Burden of disease attributable to risk factors in European countries: a scoping literature review

Vanessa Gorasso*, Joana Nazaré Morgado, Periklis Charalampous, Sara M. Pires, Juanita A. Haagsma, João Vasco Santos, Jane Idavain, Che Henry Ngwa, Isabel Noguer, Alicia Padron-Monedero, Rodrigo Sarmiento, Vera Pinheiro, Elena Von der Lippe, Lea Sletting Jakobsen, Brecht Devleesschauwer, Dietrich Plass, The COST Action CA18218 participants

*Corresponding author for this work

Research output: Contribution to journalReview articlepeer-review

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Objectives: Within the framework of the burden of disease (BoD) approach, disease and injury burden estimates attributable to risk factors are a useful guide for policy formulation and priority setting in disease prevention. Considering the important differences in methods, and their impact on burden estimates, we conducted a scoping literature review to: (1) map the BoD assessments including risk factors performed across Europe; and (2) identify the methodological choices in comparative risk assessment (CRA) and risk assessment methods. Methods: We searched multiple literature databases, including grey literature websites and targeted public health agencies websites. Results: A total of 113 studies were included in the synthesis and further divided into independent BoD assessments (54 studies) and studies linked to the Global Burden of Disease (59 papers). Our results showed that the methods used to perform CRA varied substantially across independent European BoD studies. While there were some methodological choices that were more common than others, we did not observe patterns in terms of country, year or risk factor. Each methodological choice can affect the comparability of estimates between and within countries and/or risk factors, since they might significantly influence the quantification of the attributable burden. From our analysis we observed that the use of CRA was less common for some types of risk factors and outcomes. These included environmental and occupational risk factors, which are more likely to use bottom-up approaches for health outcomes where disease envelopes may not be available. Conclusions: Our review also highlighted misreporting, the lack of uncertainty analysis and the under-investigation of causal relationships in BoD studies. Development and use of guidelines for performing and reporting BoD studies will help understand differences, avoid misinterpretations thus improving comparability among estimates. Registration: The study protocol has been registered on PROSPERO, CRD42020177477 (available at: https://www.crd.york.ac.uk/PROSPERO/).

Original languageEnglish
Article number116
JournalArchives of Public Health
Issue number1
Publication statusPublished - 25 Jun 2023


  • burden of disease
  • comparative risk assessment
  • risk factors

ASJC Scopus subject areas

  • Public Health, Environmental and Occupational Health


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