Epidemiology Cardiovascular Disease in Europeassets.escardio.org/assets/Presentations/CCNAP2011/CCNAP2011-… · Hospital Discharge Cardiovascular Disease 1000 1500 2000 2500 3000

Epidemiology

Cardiovascular Disease in Europe

Wilma Scholte op Reimer, RN, PhD

Amsterdam School of Health Professions

Academic Medical Center / University of Applied Sciences Amsterdam

Disclosures

• No conflict of interest

Data sources

• WHO European Health for all database (HFA-DB)

• WHO Mortality database (WHO-MDB)

• Provides health statistics for 52 Member States of the WHO European Region

• Initiated mid-80s

• Data mainly submitted by member states

• Data from international organisations, e.g.,

– OECD health database, Paris

– United Nations Food and Agriculture Organization, Rome

– UNESCO statistical yearbook, Paris

• New data is continously collected

• June 2008

Groups of countries

• European Region: the 52 countries of the WHO Region

• EU: the Member States of the European Union

• EU-15: the 15 Member States of the European Union prior

to 1 May 2004

• EU-10: the 10 Member States which joined the European

Union from 1 May 2004

• CIS: the 12 countries of the Commonwealth of

Independent States, which are 12 out of 15 countries of

the former USSR

Increasing Life Expectancy

LIFE EXPECTANCY AT BIRTH

75 to 8070 to 7565 to 70

>=80No data

Years

Life expectancy at birth in Europe

60

65

70

75

80

1980 1985 1990 1995 2000 2005

0

70

75

80

Years

▬ European Region▬ EU-10

▬ European Union

▬ EU-15

▬ CIS

65

1980 1985 1990 1995 2000 2005 2010

Europe is ageing rapidly

POPULATION AGED 65+ YEARS

12 to 168 to 124 to 8

16 to 20No data

Percentage

Proportion of 65+ years of age

5

10

15

20

1980 1985 1990 1995 2000 2005

0

10

15

20

% 65+

▬ European Region

▬ EU-10

▬ European Union

▬ EU-15

▬ CIS

1980 1985 1990 1995 2000 2005 2010

159

141822273135404448535761667074798388

Age pyramid for Europe in 2008Age

Men Women

4 3 2 1 0 1 2 3 4

Numbers per million

90+

85

80

75

70

65

60

55

50

45

40

35

30

25

20

15

10

5

0

159

141822273135404448535761667074798388

Age pyramid for Europe in 2050Age

Men Women

4 3 2 1 0 1 2 3 4

Numbers per million

90+

85

80

75

70

65

60

55

50

45

40

35

30

25

20

15

10

5

0

Age = CVD

Major causes of death by age

0%

20%

40%

60%

80%

100%

Cardiovascular diseases Respiratory diseases Digestive disease

Cancer External causes of injury Other

0 10 20 30 40 50 60 70 80 ≥90 Total

AGE

Decreasing CVD mortality?

Standardised Cardiovascular Mortality

0

200

400

600

800

1000

1200

1980 1985 1990 1995 2000 2005

0

8

12

No / 1,000

▬ European Region

▬ EU-10

▬ European Union

▬ EU-15

▬ CIS

4

10

6

2

MEN

1980 1985 1990 1995 2000 2005 2010

0

20

40

60

80

100

EA-I EA-II ACS I CR AP DM ACS II PCI

%

Improved Secondary Prevention

since 1995Antithrombotics

Lipid lowering

Beta-blockers

ACE-I/ARB

Surveys

1995 2005-2006

Standardisation procedure

• Large heterogeneity in age across countries

• Standardisation is needed for comparison of health

indicators (e.g., mortality)

• Age-standardised death rates are calculated using the

direct method

– They represent what the crude rate would have been if the

population had the same age distribution as the European standard

population, as follows …

European standard population

7.2 to 9.64.8 to 7.2

<= 2.42.4 to 4.8

9.6 to 12.0No data

STANDARDISED CARDIOVASCULAR

MORTALITY ~ 2008 MEN

Number/1,000

Standardised Cardiovascular Mortality

0

200

400

600

800

1000

1200

1980 1985 1990 1995 2000 2005

0

8

12

No / 1,000

▬ European Region

▬ EU-10

▬ European Union

▬ EU-15

▬ CIS

4

10

6

2

MEN

1980 1985 1990 1995 2000 2005 2010

Crude Cardiovascular Mortality

0

0,2

0,4

0,6

0,8

1

1,2

1980 1985 1990 1995 2000 2005

0

8

12

No / 1,000

▬ European Region

▬ EU-10

▬ European Union

▬ EU-15

▬ CIS

4

10

6

2

MEN

1980 1985 1990 1995 2000 2005 2010

Increasing number of

hospital discharges

Hospital Discharge Cardiovascular Disease

1000

1500

2000

2500

3000

3500

1990 1995 2000 2005

No / 1,000 inhabitants

▬ European Region

▬ EU-10

▬ European Union

▬ EU-15

▬ CIS

0

25

35

20

30

15

1990 1995 2000 2005 2010

Hospital Discharge Cardiovascular Disease

1000

1500

2000

2500

3000

3500

1990 1995 2000 2005

No / 1,000 inhabitants

▬ European Region

▬ EU-10

▬ European Union

▬ EU-15

▬ CIS

0

25

35

20

30

15

Ischemic Heart Diseases

29%

Cerebrovascular Diseases

41%

1990 1995 2000 2005 2010

Hospital Discharge Cardiovascular Disease

1000

1500

2000

2500

3000

3500

1990 1995 2000 2005

No / 1,000 inhabitants

▬ European Region

▬ EU-10

▬ European Union

▬ EU-15

▬ CIS

0

25

35

20

30

15

1990 1995 2000 2005 2010

40% of hospital discharges is

due to CVD

Length of Hospital Stay

6

8

10

12

14

16

18

1985 1990 1995 2000 2005

Days

▬ European Region

▬ EU-10

▬ European Union

▬ EU-15

▬ CIS

0

12

18

10

16

8

14

1985 1990 1995 2000 2005 2010

CVD patients often suffer

from comorbidity

Underlying Heart Diseases in AFib

61

31 3025

70

41 40

29

0

20

40

60

80

Hypertension Heart failure CAD Valvular HD

≤ 75 years > 75 years

%

Number of underlying Heart Diseases

0%

20%

40%

60%

80%

100%

Age ≤ 75 Age > 75

4

3

2

1

0

Increasing number of

persons at risk

30 to 3525 to 30

< 2020 to 25

35 to 40No data

DAILY SMOKERS, AGE 15+

Percentage

20 to 2515 to 20

< 1010 to 15

> 25No data

BMI ≥ 30 kg/m2, MEN

Percentage

20 to 2515 to 20

< 1010 to 15

> 25No data

BMI ≥ 30 kg/m2, WOMEN

Percentage

Prevalence of Diabetes in Adults (Age 20-29)

0

2

4

6

8

10

12

Africa Eastern

Mediterranean

and Middle

East Region

Europe North America South &

Central

America

South-East

Asia

Western

Pacific

2003 2025

%

Also increasing number of

caregivers ?

4.2 to 5.62.8 to 4.2

1 to 1.41.4 to 2.8

5.6 to 7.0No data

PHYSICIANS PER 1,000 INHABITANTS

4.2 to 5.62.8 to 4.2

1 to 1.41.4 to 2.8

5.6 to 7.0No data

PHYSICIANS PER 1,000 INHABITANTS

Average number of physicians

in European Region

per 1,000 inhabitants:

1985: 3,0

2008: 3,5

10 to 146 to 10

2 to 33 to 6

14 to 19No data

NURSES PER 1,000 INHABITANTS

10 to 146 to 10

2 to 33 to 6

14 to 19No data

NURSES PER 1,000 INHABITANTS

6.8 nurses to 1 physician in Ireland

0.5 nurses to 1 physician in Italy

4.5 nurses to 1 physician in the Netherlands

10 to 146 to 10

2 to 33 to 6

14 to 19No data

NURSES PER 1,000 INHABITANTS

Average number of nurses

in European Region

per 1,000 inhabitants:

1985: 6,8

2008: 6,7

Thank you