1. 07/02/02 1 Mortality (07/02/02) Morbidity (21/02/02) (Dr JL Botha) Director, Trent Cancer Registry Hon Senior Lecturer Hannes Botha blj @ le.ac.uk Vital statistics

2. 07/02/02 2 Mortality data Death Registration –Video –Other issues Uses of mortality data –Historical –Current Problems Trends

3. 07/02/02 3 International Classification of Diseases

4. 07/02/02 4 Uses of Mortality Data Variation by Person Time Place Snow/Current

5. 07/02/02 5 “I found, moreover, that the water varied, during the next two days, in the amount of organic impurity, visible to the naked eye, on close inspection, in the form of small white, flocculent particles; and I concluded that, at the commencement of the outbreak, it might possibly have been still more impure.” “I requested permission, therefore, to take a list, at the General Register Office, of the deaths from cholera, registered during the week ending 2 nd September, in the subdistricts of Golden Square, Berwick Street, and St Ann’s, Soho, which was kindly granted. Eighty-nine deaths from cholera were registered, during the week, in the three subdistricts.” Cholera - Snow (1854)

6. 07/02/02 6 P Pump Deaths from cholera Map of cholera cases

7. 07/02/02 7 “ There is a Brewery in Broad Street, near to the pump and on perceiving that no brewer’s men were registered as having died of cholera, I called on Mr. Huggins, the proprietor. He informed me that there were above seventy workmen employed in the brewery, and that none of them had suffered from cholera, - at least in a severe form, - only two having been indisposed, and that not seriously …” Cholera ctd “The men are allowed a certain quantity of malt liquor, and Mr. Huggins believes they do not drink water at all; and he is quite certain that the workmen never obtained water from the pump in the street. There is a deep well in the brewery, in addition to the New River water.”

8. 07/02/02 8 “… the following death is recorded as occurring in the Hampstead district. ‘At West End ….the widow of a percussion-cap maker, aged 59 years, diarrhoea two hours, cholera epidemica sixteen hours.’ Cholera ctd I was informed by this lady’s son that she had not been in the neighbourhood of Broad Street for many months. A cart went from Broad Street to West End every day, and it was the custom to take out a large bottle of the water from the pump in Broad Street, as she preferred it. The water was taken on Thursday, 31 st August, and she drank of it in the evening, and also on Friday. She was seized with cholera on the evening of the latter day, and died on Saturday, …”

9. 07/02/02 9 Cholera ctd Broad Street pump’s handle removed - epidemic already declining - understanding of disease causation

10. 07/02/02 10 Uses of Mortality Data Variation by Person Time Place Snow/Current

11. 07/02/02 11 18% Ischaemic heart disease 15% Other cancers 3% Cerebrovascular disease 3% Other circulatory disease 5% Lung cancer 10% Motor vehicle traffic accidents Other accidental deaths 6% Suicide 7% Motor vehicle traffic accidents 10% Respiratory diseases 7% Other diseases 22% Distribution of years of life lost up to age 65 years * By cause of death, England & Wales, 1988 Males * Deaths under 28 days excluded Source: OPCS

12. 07/02/02 12 11% Breast cancer 6% Ischaemic heart disease 4% Lung cancer 7% Genitourinary cancer 15% Other cancers 3% Cerebrovascular disease Other accidental deaths 3% Suicide 3% Motor vehicle traffic accidents 5% Sudden infant deaths 6% Other diseases 25% Distribution of years of life lost up to age 65 years * By cause of death, England & Wales, 1988 Females * Deaths under 28 days excluded Source: OPCS Respiratory disease 6% Other circulatory 3%

13. 07/02/02 13 Distribution of total deaths By cause & age, England & Wales Males Accidents and violence Other diseases Genitourinary diseases Respiratory diseases Circulatory diseases Neoplasms Infectious diseases 100 75 50 25 0 100 75 50 25 0 0-420-2440-4460-6490+0-420-2440-4460-6490+ age Percentage of total deaths Source: Registrar General’s annual report 1931 OPCS mortality statistics 1988 1931 1988 Causes of death

14. 07/02/02 14 Distribution of total deaths By cause & age, England & Wales Females Accidents and violence Other diseases Maternal causes Genitourinary diseases Respiratory diseases Circulatory diseases Neoplasms Infectious diseases 100 75 50 25 0 100 75 50 25 0 0-420-2440-4460-6490+0-420-2440-4460-6490+ age Percentage of total deaths Source: Registrar General’s annual report 1931 OPCS mortality statistics 1988 1931 1988 Causes of death

15. 07/02/02 15 East Midlands Local Authorities Courtesy of Trent PH Obs Trent GIS Unit Male Life Expectancy 1997-99 Corby Rutland

16. 07/02/02 16 Saving Lives: Our Healthier Nation – July 1999 By the year 2010: CANCER. –Target: to reduce the death rate from cancer amongst people aged under 75 years by at least one fifth DoH website: http://www.doh.gov.uk/ohn.htmwebsite Government targets based on mortality e.g.

17. 07/02/02 17 Problems with Mortality Data Numerator –Death certification –ICD coding Denominator –Census, estimation, projection

18. 07/02/02 18 Diabetes Mellitus Death Rates Insulin ICD 6: <1949 DM always >1949 DM not

19. 07/02/02 19 Interpretation of trends Chance Artefactual –Numerator –Denominator Real –‘Natural’ (epidemiological) –Medical care effects