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3 History After 1945 two simultaneous phenomenon: Infection diseases, infant mortality, maternal mortality decline Non-communicable diseases + injury increase
Citation preview
W.Z. CO 20061
Dramatic changes in structure of fat consumption and CVD
What can we learn from CVD trends in CEE:case of Poland
Dubai, January 7, 2006
Witold Zatoński, M.D.,Witold Zatoński, M.D.,POLANDPOLAND
Supported by European Supported by European Commission Commission grant no 2003121grant no 2003121
W.Z. CO 20062
Poland
W.Z. CO 20063
HistoryAfter 1945 two simultaneous phenomenon:
Infection diseases, infant mortality, maternal mortality decline
Non-communicable diseases + injury increase
W.Z. CO 20064
Mortality rates from all causesPoland and UK
0
100
200
300
400
500
600
700
800
1957 1962 1967 1972 1977 1982 1987 1992 1997 2002year
deat
hs /
100,
000
Poland UK
Males 0-14
200
250
300
350
400
450
500
550
600
1964 1968 1972 1976 1980 1984 1988 1992year
deat
hs /
100,
000
Poland UK
Males 15-59
W.Z. CO 20065
PROBABILITY OF DYING BY REGION, 1990(data adapted from Murray and Lopez, 1994)
0
10
20
30
40
EME CHN MEC LAC OAI IND POL SSApe
rcen
tage
INJURIES NON-COMMUNICABLE DISEASES
COMMUNICABLE DISEASES
Males, age 15-59
EME - Established Market EconomiesPOL - PolandCHN - ChinaLAC - Latin America and the Caribbean
OAI - Other Asia and IslandsMEC - Middle Eastern CrescentIND - IndiaSSA - Sub-Saharan Africa
0
10
20
30
EME POL CHN LAC OAI MEC IND SSA
perc
enta
ge
INJURIES NON-COMMUNICABLE DISEASES
COMMUNICABLE DISEASES
Males, age 0-14
W.Z. CO 20066
Male deaths at age 15-591960-1990
0
5
10
15
20
25
30
35
40
45
1960 1970 1980 1990
deat
hs /
100,
000
UK Poland
0
20
40
60
80
100
120
140
160
1960 1975 1990
deat
hs /
100,
000
Poland UK
0
50
100
150
200
250
300
1962 1972 1982 1992
deat
hs /
100,
000
Poland Finland
Lung cancer InjuriesCardiovascular diseases
W.Z. CO 20067
Mortality rates from cardiovascular diseases,Poland and Finland 1959-1991
0
200
400
600
800
1000
1200
1956 1961 1966 1971 1976 1981 1986 1991year
deat
hs /
100,
000
Finland Poland
Finland: annual decline since 1986 : 4.9%Poland: annual incline since 1964 to 1990: 2.5%
1986
1964
Males, age 45-64
0
50
100
150
200
250
300
350
400
1956 1961 1966 1971 1976 1981 1986 1991year
deat
hs /
100,
000
Finland Poland
1974
1968
Finland: annual decline since 1968 to 1991: 4.5%Poland: annual incline since 1974 to 1990: 1.1%
Females, age 45-64
W.Z. CO 20068
Economical and political transformation in central Europe.A health miracle.Democracy is healthier
W.Z. CO 20069
Premature mortality, Poland 1962-2002age group 20-64
150
200
250
300
350
400
450
1962 1970 1978 1986 1994 2002
deat
hs /
100,
000
Males Females
400
450
500
550
600
650
700
750
800
850
900
1962 1970 1978 1986 1994 2002
deat
hs /
100,
000
W.Z. CO 200610
Premature mortality in selected countries 1959-2002
0
500
1000
1500
2000
2500
1958 1965 1972 1979 1986 1993 2000year
deat
hs /
100,
000
Poland Czech Rep. Hungary Finland
Males, age 45-64
W.Z. CO 200611
Premature mortality in selected countries 1959-2002
0
100
200
300
400
500
600
700
800
900
1000
1958 1965 1972 1979 1986 1993 2000year
deat
hs /
100,
000
Poland Czech Rep. Hungary Finland
Females, age 45-64
W.Z. CO 200612
Mortality trends in Poland 1959-2002
0
100
200
300
400
500
600
700
800
900
1957 1972 1987 2002year
deat
hs /
100,
000
cvd cancers injuries
Males, age 45-64
0
50
100
150
200
250
300
1957 1972 1987 2002year
deat
hs /
100,
000
cvd cancers injuries
Females, age 45-64
W.Z. CO 200613
Unexpected phenomenon of transition period in CEE countries is rapid decrease in premature
mortality due to CVD
W.Z. CO 200614
Standardized incidence rates from myocardial infarction population of Warsaw at age 35-64 (Pol-Monica Warsaw)
0
100
200
300
400
500
600
700
800
900
1000
1984 1986 1988 1990 1992 1994year
deat
hs /
100,
000
malesfemales
-32%
-33%
Source: Stefan Rywik „Czy zmienia się zagrożenie chorobami układu krążenia w Polsce? na przykładzie populacji Warszawy w średnim wieku”
W.Z. CO 200615
Cardiovascular diseases mortality,Poland 1963-2002
0
10
20
30
40
50
60
70
80
1957 1972 1987 2002
deat
hs /
100,
000
0
100
200
300
400
500
600
700
800
900
1957 1972 1987 2002
deat
hs /
100,
000
0
500
1000
1500
2000
2500
3000
3500
4000
4500
5000
1957 1972 1987 2002
deat
hs /
100,
000
Males, age 20-44 Males, age 45-64 Males, age 65+
0
5
10
15
20
25
30
35
40
1957 1972 1987 2002
deat
hs /
100,
000
0
50
100
150
200
250
300
1957 1972 1987 2002
deat
hs /
100,
000
0
500
1000
1500
2000
2500
3000
3500
1957 1972 1987 2002
deat
hs /
100,
000
Females, age 20-44 Females, age 45-64 Females, age 65+
W.Z. CO 200616
Changes in standardized mortality rates from cardiovascular diseases, Poland 1990-2002
(expressed as a percentage, 1991=100%)
40
50
60
70
80
90
100
110
1990 1993 1996 1999 2002
year
%
-49%
-51%
50
60
70
80
90
100
110
1990 1993 1996 1999 2002year
%
-39%
-44%
60
70
80
90
100
110
1990 1993 1996 1999 2002year
% -30%
-31%
age 20-44 age 45-64 age 65 and over
males females
W.Z. CO 200617
Standardizet mortality rates from cardiovascular diseases by place of living, all age,Poland 1985-2002
250
300
350
400
450
500
550
1984 1990 1996 2002year
deat
hs /
100,
000
males - rural males - urban
-38%
-29%
150
170
190
210
230
250
270
290
310
1984 1990 1996 2002year
deat
hs /
100,
000
females - rural females - urban
-28%
-36%
femalesmales
W.Z. CO 200618
CVD mortality by education in Poland 1994 to 2002*
-15%
-40%
0
100
200
300
400
500
600
700
800
900
academic primary
deat
hs /
100,
000
1994-1996 2000-2002
femalesmales
-19%
-41%
0
100
200
300
400
500
600
700
800
900
academic primary
deat
hs /
100,
000
1994-1996 2000-2002
*age 45-64
W.Z. CO 200619
Cardiovascular diseases mortality,Poland and Finland 1963-2002
0
10
20
30
40
50
60
70
80
90
1957 1972 1987 2002
deat
hs /
100,
000
Poland
Finland
Finland: annual decrease since 1967: 4.1%Poland: annual decrease since 1991: 6.1%
0
200
400
600
800
1000
1200
1957 1972 1987 2002
deat
hs /
100,
000
Poland
Finland
Finland: annual decline since 1976: 3.6%Poland: annual decline since 1990: 3.9%
0
1000
2000
3000
4000
5000
6000
1957 1972 1987 2002
deat
hs /
100,
000
Poland
Finland
Finland: annual decrease since 1992: 3.7%
Poland: annual decrease since 1991: 3.5%
Males, age 20-44 Males, age 45-64 Males, age 65+
0
5
10
15
20
25
30
35
40
1957 1972 1987 2002
deat
hs /
100,
000
Poland
Finland
Finland: annual decrease since 1982: 2.1%Poland: annual decrease since 1991: 3.1%
0
50
100
150
200
250
300
350
400
1957 1972 1987 2002
deat
hs /
100,
000
Poland
Finland
Finland: annual decline since 1968: 4.5%Poland: annual decline since 1990: 4.7%
0
500
1000
1500
2000
2500
3000
3500
4000
4500
5000
1957 1972 1987 2002
deat
hs /
100,
000
Poland
Finland
Finland: annual decline since 1990: 3.7%Poland: annual decline since 1991: 3.1%
Females, age 20-44 Females, age 45-64
Females, age 65+
W.Z. CO 200620
Mortality trands from cardiovascular diseases,selected countries 1959-2002
300
400
500
600
700
800
900
1957 1962 1967 1972 1977 1982 1987 1992 1997 2002
deat
hs / 1
00,0
00
Poland
Czech rep.
Hungary
1990
1990
Poland: annual decline since 1990: 3.9%Czech Rep.: annual decline since 1990: 4.7%Hungary: annual decline since 1994: 3.6%
1994
Males, age 45-64
0
50
100
150
200
250
300
350
400
1957 1962 1967 1972 1977 1982 1987 1992 1997 2002
deat
hs /
100,
000
PolandCzech rep.Hungary
1990
Poland: annual decline since 1990: 4.7%Czech Rep.: annual decline since 1995: 5.2%Hungary: annual decline since 1998: 6.1%
1995
1998
Females, age 45-64
W.Z. CO 200621
„Natural” experiment in Poland
W.Z. CO 200622
Polyunsaturated / saturated fatty acids ratio in Poland, 1950-1999
0
0,1
0,2
0,3
0,4
0,5
0,6
1950 1960 1970 1980 1990 2000year
ratio
W.Z. CO 200623
Consumption of vegetable oils in Poland in 1970-2000 (kg/capita/year)
0
2
4
6
8
10
12
14
16
18
20
1970 1980 1990 2000year
kg
Source: National Food and Nutrition Institute, Poland
W.Z. CO 200624
Consumption of vegetable oils and butter in Poland in 1970-2000 (kg/capita/year)
0
2
4
6
8
10
12
14
16
18
20
1970 1975 1980 1985 1990 1995 2000year
kg
vegetable oils butter
Source: National Food and Nutrition Institute, Poland
W.Z. CO 200625
29
8
1
45
0
10
20
30
40
50
2002
%
Rape Oil
Soyabean Oil
Sunflowerseed Oil
Olive Oil
Structure of vegetable oils consumption in Poland in 2002
W.Z. CO 200626
Risk of ischaemic heart diseases* according to polyunsaturated / saturated fatty acids ratio (in NHS**)
0
0.2
0.4
0.6
0.8
1
1.2
0.23 0.29 0.34 0.38 0.42 0.45 0.49 0.54 0.6 0.72P/S Ratio in NHS (median for decile)
RR o
f CHD
in N
HS
Poland 1990
Poland 1992
Poland1994
Poland1996
1
Pred
icted
RR
for P
olan
d
**W.Willett at al., Nurses Health Study - Personal Comunication*IHS + atherosclerosis and arterial diseases at age 45-64
0.8
W.Z. CO 200627
Consumption of exotic fruit in Poland, 1983-2002 (kg/capita/quarter)
0
0,2
0,4
0,6
0,8
1
1,2
1,419
83
1984
1985
1986
1987
1988
1989
1990
1991
1992
1993
1994
1995
1996
1997
1998
1999
2000
2001
2002
year
ratio
W.Z. CO 200628
Fruits consumption in Poland in 1990-2002
0
10
20
30
40
50
60
1990 1992 1994 1996 1998 2000 2002y ear
kg /
pers
on /
year
Annual increase since 1990: 4%
W.Z. CO 200629
Vegetable consumption in Poland in 1990-2002
0
20
40
60
80
100
120
140
160
1990 1992 1994 1996 1998 2000 2002y ear
kg /
pers
on /
year
Stable trend since 1990
W.Z. CO 200630
Smoking prevalence. Adults (>15)in Poland in 1980-2002
0
10
20
30
40
50
60
70
1980 1984 1988 1992 1996 2000y ear
perc
enta
ge
Males: annual decline since 1989: 1.9% Females: stable trend since 1982
W.Z. CO 200631
0
10
20
30
40
50
60
70
80
20-29 30-39 40-49 50-59 60+
perc
enta
ge
1974 1982 1985-1989 1990-1994 1995-1999 2000-2004
64%-39%
79%-52% 70%-52%
66%-46%
51%-28%
Prevalence of tobacco smoking by age groups, males, Poland, 1974-2004
W.Z. CO 200632
0
10
20
30
40
50
60
20-29 30-39 40-49 50-59 60+
perc
enta
ge
1974 1982 1985-1988 1990-1994 1995-1999 2000-2004
45%-26%
48%-33%
23%-41%
16%-33%
8%-9%
Prevalence of tobacco smoking by age groups, females, Poland, 1974-2004
W.Z. CO 200633
Medical service
W.Z. CO 200634
Premature mortality time trends, Russia, Poland and Lithuania in 1980-2002
0
200
400
600
800
1000
1200
1400
1980 1984 1988 1992 1996 2000year
deat
hs /
100,
000
Russia
Lithuania
Poland612
521
529
1143
418
669
Males aged 15-59
W.Z. CO 200635
Life Expectancy at Birth in selected countries
63
65
67
69
71
73
75
77
79
1982 1986 1990 1994 1998 2002
Life
exp
ecta
ncy EUaverage
CzechRepublicPolandHungaryRussia