1. 03/20151 Back to Basics, 2015 POPULATION HEALTH : Vital & Health Statistics Dr. Nicholas Birkett School of Epidemiology, Public Health and Preventive Medicine

2. LMCC Links Links to three objectives: 03/20152 78.2Assessing and Measuring Health Status at the Population Level 78.1Concepts of Health and its Determinants 78.7Health of Special Populations

3. 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

4. 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)

5. 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

6. 03/20156 Population Dynamics, 2007 CanadaNfldNunavut % aged >6514% Total fertility1.7 Birth rate/1,00011.3 Death rate/1,0007.3 Rate of Natural Increase/1,000 4.0 CanadaNfldNunavut % aged >6514%15% Total fertility1.71.5 Birth rate/1,00011.38.9 Death rate/1,0007.38.9 Rate of Natural Increase/1,000 4.00 CanadaNfldNunavut % aged >6514%15%3% Total fertility1.71.53.0 Birth rate/1,00011.38.925.8 Death rate/1,0007.38.94.3 Rate of Natural Increase/1,000 4.0021.5

7. 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.

8. 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 Canada34,0171.056201.7816 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 Canada34,0171.056201.7816 China France Japan USA310,3840.961182.1798 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 31,4123.210046.348149 Canada34,0171.056201.7816 China France Japan USA310,3840.961182.1798 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 31,4123.210046.348149 Canada34,0171.056201.7816 China France Japan126,5360.175301.4833 USA310,3840.961182.1798 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 31,4123.210046.348149 Canada34,0171.056201.7816 China1,348,9320.645121.67418 France Japan126,5360.175301.4833 USA310,3840.961182.1798 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 31,4123.210046.348149 Canada34,0171.056201.7816 China1,348,9320.645121.67418 France62,7870.670232.0814 Japan126,5360.175301.4833 USA310,3840.961182.1798

9. 03/20159

10. 10 Population Pyramids Canada, 1901-2001 Ontario 1901-2001 Newfoundland 1949-2001 Yukon 1901-2001

11. General (All-Causes) Mortality 03/201511

12. 03/201512 # deaths in Canada from 1979-2004; men and women. Population got: Bigger Older

13. 03/201513 Mortality RATES in Canada from 1979-2004; men and women.

14. 03/201514 Infant Mortality, 1935-2005

15. 03/201515

16. 03/201516

17. 17

18. 03/201518 Rectangularization of the mortality curve

19. Cause-Specific Mortality 03/201519

20. 03/201520 Leading causes of death (2009) Cause20042009 Cancer3029.8 - Lung9(M); 8(F)7.8 - Breast5 (F)4.2 (F) - Prostate3 (M)3.1 (M) Cardiovascular2826.6 - Ischemic heart1715.5 - Other circulatory55.2 - Stroke65.9 Respiratory disease77.0 Injuries44.3 Diabetes42.9 Alzheimer’s disease22.6 Suicide1.6

21. 03/201521 CANCER: 30.3% Circ Disease: 27.6% † † Pneumonia & influenza grouped with respiratory disease. Would increase infectious % to about 3.4%.

22. 03/201522 CANCER: 29.8% Circ Disease: 29.0% † † † Pneumonia & influenza grouped with respiratory disease. Would increase infectious % to about 3.5%. { EXTERNAL CAUSES: 4.8%+

23. 03/201523 CANCER: 31.6% Circ Disease: 27.3% † † † Pneumonia & influenza grouped with respiratory disease. Would increase infectious % to about 3.3%. { EXTERNAL CAUSES: 3.4%+

24. 03/201524 Cancer Cluster Cardio- vascular Cluster ‘Other’ Cluster

25. 03/201525 ‘Other’ Cluster

26. 03/201526 Suicide Crime

27. 03/201527

28. 03/201528 Cancer and Age Age-Specific Mortality Rates for All Cancers by Sex, Canada, 2003 Surveillance Division, CCDPC, Public Health Agency of Canada

29. 03/201529 Cancer and Age Age-Specific Incidence Rates for All Cancers by Sex, Canada, 2003 Surveillance Division, CCDPC, Public Health Agency of Canada

30. 03/201530 Time trends in Males IncidenceMortality

31. 03/201531 Time trends in Males (up to 2013) IncidenceMortality

32. 03/201532 Time trends in Females IncidenceMortality

33. 03/201533 Time trends in Females (up to 2013) IncidenceMortality

34. 03/201534

35. 03/201535

36. Income Inequalities in Health 03/201536

37. 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. 38

39. 1 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 03/201539

40. Remaining life expectancy at age 25, 1991-2001 MenWomen Total, all quintiles53.759.3 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-Q15.33.3 03/2015 40

41. Probability of survival to age 75 (conditional on surviving to age 25), 1991-2001 MenWomen Total, all quintiles66.980.1 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-Q117.210.3 03/2015 41

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

43. 03/201543 Impact of Chronic Diseases CategoryMortalityMorbidity Cancer85%15% Cardiovascular79%21% Diabetes37%63% Respiratory33%67% Neuropsychiatric8%92% Musculoskeletal7%93% Sense organs0%100%

44. 03/201544 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)

45. 03/201545 2001 Life Expectancy and Health-Adjusted Life Expectancy Gender Indicator MalesFemalesDifference LE76.982.05.1 HALE68.370.82.5 Difference8.612.8 HALE always < LE Females live longer (but gap is narrowing) Females suffer more morbidity

46. 03/201546 Disability-Adjusted Life-Years Lost

47. 03/201547 Which Chronic Diseases? Cancer CHD Diabetes Respiratory Neuro-Psych Musculoskeletal Sensory

48. 03/201548 Deaths vs Prevalence, Canada

49. 03/201549

50. Aboriginal Health 03/201550

51. Population Pyramids 03/201551

52. Age-specific Fertility Rates 03/201552

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

54. Crude Mortality Rate 03/201554

55. Age-adjusted Mortality Rate 03/201555

56. Age-specific Mortality Ratio 03/201556

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

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

59. Potential Years of Life Lost (PYLL) 03/201559 First NationsCanada

60. 03/201560