Expressing disease burden in a single measure allows for the comparison of health loss from different diseases. Such a comparison is important for prioritizing policies and resources to combat (infectious) diseases. A commonly used measure for disease burden is the disability-adjusted life year (DALY). Disease burden in DALYs represents a sum of lost healthy life years due to illness and disability (years lived with disability: YLD) and due to premature death (years of life lost: YLL). Detailed descriptions of the methods used can be found in a previous edition of the State of Infectious Diseases. This webpage presents estimates of DALYs for COVID-19 and influenza. The disease burden of the long-term effects after a SARS-CoV-2 infection, or the 'post-COVID syndrome,' is not included, regardless of whether the person had a mild COVID-19 infection or was hospitalized. A more comprehensive description of these two infectious diseases, and 35 other infectious diseases in the Netherlands, is published in the State of Infectious Diseases 2023 (in Dutch).
COVID-19 highest disease burden, influenza in third place
In 2023, COVID-19 caused the highest disease burden, just as in 2022, with an estimated disease burden of 37,800 DALYs (95% CI 36,400-39,200). However, the number of DALYs due to COVID-19 has more than halved compared to 2022. The disease burden of COVID-19 is caused for 84% by premature death (31,600 DALYs of the total 37,800 DALYs). The total YLD was 6,150 (95% CI: 6,060-6,240) DALYs. When looking at the total disease burden of individuals who did not die, the burden due to mild cases is the largest. The number of DALYs due to COVID-19 was more than three times higher than the number of DALYs due to influenza, with 10,900 DALYs (95% CI 10,100-11,800). Influenza has the third-highest disease burden, behind legionellosis.
| DALY (95% confidence interval) | |||||
|---|---|---|---|---|---|
| 2019 | 2020 | 2021 | 2022 | 2023 | |
| COVID-19 | 207.000 (203.600-210.400) | 218.900 (215.300-222.600) | 93.800 (91.600-96.100) | 37.800 (36.400-39.200) | |
| 2019/2020 | 2020/2021 | 2021/2022 | 2022/2023 | 2023/2024 | |
| Influenza | 4900 (4500-5300) | NAa | 14.200 (12.600-16.000) | 9500 (8600-10.400) | 10.900 (10.100-11.800) |
Figure 1. Average annual DALY, split by YLL (years of life lost due to mortality) and YLD (years lived with disability), in the Netherlands for influenza (respiratory season 2019/2020 to 2023/2024) and COVID-19 (Calendar Years 2019-2023).
Note: In the winter season 2020-2021, it was not possible to estimate the disease burden of influenza with the current methodology