Deaths in New Zealand: History, Projections and …...A History of Survival in New Zealand: Cohort life tables 1876 –2004. 3 Deaths in New Zealand 2000-2010 30.1% of all deaths are

Deaths in New Zealand: History, Projections

and Challengesfor Palliative Care

Genesis Lecture Series

5 June 2014

1

Historic Births and Deaths 1876-2012

Baby Boomers are usually regarded as those born in the years 1946–65

Source: Statistics New Zealand data, 1876 to 2012 2

The great majority of survivorship

improvements occurred at childhood

and young adult ages.

Age by Which Selected

Percentage Have Died, by Birth Cohorts

Source: Statistics New Zealand (2006). A History of Survival in New Zealand: Cohort life tables 1876–2004.

3

Deaths in New Zealand 2000-2010

30.1% of all deaths are over age 85; 60.1% are over age 75 and 77.4% are

over age 65.

Source: Analysis of Ministry of Health MORT data 2000 to 2010 4

Historic Deaths and Future Projections by Age Band

Deaths will change in their distribution across age groups. Expected to be

a continued decline in deaths under age 65 and age 65-74, with a dramatic

increase in the number of deaths over age 85.

Source: Palliative Care Council, Working Paper No. 1, July 2013. Drawn using data from Statistics New Zealand; personal communication Joanna Broad. 5

Trajectories at the End of Life

Accidents

Cancer

Organ failure

Frailty and dementia

Source: Palliative Care Australia (2010). Health System Reform and Care at the End of Life: a Guidance Document. 2010. Canberra: Palliative Care Australia.Diagram from Lynn, J., & Adamson, D. M. (2003). Living Well at the End of Life. Adapting Health Care to Serious Chronic Illness in Old Age. 2003. RAND Health.

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Trajectories at the End of Life

The three characteristic trajectories are roughly sequential

in relation to the ages afflicted

with cancer (trajectory 1) peaking around age 65

fatal chronic organ system failure (trajectory 2) about a

decade later, and

frailty and dementia (trajectory 3) afflicting those who live

past their mid-eighties.

Source: Palliative Care Australia (2010). Health System Reform and Care at the End of Life: a Guidance Document. 2010. Canberra: Palliative Care Australia. 7

Total Deaths 1948 to 2010

Source: Analysis of Ministry of Health data: “Mortality: Historical summary

1948–2010”, published online May 2014. 8

Implications of Older Deaths

The major challenge for palliative care will be that not only will

the number of deaths be increasing, but they will be

increasing in older age bands.

These deaths are likely to be occurring to people with more

co-morbidities and a high prevalence of dementia.

If current patterns of end-of-life care continue most of these

deaths over age 85 will occur in residential aged care facilities

after an extended period of care.

Will challenge existing models of care.

Will challenge the way end of life care is funded.

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Regional and Ethnic Projections2014 to 2026

February 2014

10

Projections of Population, Births and Deaths: 2014 to 2026

Prepared annually by Statistics New Zealand, using assumptions

specified by the Ministry of Health. Usually available from late October.

Projections by prioritised ethnicity: Māori, Pacific, Asian, Other

Source: Palliative Care Council, Working Paper No. 1, July 2013.

Period of projections

2014 to 2026

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New Zealand Population 2014

The population has a relatively flat structure from childhood to age 55,

with a steep decline in numbers thereafter.

Source: Analysis of projections produced by Statistics New Zealand

according to assumptions specified by the Ministry of Health 12

Major differences between ethnic groups. Māori and Pacific have high

proportion in childhood and young adult years. Asian very high in early

working years. Other highest from age 45, with many more elderly.


according to assumptions specified by the Ministry of Health

Standardised Age Profiles by Ethnicity

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Ethnicity New Zealand 2014

The population has a relatively flat structure from childhood to age 55,

with a steep decline in numbers thereafter.



Ethnicity New Zealand 2014

Significant bulge in the Asian population in the early working years. High

proportion of children for Māori and Pacific. At oldest ages, predominantly

Other (non- Māori, non-Pacific, non-Asian).



Expected Births in New Zealand FY 2014

Māori make up 28.4% of births. Māori, Pacific and Asian together make up

more than half of births, 52.8%.



Expected Population New Zealand FY 2014

Māori make up 15.3% of the population, with Other (non- Māori, non-

Pacific, non-Asian) making up 65.8%.



Expected Deaths in New Zealand FY 2014

Māori make up 10.3% of deaths, with Other (non- Māori, non-Pacific, non-

Asian) making up 82.9%.



Expected Deaths in New Zealand by DHB, financial year 2014

T



Projected Ageing of Deaths

by Ethnicity

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Projected Deaths 2014 to 2026All Deaths in New Zealand

Over the period, the proportion of deaths over age 85 is expected to

increase from 35.7% to 40.7%.



Projected Deaths 2014 to 2026Māori Deaths



Māori deaths tend to be at much younger ages. Deaths below age 65 are

expected to decline with those at older ages increasing.

22

Projected Deaths 2014 to 2026Pacific Deaths



Pacific deaths are also at younger ages. Like Māori deaths, deaths below

age 65 are expected to decline with those at older ages increasing.

23

Projected Deaths 2014 to 2026Asian Deaths



Asian deaths are expected to show the most rapid ageing over the period,

with deaths over age 85 increasing from 18.5% to 36.5%.

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Projected Deaths 2014 to 2026Other Deaths



Deaths of the Other group, including NZ European, already occur at much

older ages and there are very few deaths under age 65. Deaths over age 85

are expected to increase from 40.7% to 46.1%.

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Deaths in New Zealand 2000-2010

30.1% of all deaths are over age 85. But 39.3% of female deaths are over age

85, while only 21.0% of male deaths are in that age band,


Place of Deathin New Zealand 2000 to 2010

April 2014

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Place of Death 2000-2010

34.2% in hospital, 30.7% in residential care and 22.3% in private residence.

Note that this seriously undercounts hospice involvement as only hospice

inpatient unit available as a place of death.


Place of Death 2010 after Hospice Adjustment

The patterns (not actual data) from the hospice benchmarking data in 2012

have been applied by indexing the deaths of clients in other settings to deaths

in hospice inpatient units. The patterns were then applied to this MORT data.

Source: Analysis of Ministry of Health MORT data 2000 to 2010; with

data from Hospice NZ29


Residential care accounts for 37.5% of female deaths but only 24.0 % of male

deaths. Private residence accounts for only 18.4% of female deaths but 26.1%

of male deaths.



Note expanding funnel shape for residential care with age. Greater proportion

of deaths of elderly women are in residential care, compared to elderly men.


Place of Death 2000-2010 Age 85+

For deaths over age 85, 54.8% in residential care and only 9.9% in private

residence. Some deaths in public hospital likely to be after transfer from

residential care.


Cause of Death and Place of Death

Work-in-progress

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Cause of Death 2000-2010

65% of deaths are from conditions other than neoplasms or external causes.


Cause of Death 2000-2010

Females account for 49.9% of deaths from all causes.


Place of Death 2000-2010Neoplasms

The largest proportion died in a private residence (28.2%), followed by hospital

(26.5%), residential care (24.1%) and hospice inpatient unit (18.6%).


Place of Death 2000-2010Other Conditions

The largest proportion died in hospital (38.5%), followed by residential care

(35.9%) and a private residence (19.1%). Hospice inpatient unit was under 1%

(0.9%) of deaths from other conditions.



18.6% of deaths from Neoplasms in hospice inpatient unit. 68.4% of deaths

from mental, behavioural and nervous system conditions are in residential care.


Need for Palliative Care

Work in progress …

Need for palliative care by diagnosis

Neoplasms

Paediatric, adolescents and young adults

Proportions needing palliative care in each setting

Residential care

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Prof Heather McLeod

Senior Analyst, Palliative CareCancer Control New Zealand

Office of the Chief Medical OfficerMinistry of Health

www.cancercontrolnz.govt.nz/palliative-care

Email: [email protected] Mobile: 0210 279 7425

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Documents

Deaths in New Zealand: History, Projections and …...A History of Survival in New Zealand: Cohort life tables 1876 –2004. 3 Deaths in New Zealand 2000-2010 30.1% of all deaths are