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Back to Basics, 2013POPULATION HEALTH : Vital & Health Statistics

Presented by N. Birkett, MDEpidemiology & Community

Medicine

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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)

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TOPICS

• Demography, population dynamics• Mortality• Morbidity• Summary measures of population health• Aboriginal health

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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

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903/2013

# deaths in Canada from 1979-2004; men and women.

1003/2013

Mortality RATES in Canada from 1979-2004; men and women.

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Infant Mortality, 1935-2005

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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

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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

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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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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

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CANCER: 30.3%

Circ Disease:27.6%

†

† Pneumonia & influenza grouped with respiratory disease. Would increase infectious % to about 3.4%.

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CANCER: 29.8%

Circ Disease:29.0%

††

† Pneumonia & influenza grouped with respiratory disease. Would increase infectious % to about 3.5%.

{EXTERNALCAUSES:4.8%+

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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

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Cancer and AgeAge-Specific Mortality Rates for All Cancers by Sex, Canada, 2003

Surveillance Division, CCDPC, Public Health Agency of Canada

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Cancer and AgeAge-Specific Incidence Rates for All Cancers by Sex, Canada, 2003

Surveillance Division, CCDPC, Public Health Agency of Canada

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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

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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

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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

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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

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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

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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%

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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)

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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

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Disability-Adjusted Life-Years Lost

05000

10000150002000025000300003500040000

I Communicable

MaternalPerinatalNutritional

II Chronic

III Injuries

MorbidityMortality

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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

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Deaths vs Prevalence, Canada

Aboriginal Health

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Population Pyramids

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Age-specific Fertility Rates

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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

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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

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Age-adjusted Mortality Rate

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Age-specific Mortality Ratio

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Life Expectancy at Birth in Years, by Sex

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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)

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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