Pre-pandemic sub-national disparities in the disease burden of ischemic heart disease and stroke in France

BACKGROUND: Ischemic heart disease (IHD) and stroke are the leading causes of mortality and morbidity worldwide. Disability-adjusted life years (DALYs) are one of the most commonly used health gap summary measures in public health and have become an important metric for quantifying disease burdens. The main objectives of this study were to quantify the disease burden of IHD and stroke for sub-national regions of France in 2017 and to assess the relationship between social deprivation score of FDep (French Deprivation Index) and age-standardized DALY rates (ASDRs) for these diseases. METHODS: We used national databases to capture mortality and morbidity data for IHD and stroke: the Center for Epidemiology on Medical Causes of Deaths (INSERM-CépiDc) and the French National Health Data system (SNDS). We applied disability weights and severity proportions retrieved from GBD (Global Burden of Disease) 2019 study to calculate the years lived with disability (YLD). DALYs estimates were calculated by combining the years of life lost due to premature mortality (YLL) and YLD for sub-national regions. RESULTS: In 2017, the age-standardized DALY rates per 100 000 population were: 1191 (95% UI: 967-1432) for IHD and 962 (95% UI: 773-1147) for stroke. DALY rates were lower for females than males (615 [95%UI: 494-731] vs. 1908 [95%UI: 1554-2277] for IHD, (807 [95%UI: 654-962] vs. 1149 [95%UI: 907-1362] for stroke, respectively). There were disparities in the disease burden according to the age distribution and sex. The mortality component contributed significantly more to the overall DALYs than the ill-health component, accounting for 85% for IHD and 76% stroke, regardless of sex. Sub-national disparities in DALYs were also evident, with lower rates observed in metropolitan regions than French overseas territories. CONCLUSIONS: These findings underscore the critical importance of disease burden due to IHD and stroke in France at sub-national level in 2017, providing valuable insights to inform health policy decisions. Future research should incorporate comorbidities, take into account the contribution of various risk factors and investigate socioeconomic determinants of health to better understand subnational disparities in these diseases.