The Burden of Disease Study for Germany: estimating disease burden at the national and regional level

Abstract The 1st German Burden of Disease (BoD) Study (2018-2021) piloted comprehensive BoD indicators for the reference year 2017, largely following the GBD study methodology, but with the gradual introduction of specific innovations. The study is currently being extended and updated for the years 2017-2022. The Robert Koch Institute, Germany's national public health institute, attaches great importance to epidemiologically reliable estimates of the BoD for the 96 German spatial planning regions. In addition to cause-of-death statistics, the study primarily uses claims data from Germany's largest statutory health insurer, covering approximately 27 million people. This data is extrapolated to the total population and disaggregated at the subnational level. Consequently, in addition to the standard BoD indicators, deaths and prevalence rates are now available for diseases for which reliable, regular subnational estimates have not been available until now, despite their high demand by national stakeholders. The subnational focus also presents an opportunity to enhance the available information by linking regional results with subnational data on concepts such as social deprivation and avoidable BoD. Methodological innovations include approaches for small-area estimation of the prevalence of diseases for which direct estimates are only available at the national level. This applies in instances where prevalence is more accurately measured by surveys than by claims data, as is the case with conditions such as pain disorders and addictions. Additionally, a novel approach to multimorbidity adjustment, grounded in correlation matrices, will be introduced. The available information system (https://www.daly.rki.de) has proven to be an essential tool for identifying the main causes of ill health. A relaunch is currently being prepared, and by the time it is implemented, the German BoD Study will be integrated into the information system of the German Federal Public Health Reporting.