back to basics, 2013 population health : vital & health statistics
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Back to Basics, 2013 POPULATION HEALTH : Vital & Health Statistics. Presented by N. Birkett, MD Epidemiology & Community Medicine. 78.1: VITAL STATISTICS INFORMATION. What are the key causes of illness or death in Canada ? Common things are common - PowerPoint PPT PresentationTRANSCRIPT
03/2013 1
Back to Basics, 2013POPULATION HEALTH : Vital & Health Statistics
Presented by N. Birkett, MDEpidemiology & Community
Medicine
03/2013 2
78.1: VITAL STATISTICS INFORMATION
• What are the key causes of illness or death in Canada?– Common things are common
• using epidemiology can help you run a better clinical practice• Hipocrates
• How have disease incidence and mortality changed in Canada in the past 20 years?– Little good information on disease incidence except for
reportable diseases and cancer (cancer registries)
03/2013 3
TOPICS
• Demography, population dynamics• Mortality• Morbidity• Summary measures of population health• Aboriginal health
03/2013 4
Population Dynamics, 2007Canada Nfld Nunavut
% aged >65 14% 15% 3%
Total fertility 1.7 1.5 3.0
Birth rate/1,000 11.3 8.9 25.8
Death rate/1,000 7.3 8.9 4.3
Rate of Natural Increase/1,000
4.0 0 21.5
World Health Report, 2012 (data mostly from 2009)
Population(x 1,000)
Growth(%)
Dependency ratio %
% aged > 60
Total Fertility
rate
LE at birth (both
sexes)
P dying< 5 yrs
(per 1000)
Afghan- istan 31,412 3.2 100 4 6.3 48 149
Canada 34,017 1.0 56 20 1.7 81 6
China 1,348,932 0.6 45 12 1.6 74 18
France 62,787 0.6 70 23 2.0 81 4
Japan 126,536 0.1 75 30 1.4 83 3
USA 310,384 0.9 61 18 2.1 79 8
603/2013
703/2013
Population Pyramids
• Canada, 1901-2001• Ontario 1901-2001• Newfoundland 1949-2001• Yukon 1901-2001
General (All-Causes) Mortality
03/2013 8
903/2013
# deaths in Canada from 1979-2004; men and women.
1003/2013
Mortality RATES in Canada from 1979-2004; men and women.
03/2013 11
Infant Mortality, 1935-2005
03/2013 12
Age/sex-specific Mortality.Canada, 2005
Age at death (years)
0 20 40 60 80
Rat
e/10
0,00
0
0
2000
4000
6000
8000
10000
12000
14000CombinedMalesFemales
03/2013 13 13
Age/sex-specific Mortality.Canada, 2005
log-scale for mortality
Age at death (years)
0 20 40 60 80
Rat
e/10
0,00
0
1
10
100
1000
10000CombinedMalesFemales
03/2013 14
Age-specific mortality: male:female mortality ratioCanada, 2005
1.0=same mortality in both sexes; > 1.0 -> higher male mortality
Age (years)
0 20 40 60 80
Rat
io (M
:F)
1.0
1.2
1.4
1.6
1.8
2.0
2.2
2.4
2.6
2.8
Cause-Specific Mortality
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03/2013 16
Leading causes of death (2009)Cause 2004 2009Cancer 30 29.8- Lung 9(M); 8(F) 7.8- Breast 5 (F) 4.2 (F)- Prostate 3 (M) 3.1 (M)Cardiovascular 28 26.6- Ischemic heart 17 15.5- Other circulatory 5 5.2- Stroke 6 5.9Respiratory disease 7 7.0
Injuries 4 4.3Diabetes 4 2.9Alzheimer’s disease 2 2.6
Suicide 1.6 1.6
1703/2013
CANCER: 30.3%
Circ Disease:27.6%
†
† Pneumonia & influenza grouped with respiratory disease. Would increase infectious % to about 3.4%.
03/2013 18
CANCER: 29.8%
Circ Disease:29.0%
††
† Pneumonia & influenza grouped with respiratory disease. Would increase infectious % to about 3.5%.
{EXTERNALCAUSES:4.8%+
03/2013 19
CANCER: 31.6%
Circ Disease:27.3%
††
† Pneumonia & influenza grouped with respiratory disease. Would increase infectious % to about 3.3%.
{EXTERNALCAUSES:3.4%+
2003/2013
Cancer Cluster
Cardio-vascular Cluster
‘Other’ Cluster
Suicide
Crime
2103/2013
03/2013 22
Cancer and AgeAge-Specific Mortality Rates for All Cancers by Sex, Canada, 2003
Surveillance Division, CCDPC, Public Health Agency of Canada
03/2013 23
Cancer and AgeAge-Specific Incidence Rates for All Cancers by Sex, Canada, 2003
Surveillance Division, CCDPC, Public Health Agency of Canada
03/2013 24
Time trends in MalesIncidence Mortality
1975 1980 1985 1990 1995 2000 20050
20
40
60
80
100
120
140
160
Prostate
Lung
Colorectal
Bladder
NHLStomach
Melanoma
LarynxLiverThyroid
1980 1985 1990 1995 2000 2005
AS
MR
(/10
0,00
0)
0
20
40
60
80
100
Prostate
Lung
Colorectal
NHL
Stomach
OralLarynxHodgkin's
03/2013 25
Time trends in FemalesIncidence Mortality
1975 1980 1985 1990 1995 2000 20050
20
40
60
80
100
120
140
160
Breast
Lung
Colorectal
NHLStomach
Cervix
Larynx
Thyroid
1980 1985 1990 1995 2000 2005
AS
MR
(/10
0,00
0)
0
20
40
60
80
100
Breast
Lung
Colorectal
NHLStomach
Cervix
03/2013 26
Injury Mortality in Canada, 2004
Age at death (years)
0 20 40 60 80
Rat
e/10
0,00
0
0
50
100
150
200
250
300
350Total MVA FallsSuffocation Other unintentional Suicide Homicide
03/2013 27
Injury Mortality in Canada, 2004Excluding poeple over age 80
Age at death (years)
0 20 40 60 80
Rat
e/10
0,00
0
0
10
20
30
40
50
60
70Total MVA FallsSuffocation Other unintentional Suicide Homicide
Income Inequalities in Health
03/2013 28
Income Inequalities• SES (socio-economic status)
– Lower worse health• Life expectancy 6.6 years lower in the poorest group.
– Complex causal pathway• Nutrition• Race• Habits• Environmental/occupational• Access to/use of health/preventive services• Political isolation• Others
2910/7/2012
3003/2013
311 2 3 4 5 1 2 3 4 5
Income adequacy quintiles
Men
Women
Remaining Life Expectancy at age 25. Based on 10-year follow-up to 1991 census
03/2013
Remaining life expectancy at age 25 (conditional on surviving to
age 25), 1991-2001Men Women
Total, all quintiles 53.7 59.3 Quintile 1 (lowest) 50.6 57.1 Quintile 2 53.0 59.2 Quintile 3 54.0 59.7 Quintile 4 55.0 60.6 Quintile 5 (highest) 56.0 60.4
Difference Q5-Q1 5.3 3.303/2013 32
Probability of survival to age 75 (conditional on surviving to age
25), 1991-2001Men Women
Total, all quintiles 66.9 80.1 Quintile 1 (lowest) 57.0 73.3 Quintile 2 64.1 79.5 Quintile 3 67.3 81.8 Quintile 4 69.5 82.9 Quintile 5 (highest) 74.1 83.6
Difference Q5-Q1 17.2 10.303/2013 33
Summary Measures of Population Health
Combine mortality and a measure of morbidity
03/2013 34
03/2013 35
Impact of Chronic Diseases
Category Mortality MorbidityCancer 85% 15%Cardiovascular 79% 21%Diabetes 37% 63%Respiratory 33% 67%Neuropsychiatric 8% 92%Musculoskeletal 7% 93%Sense organs 0% 100%
03/2013 36
Summary Measures ofPopulation Health
IndicatorType
Life (Survival) Health-Adjusted Life (Survival)
Gap Years of Life Lost(YLL)
Disability-Adj Life Years (DALY)
Expectancy Life Expectancy(LE)
Health-Adj LifeExpectancy
(HALE)
03/2013 37
2001 Life Expectancy andHealth-Adjusted Life Expectancy
GenderIndicator
Males Females Difference
LE 76.9 82.0 5.1HALE 68.3 70.8 2.5Difference 8.6 12.8
• HALE always < LE• Females live longer (but gap is narrowing)• Females suffer more morbidity
03/2013 38
Disability-Adjusted Life-Years Lost
05000
10000150002000025000300003500040000
I Communicable
MaternalPerinatalNutritional
II Chronic
III Injuries
MorbidityMortality
03/2013 39
Which Chronic Diseases?
0
2000
4000
6000
8000
10000
12000
14000
Ca CVSDMRespN-PM-SSense
MorbidityMortality
Cancer CHD Diabetes Respiratory Neuro-Psych Musculoskeletal Sensory
Cancer CHD DiabetesRespiratoryNeuro-psychMusculoskeltalSensory
03/2013 40
Deaths vs Prevalence, Canada
Aboriginal Health
03/2013 41
Population Pyramids
03/2013 42
Age-specific Fertility Rates
03/2013 43
0
20
40
60
80
100
120
140
160
180
200
15-19 20-24 25-29 30-34 35-39 40-44
First Nations (2001-2002 average)
General Canadian Population (2000)
Age group of mother (years)
Ferti
lity
rate
per
1,0
00 fe
mal
es
Percentage of Live Births by Age Group of Mother
03/2013 44
0
5
10
15
20
25
30
35
15-19 20-24 25-29 30-34 35-39 40-44
Age group of mother (years)
Perc
enta
ge o
f liv
e bi
rths
First Nations (2001-2002 average)
General Canadian Population (2000)
Crude Mortality Rate
03/2013 45
Age-adjusted Mortality Rate
03/2013 46
Age-specific Mortality Ratio
03/2013 47
Life Expectancy at Birth in Years, by Sex
03/2013 48
70.466.9
60.9
76.574.371.875.574.0
68.0
82.180.879.0
0
10
20
30
40
50
60
70
80
90
1980 1990 2001
Age
(yea
rs)
Registered Indian males Canadian males Registered Indian females Canadian females
Leading Causes of Death (age-standardized)
03/2013 49
0
20
40
60
80
100
120
140
Extern
al Cau
ses o
f Injury
Circulat
ory di
sease
s
Neoplas
ms
Digesti
ve di
sease
s
Respira
tory d
isease
s
Endocri
ne dise
ases
Infectious
and pa
rasit
ic
Mental a
nd be
havio
ural
disord
ers
Genitourin
ary dise
ases
Nervous
syste
m
Age
-sta
ndar
dize
d ra
te p
er 1
00,0
00 p
opul
atio
n
First Nations 2001-2002 (average)
General Canadian Population2001-2002 (average)
Potential Years of Life Lost (PYLL)
03/2013 50
8000 6000 4000 2000 0 2000 4000
External causes of injury
Ciculatory diseases
Neoplasms
Digestive diseases
Congenital malformations
Perinatal conditions
Symptoms and ill-defined
Respiratory diseases
Endocrine diseases
Infectious and parasitic
PYLL per 100,000 population
First Nations Canada
5103/2013