Upload
adele-stanley
View
234
Download
0
Embed Size (px)
Citation preview
Population Mortality and Morbidity in Ireland
April 2001
Irish Population Mortality 1962-1996
Age Standardised Mortality Rates - Ireland Population 1962-1996
0
200
400
600
800
1000
1200
140019
62
1964
1966
1968
1970
1972
1974
1976
1978
1980
1982
1984
1986
1988
1990
1992
1994
1996
Year
Dea
ths
per 1
00,0
00
m
f
Mortality Improvement by Age Group
Males FemalesAge-band % Reduction % Reduction
0-4 80% 77%5-14 51% 73%
15-24 -13% 37%25-34 3% 47%35-44 38% 57%45-54 42% 52%55-64 34% 42%65-74 19% 36%75-84 15% 32%85+ 18% 23%
Mortality rates by cause for 15-34 year olds
Males Males Females FemalesCause 15-24 25-34 15-24 25-34
Infectious and ParasiticDiseases
2% 1% 7% 1%
Malignant Neoplasms 7% 9% 10% 23%All Circulatory Diseases 3% 7% 11% 10%Injury and Poisoning 75% 66% 44% 40%Road Traffic Accidents 33% 24% 16% 18%Suicide 25% 26% 15% 12%Homicide 1% 1% 0% 3%Other 16% 15% 12% 7%All Other Diseases 13% 19% 28% 26%
Mortality Rates from Road Traffic Accidents 1962 - 1996
Trend in mortality rates from rtas - males 1968 to 1996
0%
30%
60%
90%
120%
150%
180%
210%
240%
1 3 5 7 9 11 13 15 17 19 21 23 25 27 29
year
15-24
25-34
35-44
45-54
55-64
Mortality Rates from Suicide 1962 - 1996
Trend in mortality rates from suicide - males 1976 to 1996
0%
50%
100%
150%
200%
250%
300%
350%
400%
1 2 3 4 5 6 7 8 9 10 11 12 13 14 15 16 17 18 19 20 21
year
15-24
25-34
35-44
45-54
55-64
Mortality rates by cause for 35-64 year olds
Males Males Males Females Females FemalesCause 35-44 45-54 55-64 35-44 45-54 55-64
Malignant Neoplasms 20% 30% 35% 52% 56% 47%Lung 2% 6% 9% 4% 6% 6%Digestive 3% 5% 7% 3% 5% 7%Breast 0% 0% 0% 14% 19% 14%Cervical 0% 0% 0% 9% 2% 1%Other 15% 19% 18% 22% 24% 19%All CirculatoryDiseases
24% 40% 45% 16% 17% 30%
Heart Disease 15% 29% 33% 4% 6% 15%Stroke 3% 5% 4% 6% 5% 7%Other 5% 6% 8% 6% 5% 7%Injury and Poisoning 35% 13% 5% 14% 7% 4%All Other Diseases 21% 16% 15% 18% 20% 20%
Mortality Rates from Circulatory Diseases 1962 - 1996
Trend in mortality rates from all circulatory diseases - females 1962 to 1996
0%
20%
40%
60%
80%
100%
120%
140%
1 3 5 7 9 11 13 15 17 19 21 23 25 27 29 31 33 35
year
35-44
45-54
55-64
65-74
75-84
85 and over
Mortality Rates from Circulatory Diseases 1962 - 1996
Trend in mortality rates from all circulatory diseases - males 1962 to 1996
0%
20%
40%
60%
80%
100%
120%
140%
1 3 5 7 9 11 13 15 17 19 21 23 25 27 29 31 33 35
year
35-44
45-54
55-64
65-74
75-84
85 and over
Mortality rates by cause for over 65 year-olds
Males Males Males Females Females FemalesCause 65-74 75-84 85+ 65-74 75-84 85+
Malignant Neoplasms 30% 22% 14% 33% 20% 9%Lung 9% 5% 2% 6% 3% 1%Digestive 6% 4% 2% 5% 4% 2%Breast 0% 0% 0% 5% 2% 1%Cervical 0% 0% 0% 1% 0% 0%Other 16% 13% 10% 16% 10% 5%All CirculatoryDiseases
46% 46% 48% 41% 49% 53%
Heart Disease 31% 27% 24% 22% 24% 24%Stroke 6% 9% 11% 8% 13% 14%Other 9% 11% 13% 10% 12% 16%Pneumonia 3% 8% 13% 4% 8% 15%Injury and Poisoning 2% 1% 1% 1% 1% 2%All Other Diseases 19% 22% 23% 21% 21% 22%
Mortality Rates from Lung Cancer 1962 - 1996
Trend in mortality rates from lung cancer - males 1962 to 1996
0%
200%
400%
600%
800%
1000%
1 3 5 7 9 11 13 15 17 19 21 23 25 27 29 31 33 35
year
35-44
45-54
55-64
65-74
75-84
85 and over
Mortality Rates from Lung Cancer 1962 - 1996
Trend in mortality rates from lung cancer - females 1962 to 1996
0%
200%
400%
600%
800%
1000%
1 3 5 7 9 11 13 15 17 19 21 23 25 27 29 31 33 35
year
35-44
45-54
55-64
65-74
75-84
85 and over
Mortality Rates from Pneumonia 1962 - 1996
Trend in mortality rates from pneumonia - females 1962 to 1996
0%
30%
60%
90%
120%
150%
180%
210%
240%
270%
300%
1 3 5 7 9 11 13 15 17 19 21 23 25 27 29 31 33 35
year
65-74
75-84
85 and over
Mortality Rates from Pneumonia 1962 - 1996
Trend in mortality rates from pneumonia - males 1962 to 1996
0%
30%
60%
90%
120%
150%
180%
210%
240%
270%
300%
1 3 5 7 9 11 13 15 17 19 21 23 25 27 29 31 33 35
year
65-74
75-84
85 and over
Male mortality improvements by decade & age group
25-34 35-44 45-54 55-64 65-7475-84 85+
1962-1970
1971-1980
1981-19901990-1996
-0.04
-0.03
-0.02
-0.01
0
0.01
0.02
0.03
0.04
0.05
ann
ual
rat
e o
f m
ort
alit
y im
pro
vem
ent
age group
decade
Male mortality improvements Ireland Population
split by decade & age group
Female mortality improvements by decade & age group
25-34 35-44 45-5455-64 65-74 75-84
85+
1962-1970
1971-19801981-1990
1990-1996-0.015
-0.01
-0.005
0
0.005
0.01
0.015
0.02
0.025
0.03
0.035
ann
ual
rat
e o
f m
ort
alit
y im
pro
vem
ent
age group
decade
Female mortality improvements - Ireland populationsplit by decade & age group
International Experience Comparisons
Irish male age standardised mortality rates expressed as percentage of average sample country rates
Infectious and parasitic diseases
Malignant neoplasms
Stomach Cancer
Lung Cancer
Breast Cancer
Prostate Cancer
Circulatory Diseases
Heart diseases
Cerebro-vascular disease
Respiratory Diseases
Bronchitis/asthma
Digestive Diseases
Liver Diseases
External causes
RTAs
Suicide
Homicide
-80% -60% -40% -20% 0% 20% 40% 60% 80%
Source – Calculated from WHO Statistical Information System Mortality Data. Countries: Ireland, Scotland, Denmark, Germany, US, England & Wales, Australia, France, Greece, Sweden, Japan. 1996 for all except Australia 1995.
International Experience Comparisons
Irish female age standardised rates expressed as a percentage of average sample country rates
Infectious and parasitic diseases
Malignant neoplasms
Stomach Cancer
Lung Cancer
Breast Cancer
Prostate Cancer
Circulatory Diseases
Heart diseases
Cerebro-vascular disease
Respiratory Diseases
Bronchitis/asthma
Digestive Diseases
Liver Diseases
External causes
RTAs
Suicide
Homicide
-80% -30% 20% 70% 120%
Source – Calculated from WHO Statistical Information System Mortality Data. Countries: Ireland, Scotland, Denmark, Germany, US, England & Wales, Australia, France, Greece, Sweden, Japan. 1996 for all except Australia 1995.
Assessing impact of diseases on population health
Cause of death analysis
Years’ lost analysis
Disability years’ lost analysis
MalesCause of Death versus Years’ Lost
Male age standardised rate split by causeIreland population 1996
Infectious and Parasitic Diseases
All Malignant NeoplasmLung
DigestiveBreastCervical
Other All Diseases of Circulatory SystemHeart Disease
StrokeOther circulatory
Pneumonia.Bronchitis AsthmaNephrosis.
All Injury/PoisoningRoad Traffic AccidentsSuicide
HomicideOther Injury
All Other Diseases
0 50 100 150 200 250 300 350
Deaths per 100,000
Male years lost split by causeIreland population deaths 1996
Infectious and P arasitic Diseases All Malignant
NeoplasmLung
DigestiveBreastCervical
OtherAll Diseases of
Circulatory SystemHeart Disease
StrokeOther circulatory
P neumonia.Bronchitis Asthma
Nephrosis.All Injury/P oisoning
Road Traffic AccidentsSuicide
HomicideOther Injury
All Other Diseases
0 10,000 20,000 30,000 40,000 50,000
Years Lost
FemalesCause of Death versus Years’ Lost
Female age standardised rate split by causeIreland population 1996
Infectious and Parasitic Diseases
All Malignant NeoplasmLungDigestive
BreastCervical
Other All Diseases of Circulatory SystemHeart Disease
StrokeOther circulatory
Pneumonia.Bronchitis AsthmaNephrosis.
All Injury/PoisoningRoad Traffic Accidents
SuicideHomicide
Other InjuryAll Other Diseases
0 50 100 150 200 250
Deaths per 100,000
Female years lost split by causePopulation deaths 1996
Infectious and P arasitic Diseases All Malignant
NeoplasmLung
Digestive
Breast
CervicalOther
All Diseases of Circulatory System
Heart Disease
StrokeOther circulatory
P neumonia.
Bronchitis AsthmaNephrosis.
All Injury/P oisoning
Road Traffic Accidents
SuicideHomicide
Other Injury
All Other Diseases
0 10,000 20,000 30,000 40,000 50,000
Years Lost
DALYs for Australia 1996Main disease groups
0 100 200 300 400 500 600 700
Intentional injuries
Diseases of the digestive system
Diabetes mellitus
Musculoskeletal diseases
Nervous system/sense disorders
Unintentional injuries
Chronic respiratory diseases
Mental disorders
Malignant neoplasms
Cardiovascular disease
Total DALYs ('000)
YLL
YLD
Part 2
Impact of particular causes and lifestyle on Mortality
Agenda Causes
– Cardiovascular conditions– Cancer– Road Traffic Accidents– Suicide– AIDS
Risk factors– Smoking– Diet & Lifestyle
Cardiovascular diseases 43% of all deaths are due to such conditions Covers many illness types such as heart failure,
diseases of the arteries, stroke and hypertension related diseases
Mortality varies significantly by age and gender Certain types of these disease are affected by
geographic area of residence Main cause of death for those over 65 years of age Trend in EU is downwards in relation in to incidence of
such diseases Though need to consider each individual cause
separately
Cardiovascular - Heart disease For heart disease, trend is downwards for both males and
females Mirrors international experience, though fall is at a faster
rate than EU average However, is still higher than EU average
Trend in mortality rates from heart disease - males 1962 to 1996
0%
20%
40%
60%
80%
100%
120%
140%
1 3 5 7 9 11
13
15
17
19
21
23
25
27
29
31
33
35
year
35-44
45-54
55-64
65-74
75-84
85 and over
Cardiovascular - Stroke Trend is downwards for incidence of death due to a stroke
for both males and females Fall again is at a faster rate than EU average So, much so that there is no statistical difference between
Ireland and EU average experience
Trend in mortality rates from stroke - females 1962 to 1996
0%
20%
40%
60%
80%
100%
120%
140%
160%
180%
200%
1 3 5 7 9 11
13
15
17
19
21
23
25
27
29
31
33
35
year
35-44
45-54
55-64
65-74
75-84
85 and over
Cancer Like cardiovascular conditions many different
forms of cancer (Over 200 known) Not all cancers cause death Second largest cause of death in Ireland Incidence rate varies significantly between
males and females Also, within geographic areas depending upon
the form of cancer In international terms, Ireland’s cancer mortality
rates are higher than the average
Cancer – Breast cancer Ireland has one of the highest rates of breast cancer in the EU Trend for incidence at younger ages is downwards For older lives, trends appears to be upward Could be explained by differences in screening programmes Western world has significantly higher incidence of breast
cancer than developing world
Trend in mortality rates from breast cancer - females 1962 to 1996
0%
30%
60%
90%
120%
150%
180%
210%
240%
270%
300%
1 3 5 7 9 11 13 15 17 19 21 23 25 27 29 31 33 35
year
35-44
45-54
55-64
65-74
75-84
85 and over
Road Traffic Accidents Road Safety performance over last 30 years has
shown considerable improvement However:
– Still one of main cause of deaths within 15-34 age
group– By international standards relatively high
At all ages, higher incidence among males than females
By number of deaths largest number within 15-24, 25-34 and 65+ age groups
Suicide Rate of suicide has risen sharply over the last 20
years Possible reasons for the increase include:
– Underlying rate has increased significantly– Reporting may have increased– Coding may be more accurate
One of main cause of deaths within 15-34 age group Significantly higher incidence among males than
females Particularly high incidence rate among young males
Suicide Significant differences between countries These differences also are by age group
• Unable to find any conclusive reason to explain this variation though climate is a possibilty
Suicide
0
5
10
15
20
25
30
35
40Japan
Sw
eden
Austr
alia
Gre
ece
Fra
nce
Eng &
Wale
s
US
Germ
any
Denm
ark
Irela
nd
Scotland
Male Mortality Rates
Death
s p
er
100,0
00
Standardised All Ages 15-24 25-34
AIDSPattern for AIDS: Low number of cases and deaths in 1980’s followed
by a rapid increase in mid-1990’s Appears to have been dramatic fall since late 1990’s
Cases of and Deaths from AIDS in Ireland, 1982 to 2000
0
10
20
30
40
50
60
70
80
90
Year
Nu
mbe
r o
f C
ase
s
Cases
Deaths
AIDS Same picture reflected internationally
Cases of and Deaths from AIDS in the US, 1982 to 1999
0
10000
20000
30000
40000
50000
60000
70000
80000
90000
Year
Num
ber
of C
ases
Cases
Deaths
AIDS However, the AIDS pattern is not reflected in HIV rates Upwards trend since mid-1990’s
Ireland HIV infected persons by year of HIV diagnosis
0
50
100
150
200
250
300
350
400
1985 1986 1987 1988 1989 1990 1991 1992 1993 1994 1995 1996 1997 1998 1999 2000
Year of diagnosis
Nu
mb
er
of
Ca
ses
Cases
AIDS Could be explained by a change in the development
times between onset of HIV, onset of full-blown AIDS
and death due to AIDS
Working Party believes significant health issue around
increase in HIV levels
However, caution needed in predicting doom as theory
that death is only deferred is open to debate
If people are living longer then heretofore increased cost
of treatment of AIDS needs to be considered
Smoking Lifestyle factor with most widely known impact
on health Peto has completed extensive research on
smoking patterns between countries SOA study on Irish Assured Lives has found that
mortality for smokers was appproximately twice that for non-smokers
Experience from Peto suggests it is could be as high as three times that of non-smokers
Smoking
6,000 people die each year as a result of causes attributed to smoking
Certain causes affected more than others from smoking e.g. lung disease, heart disease
By international standards, Irish smoking rates comparatively low for males but high for females
Continued innovative ‘no-smoking’ campaigns are to be encouraged
Diet & Nutrition No data for working party to consider effects of
diet explicity Long term relationship between health status
and diet International studies have found that there is a
change in mortality depending upon the in-take of certain food groups
I have good news
…and even better news
The good news is
mortality will, we believe, improve over the immediate future
Reasons for this
Reasons for this
Continuation of past trends
Reasons for this
Continuation of past trends Cohort Effect
Reasons for this
Continuation of past trends Cohort Effect Increasing Wealth
Reasons for this
Continuation of past trends Cohort Effect Increasing Wealth Screening
Reasons for this
Continuation of past trends Cohort Effect Increasing Wealth Screening Smoking behaviour
The Even Better News
The scope for improvement is considerable
Reasons for this
Reasons for this
Many of the areas where we have been performing comparatively poorly are fixable
Reasons for this
Many of the areas where we have been performing comparatively poorly are fixable
Suicide levels can be brought to the levels of our neighbours
Reasons for this
Many of the areas where we have been performing comparatively poorly are fixable
Suicide levels can be brought to the levels of our neighbours
Similarly RTA
Reasons for this
Many of the areas where we have been performing comparatively poorly are fixable
Suicide levels can be brought to the levels of our neighbours
Similarly RTA Heart Disease can be brought down to
Swedish Levels
Reasons for this
Many of the areas where we have been performing comparatively poorly are fixable
Suicide levels can be brought to the levels of our neighbours
Similarly RTA Heart Disease can be brought down to
Swedish Levels Breast Cancer can be detected earlier and
this will lead to more survival
Reasons for this
Smoking levels can be reduced
Can we fix it
Can we fix it --- Yes We Can
Can we fix it --- Yes We Can
As a state we are aware of the “problems”
Can we fix it --- Yes We Can
As a state we are aware of the “problems”
We have the financial resources
Can we fix it --- Yes We Can
As a state we are aware of the “problems”
We have the financial resources Do we have the collective will?
“Rage, rage against the dying of the Light”
Dylan Thomas