Years of life lost: known methods and a refined approach using the example of the most frequent causes of death in Germany

Background Years of life lost (YLL) is a meaningful indicator of the relevance of causes of death, although it is rarely used in Germany. Numerous methods have been developed to calculate YLL. Objective Prototypical methods for calculating YLL are presented and critically appraised. An improved method is proposed that is based on cause-elimination life tables (CELTs). Methods The different methods are applied to deaths in Germany in 2018. Changes in comparison to 1998 are presented using the modified method. Results While in 2018 cardiovascular diseases were the leading cause of death by number of cases, cancer was responsible for most YLL. Different methods of calculating YLL lead to divergent ranks for less frequent causes of death. YLL on the basis of general life tables underestimate CELT-based YLL by up to 18.4% (cardiovascular diseases). Measured by CELT-based YLL, cardiovascular diseases were the most important cause of death in 1998. Conclusion The calculation of YLL on the basis of CELTs avoids inconsistencies of established methods and leads to relevantly different results. Characteristics of the proposed method (violation of the egalitarian principle, lack of additivity) do not affect its usefulness as a tool for health planning.