W.Z. CO 2006 1 Dramatic changes in structure of fat consumption and CVD What can we learn from CVD trends in CEE: case of Poland Dubai, January 7, 2006.

W.Z. CO 20061

Dramatic changes in structure of fat consumption and CVD

What can we learn from CVD trends in CEE:case of Poland

Dubai, January 7, 2006

Witold Zatoński, M.D.,Witold Zatoński, M.D.,POLANDPOLAND

Supported by European Supported by European Commission Commission grant no 2003121grant no 2003121

W.Z. CO 20062

Poland

W.Z. CO 20063

HistoryAfter 1945 two simultaneous phenomenon:

Infection diseases, infant mortality, maternal mortality decline

Non-communicable diseases + injury increase

W.Z. CO 20064

Mortality rates from all causesPoland and UK

0

100

200

300

400

500

600

700

800

1957 1962 1967 1972 1977 1982 1987 1992 1997 2002year

deat

hs /

100,

000

Poland UK

Males 0-14

200

250

300

350

400

450

500

550

600

1964 1968 1972 1976 1980 1984 1988 1992year

deat

hs /

100,

000

Poland UK

Males 15-59

W.Z. CO 20065

PROBABILITY OF DYING BY REGION, 1990(data adapted from Murray and Lopez, 1994)

0

10

20

30

40

EME CHN MEC LAC OAI IND POL SSApe

rcen

tage

INJURIES NON-COMMUNICABLE DISEASES

COMMUNICABLE DISEASES

Males, age 15-59

EME - Established Market EconomiesPOL - PolandCHN - ChinaLAC - Latin America and the Caribbean

OAI - Other Asia and IslandsMEC - Middle Eastern CrescentIND - IndiaSSA - Sub-Saharan Africa

0

10

20

30

EME POL CHN LAC OAI MEC IND SSA

perc

enta

ge

INJURIES NON-COMMUNICABLE DISEASES

COMMUNICABLE DISEASES

Males, age 0-14

W.Z. CO 20066

Male deaths at age 15-591960-1990

0

5

10

15

20

25

30

35

40

45

1960 1970 1980 1990

deat

hs /

100,

000

UK Poland

0

20

40

60

80

100

120

140

160

1960 1975 1990

deat

hs /

100,

000

Poland UK

0

50

100

150

200

250

300

1962 1972 1982 1992

deat

hs /

100,

000

Poland Finland

Lung cancer InjuriesCardiovascular diseases

W.Z. CO 20067

Mortality rates from cardiovascular diseases,Poland and Finland 1959-1991

0

200

400

600

800

1000

1200

1956 1961 1966 1971 1976 1981 1986 1991year

deat

hs /

100,

000

Finland Poland

Finland: annual decline since 1986 : 4.9%Poland: annual incline since 1964 to 1990: 2.5%

1986

1964

Males, age 45-64

0

50

100

150

200

250

300

350

400

1956 1961 1966 1971 1976 1981 1986 1991year

deat

hs /

100,

000

Finland Poland

1974

1968

Finland: annual decline since 1968 to 1991: 4.5%Poland: annual incline since 1974 to 1990: 1.1%

Females, age 45-64

W.Z. CO 20068

Economical and political transformation in central Europe.A health miracle.Democracy is healthier

W.Z. CO 20069

Premature mortality, Poland 1962-2002age group 20-64

150

200

250

300

350

400

450

1962 1970 1978 1986 1994 2002

deat

hs /

100,

000

Males Females

400

450

500

550

600

650

700

750

800

850

900

1962 1970 1978 1986 1994 2002

deat

hs /

100,

000

W.Z. CO 200610

Premature mortality in selected countries 1959-2002

0

500

1000

1500

2000

2500

1958 1965 1972 1979 1986 1993 2000year

deat

hs /

100,

000

Poland Czech Rep. Hungary Finland

Males, age 45-64

W.Z. CO 200611

Premature mortality in selected countries 1959-2002

0

100

200

300

400

500

600

700

800

900

1000

1958 1965 1972 1979 1986 1993 2000year

deat

hs /

100,

000

Poland Czech Rep. Hungary Finland

Females, age 45-64

W.Z. CO 200612

Mortality trends in Poland 1959-2002

0

100

200

300

400

500

600

700

800

900

1957 1972 1987 2002year

deat

hs /

100,

000

cvd cancers injuries

Males, age 45-64

0

50

100

150

200

250

300

1957 1972 1987 2002year

deat

hs /

100,

000

cvd cancers injuries

Females, age 45-64

W.Z. CO 200613

Unexpected phenomenon of transition period in CEE countries is rapid decrease in premature

mortality due to CVD

W.Z. CO 200614

Standardized incidence rates from myocardial infarction population of Warsaw at age 35-64 (Pol-Monica Warsaw)

0

100

200

300

400

500

600

700

800

900

1000

1984 1986 1988 1990 1992 1994year

deat

hs /

100,

000

malesfemales

-32%

-33%

Source: Stefan Rywik „Czy zmienia się zagrożenie chorobami układu krążenia w Polsce? na przykładzie populacji Warszawy w średnim wieku”

W.Z. CO 200615

Cardiovascular diseases mortality,Poland 1963-2002

0

10

20

30

40

50

60

70

80

1957 1972 1987 2002

deat

hs /

100,

000

0

100

200

300

400

500

600

700

800

900

1957 1972 1987 2002

deat

hs /

100,

000

0

500

1000

1500

2000

2500

3000

3500

4000

4500

5000

1957 1972 1987 2002

deat

hs /

100,

000

Males, age 20-44 Males, age 45-64 Males, age 65+

0

5

10

15

20

25

30

35

40

1957 1972 1987 2002

deat

hs /

100,

000

0

50

100

150

200

250

300

1957 1972 1987 2002

deat

hs /

100,

000

0

500

1000

1500

2000

2500

3000

3500

1957 1972 1987 2002

deat

hs /

100,

000

Females, age 20-44 Females, age 45-64 Females, age 65+

W.Z. CO 200616

Changes in standardized mortality rates from cardiovascular diseases, Poland 1990-2002

(expressed as a percentage, 1991=100%)

40

50

60

70

80

90

100

110

1990 1993 1996 1999 2002

year

%

-49%

-51%

50

60

70

80

90

100

110

1990 1993 1996 1999 2002year

%

-39%

-44%

60

70

80

90

100

110

1990 1993 1996 1999 2002year

% -30%

-31%

age 20-44 age 45-64 age 65 and over

males females

W.Z. CO 200617

Standardizet mortality rates from cardiovascular diseases by place of living, all age,Poland 1985-2002

250

300

350

400

450

500

550

1984 1990 1996 2002year

deat

hs /

100,

000

males - rural males - urban

-38%

-29%

150

170

190

210

230

250

270

290

310

1984 1990 1996 2002year

deat

hs /

100,

000

females - rural females - urban

-28%

-36%

femalesmales

W.Z. CO 200618

CVD mortality by education in Poland 1994 to 2002*

-15%

-40%

0

100

200

300

400

500

600

700

800

900

academic primary

deat

hs /

100,

000

1994-1996 2000-2002

femalesmales

-19%

-41%

0

100

200

300

400

500

600

700

800

900

academic primary

deat

hs /

100,

000

1994-1996 2000-2002

*age 45-64

W.Z. CO 200619

Cardiovascular diseases mortality,Poland and Finland 1963-2002

0

10

20

30

40

50

60

70

80

90

1957 1972 1987 2002

deat

hs /

100,

000

Poland

Finland

Finland: annual decrease since 1967: 4.1%Poland: annual decrease since 1991: 6.1%

0

200

400

600

800

1000

1200

1957 1972 1987 2002

deat

hs /

100,

000

Poland

Finland

Finland: annual decline since 1976: 3.6%Poland: annual decline since 1990: 3.9%

0

1000

2000

3000

4000

5000

6000

1957 1972 1987 2002

deat

hs /

100,

000

Poland

Finland

Finland: annual decrease since 1992: 3.7%

Poland: annual decrease since 1991: 3.5%

Males, age 20-44 Males, age 45-64 Males, age 65+

0

5

10

15

20

25

30

35

40

1957 1972 1987 2002

deat

hs /

100,

000

Poland

Finland

Finland: annual decrease since 1982: 2.1%Poland: annual decrease since 1991: 3.1%

0

50

100

150

200

250

300

350

400

1957 1972 1987 2002

deat

hs /

100,

000

Poland

Finland

Finland: annual decline since 1968: 4.5%Poland: annual decline since 1990: 4.7%

0

500

1000

1500

2000

2500

3000

3500

4000

4500

5000

1957 1972 1987 2002

deat

hs /

100,

000

Poland

Finland

Finland: annual decline since 1990: 3.7%Poland: annual decline since 1991: 3.1%

Females, age 20-44 Females, age 45-64

Females, age 65+

W.Z. CO 200620

Mortality trands from cardiovascular diseases,selected countries 1959-2002

300

400

500

600

700

800

900

1957 1962 1967 1972 1977 1982 1987 1992 1997 2002

deat

hs / 1

00,0

00

Poland

Czech rep.

Hungary

1990

1990

Poland: annual decline since 1990: 3.9%Czech Rep.: annual decline since 1990: 4.7%Hungary: annual decline since 1994: 3.6%

1994

Males, age 45-64

0

50

100

150

200

250

300

350

400

1957 1962 1967 1972 1977 1982 1987 1992 1997 2002

deat

hs /

100,

000

PolandCzech rep.Hungary

1990

Poland: annual decline since 1990: 4.7%Czech Rep.: annual decline since 1995: 5.2%Hungary: annual decline since 1998: 6.1%

1995

1998

Females, age 45-64

W.Z. CO 200621

„Natural” experiment in Poland

W.Z. CO 200622

Polyunsaturated / saturated fatty acids ratio in Poland, 1950-1999

0

0,1

0,2

0,3

0,4

0,5

0,6

1950 1960 1970 1980 1990 2000year

ratio

W.Z. CO 200623

Consumption of vegetable oils in Poland in 1970-2000 (kg/capita/year)

0

2

4

6

8

10

12

14

16

18

20

1970 1980 1990 2000year

kg

Source: National Food and Nutrition Institute, Poland

W.Z. CO 200624

Consumption of vegetable oils and butter in Poland in 1970-2000 (kg/capita/year)

0

2

4

6

8

10

12

14

16

18

20

1970 1975 1980 1985 1990 1995 2000year

kg

vegetable oils butter

Source: National Food and Nutrition Institute, Poland

W.Z. CO 200625

29

8

1

45

0

10

20

30

40

50

2002

%

Rape Oil

Soyabean Oil

Sunflowerseed Oil

Olive Oil

Structure of vegetable oils consumption in Poland in 2002

W.Z. CO 200626

Risk of ischaemic heart diseases* according to polyunsaturated / saturated fatty acids ratio (in NHS**)

0

0.2

0.4

0.6

0.8

1

1.2

0.23 0.29 0.34 0.38 0.42 0.45 0.49 0.54 0.6 0.72P/S Ratio in NHS (median for decile)

RR o

f CHD

in N

HS

Poland 1990

Poland 1992

Poland1994

Poland1996

1

Pred

icted

RR

for P

olan

d

**W.Willett at al., Nurses Health Study - Personal Comunication*IHS + atherosclerosis and arterial diseases at age 45-64

0.8

W.Z. CO 200627

Consumption of exotic fruit in Poland, 1983-2002 (kg/capita/quarter)

0

0,2

0,4

0,6

0,8

1

1,2

1,419

83

1984

1985

1986

1987

1988

1989

1990

1991

1992

1993

1994

1995

1996

1997

1998

1999

2000

2001

2002

year

ratio

W.Z. CO 200628

Fruits consumption in Poland in 1990-2002

0

10

20

30

40

50

60

1990 1992 1994 1996 1998 2000 2002y ear

kg /

pers

on /

year

Annual increase since 1990: 4%

W.Z. CO 200629

Vegetable consumption in Poland in 1990-2002

0

20

40

60

80

100

120

140

160

1990 1992 1994 1996 1998 2000 2002y ear

kg /

pers

on /

year

Stable trend since 1990

W.Z. CO 200630

Smoking prevalence. Adults (>15)in Poland in 1980-2002

0

10

20

30

40

50

60

70

1980 1984 1988 1992 1996 2000y ear

perc

enta

ge

Males: annual decline since 1989: 1.9% Females: stable trend since 1982

W.Z. CO 200631

0

10

20

30

40

50

60

70

80

20-29 30-39 40-49 50-59 60+

perc

enta

ge

1974 1982 1985-1989 1990-1994 1995-1999 2000-2004

64%-39%

79%-52% 70%-52%

66%-46%

51%-28%

Prevalence of tobacco smoking by age groups, males, Poland, 1974-2004

W.Z. CO 200632

0

10

20

30

40

50

60

20-29 30-39 40-49 50-59 60+

perc

enta

ge

1974 1982 1985-1988 1990-1994 1995-1999 2000-2004

45%-26%

48%-33%

23%-41%

16%-33%

8%-9%

Prevalence of tobacco smoking by age groups, females, Poland, 1974-2004

W.Z. CO 200633

Medical service

W.Z. CO 200634

Premature mortality time trends, Russia, Poland and Lithuania in 1980-2002

0

200

400

600

800

1000

1200

1400

1980 1984 1988 1992 1996 2000year

deat

hs /

100,

000

Russia

Lithuania

Poland612

521

529

1143

418

669

Males aged 15-59

W.Z. CO 200635

Life Expectancy at Birth in selected countries

63

65

67

69

71

73

75

77

79

1982 1986 1990 1994 1998 2002

Life

exp

ecta

ncy EUaverage

CzechRepublicPolandHungaryRussia