Population Mortality and Morbidity in Ireland n April 2001.

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