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April 13, 2011 Back to Basics, 2011 POPULATION HEALTH : Vital & Health Statistics Presented by Robert Spasoff, MD Epidemiology & Community Medicine 1
April 13, 2011
Back to Basics, 2011POPULATION HEALTH :
Vital & Health Statistics
Presented by Robert Spasoff, MDEpidemiology & Community
Medicine
1
April 13, 2011
78.1: VITAL STATISTICS INFORMATION
• What are the key causes of illness or death in Canada? Common things are common – using epidemiology can help you run a better clinical practice
• 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)
2
April 13, 2011
TOPICS
• Demography, population dynamics
• Mortality, and inequalities therein
• Morbidity
• Summary measures of population health
• Aboriginal health
3
April 13, 2011
Population Dynamics, 2007
Canada Nfld Nunavut
% aged 65+ 14% 15% 3%
Total fertility 1.7 1.5 3.0
Crude Birth rate 11.3 8.9 25.8
Crude Death rate 7.3 8.9 4.3
Rate of Natural Increase
4.0 0 21.5
4
World Health Report, 2006 (data mostly from 2004)
Population(x 1,000)
Growth(%)
Dependency ratio %
% aged > 60
Total Fertility
rate
LE at birth (both
sexes)
P dying< 5 yrs
(per 1000)
Canada 31,958 1.0 45 17.5 1.5 80 6
USA 295,410 1.0 50 16.5 2.0 78 8
France 60,257 0.4 53 20.9 1.9 80 5
Japan 127,923 0.2 50 25.6 1.3 82 4
China 1,315,409 0.8 42 10.8 1.7 72 31
Afghan- istan
28,574 3.9 97 4.4 7.4 42 257April 13, 2011 5
Canadian Historical Population Pyramids
• http://www12.statcan.ca/english/census01/products/analytic/companion/age/cda01pymd.cfm
April 13, 2011 6
April 13, 2011
Standardization
• An older method of adjusting for confounding (usually used for differences in age between two populations)
• Refers observed events to a standard population, producing hypothetical values
• Direct: yields age-standardized rate (ASMR)• Indirect: yields standardized mortality ratio
(SMR)
7
April 13, 2011
Mortality dataThree ways to summarize them
• Mortality rates (crude, specific, standardized)
• PYLL: subtracts age at death from some “acceptable” age of death. Emphasizes causes that kill at younger ages.
• Life expectancy: average age at death if current mortality rates continue. Derived from life table.
8
General (All-Causes) Mortality
April 13, 2011 9
April 13, 2011 10
Annual NUMBER of Deaths,by Sex, Canada, 1979-2004
April 13, 2011
Age-Standardized Mortality RATES,Canada, 1979-2004
April 13, 2011
Infant Mortality, 1935-2005
12
April 13, 2011
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
Loses a lot
of detail here
13
April 13, 2011 14
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
April 13, 2011
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
15
Income Inequalities in Health
April 13, 2011 16
April 13, 2011 17
40
42
44
46
48
50
52
54
56
58
60
62
1 2 3 4 5 1 2 3 4 5 Income adequacy quintiles
Remaining Life Expectancy at age 25. Based on 10-year follow-up to 1991 census
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Remaining life expectancy at age 25 (conditional on surviving to
age 25), 1991-2001Men 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 3.3April 13, 2011 19
Probability of survival to age 75 (conditional on surviving to age
25), 1991-2001Men 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 10.3April 13, 2011 20
Cause-Specific Mortality
April 13, 2011 21
April 13, 2011
Leading causes of death– Cardiovascular disease: 37%
• Heart disease: 20%• Other circulatory disease: 10%• Stroke 7%
– Cancer: 28%• Lung cancer: 9% (M); 6% (W)• Breast cancer: 4% (W)• Prostate cancer: 4% (M)
– Respiratory Disease: 10%– Injuries: 6%– Diabetes: 3%– Alzheimer’s: 1%
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April 13, 2011
0 100 200 300 400 500
HIV/AIDS
Respiratory disese
Suicide and violence
Unintentional injury
Circulatory disease
Cancer
Mortality rate (per 100,000) PYLL (000)
•Impact of different causes of death in Canada 2001: •Mortality rates and PYLL
•Source: Statistics Canada
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April 13, 2011
Mortality (2004) - Canada, both sexesAge standardized: 1991 population
Stroke (6.1%)
IHD (16.1%)
CHD:other (5.4%)Cancer: Lung (8.1%)
Cancer: Colon (3.3%)
Cancer: Breast (2.2%)
Cancer: Other (16.7%)
Accidents:MVA (1.5%)
Accidents:Other (2.8%)
Diabetes (3.5%)
Infections (1.2%)
Respiratory (6.7%)
Other (21.8%)
Alzheimer's (2.2%)Suicide (1.9%)
CANCER: 30.3%
Circ Disease:27.6%
†††
† Pneumonia & influenza grouped with respiratory disease. Would increase infectious % to about 3.4%.
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April 13, 2011
Mortality (2004) - Canada, MEN onlyAge standardized: 1991 population
Stroke (5.3%)
IHD (18.8%)
CHD:other (4.9%)Cancer: Lung (8.5%)
Cancer: Colon (3.3%)
Cancer: Prostate (3.3%)
Cancer: Other (14.7%)
Accidents:MVA (1.8%)
Accidents:Other (3.0%)
Diabetes (3.5%)
Infections (1.1%)
Respiratory (7.2%)
Other (20.8%)
Alzheimer's (1.5%)Suicide (2.3%)
CANCER: 29.8%
Circ Disease:29.0%
††
† Pneumonia & influenza grouped with respiratory disease. Would increase infectious % to about 3.5%.
{EXTERNALCAUSES:4.8%+
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April 13, 2011
Mortality (2004) - Canada, WOMEN onlyAge standardized: 1991 population
Stroke (7.0%)
IHD (14.5%)
CHD:other (5.8%)Cancer: Lung (7.8%)
Cancer: Colon (3.2%)
Cancer: Breast (5.0%)
Cancer: Other (15.6%)
Accidents:MVA (1.0%)
Accidents:Other (2.4%)
Diabetes (3.4%)
Infections (1.0%)
Respiratory (6.5%)
Other (22.7%)
Alzheimer's (2.9%)Suicide (1.1%)
CANCER: 31.6%
Circ Disease:27.3%
††
† Pneumonia & influenza grouped with respiratory disease. Would increase infectious % to about 3.3%.
{EXTERNALCAUSES:3.4%+
26
Deaths due to Cardiovascular Disease and Cancer, Canada,
1979-2004: Sex ratio (M/F)
April 13, 2011 27
April 13, 2011
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
Loses a lot
of detail here
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April 13, 2011
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
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April 13, 2011
Pattern of Injury deaths, Canada, 2004Age 1 to 10.
MVA FallsSuffocationOther unintentionalHomicide
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April 13, 2011
Pattern of Injury deaths, Canada, 2004Age 80 and over.
MVAFallsSuffocationOther unintentionalSuicideHomicde
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April 13, 2011
Overall trends in mortality from Cancer 1976-2005:rates and numbers
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April 13, 2011
Overall trends in mortality 1976-2005: rates and numbers
33
April 13, 2011
Cancer and AgeAge-Specific Incidence Rates for All Cancers by Sex, Canada, 2003
Surveillance Division, CCDPC, Public Health Agency of Canada34
April 13, 2011
Cancer and AgeAge-Specific Mortality Rates for All Cancers by Sex, Canada, 2003
Surveillance Division, CCDPC, Public Health Agency of Canada35
April 13, 2011
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
00,0
00)
0
20
40
60
80
100
Prostate
Lung
Colorectal
NHL
Stomach
Oral
Larynx
Hodgkin's
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April 13, 2011
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
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Summary Measures of Population Health
April 13, 2011 38
April 13, 2011
Summary measuresof population health
• Combine mortality and morbidity statistics, in order to provide a more comprehensive population health indicator, e.g., QALY
• Years lived are weighted according to quality of life, disability, etc.
• Two types:– Health expectancies point up from zero– Health gaps point down from ideal (Japan)
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April 13, 2011
Summary Measures ofPopulation Health
Indicator
Type
Life (Survival) Health-Adjusted Life (Survival)
Gap Years of Life Lost
(YLL)
Disability-Adj Life Years (DALY)
Expectancy Life Expectancy
(LE)
Health-Adj Life
Expectancy
(HALE)
40
April 13, 2011
2001 Life Expectancy andHealth-Adjusted Life Expectancy
Gender
Indicator
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
41
April 13, 2011
Disability-Adjusted Life-Years Lost, by Disease Group
0
5000
10000
15000
20000
25000
30000
35000
40000
I Communicable
MaternalPerinatal
Nutritional
II Chronic
III Injuries
MorbidityMortality
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April 13, 2011
Which Chronic Diseases?
0
2000
4000
6000
8000
10000
12000
14000
Ca CVSDMRespN-PM-SSense
MorbidityMortality
43
April 13, 2011
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%44
April 13, 2011
Deaths vs Prevalence, Canada
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LE vs HALE, Canada
April 13, 2011 46
Aboriginal Health
April 13, 2011 47
Population Pyramids
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April 13, 2011
Canadian population pyramids
A. First Nations and overall population compared
B. Animated display, showing changing
Canadian population 1901 - 2001
Link to Statistics Canada
49
Age-specific Fertility Rates
April 13, 2011
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
50
Percentage of Live Births by Age Group of Mother
April 13, 2011
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)
51
First Nations: Birth Weights as
% of Live Births
April 13, 2011
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)
Low birth weight (< 2,500g)
High birth weight (> 4,000g)
Per
cent
of l
ive
birt
hs
52
. Crude Mortality Rate
April 13, 2011
0
100
200
300
400
500
600
700
800
Male Female Total
Cru
de
mo
rtal
ity
rate
per
100
,000
po
pu
lati
on
First Nations (2001-2002 average) General Canadian Population (2001-2002 average)
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Life Expectancy at Birth in Years, by Sex
April 13, 2011
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
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Leading Causes of Death (crude rates)
April 13, 2011
0 20 40 60 80 100 120 140 160 180 200
Nervous system
Symptoms and ill-defined
Infectious and parasitic
Mental and behavioural disorders
Endocrine diseases
Digestive diseases
Respiratory diseases
Neoplasms
Circulatory diseases
External Causes of Injury
Crude rate per 100,000 population
First Nation Females First Nation Males
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Leading Causes of Death (age-standardized)
April 13, 2011
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)
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Potential Years of Life Lost (PYLL)
April 13, 2011
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
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Age-standardized Potential Years of Life Lost (PYLL) by
Cause of Death
April 13, 2011
6000
5500
5000
4500
4000
3500
3000
2500
2000
1500
1000 50
0 050
010
0015
0020
0025
0030
00
External causes of injury
Neoplasms
Ciculatory diseases
Digestive diseases
Perinatal conditions
Congenital malformations
Respiratory diseases
Infectious and parasitic
Endocrine diseases
Symptoms and ill-defined
Age-standardized PYLL per 100,000 population
First Nations, 2001-2002 (average) General Canadian Population, 2001-2002 (average)
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April 13, 2011
Vital & Health Statistics
Multiple Choice Questionsfor discussion
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April 13, 2011
Which of the following statements regarding the measurement of health and disease in a population is true?
a) a rate is the number of times an event has occurred during a certain time interval divided by the number of persons at risk during the same interval
b) when calculating a ratio, the numerator is a portion of the denominator
c) a ratio is the number of times an event has occurred during a certain time interval multiplied by the number of times an event has not occurred during the same interval
d) when calculating a rate, the numerator is not a portion of the denominator
e) none of the above
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April 13, 2011
Which of the following statements regarding the measurement of health and disease in a population is true?a) a rate is the number of times an event has occurred
during a certain time interval divided by the number of persons at risk during the same interval YES, APPROXIMATELY (DENOMINATOR IS PERSON-YEARS)
b) when calculating a ratio, the numerator is a portion of the denominator NOT NECESSARILY
c) a ratio is the number of times an event has occurred during a certain time interval multiplied by the number of times an event has not occurred during the same interval NO, THIS IS ODDS
d) when calculating a rate, the numerator is not a portion of the denominator NO, IT IS PART OF THE DENOMINATOR
e) none of the above61
April 13, 2011
In describing the leading causes of death in Canada, two very different lists emerge, depending on whether proportional mortality rates or person-years of life lost (PYLL) are used. This is because:
a) one measure uses a calendar year and the other a fiscal year to calculate annual experience
b) one measure includes morbidity as well as mortality experience
c) both rates exclude deaths occurring over the age of 70d) different definitions of “cause of death” are usede) one measure gives greater weight to deaths occurring in
younger age groups
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April 13, 2011
In describing the leading causes of death in Canada, two very different lists emerge, depending on whether proportional mortality rates or person-years of life lost (PYLL) are used. This is because:
a) one measure uses a calendar year and the other a fiscal year to calculate annual experience NO, IT HAS NOTHING TO DO WITH MONEY
b) one measure includes morbidity as well as mortality experience NO, THIS SOUNDS LIKE SUMMARY MEASURES OF POPULATION HEALTH
c) both rates exclude deaths occurring over the age of 70 NO, ALTHOUGH PYLL MIGHT, IN A WAY
d) different definitions of “cause of death” are used NOe) one measure gives greater weight to deaths occurring in
younger age groups YES, PYLL DOES THAT
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April 13, 2011
All of the following statements are true EXCEPT:
a) one indirect measure of a population’s health status is the percentage of low birth weight neonates
b) accidents are the largest cause of potential years of life lost in Canada
c) the Canadian population is steadily undergoing rectangularization of mortality
d) morbidity is defined as all health outcomes excluding death
e) the neonatal mortality rate is the number of infant deaths divided by the number of live births multiplied by 1000
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April 13, 2011
All of the following statements are true EXCEPT:a) one indirect measure of a population’s health status is
the percentage of low birth weight neonates TRUE, ALTHOUGH INFANT MORTALITY IS USUAL
b) accidents are the largest cause of potential years of life lost in Canada YES THEY ARE…..?
c) the Canadian population is steadily undergoing rectangularization of mortality TRUE UP TO ABOUT AGE 85, BUT THE VERY OLD ARE LIVING LONGER
d) morbidity is defined as all health outcomes excluding death NOT USUALLY DEFINED THAT WAY, BUT IT AMOUNTS TO THAT
e) the neonatal mortality rate is the number of infant deaths divided by the number of live births multiplied by 1000 NO, IT IS THE NUMBER OF NEONATAL DEATHS
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April 13, 2011
In 1981, the crude birth rate in Ontario was approximately 14 per 1000 and the crude death rate was 7 per 1000. The estimated rate of net migration was –1 per 1000. The growth rate of the province, per 1000 population was:
a) 6b) 7c) 8d) 20e) 22
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April 13, 2011
In 1981, the crude birth rate in Ontario was approximately 14 per 1000 and the crude death rate was 7 per 1000. The estimated rate of net migration was –1 per 1000. The growth rate of the province, per 1000 population was:
a) 6 YUP, 14 – 7 -1 = 6b) 7 NO, THAT IS RATE OF NATURAL
INCREASEc) 8 EPIDEMIOLOGIC AND ARITHMETIC
NONSENSEd) 20 DITTOe) 22 DITTO
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