The epidemiological burden and societal cost of 14 respiratory conditions in the World Health Organization European region: systematic evidence map and economic analysis

Introduction: Our systematic evidence map aimed to identify lung-related epidemiological estimates to populate the International Respiratory Coalition's Lung Facts website. We highlight important evidence gaps, suggest how they could be filled, and provide bespoke societal cost estimates to inform resource allocation. Methods: We examined 14 lung conditions across 53 World Health Organization Europe countries, seeking incidence, prevalence, mortality, years of life lost, years lived with disability, and disability-adjusted life year (DALY) estimates by age/sex. Global Burden of Disease (GBD) study estimates were obtained for nine GBD-included lung conditions: asthma, COPD, interstitial lung disease and pulmonary sarcoidosis, lower respiratory infections, lung cancer/tracheal, bronchus and lung cancer, tuberculosis, mesothelioma, COVID-19 and pulmonary arterial hypertension. Systematic searches of bibliographic databases were necessary for five non-GBD-included lung conditions: cystic fibrosis, obstructive sleep apnoea (OSA), influenza, alpha-1 antitrypsin deficiency (A1AD) and bronchiectasis. All-age country-specific DALY estimates were multiplied by gross domestic product per capita as a proxy for a country's wealth and prosperity to estimate societal costs. Results: Complete data for nine lung conditions for all countries were extracted from GBD, enabling societal cost estimation. Significant gaps were found for A1AD (only prevalence for 24 countries) and bronchiectasis (incidence, prevalence and mortality for between one and five countries), with more, but incomplete, estimates for cystic fibrosis, OSA and influenza. Conclusions: More epidemiological evidence is required for A1AD, bronchiectasis, cystic fibrosis, OSA, and influenza. Inclusion in the GDB study could help address these gaps. Lung Facts provides comprehensive lung-related epidemiological and societal cost estimates covering 53 countries to support policy-makers advocating for respiratory interventions.