Vitale Gesellschaft Health and disease in Germany, Europe and worldwide: Facts, predictions and chances for prevention Ulrich Keil Institut für Epidemiologie und Sozialmedizin der Universität Münster WHO Collaborating Centre for Epidemiology and Prevention of Cardiovascular and Other Chronic Diseases
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Vitale Gesellschaft Health and disease in Germany, Europe and worldwide: Facts, predictions and chances for prevention Ulrich Keil Institut für Epidemiologie.
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Vitale Gesellschaft
Health and disease in Germany, Europe and worldwide: Facts, predictions and chances for prevention
Ulrich Keil
Institut für Epidemiologie und Sozialmedizin der Universität Münster
WHO Collaborating Centre for Epidemiology and Preventionof Cardiovascular and Other Chronic Diseases
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Vitale Gesellschaft – Münster 2003
Growing of the world population
According to the UN the world population reached6 billion on October 12, 1999.
1804 1 billion people
1926 2 billion people
1960 3 billion people
1999 6 billion people
prognosis for 2050 9 billion people
122 years
34 years
39 years
Source: Statistisches Bundesamt, Bundesinstitut für Bevölkerungsstudien
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Population of Germany by age groups1950–1998
Age groups in %
Year <20 years 20–29 years 30–59 years 60 years
1950 30.4 14.1 40.9 14.6
1970 30.0 12.9 37.1 19.9
1990 21.7 16.7 41.2 20.4
1998 21.4 12.3 43.9 22.4
Source: Statistisches Bundesamt
Life expectancy at birth for men in Europe1991 and 1998
Source: WHO – European health for all database (HFA-DB) – www.who.dk/hfadb * 1997
60 62 64 66 68 70 72 74 76 78 80
Russia
Hungary
Romania
Poland
Europe
Portugal
Finland
Germany
Austria
EU average
UK
France
Spain
Netherlands
Greece
Italy
Israel*
Sweden
1991
1998
years
EU average
Europe
Germany
77.0
74.6
Life expectancy at birth for women in Europe1991 and 1998
Source: WHO – European health for all database (HFA-DB) – www.who.dk/hfadb * 1997
70 72 74 76 78 80 82 84 86
Russia
Romania
Hungary
Poland
Europe
Portugal
UK
Israel*
Germany
Greece
Netherlands
Austria
Finland
EU average
Sweden
Italy
Spain
France
1991
1998
years
EU average
Europe
Germany
82.7
80.8
Contribution to gap in life expectancy between central and eastern Europe andrest of European region for men and women by age and cause of death in 1992
Figures are difference in years between West minus East
Age group (years)
Cause of death 1 1–34 35–64 65 All ages
Infectious and parasitic diseases 0.30 0.10 0.08 – 0.01 0.47
Cancer 0 0.05 0.25 – 0.35 – 0.05
Cardiovascular diseases 0 0.07 1.36 1.85 3.28
Respiratory diseases 0.68 0.20 0.15 – 0.05 0.97
Digestive diseases 0.02 0.03 0.08 – 0.04 0.09
External causes 0.04 0.64 0.71 0.03 1.41
Ill defined conditions – 0.10 0.01 0.04 0.18 0.12
Other diseases 0 0 – 0.02 –0.20 – 0.22
All causes 0.93 1.09 2.63 1.40 6.06
Source: Bobak, M and Marmot, M. East-West mortality divide and its potential explanations. BMJ 1996; 312: 421–25
Change in rank order of leading causes of death (world)
1990Disease or injury
2020*Disease or injury
1 Ischaemic heart disease
2 Cerebrovascular disease
3 Chronic obstructive pulmonary disease
4 Lower respiratory infections
5 Trachea, bronchus and lung cancers
6 Road traffic accidents
7 Tuberculosis
8 Stomach cancer
9 HIV
10 Self-inflicted injuries
11
16
27* baseline scenarios
Source: Murray CJL, Lopez AD. The Global Burden of Disease. Cambridge: Harvard University Press, 1996.
Ischaemic heart disease 1
Cerebrovascular disease 2
Lower respiratory infections 3
Diarrhoeal diseases 4
Conditions arising during the perinatalperiod
5
Chronic obstructive pulmonary disease 6
Tuberculosis 7
Measles 8
Road traffic accidents 9
Trachea, bronchus and lung cancers 10
12
14
30
Burden of disease due to leading regional risk factors
divided by disease type – Developed regions
Source: Ezzati M et al. Selected major risk factors and global and regional burden of disease. Lancet 2002; 360:1347–1360
Causes of death (ICD-10) Deaths
(men and women)
Total 838,797
Cardiovascular diseases (I 00–I 99) 395,043
Ischemic heart disease (I 120–I 125) 167,681
Stroke (I 160–I 169) 80,786
Neoplasms (C00–C97) 210,738
Lung cancer (including larynx and trachea) (C32–C 34) 40,553
Colon and rectum cancer (C18–C21) 28,987
Breast cancer in women (C50) 17,814
Lymphatic and hematopoietic system (C81–C96) 16,186
Prostate cancer (C61) 11,107
Bladder cancer (C67) 5,977
Most frequent causes of death in Germany in 2000 (1)
Source: StBA, Statistisches Jahrbuch (2002)
Causes of death (ICD-10) Deaths
(men and women)
Pneumonia (J10–J18) 18,757
COPD (J40–J47) 25,798
Chronic liver disease and -zirrhosis (K70–K77) 18,428
Diabetes mellitus (E10–E14) 21,180
Suicide (X60–X84) 11,065
Traffic accidents (V01–V99) 7,747
Falls (W00–W19) 7,404
HIV / AIDS (B20–B24) 580
Sudden infant death syndrome (SIDS) (R95) 482
Severe acute respiratory syndrome (SARS) 0
Most frequent causes of death in Germany in 2000 (2)
Source: StBA, Statistisches Jahrbuch (2002)
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Prevalence of gross obesity (BMI 30)German National Health Survey 1998 (n= 7124)
• Replace butter and cream by a special canola (rapeseed) oilmargarine*, rich in α linolenic acid* This margarine contains 5% of 18:3n -3 instead of 0,6% in olive oil.
swimming) preferably daily and at least 30–45 minutes,
reduces the risk in men and women for cardiovascular
diseases by ~45% and for all cause mortality by 30–50%.
Sources: Physical activity and health: a report of the Surgeon General. Centre for Disease Control and Prevention. Atlanta, 1996
Blair SN et al. Influences of cardiorespiratory fitness and other precursors on cardiovascular disease and all-cause mortalityin men and women. JAMA 1996; 276: 205–210
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Physical activity improves health in the following ways:
• reduces risk of dying prematurely
• reduces risk of dying from heart disease
• reduces risk of developing diabetes mellitus
• reduces risk of developing high blood pressure (BP)
• helps reduce BP in people who already have high BP
Source: Physical activity and health: a report of the Surgeon General. Centre for Disease Control and Prevention. Atlanta, 1996
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Other documented health benefits include:
• reduces the risk of developing colon cancer
• reduces feelings of depression and anxiety
• helps control weight
• helps build healthy bones, muscles, and joints
• helps older adults become stronger and better able to move about without falling
• promotes psychological well-beingSource: Physical activity and health: a report of the Surgeon General. Centre for Disease Control and Prevention. Atlanta, 1996
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Smoking – Non Smoking
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Relative and attributable risks of mortality from lung cancer and CHD among cigarette smokers in a prospective study of
34,000 male British doctors, 1951–1971
Source: Doll R, Peto R. Mortality in relation to smoking: 20 years' observations on male British doctors. BMJ 1976; 2: 1525–36
Annual mortality rates per 100,000 Lung cancer Coronary heart disease Cigarette smokers 140 669 Nonsmokers 10 413
Relative risk = 14.0 = 1.6 Attributable risk 130 / 105 / year 256 / 105 / year
140 / 105
10 / 105
669 / 105
413 / 105
Effects of cigarette smoking on survival to age 70 and to age 85, in 40-year prospective study of 34,000 male British doctors, 1951–1991
Source: Doll R, Peto R, Wheatley K et al. Mortality in relation to smoking. BMJ 1994; 309: 901–911
Age
% S
urv
ivo
rs
40 55 70 85 1000
20
40
60
80
100
1–14 / day 15–24 / day 25+ / day
Never smoked regularly
33%
8%
80%
50%Cigarettesmokers:
Age-adjusted incidence rates and age-adjusted HRRs of non-fatal and fatal MI by the risk factors hypertension, TC/HDL-C 5.5, and smoking
• scored in the highest 40% of the cohort for a diet high in cereal fiber, marine n–3 fatty acids, and folate, with a high P/S ratio, and low in trans fat and glycemic load
• alcohol 5 g/day
Source: Stampfer MJ et al. N Engl J Med 2000; 343: 16–22
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Risk of coronary heart disease (CHD) in low-risk groups in the Nurses’ Health Study 1980–1994
Source: Stampfer MJ et al. N Engl J Med 2000; 343: 16–22
Group % of women
in group
Number of CHD events
Rel. Risk (95% CI)
Attributable Risk
(95% CI) %
Three low-risk factors Diet in upper 40% Nonsmoking, exercise 30 min/day