studying mortality trends: the impact chd policy model prof simon capewell chair of clinical...
TRANSCRIPT
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Studying mortality trends:The IMPACT CHD Policy ModelProf Simon Capewell Chair of Clinical Epidemiology DIVISION OF PUBLIC HEALTHLIVERPOOL UNIVERSITY UK14th January 2008
Particular thanks to: Julia Critchley, Kath Bennett Martin OFlaherty, Robin Ireland, Ann CapewellCharity No: 1110067
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Source:BHF Heartstats (WHO statistics Men aged 35 - 74, Standardised)International mortality trends 1968-2003 men, coronary heart disease [CHD]
-
Per 100,000
Ireland
UK
USA
Netherlands
Finland
Italy
France
3
Death rates from CHD have been falling in the UK since the late 1970s. But decrease in mortality rates were relatively less than some other developed countries which had high rates. These falls need to be explained to better predict the future trends and to find better policy options. Modelling is one of the ways to do it.
Update this slide with latest death rates:WHO England 1997=118.7Scotland1997=150.4 /1USA1997=106.5Finland 1996=143.8New Zealand1996=127.3
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Source:BHF Heartstats (WHO statistics Men aged 35 - 74, Standardised)International mortality trends 1968-2003 men, coronary heart disease [CHD]Why have CHD mortality rates halved?
-
Per 100,000
Ireland
UK
USA
Netherlands
Finland
Italy
France
3
Death rates from CHD have been falling in the UK since the late 1970s. But decrease in mortality rates were relatively less than some other developed countries which had high rates. These falls need to be explained to better predict the future trends and to find better policy options. Modelling is one of the ways to do it.
Update this slide with latest death rates:WHO England 1997=118.7Scotland1997=150.4 /1USA1997=106.5Finland 1996=143.8New Zealand1996=127.3
-
Explaining the fall in coronary heart disease deaths in England & Wales 1981-2000 20001981?68,230 fewer deaths in 2000 Unal, Critchley & Capewell Circulation 2004 109(9) 1101 Why did CHD mortality halve in spite of population ageing??
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Explaining the fall in coronary heart disease deaths in England & Wales 1981-2000 Risk Factors worse +13%
Risk Factors better -71%
Treatments -42%
20001981Unal, Critchley & Capewell Circulation 2004 109(9) 1101 68,230 fewer deathsin 2000
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Explaining the fall in coronary heart disease deaths in England & Wales 1981-2000 Risk Factors worse +13% Obesity (increase) +3.5% Diabetes (increase) +4.8% Physical activity (less) +4.4%Risk Factors better -71%Smoking -41%Cholesterol -9%Population BP fall -9%Deprivation -3%Other factors -8%Treatments -42%AMI treatments -8%Secondary prevention -11%Heart failure -12%Angina:CABG & PTCA -4%Angina: Aspirin etc -5%Hypertension therapies -3%
20001981Unal, Critchley & Capewell Circulation 2004 109(9) 1101 68,230 fewer deathsin 2000
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Risk Factors obviously powerful
but was it tablets or lifestyles??
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CHD prevention in England & Wales 1981-2000: Population v. High Risk StrategiesDeaths prevented or postponed (Sensitivity analysis )C h o l e s t e r o lPopulation dietPopulation secular trendsHigh Risk StatinsTreatingHigh RiskDiet in CHD patientsStatins CHD patientsBlood PressureSecular trendsCHDpatientsUnal et al BMJ 2005 331 614
Chart
329045659650
64512052455
45145410
130519904180
3125534511740
84018902785
285520940
Number of deaths prevented or postponed
Sheet1
MinimumBestMaximum
ALL PRIMARY PREVENTION242353662561005
ALL SECONDARY PREVENTION5335874515830
SmokingPrimary169352468036420
Cessation CHD patients310050358255
CholesterolDiet 1' prevention329045659650
Diet in CHD patients64512052455
Statins 1' prevention45145410
Statins CHD patients130519904180
BPBP secular trends3125534511740
Hypertension treatments84018902785
BP secular trends CHD patients285520940
Smoking65.479663194432.510447777348.2132912079
Cholesterol27.08345457688.57277757979.5929566468
Population BP20.57807654455.52633017979.5206610712
Deprivation5.17370871791.72456957263.4491391452
Obesity-4.1977050728-2.1729746574-3.4018411314
Physical Inactivity-5.6142353493-2.4184398428-4.3186425764
Diabetes-7.6024124859-4.1657054717-4.6864186557
Sheet1
4.52116348411.36365727923.0625742283
5.66997900271.92650492743.7645362461
13.45096855675.23561108467.7520334432
20.61017620167.469162974411.1943225192
22.10701871136.769455012812.585897931
55.156591419525.013184378141.8621545026
76.126692411437.568249461658.1378454974
65.479663194432.510447777348.2132912079
27.08345457688.57277757979.5929566468
20.57807654455.52633017979.5206610712
5.17370871791.72456957263.4491391452
-4.1977050728-2.1729746574-3.4018411314
-5.6142353493-2.4184398428-4.3186425764
-7.6024124859-4.1657054717-4.6864186557
Maximum
Minimum
Best
% of total deaths prevented or postponed
000
000
000
000
000
000
000
000
000
000
000
Number of deaths prevented or postponed
-
CHD prevention in England & Wales 1981-2000: Population v. High Risk StrategiesDeaths prevented or postponed (Sensitivity analysis )C h o l e s t e r o lPopulation dietPopulation secular trendsHigh Risk StatinsTreatingHigh RiskDiet in CHD patientsStatins CHD patientsBlood PressureSecular trendsCHDpatientsUnal et al BMJ 2005 331 614
Chart
329045659650
64512052455
45145410
130519904180
3125534511740
84018902785
285520940
Number of deaths prevented or postponed
Sheet1
MinimumBestMaximum
ALL PRIMARY PREVENTION242353662561005
ALL SECONDARY PREVENTION5335874515830
SmokingPrimary169352468036420
Cessation CHD patients310050358255
CholesterolDiet 1' prevention329045659650
Diet in CHD patients64512052455
Statins 1' prevention45145410
Statins CHD patients130519904180
BPBP secular trends3125534511740
Hypertension treatments84018902785
BP secular trends CHD patients285520940
Smoking65.479663194432.510447777348.2132912079
Cholesterol27.08345457688.57277757979.5929566468
Population BP20.57807654455.52633017979.5206610712
Deprivation5.17370871791.72456957263.4491391452
Obesity-4.1977050728-2.1729746574-3.4018411314
Physical Inactivity-5.6142353493-2.4184398428-4.3186425764
Diabetes-7.6024124859-4.1657054717-4.6864186557
Sheet1
4.52116348411.36365727923.0625742283
5.66997900271.92650492743.7645362461
13.45096855675.23561108467.7520334432
20.61017620167.469162974411.1943225192
22.10701871136.769455012812.585897931
55.156591419525.013184378141.8621545026
76.126692411437.568249461658.1378454974
65.479663194432.510447777348.2132912079
27.08345457688.57277757979.5929566468
20.57807654455.52633017979.5206610712
5.17370871791.72456957263.4491391452
-4.1977050728-2.1729746574-3.4018411314
-5.6142353493-2.4184398428-4.3186425764
-7.6024124859-4.1657054717-4.6864186557
Maximum
Minimum
Best
% of total deaths prevented or postponed
000
000
000
000
000
000
000
000
000
000
000
Number of deaths prevented or postponed
-
Explaining the fall in CHD deaths in USA 1980-2000 : RESULTS341,745 fewer deathsin 2000 Risk Factors worse +17% Obesity (increase) +7% Diabetes (increase) +10%Risk Factors better -65%Population BP fall -20%Smoking -12%Cholesterol (diet) -24%Physical activity -5%Treatments -47%AMI treatments -10%Secondary prevention -11%Heart failure -9%Angina:CABG & PTCA -5%Hypertension therapies -7% Statins (primary prevention) -5%Unexplained -9%20001980NEJM 2007; 356: 2388.
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Comparisons with other studies: % CHD mortality falls attributed toNEJM 2007; 356: 2388.
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EXPLOITING THE IMPACT MODELReplication in other populationsPopulations with RISING CHDCalculating life-years gained Cost effectivenessWHAT IF treatment uptakes increased?WHAT IF risk factors reduced further?
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WHAT IF Treatment Uptakes in England & Wales Increased? Actual Uptakes 50%25,805 Deaths prevented or postponed (DPPs)
IF Uptakes at least 80%20,910 additional DPPsCapewell et al Heart 2006 92 521[ Capewell, Pell et al et al Eur Heart J 1999 20 1836 ]
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IF Treatment Uptakes Increased in England & Wales Actual Uptakes 50%25,805 Deaths prevented/postponed (DPPs)
IF Uptakes at least 80%20,910 additional DPPsCapewell et al Heart 2006 92 521
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EXPLOITING THE IMPACT MODELReplication in other populationsPopulations with RISING CHDCalculating life-years gained Cost effectivenessWHAT IF treatment uptakes increased?WHAT IF risk factors reduced further?
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Estimating the potential changes in CHD mortality in England & Wales between 2000 and 2010 WHAT IF risk factors
a) continue recent trends ?
b) undergo additional reductions ? (as already achieved in Australia, USA, Sweden, Finland etc)Unal et al J Clin Epid 2005 58 733Kelly & Capewell HDA 2004 www
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Potential changes in CHD mortality in England & Wales between 2000 and 2010 IF risk factors a) continue recent trends b) additional reductions already achieved elsewhereUnal et al J Clin Epid 2005 58 733
E&W 2010
current trendadditionalminmax
Cholesterol-2525-22500-7000-6100
Smoking-8879-8260701713556
Blood Pressure-5135-1370-3002-2629
Diabetes4200-485-8400-1900
Obesity2080-85014397177
Inactivity705-1055-2700-750
E&W 2010
1-7000-6100
701713556
-3002-2629
-8400-1900
14397177
-2700-750
current trend
additional
risk factor
deaths prevented or postponed in 2010
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Modest additional risk factor reductions already achieved in USA & Scandinavia could prevent or postpone over 50,000 deaths by 2010 halving current CHD deaths (100,000) in UKThe IMPACT Model Thus, to reduce CHD mortality in UKUnal et al J Clin Epid 2005 58 733
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Key Targets: Healthier food Smoking reduction hence:Heart of Mersey CHD primary prevention programme
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Is the party over?
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US Trends in age-adjusted CHD mortality rates: men & women aged 35 years Ford & Capewell JACC 2007 50 2128
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US Trends in AGE-SPECIFIC CHD mortality rates: men & women aged 35 years Ford & Capewell JACC 2007 50 2128
Chart3
11.252.2
10.751
10.547.5
9.745.1
9.543.5
9.242.1
8.941
8.438.3
835.2
7.433.4
7.132.3
7.631.6
7.931.1
7.930.6
7.929.6
7.929.6
828.2
7.426.8
7.726.7
7.926.6
7.625.8
8.125.5
8.226.1
Women
Men
Year
Per 100,000 population
35-44 years
Sheet1
CHD mortality rates for ages 25+ years
Total
YearDeath CountPopulationAge Adjusted RateCrude Death Rate
1979617,137130,668,000524.4472.3472.3050%0.0215816005
1980635,330132,768,638533.7478.5478.50-1.3%51%0.0229614867
1981623,891136,009,066509.5458.7458.704.1%
1982620,454138,690,289495.3447.4447.402.5%
1983624,571141,303,090488.644244201.2%
1984612,846143,881,783470.1425.9425.903.6%
1985607,943146,398,041457.9415.3415.302.5%
1986592,932149,041,120438.1397.8397.804.2%
1987584,299151,539,755423.4385.6385.603.1%
1988582,148153,897,145415.1378.3378.301.9%
1989568,651156,206,784398.136436403.8%
1990558,029157,843,690385.9353.5353.502.9%
1991554,535161,231,105371.9343.9343.902.7%
1992548,762163,875,074359.6334.9334.902.6%
1993562,445166,358,177360.5338.1338.10-1.0%
1994552,438168,791,121347327.3327.303.2%
1995552,213171,332,456339.7322.3322.301.5%
1996544,404173,893,568327.9313.1313.102.9%
1997532,822176,251,758314.7302.3302.303.4%
1998526,400178,366,837304.7295.1295.102.4%0.0206506365
1999529,429180,408,769300.8293.5293.50.5%
2000514,977181,984,640288.72832833.6%
2001501,923184,413,685274.8272.2272.23.8%
2002494,162187,132,490264.1264.1264.13.0%
Males
1979339,63161,436,000703552.8552.8052%0.0234255787
1980344,37062,417,211710.8551.7551.7052%0.0236673147
1981337,09363,994,132680.5526.8526.80
1982333,28465,295,382661.4510.4510.40
1983332,16966,573,597650.14994990
1984323,66467,840,425624.2477.1477.10
1985320,19569,079,726608.6463.5463.50
1986309,02770,397,389577.14394390
1987302,53571,636,664556.1422.3422.30
1988299,62772,802,521544.4411.6411.60
1989291,91073,955,379521.6394.7394.70
1990286,43074,754,104507.4383.2383.20
1991283,82376,485,691488.9371.1371.10
1992280,78777,843,217473.1360.7360.70
1993286,21679,095,623472.6361.9361.90
1994280,82680,325,041454.3349.6349.60
1995279,95781,617,773442.93433430
1996276,39382,914,201428333.3333.30
1997270,89284,115,895410.53223220
1998267,03085,206,175395.8313.4313.40
1999267,11186,285,677388.3309.6309.6
2000260,42687,120,538373.2298.9298.9
2001253,82088,389,810353.2287.2287.2
2002252,60989,801,783340.7281.3281.3
1979277,50669,232,000395400.8400.8048%0.0216915995
1980290,96070,351,427406.8413.6413.6049%0.0223808885
1981286,79872,014,934387398.2398.20
1982287,17073,394,907376.8391.3391.30
1983292,40274,729,493373.8391.3391.30
1984289,18276,041,358360.8380.3380.30
1985287,74877,318,315351372.2372.20
1986283,90578,643,731338.73613610
1987281,76479,903,091328.6352.6352.60
1988282,52181,094,624323.1348.4348.40
1989276,74182,251,405309.9336.5336.50
1990271,59983,089,586299.7326.9326.90
1991270,71284,745,414288.8319.4319.40
1992267,97586,031,857278.7311.5311.50
1993276,22987,262,554280.3316.5316.50
1994271,61288,466,0802703073070
1995272,25689,714,683264.9303.5303.50
1996268,01190,979,367255.6294.6294.60
1997261,93092,135,863245284.3284.30
1998259,37093,160,662238278.4278.40
1999262,31894,123,092236.4278.7278.70
2000254,55194,864,102226.4268.3268.30
2001248,10396,023,875216.3258.4258.40
2002241,55397,330,707206.5248.2248.20
YearMenWomen
1979703395
1980710.8406.8
1981680.5387
1982661.4376.8
1983650.1373.8
1984624.2360.8
1985608.6351
1986577.1338.7
1987556.1328.6
1988544.4323.1
1989521.6309.9
1990507.4299.7
1991488.9288.8
1992473.1278.7
1993472.6280.3
1994454.3270
1995442.9264.9
1996428255.6
1997410.5245
1998395.8238
1999388.3236.4
2000373.2226.4
2001353.2216.3
2002340.7206.5
Sheet1
00
00
00
00
00
00
00
00
00
00
00
00
00
00
00
00
00
00
00
00
00
00
00
00
Sheet2
00
00
00
00
00
00
00
00
00
00
00
00
00
00
00
00
00
00
00
00
00
00
00
00
Men
Women
Year
Per 100,000 population
Sheet3
CHD mortality rates for ages 25-74 years
ICD9: 410-414; ICD10: I20-I25
Total
YearDeath CountPopulationAge Adjusted RateCrude Death Rate
1979432,971128,471,000345.333749%0.021090671
1980438,842130,528,571345.4336.249%0.0220561141
1981428,502133,659,891329.9320.6
1982425,023136,253,582321.4311.9
1983420,660138,784,655312.5303.1
1984410,184141,287,142299.9290.3
1985402,920143,730,769289.7280.3
1986388,522146,299,072274.6265.6
1987378,765148,716,725263.3254.7
1988373,254151,011,885255.4247.2
1989361,966153,239,040244236.2
1990353,057154,822,265235.4228
1991346,985158,041,966226.6219.6
1992340,329160,560,414218.4212
1993342,196162,912,611216.2210
1994333,321165,230,089207.5201.7
1995330,437167,651,734202.5197.1
1996325,280170,098,676196.1191.2
1997314,900172,346,282186.8182.7
1998307,897174,334,302180.1176.6
1999350,053176,254,751202.1198.6
2000337,658177,745,053193190
2001327,614180,009,926184.3182
2002320,774182,539,421177.8175.7
Males
1979265,25860,760,000494.7436.650%0.0218841459
1980266,26061,735,686492.1431.350%0.0227596017
1981260,42363,293,600471.8411.5
1982257,31764,578,768458.7398.5
1983253,39265,841,270444.8384.9
1984246,00967,093,583426366.7
1985242,25668,318,382412.9354.6
1986231,74369,618,620388.5332.9
1987225,20470,838,443371.6317.9
1988221,15271,992,302359.7307.2
1989214,53073,124,241343.6293.4
1990209,39273,912,877331.8283.3
1991205,84875,602,687318.4272.3
1992202,45176,927,594307263.2
1993203,65478,143,684303.3260.6
1994198,47179,338,817290.1250.2
1995197,16280,594,187282.8244.6
1996193,81381,854,270272.6236.8
1997188,59983,015,716260.3227.2
1998184,17684,059,350249.9219.1
1999209,38585,092,367279246.1
2000202,73685,893,540266.8236
2001196,71487,090,702253.9225.9
2002194,16388,411,975245.7219.6
Females
1979167,71367,711,000231.7247.747%0.0203223809
1980172,58268,792,885234.5250.947%0.0215351812
1981168,07970,366,291222.8238.9
1982167,70671,674,814217.8234
1983167,26872,943,385212.9229.3
1984164,17574,193,559205221.3
1985160,66475,412,387197.1213
1986156,77976,680,452188.8204.5
1987153,56177,878,282181.7197.2
1988152,10279,019,583177192.5
1989147,43680,114,799168.9184
1990143,66580,909,388162.7177.6
1991141,13782,439,279156.9171.2
1992137,87883,632,820151164.9
1993138,54284,768,927149.6163.4
1994134,85085,891,272143.9157
1995133,27587,057,547140.4153.1
1996131,46788,244,406136.6149
1997126,30189,330,566129.5141.4
1998123,72190,274,952125.4137
1999140,66891,162,384141.3154.3
2000134,92291,851,513134.4146.9
2001130,90092,919,224128.8140.9
2002126,61194,127,446123.4134.5
Sheet4
CHD mortality rates for ages 25-74 years
ICD9: 410-414, 429.2; ICD10: I20-I25
YearDeath CountPopulationAge Adjusted RateCrude Death Rate
1979478,924128,471,000382.7372.8
1980486,535130,528,571383.7372.7
1981475,304133,659,891366.6355.6
1982470,854136,253,582356.6345.6
1983469,246138,784,655349.1338.1
1984458,122141,287,142335.2324.2
1985450,525143,730,769324.1313.5
1986436,687146,299,072308.8298.5
1987427,100148,716,725297287.2
1988421,816151,011,885288.8279.3
1989409,619153,239,040276.3267.3
1990399,672154,822,265266.6258.1
1991393,611158,041,966257.1249.1
1992386,527160,560,414248.2240.7
1993390,818162,912,611247239.9
1994381,051165,230,089237.3230.6
1995377,675167,651,734231.5225.3
1996370,803170,098,676223.6218
1997359,446172,346,282213.3208.6
1998352,303174,334,302206.1202.1
1999350,053176,254,751202.1198.6
2000337,658177,745,053193190
2001327,614180,009,926184.3182
2002320,774182,539,421177.8175.7
Males
1979291,30060,760,000544.6479.4
1980292,95361,735,686542.9474.5
1981286,87563,293,600521.1453.2
1982283,24764,578,768506.1438.6
1983280,93265,841,270494.2426.7
1984273,22267,093,583473.6407.2
1985269,36368,318,382459.6394.3
1986259,69869,618,620435.6373
1987253,23570,838,443418357.5
1988249,50471,992,302405.8346.6
1989242,41073,124,241388.1331.5
1990236,89473,912,877375.2320.5
1991233,53775,602,687360.9308.9
1992230,00676,927,594348.5299
1993232,76278,143,684346.3297.9
1994227,13979,338,817331.7286.3
1995225,55280,594,187323.2279.9
1996221,41381,854,270311270.5
1997215,72383,015,716297.3259.9
1998211,38084,059,350286.3251.5
1999209,38585,092,367279246.1
2000202,73685,893,540266.8236
2001196,71487,090,702253.9225.9
2002194,16388,411,975245.7219.6
Females
1979187,62467,711,000259.5277.1
1980193,58268,792,885263.3281.4
1981188,42970,366,291249.9267.8
1982187,60771,674,814243.8261.7
1983188,31472,943,385239.8258.2
1984184,90074,193,559231249.2
1985181,16275,412,387222.3240.2
1986176,98976,680,452213.2230.8
1987173,86577,878,282205.7223.3
1988172,31279,019,583200.6218.1
1989167,20980,114,799191.6208.7
1990162,77880,909,388184.4201.2
1991160,07482,439,279178194.2
1992156,52183,632,820171.4187.2
1993158,05684,768,927170.8186.5
1994153,91285,891,272164.3179.2
1995152,12387,057,547160.3174.7
1996149,39088,244,406155.3169.3
1997143,72389,330,566147.4160.9
1998140,92390,274,952143156.1
1999140,66891,162,384141.3154.3
2000134,92291,851,513134.4146.9
2001130,90092,919,224128.8140.9
2002126,61194,127,446123.4134.5
Sheet5
http://wonder.cdc.gov/mortSQL.html
All ages
YearDeath CountPopulationAge Adjusted RateCrude Death Rate
1999529,659279,203,823190194.6189.7
2000515,204281,675,072183186.7182.94.1%3.6%
2001502,189284,789,072176177.8176.34.8%3.6%
2002494,382288,356,713171170.9171.43.9%2.8%
2003164.1166.30.043.0%
2004157.5161.3
2005151.2156.4
2006145.2151.7
2007139.3147.2
2008133.8142.8
2009128.4138.5
2010424494316,000,000134123.3134.3
fall 2000-2010 all ages
90,710
Aged 25-84
YearDeath CountPopulationAge Adjusted RateCrude Death Rate
1999350,053176,254,751199202.1198.6
2000337,658177,745,0531901931904.3%0.0%
2001327,614180,009,926182184.31824.2%0.0%
2002320,774182,539,421176177.8175.73.5%0.0%
2003170.7170.40.043.0%
2004163.9165.3
2005157.3160.4
2006151.0155.5
2007145.0150.9
2008139.2146.4
2009133.6142.0
2010278161202,000,000138128.3137.7
fall 2000-2010 all ages
59,497
Base (no change)
383800
19992002
GenderAgeDeath CountPopulationCrude Death RateGenderAgeDeath CountPopulationCrude Death Rate
DescriptionDescription
F25-34 years27519,945,0901.41.3787854555F25-34 years25519,725,5281.31.29274106122.1%
F35-44 years1,78122,669,6047.97.8563348526F35-44 years1,84322,550,1008.28.1729127587-1.3%
F45-54 years5,71418,632,30530.730.6671665154F45-54 years6,02420,407,61629.529.51839156521.2%
F55-64 years14,25412,378,763115.1115.1488238364F55-64 years13,60613,817,41598.598.46993811794.8%
F65-74 years36,65310,125,424362361.989779391F65-74 years30,7319,973,210308.1308.13549499115.0%
F75-84 years81,9917,411,1981,106.301106.3123667726F75-84 years74,1527,653,577968.9968.85417106284.1%
M25-34 years73920,233,3163.73.6523919263M25-34 years74120,202,7763.73.6678127798-0.1%
M35-44 years5,97022,407,07326.626.6433728314M35-44 years5,84022,366,50626.126.1104707190.7%
M45-54 years19,06117,945,514106.2106.2159601558M45-54 years19,55119,676,32199.499.36308723572.2%
M55-64 years34,12311,399,263299.3299.3439137249M55-64 years33,65612,784,311263.3263.26017882394.0%
M65-74 years62,1878,293,485749.8749.8295348698M65-74 years53,1368,301,005640.1640.11526315194.9%
M75-84 years87,3054,813,7161,813.701813.6716000695M75-84 years81,2395,081,0561,598.901598.86055182233.9%
2000
GenderAgeDeath CountPopulationCrude Death Rate
Description
F25-34 years23119,771,1951.2
F35-44 years1,73222,700,7297.6
F45-54 years5,74119,180,72229.9
F55-64 years13,94212,629,328110.4
F65-74 years34,33110,087,712340.3
F75-84 years78,9457,481,8271,055.20
M25-34 years70420,120,5293.5
M35-44 years5,78722,447,79825.8
M45-54 years19,14918,497,230103.5
M55-64 years33,79511,645,356290.2
M65-74 years58,5548,303,274705.2
M75-84 years84,7474,879,3531,736.80
2001
GenderAgeDeath CountPopulationCrude Death Rate
Description
F25-34 years28619,593,7341.5
F35-44 years1,82222,615,7568.1
F45-54 years5,93219,952,10729.7
F55-64 years13,56813,154,612103.1
F65-74 years32,39110,015,772323.4
F75-84 years76,9017,587,2431,013.60
M25-34 years83020,013,5724.1
M35-44 years5,71222,402,91125.5
M45-54 years19,14119,236,08599.5
M55-64 years33,00612,153,966271.6
M65-74 years55,0728,297,451663.7
M75-84 years82,9534,986,7171,663.50
Age 35-44 years
GenderYearDeath CountPopulationCrude Death Rate
F19791,41012,801,00011
F19801,35113,064,99110.3
F19811,33213,442,8879.9
F19821,40314,264,2939.8
F19831,33114,885,2488.9
F19841,35315,505,5408.7
F19851,36216,097,0388.5
F19861,36016,748,4578.1
F19871,32317,349,5287.6
F19881,28517,818,0577.2
F19891,23618,423,0386.7
F19901,20618,925,1156.4
F19911,31919,861,2126.6
F19921,41520,173,6747
F19931,43120,635,1376.9
F19941,43721,083,5656.8
F19951,48321,521,8096.9
F19961,54421,936,5087
F19971,42322,266,2786.4
F19981,49822,516,7746.7
M19796,15812,313,00050
M19806,12112,569,71948.7
M19816,13012,951,50347.3
M19826,05313,766,05744
M19835,97114,382,05941.5
M19845,96514,997,39339.8
M19856,05115,593,97638.8
M19866,05816,260,53837.3
M19875,80116,876,88134.4
M19885,50817,362,37931.7
M19895,31717,991,41429.6
M19905,26918,509,65228.5
M19915,39619,468,25427.7
M19925,37419,802,66027.1
M19935,34920,276,41326.4
M19945,28420,735,30125.5
M19955,40921,188,95925.5
M19965,20621,614,75524.1
M19975,00321,962,13722.8
M19985,03722,231,58022.7
YearWomenMen
410-41419791150
198010.348.7
19819.947.3
19829.844
19838.941.5
19848.739.8
19858.538.8
19868.137.3
19877.634.4
19887.231.7
19896.729.6
19906.428.5
19916.627.7
1992727.1
19936.926.4
19946.825.5
19956.925.5
1996724.1
19976.422.8
19986.722.7
I20-I2519997.926.6
20007.625.8
20018.125.5
20028.226.1
414-414 PLUS 429.2
GenderYearDeath CountPopulationCrude Death Rate
F19791,51012,801,00011.8
F19801,46413,064,99111.2
F19811,44213,442,88710.7
F19821,49614,264,29310.5
F19831,44414,885,2489.7
F19841,46715,505,5409.5
F19851,47416,097,0389.2
F19861,49216,748,4578.9
F19871,45617,349,5288.4
F19881,42317,818,0578
F19891,36318,423,0387.4
F19901,35118,925,1157.1
F19911,50019,861,2127.6
F19921,59320,173,6747.9
F19931,62820,635,1377.9
F19941,66221,083,5657.9
F19951,69721,521,8097.9
F19961,75021,936,5088
F19971,64422,266,2787.4
F19981,74022,516,7747.7
M19796,61712,313,00053.7
M19806,56412,569,71952.2
M19816,60512,951,50351
M19826,54213,766,05747.5
M19836,48614,382,05945.1
M19846,52614,997,39343.5
M19856,56715,593,97642.1
M19866,67116,260,53841
M19876,47116,876,88138.3
M19886,11517,362,37935.2
M19896,00717,991,41433.4
M19905,97318,509,65232.3
M19916,14819,468,25431.6
M19926,15719,802,66031.1
M19936,19920,276,41330.6
M19946,12920,735,30129.6
M19956,26721,188,95929.6
M19966,10321,614,75528.2
M19975,88221,962,13726.8
M19985,94322,231,58026.7
F19991,78122,669,6047.9
F20001,73222,700,7297.6
F20011,82222,615,7568.1
F20021,84322,550,1008.2
M19995,97022,407,07326.6
M20005,78722,447,79825.8
M20015,71222,402,91125.5
M20025,84022,366,50626.1
YearWomenMen
410-414, 429.2197911.853.7
198011.252.2
198110.751
198210.547.5
19839.745.1
19849.543.5
19859.242.1
19868.941
19878.438.3
1988835.2
19897.433.4
19907.132.3
19917.631.6
19927.931.1
19937.930.6
19947.929.6
19957.929.6
1996828.2
19977.426.8
19987.726.7
I20-I2519997.926.6
20007.625.8
20018.125.5
20028.226.110.8%-2.6%
Age 45-54 years
GenderYearDeath CountPopulationCrude Death Rate
F19796,27611,868,00052.9
F19806,15611,790,86852.2
F19816,07011,653,22452.1
F19825,72811,556,57449.6
F19835,53611,507,04848.1
F19845,20511,510,37045.2
F19855,03011,542,76243.6
F19864,72411,632,80640.6
F19874,73811,843,52540
F19884,57312,268,19837.3
F19894,37012,611,52834.7
F19904,31412,824,34933.6
F19914,40013,208,75433.3
F19924,42914,075,70931.5
F19934,51814,741,97130.6
F19944,67915,396,12230.4
F19954,67716,066,64129.1
F19964,99916,734,52529.9
F19974,77217,427,69527.4
F19984,62317,958,69125.7
M197924,93511,067,000225.3
M198023,91811,008,919217.3
M198122,87810,926,311209.4
M198221,76910,868,735200.3
M198320,49810,848,423188.9
M198419,42010,875,053178.6
M198518,62210,916,542170.6
M198617,16211,026,121155.6
M198716,66811,252,355148.1
M198815,80711,681,050135.3
M198915,63112,021,662130
M199015,14312,232,301123.8
M199115,02312,611,398119.1
M199215,39113,472,009114.2
M199315,67914,121,978111
M199415,93914,756,639108
M199516,32115,413,598105.9
M199616,14616,065,440100.5
M199716,12916,749,81396.3
M199815,54217,273,16690
F19995,71418,632,30530.7
F20005,74119,180,72229.9
F20015,93219,952,10729.7
F20026,02420,407,61629.5
M199919,06117,945,514106.2
M200019,14918,497,230103.5
M200119,14119,236,08599.5
M200219,55119,676,32199.4
YearWomenMen
410-414197952.9225.3
198052.2217.3
198152.1209.4
198249.6200.3
198348.1188.9
198445.2178.6
198543.6170.6
198640.6155.6
198740148.1
198837.3135.3
198934.7130
199033.6123.8
199133.3119.1
199231.5114.2
199330.6111
199430.4108
199529.1105.9
199629.9100.5
199727.496.3
199825.790
I20-I25199930.7106.2
200029.9103.5
200129.799.5
200229.599.4
414-414 PLUS 429.2
GenderYearDeath CountPopulationCrude Death Rate
F19796,91311,868,00058.2
F19806,81911,790,86857.8
F19816,64111,653,22457
F19826,25011,556,57454.1
F19836,09211,507,04852.9
F19845,72311,510,37049.7
F19855,52011,542,76247.8
F19865,28211,632,80645.4
F19875,28811,843,52544.6
F19885,16012,268,19842.1
F19894,98112,611,52839.5
F19904,97212,824,34938.8
F19915,01713,208,75438
F19925,07314,075,70936
F19935,26914,741,97135.7
F19945,46415,396,12235.5
F19955,47616,066,64134.1
F19965,76416,734,52534.4
F19975,57417,427,69532
F19985,42017,958,69130.2
M197927,17011,067,000245.5
M198026,02311,008,919236.4
M198124,98910,926,311228.7
M198223,66710,868,735217.8
M198322,60510,848,423208.4
M198421,33910,875,053196.2
M198520,57810,916,542188.5
M198619,24511,026,121174.5
M198718,79311,252,355167
M198817,96811,681,050153.8
M198917,92912,021,662149.1
M199017,48312,232,301142.9
M199117,46112,611,398138.5
M199217,95313,472,009133.3
M199318,43514,121,978130.5
M199418,90414,756,639128.1
M199519,27215,413,598125
M199619,20616,065,440119.5
M199719,24716,749,813114.9
M199818,79117,273,166108.8
YearWomenMen
410-414, 429.2197958.2245.5
198057.8236.4
198157228.7
198254.1217.8
198352.9208.4
198449.7196.2
198547.8188.5
198645.4174.5
198744.6167
198842.1153.8
198939.5149.1
199038.8142.9
199138138.5
199236133.3
199335.7130.5
199435.5128.1
199534.1125
199634.4119.5
199732114.9
199830.2108.8
I20-I25199930.7106.2
200029.9103.5
200129.799.5
200229.599.4
Age 55-64 years
GenderYearDeath CountPopulationCrude Death Rate
F197921,54711,407,000188.9
F198021,83511,551,120189
F198121,57311,663,739185
F198221,11411,722,330180.1
F198320,90211,759,260177.7
F198420,17411,772,191171.4
F198519,33311,751,158164.5
F198618,40611,674,307157.7
F198717,63711,536,984152.9
F198816,97111,399,649148.9
F198915,84711,238,141141
F199015,10611,157,583135.4
F199114,73411,089,269132.9
F199213,95511,040,886126.4
F199313,69411,036,850124.1
F199413,28411,088,628119.8
F199512,94911,161,349116
F199612,75811,285,267113.1
F199712,35811,534,771107.1
F199812,05211,989,847100.5
M197960,17510,041,000599.3
M198058,99210,151,755581.1
M198157,37710,250,084559.8
M198255,89010,307,563542.2
M198353,91010,352,622520.7
M198451,94210,381,976500.3
M198549,83010,383,963479.9
M198646,63010,319,584451.9
M198743,71210,213,704428
M198841,29610,114,072408.3
M198939,27610,002,857392.6
M199037,3759,955,069375.4
M199135,7879,956,592359.4
M199234,2149,957,172343.6
M199333,5409,991,621335.7
M199432,28310,070,509320.6
M199531,39610,158,673309.1
M199630,84310,304,719299.3
M199729,72210,564,540281.3
M199828,91611,021,108262.4
GenderYearDeath CountPopulationCrude Death Rate
F199914,25412,378,763115.1
F200013,94212,629,328110.4
F200113,56813,154,612103.1
F200213,60613,817,41598.5
M199934,12311,399,263299.3
M200033,79511,645,356290.2
M200133,00612,153,966271.6
M200233,65612,784,311263.3
YearWomenMen
410-4141979188.9599.3
1980189581.1
1981185559.8
1982180.1542.2
1983177.7520.7
1984171.4500.3
1985164.5479.9
1986157.7451.9
1987152.9428
1988148.9408.3
1989141392.6
1990135.4375.4
1991132.9359.4
1992126.4343.6
1993124.1335.7
1994119.8320.6
1995116309.1
1996113.1299.3
1997107.1281.3
1998100.5262.4
I20-I251999115.1299.3
2000110.4290.2
2001103.1271.6
200298.5263.3
414-414 PLUS 429.2
GenderYearDeath CountPopulationCrude Death Rate
F197923,65211,407,000207.3
F198024,10211,551,120208.7
F198123,67111,663,739202.9
F198223,22211,722,330198.1
F198323,14911,759,260196.9
F198422,45411,772,191190.7
F198521,50611,751,158183
F198620,59411,674,307176.4
F198719,81311,536,984171.7
F198819,13811,399,649167.9
F198918,02911,238,141160.4
F199017,23211,157,583154.4
F199116,67211,089,269150.3
F199215,97011,040,886144.6
F199315,87711,036,850143.9
F199415,32511,088,628138.2
F199514,96911,161,349134.1
F199614,76011,285,267130.8
F199714,33911,534,771124.3
F199814,03311,989,847117
M197965,55210,041,000652.8
M198064,37810,151,755634.2
M198162,65510,250,084611.3
M198261,06910,307,563592.5
M198359,48910,352,622574.6
M198457,54210,381,976554.2
M198555,40410,383,963533.6
M198652,43210,319,584508.1
M198749,36710,213,704483.3
M198847,12110,114,072465.9
M198944,97310,002,857449.6
M199042,9029,955,069431
M199141,2659,956,592414.4
M199239,6859,957,172398.6
M199339,2589,991,621392.9
M199437,80510,070,509375.4
M199536,78010,158,673362.1
M199636,25710,304,719351.8
M199735,07310,564,540332
M199834,14511,021,108309.8
YearWomenMen
410-414, 429.21979207.3652.8
1980208.7634.2
1981202.9611.3
1982198.1592.5
1983196.9574.6
1984190.7554.2
1985183533.6
1986176.4508.1
1987171.7483.3
1988167.9465.9
1989160.4449.6
1990154.4431
1991150.3414.4
1992144.6398.6
1993143.9392.9
1994138.2375.4
1995134.1362.1
1996130.8351.8
1997124.3332
1998117309.8
I20-I251999115.1299.3
2000110.4290.2
2001103.1271.6
200298.5263.3
Ages 65-74
GenderYearDeath CountPopulationCrude Death Rate
F197957,0488,690,000656.5
F198059,1168,824,103669.9
F198157,8179,000,646642.4
F198257,2639,145,145626.2
F198357,1479,287,321615.3
F198456,1849,401,244597.6
F198554,6219,519,833573.8
F198653,0229,662,377548.7
F198751,9429,812,004529.4
F198850,7199,916,415511.5
F198948,55510,040,330483.6
F199047,38210,138,681467.3
F199146,27610,253,227451.3
F199245,33310,341,223438.4
F199345,38910,428,798435.2
F199443,56310,458,903416.5
F199542,95110,470,931410.2
F199641,33110,426,193396.4
F199739,01810,326,142377.9
F199837,83910,236,956369.6
M197998,7216,648,0001,485.00
M1980100,1326,756,5021,482.00
M198198,1766,889,2241,425.10
M198297,2147,002,7551,388.20
M198396,4757,126,1151,353.80
M198492,8857,225,3451,285.50
M198591,8557,338,8271,251.60
M198688,7157,474,8821,186.80
M198786,6687,614,6761,138.20
M198885,3507,709,8901,107.00
M198982,0567,823,7721,048.80
M199080,0947,906,8141,013.00
M199178,9618,040,677982
M199277,0298,144,796945.7
M199377,3538,263,821936
M199475,0058,330,888900.3
M199573,3408,395,157873.6
M199670,1738,398,295835.6
M199767,0158,357,732801.8
M199864,4018,333,291772.8
GenderYearDeath CountPopulationCrude Death Rate
F199936,65310,125,424362
F200034,33110,087,712340.3
F200132,39110,015,772323.4
F200230,7319,973,210308.1
M199962,1878,293,485749.8
M200058,5548,303,274705.2
M200155,0728,297,451663.7
M200253,1368,301,005640.1
YearWomenMen
410-414, 429.21979656.51,485.00
1980669.91,482.00
1981642.41,425.10
1982626.21,388.20
1983615.31,353.80
1984597.61,285.50
1985573.81,251.60
1986548.71,186.80
1987529.41,138.20
1988511.51,107.00
1989483.61,048.80
1990467.31,013.00
1991451.3982
1992438.4945.7
1993435.2936
1994416.5900.3
1995410.2873.6
1996396.4835.6
1997377.9801.8
1998369.6772.8
I20-I251999362749.8
2000340.3705.2
2001323.4663.7
2002308.1640.1
Ages 75-84
GenderYearDeath CountPopulationCrude Death Rate
F197998,2434,769,0002,060.00
F1980101,8294,861,8672,094.40
F198198,5825,023,4491,962.40
F198299,1275,164,2761,919.50
F1983100,2165,307,8641,888.10
F198498,8255,452,3491,812.50
F198597,7455,598,1281,746.00
F198696,2945,744,8851,676.20
F198795,0615,894,5631,612.70
F198895,5846,034,2901,584.00
F198993,9816,171,7971,522.70
F199091,5666,267,2501,461.00
F199190,2996,441,7071,401.80
F199288,2356,562,6501,344.50
F199389,5766,672,7811,342.40
F199487,5636,784,0951,290.70
F199586,7096,905,9251,255.60
F199685,4827,057,5051,211.20
F199782,8417,206,8971,149.50
F199881,5947,306,1661,116.80
M197992,1212,829,0003,256.30
M198094,8192,866,8883,307.40
M198193,3992,958,3033,157.20
M198293,6213,038,5983,081.10
M198394,8013,120,9383,037.60
M198493,8933,203,9282,930.60
M198593,8803,292,1192,851.70
M198691,5513,383,4052,705.90
M198790,8843,481,8932,610.20
M198891,9603,577,7522,570.30
M198990,4693,678,1132,459.70
M199089,5253,744,7252,390.70
M199188,7713,886,8742,283.90
M199288,2343,992,6652,209.90
M199390,5824,090,8452,214.30
M199488,4194,195,8852,107.30
M199588,9754,316,5692,061.20
M199688,7734,466,1641,987.70
M199787,6604,605,3141,903.50
M199887,3184,710,2111,853.80
GenderYearDeath CountPopulationCrude Death Rate
F199981,9917,411,1981,106.30
F200078,9457,481,8271,055.20
F200176,9017,587,2431,013.60
F200274,1527,653,577968.9
M199987,3054,813,7161,813.70
M200084,7474,879,3531,736.80
M200182,9534,986,7171,663.50
M200281,2395,081,0561,598.90
YearWomenMen
410-414, 429.219792,060.003,256.30
19802,094.403,307.40
19811,962.403,157.20
19821,919.503,081.10
19831,888.103,037.60
19841,812.502,930.60
19851,746.002,851.70
19861,676.202,705.90
19871,612.702,610.20
19881,584.002,570.30
19891,522.702,459.70
19901,461.002,390.70
19911,401.802,283.90
19921,344.502,209.90
19931,342.402,214.30
19941,290.702,107.30
19951,255.602,061.20
19961,211.201,987.70
19971,149.501,903.50
I20-I2519981,116.801,853.80
19991,106.301,813.70
20001,055.201,736.80
20011,013.601,663.50
2002968.91,598.90
Ages 85+
GenderYearDeath CountPopulationCrude Death Rate
F197989,8821,521,0005,909.40
F198097,3781,558,5426,248.00
F198198,3691,648,6435,966.70
F198299,5631,720,0935,788.20
F1983104,0881,786,1085,827.60
F1984104,2821,847,7995,643.60
F1985106,5861,905,9285,592.30
F1986106,9161,963,2795,445.80
F1987107,8992,024,8095,328.80
F1988110,2092,075,0415,311.20
F1989109,5322,136,6065,126.40
F1990108,8212,180,1984,991.30
F1991110,6382,306,1354,797.60
F1992111,4542,399,0374,645.80
F1993118,1732,493,6274,739.00
F1994117,7002,574,8084,571.20
F1995120,1332,657,1364,521.10
F1996118,6212,734,9614,337.20
F1997118,2072,805,2974,213.70
F1998118,4472,885,7104,104.60
M197948,331676,0007,149.60
M198051,417681,5257,544.40
M198150,218700,5327,168.60
M198250,037716,6146,982.40
M198351,237732,3276,996.50
M198450,442746,8426,754.00
M198550,832761,3446,676.60
M198649,329778,7696,334.20
M198749,300798,2216,176.20
M198850,123810,2196,186.40
M198949,500831,1385,955.70
M199049,536841,2275,888.50
M199150,286883,0045,694.90
M199250,781915,6235,546.10
M199353,454951,9395,615.30
M199453,687986,2245,443.70
M199554,4051,023,5865,315.10
M199654,9801,059,9315,187.10
M199755,1691,100,1795,014.50
M199855,6501,146,8254,852.50
GenderYearDeath CountPopulationCrude Death Rate
F1999121,6502,960,7084,108.80
F2000119,6293,012,5893,971.00
F2001117,2033,104,6513,775.10
F2002114,9423,203,2613,588.30
M199957,7261,193,3104,837.50
M200057,6901,226,9984,701.70
M200157,1061,299,1084,395.80
M200258,4461,389,8084,205.30
YearWomenMen
410-414, 429.219795,909.407,149.60
19806,248.007,544.40
19815,966.707,168.60
19825,788.206,982.40
19835,827.606,996.50
19845,643.606,754.00
19855,592.306,676.60
19865,445.806,334.20
19875,328.806,176.20
19885,311.206,186.40
19895,126.405,955.70
19904,991.305,888.50
19914,797.605,694.90
19924,645.805,546.10
19934,739.005,615.30
19944,571.205,443.70
19954,521.105,315.10
19964,337.205,187.10
19974,213.705,014.50
19984,104.604,852.50
I20-I2519994,108.804,837.50
20003,971.004,701.70
20013,775.104,395.80
20023,588.304,205.30
Sheet5
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Women
Men
Age 35-44
Sheet6
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00
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Women
Men
Age 45-54 years
Sheet7
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00
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00
00
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00
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00
Women
Men
Age 55-64
00
00
00
00
00
00
00
00
00
00
00
00
00
00
00
00
00
00
00
00
00
00
00
00
Women
Men
Age 55-64 years; ICD9 410-414, 429.2; ICD10 I20-I25
00
00
00
00
00
00
00
00
00
00
00
00
00
00
00
00
00
00
00
00
00
00
00
00
Women
Men
Age 35-44: ICD9 410-414, 429.2; ICD10: I20-I25
00
00
00
00
00
00
00
00
00
00
00
00
00
00
00
00
00
00
00
00
00
00
00
00
Women
Men
Ages 45-54 years: ICD9 410-414, 429.2; ICD 10 I20-I25
00
00
00
00
00
00
00
00
00
00
00
00
00
00
00
00
00
00
00
00
00
00
00
00
Women
Men
Ages 65-74 years; ICD9 410-414, 429.2; ICD10 I20-I25
00
00
00
00
00
00
00
00
00
00
00
00
00
00
00
00
00
00
00
00
00
00
00
00
Women
Men
Ages 75-84; ICD9 410-414, 429.2; ICD10 I20-I25
00
00
00
00
00
00
00
00
00
00
00
00
00
00
00
00
00
00
00
00
00
00
00
00
Women
Men
Ages 85+ years: ICD9 410-414, 429.2; ICD10 I20-I25
ICD-9 410-414, 429.2 and ICD-10 I20-I25
35-44 years45-54 years55-64 years65-74 years75-84 years85+ years
YearWomenMenWomenMenWomenMenWomenMenWomenMenWomenMen
198011.252.257.8236.4208.7634.2669.91482.02094.43307.46248.07544.4
198110.751.057.0228.7202.9611.3642.41425.11962.43157.25966.77168.6
198210.547.554.1217.8198.1592.5626.21388.21919.53081.15788.26982.4
19839.745.152.9208.4196.9574.6615.31353.81888.13037.65827.66996.5
19849.543.549.7196.2190.7554.2597.61285.51812.52930.65643.66754.0
19859.242.147.8188.5183.0533.6573.81251.61746.02851.75592.36676.6
19868.941.045.4174.5176.4508.1548.71186.81676.22705.95445.86334.2
19878.438.344.6167.0171.7483.3529.41138.21612.72610.25328.86176.2
19888.035.242.1153.8167.9465.9511.51107.01584.02570.35311.26186.4
19897.433.439.5149.1160.4449.6483.61048.81522.72459.75126.45955.7
19907.132.338.8142.9154.4431.0467.31013.01461.02390.74991.35888.5
19917.631.638.0138.5150.3414.4451.3982.01401.82283.94797.65694.9
19927.931.136.0133.3144.6398.6438.4945.71344.52209.94645.85546.1
19937.930.635.7130.5143.9392.9435.2936.01342.42214.34739.05615.3
19947.929.635.5128.1138.2375.4416.5900.31290.72107.34571.25443.7
19957.929.634.1125.0134.1362.1410.2873.61255.62061.24521.15315.1
19968.028.234.4119.5130.8351.8396.4835.61211.21987.74337.25187.1
19977.426.832.0114.9124.3332.0377.9801.81149.51903.54213.75014.5
19987.726.730.2108.8117.0309.8369.6772.81116.81853.84104.64852.5
19997.926.630.7106.2115.1299.3362.0749.81106.31813.74108.84837.5
20007.625.829.9103.5110.4290.2340.3705.21055.21736.83971.04701.7
20018.125.529.799.5103.1271.6323.4663.71013.61663.53775.14395.8
20028.226.129.599.498.5263.3308.1640.1968.91598.93588.34205.3
-0.1263833992-1.20276679840-1.3223320158-6.19130434780-4.9726284585-16.80237154150-15.9977272727-37.41996047430-48.8744071146-75.78537549410-111.1033596838-136.3346837945
197911.853.758.2245.5207.3652.8656.51485.02060.03256.35909.47149.6
00
00
00
00
00
00
00
00
00
00
00
00
00
00
00
00
00
00
00
00
00
00
00
Women
Men
Year
Per 100,000 population
35-44 years
00
00
00
00
00
00
00
00
00
00
00
00
00
00
00
00
00
00
00
00
00
00
00
Women
Men
Year
Per 100,000 population
45-54 years
00
00
00
00
00
00
00
00
00
00
00
00
00
00
00
00
00
00
00
00
00
00
00
Women
Men
Year
Per 100,000 population
55-64 years
00
00
00
00
00
00
00
00
00
00
00
00
00
00
00
00
00
00
00
00
00
00
00
Women
Men
Year
Per 100,000 population
65-74 years
00
00
00
00
00
00
00
00
00
00
00
00
00
00
00
00
00
00
00
00
00
00
00
Women
Men
Year
Per 100,000 population
75-84 years
00
00
00
00
00
00
00
00
00
00
00
00
00
00
00
00
00
00
00
00
00
00
00
Women
Men
Year
Per 100,000 population
85+ years
35-44 years45-54 years55-64 years65-74 years75-84 years85+ years
YearWomenMenWomenMenWomenMenWomenMenWomenMenWomenMen
198011.252.257.8236.4208.7634.2669.91482.02094.43307.46248.07544.4
198110.7-4.5%51.0-2.3%57.0-1.4%228.7-3.3%202.9-2.8%611.3-3.6%642.4-4.1%1425.1-3.8%1962.4-6.3%3157.2-4.5%5966.7-4.5%7168.6-5.0%
198210.5-1.9%47.5-6.9%54.1-5.1%217.8-4.8%198.1-2.4%592.5-3.1%626.2-2.5%1388.2-2.6%1919.5-2.2%3081.1-2.4%5788.2-3.0%6982.4-2.6%
19839.7-7.6%45.1-5.1%52.9-2.2%208.4-4.3%196.9-0.6%574.6-3.0%615.3-1.7%1353.8-2.5%1888.1-1.6%3037.6-1.4%5827.60.7%6996.50.2%
19849.5-2.1%43.5-3.5%49.7-6.0%196.2-5.9%190.7-3.1%554.2-3.6%597.6-2.9%1285.5-5.0%1812.5-4.0%2930.6-3.5%5643.6-3.2%6754.0-3.5%
19859.2-3.2%42.1-3.2%47.8-3.8%188.5-3.9%183.0-4.0%533.6-3.7%573.8-4.0%1251.6-2.6%1746.0-3.7%2851.7-2.7%5592.3-0.9%6676.6-1.1%
19868.9-3.3%41.0-2.6%45.4-5.0%174.5-7.4%176.4-3.6%508.1-4.8%548.7-4.4%1186.8-5.2%1676.2-4.0%2705.9-5.1%5445.8-2.6%6334.2-5.1%
19878.4-5.6%38.3-6.6%44.6-1.8%167.0-4.3%171.7-2.7%483.3-4.9%529.4-3.5%1138.2-4.1%1612.7-3.8%2610.2-3.5%5328.8-2.1%6176.2-2.5%
19888.0-4.8%35.2-8.1%42.1-5.6%153.8-7.9%167.9-2.2%465.9-3.6%511.5-3.4%1107.0-2.7%1584.0-1.8%2570.3-1.5%5311.2-0.3%6186.40.2%
19897.4-7.5%33.4-5.1%39.5-6.2%149.1-3.1%160.4-4.5%449.6-3.5%483.6-5.5%1048.8-5.3%1522.7-3.9%2459.7-4.3%5126.4-3.5%5955.7-3.7%
19907.1-4.1%32.3-3.3%38.8-1.8%142.9-4.2%154.4-3.7%431.0-4.1%467.3-3.4%1013.0-3.4%1461.0-4.1%2390.7-2.8%4991.3-2.6%5888.5-1.1%
19917.67.0%31.6-2.2%38.0-2.1%138.5-3.1%150.3-2.7%414.4-3.9%451.3-3.4%982.0-3.1%1401.8-4.1%2283.9-4.5%4797.6-3.9%5694.9-3.3%
19927.93.9%31.1-1.6%36.0-5.3%133.3-3.8%144.6-3.8%398.6-3.8%438.4-2.9%945.7-3.7%1344.5-4.1%2209.9-3.2%4645.8-3.2%5546.1-2.6%
19937.90.0%30.6-1.6%35.7-0.8%130.5-2.1%143.9-0.5%392.9-1.4%435.2-0.7%936.0-1.0%1342.4-0.2%2214.30.2%4739.02.0%5615.31.2%
19947.90.0%29.6-3.3%35.5-0.6%128.1-1.8%138.2-4.0%375.4-4.5%416.5-4.3%900.3-3.8%1290.7-3.9%2107.3-4.8%4571.2-3.5%5443.7-3.1%
19957.90.0%29.60.0%34.1-3.9%125.0-2.4%134.1-3.0%362.1-3.5%410.2-1.5%873.6-3.0%1255.6-2.7%2061.2-2.2%4521.1-1.1%5315.1-2.4%
19968.01.3%28.2-4.7%34.40.9%119.5-4.4%130.8-2.5%351.8-2.8%396.4-3.4%835.6-4.3%1211.2-3.5%1987.7-3.6%4337.2-4.1%5187.1-2.4%
19977.4-7.5%26.8-5.0%32.0-7.0%114.9-3.8%124.3-5.0%332.0-5.6%377.9-4.7%801.8-4.0%1149.5-5.1%1903.5-4.2%4213.7-2.8%5014.5-3.3%
19987.74.1%26.7-0.4%30.2-5.6%108.8-5.3%117.0-5.9%309.8-6.7%369.6-2.2%772.8-3.6%1116.8-2.8%1853.8-2.6%4104.6-2.6%4852.5-3.2%
19997.92.6%26.6-0.4%30.71.7%106.2-2.4%115.1-1.6%299.3-3.4%362.0-2.1%749.8-3.0%1106.3-0.9%1813.7-2.2%4108.80.1%4837.5-0.3%
20007.6-3.8%25.8-3.0%29.9-2.6%103.5-2.5%110.4-4.1%290.2-3.0%340.3-6.0%705.2-5.9%1055.2-4.6%1736.8-4.2%3971.0-3.4%4701.7-2.8%
20018.16.6%25.5-1.2%29.7-0.7%99.5-3.9%103.1-6.6%271.6-6.4%323.4-5.0%663.7-5.9%1013.6-3.9%1663.5-4.2%3775.1-4.9%4395.8-6.5%
20028.21.2%26.12.4%29.5-0.7%99.4-0.1%98.5-4.5%263.3-3.1%308.1-4.7%640.1-3.6%968.9-4.4%1598.9-3.9%3588.3-4.9%4205.3-4.3%
35-44 years45-54 years55-64 years65-74 years75-84 years85+ years
YearWomen: 35-44 yMen: 35-44 yWomen:45-54 yMen: 45-54 y
1981-4.5%-2.3%-1.4%-3.3%-0.0277910877-0.0361084831-0.0410509031-0.0383940621-0.0630252101-0.0454133156-0.0450224072-0.0498117809
1982-1.9%-6.9%-5.1%-4.8%-0.0236569739-0.0307541305-0.0252179328-0.0258929198-0.0218609865-0.0241036361-0.029916034-0.0259743883
1983-7.6%-5.1%-2.2%-4.3%-0.0060575467-0.0302109705-0.0174065794-0.024780291-0.0163584267-0.01411833440.00680695210.002019363
1984-2.1%-3.5%-6.0%-5.9%-0.031488065-0.0355029586-0.0287664554-0.0504505835-0.0400402521-0.0352251778-0.0315738898-0.0346601872
1985-3.2%-3.2%-3.8%-3.9%-0.0403775564-0.0371706965-0.0398259705-0.0263710618-0.0366896552-0.0269228144-0.0090899426-0.0114598756
1986-3.3%-2.6%-5.0%-7.4%-0.0360655738-0.0477886057-0.0437434646-0.0517737296-0.0399770905-0.0511273977-0.0261967348-0.0512835875
1987-5.6%-6.6%-1.8%-4.3%-0.0266439909-0.0488092895-0.0351740477-0.040950455-0.0378833075-0.0353671606-0.0214844467-0.024943955
1988-4.8%-8.1%-5.6%-7.9%-0.0221316249-0.0360024829-0.0338118625-0.0274117027-0.0177962423-0.015286185-0.00330280740.0016515009
1989-7.5%-5.1%-6.2%-3.1%-0.0446694461-0.0349860485-0.0545454545-0.0525745257-0.0386994949-0.0430299965-0.0347943967-0.0372914781
1990-4.1%-3.3%-1.8%-4.2%-0.0374064838-0.0413701068-0.0337055418-0.0341342487-0.0405201287-0.0280522015-0.0263537765-0.0112833084
19917.0%-2.2%-2.1%-3.1%-0.0265544041-0.0385150812-0.0342392467-0.0306021718-0.0405201916-0.0446731083-0.0388075251-0.0328776429
19923.9%-1.6%-5.3%-3.8%-0.0379241517-0.0381274131-0.0285840904-0.0369653768-0.0408760166-0.0324007181-0.0316408204-0.0261286414
19930.0%-1.6%-0.8%-2.1%-0.0048409405-0.0143000502-0.0072992701-0.0102569525-0.00156191890.00199104030.02006113050.0124772363
19940.0%-3.3%-0.6%-1.8%-0.0396108409-0.0445405956-0.04296875-0.0381410256-0.0385131108-0.0483222689-0.035408314-0.0305593646
19950.0%0.0%-3.9%-2.4%-0.0296671491-0.0354288759-0.0151260504-0.0296567811-0.0271945456-0.0218763346-0.010959923-0.0236236383
19961.3%-4.7%0.9%-4.4%-0.0246085011-0.0284451809-0.0336421258-0.0434981685-0.0353615801-0.0356588395-0.0406759417-0.0240823315
1997-7.5%-5.0%-7.0%-3.8%-0.0496941896-0.0562819784-0.0466700303-0.0404499761-0.0509412153-0.0423605172-0.0284745919-0.0332748549
19984.1%-0.4%-5.6%-5.3%-0.0587288817-0.0668674699-0.0219634824-0.0361686206-0.0284471509-0.0261097977-0.0258917341-0.0323063117
19992.6%-0.4%1.7%-2.4%-0.0162393162-0.0338928341-0.0205627706-0.0297619048-0.0094018625-0.02163124390.0010232422-0.0030911901
2000-3.8%-3.0%-2.6%-2.5%-0.0408340573-0.0304042766-0.0599447514-0.0594825287-0.0461900027-0.0423995148-0.0335377726-0.0280723514
20016.6%-1.2%-0.7%-3.9%-0.0661231884-0.0640937285-0.0496620629-0.0588485536-0.0394238059-0.0422040534-0.0493326618-0.0650615735
20021.2%2.4%-0.7%-0.1%-0.0446168768-0.0305596465-0.047309833-0.0355582341-0.0441002368-0.0388337842-0.0494821329-0.0433368215
YearWomen:55-64 yMen:55-64 yWomen:65-75 yMen:65-75 y
1981-2.8%-3.6%-4.1%-3.8%
1982-2.4%-3.1%-2.5%-2.6%
1983-0.6%-3.0%-1.7%-2.5%
1984-3.1%-3.6%-2.9%-5.0%
1985-4.0%-3.7%-4.0%-2.6%
1986-3.6%-4.8%-4.4%-5.2%
1987-2.7%-4.9%-3.5%-4.1%
1988-2.2%-3.6%-3.4%-2.7%
1989-4.5%-3.5%-5.5%-5.3%
1990-3.7%-4.1%-3.4%-3.4%
1991-2.7%-3.9%-3.4%-3.1%
1992-3.8%-3.8%-2.9%-3.7%
1993-0.5%-1.4%-0.7%-1.0%
1994-4.0%-4.5%-4.3%-3.8%
1995-3.0%-3.5%-1.5%-3.0%
1996-2.5%-2.8%-3.4%-4.3%
1997-5.0%-5.6%-4.7%-4.0%
1998-5.9%-6.7%-2.2%-3.6%
1999-1.6%-3.4%-2.1%-3.0%
2000-4.1%-3.0%-6.0%-5.9%
2001-6.6%-6.4%-5.0%-5.9%
2002-4.5%-3.1%-4.7%-3.6%
YearWomen: 75-84 yMen: 75-84 yWomen: 85+ yMen: 85+ y
1981-6.3%-4.5%-4.5%-5.0%
1982-2.2%-2.4%-3.0%-2.6%
1983-1.6%-1.4%0.7%0.2%
1984-4.0%-3.5%-3.2%-3.5%
1985-3.7%-2.7%-0.9%-1.1%
1986-4.0%-5.1%-2.6%-5.1%
1987-3.8%-3.5%-2.1%-2.5%
1988-1.8%-1.5%-0.3%0.2%
1989-3.9%-4.3%-3.5%-3.7%
1990-4.1%-2.8%-2.6%-1.1%
1991-4.1%-4.5%-3.9%-3.3%
1992-4.1%-3.2%-3.2%-2.6%
1993-0.2%0.2%2.0%1.2%
1994-3.9%-4.8%-3.5%-3.1%
1995-2.7%-2.2%-1.1%-2.4%
1996-3.5%-3.6%-4.1%-2.4%
1997-5.1%-4.2%-2.8%-3.3%
1998-2.8%-2.6%-2.6%-3.2%
1999-0.9%-2.2%0.1%-0.3%
2000-4.6%-4.2%-3.4%-2.8%
2001-3.9%-4.2%-4.9%-6.5%
2002-4.4%-3.9%-4.9%-4.3%
0000
0000
0000
0000
0000
0000
0000
0000
0000
0000
0000
0000
0000
0000
0000
0000
0000
0000
0000
0000
0000
0000
Women: 35-44 y
Men: 35-44 y
Women:45-54 y
Men: 45-54 y
Year
Percent change
0000
0000
0000
0000
0000
0000
0000
0000
0000
0000
0000
0000
0000
0000
0000
0000
0000
0000
0000
0000
0000
0000
Women: 35-44 y
Men: 35-44 y
Women:45-54 y
Men: 45-54 y
Year
Percent change
0000
0000
0000
0000
0000
0000
0000
0000
0000
0000
0000
0000
0000
0000
0000
0000
0000
0000
0000
0000
0000
0000
Women:55-64 y
Men:55-64 y
Women:65-75 y
Men:65-75 y
Year
Percent change
0000
0000
0000
0000
0000
0000
0000
0000
0000
0000
0000
0000
0000
0000
0000
0000
0000
0000
0000
0000
0000
0000
Women:55-64 y
Men:55-64 y
Women:65-75 y
Men:65-75 y
Year
Percent change
0000
0000
0000
0000
0000
0000
0000
0000
0000
0000
0000
0000
0000
0000
0000
0000
0000
0000
0000
0000
0000
0000
Women: 75-84 y
Men: 75-84 y
Women: 85+ y
Men: 85+ y
Year
Percent change
0000
0000
0000
0000
0000
0000
0000
0000
0000
0000
0000
0000
0000
0000
0000
0000
0000
0000
0000
0000
0000
0000
Women: 75-84 y
Men: 75-84 y
Women: 85+ y
Men: 85+ y
Year
Percent change
Waist circumference
Men
20-29 y4.287.84.8%
30-39 y2.793.62.9%
40-49 y2.197.72.1%
50-59 y2.5100.52.5%
60-69 y3.7101.73.6%
70+3.199.33.1%
Women
20-29 y5.680.57.0%
30-39 y486.54.6%
40-49 y2.389.72.6%
50-59 y2.494.42.5%
60-69 y2.894.53.0%
70+1.293.11.3%
Diabetes
20-39 y1.62.237.5%
40-59 y8.99.23.4%
60+ y1919.31.6%
Metabolic syndrome
20-39 y
40-59 y
60+ y
Cholesterol
-
Trends in age-specific CHD mortality rates England & Wales 1984-2004 [lines indicate 5 year moving averages]Heart~ July 2007 doi: 10.1136/hrt.2007.118323
-
CHD mortality: big falls in UK & elsewhere 25%-50% due to evidence-based therapies50% -75% due to risk factor reductions(especially smoking & cholesterol)
Using IMPACT to explain CHD trends and examine future policy options
Conclusions
-
CHD mortality: big falls in UK & elsewhere 25%-50% due to evidence-based therapies50% -75% due to risk factor reductions(especially smoking & cholesterol)
small reductions in UK risk factors could Halve CHD deaths Healthy diet & Tobacco controlremain top policy prioritiesUsing IMPACT to explain CHD trends and examine future policy options
Conclusions
-
Reserve slides
-
IMPACT Model: Main Components
RISK F FACTORS
Patient Groups
TREATMENTS
OUTCOMES CholesterolSmokingAge & SexPhysical ActivityBMI & DiabetesMedicalCABG/PTCAsurgeryBlood PressureSurvivalDeath Ford et al NEJM 2007 356 2388
-
Modelling UK trends to 2010 Unal, Critchley & Capewell Circulation 2004 109 (9) 1101; J Clin Epid 2005 58 733; Heart 2006 92 5212010predicted
-
Per 100,000
3
Death rates from CHD have been falling in the UK since the late 1970s. But decrease in mortality rates were relatively less than some other developed countries which had high rates. These falls need to be explained to better predict the future trends and to find better policy options. Modelling is one of the ways to do it.
Update this slide with latest death rates:WHO England 1997=118.7Scotland1997=150.4 /1USA1997=106.5Finland 1996=143.8New Zealand1996=127.3
-
Modelling UK trends to 2010 predictedIF additional treatmentsper 100,000 If more treatments for more patients 21,000 fewer deathsUnal, Critchley & Capewell Circulation 2004 109 (9) 1101; Heart 2006 92 521; J Clin Epid 2005 58 733
-
Per 100,000
3
Death rates from CHD have been falling in the UK since the late 1970s. But decrease in mortality rates were relatively less than some other developed countries which had high rates. These falls need to be explained to better predict the future trends and to find better policy options. Modelling is one of the ways to do it.
Update this slide with latest death rates:WHO England 1997=118.7Scotland1997=150.4 /1USA1997=106.5Finland 1996=143.8New Zealand1996=127.3
-
Modelling UK trends to 2010 predictedIF additional treatmentsper 100,000 IF modest risk factor reductionsAdditional risk factor reductions 50,000 fewer deathsIf more treatments for more patients 21,000 fewer deathsUnal, Critchley & Capewell Circulation 2004 109 (9) 1101; Heart 2006 92 521; J Clin Epid 2005 58 733
-
Per 100,000
3
Death rates from CHD have been falling in the UK since the late 1970s. But decrease in mortality rates were relatively less than some other developed countries which had high rates. These falls need to be explained to better predict the future trends and to find better policy options. Modelling is one of the ways to do it.
Update this slide with latest death rates:WHO England 1997=118.7Scotland1997=150.4 /1USA1997=106.5Finland 1996=143.8New Zealand1996=127.3
-
Natural Course of CHDThe Natural History of CHD Atheroma Atheroma & ThrombosisHanlon, Capewell et al 1997
-
CHD Prevention optionsNatural Course of CHDHanlon, Capewell et al 1997
-
US Trends in AGE-SPECIFIC CHD mortality rates: men & women aged 35 years Ford & Capewell JACC 2007 50 2128
-
Biological Risk FactorsPopulation Policies & BehavioursCombinedCVD RiskCVD PatientGroupsIMPACT2 CVD Policy ModelOUTPUTS
-
Combined CVD RiskUnstableAnginaChronic AnginaEarly Heart FailureSevere Heart FailureMIsurvivorsFirstMIStrokeOther CVDFromany StatePopulations: UK>E&W>Regions>PCTsOutputs: Population-based incidence, prevalence; Deaths prevented; Life-Years; Life expectancy; Costs; Cost-effectiveness ratiosPopulation Policies & BehavioursBiological Risk FactorsCombinedCVD RiskCVD PatientGroupsCHD DeathNon-CHD DeathRecurrentMISUDSNON-SUDSOUTPUTS
-
PhysicalActivityDietSmokingDeprivationObesity(BMI)Diabetesor IGTCholesterol LDL(& HDL)Blood PressureCombined CVD RiskUnstableAnginaChronic AnginaEarly Heart FailureSevere Heart FailureMIsurvivorsAcuteMIStrokeOther CVDAdditional CVD Risk FactorsFromany StatePopulations: UK>E&W>Regions>PCTsOutputs: Population-based incidence, prevalence; Deaths prevented; Life-Years; Life expectancy; Costs; Cost-effectiveness ratiosPopulation Policies & BehavioursBiological Risk FactorsCombinedCVD RiskCVD PatientGroupsOUTPUTSCHD DeathNon-CHD DeathRecurrentMISUDSNON-SUDS
-
IMPACT2 structure
Primary Prevention
E.g. Bayesian network
Generator
Stochastic matrices
Posterior density over states, age, gender and costs
Generator
Markov simulated patient numbers
Generator
Relative risksUptakesCostsQALYs
Generator
Incidenceandcosts
Intervention 1
Generator
Costs and QALYs
Generator
Discount rates
Intervention 2
Generator
Economicandstatistical
Generator
Baselinematrices
...
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Additional risk factor reductions achieved elsewhere UK 2000 level TARGET in 2010SMOKING 26% 17% (USA 2002)
CHOLESTEROL 5.6 5.2 (mmol/l) Gothenberg (Sweden), Stanford (USA) & Perth (Australia) BLOOD PRESSURE (Diastolic BP mmHg) 77 73 (4 mmHg fall) New Zealand (4.4 ) Finland (5.2 ) & France (6.0 )
OBESITY USA: 15% prevalence reduction by 2010 (??)
PHYSICAL ACTIVITY increase prevalence by 5% (?) [best]
DIABETES No successful community reductionsAssume 5% decrease in prevalence (??)Unal et al J Clin Epid 2005 58 733
*Greeting:Good afternoon and thank you for coming to this presentation! Today I would like to talk about our research project titled Before starting my presentation I would like to thank Simon and Julia for their valuable scientific and social support.
Guven araliklarini koyarsan iyi olur results tablosunaCHD icin akis semasini koyDegiskenlerin tanimlarini koy********