SUBOD - Improved monitoring of the disease burden attributable to substance use

The aim of the SUBOD project is to integrate the burden attributable to tobacco and alcohol use in the Belgian national burden of disease study. We want to initiate an improved and routine monitoring of these impacts and estimate the economic cost of tobacco and alcohol use. We quantify the disease-specific burden of tobacco and alcohol use using the comparative risk assessment framework, defining the burden of risk factors as the sum of the attributable burdens of the different causally related diseases. For each risk-outcome pair, the attributable burden is obtained by multiplying the overall burden of the health outcome (e.g. in terms of Disability-Adjusted Life Years or economic cost) with the population attributable fraction (PAF), which is obtained by integrating data on exposure (consumption) with the relative risks associating consumption with disease incidence or mortality.

The SUBOD project assesses the burden of tobacco and alcohol use in Belgium, leveraging local data and knowledge in three steps. 

1. First, SUBOD critically assesses available data sources on tobacco and alcohol use and sales in Belgium, with an aim to establish a methodology for monitoring the extent of tobacco and alcohol use. 
2. Next, we perform a scoping review of relative risks for tobacco and alcohol use and their attributable diseases, leveraging scientific and grey literature, with an aim to establish an open access repository of best-evidence relative risks. 
3. Finally, the Belgian national burden of disease study will be extended to estimate the attributable burden of disease to tobacco use and quantified in terms of attributable deaths, Years of Life Lost, Disability-Adjusted Life Years, and costs, by age, sex, region, and year.

Knowledge translation and policy transfer are at the heart of the SUBOD project. The project is developed in close collaboration with key policy stakeholders, building on existing networks and interactions. Through pro-active project communication, SUBOD also contributes to an increased visibility of the concerned data collections.

The SUBOD project directly contributes to the federal tobacco and alcohol plans, which explicitly call for an improved monitoring of tobacco and alcohol use and their respective impacts. The project also provides the basis for studies evaluating the impact of interventions targeted at diminishing the alcohol and tobacco burden (e.g. evaluating the cost-effectiveness of such interventions). The project fits into the global strategic priorities of Sciensano, in terms of its scientific expertise and its core mission to provide advice to health authorities, and benefits from collaboration in international projects, such as the European Burden of Disease Network (www.burden-eu.net), chaired by the project coordinator.