Future Dutch DALYs as part of the Dutch Public health Foresight Study

The Dutch Public Health Foresight Study (PHFS) provides insight into the most important societal challenges for public health and health care in the Netherlands. An important element of this study are the Burden of Disease indicators, among which the Disability-Adjusted Life Year (DALY). In the last editions of the PHFS future DALYs are also included. The methodology applied to obtain future projections varies. For around 100 diseases and health conditions, projections are obtained from demographic and epidemiological projections. For the projections of causes of death, a Poisson regression technique is used, based on historical data from 1996 onwards. These projections are made consistent with the population projections from the Nacional Statistical Office. The life tables from these population projections for the projection period till 2050 are also used to calculate the Years of Life Lost. Next, projections of a set of health determinants are used to allocate the future DALYs to the risk factors, making used of population attributable fractions. The results show an enormous increase in the burden of disease due to dementia. Where dementia ranked 10th in 2015, in the future this will be by far the major cause of the burden of disease - because of an increase in prevalence, but also because an increase as cause of death, partly due to further progress in survival from cardiovascular diseases and cancer. Arthrosis will also be gaining importance - due to the ageing of the population in combination with increasing overweight. Smoking and dietary risks will be among the main risks factors for the future burden. The projections of DALYs for the Dutch PHFS show a strong increase in disease that progress with age, such as dementia. These are partly due to successes in survival from other diseases. Policy makers should be prepared for these future development, and at the same time invest in prevention to reduce future disease burden of for example cancer and arthrosis.