The BURDEN 2020 Project - The Burden of Disease in Germany and its Regions

The research project, under the leadership of the Robert Koch Institute (RKI), was funded in order to develop, for the first time, a national Burden of Disease study for Germany. The Federal Environment Agency (UBA) and the Scientific Institute of the AOK (WIdO) were key cooperation partners in the project.

Demographic changes present challenges for the German health care system. Regional aspects as well as the aging of the population and therefore increasing care needs are important aspects that should be considered when planning measures. This requires a robust database, in order to comprehensively and comparably map the Burden of Disease across socio-demographic groups at national and regional levels. The BURDEN 2020 project addressed this knowledge gap by developing an approach to calculate the Burden of Disease in Germany using indicators which summarize health losses due to both morbidity (Years lived with disability, YLD) and mortality (Years of life lost, YLL). This population-related information on morbidity and mortality is combined in the indicator DALY (Disability-adjusted life years), representing the overall burden for a disease or group of diseases.

With regard to mortality, the pilot project considered all ICD-10-causes of death. With regard to health losses due to morbidity, this was initially limited to a selection of the most common and important diseases and injuries in Germany, such as cardiovascular diseases or cancer. The data analyses were based on existing primary and secondary data, supplemented by additional surveys. In addition to causes of death and diseases, risk factors were also taken into account in order to identify prevention and treatment needs. The resulting information system is intended to support decision-makers in politics and the healthcare system in demand-oriented, expedient and economic planning.

The methods for calculating Burden of Disease relied on the methodology used in the Global Burden of Disease (GBD) study. The GBD study is conducted by the Institute for Health Metrics and Evaluation (IHME). In comparison to previous GBD analyses, the analyses within the framework of the BURDEN 2020 project were based on a much broader and improved data basis for Germany; the methods were adapted for the purposes of a national Burden of Disease study.

With this website (, a general information platform was created for the first time in November 2022 to introduce the topic of burden of disease calculations at the RKI. Interested parties can also find information with a focus on prevalence on the information platform of the WIdO

Duration: April 2018 – June 2021

Client/Funding: Funding of the research project by the Innovation Fund at the Federal Joint Committee (G-BA), funding code: 01VSF17007.

Cooperation partners: Scientific Institute of the AOK (WIdO), Federal Environmental Agency (UBA)

International networking: BURDEN 2020 is part of the European Burden of Disease Network der WHO Europe (EBoDN) and within the COST Action Burden-EU (CA18218) and cooperates with the following organizations:

The project is accompanied by a scientific advisory board: Prof. Dr. Hajo Zeeb (chair); Prof. Dr. Gabriele Doblhammer (vice chair); Prof. Dr. Reinhard Busse; Conrad Franke; Henk Hilderink, PhD; Prof. Dr. Tobia Lakes; Dr. Odile Mekel; Prof. Dr. Ralf Münnich; Prof. Dr. Annette Peters; Dr. Enno Swart; Prof. Dr. Susanne Wurm

Collaborators of the project

Robert Koch Institute

Dr. Aline Anton (project coordination); Tim Fleckenstein (website and visualization); Janko Leddin (data managemen); Dr. Elena von der Lippe (methodological management); Michael Porst (morbidity analyses, modeling); Dr. Alexander Rommel (project management); Dr. Annelene Wengler (mortality analyses, modeling); Dr. Thomas Ziese (project management)

Federal Environmental Agency

Heike Gruhl (environment-related risk analyses); Dr. Dietrich Plaß (project management UBA)

Wissenschaftliches Institut der AOK (WIdO)

Dr. Jan Breitkreuz (secondary data analyses); Dr. Katrin Schüssel (secondary data analyses); Gabriela Brückner (secondary data analyses); Helmut Schröder (project management WIdO WIdO)

Data sources Mortality

Causes of death: Official cause of death statistics Destatis for 2017, own calculations after redistribution of non-informative ICD-10 codes
Life expectancy: own calculations based on mortality tables 2016-2018, Destatis
Population: average of populations at year-end 2016 and 2017, by age groups and counties (aggregated to spatial planning regions), Destatis

Data Sources Morbidity

Interview and survey data:
Epidemiological Survey on Addiction 2018
RKI survey data 2019/2020 on pain disorders (headache, back pain and neck pain) Please contact us directly for this and see publications
Health insurance routing data: AOK routine data 2017
Road accident statistics 2017
GBD Study: Disability weights, severity and average duration of a disease for some of the selected diseases - see table YLD-DALY-publication