperation in Science and Technology). This article was supported by National Funds through FCT - Funda\u00E7\u00E3o para a Ci\u00EAncia e a Tecnologia,I.P., within CINTESIS, R&D Unit (reference UIDB/4255/2020). Publisher Copyright: {\textcopyright} The Author(s) 2024.",

year = "2024",

month = dec,

day = "1",

doi = "10.1186/s12889-024-18529-3",

language = "English",

volume = "24",

journal = "BMC Public Health",

issn = "1471-2458",

publisher = "BioMed Central Ltd",

number = "1",

}

Santos, JV, Padron-Monedero, A, Bikbov, B, Grad, DA, Plass, D, Mechili, EA, Gazzelloni, F, Fischer, F, Sulo, G, Ngwa, CH, Noguer-Zambrano, I, Peñalvo, JL, Haagsma, JA, Kissimova-Skarbek, K, Monasta, L, Ghith, N, Sarmiento-Suarez, R, Hrzic, R, Haneef, R, O’Caoimh, R, Cuschieri, S, Mondello, S, Kabir, Z, Freitas, A & Devleesschauwer, B 2024, 'The state of health in the European Union (EU-27) in 2019: a systematic analysis for the Global Burden of Disease study 2019', BMC Public Health, vol. 24, no. 1, 1374. https://doi.org/10.1186/s12889-024-18529-3

TY - JOUR

T1 - The state of health in the European Union (EU-27) in 2019

T2 - a systematic analysis for the Global Burden of Disease study 2019

AU - Santos, João Vasco

AU - Padron-Monedero, Alicia

AU - Bikbov, Boris

AU - Grad, Diana Alecsandra

AU - Plass, Dietrich

AU - Mechili, Enkeleint A.

AU - Gazzelloni, Federica

AU - Fischer, Florian

AU - Sulo, Gerhard

AU - Ngwa, Che Henry

AU - Noguer-Zambrano, Isabel

AU - Peñalvo, José L.

AU - Haagsma, Juanita A.

AU - Kissimova-Skarbek, Katarzyna

AU - Monasta, Lorenzo

AU - Ghith, Nermin

AU - Sarmiento-Suarez, Rodrigo

AU - Hrzic, Rok

AU - Haneef, Romana

AU - O’Caoimh, Rónán

AU - Cuschieri, Sarah

AU - Mondello, Stefania

AU - Kabir, Zubair

AU - Freitas, Alberto

AU - Devleesschauwer, Brecht

N1 - Funding Information: The authors would like to acknowledge the networking support from COST Action CA18218 (European Burden of Disease Network), supported by COST (European Cooperation in Science and Technology).\u00A0This article was supported by National Funds through FCT - Funda\u00E7\u00E3o para a Ci\u00EAncia e a Tecnologia,I.P., within CINTESIS, R&D Unit (reference UIDB/4255/2020). GBD 2019 EU State of Health Collaborators Jo\u00E3o Vasco Santos, MD,1,2 Alicia Padron-Monedero, PhD,3 Boris Bikbov, MD,4 Diana Alecsandra Grad, BA,5,6 Dietrich Plass, DrPH,7 Enkeleint A Mechili, PhD,8,9 Federica Gazzelloni, BSc,10 Florian Fischer, PhD,11 Gerhard Sulo, PhD,12 Che Henry Ngwa, MSc,13 Prof Isabel Noguer-Zambrano, PhD,3 Prof Jos\u00E9 L Pe\u00F1alvo, PhD,14,15 Juanita A Haagsma, PhD,16 Katarzyna Kissimova-Skarbek, PhD,17 Lorenzo Monasta, DSc,18 Nermin Ghith, PhD,19 Prof Rodrigo Sarmiento-Su\u00E1rez, MPH,20,3 Rok Hrzic, MSc,21 Romana Haneef, PhD,22 R\u00F3n\u00E1n O'Caoimh, PhD,23,24 Sarah Cuschieri, PhD,25 Prof Stefania Mondello, NA,26 Zubair Kabir, PhD,27 Cristiana Abbafati, PhD,28 Hassan Abolhassani, PhD,29,30 Victor Adekanmbi, PhD,31 Keivan Ahmadi, PhD,32 Sepideh Ahmadi, PhD,33 Prof Adel Al-Jumaily, PhD,34,35 Prof Fran\u00E7ois Alla, PhD,36 Jordi Alonso, MD,37,38 Prof Robert Ancuceanu, PhD,39 Catalina Liliana Andrei, PhD,40 Prof Tudorel Andrei, PhD,41 Sofia Androudi, PhD,42 Prof Josep M Ant\u00F3, MD,43,44 Seth Christopher Yaw Appiah, PhD,45,46 Olatunde Aremu, PhD,47 Benedetta Armocida, MSc,48 Prof Johan \u00C4rnl\u00F6v, PhD,49,50 Ashokan Arumugam, PhD,51,52 Sameh Attia, MSc,53 Avinash Aujayeb, MBBS,54 Prof Marcel Ausloos, PhD,55,41 Prof Jose L Ayuso-Mateos, PhD,56,57 Prof Maciej Banach, PhD,58,59 Prof Till Winfried B\u00E4rnighausen, MD,60,61 Francesco Barone-Adesi, PhD,62 Sandra Barteit, PhD,63 Sanjay Basu, PhD,64,32 Prof Bernhard T Baune, PhD,65,66 Massimiliano Beghi, MD,67 Luis Belo, PhD,68,69 Derrick A Bennett, PhD,70 Prof Antonio Biondi, PhD,71 Mahdi Bohluli, PhD,72,73 Israel J\u00FAnior Borges do Nascimento, MD,74,75 Nicola Luigi Bragazzi, PhD,76 Tasanee Braithwaite, PhD,77,78 Prof Hermann Brenner, MD,79 Danilo Buonsenso, MD,80,81 Prof Reinhard Busse, PhD,82 Prof Daniela Calina, PhD,83 Giulia Carreras, PhD,84 M\u00E1rcia Carvalho, PhD,85,69 Giulio Castelpietra, PhD,86,87 Prof Alberico L Catapano, PhD,88,89 Maria Sofia Cattaruzza, PhD,90 Joht Singh Chandan, MFPH,91 Periklis Charalampous, MSc,16 Vijay Kumar Chattu, MD,92,93 Simiao Chen, DSc,60 Prof Rajiv Chowdhury, PhD,94,95 Prof Hanne Christensen, DMSci,96 Sheng-Chia Chung, PhD,97,98 Joao Conde, PhD,99 Barbara Corso, PhD,100 Prof Nat\u00E1lia Cruz-Martins, PhD,101,102 Giovanni Damiani, MD,103,104 Alejandro de la Torre-Luque, PhD,105 Andreas K Demetriades, MD,106,107 Nikolaos Dervenis, MD,108,109 Mostafa Dianatinasab, MSc,110,111 Prof Diana Dias da Silva, PhD,112,69 Abdel Douiri, PhD,113 Prof David Edvardsson, PhD,114,115 Luchuo Engelbert Bain, PhD,116 Francesco Esposito, MD,117 Adeniyi Francis Fagbamigbe, PhD,118,119 Carla Sofia e S\u00E1 Farinha, MSc,120,121 Seyed-Mohammad Fereshtehnejad, PhD,49,122 Jo\u00E3o C Fernandes, PhD,123 Pietro Ferrara, MD,124 Peter Andras Gaal, PhD,125,126 Silvano Gallus, DSc,127 Lucia Galluzzo, MA,48 Mariana Gaspar Fonseca, PhD,128 Prof Gus Gazzard, MD,129,130 Alessandro Gialluisi, PhD,131 Simona Giampaoli, MD,132 Prof Paramjit Singh Gill, DM,133 James C Glasbey, MSc,134 Giuseppe Gorini, MD,135 Prof Michal Grivna, PhD,136,137 Abdul Hafiz, PhD,138,139 Josep Maria Haro, MD,140,141 Prof Jan Hartvigsen, PhD,142,143 Prof Simon I Hay, FMedSci,144,145 Behzad Heibati, PhD,146 David Hillus, MD,147 Mehdi Hosseinzadeh, PhD,148,149 Mihaela Hostiuc, PhD,150 Sorin Hostiuc, PhD,151,152 Salman Hussain, PhD,153,154 Prof Gaetano Isola, PhD,155 Olatunji Johnson, PhD,156 Prof Jost B Jonas, MD,157,158 Tamas Joo, PhD,125,159 Jacek Jerzy Jozwiak, PhD,160 Mikk J\u00FCrisson, PhD,161 Marina Karanikolos, PhD,162,163 Joonas H Kauppila, MD,164,165 Moien AB Khan, MSc,166,167 Khaled Khatab, PhD,168,169 Miloslav Klugar, PhD,153,170 Ai Koyanagi, MD,171,172 Om P Kurmi, PhD,173,174 Dian Kusuma, DSc,175,176 Prof Carlo La Vecchia, MD,177 Ben Lacey, PhD,70,178 Demetris Lamnisos, PhD,179 Prof Heidi Jane Larson, PhD,180,144 Prof Anders O Larsson, PhD,181,182 Savita Lasrado, MS,183 Paolo Lauriola, MD,184 Prof Jeffrey V Lazarus, PhD,185 Caterina Ledda, PhD,186 Paul H Lee, PhD,187 Mall Leinsalu, PhD,188,189 Matilde Leonardi, MD,190 Miriam Levi, PhD,191,192 An Li, PhD,193,194 Christine Linehan, PhD,195 Prof Giancarlo Logroscino, PhD,196,197 Prof Stefan Lorkowski, PhD,198,199 Joana A Loureiro, PhD,200,201 Prof Ronan A Lyons, MD,202 \u00C1urea M Madureira-Carvalho, PhD,112,203 Prof Azeem Majeed, MD,204 Alexander G Mathioudakis, PhD,205,206 Colm McAlinden, PhD,207 Prof John J McGrath, MD,208,209 Prof Ritesh G Menezes, MD,210 Alexios-Fotios A Mentis, MD,211 Atte Meretoja, MD,212,213 Tuomo J Meretoja, MD,214,215 Tomislav Mestrovic, PhD,216,144 Junmei Miao Jonasson, PhD,217 Bartosz Miazgowski, MD,218,219 Prof Tomasz Miazgowski, MD,220 Andreea Mirica, PhD,41 Shafiu Mohammed, PhD,221,82 Ali H Mokdad, PhD,144,145 Prof Ute Mons, PhD,222 Joana Morgado-da-Costa, MSc,223 Francesk Mulita, PhD,224,225 Prof Christopher J L Murray, DPhil,144,145 Ionut Negoi, PhD,226,227 Ruxandra Irina Negoi, PhD,228,229 Serban Mircea Negru, MD,230 Evangelia Nena, MD,231 Nurulamin M Noor, MRCP,232,233 George Ntaios, PhD,234 Prof Bogdan Oancea, PhD,235 Frank B Osei, PhD,236,237 Adrian Otoiu, PhD,41 Raffaele Palladino, MD,238,204 Songhomitra Panda-Jonas, MD,239 Prof Shahina Pardhan, PhD,240 Jay Patel, NA,241,242 Prof Mihaela Paun, PhD,243,244 Paolo Pedersini, MSc,245 Umberto Pensato, MD,246 Renato B Pereira, PhD,247 Prof Jorge P\u00E9rez-G\u00F3mez, PhD,248 Norberto Perico, MD,249 Ionela-Roxana Petcu, PhD,41 Carrie B Peterson, PhD,250 Marina Pinheiro, PhD,247 Prof Maarten J Postma, PhD,251,252 Alberto Raggi, PhD,190 Amir Masoud Rahmani, PhD,253 Chythra R Rao, MD,254 Prof Salman Rawaf, MD,204,255 Reza Rawassizadeh, PhD,256 Prof Giuseppe Remuzzi, MD,249 Abanoub Riad, DDS,257,153 Prof Simona Sacco, MD,258 Prof Mohammad Reza Saeb, PhD,259 Brijesh Sathian, PhD,260,261 Davide Sattin, PsyD,262 Prof Nikolaos Scarmeas, PhD,263,264 Prof Falk Schwendicke, PhD,265 Rahman Shiri, PhD,266 Velizar Shivarov, PhD,267,268 Kibrom T Sibhatu, PhD,269 Prof Biagio Simonetti, PhD,270,271 Prof S\u00F8ren T Skou, PhD,142,272 Prof Joan B Soriano, MD,273,274 Ireneous N Soyiri, PhD,275 Prof Nicholas Steel, PhD,276,277 Simona C\u0103t\u0103lina \u0218tefan, PhD,278 Fridolin Steinbeis, MD,147 Paschalis Steiropoulos, MD,231 Leo Stockfelt, PhD,279 Prof Saverio Stranges, MD,280,281 Prof Johan Sundstr\u00F6m, PhD,181,282 Prof Rafael Tabar\u00E9s-Seisdedos, PhD,283,284 Arulmani Thiyagarajan, MPH,285 Roman Topor-Madry, PhD,286,287 Marcos Roberto Tovani-Palone, PhD,288,289 Nikolaos Tsilimparis, PhD,290 Brigid Unim, PhD,48 Marco Vacante, PhD,71 Jef Van den Eynde, BSc,291 Prof Tommi Juhani Vasankari, MD,292,293 Prof Massimiliano Veroux, PhD,294 Jorge Hugo Villafa\u00F1e, PhD,245 Prof Francesco S Violante, MD,295,296 Yanzhong Wang, PhD,113 Ronny Westerman, DSc,297 Prof Charles D A Wolfe, MD,113,298 Grant M A Wyper, MSc,299 Prof Sanni Yaya, PhD,300,301 Prof Vesna Zadnik, PhD,302 Jean-David Zeitoun, PhD,303,304 Prof Alimuddin Zumla, PhD,305,306 Alberto Freitas, PhD,307,1 Prof. Brecht Devleesschauwer, PhD.308,309 Affiliations 1CINTESIS@RISE, MEDCIDS, Faculty of Medicine,\u00A0University of Porto, Porto, Portugal; 2Public Health Unit, ULS Santo Ant\u00F3nio,\u00A0Porto, Portugal; 3National School of Public Health, Institute of Health Carlos III, Madrid, Spain; 4Scientific-Tools.Org, Bergamo, Italy; 5Research Department, RoNeuro Institute for Neurological Research and Diagnostic, Cluj-Napoca, Romania; 6Department of Public Health, Babes-Bolyai University, Cluj-Napoca, Romania; 7Department for Exposure Assessment and Environmental Health Indicators, German Environment Agency, Dessau-Ro\u00DFlau, Germany; 8Department of Healthcare, University of Vlora, Vlora, Albania; 9Clinic of Social and Family Medicine, University of Crete, Heraklion, Greece; 10Independent researcher; 11Institute of Gerontological Health Services and Nursing Research, Ravensburg-Weingarten University of Applied Sciences, Weingarten, Germany; 12Department of Disease Burden, Norwegian Institute of Public Health, Bergen, Norway; 13\u00A0Department of Epidemiology and Population Health, Faculty of Health Sciences, American University of Beirut, Beirut, Lebanon; 14National Center for Epidemiology, Instituto de Salud Carlos III, Madrid, Spain; 15The Gerald J. and Dorothy R. Friedman School of Nutrition Science and Policy, Tufts University, Boston, MA, USA; 16Department of Public Health, Erasmus University Medical Center, Rotterdam, Netherlands; 17Department of Health Economics and Social Security, Jagiellonian University Medical College, Krakow, Poland; 18Clinical Epidemiology and Public Health Research Unit, Burlo Garofolo Institute for Maternal and Child Health, Trieste, Italy; 19Research group for Childhood Cancer, Danish Cancer Institute, Danish Cancer Society, Copenhagen, Denmark; 20Department of Health and Society, Faculty of Medicine, University of Applied and Environmental Sciences, Bogota, Colombia; 21Department of International Health, Maastricht University, Maastricht, Netherlands; 22Department of Non-communicable Diseases and Injuries, Sant\u00E9 Publique France (Public Health France), Saint-Maurice, France; 23Department of Medicine, University College Cork, Cork, Ireland; 24Department of Geriatric Medicine, Mercy University Hospital, Cork, Ireland; 25Anatomy Department, University of Malta, Msida, Malta; 26Department of Biomedical and Dental Sciences and Morphofunctional Imaging, Messina University, Messina, Italy; 27School of Public Health, University College Cork, Cork, Ireland; 28Department of Juridical and Economic Studies, La Sapienza University, Rome, Italy; 29Research Center for Immunodeficiencies, Tehran University of Medical Sciences, Tehran, Iran; 30Department of Biosciences and Nutrition, Karolinska University Hospital, Huddinge, Sweden; 31Department of Obstetrics & Gynecology, University of Texas, Galveston, TX, USA; 32School of Public Health, Imperial College London, London, UK; 33School of Advanced Technologies in Medicine, Shahid Beheshti University of Medical Sciences, Tehran, Iran; 34School of Computing, Mathematics and Engineering, Charles Sturt University, Wagga Wagga, NSW, Australia; 35Information and Communication Sciences and Technologies Pole, Mathematics, Algorithms and Decision Team, ENSTA Bretagne, Brest, France; 36Bordeaux School of Public Health, University of Bordeaux, Bordeaux, France; 37Research Program of Epidemiology and Public Health, Pompeu Fabra University, Barcelona, Spain; 38Department of Experimental and Health Sciences, Biomedical Research Networking Center in Epidemiology and Public Health (CiberESP), Madrid, Spain; 39Faculty of Pharmacy, Carol Davila University of Medicine and Pharmacy, Bucharest, Romania; 40Cardiology Department, Carol Davila University of Medicine and Pharmacy, Bucharest, Romania; 41Department of Statistics and Econometrics, Bucharest University of Economic Studies, Bucharest, Romania; 42Department of Medicine, University of Thessaly, Volos, Greece; 43Non-Communicable Diseases & Environment Programme, Barcelona Institute for Global Health, Barcelona, Spain; 44Department of Experimental and Health Sciences, Pompeu Fabra University, Barcelona, Spain; 45Department of Sociology and Social Work, Kwame Nkrumah University of Science and Technology, Kumasi, Ghana; 46Center for International Health, Ludwig Maximilians University, Munich, Germany; 47Department of Public Health, Birmingham City University, Birmingham, UK; 48Department of Cardiovascular, Endocrine-metabolic Diseases and Aging, National Institute of Health, Rome, Italy; 49Department of Neurobiology, Care Sciences and Society, Karolinska Institute, Stockholm, Sweden; 50School of Health and Social Studies, Dalarna University, Falun, Sweden; 51Department of Physiotherapy, University of Sharjah, Sharjah, United Arab Emirates; 52Department Community Medicine and Rehabilitation, Ume\u00E5 University, Umea, Sweden; 53Oral and Maxillofacial Surgery, Justus Liebig University of Giessen, Giessen, Germany; 54Northumbria HealthCare NHS Foundation Trust, National Health Service (NHS) Scotland, Newcastle upon Tyne, UK; 55School of Business, University of Leicester, Leicester, UK; 56Department of Psychiatry, Autonomous University of Madrid (Universidad Aut\u00F3noma de Madrid), Madrid, Spain; 57CIBERSAM, Institute of Health Carlos III, Madrid, Spain; 58Department of Hypertension, Medical University of Lodz, Lodz, Poland; 59Polish Mothers' Memorial Hospital Research Institute, Lodz, Poland; 60Heidelberg Institute of Global Health (HIGH), Heidelberg University, Heidelberg, Germany; 61T.H. Chan School of Public Health, Harvard University, Boston, MA, USA; 62Department of Translational Medicine, University of Eastern Piedmont, Novara, Italy; 63Heidelberg Institute of Global Health (HIGH), Heidelberg University Hospital, Heidelberg, Germany; 64Center for Primary Care, Harvard University, Boston, MA, USA; 65Department of Psychiatry, University of M\u00FCnster, M\u00FCnster, Germany; 66Department of Psychiatry, Melbourne Medical School, Melbourne, VIC, Australia; 67Department of Mental Health, AUSL Romagna, Ravenna, Italy; 68Biological Sciences Department, University of Porto, Porto, Portugal; 69Research Unit on Applied Molecular Biosciences (UCIBIO), University of Porto, Porto, Portugal; 70Nuffield Department of Population Health, University of Oxford, Oxford, UK; 71Department of General Surgery and Medical-Surgical Specialties, University of Catania, Catania, Italy; 72Department of Computer Science and Information Technology, Institute for Advanced Studies in Basic Sciences, Zanjan, Iran; 73Department of Research and Innovation, Petanux Research GmBH, Bonn, Germany; 74School of Medicine and University Hospital, Federal University of Minas Gerais, Belo Horizonte, Brazil; 75Division of Country Health Policies and Systems, World Health Organization (WHO), Denmark, Denmark; 76University of Genoa, Genoa, Italy; 77Ophthalmology Department, Moorfields Eye Hospital NHS Foundation Trust, London, UK; 78International Centre for Eye Health, London School of Hygiene & Tropical Medicine, London, UK; 79Division of Clinical Epidemiology and Aging Research, German Cancer Research Center, Heidelberg, Germany; 80Department of Woman and Child Health and Public Health, Agostino Gemelli University Polyclinic IRCCS (Fondazione Policlinico Universitario A. Gemelli IRCCS), Roma, Italy; 81Global Health Research Institute, Universit\u00E0 Cattolica del Sacro Cuore (Catholic University of Sacred Heart), Roma, Italy; 82Department of Health Care Management, Technical University of Berlin, Berlin, Germany; 83Clinical Pharmacy, University of Medicine and Pharmacy of Craiova, Romania, Craiova, Romania; 84Institute for Cancer Research, Prevention and Clinical Network, Florence, Italy; 85Faculty of Health Sciences, University Fernando Pessoa, Porto, Portugal; 86Department of Medicine, University of Udine, Udine, Italy; 87Department of Mental Health, Healthcare Agency \"Friuli Occidentale\", Pordenone, Italy; 88Department of Pharmacological and Biomolecular Sciences, University of Milan, Milan, Italy; 89MultiMedica, IRCCS, Sesto S. Giovanni, Italy; 90Department of Public Health and Infectious Diseases, La Sapienza University, Rome, Italy; 91Institute of Applied Health Research, University of Birmingham, Birmingham, UK; 92Faculty of Medical Sciences, University of the West Indies, St Augustine, Trinidad and Tobago; 93Independent Consultant, Athens, Greece; 94Florida International University, Florida International University, Miami, FL, USA; 95Department of Epidemiology, University of Bern, Bern, Switzerland; 96Bispebjerg Hospital, University of Copenhagen, Copenhagen, Denmark; 97Department of Health Informatics, University College London, London, UK; 98Health Data Research UK, London, UK; 99Nova Medical School, Nova University of Lisbon, Lisbon, Portugal; 100Institute of Neuroscience, National Research Council, Pisa, Italy; 101Therapeutic and Diagnostic Technologies, Cooperativa de Ensino Superior Polit\u00E9cnico e Universit\u00E1rio (Polytechnic and University Higher Education Cooperative), Gandra, Portugal; 102Institute for Research and Innovation in Health, University of Porto, Porto, Portugal; 103IRCCS Istituto Ortopedico Galeazzi (Galeazzi Orthopedic Institute IRCCS), University of Milan, Milan, Italy; 104Department of Dermatology, Case Western Reserve University, Cleveland, OH, USA; 105Department of Legal Medicine, Psychiatry and Pathology, Complutense University of Madrid (Universidad Complutense de Madrid), Madrid, Spain; 106Department of Neurosurgery, University of Edinburgh, Edinburgh, UK; 107Department of Neurosurgery, National Health Service (NHS) Scotland, Edinburgh, UK; 108St Paul's Eye Unit, Royal Liverpool University Hospital, Liverpool, UK; 109Department of Ophthalmology, Aristotle University of Thessaloniki, Thessaloniki, Greece; 110Department of Epidemiology, Maastricht University, Maastricht, Netherlands; 111Department of Epidemiology, Shiraz University of Medical Sciences, Shiraz, Iran; 112Toxicology Research Unit (TOXRUN), Cooperativa de Ensino Superior Polit\u00E9cnico e Universit\u00E1rio (CESPU) (University Polytechnic Higher Education Cooperative), Gandra, Portugal; 113School of Population Health and Environmental Sciences, King's College London, London, UK; 114School of Nursing and Midwifery, La Trobe University, Melbourne, VIC, Australia; 115Department of Nursing, Ume\u00E5 University, Umea, Sweden; 116Lincoln International Institute for Rural Health, University of Lincoln, Lincoln, UK; 117Dipartimento di Scienze Biomediche e Neuromotorie (Department of Biomedical and Neuromotor Sciences), University of Bologna, Bologna, Italy; 118Department of Epidemiology and Medical Statistics, University of Ibadan, Ibadan, Nigeria; 119Institute of Applied Health Sciences, University of Aberdeen, Aberdeen, UK; 120Dissemination Division, National Institute of Statistics, Lisbon, Portugal; 121Activity Planning and Control Unit, Directorate-General of Health\u00A0(DGS), Lisbon, Portugal; 122Division of Neurology, University of Ottawa, Ottawa, ON, Canada; 123Center for Biotechnology and Fine Chemistry, Catholic University of Portugal, Porto, Portugal; 124Research Center on Public Health, University of Milan Bicocca, Monza, Italy; 125Health Services Management Training Centre, Semmelweis University, Budapest, Hungary; 126Department of Applied Social Sciences, Sapientia Hungarian University of Transylvania, T\u00E2rgu-Mure\u015F, Romania; 127Department of Environmental Health Sciences, Mario Negri Institute for Pharmacological Research, Milan, Italy; 128National Health Service, London, UK; 129Institute of Ophthalmology, University College London, London, UK; 130Moorfields Eye Hospital NHS Foundation Trust, London, UK; 131Department of Epidemiology and Prevention, IRCCS Neuromed, Pozzilli, Italy; 132Department of Cardiovascular Endocrine-metabolic Diseases and Aging, Istituto Superiore di Sanit\u00E0, Rome, Italy; 133Warwick Medical School, University of Warwick, Coventry, UK; 134NIHR Global Health Research Unit on Global Surgery, University of Birmingham, Birmingham, UK; 135Oncological Network, Prevention and Research Institute, Institute for Cancer Research, Prevention and Clinical Network, Florence, Italy; 136College of Medicine and Health Sciences, United Arab Emirates University, Al Ain, United Arab Emirates; 137Department of Public Health and Preventive Medicine, Charles University, Prague, Czech Republic; 138College of Medicine, Umm AL Qura University, Makkah, Saudi Arabia; 139MSc Epidemiology Programme, London School of Hygiene & Tropical Medicine, London, UK; 140Research Unit, University of Barcelona, Barcelona, Spain; 141Biomedical Research Networking Center for Mental Health Network (CiberSAM), Barcelona, Spain; 142Department of Sports Science and Clinical Biomechanics, University of Southern Denmark, Odense, Denmark; 143Research Department, Nordic Institute of Chiropractic and Clinical Biomechanics, Odense, Denmark; 144Institute for Health Metrics and Evaluation, University of Washington, Seattle, WA, USA; 145Department of Health Metrics Sciences, School of Medicine, University of Washington, Seattle, WA, USA; 146Research Unit of Population Health, University of Oulu, Oulu, Finland; 147Department of Infectious Diseases and Respiratory Medicine, Charit\u00E9 Medical University Berlin, Berlin, Germany; 148Institute of Research and Development, Duy Tan University, Da Nang, Viet Nam; 149Department of Computer Science, University of Human Development, Sulaymaniyah, Iraq; 150Internal Medicine Department, Carol Davila University of Medicine and Pharmacy, Bucharest, Romania; 151Department of Legal Medicine and Bioethics, Carol Davila University of Medicine and Pharmacy, Bucharest, Romania; 152Clinical Legal Medicine Department, National Institute of Legal Medicine Mina Minovici, Bucharest, Romania; 153Czech National Centre for Evidence-based Healthcare and Knowledge Translation, Masaryk University, Brno, Czech Republic; 154Institute of Biostatistics and Analyses, Masaryk University, Brno, Czech Republic; 155Department of General Surgery and Surgical-Medical Specialties, University of Catania, Catania, Italy; 156Department of Mathematics, University of Manchester, Manchester, UK; 157Institute of Molecular and Clinical Ophthalmology Basel, Basel, Switzerland; 158Department of Ophthalmology, Heidelberg University, Mannheim, Germany; 159Hungarian Health Management Association, Budapest, Hungary; 160Department of Family Medicine and Public Health, University of Opole, Opole, Poland; 161Institute of Family Medicine and Public Health, University of Tartu, Tartu, Estonia; 162European Observatory on Health Systems and Policies, London School of Hygiene & Tropical Medicine, London, UK; 163Department of Health Services Research and Policy, London School of Hygiene & Tropical Medicine, London, UK; 164Surgery Research Unit, University of Oulu, Oulu, Finland; 165Department of Molecular Medicine and Surgery, Karolinska Institute, Stockholm, Sweden; 166Family Medicine Department, United Arab Emirates University, Al Ain, United Arab Emirates; 167Primary Care Department, NHS North West London, London, UK; 168Faculty of Health and Wellbeing, Sheffield Hallam University, Sheffield, UK; 169College of Arts and Sciences, Ohio University, Zanesville, OH, USA; 170Institute for Health Information and Statistics of the Czech Republic, Prague, Czech Republic; 171Biomedical Research Networking Center for Mental Health Network (CIBERSAM), San Juan de Dios Sanitary Park, Sant Boi de Llobregat, Spain; 172Catalan Institution for Research and Advanced Studies (ICREA), Barcelona, Spain; 173Faculty of Health and Life Sciences, Coventry University, Coventry, UK; 174Department of Medicine, McMaster University, Hamilton, ON, Canada; 175Department of Health Services Research and Management, City University of London, London, UK; 176Faculty of Public Health, University of Indonesia, Depok, Indonesia; 177Department of Clinical Sciences and Community Health, University of Milan, Milan, Italy; 178National Institute for Health Research (NIHR) Oxford Biomedical Research Centre, Oxford, UK; 179Department of Health Sciences, European University Cyprus, Nicosia, Cyprus; 180Department of Infectious Disease Epidemiology, London School of Hygiene & Tropical Medicine, London, UK; 181Department of Medical Sciences, Uppsala University, Uppsala, Sweden; 182Department of Clinical Chemistry and Pharmacology, Uppsala University Hospital, Uppsala, Sweden; 183Department of Otorhinolaryngology, Father Muller Medical College, Mangalore, India; 184International Society Doctors for the Environment, Arezzo, Italy; 185Barcelona Institute for Global Health, Barcelona, Spain; 186Clinical and Experimental Medicine, University of Catania, Catania, Italy; 187Department of Health Sciences, University of Leicester, Leicester, UK; 188School of Social Sciences, S\u00F6dert\u00F6rn University, Huddinge, Sweden; 189Department of Epidemiology and Biostatistics, National Institute for Health Development, Tallinn, Estonia; 190UO Neurologia, Salute Pubblica e Disabilit\u00E0, Fondazione IRCCS Istituto Neurologico Carlo Besta (Neurology, Public Health and Disability Unit, Carlo Besta Neurological Institute), Milan, Italy; 191Department of Prevention, USL Tuscany Center, Firenze, Italy; 192Department of Health Sciences, University of Florence, Florence, Italy; 193Center for Dentistry and Oral Hygiene, University of Groningen, Groningen, Netherlands; 194Stomatological Hospital, Southern Medical University, Guangzhou, China; 195UCD Centre for Disability Studies, University College Dublin, Dublin, Ireland; 196Department of Basic Medical Sciences, Neuroscience and Sense Organs, University of Bari Aldo Moro, Bari, Italy; 197Department of Clinical Research in Neurology, Fondazione Cardinale Giovanni Panico Hospital, Tricase, Italy; 198Institute of Nutritional Sciences, Friedrich Schiller University Jena, Jena, Germany; 199Competence Cluster for Nutrition and Cardiovascular Health (nutriCARD), Jena, Germany; 200Laboratory for Process Engineering, Environment, Biotechnology and Energy (LEPABE), University of Porto, Porto, Portugal; 201School of Health, Polytechnic Institute of Porto, Portugal; 202School of Medicine, Swansea University, Swansea, UK; 203Laborat\u00F3rio de Farmacognosia (LAQV) (Associated Laboratory for Green Chemistry, University of Porto, Porto, Portugal; 204Department of Primary Care and Public Health, Imperial College London, London, UK; 205Division of Infection, Immunity and Respiratory Medicine, University of Manchester, Manchester, UK; 206North West Lung Centre, Manchester University NHS Foundation Trust, Manchester, UK; 207Department of Ophthalmology, Singleton Hospital, Swansea, UK; 208Queensland Brain Institute, The University of Queensland, Brisbane, QLD, Australia; 209National Centre for Register-based Research, Aarhus University, Aarhus, Denmark; 210Forensic Medicine Division, Imam Abdulrahman Bin Faisal University, Dammam, Saudi Arabia; 211International Dx Department, BGI Genomics, Copenhagen, Denmark; 212Neurology Unit, Helsinki University Hospital, Helsinki, Finland; 213School of Health Sciences, University of Melbourne, Melbourne, VIC, Australia; 214Breast Surgery Unit, Helsinki University Hospital, Helsinki, Finland; 215University of Helsinki, Helsinki, Finland; 216University Centre Varazdin, University North, Varazdin, Croatia; 217School of Public Health and Community Medicine, University of Gothenburg, Gothenburg, Sweden; 218Center for Innovation in Medical Education, Pomeranian Medical University, Szczecin, Poland; 219Pomeranian Medical University, Szczecin, Poland; 220Department of Propedeutics of Internal Diseases & Arterial Hypertension, Pomeranian Medical University, Szczecin, Poland; 221Health Systems and Policy Research Unit, Ahmadu Bello University, Zaria, Nigeria; 222Faculty of Medicine and University Hospital Cologne, University of Cologne, Cologne, Germany; 223University Hospital Center of Porto, University of Porto, Porto, Portugal; 224Department of Surgery, General University Hospital of Patras, Patras, Greece; 225Medical School, University of Thessaly, Larissa, Greece; 226Department of General Surgery, Carol Davila University of Medicine and Pharmacy, Bucharest, Romania; 227Department of General Surgery, Emergency Hospital of Bucharest, Bucharest, Romania; 228Department of Anatomy and Embryology, Carol Davila University of Medicine and Pharmacy, Bucharest, Romania; 229Department of Cardiology, Cardio-Aid, Bucharest, Romania; 230Department of Oncology, Victor Babes University of Medicine and Pharmacy, Timisoara, Romania; 231Department of Medicine, Democritus University of Thrace, Alexandroupolis, Greece; 232Medical Research Council Clinical Trials Unit, University College London, London, UK; 233Department of Gastroenterology, Cambridge University Hospitals, Cambridge, UK; 234Department of Internal Medicine, University of Thessaly, Larissa, Greece; 235Department of Applied Economics and Quantitative Analysis, University of Bucharest, Bucharest, Romania; 236Faculty of Geo-Information Science and Earth Observation, University of Twente, Enschede, Netherlands; 237Department of Mathematics and Statistics, University of Energy and Natural Resources, Sunyani, Ghana; 238Department of Public Health, University of Naples Federico II, Naples, Italy; 239Privatpraxis, Heidelberg, Germany; 240Vision and Eye Research Institute, Anglia Ruskin University, Cambridge, UK; 241Global Health Governance Programme, University of Edinburgh, Edinburgh, UK; 242School of Dentistry, University of Leeds, Leeds, UK; 243Department of Bioinformatics and Biostatistics, National Institute of Research and Development for Biological Sciences, Bucharest, Romania; 244Department of Statistics and Cybernetics, University of Bucharest, Bucharest, Romania; 245Clinical Research Department, IRCCS Fondazione Don Carlo Gnocchi, Milan, Italy; 246Department of Neurology, IRCCS Humanitas Research Hospital, Milan, Italy; 247Department of Chemistry, University of Porto, Porto, Portugal; 248Departamento de Did\u00E1ctica de la Expresi\u00F3n Musical, Pl\u00E1stica y Corportal, University of Extremadura, C\u00E1ceres, Spain; 249Mario Negri Institute for Pharmacological Research, Bergamo, Italy; 250Independent Consultant, Copenhagen, Denmark; 251University Medical Center Groningen, University of Groningen, Groningen, Netherlands; 252Center of Excellence in Higher Education for Pharmaceutical Care Innovation, Universitas Padjadjaran (Padjadjaran University), Bandung, Indonesia; 253Future Technology Research Center, National Yunlin University of Science and Technology, Yunlin, Taiwan; 254Department of Community Medicine, Manipal Academy of Higher Education, Manipal, India; 255Academic Public Health England, Public Health England, London, UK; 256Department of Computer Science, Boston University, Boston, MA, USA; 257Department of Public Health, Masaryk University, Brno, Czech Republic; 258Department of Neurology, University of L'Aquila, L'Aquila, Italy; 259Department of Polymer Technology, Independent Consultant, Gdansk, Poland; 260Geriatric and Long Term Care Department, Hamad Medical Corporation, Doha, Qatar; 261Faculty of Health & Social Sciences, Bournemouth University, Bournemouth, UK; 262IRCCS Istituti Clinici Scientifici Maugeri (IRCCS Maugeri Scientific Clinical Institute), Milan, Italy; 263Department of Neurology, National and Kapodistrian University of Athens, Athens, Greece; 264Department of Neurology, Columbia University, New York, NY, USA; 265Oral Diagnosis, Digital Health and Health Services Research, Charit\u00E9 University Medical Center Berlin, Berlin, Germany; 266Finnish Institute of Occupational Health, Helsinki, Finland; 267Clinical Immunology and Hematology, Sofiamed University Hospital, Sofia, Bulgaria; 268Department of Genetics, Sofia University \"St. Kliment Ohridiski\", Sofia, Bulgaria; 269Department of Agricultural Economics and Rural Development, University of G\u00F6ttingen, G\u00F6ttingen, Germany; 270Department of Law, Economics, Management and Quantitative Methods, University of Sannio, Benevento, Italy; 271WSB University in Gda\u0144sk, Gda\u0144sk, Poland; 272Department of Physiotherapy and Occupational Therapy, N\u00E6stved-Slagelse-Ringsted Hospitals, Slagelse, Denmark; 273Hospital Universitario de La Princesa (Princess University Hospital), Autonomous University of Madrid, Madrid, Spain; 274Centro de Investigaci\u00F3n Biom\u00E9dica en Red Enfermedades Respiratorias (CIBERES) (Center for Biomedical Research in Respiratory Diseases Network), Madrid, Spain; 275Hull York Medical School, University of Hull, Hull City, UK; 276Department of Primary Care and Public Health, University of East Anglia, Norwich, UK; 277Public Health England, London, UK; 278Management Department, Bucharest University of Economic Studies, Bucharest, Romania; 279Occupational and Environmental Medicine Department, University of Gothenburg, Gothenburg, Sweden; 280Department of Epidemiology & Biostatistics, The University of Western Ontario, London, ON, Canada; 281Department of Population Health, Luxembourg Institute of Health, Strassen, Luxembourg; 282The George Institute for Global Health, Sydney, NSW, Australia; 283Department of Medicine, University of Valencia, Valencia, Spain; 284Institute of Health Carlos III, Biomedical Research Networking Center for Mental Health Network (CiberSAM), Madrid, Spain; 285Clinical Epidemiology, Leibniz Institute for Prevention Research and Epidemiology, Bremen, Germany; 286Institute of Public Health, Jagiellonian University Medical College, Krak\u00F3w, Poland; 287Agency for Health Technology Assessment and Tariff System, Warsaw, Poland; 288Saveetha Dental College and Hospitals, Saveetha Institute of Medical and Technical Sciences (SIMATS), Chennai, India; 289Modestum LTD, Eastbourne, UK; 290Department of Vascular Surgery, Ludwig Maximilians University, Munich, Germany; 291Department of Cardiovascular Sciences, Katholieke Universiteit Leuven, Leuven, Belgium; 292UKK Institute, Tampere, Finland; 293Faculty of Medicine and Health Technology, Tampere University, Tampere, Finland; 294Department of Medical and Surgical Sciences and Advanced Technologies, University of Catania, Catania, Italy; 295Department of Medical and Surgical Sciences, University of Bologna, Bologna, Italy; 296Occupational Health Unit, Sant'Orsola Malpighi Hospital, Bologna, Italy; 297Competence Center of Mortality-Follow-Up of the German National Cohort, Federal Institute for Population Research, Wiesbaden, Germany; 298NIHR-Biomedical Research Centre (NIHR-BRC), Guy's and St. Thomas' Hospital and Kings College London, London, UK; 299School of Health and Wellbeing, University of Glasgow, Glasgow, UK; 300School of International Development and Global Studies, University of Ottawa, Ottawa, ON, Canada; 301The George Institute for Global Health, Imperial College London, London, UK; 302Epidemiology and Cancer Registry Sector, Institute of Oncology Ljubljana, Ljubljana, Slovenia; 303Centre of Clinical Epidemiology, H\u00F4tel Dieu Hospital, Assistance Publique H\u00F4pitaux de Paris (Public Hospitals of Paris), Paris, France; 304Gastroenterology and Nutrition, Saint-Antoine Hospital, Assistance Publique H\u00F4pitaux de Paris (Public Hospitals of Paris), Paris, France; 305Department of Infection, University College London, London, UK; 306NIHR-Biomedical Research Centre (NIHR-BRC), University College London Hospitals, London, UK; 307Department of Community Medicine, Information and Health Decision Sciences, University of Porto, Porto, Portugal; 308Department of Epidemiology and Public Health, Sciensano, Brussels, Belgium; 309Department of Translational Physiology, Infectiology and Public Health, Ghent University, Ghent, Belgium. Only secondary data was used for this study. Funding Information: T W B\u00E4rnighausen was supported by the Alexander von Humboldt Foundation through the Alexander von Humboldt Professor award, funded by the German Federal Ministry of Education and Research. L Belo acknowledges the support from FCT in the scope of the project UIDP/04378/2020 and UIDB/04378/2020 of UCIBIO and the project LA/P/0140/2020 of i4HB. D A Bennett is supported by the UK Medical Research Council Population Health Research Unit at the University of Oxford. M Carvalho acknowledges the support from FCT in the scope of the project UIDP/04378/2020 and UIDB/04378/2020 of UCIBIO and the project LA/P/0140/2020 of i4HB. A L Catapano is supported in part by the Ministero della Salute ricerca corrente. J S Chandan acknowledges the National Institute of Health Research. J Conde would like to acknowledge the European Research Council Starting Grant (ERC-StG-2019\u2013848325). D Dias da Silva acknowledges the projects UIDP/04378/2022 and UIDB/04378/2022 of the Research Unit on Applied Molecular Biosciences UCIBIO; the project LA/P/ 0140/2022 of the Associate Laboratory Institute for Health and Bioeconomy i4HB; and IINFACTS-Institute of Research and Advanced Training in Health Sciences and Technologies (project PsiloPharm) and TOXRUN Toxicology Research Unit, University Institute of Health Sciences, IUCS-CESPU, Portugal. A Douiri acknowledges support by King\u2019s Health Partners/Guy\u2019s and St Thomas Charity \u201CMLTC Challenge Fund\u201D (grant number EIC180702) and the NIHR Applied Research Collaboration (ARC) South London at King\u2019s College Hospital NHS Foundation Trust. The views expressed are those of the authors and not necessarily those of the NIHR or the Department of Health and Social Care. J C Fernandes acknowledges support from Funda\u00E7\u00E3o para a Ci\u00EAncia e Tecnologia (FCT) with funding for UID/Multi/50016/2019. G Gazzard acknowledges support from NIHR Biomedical Research Centre at Moorfields Eye Hospital NHS Foundation Trust, London, UK and Institute of Ophthalmology, University College London, UK. P S Gill acknowledges being NIHR senior investigator for the NIHR Department of Health and Social Care. The views expressed are those of the author(s) and not necessarily those of the NHS, the NIHR or the Department of Health and Social Care. J C Glasbey is supported by a UK National Institute of Health Research Doctoral Research Fellowship (NIHR300175). S Hussain was supported from Operational Programme Research, Development and Education \u201CProject, Postdoc2MUNI\u201D (No.CZ.02.2.69/0.0/0.0/18_053/0016952). M AB Khan acknowledges support as recipient of research grants G00003634- CMHS \u201CNP-22\u201320 80, 000 AED (2021), G00003569 NP-21\u201313 80,000 AED, and 1976\u2014SDG Research Program Grant 40,000 AED. B Lacey acknowledges support from UK Biobank, which is funded largely by the UK Medical Research Council and Wellcome. J A Loureiro was supported by National Funds through Funda\u00E7\u00E3o para a Ci\u00EAncia e Tecnologia (FCT) under the Scientific Employment Stimulus\u2019 Institutional Call\u2014[CEECINST/00049/2018]. S Lorkowski acknowledges institutional support from the Competence Cluster for Nutrition and Cardiovascular Health (nutriCARD) Halle-Jena-Leipzig (Germany; German Federal Ministry of Education and Research; grant agreement number 01EA1808A). A G Mathioudakis acknowledges support by the National Institute for Health and Care Research Manchester Biomedical Research Centre (NIHR Manchester BRC) and by an NIHR Clinical Lectureship in Respiratory Medicine. J J McGrath was supported by the Danish National Research Foundation (Niels Bohr Professorship) and is employed by The Queensland Centre for Mental Health Research, which receives core funding from the Queensland Health. S Mohammed reports fellowship grant from Alexander von Humboldt Foundation, outside the submitted work. L Monasta received support from the Italian Ministry of Health, through the contribution given to the Institute for Maternal and Child Health IRCCS Burlo Garofolo, Trieste, Italy (RC 34/2017). P Pedersini was supported and funded by the Italian Ministry of Health\u2014Ricerca Corrente 2021. M Pinheiro thanks FCT for funding through program DL 57/2016 Norma transita. A Raggi acknowledges support by the Italian Ministry of Health (RRC). A Riad was supported by the project of the Ministry of Education, Youth and Sports of the Czech Republic (Systemic Risk Institute \"SYRI\": LX22NPO5101) and the projects of Masaryk University (MUNI/A/1402/2021 and MUNI/IGA/1104/2021). S T Skou is currently funded by a grant from Region Zealand (Exercise First) and two grants from the European Union\u2019s Horizon 2020 Research and Innovation Program, one from the European Research Council (MOBILIZE, grant agreement No 801790) and the other under grant agreement No 945377 (ESCAPE). J B Soriano is supported by Centro de Investigacion Biomedica en Red de Enfermedades Respiratorias, Instituto de Salud Carlos III, Madrid, Spain. L Stockfelt was funded by the Swedish state under the agreement between the Swedish government and the country councils, the ALF-agreement. Johan Sundstr\u00F6m acknowledges stock ownership in Anagram kommunikation AB and Symptoms Europe AB. R Tabares-Seisdedos is supported by the Spanish Ministry of Science and Innovation, Institute of Health Carlos III, CIBERSAM, INCLIVA (PID2021-129099OB-I00). M R Tovani-Palone acknowledges Saveetha Institute of Medical and Technical Sciences (SIMATS) for its support. J H Villafa\u00F1e was supported and funded by the Italian Ministry of Health\u2014Ricerca Corrente 2021. A Zumla acknowledges grant support from the Pan-African Network for Rapid Research, Response, Relief and Preparedness for Infectious Diseases Epidemics (PANDORA-ID-NET) ONE-HEALTH (Europe-Africa) consortium funded by the European and Developing Countries Clinical Trials Partnership, which is supported by Horizon 2020, the EU's Framework Programme for Research and Innovation. Funding Information: The authors would like to acknowledge the networking support from COST Action CA18218 (European Burden of Disease Network), supported by COST (European Cooperation in Science and Technology). This article was supported by National Funds through FCT - Funda\u00E7\u00E3o para a Ci\u00EAncia e a Tecnologia,I.P., within CINTESIS, R&D Unit (reference UIDB/4255/2020). Publisher Copyright: © The Author(s) 2024.

PY - 2024/12/1

Y1 - 2024/12/1

N2 - Background: The European Union (EU) faces many health-related challenges. Burden of diseases information and the resulting trends over time are essential for health planning. This paper reports estimates of disease burden in the EU and individual 27 EU countries in 2019, and compares them with those in 2010. Methods: We used the Global Burden of Disease 2019 study estimates and 95% uncertainty intervals for the whole EU and each country to evaluate age-standardised death, years of life lost (YLLs), years lived with disability (YLDs) and disability-adjusted life years (DALYs) rates for Level 2 causes, as well as life expectancy and healthy life expectancy (HALE). Results: In 2019, the age-standardised death and DALY rates in the EU were 465.8 deaths and 20,251.0 DALYs per 100,000 inhabitants, respectively. Between 2010 and 2019, there were significant decreases in age-standardised death and YLL rates across EU countries. However, YLD rates remained mainly unchanged. The largest decreases in age-standardised DALY rates were observed for “HIV/AIDS and sexually transmitted diseases” and “transport injuries” (each -19%). “Diabetes and kidney diseases” showed a significant increase for age-standardised DALY rates across the EU (3.5%). In addition, “mental disorders” showed an increasing age-standardised YLL rate (14.5%). Conclusions: There was a clear trend towards improvement in the overall health status of the EU but with differences between countries. EU health policymakers need to address the burden of diseases, paying specific attention to causes such as mental disorders. There are many opportunities for mutual learning among otherwise similar countries with different patterns of disease.

AB - Background: The European Union (EU) faces many health-related challenges. Burden of diseases information and the resulting trends over time are essential for health planning. This paper reports estimates of disease burden in the EU and individual 27 EU countries in 2019, and compares them with those in 2010. Methods: We used the Global Burden of Disease 2019 study estimates and 95% uncertainty intervals for the whole EU and each country to evaluate age-standardised death, years of life lost (YLLs), years lived with disability (YLDs) and disability-adjusted life years (DALYs) rates for Level 2 causes, as well as life expectancy and healthy life expectancy (HALE). Results: In 2019, the age-standardised death and DALY rates in the EU were 465.8 deaths and 20,251.0 DALYs per 100,000 inhabitants, respectively. Between 2010 and 2019, there were significant decreases in age-standardised death and YLL rates across EU countries. However, YLD rates remained mainly unchanged. The largest decreases in age-standardised DALY rates were observed for “HIV/AIDS and sexually transmitted diseases” and “transport injuries” (each -19%). “Diabetes and kidney diseases” showed a significant increase for age-standardised DALY rates across the EU (3.5%). In addition, “mental disorders” showed an increasing age-standardised YLL rate (14.5%). Conclusions: There was a clear trend towards improvement in the overall health status of the EU but with differences between countries. EU health policymakers need to address the burden of diseases, paying specific attention to causes such as mental disorders. There are many opportunities for mutual learning among otherwise similar countries with different patterns of disease.

KW - European Burden of Disease Network

KW - European Union

KW - Global Burden of Diseases

KW - Health status

KW - Population health

U2 - 10.1186/s12889-024-18529-3

DO - 10.1186/s12889-024-18529-3

M3 - Article

SN - 1471-2458

VL - 24

JO - BMC Public Health

JF - BMC Public Health

IS - 1

M1 - 1374

ER -

The state of health in the European Union (EU-27) in 2019: a systematic analysis for the Global Burden of Disease study 2019

Abstract

Keywords

Access to Document

Fingerprint

Cite this