WhiteBook2_Part1 - 179

Discussion
digestive cancers apart from stomach cancer. Furthermore, estimated age-standardised
incidence and mortality rates have increased for liver and pancreatic cancers for most
member countries since the year 2000.
Colon and rectum cancers account for a large share of all DALYs due to digestive cancers
amongst the member countries, and whilst age-standardised DALY rates have decreased
within some countries, others have experienced increases over time. The availability and
uptake of colorectal cancer screening programmes have been suggested as key drivers of
diverging trends in the burden of this cancer in Europe.130 Since the year 2000, age-specific
incidence rates have increased amongst those aged 25-39 years for the UEG member
countries combined, and increasing incidence among young adults has been observed by
other studies.131 Explanations for this trend are unknown but likely include changes in the
prevalence of modifiable risk factors.131 132
We observed several changes in the proportion of digestive disorder burden attributable to
different risk factors amongst the member countries over time. The biggest change is the
reduction in smoking attributable burden, alongside increases in digestive disorder burden
attributable to high BMI. The contribution of drug use to the burden of cirrhosis due to viral
hepatitis has also increased since the year 2000 within most UEG member countries. Whilst
some progress has been made to reduce alcohol attributable burden since the year 2000,
alcohol use remains a major contributor to disease burden.
As observed by the previous White Book, there appear to be geographical variations in the
burden of digestive diseases between Eastern and Western Europe. Estimated agestandardised
DALY rates for several diseases, including chronic liver diseases, pancreatitis,
peptic ulcer disease, gastritis and duodenitis, appendicitis, inguinal, femoral, and abdominal
hernia and vascular intestinal disorders tend to be higher amongst UEG member countries
within Central and Eastern Europe compared to Western and Southern Europe. Gaps in life
expectancy and other health-related measures between Eastern and Western Europe have
persisted over time and whilst explanations are complex, consequences of the vast
economic, political and social changes that have occurred within Central and Eastern Europe
have likely contributed to the health divide, as well as variations in health policies and
cultural factors which may also play a role.133 134 135 A key factor highlighted in this report is
that population-level social and economic differences between countries explain much of the
differences in digestive disease burden, with more disadvantaged countries, as measured by
the Human Development Index, experiencing a greater burden of digestive diseases. There
are however digestive diseases, most notably inflammatory bowel disease, that tend to be
more common in more affluent countries.
White Book 2: Part 1
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