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The Burden of Lung Disease in Hong Kong
Moira Chan-Yeung on behalf of the Hong Kong Thoracic Society and
Hong Kong Lung Foundation
Co-authorsKS Chan Fanny W KoHS Chan Christopher LaiAmy Cheung WK Lam CM Chu CY TamAlice SS Ho KS Tsang JC Ho PC WongDavid Hui Loretta Y YamMary S Ip TJ Yao
WC Yu
Specific aims
• To determine mortality and hospitalization rates of lung diseases in 2005 in Hong Kong
• The trend in mortality and hospitalization rates of lung diseases from 1997 to 2005
• To find out the prevalence/incidence of major lung diseases and their risk factors
• To provide comprehensive data of lung diseases to authorities for informed policy making
Respiratory diseasesAll respiratory diseasesSpecific respiratory diseases
Acute respiratory infections: pneumonia, influenzaTuberculosisCOPDAsthmaRespiratory tract cancersBronchiectasisObstructive sleep apneaPneumoconiosis
Defined by ICD code
Local data sources - 1
Census and Statistics Department• Local population Department of Health• Local mortality (ICD-9 before ICD-10 after 2001)• Notification of tuberculosis
Local data sources-2
Hospital Authority: ICD-9 throughout study period• Hospitalization (principal diagnosis and head counts )• In-patient bed-days Cancer Registry• Mortality and incidence of respiratory tract cancersLocal research studies• Prevalence of asthma, COPD
Other data source - 3
World Health Organization:• Global mortality data – 2002• World population data - 2002British Thoracic Society • Mortality of respiratory diseases in UK- 2004
Hong Kong in 2005
Population: 6.81 MMortality: 38,683 (568)Hospitalization: 568,266* (8341)Inpatient bed days: 7.78 M* (114,000)
*public hospitals only( ) rate/100,000
Mortality and hospitalization rates of major diseases in 2005 in Hong Kong
Crude mortality rates of major diseases in 2005 in Hong Kong
Crude mortality rate(100,000) %
Respiratory 163 28.7Cardiovascular 148 26.1Neoplasm 126 22.3Digestive 21 3.7
All 568 100.0
Hong Kong
External causes / Injuries5.5%
Others14.9%
Respiratory 18.8%
CVS 33.3%
Neoplasm(excluding lung)
22.3%
Digestive5.3%
UK
Respiratory 27.8%
Others13.3%
External causes / Injuries7.5%
Digestive 3.7%
Neoplasm(excluding lung)
22.3%CVS
24.4%
Respiratory 18.4%
Others29.2%
External causes / Injuries9.1%
Digestive 3.5%
Neoplasm (excluding lung )10.6%
CVS 29.3%
Global
Proportion of Deaths from Different Diseases –age-standardized
Utilization of hospital beds and cost in 2005 in Hong Kong
% Bed-days Cost (HKD)
Respiratory 16.0 1242x103 4,075x106
CVS 11.6 903 2,961Neoplasm 7.2 560 1,838Digestive 5.1 396 1,298Others 4679 15,344
Total 100.0 7,780x103 25,517x106
Based on $3280/day (HA) for public hospitals
Mortality and hospitalization rates of major respiratory diseases in 2005 in Hong Kong
Mortality (%) of different respiratory diseases in 2005 in Hong Kong
All Male FemaleRespiratory infections 39.0 33.2 48.5Respiratory tract cancer 33.2 36.3 28.2COPD 17.9 21.6 11.7TB 2.4Bronchiectasis 1.7Asthma 0.9
Others 4.9Total 100.0
Respiratory infections37.3%
COPD & bronchiectasis18.5%
TB2.4%
Lung cancer34.7%
Asthma1.0%
Others 6.1%
Hong Kong
Respiratory infections27.0%
COPD & bronchiectasis23.0%
TB0.4%
Lung cancer31.7%
Asthma1.5%
Others 16.4%
UK
Respiratory infections37.8%
COPD & bronchiectasis26.2%
TB15%
Lung cancer11.9%
Asthma2.3%
Others6.9%
Global
Proportion of deaths from major respiratory diseases – age standardized
Utilization of hospital beds and cost in 2005 in Hong Kong
Bed days Cost (HKD)Respiratory infections 462.5x103 1,517x106
COPD 254.1 833.6 Respiratory tract cancer 114.6 375.8 TB 88.8 291.2Asthma 32.4 106.1Bronchiectasis 21.7 71.1
Others 259.5 851.2Total 1242.4 4,075.0
Trends in mortality, hospitalization and incidence/prevalence of major respiratory diseases in Hong Kong, 1997-2005
050
100150200250300350400
1997 1998 1999 2000 2001 2002 2003 2004 2005Year
per 1
00,0
00
Male Female To tal
0500
1000150020002500300035004000
1997 1998 1999 2000 2001 2002 2003 2004 2005
Yearpe
r 100
,000
Male Female To tal
Mortality Hospitalization
ALL RESPIRATORY DISEASES in HONG KONG(Age Standardized Rate/100,000) 1997-2005
% annual change: -2.3 (-3.5 to -1.2)* -0.3 (-2.3 to 1.7)
0
10
20
30
40
50
60
70
80
90
100
1997 1998 1999 2000 2001 2002 2003 2004 2005
Year
per
100,
000
Male Female Total
0
100
200
300
400
500
600
700
800
900
1000
1997 1998 1999 2000 2001 2002 2003 2004 2005
Ye a r
Male Female To ta l
PNEUMONIA (age standardized rates/100,000) 1997-2005
Mortality Hospitalization
% annual change: 1997-2005 -3 (-6.3 to 0.3)1997-2001 -13.5 (-18.4 to -8.2) *2001-2005 4.1 (0.3 to 8.2) *
2.8 (-1.8 to 7.7)16.7 (9.1 to 24.9) *-6.5 (-11.2 to -1.5)*
0.0
0.2
0.4
0.6
0.8
1.0
1.2
1.4
1.6
1.8
2.0
1997 1998 1999 2000 2001 2002 2003 2004 2005
Year
pe
r 10
0,00
0Male Female Total
0
10
20
30
40
50
60
70
80
90
100
1997 1998 1999 2000 2001 2002 2003 2004 2005
per 1
00,00
0
Year
Male Female Total
Mortality Hospitalization
INFLUENZA (age standardized rates/100,000) 1999-2005
% annual change: 39 (2.9 to 87.9)* 14.6 (0.2 to 31.1)*
No. of specimens submitted for viral culture and no positive
0
5000
10000
15000
20000
25000
30000
35000
40000
45000
50000
1997 1998 1999 2000 2001 2002 2003 2004 2005
Year
No.
of s
peci
men
s
Negative Positive
Mortality Hospitalization
COPD ( age standardized rates /100,000) 1997-2005
0
10
20
30
40
50
60
70
80
90
100
1997 1998 1999 2000 2001 2002 2003 2004 2005
Year
per
100
000
Male Female Total
0
50
100
150
200
250
300
350
400
450
500
1997 1998 1999 2000 2001 2002 2003 2004 2005
Yearpe
r 100
000
Male Female Total
% annual change: -3.9 (-5.2 to -2.7)* -2.8 (-4.8 to – 0.7)*
Prevalence of COPD according to GOLD criteria in Hong Kong
%
%
Stage 1: FEV1/FVC<70%; FEV1 % predicted > 80%
0
10
20
30
40
50
60
70
80
90
100
1997 1998 1999 2000 2001 2002 2003 2004 2005Year
per
100
,000
Male Female Total
0
20
40
60
80
100
120
140
160
180
200
1997 1998 1999 2000 2001 2002 2003 2004 2005
Year
pe
r 100
,000
Male Female Total
0
20
40
60
80
100
120
1997 1998 1999 2000 2001 2002 2003 2004 2005Year
Rat
e pe
r 10
0,00
0
MaleFemaleBoth
Mortality Hospitalization
Incidence
Respiratory Tract Cancers (age standardized rate/100,000)1997-2005
% annual change: -0.91 (-1.4 to - 0.4)* -3.4 (-4.3 to -2.6)*
-1.7 (-2.3 to -1.1)*
0
2
4
6
8
10
12
14
16
18
20
1997 1998 1999 2000 2001 2002 2003 2004 2005Year
pe
r 100
,000
Male Female Total
0
20
40
60
80
100
120
140
160
180
200
1997 1998 1999 2000 2001 2002 2003 2004 2005
Year
per 1
00,0
00
Male Female Total
0
50
100
150
200
250
300
350
400
450
500
1997 1998 1999 2000 2001 2002 2003 2004 2005
per 1
00,0
00
Year
MaleFemaleTotal
Mortality Hospitalization
Incidence
Tuberculosis (age standardized rates /100,000) 1997- 2005
% annual change: -2.9 (-4.8 to -1.0)* -6.4 (-7.8 to -5.0)*
-3.8 (-5 to -2.6)*
0.0
0.5
1.0
1.5
2.0
2.5
3.0
3.5
4.0
4.5
5.0
1997 1998 1999 2000 2001 2002 2003 2004 2005
Year
per
100
,000
Male Female Total
0
20
40
60
80
100
120
140
160
180
200
1997 1998 1999 2000 2001 2002 2003 2004 2005
Year
per 1
00,0
00
Male Female Total
Mortality Hospitalization
Asthma – age standardized rates/100,000 1997-2005
% annual change: -2.0 (-4.8 to 1.0) -6.2 (-9.9 to -2.4)*
Time trends of asthma in 13/14 years old schoolchildren in HK
05
1015202530
12-m
whe
eze
(WQ
)
12-m
whe
eze
(VQ
)
Dia
gnos
edas
thm
a
curr
ent
rhin
o-co
njun
ctiv
itis
curr
ent
flexu
ral
ecze
ma
%
1995 2002
GWK Wong & CKW Lai, 2002
p<0.0001 nsp<0.0001
p<0.01
ns
Summary -1
• Respiratory diseases ranked first as a cause of mortality, and hospital utilization in Hong Kong in 2005;
• There was a significant reduction in respiratory mortality but not in hospital utilization in the past decade;
• Respiratory diseases are responsible for the largest share of health care cost
Summary and recommendations-2• Respiratory infection was the most common cause
of respiratory mortality and hospital utilization in 2005
• No reduction in mortality and hospital utilization from respiratory infection in the past decade
• Influenza vaccination program provided by the government should be supported and promoted
• Pneumococcal vaccination should be considered
Summary and recommendations-3• COPD ranked 3rd as a cause of respiratory
mortality but 2nd in hospital utilization• Respiratory tract cancer ranked 2nd as a cause
of respiratory mortality and 3rd in hospital utilization
• TB ranked 4th as a cause of respiratory mortality and hospital utilization
• The major risk factor of the above diseases is tobacco smoking.
• Primary prevention of these diseases lies in tobacco control, anti-smoking, and smoke cessation
September 2007
• Air pollution is a major risk factor for acute exacerbations of asthma and COPD locally and hospitalization for these 2 diseases
Summary - 4
• Tighter air pollution control to reduce acute exacerbations and the cost of hospitalization
Recommendation
Summary and recommendations - 5
• Ideal respiratory specialist /population = 1/69,000• Hong Kong 1/95,000
72 in active practice: 43 in acute 29 in non-acute
• Need altogether 100 – especially in acute care
Acknowledgements
Hospital Authority – Dr. Vivian WongDr. S.V. LoEdwina ShungPK MakDavid Wong
Department of Health – Dr. CM TamWally Tse