Back to Basics, 2015
POPULATION HEALTH :
Vital & Health Statistics
Dr. Nicholas Birkett
School of Epidemiology, Public Health and
Preventive Medicine
03/2015
1
LMCC Links
• Links to three objectives:
78.2
Assessing and Measuring Health
Status at the Population Level
78.1
Concepts of Health and its
Determinants
Health of Special Populations
78.7
03/2015
2
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
03/2015
3
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)
03/2015
4
TOPICS
•
•
•
•
•
•
Demography, population dynamics
Mortality
Morbidity
Summary measures of population health
Aboriginal health
Many slides present information on key
diseases and causes of death
03/2015
5
Population Dynamics, 2007
Canada
Nfld
Nunavut
% aged >65
14%
15%
3%
Total fertility
1.7
1.5
3.0
Birth rate/1,000
11.3
8.9
25.8
Death rate/1,000
7.3
8.9
4.3
Rate of Natural
Increase/1,000
4.0
0
21.5
03/2015
6
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.
03/2015
7
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)
Afghanistan
31,412
3.2
100
4
6.3
48
149
Canada
34,017
1.0
56
20
1.7
81
6
1,348,932
0.6
45
12
1.6
74
18
France
62,787
0.6
70
23
2.0
81
4
Japan
126,536
0.1
75
30
1.4
83
3
USA
310,384
0.9
61
18
2.1
79
8
China
03/2015
9
Population Pyramids
•
•
•
•
Canada, 1901-2001
Ontario 1901-2001
Newfoundland 1949-2001
Yukon 1901-2001
03/2015
10
General (All-Causes) Mortality
03/2015
11
# deaths in Canada from 1979-2004; men and women.
Population got:
• Bigger
• Older
03/2015
12
Mortality RATES in Canada from 1979-2004; men and women.
03/2015
13
Infant Mortality, 1935-2005
03/2015
14
Age/sex-specific Mortality.
Canada, 2005
14000
Combined
Males
Females
12000
Rate/100,000
10000
8000
6000
4000
2000
0
0
20
40
60
80
Age at death (years)
03/2015
15
Age/sex-specific Mortality.
Canada, 2005
log-scale for mortality
Combined
Males
Females
10000
Rate/100,000
1000
100
10
1
0
20
40
60
80
Age at death (years)
03/2015
16 16
Age-specific mortality: male:female mortality ratio
Canada, 2005
1.0=same mortality in both sexes; > 1.0 -> higher male mortality
2.8
2.6
2.4
Ratio (M:F)
2.2
2.0
1.8
1.6
1.4
1.2
1.0
0
20
40
Age (years)
60
80
17
Rectangularization of the mortality curve
03/2015
18
Cause-Specific Mortality
03/2015
19
Leading causes of death (2009)
03/2015
Cause
2004
2009
Cancer
30
29.8
- Lung
9(M); 8(F)
7.8
- Breast
5 (F)
4.2 (F)
- Prostate
3 (M)
3.1 (M)
Cardiovascular
28
26.6
- Ischemic heart
17
15.5
- Other circulatory
5
5.2
- Stroke
6
5.9
Respiratory disease
7
7.0
Injuries
4
4.3
Diabetes
4
2.9
Alzheimer’s disease
2
2.6
Suicide
1.6
1.6
20
Circ
Disease:
27.6%
CANCER:
30.3%
†
03/2015
† Pneumonia & influenza grouped with respiratory disease.
Would increase infectious % to about 3.4%.
21
CANCER:
29.8%
Circ
Disease:
29.0%
EXTERNAL
CAUSES:
4.8%+
{
†
†
03/2015
† Pneumonia & influenza grouped with respiratory disease.
Would increase infectious % to about 3.5%.
22
CANCER:
31.6%
Circ
Disease:
27.3%
EXTERNAL
CAUSES:
3.4%+
{
†
†
03/2015
† Pneumonia & influenza grouped with respiratory disease.
Would increase infectious % to about 3.3%.
23
Cancer
Cluster
Cardiovascular
Cluster
‘Other’
Cluster
03/2015
24
‘Other’
Cluster
03/2015
25
Suicide
Crime
03/2015
26
03/2015
27
Cancer and Age
Age-Specific Mortality Rates for All Cancers by Sex, Canada, 2003
03/2015
Surveillance Division, CCDPC, Public Health Agency of Canada
28
Cancer and Age
Age-Specific Incidence Rates for All Cancers by Sex, Canada, 2003
03/2015
Surveillance Division, CCDPC, Public Health Agency of Canada
29
Time trends in Males
Incidence
Mortality
100
160
140
Prostate
Lung
80
120
Lung
100
ASMR (/100,000)
60
80
Colorectal
40
60
Colorectal
Prostate
40
Bladder
20
Stomach
Stomach
NHL
20
Melanoma
0
1975
NHL
Larynx
Liver
Thyroid
1980
03/2015
1985
1990
1995
2000
2005
Oral
Larynx
Hodgkin's
0
1980
1985
1990
1995
2000
2005
30
Time trends in Males (up to 2013)
Incidence
Mortality
03/2015
31
Time trends in Females
Incidence
Mortality
160
100
140
80
120
100
Breast
ASMR (/100,000)
60
80
40
Lung
60
Colorectal
Breast
40
Colorectal
Lung
20
Thyroid
20
Stomach
NHL
Stomach
NHL
Cervix
Cervix
Larynx
0
1975
0
1980
03/2015
1985
1990
1995
2000
2005
1980
1985
1990
1995
2000
2005
32
Time trends in Females (up to 2013)
Incidence
Mortality
03/2015
33
Injury Mortality in Canada, 2004
350
Total
MVA
Falls
Suffocation
Other unintentional
Suicide
Homicide
300
Rate/100,000
250
200
150
100
50
0
0
20
40
60
80
Age at death (years)
03/2015
34
Injury Mortality in Canada, 2004
Excluding poeple over age 80
70
Total
MVA
Falls
Suffocation
Other unintentional
Suicide
Homicide
60
Rate/100,000
50
40
30
20
10
0
0
20
40
60
80
Age at death (years)
03/2015
35
Income Inequalities in Health
03/2015
36
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
03/2015
37
03/2015
38
Remaining Life Expectancy at age 25.
Based on 10-year follow-up to 1991 census
62
Women
60
58
Men
56
54
52
50
48
46
44
42
40
03/2015
1
2
3
4
5
1
2
Income adequacy quintiles
3
4
5
39
Remaining life expectancy at age
25, 1991-2001
Total, all quintiles
Quintile 1 (lowest)
Quintile 2
Quintile 3
Quintile 4
Quintile 5 (highest)
Difference Q5-Q1
03/2015
Men
53.7
Women
59.3
50.6
57.1
53.0
54.0
59.2
59.7
55.0
56.0
60.6
60.4
5.3
3.3
40
Probability of survival to age 75
(conditional on surviving to age 25),
1991-2001
Total, all quintiles
Quintile 1 (lowest)
Quintile 2
Quintile 3
Quintile 4
Quintile 5 (highest)
Difference Q5-Q1
03/2015
Men
66.9
Women
80.1
57.0
73.3
64.1
67.3
79.5
81.8
69.5
74.1
82.9
83.6
17.2
10.3
41
Summary Measures of
Population Health
Combine mortality and a measure of
morbidity
03/2015
42
Impact of Chronic Diseases
Category
Mortality
Morbidity
Cancer
Cardiovascular
85%
79%
15%
21%
Diabetes
37%
63%
Respiratory
33%
67%
Neuropsychiatric
8%
92%
Musculoskeletal
7%
93%
Sense organs
0%
100%
03/2015
43
Summary Measures of
Population Health
Indicator
Life (Survival)
Health-Adjusted
Life (Survival)
Years of Life Lost
(YLL)
Disability-Adj
Life Years
(DALY)
Health-Adj Life
Expectancy
(HALE)
Type
Gap
Expectancy
03/2015
Life Expectancy
(LE)
44
2001 Life Expectancy and
Health-Adjusted Life Expectancy
Gender
Indicator
LE
HALE
Difference
Males
Females
Difference
76.9
68.3
82.0
70.8
5.1
2.5
8.6
12.8
• HALE always < LE
• Females live longer (but gap is narrowing)
• Females suffer more morbidity
03/2015
45
Disability-Adjusted Life-Years Lost
40000
35000
30000
25000
20000
15000
10000
5000
0
I
II
Communicable
Chronic
Maternal
Perinatal
Nutritional
03/2015
Morbidity
Mortality
III
Injuries
46
Which Chronic Diseases?
14000
12000
10000
M
S
u
e
s
n
8000
c
s
u
o
l
r
6000
o
y
s
4000
k
e
l
2000
t
a
0
l
Ca
CVS
DMRespN-P
M-S
Sense
Cancer CHD Diabetes Respiratory Neuro-Psych Musculoskeletal
Sensory
03/2015
C
a
n
c
e
r
C
H
D
D
i
a
b
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t
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s
R
e
s
p
i
r
a
t
o
r
y
N
e
u
r
o
p
s
y
c
h
Morbidity
Mortality
47
Deaths vs Prevalence, Canada
03/2015
48
03/2015
49
Aboriginal Health
03/2015
50
Population Pyramids
03/2015
51
Age-specific Fertility Rates
200
First Nations (2001-2002 average)
180
General Canadian Population (2000)
Fertility rate per 1,000 females
160
140
120
100
80
60
40
20
0
15-19
20-24
25-29
30-34
35-39
40-44
Age group of mother (years)
03/2015
52
Percentage of Live Births by
Age Group of Mother
35
First Nations (2001-2002 average)
Percentage of live births
30
General Canadian Population (2000)
25
20
15
10
5
0
15-19
20-24
25-29
30-34
35-39
40-44
Age group of m other (years)
03/2015
53
Crude Mortality Rate
03/2015
54
Age-adjusted Mortality Rate
03/2015
55
Age-specific Mortality Ratio
03/2015
56
Life Expectancy at Birth in
Years, by Sex
Registered Indian males
Canadian males
Registered Indian females
90
71.8
70
68.0
82.1
80.8
79.0
80
Canadian females
74.3
74.0
76.5
75.5
70.4
66.9
Age (years)
60.9
60
50
40
30
20
10
0
1980
03/2015
1990
2001
57
03/2015
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en
ta
la
io
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an
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se
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as
es
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s
pa
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is
or
it o
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N
er
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sy
st
em
be
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us
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ea
di
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la
s
Age-standardized rate per 100,000 population
120
G
en
nd
tio
In
fe
c
e
ira
to
ry
do
c
es
p
En
R
st
iv
N
se
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In
ju
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of
di
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p
au
se
at
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ig
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irc
D
C
na
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Ex
te
r
Leading Causes of Death (agestandardized)
140
First Nations 2001-2002 (average)
General Canadian Population
2001-2002 (average)
80
60
40
20
0
58
Potential Years of Life Lost
(PYLL)
Infectious and parasitic
Endocrine diseases
Respiratory diseases
Symptoms and ill-defined
First Nations
Canada
Perinatal conditions
Congenital malformations
Digestive diseases
Neoplasms
Ciculatory diseases
External causes of injury
8000
6000
4000
2000
0
2000
4000
PYLL per 100,000 population
03/2015
59
03/2015
60