Open Access Research article

The impact of demographic change on the estimated future burden of infectious diseases: examples from hepatitis B and seasonal influenza in the Netherlands

Scott A McDonald1*, Alies van Lier1, Dietrich Plass2 and Mirjam EE Kretzschmar13

Author affiliations

1 Centre for Infectious Disease Control, National Institute for Public Health and the Environment, PO Box 1, Bilthoven, 3720, BA, the Netherlands

2 Department of Public Health Medicine, School of Public Health, University of Bielefeld, Bielefeld, Germany

3 Julius Centre for Health Sciences & Primary Care, University Medical Centre Utrecht, Utrecht, The Netherlands

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Citation and License

BMC Public Health 2012, 12:1046  doi:10.1186/1471-2458-12-1046

Published: 5 December 2012



For accurate estimation of the future burden of communicable diseases, the dynamics of the population at risk – namely population growth and population ageing – need to be taken into account. Accurate burden estimates are necessary for informing policy-makers regarding the planning of vaccination and other control, intervention, and prevention measures. Our aim was to qualitatively explore the impact of population ageing on the estimated future burden of seasonal influenza and hepatitis B virus (HBV) infection in the Netherlands, in the period 2000–2030.


Population-level disease burden was quantified using the disability-adjusted life years (DALY) measure applied to all health outcomes following acute infection. We used national notification data, pre-defined disease progression models, and a simple model of demographic dynamics to investigate the impact of population ageing on the burden of seasonal influenza and HBV. Scenario analyses were conducted to explore the potential impact of intervention-associated changes in incidence rates.


Including population dynamics resulted in increasing burden over the study period for influenza, whereas a relatively stable future burden was predicted for HBV. For influenza, the increase in DALYs was localised within YLL for the oldest age-groups (55 and older), and for HBV the effect of longer life expectancy in the future was offset by a reduction in incidence in the age-groups most at risk of infection. For both infections, the predicted disease burden was greater than if a static demography was assumed: 1.0 (in 2000) to 2.3-fold (in 2030) higher DALYs for influenza; 1.3 (in 2000) to 1.5-fold (in 2030) higher for HBV.


There are clear, but diverging effects of an ageing population on the estimated disease burden of influenza and HBV in the Netherlands. Replacing static assumptions with a dynamic demographic approach appears essential for deriving realistic burden estimates for informing health policy.

Population ageing; Influenza; Hepatitis B; Disease burden; Disability-adjusted life-years