Years lived with disability total

Rehabilitation aims to optimize functioning and reduce disability in individuals with health conditions in interaction with their environment. It is a cost-effective service that anyone may need at some point in their lives. Universal health coverage and the attainment of the Sustainable Development Goals cannot be achieved without access to quality rehabilitation services without financial hardship.

The 1990–2019 Global Burden of Diseases data from the Institute for Health Metrics and Evaluation based in Seattle, Washington, United States of America, was used to estimate the need for rehabilitation services by presenting the prevalence, and associated years lived with disability, of 25 health conditions – disease causes, impairments and sequelae – that are amenable to rehabilitation at some point in the course of disease. The methods are the same as used in a paper published in 2020 (1).

The 25 health conditions were selected using a three-step approach. First, 20 conditions with the highest number of associated years lived with disability were identified. Second, from the 20 conditions, some were excluded, as rehabilitation is considered not essential and is indicated as a secondary intervention. Third, WHO convened a group of rehabilitation experts to discuss the list of conditions and add any other condition for which rehabilitation is a key intervention. The resulting 25 disease causes, impairments and sequelae are categorized within seven groups of diseases and injuries:

 1. Musculoskeletal disorders: low back pain, neck pain, fractures, other injuries, osteoarthritis, amputation and rheumatoid arthritis

 2. Neurological disorders: cerebral palsy, stroke, traumatic brain injury, Alzheimer’s disease and dementia, spinal cord injury, Parkinson’s disease, multiple sclerosis, motor neuron disease and Guillain-Barré syndrome

 3. Sensory impairments: hearing loss and vision loss

 4. Mental disorders: developmental intellectual disability, schizophrenia and autism spectrum disorders

 5. Chronic respiratory diseases: chronic obstructive pulmonary disease

 6. Cardiovascular diseases: heart failure and acute myocardial infarction

 7. Neoplasms: neoplasms.

Exclusions included mild health states, motor impairment, borderline intellectual disability, mild hearing loss, mild vision loss and minor injuries, assuming people with these conditions would be less likely to require rehabilitation. For cancer, the diagnosis and primary therapy phase of all cancers, as well as colon and rectum cancer with stoma, larynx cancer with laryngectomy and breast cancer with mastectomy, were included (1).

Years lived with disability is a measure of the burden of non-fatal disease and injury; it was calculated by multiplying the prevalence of each condition by the estimated level of health loss in the form of a disability weight. Disability weights range from 0 (i.e., perfect health) to 1 (i.e., death) and represent the severity of the disease. These weights were derived from population surveys using pairwise comparison methods between random pairs of health states. The disability weights were defined, measured and given numerical value to quantify the time lived in non-fatal health states. All Global Burden of Diseases years lived with disability estimates were corrected for comorbidity using simulation methods and assumed a multiplicative model for coexisting health states, to account for the cumulative effect of comorbidities (1).

In the WHO European Region in 2019, 394 million people had a health condition amenable to rehabilitation services during its course. This represents two in five people. Musculoskeletal disorders, sensory impairments and neurological disorders were the most prevalent groups of diseases and injuries. The significant rehabilitation needs in the overall population require strong rehabilitation services.

For more information on this dataset, the wide range and high prevalence of conditions that are amenable to rehabilitation and resources that can support the strengthening of rehabilitation within health systems, please visit: http://www.who.int/europe/health-topics/rehabilitation

For more information on how WHO is assisting Member States in evaluating their existing rehabilitation services, and to expand them to provide accessible and quality rehabilitation programs, please visit: http://www.who.int/europe/health-topics/rehabilitation

1. Cieza A, Causey K, Kamenov K, Hanson SW, Chatterji S, Vos T. Global estimates of the need for rehabilitation based on the Global Burden of Disease study 2019: a systematic analysis for the Global Burden of Disease Study 2019. Lancet. 2021 Dec 19;396(10267):2006-2017. doi: 10.1016/S0140-6736(20)32340-0. Epub 2020 Dec 1.