1. 03/20131 Back to Basics, 2013 POPULATION HEALTH : Vital & Health Statistics Presented by N. Birkett, MD Epidemiology & Community Medicine

2. 03/20132 78.1: VITAL STATISTICS INFORMATION What are the key causes of illness or death in Canada?key causes of illness or death –Common things are common using epidemiology can help you run a better clinical practice Hipocrates 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)

3. 03/20133 TOPICS Demography, population dynamics Mortality Morbidity Summary measures of population health Aboriginal health

4. 03/20134 Population Dynamics, 2007 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

5. 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 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

6. 03/20136

7. 7 Population Pyramids Canada, 1901-2001 Ontario 1901-2001 Newfoundland 1949-2001 Yukon 1901-2001

8. General (All-Causes) Mortality 03/20138

9. 9 # deaths in Canada from 1979-2004; men and women.

10. 03/201310 Mortality RATES in Canada from 1979-2004; men and women.

11. 03/201311 Infant Mortality, 1935-2005

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15. Cause-Specific Mortality 03/201315

16. 03/201316 Leading causes of death (2009)

17. 03/201317 CANCER: 30.3% Circ Disease: 27.6% † † Pneumonia & influenza grouped with respiratory disease. Would increase infectious % to about 3.4%.

18. 03/201318 CANCER: 29.8% Circ Disease: 29.0% † † † Pneumonia & influenza grouped with respiratory disease. Would increase infectious % to about 3.5%. { EXTERNAL CAUSES: 4.8%+

19. 03/201319 CANCER: 31.6% Circ Disease: 27.3% † † † Pneumonia & influenza grouped with respiratory disease. Would increase infectious % to about 3.3%. { EXTERNAL CAUSES: 3.4%+

20. 03/201320 Cancer Cluster Cardio- vascular Cluster ‘Other’ Cluster Suicide Crime

21. 03/201321

22. 03/201322 Cancer and Age Age-Specific Mortality Rates for All Cancers by Sex, Canada, 2003 Surveillance Division, CCDPC, Public Health Agency of Canada

23. 03/201323 Cancer and Age Age-Specific Incidence Rates for All Cancers by Sex, Canada, 2003 Surveillance Division, CCDPC, Public Health Agency of Canada

24. 03/201324 Time trends in Males IncidenceMortality

25. 03/201325 Time trends in Females IncidenceMortality

26. 03/201326

27. 03/201327

28. Income Inequalities in Health 03/201328

29. 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 29 10/7/2012

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31. 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 03/201331

32. Remaining life expectancy at age 25 (conditional on surviving to 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 03/2013 32

33. 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 03/2013 33

34. Summary Measures of Population Health Combine mortality and a measure of morbidity 03/201334

35. 03/201335 Impact of Chronic Diseases CategoryMortalityMorbidity Cancer85%15% Cardiovascular79%21% Diabetes37%63% Respiratory33%67% Neuropsychiatric8%92% Musculoskeletal7%93% Sense organs0%100%

36. 03/201336 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)

37. 03/201337 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

38. 03/201338 Disability-Adjusted Life-Years Lost

39. 03/201339 Which Chronic Diseases? Cancer CHD Diabetes Respiratory Neuro-Psych Musculoskeletal Sensory

40. 03/201340 Deaths vs Prevalence, Canada

41. Aboriginal Health 03/201341

42. Population Pyramids 03/201342

43. Age-specific Fertility Rates 03/201343

44. Percentage of Live Births by Age Group of Mother 03/201344

45. Crude Mortality Rate 03/201345

46. Age-adjusted Mortality Rate 03/201346

47. Age-specific Mortality Ratio 03/201347

48. Life Expectancy at Birth in Years, by Sex 03/201348

49. Leading Causes of Death (age- standardized) 03/201349

50. Potential Years of Life Lost (PYLL) 03/201350 First NationsCanada

51. 03/201351