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In the recent years, the environmental noise is a global issue of great concern. Especially, it is considered to be one of the most deleterious environmental risk factors for the human health and well-being in urban areas. In this study, we focus on the major source of the transportation noise in the modern-day urbanized societies, which is the road traffic noise. The study was performed in the urban complex in Thessaloniki-Neapoli in Greece, and the estimation of the road traffic noise levels was based on the CoRTN (Calculation of Road Traffic Noise) prediction method. In addition, we estimated the EBD (environmental burden of disease), in terms of DALYs (disability-adjusted life years), due to the annoyance and sleep disturbances associated with the exposure to road traffic noise. The estimation of the EBD was based on the strategic noise mapping in Thessaloniki-Neapoli as well as on the guidance document produced by the WHO (World Health Organization) for the quantitative assessment on the humans' health consequences of the environmental noise. Above all, the results revealed the magnitude of the health damage caused by the transportation noise.

Background Type 2 diabetes (T2D) causes substantial disease burden and is projected to affect an increasing number of people in coming decades. This study provides projected estimates of life years free of type 2 diabetes (T2D) and years of life lost ($${\mathrm{YLL}}$$ YLL ) associated with T2D for Germany in the years 2015 and 2040. Methods Based on an illness-death model and the associated mathematical relation between prevalence, incidence and mortality, we projected the prevalence of diagnosed T2D using currently available data on the incidence rate of diagnosed T2D and mortality rates of people with and without diagnosed T2D. Projection of prevalence was achieved by integration of a partial differential equation, which governs the illness-death model. These projected parameters were used as input values to calculate life years free of T2D and $${\mathrm{YLL}}$$ YLL associated with T2D for the German population aged 40 to 100 years in the years 2015 and 2040, while accounting for different assumptions on future trends in T2D incidence and mortality. Results Assuming a constant incidence rate, women and men at age 40 years in 2015 will live approximately 38 years and 33 years free of T2D, respectively. Up to the year 2040, these numbers are projected to increase by 1.0 years and 1.3 years. Assuming a decrease in T2D-associated excess mortality of 2% per year, women and men aged 40 years with T2D in 2015 will be expected to lose 1.6 and 2.7 years of life, respectively, compared to a same aged person without T2D. In 2040, these numbers would reduce by approximately 0.9 years and 1.6 years. This translates to 10.8 million and 6.4 million $${\mathrm{YLL}}$$ YLL in the German population aged 40–100 years with prevalent T2D in 2015 and 2040, respectively. Conclusions Given expected trends in mortality and no increase in T2D incidence, the burden due to premature mortality associated with T2D will decrease on the individual as well as on the population level. In addition, the expected lifetime without T2D is likely to increase. However, these trends strongly depend on future improvements of excess mortality associated with T2D and future incidence of T2D, which should motivate increased efforts of primary and tertiary prevention.

This commentary follows a previous work on women’s life span and age at parity. It raises questions about the relationship between women’s health late in life and age of parity and aims to provide statistical evidence thereof. This study used data at a national level to estimate a panel data for the EU countries for the period 2005–2013. The women’s health was measured by healthy life years after 65, morbidity after 65 and self-perceived health status after 65. The age of parity was captured by mean age of women at birth of first child, mean age of women at childbirth (for the first child and for any other) and percentage of adolescent mothers. There is a positive relationship between the mean age of women at childbirth (both the first child and any other) and the good or very good self-perceived health status reported by women older than 65, while there is a negative relationship between a bad and very bad reported health status. No statistical relation was found between women age of parity and healthy life years and health morbidity for women over 65 years old. The analysis with aggregated data showed that there is a large heterogeneity, which prevents conclusions being drawn about general trends for EU countries. The exception was for self-reported health and age of parity, for which is there was a statistical correlation across EU countries. The results reported here are expected to motivate further research on this topic in order to establish the long-term effects of each age of parity and the optimal age for first birth.

Background In 2005, the European Union (EU) started to use a disability-free life expectancy, known as Healthy Life Years (HLY), to monitor progress in the strategic European policies such as the 2000 Lisbon strategy. HLY are based on the underlying measure: the Global Activity Limitation Indicator (GALI). Twelve years after its implementation, this study aims to assess its current use in EU Member States and the European Commission. Methods In March 2017, a questionnaire was sent to 28 Member states and the European Commission. The questionnaire inquired how the GALI and HLY are used to set policy targets, in which surveys the GALI has been introduced since 2005, how the GALI and HLY are presented, and what the capacity in each country is to investigate the GALI and HLY. Results The survey was answered by 22 Member States and by the Commission. HLY are often used to set targets and develop strategies in health such as national health plans. Analysis of HLY has even led to policy change. In some countries, HLY have become the main indicator for health, gaining more importance than life expectancy. More recently, the GALI and HLY have also been used for policy targets outside the health sector such as in the area of pension and retirement age or in the context of sustainable development. Regarding surveys, the GALI is mostly obtained from the EU-SILC, SHARE and EHIS, but is also increasingly introduced in national surveys. National health reporting systems usually present HLY on their national statistics websites. Most countries have up to three specialists working on the GALI and HLY, which has been consistent through time. Others have increased their capacity over various institutions. Conclusion HLY is an indicator that is systematically used to monitor health developments in most EU countries. The SHARE, EU-SILC and EHIS are commonly used to assess HLY through the GALI. The results are then described in reports and presented on national statistics websites and used in different policy settings. Expertise to analyse the GALI and HLY is available in most countries. Electronic supplementary material The online version of this article (10.1186/s13690-018-0279-z) contains supplementary material, which is available to authorized users.

Hip fractures are one of the most serious conditions in frail elderly subjects, greatly increasing morbidity and mortality, and decreasing healthy life years. Since their first introduction on the market, hip protectors have been revealed to be a potential preventive measure for hip fractures, in addition to other well-known recognized medical interventions and rehabilitation procedures. However, randomized controlled trials have given contradictory results regarding their efficacy. Moreover, little data are available on the cost effectiveness of hip protectors. Adherence is a major problem in assessing the effectiveness of hip protectors in preventing fractures. Indeed, there is a lack of general consensus on a standard definition and quantitative objective estimation of adherence to hip protectors, along with still scarce evidence on specific interventions on how to ameliorate it. From what is known so far, it seems reasonable to advise the use of hip protectors in aged care facilities, since recent pooled analyses have suggested their efficacy in this setting. The introduction of sensors combined with hip protectors will probably address this issue, both for monitoring and optimizing compliance, especially in elderly people. In the meantime, new, well-designed studies following specific guidelines are strongly encouraged and needed. In particular, studies in community-dwelling elderly individuals at high risk of first or further fragility fractures are required. The optimization of the tested devices in a preclinical setting according to international standard biomechanical testing is necessary.

Background The annual burden of disease caused indoor air pollution, including polluted outdoor air used to ventilate indoor spaces, is estimated to correspond to a loss of over 2 million healthy life years in the European Union (EU). Based on measurements of the European Environment Agency (EEA), approximately 90 % of EU citizens live in areas where the World Health Organization (WHO) guidelines for air quality of particulate matter sized

Background Healthy life expectancy (HLE) is an important indicator which combines longevity with health status. This article examines inequalities in HLE by socio-economic position in England, and between Local Authorities (LAs) in the deprived ‘Spearhead group’ and other LAs. Methods Census and vital event data available from the ONS Longitudinal Study were used to calculate estimates of HLE based on general health status for each Registrar General's Social Class (RGSC) in 2001–03, in England as a whole and within the ‘Spearhead group’ and non-Spearhead LAs. Results A predominantly linear relationship was present with HLE increasing with rising social class. The differences observed in HLE at birth and at age 65 between people assigned to the professional and unskilled manual social classes were statistically significant and substantial, demonstrating a clear social inequality in the amount of life, the quality of those years lived, the absolute number of healthy life years, and thus the relative proportion of life spent in ‘Good’ or ‘Fairly Good’ health. HLEs at birth were statistically significantly higher for women than for men in the non-Spearhead LAs for all social classes; however, in the ‘Spearhead group’ of areas higher HLEs in women were only present among the skilled non-manual, skilled manual and partly skilled social classes. This suggests that an interaction effect between sex and area in the level of HLE may be operating. The magnitude of inequality in HLE between professionals and the unskilled manual class in the proportion of life spent in ‘Good’ or ‘Fairly Good’ health also varied between the ‘Spearhead group’ and non-Spearhead LAs: among men, a difference of 6.6 per cent was present in non-Spearhead LAs, compared with 10.6 per cent in the ‘Spearhead group’; among women, the equivalent differences were 5.3 per cent and 7.6 per cent. Conclusions The within-class HLEs for men and women were lower in the ‘Spearhead group’ compared with the non-Spearhead LAs, and statistically significantly lower among the intervening social classes for men; among women they are significant for all social classes other than the professional class. The scale of inequalities shown is important for policy responses and understanding of differences in service needs. List of Tables, 30

Background The Global Activity Limitation Indicator (GALI), the measure underlying the European indicator Healthy Life Years (HLY), is widely used to compare population health across countries. However, the comparability of the item has been questioned. This study aims to further validate the GALI in the adult European population. Methods Data from the European Health Interview Survey (EHIS), covering 14 European countries and 152,787 individuals, were used to explore how the GALI was associated with other measures of disability and whether the GALI was consistent or reflected different disability situations in different countries. Results When considering each country separately or all combined, we found that the GALI was significantly associated with measures of activities of daily living, instrumental activity of daily living, and functional limitations (P

In December 1997, public health units in Ontario received revised mandatory program guidelines from the Ministry of Health in advance of the downloading of public health to municipalities. Public health units face difficult decisions in allocating municipal resources to meet the Province's mandated programs. To set priorities for resource allocation, it is critical to assess need across program areas and to use a common unit in doing so. This paper applies the Healthy Life Years (HeaLYs) method in assessing health need related to the mandatory programs for the population of Wellington and Dufferin counties in Ontario. The HeaLYs method incorporates duration and severity of ill-health, incidence and mortality in calculating years of healthy life lost (YHLL). For Wellington-Dufferin, the leading causes of YHLL were concentrated in the program areas of chronic disease, injury, and substance abuse and included four areas not addressed in the MPG (suicide, depression, dementia, and osteoarthritis).

Background Sustainable development and public health quite strongly correlate, being connected and conditioned by one another. This paper therein attempts to offer a representation of Europe’s current situation of sustainable development in the area of public health. Methods A dataset on sustainable development in the area of public health consisting of 31 European countries (formally proposed by the European Union Commission and EUROSTAT) has been used in this paper in order to evaluate said issue for the countries listed thereof. A statistical method which synthesizes several indicators into one quantitative indicator has also been utilized. Furthermore, the applied method offers the possibility to obtain an optimal set of variables for future studies of the problem, as well as for the possible development of indicators. Results According to the results obtained, Norway and Iceland are the two foremost European countries regarding sustainable development in the area of public health, whereas Romania, Lithuania, and Latvia, some of the European Union’s newest Member States, rank lowest. The results also demonstrate that the most significant variables (more than 80%) in rating countries are found to be “healthy life years at birth, females” (r2 = 0.880), “healthy life years at birth, males” (r2 = 0.864), “death rate due to chronic diseases, males” (r2 = 0.850), and “healthy life years, 65, females” (r2 = 0.844). Conclusions Based on the results of this paper, public health represents a precondition for sustainable development, which should be continuously invested in and improved. After the assessment of the dataset, proposed by EUROSTAT in order to evaluate progress towards the agreed goals of the EU Sustainable Development Strategy (SDS), this paper offers an improved set of variables, which it is hoped, may initiate further studies concerning this problem.

Background The objective of this paper is to provide analytical research that supported the European Commission in setting the global target of additional two healthy life years (HLY) at birth by 2020 in the EU on average, within the European Innovation Partnership on Active and Healthy Ageing (the EIP on AHA). It produces a straightforward analysis of HLY projections that helped the European Commission set a firm, politically sound, target. In order to reach that goal, policy makers need to commit to redefining health priorities and goals and developing and implementing relevant strategies and programmes. Methods The study computes a simple simulation of the HLY at birth based on three demographic scenarios: compression of morbidity, expansion of morbidity and an intermediary scenario, the dynamic equilibrium, given the expected 2.1 year gain in male and 1.6 in female life expectancy (LE) by 2020. Data on HLY and projections of life expectancy were obtained from Eurostat and 2008 was taken as a baseline. For consistency and given data gaps, EU27 average values of HLY were calculated. Results In the EU27 as a whole, the difference between LE and HLY in 2008 was nearly 15 years for men and 20 years for women. The developments of healthy life expectancies across the EU Member States (MSs) are even more diverse that makes it difficult to model any robust EU level trends. Under compression of morbidity, life expectancy and HLY would increase by 2020 on average by 2.1 and 2.0 years for men and by 1.6 and 1.4 years for women respectively. The expected years with disability would remain unchanged while the HLY/LE ratio would improve leading to a 0.5% gain for both genders. Under expansion of morbidity, life expectancy would increase by 2.1 years for men and 1.4 years for women by 2020, while HLY would remain unchanged and the expected years with disability would increase by 2.1 years and 1.6 years in women. This would imply the deterioration of the HLY/LE ratio for both men and women generating a 2.2% and 1.4% loss of health for men and women accordingly. Under dynamic equilibrium, the HLY would increase but to a lesser extent as the rise in life expectancy. The HLY would increase by 1.6 and 1.2 years for men and women respectively. HLY/LE ratio would remain unchanged for both men (+0.1%) and women. The study shows that the first scenario would reduce the HLY gap between the EU MSs by 1.4 years in men and 1.2 years in women, the second would generate no change, while the third one would reduce the gap by 0.9 years in men and increase it by 0.7 years in women. Conclusions The results of the study triggered the political decision of setting the global target of 2 additional HLY for the European Innovation Partnership on Active and Healthy Ageing to be achieved by 2020. It is a ‘grand’ goal but can be achieved. Statistics clearly show that EU countries characterise very different levels of health progress, with a gap of 2 decades and diverging trends. With this in mind, the EU HLY target should be complemented by national HLY targets for men and women, set by MSs.

The present study aimed at developing a standardized heat wave definition to estimate and compare the impact on mortality by gender, age and death causes in Europe during summers 1990-2004 and 2003, separately, accounting for heat wave duration and intensity.Heat waves were defined considering both maximum apparent temperature and minimum temperature and classified by intensity, duration and timing during summer. The effect was estimated as percent increase in daily mortality during heat wave days compared to non heat wave days in people over 65 years. City specific and pooled estimates by gender, age and cause of death were calculated.The effect of heat waves showed great geographical heterogeneity among cities. Considering all years, except 2003, the increase in mortality during heat wave days ranged from + 7.6% in Munich to + 33.6% in Milan. The increase was up to 3-times greater during episodes of long duration and high intensity. Pooled results showed a greater impact in Mediterranean (+ 21.8% for total mortality) than in North Continental (+ 12.4%) cities. The highest effect was observed for respiratory diseases and among women aged 75-84 years. In 2003 the highest impact was observed in cities where heat wave episode was characterized by unusual meteorological conditions.Climate change scenarios indicate that extreme events are expected to increase in the future even in regions where heat waves are not frequent. Considering our results prevention programs should specifically target the elderly, women and those suffering from chronic respiratory disorders, thus reducing the impact on mortality.

Background: Haemophilia is a rare hereditary haemorrhagic disease that requires regular intravenous injections of clotting factor (CF) concentrates. This study sought to estimate the health and economic burden of haemophilia in Belgium. This is the first study of its type to be conducted, and reflects the Belgian authorities' growing interest for haemophilia as part of their priority planning for rare and chronic diseases. Methods: A probabilistic model was developed in order to estimate the lifetime haemophilia burden for the 2011 birth-year Belgian cohort. The health burden was initially expressed in terms of disability-adjusted life years (DALYs), the number of healthy life years lost due to living with disability and dying prematurely. An incidence perspective was used in line with World Health Organization recommendations. The economic burden calculated from direct and indirect haemophilia-related costs was expressed in euros. Data were drawn from the literature if none were available from federal institutions or health insurance. Disability weights for DALY calculation were derived using generic quality-of-life tools such as SF-6D from the SF-36 (36-item Short-Form Health Survey; for adults) and KINDL (generic quality-of-life instrument; for children) compared to population norms. Analyses were stratified according to haemophilia type and severity. Results: In Belgium, haemophilia resulted in 145 undiscounted and unweighted DALYs in total (95% credible interval [CrI] = 90-222), which represents an average of 11 DALYs per incident case with haemophilia (95% CrI = 8-15) during his life, varying according to haemophilia severity (17 DALYs for severe haemophilia, 12 DALYs for moderate, and 4 DALYs for mild). Mean total lifetime costs reached (sic)7.8 million per people with haemophilia, 94.3% being direct costs and 5.7% indirect costs. Clotting factors accounted for 82.5% of direct costs. Conclusions: Haemophilia represents both an economic and health burden, especially regarding individual health on an individual patient level. Initiatives to counteract this burden should be clearly identified and given full support, as this burden is likely to increase in the future, especially from an economic perspective. Our study may also contribute towards a better global evaluation of haemophilia in the future.