Population Mortality and Morbidity in Ireland n April 2001

Irish Population Mortality

Mortality Improvement by Age Group

Mortality rates by cause for year olds

Mortality Rates from Road Traffic Accidents

Mortality Rates from Suicide

Mortality rates by cause for year olds

Mortality Rates from Circulatory Diseases

Mortality rates by cause for over 65 year-olds

Mortality Rates from Lung Cancer

Mortality Rates from Pneumonia

Male mortality improvements by decade & age group

Female mortality improvements by decade & age group

International Experience Comparisons Source – Calculated from WHO Statistical Information System Mortality Data. Countries: Ireland, Scotland, Denmark, Germany, US, England & Wales, Australia, France, Greece, Sweden, Japan for all except Australia 1995.

International Experience Comparisons Source – Calculated from WHO Statistical Information System Mortality Data. Countries: Ireland, Scotland, Denmark, Germany, US, England & Wales, Australia, France, Greece, Sweden, Japan for all except Australia 1995.

Assessing impact of diseases on population health n Cause of death analysis n Years’ lost analysis n Disability years’ lost analysis

Males Cause of Death versus Years’ Lost

Females Cause of Death versus Years’ Lost

Part 2 n Impact of particular causes and lifestyle on Mortality

Agenda n Causes –Cardiovascular conditions –Cancer –Road Traffic Accidents –Suicide –AIDS n Risk factors –Smoking –Diet & Lifestyle

Cardiovascular diseases n 43% of all deaths are due to such conditions n Covers many illness types such as heart failure, diseases of the arteries, stroke and hypertension related diseases n Mortality varies significantly by age and gender n Certain types of these disease are affected by geographic area of residence n Main cause of death for those over 65 years of age n Trend in EU is downwards in relation in to incidence of such diseases n Though need to consider each individual cause separately

Cardiovascular - Heart disease n For heart disease, trend is downwards for both males and females n Mirrors international experience, though fall is at a faster rate than EU average n However, is still higher than EU average

Cardiovascular - Stroke n Trend is downwards for incidence of death due to a stroke for both males and females n Fall again is at a faster rate than EU average n So, much so that there is no statistical difference between Ireland and EU average experience

Cancer n Like cardiovascular conditions many different forms of cancer (Over 200 known) n Not all cancers cause death n Second largest cause of death in Ireland n Incidence rate varies significantly between males and females n Also, within geographic areas depending upon the form of cancer n In international terms, Ireland’s cancer mortality rates are higher than the average

Cancer – Breast cancer n Ireland has one of the highest rates of breast cancer in the EU n Trend for incidence at younger ages is downwards n For older lives, trends appears to be upward n Could be explained by differences in screening programmes n Western world has significantly higher incidence of breast cancer than developing world

Road Traffic Accidents n Road Safety performance over last 30 years has shown considerable improvement n However: –Still one of main cause of deaths within age group –By international standards relatively high n At all ages, higher incidence among males than females n By number of deaths largest number within , and 65+ age groups

Suicide n Rate of suicide has risen sharply over the last 20 years n Possible reasons for the increase include: –Underlying rate has increased significantly –Reporting may have increased –Coding may be more accurate n One of main cause of deaths within age group n Significantly higher incidence among males than females n Particularly high incidence rate among young males

Suicide n Significant differences between countries n These differences also are by age group Unable to find any conclusive reason to explain this variation though climate is a possibilty

AIDS Pattern for AIDS: n Low number of cases and deaths in 1980’s followed by a rapid increase in mid-1990’s n Appears to have been dramatic fall since late 1990’s

AIDS n Same picture reflected internationally

AIDS n However, the AIDS pattern is not reflected in HIV rates n Upwards trend since mid-1990’s

AIDS n Could be explained by a change in the development times between onset of HIV, onset of full-blown AIDS and death due to AIDS n Working Party believes significant health issue around increase in HIV levels n However, caution needed in predicting doom as theory that death is only deferred is open to debate n If people are living longer then heretofore increased cost of treatment of AIDS needs to be considered

Smoking n Lifestyle factor with most widely known impact on health n Peto has completed extensive research on smoking patterns between countries n SOA study on Irish Assured Lives has found that mortality for smokers was appproximately twice that for non-smokers n Experience from Peto suggests it is could be as high as three times that of non-smokers

Smoking n 6,000 people die each year as a result of causes attributed to smoking n Certain causes affected more than others from smoking e.g. lung disease, heart disease n By international standards, Irish smoking rates comparatively low for males but high for females n Continued innovative ‘no-smoking’ campaigns are to be encouraged

Diet & Nutrition n No data for working party to consider effects of diet explicity n Long term relationship between health status and diet n International studies have found that there is a change in mortality depending upon the in-take of certain food groups

I have good news

…and even better news

The good news is n mortality will, we believe, improve over the immediate future

Reasons for this

n Continuation of past trends

Reasons for this n Continuation of past trends n Cohort Effect

Reasons for this n Continuation of past trends n Cohort Effect n Increasing Wealth

Reasons for this n Continuation of past trends n Cohort Effect n Increasing Wealth n Screening

Reasons for this n Continuation of past trends n Cohort Effect n Increasing Wealth n Screening n Smoking behaviour

The Even Better News n The scope for improvement is considerable

Reasons for this

n Many of the areas where we have been performing comparatively poorly are fixable

Reasons for this n Many of the areas where we have been performing comparatively poorly are fixable n Suicide levels can be brought to the levels of our neighbours

Reasons for this n Many of the areas where we have been performing comparatively poorly are fixable n Suicide levels can be brought to the levels of our neighbours n Similarly RTA

Reasons for this n Many of the areas where we have been performing comparatively poorly are fixable n Suicide levels can be brought to the levels of our neighbours n Similarly RTA n Heart Disease can be brought down to Swedish Levels

Reasons for this n Many of the areas where we have been performing comparatively poorly are fixable n Suicide levels can be brought to the levels of our neighbours n Similarly RTA n Heart Disease can be brought down to Swedish Levels n Breast Cancer can be detected earlier and this will lead to more survival

Reasons for this n Smoking levels can be reduced

Can we fix it

Can we fix it --- Yes We Can

n As a state we are aware of the “problems”

Can we fix it --- Yes We Can n As a state we are aware of the “problems” n We have the financial resources

Can we fix it --- Yes We Can n As a state we are aware of the “problems” n We have the financial resources n Do we have the collective will?

“Rage, rage against the dying of the Light” Dylan Thomas