03/20151 Back to Basics, 2015 POPULATION HEALTH : Vital & Health Statistics Dr. Nicholas Birkett School of Epidemiology, Public Health and Preventive Medicine

LMCC Links Links to three objectives: 03/ Assessing and Measuring Health Status at the Population Level 78.1Concepts of Health and its Determinants 78.7Health of Special Populations

03/20153 Important Questions What are the main causes of illness or death in Canada? –Common things are common using epidemiology can help you run a better clinical practice Hippocrates

03/20154 Important Questions 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)

03/20155 TOPICS Demography, population dynamics Mortality Morbidity Summary measures of population health Aboriginal health Many slides present information on key diseases and causes of death

03/20156 Population Dynamics, 2007 CanadaNfldNunavut % aged >6514% Total fertility1.7 Birth rate/1, Death rate/1, Rate of Natural Increase/1, CanadaNfldNunavut % aged >6514%15% Total fertility Birth rate/1, Death rate/1, Rate of Natural Increase/1, CanadaNfldNunavut % aged >6514%15%3% Total fertility Birth rate/1, Death rate/1, Rate of Natural Increase/1,

03/20157 Some definitions Dependency ratio –a measure of the degree to which a population ‘dependent’ –Usually based on the number under age 15 and over age 65 –Compares to the number between age 15 and 65. Total Fertility rate –Average number children expected to be born to a women IF: Current fertility patterns hold throughout her lifetime.

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 Canada34, China France Japan USA 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 Canada34, China France Japan USA310, 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, Canada34, China France Japan USA310, 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, Canada34, China France Japan126, USA310, 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, Canada34, China1,348, France Japan126, USA310, 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, Canada34, China1,348, France62, Japan126, USA310,

03/20159

10 Population Pyramids Canada, Ontario Newfoundland Yukon

General (All-Causes) Mortality 03/201511

03/ # deaths in Canada from ; men and women. Population got: Bigger Older

03/ Mortality RATES in Canada from ; men and women.

03/ Infant Mortality,

03/201515

03/201516

17

03/ Rectangularization of the mortality curve

Cause-Specific Mortality 03/201519

03/ Leading causes of death (2009) Cause Cancer Lung9(M); 8(F)7.8 - Breast5 (F)4.2 (F) - Prostate3 (M)3.1 (M) Cardiovascular Ischemic heart Other circulatory Stroke65.9 Respiratory disease77.0 Injuries44.3 Diabetes42.9 Alzheimer’s disease22.6 Suicide1.6

03/ CANCER: 30.3% Circ Disease: 27.6% † † Pneumonia & influenza grouped with respiratory disease. Would increase infectious % to about 3.4%.

03/ CANCER: 29.8% Circ Disease: 29.0% † † † Pneumonia & influenza grouped with respiratory disease. Would increase infectious % to about 3.5%. { EXTERNAL CAUSES: 4.8%+

03/ CANCER: 31.6% Circ Disease: 27.3% † † † Pneumonia & influenza grouped with respiratory disease. Would increase infectious % to about 3.3%. { EXTERNAL CAUSES: 3.4%+

03/ Cancer Cluster Cardio- vascular Cluster ‘Other’ Cluster

03/ ‘Other’ Cluster

03/ Suicide Crime

03/201527

03/ Cancer and Age Age-Specific Mortality Rates for All Cancers by Sex, Canada, 2003 Surveillance Division, CCDPC, Public Health Agency of Canada

03/ Cancer and Age Age-Specific Incidence Rates for All Cancers by Sex, Canada, 2003 Surveillance Division, CCDPC, Public Health Agency of Canada

03/ Time trends in Males IncidenceMortality

03/ Time trends in Males (up to 2013) IncidenceMortality

03/ Time trends in Females IncidenceMortality

03/ Time trends in Females (up to 2013) IncidenceMortality

03/201534

03/201535

Income Inequalities in Health 03/201536

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 37 03/2015

38

Income adequacy quintiles Men Women Remaining Life Expectancy at age 25. Based on 10-year follow-up to 1991 census 03/201539

Remaining life expectancy at age 25, MenWomen Total, all quintiles Quintile 1 (lowest) Quintile Quintile Quintile Quintile 5 (highest) Difference Q5-Q /

Probability of survival to age 75 (conditional on surviving to age 25), MenWomen Total, all quintiles Quintile 1 (lowest) Quintile Quintile Quintile Quintile 5 (highest) Difference Q5-Q /

Summary Measures of Population Health Combine mortality and a measure of morbidity 03/201542

03/ Impact of Chronic Diseases CategoryMortalityMorbidity Cancer85%15% Cardiovascular79%21% Diabetes37%63% Respiratory33%67% Neuropsychiatric8%92% Musculoskeletal7%93% Sense organs0%100%

03/ Summary Measures of Population Health Indicator Type Life (Survival)Health-Adjusted Life (Survival) GapYears of Life Lost (YLL) Disability-Adj Life Years (DALY) ExpectancyLife Expectancy (LE) Health-Adj Life Expectancy (HALE)

03/ Life Expectancy and Health-Adjusted Life Expectancy Gender Indicator MalesFemalesDifference LE HALE Difference HALE always < LE Females live longer (but gap is narrowing) Females suffer more morbidity

03/ Disability-Adjusted Life-Years Lost

03/ Which Chronic Diseases? Cancer CHD Diabetes Respiratory Neuro-Psych Musculoskeletal Sensory

03/ Deaths vs Prevalence, Canada

03/201549

Aboriginal Health 03/201550

Population Pyramids 03/201551

Age-specific Fertility Rates 03/201552

Percentage of Live Births by Age Group of Mother 03/201553

Crude Mortality Rate 03/201554

Age-adjusted Mortality Rate 03/201555

Age-specific Mortality Ratio 03/201556

Life Expectancy at Birth in Years, by Sex 03/201557

Leading Causes of Death (age- standardized) 03/201558

Potential Years of Life Lost (PYLL) 03/ First NationsCanada

03/201560