Cardiovascular disease in Europe 2016: an epidemiological update.

In this, the fourth in a series of papers describing the epidemiology of cardiovascular disease (CVD) in Europe, we present new data on the mortality, morbidity, and treatment of CVD across the continent. In previous publications, we have described inequalities in CVD burden across Europe, particularly in the form of higher age standardized deaths rates (ASDRs), in Eastern European countries. In this article, we also consider countries of the European Union (EU), with a lesser burden from CVD found in the EU-15 countries (those in the EU prior to the accession of ten candidate countries on the 1st of May) than in EU-28 countries (the 13 additional countries which have subsequently joined the EU) and non-EU countries. Of all the deaths registered in EU-15 countries, 33% were caused by CVD, this compares with 38% of total deaths in EU-28 countries and 54% of deaths in non-EU member countries. In addition, although non-EU countries include Switzerland, Norway, and Israel, in which ASDRs for CVD are traditionally low, the highest ASDRs within Europe are found in countries which are not in the EU. When categorized by EU membership, the lowest rate for any one country, as well as the narrowest range in ASDRs, were both found amongst EU-15 countries. With 10 of the 15 EU-15 countries now suffering a greater number of deaths from cancer than CVD in men, accounting for all bar 2 of the countries in which this has happened, it is clear that these countries are more likely to make the transition from CVD to cancer as the most common cause of death. Most likely due to the large decreases in CVD mortality in preceding decades (Figure 1). Such inequalities are not only found for mortality. Within the article, we present new statistics on Disability Adjusted Life-Years (DALYs) for CVD in European countries which demonstrate a similar pattern to ASDRs. DALYs are a composite measure of years of life lost due to death from a condition and years lived with disability due to a condition, with one DALY being the equivalent to one year of healthy life lost. By combining mortality and morbidity into a single common metric, DALYs enable us to estimate the total burden imposed by a condition by considering both those living with the disease and those dying from it. DALYs calculated for the World Health Organization (WHO), using estimates that draw on the methods used by the Global Burden of Disease project, once again point to a greater burden of CVD in Eastern European and non-EU countries (Figure 2). Differences are not so stark, however, when we consider crude rates in hospital discharges for CVD, a measure of the number of patients who leave hospital after receiving care. Hospital discharge data provide an indication of the burden of CVD on health services within European countries and differences between countries in discharge rate may in part be a reflection of health service access and efficiency. With hospital admission and discharge rates influenced by not only the quality of care provided in hospitals but also differences in hospital transfers, average length of hospital stay and severity of