The role of burden of disease estimates in European Union Health policymaking: A systematic analysis of EU legislation

Background: The use of burden of disease (BoD) metrics in policymaking is crucial for evidence-based decision-making. However, there is currently no information available regarding their utilisation in policies at the European level. Objective: This study aimed to analyse the use of BoD metrics within the European legislation. Methods: Systematic searches on EUR-Lex were conducted for documents published between 2004 and 2023, to account for European Union-25 (EU-25). Network and qualitative analyses of documents were conducted to assess the legislation content. Results: In total, 2615 documents were found, of which 191 included BoD metrics. Among the selected documents, 131 (69 %) were published after 2018. Ten were legally binding documents. The most prevalent EuroVoc (EU's multilingual and multidisciplinary thesaurus) domains were social questions and environment. The most frequent EuroVoc terms were climate change policy (n = 45), EU environmental policy (n = 32) and pollution control measures (n = 32). The most common EU institution responsible for the retrieved documents was the European Commission (n = 152). As for the purposes of usage, argument (n = 93) and impact assessment (n = 50) were most common. Most BoD metrics were localized in the main text (n = 122). Conclusion: Despite growing recognition of BoD metrics in supporting policymaking, their use remains focused on environmental health topics. Further efforts in training policymakers, knowledge dissemination and policy-oriented research could enhance the uptake of BoD studies in EU policies.