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

Our plain-English summary of The epidemiological burden and societal cost of 14 respiratory conditions in the World Health Organization European region: systematic evidence map and economic analysis, by S. Harnan, M. Franklin, C. Angus, et al (ERJ Open Research, 2026).

The study

• Authors: S. Harnan, M. Franklin, C. Angus, J.B. Soriano, A. Johannessen, A. Sutton, J. Garcia-Aymerich, A. Auer, C. Carroll, E. Simpson, P. Powell, L. Anderson, G. Joos
• Journal: ERJ Open Research
• Published: 2026;12(3)
• Cited by: 1 article, as counted by NIH iCite
• Read it: PubMed · Publisher · Free full text

Abstract

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.

Copyright ©The authors 2026.

In plain English

This was a systematic evidence map with an economic analysis, prepared to supply data for the International Respiratory Coalition's Lung Facts website. The authors sought estimates of new and existing cases, deaths and disability-adjusted life years (DALYs) for 14 lung conditions in the 53 World Health Organization European region countries. The work was done in 2022 and updated in 2024. For nine conditions, including mesothelioma, they used Global Burden of Disease study data. For five others they searched the medical literature. The article does not mention asbestos and prints no mesothelioma figures; its example tables cover asthma only. Global Burden of Disease data, including DALYs, were complete. For the other five conditions some measures were missing, and data were sparse for alpha-1 antitrypsin deficiency and bronchiectasis. The authors estimated a 'societal cost' by multiplying DALYs by each country's gross domestic product per person. This is the money value of the health burden, not the cost of care. For asthma, the regional figure was USD 5 813 713 per 100 000 people. The authors concluded that more research is needed on poorly covered conditions.

We wrote this plain-English summary from the full article with the help of AI, and a second AI model checked each sentence against the article. It is not the authors' wording; the abstract and the article are their own account.

What the study did and found

• Design: Systematic evidence map (collation of Global Burden of Disease data plus focused literature searches) with an economic analysis estimating societal costs; carried out in 2022 with a 2024 update
• Who was studied: Published estimates for 14 respiratory conditions in the 53 countries of the WHO European region, for 2010 onwards
• Exposure: No asbestos or other exposure was studied. The article covers 14 lung conditions. Nine came from the Global Burden of Disease study: asthma, COPD, interstitial lung disease and pulmonary sarcoidosis, lower respiratory infections, tracheal, bronchus and lung cancer, tuberculosis, mesothelioma, pulmonary arterial hypertension and COVID-19. Five came from literature searches: cystic fibrosis, obstructive sleep apnoea, influenza, alpha-1 antitrypsin deficiency and bronchiectasis.
• Main results:
  • For the nine conditions covered by the Global Burden of Disease study, complete data were available for all countries, which made the societal cost estimates possible.
  • In the 2022 literature search, 1622 records were identified. Full texts of 129 were obtained, and data were extracted from 16 studies.
  • Alpha-1 antitrypsin deficiency had poor coverage. Its prevalence was based on allele frequency rather than diagnoses.
  • Bronchiectasis data came from only six primary studies covering five countries.
  • For cystic fibrosis and obstructive sleep apnoea, reviews gave cross-country estimates. There were no mortality estimates for either condition and no incidence estimates for obstructive sleep apnoea.
  • The Global Burden of Disease influenza study did not report prevalence, years of life lost or DALYs.
  • Asthma example for the whole WHO European region: an asthma burden of 211.7 (95% CI 148.1 to 288.8) DALYs per 100 000 people corresponded to a societal cost of USD 5 813 713 per 100 000 people (USD 58.14 per person).
  • Austria had a lower asthma DALY burden than Türkiye but a higher GDP per capita (USD 53 777 versus USD 9661). This made Austria's estimated asthma societal cost higher.
  • The authors stated that the societal cost estimates represent the money value of the disease burden (monetised DALYs), not the cost of illness such as healthcare spending.
• The authors' conclusion: The authors concluded that there are evidence gaps for several respiratory conditions. They said researchers, including the Global Burden of Disease study, should extend their scope to alpha-1 antitrypsin deficiency, cystic fibrosis, obstructive sleep apnoea and bronchiectasis.
• Limitations the authors state:
  • The search strategies were focused, so some studies may have been missed.
  • For some conditions only systematic reviews were included, so primary studies published after the most recent review will have been missed.
  • The included studies used different methods, so their estimates may not be interchangeable or comparable with Global Burden of Disease estimates.
  • Valuing DALYs at gross domestic product per person is by design a simplistic, theory-based approach.
  • Data from the 2024 update were not fully extracted with double checking.

Topics

Medical terms in this study, explained in our Lexicon: COPD, Interstitial Lung Disease, Lung Cancer, Bronchus, Mesothelioma, Fibrosis.

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