03/20151 Back to Basics, 2015 POPULATION HEALTH : Vital & Health Statistics Dr. Nicholas Birkett School of Epidemiology, Public Health and Preventive Medicine.

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Back to Basics, 2015POPULATION HEALTH : Vital & Health Statistics

Dr. Nicholas BirkettSchool of Epidemiology, Public Health and

Preventive Medicine

2

LMCC Links

• Links to three objectives:

03/2015

78.2 Assessing and Measuring Health Status at the Population Level

78.1 Concepts of Health and its Determinants

78.7 Health of Special Populations

03/2015 3

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 4

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 5

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 6

Population Dynamics, 2007

Canada Nfld Nunavut

% aged >65 14%

Total fertility 1.7

Birth rate/1,000 11.3

Death rate/1,000 7.3

Rate of Natural Increase/1,000

4.0

Canada Nfld Nunavut

% aged >65 14% 15%

Total fertility 1.7 1.5

Birth rate/1,000 11.3 8.9

Death rate/1,000 7.3 8.9

Rate of Natural Increase/1,000

4.0 0

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 7

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.

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)

Afghan- istan

Canada 34,017 1.0 56 20 1.7 81 6

China

France

Japan

USA

Population(x 1,000)

Growth(%)

Dependency ratio %

% aged > 60

Total Fertility

rate

LE at birth (both

sexes)

P dying< 5 yrs

(per 1000)

Afghan- istan

Canada 34,017 1.0 56 20 1.7 81 6

China

France

Japan

USA 310,384 0.9 61 18 2.1 79 8

Population(x 1,000)

Growth(%)

Dependency ratio %

% aged > 60

Total Fertility

rate

LE at birth (both

sexes)

P dying< 5 yrs

(per 1000)

Afghan- istan

31,412 3.2 100 4 6.3 48 149

Canada 34,017 1.0 56 20 1.7 81 6

China

France

Japan

USA 310,384 0.9 61 18 2.1 79 8

Population(x 1,000)

Growth(%)

Dependency ratio %

% aged > 60

Total Fertility

rate

LE at birth (both

sexes)

P dying< 5 yrs

(per 1000)

Afghan- istan

31,412 3.2 100 4 6.3 48 149

Canada 34,017 1.0 56 20 1.7 81 6

China

France

Japan 126,536 0.1 75 30 1.4 83 3

USA 310,384 0.9 61 18 2.1 79 8

Population(x 1,000)

Growth(%)

Dependency ratio %

% aged > 60

Total Fertility

rate

LE at birth (both

sexes)

P dying< 5 yrs

(per 1000)

Afghan- istan

31,412 3.2 100 4 6.3 48 149

Canada 34,017 1.0 56 20 1.7 81 6

China 1,348,932 0.6 45 12 1.6 74 18

France

Japan 126,536 0.1 75 30 1.4 83 3

USA 310,384 0.9 61 18 2.1 79 8

Population(x 1,000)

Growth(%)

Dependency ratio %

% aged > 60

Total Fertility

rate

LE at birth (both

sexes)

P dying< 5 yrs

(per 1000)

Afghan- istan

31,412 3.2 100 4 6.3 48 149

Canada 34,017 1.0 56 20 1.7 81 6

China 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

903/2015

1003/2015

Population Pyramids

• Canada, 1901-2001• Ontario 1901-2001• Newfoundland 1949-2001• Yukon 1901-2001

General (All-Causes) Mortality

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1203/2015

# deaths in Canada from 1979-2004; men and women.

Population got:• Bigger• Older

1303/2015

Mortality RATES in Canada from 1979-2004; men and women.

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Infant Mortality, 1935-2005

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Age/sex-specific Mortality.Canada, 2005

Age at death (years)

0 20 40 60 80

Rat

e/10

0,00

0

0

2000

4000

6000

8000

10000

12000

14000CombinedMalesFemales

03/2015 16 16

Age/sex-specific Mortality.Canada, 2005

log-scale for mortality

Age at death (years)

0 20 40 60 80

Rat

e/10

0,00

0

1

10

100

1000

10000CombinedMalesFemales

17

Age-specific mortality: male:female mortality ratioCanada, 2005

1.0=same mortality in both sexes; > 1.0 -> higher male mortality

Age (years)

0 20 40 60 80

Rat

io (

M:F

)

1.0

1.2

1.4

1.6

1.8

2.0

2.2

2.4

2.6

2.8

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Rectangularization of the mortality curve

Cause-Specific Mortality

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Leading causes of death (2009)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

2103/2015

CANCER: 30.3%

Circ Disease:27.6%

†

† Pneumonia & influenza grouped with respiratory disease. Would increase infectious % to about 3.4%.

03/2015 22

CANCER: 29.8%

Circ Disease:29.0%

††

† Pneumonia & influenza grouped with respiratory disease. Would increase infectious % to about 3.5%.

{EXTERNALCAUSES:4.8%+

03/2015 23

CANCER: 31.6%

Circ Disease:27.3%

††

† Pneumonia & influenza grouped with respiratory disease. Would increase infectious % to about 3.3%.

{EXTERNALCAUSES:3.4%+

2403/2015

Cancer Cluster

Cardio-vascular Cluster

‘Other’ Cluster

2503/2015

‘Other’ Cluster

2603/2015

Suicide

Crime

2703/2015

03/2015 28

Cancer and AgeAge-Specific Mortality Rates for All Cancers by Sex, Canada, 2003

Surveillance Division, CCDPC, Public Health Agency of Canada

03/2015 29

Cancer and AgeAge-Specific Incidence Rates for All Cancers by Sex, Canada, 2003

Surveillance Division, CCDPC, Public Health Agency of Canada

03/2015 30

Time trends in MalesIncidence Mortality

1975 1980 1985 1990 1995 2000 2005

0

20

40

60

80

100

120

140

160

Prostate

Lung

Colorectal

Bladder

NHLStomach

Melanoma

Larynx

Liver

Thyroid

1980 1985 1990 1995 2000 2005

AS

MR

(/1

00

,00

0)

0

20

40

60

80

100

Prostate

Lung

Colorectal

NHL

Stomach

Oral

Larynx

Hodgkin's

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Time trends in Males (up to 2013)Incidence Mortality

03/2015 32

Time trends in FemalesIncidence Mortality

1975 1980 1985 1990 1995 2000 2005

0

20

40

60

80

100

120

140

160

Breast

Lung

Colorectal

NHLStomach

Cervix

Larynx

Thyroid

1980 1985 1990 1995 2000 2005

AS

MR

(/1

00,0

00)

0

20

40

60

80

100

Breast

Lung

Colorectal

NHL

Stomach

Cervix

03/2015 33

Time trends in Females (up to 2013)Incidence Mortality

03/2015 34

Injury Mortality in Canada, 2004

Age at death (years)

0 20 40 60 80

Rat

e/10

0,00

0

0

50

100

150

200

250

300

350

Total MVA FallsSuffocation Other unintentional Suicide Homicide

03/2015 35

Injury Mortality in Canada, 2004Excluding poeple over age 80

Age at death (years)

0 20 40 60 80

Rat

e/10

0,00

0

0

10

20

30

40

50

60

70

Total MVA FallsSuffocation Other unintentional Suicide Homicide

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

3703/2015

3803/2015

391 2 3 4 5 1 2 3 4 5

Income adequacy quintiles

Men

Women

Remaining Life Expectancy at age 25. Based on 10-year follow-up to 1991 census

03/2015

Remaining life expectancy at age 25, 1991-2001

Men Women

Total, all quintiles 53.7 59.3

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-Q1 5.3 3.3

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Probability of survival to age 75 (conditional on surviving to age 25),

1991-2001

Men Women

Total, all quintiles 66.9 80.1

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-Q1 17.2 10.3

03/2015 41

Summary Measures of Population Health

Combine mortality and a measure of morbidity

03/2015 42

03/2015 43

Impact of Chronic Diseases

Category Mortality Morbidity

Cancer 85% 15%

Cardiovascular 79% 21%

Diabetes 37% 63%

Respiratory 33% 67%

Neuropsychiatric 8% 92%

Musculoskeletal 7% 93%

Sense organs 0% 100%

03/2015 44

Summary Measures ofPopulation Health

IndicatorType

Life (Survival) Health-Adjusted Life (Survival)

Gap Years of Life Lost(YLL)

Disability-Adj Life Years (DALY)

Expectancy Life Expectancy(LE)

Health-Adj LifeExpectancy

(HALE)

03/2015 45

2001 Life Expectancy andHealth-Adjusted Life Expectancy

GenderIndicator

Males Females Difference

LE 76.9 82.0 5.1

HALE 68.3 70.8 2.5

Difference 8.6 12.8

• HALE always < LE• Females live longer (but gap is narrowing)• Females suffer more morbidity

03/2015 46

Disability-Adjusted Life-Years Lost

0

5000

10000

15000

20000

25000

30000

35000

40000

I Communicable

MaternalPerinatalNutritional

II Chronic

III Injuries

MorbidityMortality

03/2015 47

Which Chronic Diseases?

0

2000

4000

6000

8000

10000

12000

14000

Ca CVSDMRespN-PM-SSense

MorbidityMortality

Cancer CHD Diabetes Respiratory Neuro-Psych Musculoskeletal Sensory

Cancer CHD DiabetesRespiratoryNeuro-psychMusculoskeltalSensory

03/2015 48

Deaths vs Prevalence, Canada

4903/2015

Aboriginal Health

03/2015 50

Population Pyramids

03/2015 51

Age-specific Fertility Rates

03/2015 52

0

20

40

60

80

100

120

140

160

180

200

15-19 20-24 25-29 30-34 35-39 40-44

First Nations (2001-2002 average)

General Canadian Population (2000)

Age group of mother (years)

Fe

rtili

ty r

ate

pe

r 1

,00

0 fe

ma

les

Percentage of Live Births by Age Group of Mother

03/2015 53

0

5

10

15

20

25

30

35

15-19 20-24 25-29 30-34 35-39 40-44

Age group of mother (years)

Per

cen

tag

e o

f liv

e b

irth

s

First Nations (2001-2002 average)

General Canadian Population (2000)

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

03/2015 57

70.466.9

60.9

76.574.371.8

75.574.068.0

82.180.879.0

0

10

20

30

40

50

60

70

80

90

1980 1990 2001

Age

(ye

ars)

Registered Indian males Canadian males Registered Indian females Canadian females

Leading Causes of Death (age-standardized)

03/2015 58

0

20

40

60

80

100

120

140

Extern

al Cau

ses o

f Inju

ry

Circul

ator

y dis

ease

s

Neopla

sms

Digesti

ve d

iseas

es

Respi

rato

ry d

iseas

es

Endoc

rine

dise

ases

Infe

ctiou

s an

d pa

rasit

ic

Men

tal a

nd b

ehav

ioura

l diso

rder

s

Genito

urina

ry d

iseas

es

Nervo

us sy

stem

Ag

e-s

tan

da

rdiz

ed

ra

te p

er

10

0,0

00

po

pu

lati

on

First Nations 2001-2002 (average)

General Canadian Population2001-2002 (average)

Potential Years of Life Lost (PYLL)

03/2015 59

8000 6000 4000 2000 0 2000 4000

External causes of injury

Ciculatory diseases

Neoplasms

Digestive diseases

Congenital malformations

Perinatal conditions

Symptoms and ill-defined

Respiratory diseases

Endocrine diseases

Infectious and parasitic

PYLL per 100,000 population

First Nations Canada

6003/2015