A national burden of disease calculation: Dutch disability-adjusted life-years

Objectives. This study estimated the burden of disease due to 48 major caus es in the Netherlands in 1994 in disability-adjusted life-years (DALY's), u sing national epidemiologic data and disability weights, and explored assoc iated problems and uncertainties. Methods. We combined data from Dutch vital statistics, registrations, and s urveys with Dutch disability weights to calculate disease-specific health l oss in DALY's, which are the sum of years of life lost (YLLs) and years liv ed with disability (YLLs) weighted for severity. Results. YLLs were primarily lost by cardiovascular diseases and cancers, w hile YLDs were mostly lost by mental disorders and a range of chronic somat ic disorders (such as chronic nonspecific lung disease and diabetes). These 4 di-agnostic groups caused approximately equal numbers of DALYs. Sensitiv ity analysis calls for improving the accuracy of the epidemiologic data in connection with disability weights, especially for mild and frequent diseas es. Conclusions. The DALY approach appeared to be feasible at a national Wester n European level and produced interpretable results, comparable to results from the Global Burden of Disease Study for the Established Market Economie s. Suggestions for improving the methodology and its applicability are pres ented.