Dutch DALYs, current and future burden of disease in the Netherlands.

BACKGROUND: The Disability Adjusted Life Year (DALY) is a measure to prioritize in the public health field. In the Netherlands, the DALY estimates are calculated since 1997 and are included in the Public Health Status and Foresight studies which is an input for public health priority setting and policy making. Over these 20 years, methodological advancements have been made, including accounting for multimorbidity and performing projections for DALYs into the future. Most important methodological choices and improvements are described and results are presented. METHODS: The DALY is composed of the two components years of life lost (YLL) due to premature mortality and years lost due to disability (YLD). Both the YLL and the YLD are distinguished by sex, age and health condition, allowing aggregation to the ICD-10 chapters. The YLD is corrected for multimorbidity, assuming independent occurrence of health conditions and a multiplicative method for the calculation of combined disability weights. Future DALYs are calculated based on projections for causes of death, and prevalence and incidence. RESULTS: The results for 2015 show that cancer is the ICD-10 chapter with the highest disease burden, followed by cardiovascular diseases and mental disorders. For the individual health conditions, coronary heart disease had the highest disease burden in 2015. In 2040, we see a strong increase in disease burden of dementia and arthrosis. For dementia this is due to a threefold increase in dementia as a cause of death, while for arthrosis this is mainly due to the increase in prevalence. CONCLUSIONS: To calculate the DALY requires a substantial amount of data, methodological choices, interpretation and presentation of results, and the personnel capacity to carry out all these tasks. However, doing a National Burden of Disease study, and especially doing that for more than 20 years, proved to have an enormous additional value in population health information and thus supports better public health policies.

Time Trends in Prevalence of Chronic Diseases and Multimorbidity Not Only due to Aging: Data from General Practices and Health Surveys.

INTRODUCTION: Chronic diseases and multimorbidity are common and expected to rise over the coming years. The objective of this study is to examine the time trend in the prevalence of chronic diseases and multimorbidity over the period 2001 till 2011 in the Netherlands, and the extent to which this can be ascribed to the aging of the population. METHODS: Monitoring study, using two data sources: 1) medical records of patients listed in a nationally representative network of general practices over the period 2002-2011, and 2) national health interview surveys over the period 2001-2011. Regression models were used to study trends in the prevalence-rates over time, with and without standardization for age. RESULTS: An increase from 34.9% to 41.8% (p<0.01) in the prevalence of chronic diseases was observed in the general practice registration over the period 2004-2011 and from 41.0% to 46.6% (p<0.01) based on self-reported diseases over the period 2001-2011. Multimorbidity increased from 12.7% to 16.2% (p<0.01) and from 14.3% to 17.5% (p<0.01), respectively. Aging of the population explained part of these trends: about one-fifth based on general practice data, and one-third for chronic diseases and half of the trend for multimorbidity based on health surveys. CONCLUSIONS: The prevalence of chronic diseases and multimorbidity increased over the period 2001-2011. Aging of the population only explained part of the increase, implying that other factors such as health care and society-related developments are responsible for a substantial part of this rise.

[59 important health problems; a selection of diseases for public health monitoring]. / 59 belangrijke volksgezondheidsproblemen: een selectie van ziekten voor het monitoren van de volksgezondheid.

Listing the top diseases is important for an overview of population health. These lists reduce the thousands of diseases to a compact selection that enables policy makers and researchers to set priorities in public health and health care. The Dutch National Institute for Public Health and the Environment uses such a selection for the Public Health Status and Forecast, a four-yearly overview of population health. This document forms the basis of the policy report on public health policy of the Ministry of Health, Welfare and Sport. The previous selection is 20 years old. The new selection not only reflects changing disease patterns, but also changing public discussions. The selection is still based on mortality and morbidity, but also on costs and participation in society, two subjects that are high on the public agenda.

Effects of hospital delivery during off-hours on perinatal outcome in several subgroups: a retrospective cohort study.

BACKGROUND: Studies have demonstrated a higher risk of adverse outcomes among infants born or admitted during off-hours, as compared to office hours, leading to questions about quality of care provide during off-hours (weekend, evening or night). We aim to determine the relationship between off-hours delivery and adverse perinatal outcomes for subgroups of hospital births. METHODS: This retrospective cohort study was based on data from the Netherlands Perinatal Registry, a countrywide registry that covers 99% of all hospital births in the Netherlands. Data of 449,714 infants, born at 28 completed weeks or later, in the period 2003 through 2007 were used. Infants with a high a priori risk of morbidity or mortality were excluded. Outcome measures were intrapartum and early neonatal mortality, a low Apgar score (5 minute score of 0-6), and a composite adverse perinatal outcome measure (mortality, low Apgar score, severe birth trauma, admission to a neonatal intensive care unit). RESULTS: Evening and night-time deliveries that involved induction or augmentation of labour, or an emergency caesarean section, were associated with an increased risk of an adverse perinatal outcome when compared to similar daytime deliveries. Weekend deliveries were not associated with an increased risk when compared to weekday deliveries. It was estimated that each year, between 126 and 141 cases with an adverse perinatal outcomes could be attributed to this evening and night effect. Of these, 21 (15-16%) are intrapartum or early neonatal death. Among the 3100 infants in the study population who experience an adverse outcome each year, death accounted for only 5% (165) of these outcomes. CONCLUSION: This study shows that for infants whose mothers require obstetric interventions during labour and delivery, birth in the evening or at night, are at an increased risk of an adverse perinatal outcomes.

Frequency of ill-founded off-label prescribing in Dutch general practice.

PURPOSE: The aim of this study is to quantify the extent of ill-founded off-label drug prescriptions in Dutch general practice. The study is based upon information on both the prescription itself and the patient's medical history. METHODS: In total, 48 combinations of drugs and off-label indications were selected from a list of 477 known off-label combinations. These 48 combinations were considered as ill-founded since pharmacotherapeutic handbooks or clinical practice guidelines did not provide evidence for their efficacy and safety. They were considered to be relevant for investigation in general practice. We used a nationally representative information network of 85 general practices in the Netherlands. By using information on the patients' diagnoses and medication in the period before and after the prescription, we were able to exclude non-conclusively off-label prescriptions. RESULTS: Twenty-one of the selected 48 off-label combinations did not occur in Dutch general practice. The drugs with the highest proportion of ill-founded off-label prescriptions were betahistine (26.7%), celecoxib (16.3%) and etoricoxib (12.5%). In total, 18.2% of the prescriptions, which were initially assessed as ill-founded off-label, were re-evaluated as on-label, after considering the patient's medical history. CONCLUSIONS: Ill-founded off-label prescribing in Dutch general practice is limited for 48 relevant combinations of drugs and off-label indications. In order to overcome limitations in registration databases, it is useful to look at as much information as possible--for example, co-medication and co-morbidity--when determining off-label prescribing. Studying ill-founded off-label prescribing should be performed on a day-to-day basis, especially for recently introduced drugs.

What factors explain the differences in morbidity estimations among general practice registration networks in the Netherlands? A first analysis.

BACKGROUND: Information on the incidence and prevalence of diseases is a core indicator for public health. There are several ways to estimate morbidity in a population (e.g., surveys, healthcare registers). In this paper, we focus on one particular source: general practice based registers. Dutch general practice is a potentially valid source because nearly all non-institutionalized inhabitants are registered with a general practitioner (GP), and the GP fulfils the role as "gatekeeper". However, there are some unexplained differences among morbidity estimations calculated from the data of various general practice registration networks (GPRNs). OBJECTIVE: To describe and categorize factors that may explain the differences in morbidity rates from different GPRNs, and to provide an overview of these factors in Dutch GPRNs. RESULTS: Four categories of factors are distinguished: "healthcare system", "methodological characteristics", "general practitioner", and "patient". The overview of 11 Dutch GPRNs reveals considerable differences in factors. CONCLUSION: Differences in morbidity estimation depend on factors in the four categories. Most attention is dedicated to the factors in the "methodology characteristics" category, mainly because these factors can be directly influenced by the GPRN.

Using registries in general practice to estimate countrywide morbidity in The Netherlands.

OBJECTIVE: Examining the possibility of using data from registries in general practice in order to present morbidity figures concerning a broad range of major diseases for the Dutch population. STUDY DESIGN: Qualitative and quantitative analysis of registered diagnoses. METHODS: Quantitative data from six registries were obtained. In addition, information about the registration process was obtained and discussed with representatives of the registries. Subjects for discussion were the general characteristics of the registries and disease-specific rules. RESULTS: Some important differences exist in the characteristics of the registries and the disease-specific coding rules for computing incidence and prevalence. However, for most diseases the rules of two or more registries corresponded with each other, so that a selection of registries that measured the occurrence of a particular disease in a similar way could be made. Nevertheless, for some age categories rather large differences between registries were observed. The best estimates for the whole country were calculated as the average incidence and prevalence of the selected registries. CONCLUSIONS: Data that were originally obtained during patient care can be made usable for public health policy purposes. To further improve the quality of data and to increase the usefulness of these data for public health policy purposes, more efforts are required.