Background and objectives:
High disease burden due to non-communicable diseases (NCDs) and the associated health inequalities are major problems in Europe. This study aimed to assess health inequalities in NCDs by Disability-Adjusted Life Years (DALYs) rates across 30 member states of the European Economic Area (EEA) between 1990 and 2019.

Methods:
The Global Burden of Disease (GBD) 2019 estimates were used for a descriptive longitudinal systematic analysis. Age-standardized DALYs rates and 95% Uncertainty Interval (UI 95%) were used. For inequality analysis, we performed DALYs rate ratios between all countries in 2019 by sex, ratio between highest and lowest-ranking country by year, annual rate-of-change between 1990 and 2019 by sex, Gini Coefficient (GC), and Slope Index of Inequality (SII).

Results:
In 2019, DALY rate of NCDs ranged from 24342 in Bulgaria (95%UI: 20406-28775) to 14845 in Iceland (95%UI: 12379-17682). The ratio between highest and lowest-ranking country in terms of NCD DALY rates was higher for males (1.90: Bulgaria/Iceland) compared to females (1.49: Bulgaria/Slovenia). The annual rate-of-change indicated DALY rate decrease in all countries between 1990 and 2019. For females it ranged from -0.12 in the Netherlands to -0.28 in Slovenia, while for males from -0.10 in Bulgaria to -0.40 in the Czech Republic. NCDs with highest GCs and ratios over the studied period were cardiovascular diseases (GC: 0.283; ratio: 5.89), digestive diseases (GC: 0.244; ratio: 6.29), diabetes and kidney diseases (GC: 0.194; ratio: 4.97), substance use disorders (GC: 0.224; ratio: 5.10), and chronic respiratory diseases (GC: 0.160; ratio: 3.45). The SII was 0.85 in 1990 and 0.59 in 2019.

Conclusion:
Although the DALY rate of NCDs decreased between 1990 and 2019 in all EEA countries, the level of inequality between countries is not decreasing. Targeted policies can help tackle NCDs with particularly high levels of inequality in EEA countries.