Burden of disease of NCDs, in Cyprus in 2017
In Cyprus in 2017, the total burden of disease was 18,287 DALYs (15,607 to 21,322 95%UI) per 100,000 of which 83% (15,129 DALYs per 100,000; 12,809 to 17,707 95%UI) were due to NCDs.
The top three Level 2 causes of NCDs in Cyprus in terms of DALYs were CVDs, neoplasms, and musculoskeletal disorders. CVDs accounted for 16.5% (2,497 DALYs per 100,000; 2,276 to 2,729 95%UI), neoplasms for 16.3% (2,469 DALYs per 100,000; 2,277 to 2,681 95%UI), and musculoskeletal conditions for 15.6% (2,365 DALYs per 100,000; 1,719 to 3,177 95%UI) of NCDs DALYs. Mental disorders and neurological disorders were also major causes of the NCD DALYs in 2017 in Cyprus; mental disorders were responsible for 11.4% of NCD DALYs (1,732 DALYs per 100,000; 1,284 to 2,239 95%UI), and neurological disorders for 9.9% (1,503 DALYs per 100,000; 1,136 to 1,932 95%UI). Together, the afore-mentioned NCD health conditions contributed approximately two-thirds of the NCD DALYs in Cyprus. The leading Level 3 NCD causes due to DALYs were low back pain (9.3%; 1,405 DALYs per 100,000; 1,001 to 1,902 95%UI) and ischemic heart disease (IHD; 9.0%; 1,376 DALYs per 100,000; 1,241 to 1,538 95%UI). Headache disorders were responsible for 6.0% (909 DALYs per 100,000; 600.4 to 1,294 95%UI) and 5% of total NCD DALYs was due to diabetes (756 DALYs per 100,000; 601.8 to 943.7 95%UI).
In 2017, YLLs were responsible for 42% of the NCD DALYs (6345 YLLs per 100,000; 5,892 to 6,856 95%UI). The leading Level 2 causes of NCD YLLs were neoplasms (36.7%; 2,327 YLLs per 100,000; 2,150 to 2,523 95%UI) and CVDs (34.2%; 2,171 YLLs per 100,000; 1,981 to 2,389 95%UI). 7.2% of the fatal NCD burden came from diabetes and CKD (460.2 YLLs per 100,000; 417.4 to 505.6 95%UI), and 6.2% from neurological disorders (391.8 YLLs per 100,000; 362.2 to 423.6 95%UI). The leading Level 3 causes of NCD YLLs were IHD (20.7%; 1,314 YLLs per 100,000; 1,187 to 1,475 95%UI), lung cancer (7.3%, 461.2 YLLs per 100,000; 412.4 to 515.5 95%UI) and stroke (6.4%; 406.6 YLLs per 100,000; 368.1 to 456.6 95%UI).
YLDs were responsible for 58% of the overall NCD DALYs (8,785 YLDs per 100,000; 6,592 to 11,303 95%UI). The leading Level 2 causes of NCD YLDs were musculoskeletal disorders (26.6%; 2,337 YLDs per 100,000; 1,692 to 3,152 95%UI), mental disorders (19.7%; 1,732 YLDs per 100,000; 1,283 to 2,239 95%UI) and neurological disorders (12.6%; 1,111 YLDs per 100,000; 748 to 1,543 95%UI). Meanwhile, the leading Level 3 causes of NCD YLDs were low back pain (1,405 YLDs per 100,000; 1,001 to 1,902 95%UI) and headache disorders (909 YLDs per 100,000; 600.4 to 1,294 95%UI), contributing 16.0% and 10.3% to the total NCD YLDs, respectively. Other NCD-groups that contributed a notable amount to the non-fatal NCD burden were depressive disorders (5.5%; 482.2 YLDs per 100,000; 342.6 to 658.9 95%UI) and anxiety disorders (5.4%; 472.3 YLDs per 100,000; 335.9 to 628.4 95%UI). Table 1 shows the rankings for the top five Level 2 and Level 3 NCDs that contributed most to the NCD YLLs, YLDs, and DALYs in Cyprus in 2017.
Table 1
The contribution of the top five Level 2 and Level 3 causes of NCD to NCD YLL, YLD and DALY in Cyprus in 2017
Rank
|
Level 2
NCD
|
DALY NCD
(%)
|
Level 2
NCD
|
YLL NCD
(%)
|
Level 2
NCD
|
YLD NCD
(%)
|
1
|
CVDs
|
16.5%
|
Neoplasms
|
36.7%
|
Musculoskeletal disorders
|
26.6%
|
2
|
Neoplasms
|
16.3%
|
CVDs
|
34.2%
|
Mental disorders
|
19.7%
|
3
|
Musculoskeletal disorders
|
15.6%
|
Diabetes and CKD
|
7.6%
|
Neurological disorders
|
12.6%
|
4
|
Mental disorders
|
11.4%
|
Neurological disorders
|
6.2%
|
Skin diseases
|
7.2%
|
5
|
Neurological disorders
|
9.9%
|
Chronic respiratory diseases
|
4.9%
|
Other NCDs
|
6.8%
|
Rank
|
Level 3
NCD
|
DALY NCD
(%)
|
Level 3
NCD
|
YLL NCD
(%)
|
Level 3
NCD
|
YLD NCD
(%)
|
1
|
Low back pain
|
9.3%
|
IHD
|
20.7%
|
Low-back pain
|
16.0%
|
2
|
IHD
|
9.0%
|
Lung cancer
|
7.3%
|
Headache disorders
|
10.3%
|
3
|
Headache disorders
|
6.0%
|
Stroke
|
6.4%
|
Depressive disorders
|
5.5.%
|
4
|
Diabetes
|
5.0%
|
Diabetes
|
4.5%
|
Neck pain
|
5.5%
|
5
|
Stroke
|
3.5%
|
Alzheimer’s disease
|
3.9%
|
Anxiety disorders
|
5.4%
|
CKD: chronic kidney disease; CVDs: cardiovascular diseases; DALY: disability-adjusted life years; IHD: ischemic heart disease; NCD: non-communicable disease; YLL: years of life lost; YLD: years lived with disability
|
Changes in NCD DALY rates in Cyprus, 1990–2017
Table 2 shows the age-standardized YLL, YLD, DALY rates and percentage change for Level 2 NCD-group, in Cyprus between 1990 and 2017. In the period 1990 to 2017 NCD DALY rates in Cyprus decreased from 19,608 DALYs per 100,000 (17,362 to 22,248 95%UI) in 1990 to 15,129 DALYs per 100,000 (12,809 to 17,707 95%UI) in 2017, representing a 23% decrease over the 28-year study period. Time trends by cause of NCD varied considerably. Overall, CVDs and neoplasms had the highest DALY rates over the 28-year study period. However, between 1999 and 2017 the CVDs DALY rate decreased steeply, whereas more gradual decreases in DALY rates were observed for neoplasms, neurological disorders, diabetes and kidney diseases, other non-communicable diseases and chronic respiratory diseases were observed. Figure 1 represents how NCDs DALY rates has changed over the period from 1990 to 2017 in Cyprus; the figure is given as age-standardized DALYs per 100,000.
Age-standardized DALY rates of Level 2 NCDs per 100,000 in Cyprus from 1990 to 2017
Age-standardized NCD DALY rates for males decreased significantly, from 21,012 DALYs (18,937 to 23,505 95%UI) in 1990 to 16,627 DALYs per 100,000 (14,358 to 19,159 95%UI) in 2017, a decrease of 20.9% (-4,385 DALYs per 100,000). Largest decreases in NCD DALY rates were observed for CVDs (-2,814 DALYs per 100,000), of which IHD (-1,944 DALYs per 100,000) and stroke (-615 DALYs per 100,000) ranked among the most significant causes of decreases in DALY rates. Congenital birth defects (-580 DALYs per 100,000), chronic obstructive pulmonary disease (COPD; -192 DALYs per 100,00) and diabetes (-124 DALYs of 100,000) also showed large decreases in DALY rates over the period from 1990 to 2017. On the other hand, DALYs associated with pancreatic cancer (+ 55 DALYs per 100,00), drug use disorders (+ 53 DALYs per 100,000), acne vulgaris (+ 31 DALYs per 100,000), and kidney cancer (+ 26 DALYs per 100,000) increased from 1990 to 2017.
For Cypriot females age-standardized NCD DALY rates declined from 18,527 DALYs (16,049 to 21,367 95%UI) in 1990 to 13,923 DALYs per 100,000 (11,453 to 16,802 95%UI) in 2017, reflecting a decline of 24.8% (-4,604 DALYs per 100,000). The leading causes of the decrease in NCD DALY rates in females, were IHD (-1,150 DALYs per 100,000), stroke (-657 DALYs per 100,000), and diabetes mellitus (-342 DALYs per 100,000). An increase in age-standardized DALY rates were observed for acne vulgaris (+ 42 DALYs per 100,000), psoriasis (+ 28 DALYs per 100,000), and eating disorders (+ 25 DALYs per 100,000) increased over the period of 1990–2017.
Changes in NCD YLL rates in Cyprus, 1990–2017
In 1990, YLLs due to NCDs constituted 55% (10,793 YLLs per 100,000; 10,484 to 11,096 95%UI) of the overall NCD DALYs (19,608 DALYs per 100,000; 17,362 to 22,248 95%UI), whereas in 2017 they accounted for 42% (6,345 YLLs per 100,000; 10,793 to 11,096 95%UI) of the overall NCD burden (15,129 DALYs per 100,000; 12,809 to 17,707 95%UI) (Table 2).
For males age-standardized NCD YLL rates declined from 13,088 YLLs (12,629 to 15,539 95%UI) in 1990 to 8,610 YLLs per 100,000 (7,747 to 9,546 95%UI) in 2017 (-34.2%; -4,478 NCD YLLs per 100,000). Key contributors that led to the NCD YLLs reductions were IHD (-1,913 YLLs), stroke (-606 YLLs per 100,000), congenital birth defects (-578 YLLs per 100,000), and diabetes (-217 YLLs per 100,000). On the other hand, YLL rates associated with pancreatic cancer, drug use disorders, kidney cancer, and liver cancer increased by 55, 40, 25, and 19 YLLs per 100,000 between 1990 and 2017.
For females NCD YLL rates decreased by 50.4%, from 8,812 YLLs (8,520 to 9,104 95%UI) in 1990 to 4,372 YLLs per 100,000 (3,961 to 4,859 95%UI) in 2017. The main contributors to this decrease were IHD (-1,125 YLLs per 100,000), stroke (-646 YLLs per 100,000), congenital birth defects (-472 YLLs per 100,000), and diabetes mellitus (-361 YLLs per 100,000). Over the same period, the DALY rates of lung cancer (+ 19 YLLs per 100,000) and pancreatic cancer (+ 18 YLLs per 100,000) increased.
Changes in NCD YLD rates in Cyprus, 1990–2017
Between 1990 and 2017, the share of NCD YLDs of the total NCD burden increased by 13%. Specifically, in 1990, NCD YLDs were responsible for 45% (8,815 YLDs per 100,000; 6,608 to 11,395 95%UI) of the overall NCD DALYs (19,608 DALYs per 100,000; 17,362 to 22,248 95%UI), while in 2017 NCD YLDs were responsible for 58% (8,785 YLDs per 100,000; 6,592 to 11,303 95%UI) of the overall NCD burden (15,129 DALYs per 100,000; 12,809 to 17,707 95%UI), (Table 2).
Between 1990 and 2017 the NCD YLD rates for Cypriot males increased by 92 YLDs per 100,000. Major contributors to this increase were observed for diabetes (+ 93 YLDs per 100,000) and neoplasms (+ 79 YLDs per 100,000). Notably, within the neoplasms category, the YLD rates of prostate cancer (+ 34 YLDs per 100,000) and colorectal cancer (+ 11 YLDs per 100,000) showed the largest increase. Age-standardized YLD rates of oral disorders (-35 YLDs per 100,000), IHD (-31 YLDs per 100,000), and asthma (-23 YLDs per 100,000) showed the largest decreases in YLD rates.
For females, between 1990 and 2017 the NCD YLD rates decreased by 166 YLDs per 100,000. The largest decreases were observed for oral disorders (-43 YLDs per 100,000), hemoglobinopathies and haemolytic anemias (-33 YLDs per 100,000), gynecological diseases (-28 YLDs per 100,000), and COPD (-25 YLDs per 100,000). The largest increases were seen in the YLD rates of neoplasms (+ 44 YLDs per 100,000), acne vulgaris (+ 42 YLDs per 100,000), psoriasis (+ 27 YLDs per 100,000), eating disorders (+ 25 YLDs per 100,000) and diabetes mellitus (+ 19 YLDs per 100,000), between 1990 and 2017.
Table 2
Age-standardized YLL, YLD, DALY rates and percentage change for Level 2 NCD-group, in Cyprus from 1990 to 2017
|
YLLs
|
YLDs
|
DALYs
|
|
1990 age-standardized rates per
100,000
|
2017 age-standardized rates per
100,000
|
Percentage change
in age-standardized rates per 100,000
|
1990 age-standardized rates per
100,000
|
2017 age-standardized rates per
100,000
|
Percentage change
in age-standardized rates per 100,000
|
1990 age-standardized rates per
100,000
|
2017 age-standardized rates per
100,000
|
Percentage change
in age-standardized rates per 100,000
|
All causes
|
14,614
(14,339 − 14,887)
|
7,904
(7,332–8,540)
|
-45.9%
|
1,0597
(7,972 − 13,641)
|
10,383
(7,841 − 13,374)
|
-2.0%
|
25,211
(22,605 − 28,229)
|
18,287
(15,607 − 21,322)
|
-27.5%
|
Group II: Non-communicable diseases
|
10,793
(10,484 − 11,096)
|
6,345
(5,892–6,856)
|
-41.2%
|
8,815
(6,608 − 11,395)
|
8,785
(6,592 − 11,303)
|
-0.3%
|
19,608
(17,362 − 22,248)
|
15,129
(12,809 − 17,707)
|
-22.8%
|
Cardiovascular diseases
|
4,583
(4,428–4,752)
|
2,171
(1,981- 2,389)
|
-52.6%
|
397.1
(291.5–516.6)
|
326.2
(241–420.6)
|
-17.9%
|
4,980
(4,787–5,183)
|
2,497
(2,276- 2,729)
|
-49.9%
|
Neoplasms
|
2,718
(2,592–2,828)
|
2,327
(2,150- 2,523)
|
-14.4%
|
81.7
(59.8–105.7)
|
142.2
(103.3–189.4)
|
74.1%
|
2,800
(2,673–2,916)
|
2,469
(2,277- 2,681)
|
-11.8%
|
Musculoskeletal disorders
|
41.9
(30.3–51.3)
|
27
(20–32)
|
-34.7%
|
2,337
(1,700–3,151)
|
2,337
(1,692–3,152)
|
0.0%
|
2,379
(1,740–3,187)
|
2,365
(1,719–3,177)
|
-0.6%
|
Mental disorders
|
0.02
(0.01–0.02)
|
0.04
(0.02–0.05)
|
100.0%
|
1,734
(1,290–2,246)
|
1,732
(1,283- 2,239)
|
-0.1%
|
1,734
(1,290–2,246)
|
1,732
(1,284–2,239)
|
-0.1%
|
Neurological disorders
|
543.2
(500.6–578.8)
|
391.8
(362.2–423.6)
|
-27.9%
|
1,117
(761–1,526)
|
1,111
(748–1,543)
|
-0.5%
|
1,660
(1,310–2,072)
|
1,503
(1,136–1,932)
|
-9.4%
|
Diabetes and kidney diseases
|
825.7
(758.4–901.3)
|
460.2
(417.4–505.6)
|
-44.3%
|
494.9
(348.6–680)
|
539.8
(373–734.9)
|
9.1%
|
1,321
(1,156–1,512)
|
1,000
(832–1,206)
|
-24.3%
|
Other non-communicable diseases
|
1,020
(725–1,272)
|
298.5
(262.1–333.6)
|
-70.7%
|
679.6
(466.5–959.7)
|
595.6
(408.8–836.7)
|
-12.4%
|
1,699
(1,314–2,095)
|
894
(706.4–1,133)
|
-47.4%
|
Chronic respiratory diseases
|
519.2
(460.3–576.9)
|
311.2
(276.1–344.2)
|
-40.0%
|
484.5
(374.5–605.4)
|
449.1
(352.8–556.9)
|
-7.3%
|
1,004
(880–1,138)
|
760.7
(659.9–870.2)
|
-24.2%
|
Skin and subcutaneous diseases
|
19.7
(8.9–27.5)
|
17.1
(8.8–21.7)
|
-13.2%
|
564.9
(383.1–809.4)
|
632.3
(433.7–902.8)
|
11.9%
|
584.7
(403.1–825.9)
|
649.4
(449.4–916.9)
|
11.1%
|
Sense organ diseases
|
0
|
0
|
N/A
|
531.5
(359.3–752.3)
|
501.8
(339.8–715.5)
|
-5.6%
|
531.5
(359.3–752.3)
|
501.8
(339.8–715.5)
|
-5.6%
|
Digestive diseases
|
474.1
(380.6–570.6)
|
270.6
(241.7–302.6)
|
-42.9%
|
204.5
(142.3–279.5)
|
217.4
(152–298)
|
6.3%
|
678.7
(557.4–799.7)
|
488
(419.4–576.7)
|
-28.1%
|
Substance use disorders
|
48
(37.9–61.2)
|
69.3
(59–84)
|
44.1%
|
188.1
(131.1–252.3)
|
199.7
(138.3–266.2)
|
6.2%
|
236.2
(178–298.7)
|
268.9
(208.8–333.9)
|
13.9%
|
Data in parentheses are 95% uncertainty intervals (UIs)
A positive percentage change indicates an increase and a negative change a decrease between 1990 and 2017
DALYs: disability-adjusted life years; YLLs: years of life lost; YLDs: years lived with disability
N/A: not applicable
|
Changes in NCD DALY rates in the elderly (70 + years) in Cyprus, 1990–2017
Over the period from 1990 to 2017, the NCD DALY rates in the elderly (70 + years) were higher compared to the age-standardized NCD-related DALYs per 100,000 of other age groups. Major contributors to the NCD DALYs in elderly in 2017 were CVDs, neoplasms, and diabetes and CKD. CVDs accounted for 27.5% (20,890 DALYs per 100,000; 19,253 to 22,783 95%UI), neoplasms for 18% (13,950 DALYs per 100,000; 12,687 to 15,184 95%UI), and diabetes and CKD for 10% (7,761 DALYs per 100,000; 6,808 to 8,847 95%UI) of the total NCD burden. Leading Level 3 causes of NCDs in the elderly in terms of DALYs were IHD (13.5%; 10,296 DALYs per 100,000; 9,384 to 11,649 95%UI) and diabetes (7%; 5,506 DALYs per 100,000; 4,663 to 6,434 95%UI). Stroke was also a major cause in the elderly contributing 7% (5,299 DALYs per 100,000; 4,749 to 5,959 95%UI) to the overall NCD burden.
Between 1990 and 2017 NCD DALY rates in the elderly decreased from 98,331 DALYs per 100,000 (92,636 to 104,594 95%UI) in 1990 to 70,432 DALYs per 100,000 (63,850 to 77,228 95%UI) in 2017, representing a 28% decline. CVDs and neoplasms DALYs showed the largest decline over the 1990–2017 period. The CVD DALY rates decreased sharply (-47.8%) from 40,014 DALYs per 100,000 (38,152 to 42,251 95%UI) in 1990 to 20,890 DALYs per 100,000 (19,253 to 22,783 95%UI) in 2017. A similar pattern was also seen in DALYs due to diabetes; from 11,285 DALYs per 100,000 (9,976 to 12,614 95%UI) in 1990 to 7,761 DALYs per 100,000 (6,808 to 8,847 95%UI) in 2017, representing a decrease of 31%. More gradual decreases in NCD DALY rates among the elderly population were observed for neoplasms, digestive diseases, mental and neurological disorders, chronic respiratory diseases, and other non-communicable diseases. Figure 2 shows the NCD DALY rates in the elderly population over the period from 1990 to 2017.