Disability-adjusted life years 19 former socialist economies in the European region, 1990-2019

Abstract Background Within the Western Balkan Strategic Partnership Project (Work Package 4: Use of Population Health Metrics for Enhanced Surveillance), we conducted a study to describe health progress in 19 former socialist economies (FSEs) in Europe from 1990 to 2019. Our metric of choice was age and sex-standardized rates per 100,000 population of total disability-adjusted life years (ASR-DALY). Methods We applied joinpoint regression with extracted ASR-DALY data from the Institute for Health Metrics and Evaluation result tool. The annual per cent change (APC) and average annual per cent change (AAPC) from 1990 to 2019 were analyzed in 19 former socialist economies (FSEs) in Europe, including Albania, Belarus, Bosnia and Herzegovina (BH), Bulgaria, Croatia, Czechia, Estonia, Latvia, Lithuania, Montenegro, North Macedonia, Poland, Moldova, Romania, Russia, Serbia, Slovakia, Slovenia, and Ukraine. Results The ASR-DALY decreased in Estonia (APC1994-1997= -5.2%, p = 0.034; APC2013-2019= -0.7%, p = 0.07), Latvia (APC1994-1997= -6.3%, p = 0.03; APC1997-2007= -1%, p = 0.001; APC2007-2011= -3.9%, p = 0.01), BH (APC1995-1998= -13.3%, p = 0.041; APC1998-2019= -0.5%, p = 0.004), Bulgaria (APC1997-2000= -2.5%, p = 0.022), Lithuania (APC2007-2010= -4.9%, p = 0.018), North Macedonia (APC2007-2011= -1.9%, p = 0.023, APC2011-2019= -0.5%, p = 0.005), Czechia (APC2014-2019= -0.6%, p = 0.014), Moldavia (APC1998-2007= -0.6%, p = 0.06), and Ukraine (APC1995-2008= -0.5%, p = 0.035). Slovenia performed the best amongst the FSEs (ASR-DALY2019: 16677.51 for women, 21985.95 for men and 19134.73 for both sexes), Ukraine the worst (ASR-DALY2019: 26154.88 for women, 47983.60 for men and 35852.17 for both sexes). Conclusions Except for Ukraine, all FSEs in the European region achieved health improvement. The most common was a three-year decline in ASR-DALY. Health policy changes, investments in health care, and harmonization with EU regulations were among the factors contributing to improved population health in the FSEs. Key messages • Bosnia and Herzegovina is the only FSE in Europe with a continuous 24-year decline in total ASR-DALY. • Reducing total ASR-DALY significantly in a three-year time frame is possible.