1. April 13, 2011 Back to Basics, 2011 POPULATION HEALTH : Vital & Health Statistics Presented by Robert Spasoff, MD Epidemiology & Community Medicine 1

2. April 13, 2011 78.1: VITAL STATISTICS INFORMATION What are the key causes of illness or death in Canada? Common things are common – using epidemiology can help you run a better clinical practicekey causes of illness or death 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) 2

3. April 13, 2011 TOPICS Demography, population dynamics Mortality, and inequalities therein Morbidity Summary measures of population health Aboriginal health 3

4. April 13, 2011 Population Dynamics, 2007 CanadaNfldNunavut % aged 65+14%15%3% Total fertility1.71.53.0 Crude Birth rate11.38.925.8 Crude Death rate7.38.94.3 Rate of Natural Increase 4.0021.5 4

5. World Health Report, 2006 (data mostly from 2004) Population (x 1,000) Growth (%) Dependency ratio % % aged > 60 Total Fertility rate LE at birth (both sexes) P dying < 5 yrs (per 1000) Canada31,9581.04517.51.5806 USA295,4101.05016.52.0788 France60,2570.45320.91.9805 Japan127,9230.25025.61.3824 China1,315,4090.84210.81.77231 Afghan- istan 28,5743.9974.47.442257 April 13, 20115

6. Canadian Historical Population Pyramids http://www12.statcan.ca/english/census01/p roducts/analytic/companion/age/cda01pymd.cfmhttp://www12.statcan.ca/english/census01/p roducts/analytic/companion/age/cda01pymd.cfm April 13, 20116

7. Standardization An older method of adjusting for confounding (usually used for differences in age between two populations) Refers observed events to a standard population, producing hypothetical values Direct: yields age-standardized rate (ASMR) Indirect: yields standardized mortality ratio (SMR) 7

8. April 13, 2011 Mortality data Three ways to summarize them Mortality rates (crude, specific, standardized) PYLL: subtracts age at death from some “acceptable” age of death. Emphasizes causes that kill at younger ages. Life expectancy: average age at death if current mortality rates continue. Derived from life table. 8

9. General (All-Causes) Mortality April 13, 20119

10. 10 Annual NUMBER of Deaths, by Sex, Canada, 1979-2004

11. April 13, 2011 Age-Standardized Mortality RATES, Canada, 1979-2004

12. April 13, 2011 Infant Mortality, 1935-2005 12

13. April 13, 2011 Loses a lot of detail here 13

14. April 13, 2011 14

15. April 13, 201115

16. Income Inequalities in Health April 13, 201116

17. April 13, 201117

18. 1 2 3 4 5 1 2 3 4 5 Income adequacy quintiles Remaining Life Expectancy at age 25. Based on 10-year follow-up to 1991 census April 13, 201118

19. 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 April 13, 2011 19

20. 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 April 13, 2011 20

21. Cause-Specific Mortality April 13, 201121

22. April 13, 2011 Leading causes of death –Cardiovascular disease: 37% Heart disease: 20% Other circulatory disease: 10% Stroke 7% –Cancer: 28% Lung cancer: 9% (M); 6% (W) Breast cancer: 4% (W) Prostate cancer: 4% (M) –Respiratory Disease: 10% –Injuries: 6% –Diabetes: 3% –Alzheimer’s: 1% 22

23. April 13, 2011 Impact of different causes of death in Canada 2001: Mortality rates and PYLL Source: Statistics Canada 23

24. April 13, 2011 CANCER: 30.3% Circ Disease: 27.6% †† † † Pneumonia & influenza grouped with respiratory disease. Would increase infectious % to about 3.4%. 24

25. April 13, 2011 CANCER: 29.8% Circ Disease: 29.0% † † † Pneumonia & influenza grouped with respiratory disease. Would increase infectious % to about 3.5%. { EXTERNAL CAUSES: 4.8%+ 25

26. April 13, 2011 CANCER: 31.6% Circ Disease: 27.3% † † † Pneumonia & influenza grouped with respiratory disease. Would increase infectious % to about 3.3%. { EXTERNAL CAUSES: 3.4%+ 26

27. Deaths due to Cardiovascular Disease and Cancer, Canada, 1979-2004: Sex ratio (M/F) April 13, 201127

28. April 13, 2011 Loses a lot of detail here 28

29. April 13, 201129

30. April 13, 201130

31. April 13, 201131

32. April 13, 2011 Overall trends in mortality from Cancer 1976-2005: rates and numbers 32

33. April 13, 2011 Overall trends in mortality 1976-2005: rates and numbers 33

34. April 13, 2011 Cancer and Age Age-Specific Incidence Rates for All Cancers by Sex, Canada, 2003 Surveillance Division, CCDPC, Public Health Agency of Canada 34

35. April 13, 2011 Cancer and Age Age-Specific Mortality Rates for All Cancers by Sex, Canada, 2003 Surveillance Division, CCDPC, Public Health Agency of Canada 35

36. April 13, 2011 Time trends in Males IncidenceMortality 36

37. April 13, 2011 Time trends in Females IncidenceMortality 37

38. Summary Measures of Population Health April 13, 201138

39. April 13, 2011 Summary measures of population health Combine mortality and morbidity statistics, in order to provide a more comprehensive population health indicator, e.g., QALY Years lived are weighted according to quality of life, disability, etc. Two types: –Health expectancies point up from zero –Health gaps point down from ideal (Japan) 39

40. April 13, 2011 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) 40

41. April 13, 2011 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 41

42. April 13, 2011 Disability-Adjusted Life-Years Lost, by Disease Group 42

43. April 13, 2011 Which Chronic Diseases? 43

44. April 13, 2011 Impact of Chronic Diseases CategoryMortalityMorbidity Cancer85%15% Cardiovascular79%21% Diabetes37%63% Respiratory33%67% Neuropsychiatric8%92% Musculoskeletal7%93% Sense organs0%100% 44

45. April 13, 2011 Deaths vs Prevalence, Canada 45

46. LE vs HALE, Canada April 13, 201146

47. Aboriginal Health April 13, 201147

48. Population Pyramids April 13, 201148

49. April 13, 2011 Canadian population pyramids A. First Nations and overall population compared B. Animated display, showing changing Canadian population 1901 - 2001 Link to Statistics Canada 49

50. Age-specific Fertility Rates April 13, 201150

51. Percentage of Live Births by Age Group of Mother April 13, 201151

52. First Nations: Birth Weights as % of Live Births April 13, 201152

53. . Crude Mortality Rate April 13, 201153

54. Life Expectancy at Birth in Years, by Sex April 13, 201154

55. Leading Causes of Death (crude rates) April 13, 201155

56. Leading Causes of Death (age- standardized) April 13, 201156

57. Potential Years of Life Lost (PYLL) April 13, 2011 First NationsCanada 57

58. Age-standardized Potential Years of Life Lost (PYLL) by Cause of Death April 13, 201158

59. April 13, 2011 Vital & Health Statistics Multiple Choice Questions for discussion 59

60. April 13, 2011 Which of the following statements regarding the measurement of health and disease in a population is true? a) a rate is the number of times an event has occurred during a certain time interval divided by the number of persons at risk during the same interval b) when calculating a ratio, the numerator is a portion of the denominator c) a ratio is the number of times an event has occurred during a certain time interval multiplied by the number of times an event has not occurred during the same interval d) when calculating a rate, the numerator is not a portion of the denominator e) none of the above 60

61. April 13, 2011 Which of the following statements regarding the measurement of health and disease in a population is true? a) a rate is the number of times an event has occurred during a certain time interval divided by the number of persons at risk during the same interval YES, APPROXIMATELY (DENOMINATOR IS PERSON- YEARS) b) when calculating a ratio, the numerator is a portion of the denominator NOT NECESSARILY c) a ratio is the number of times an event has occurred during a certain time interval multiplied by the number of times an event has not occurred during the same interval NO, THIS IS ODDS d) when calculating a rate, the numerator is not a portion of the denominator NO, IT IS PART OF THE DENOMINATOR e) none of the above 61

62. April 13, 2011 In describing the leading causes of death in Canada, two very different lists emerge, depending on whether proportional mortality rates or person- years of life lost (PYLL) are used. This is because: a) one measure uses a calendar year and the other a fiscal year to calculate annual experience b) one measure includes morbidity as well as mortality experience c) both rates exclude deaths occurring over the age of 70 d) different definitions of “cause of death” are used e) one measure gives greater weight to deaths occurring in younger age groups 62

63. April 13, 2011 In describing the leading causes of death in Canada, two very different lists emerge, depending on whether proportional mortality rates or person- years of life lost (PYLL) are used. This is because: a) one measure uses a calendar year and the other a fiscal year to calculate annual experience NO, IT HAS NOTHING TO DO WITH MONEY b) one measure includes morbidity as well as mortality experience NO, THIS SOUNDS LIKE SUMMARY MEASURES OF POPULATION HEALTH c) both rates exclude deaths occurring over the age of 70 NO, ALTHOUGH PYLL MIGHT, IN A WAY d) different definitions of “cause of death” are used NO e) one measure gives greater weight to deaths occurring in younger age groups YES, PYLL DOES THAT 63

64. April 13, 2011 All of the following statements are true EXCEPT: a) one indirect measure of a population’s health status is the percentage of low birth weight neonates b) accidents are the largest cause of potential years of life lost in Canada c) the Canadian population is steadily undergoing rectangularization of mortality d) morbidity is defined as all health outcomes excluding death e) the neonatal mortality rate is the number of infant deaths divided by the number of live births multiplied by 1000 64

65. April 13, 2011 All of the following statements are true EXCEPT: a) one indirect measure of a population’s health status is the percentage of low birth weight neonates TRUE, ALTHOUGH INFANT MORTALITY IS USUAL b) accidents are the largest cause of potential years of life lost in Canada YES THEY ARE…..? c) the Canadian population is steadily undergoing rectangularization of mortality TRUE UP TO ABOUT AGE 85, BUT THE VERY OLD ARE LIVING LONGER d) morbidity is defined as all health outcomes excluding death NOT USUALLY DEFINED THAT WAY, BUT IT AMOUNTS TO THAT e) the neonatal mortality rate is the number of infant deaths divided by the number of live births multiplied by 1000 NO, IT IS THE NUMBER OF NEONATAL DEATHS 65

66. April 13, 2011 In 1981, the crude birth rate in Ontario was approximately 14 per 1000 and the crude death rate was 7 per 1000. The estimated rate of net migration was –1 per 1000. The growth rate of the province, per 1000 population was: a) 6 b) 7 c) 8 d) 20 e) 22 66

67. April 13, 2011 In 1981, the crude birth rate in Ontario was approximately 14 per 1000 and the crude death rate was 7 per 1000. The estimated rate of net migration was –1 per 1000. The growth rate of the province, per 1000 population was: a) 6 YUP, 14 – 7 -1 = 6 b) 7 NO, THAT IS RATE OF NATURAL INCREASE c) 8 EPIDEMIOLOGIC AND ARITHMETIC NONSENSE d) 20 DITTO e) 22 DITTO 67