Definition

The indicator years lived with disability is defined as the number of years of life lost due to disability (YLD) as a result of diabetes in the overall population. The indicator is calculated from information concerning the prevalence of diabetes in the general population, the severity distribution in the diseased population and the severity-specific weights for the extent of disability (disability weights). The severity distribution is based on the frequency of complications associated with diabetes, such as diabetic neuropathy, diabetic foot syndrome or severe visual impairments. The larger the disability due to a secondary disease, the higher is the disability weight and the more years lived with disability are considered by the indicator‎ (Murray et al. 2002).

Reference population

Resident population in Germany.

Data sources

The data are based on the national burden of disease study BURDEN 2020 – Burden of disease in Germany at the national and regional level (Rommel et al. 2018).‎ The calculation of prevalence and severity distribution was based on the claims data of the Scientific Institute of the AOK (WIdO). The prevalence was extrapolated from the persons insured by AOK to the overall population using the DRG statistics (Breitkreuz et al. 2019).‎ The disability weights from the Global Burden of Disease study were applied (James et al. 2018).

Calculation

The calculation of the indicator involves multiple steps: (1) Estimation of the prevalence and/or prevalent cases, (2) estimation of the severity distribution (secondary diseases), (3) application of the severity-specific disability weights, (4) estimation of the YLD and (5) adjustment for multi-morbidity. The YLD are calculated as the product of the number of prevalent cases multiplied by a disability weight averaged across degrees of severity. This calculation is done separately by age and sex and can be added up into total values.

Data quality

The burden of disease study BURDEN 2020 yields results on selected YLD in Germany (Rommel et al. 2018)‎. BURDEN 2020 utilises the claims data of the AOK for estimation of the prevalence of diabetes.‎ The prevalence depends on the selection and combination of the applied criteria (Breitkreuz et al. 2021).‎ Claims data in public health may be limited by aspects of invoicing. Moreover, the cohort of persons insured by AOK does not reflect a representative cross-section of the population. ‎This aspect was addressed through a morbidity-adjusted extrapolation (Breitkreuz et al. 2019).