03/20131 Back to Basics, 2013 POPULATION HEALTH : Vital & Health Statistics Presented by N. Birkett, MD Epidemiology & Community Medicine

03/ : VITAL STATISTICS INFORMATION What are the key causes of illness or death in Canada?key causes of illness or death –Common things are common using epidemiology can help you run a better clinical practice Hipocrates 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)

03/20133 TOPICS Demography, population dynamics Mortality Morbidity Summary measures of population health Aboriginal health

03/20134 Population Dynamics, 2007 CanadaNfldNunavut % aged >6514%15%3% Total fertility Birth rate/1, Death rate/1, Rate of Natural Increase/1,

World Health Report, 2012 (data mostly from 2009) Population (x 1,000) Growth (%) Dependency ratio % % aged > 60 Total Fertility rate LE at birth (both sexes) P dying < 5 yrs (per 1000) Afghan- istan 31, Canada34, China1,348, France62, Japan126, USA310,

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7 Population Pyramids Canada, Ontario Newfoundland Yukon

General (All-Causes) Mortality 03/20138

9 # deaths in Canada from ; men and women.

03/ Mortality RATES in Canada from ; men and women.

03/ Infant Mortality,

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Cause-Specific Mortality 03/201315

03/ Leading causes of death (2009)

03/ CANCER: 30.3% Circ Disease: 27.6% † † Pneumonia & influenza grouped with respiratory disease. Would increase infectious % to about 3.4%.

03/ CANCER: 29.8% Circ Disease: 29.0% † † † Pneumonia & influenza grouped with respiratory disease. Would increase infectious % to about 3.5%. { EXTERNAL CAUSES: 4.8%+

03/ CANCER: 31.6% Circ Disease: 27.3% † † † Pneumonia & influenza grouped with respiratory disease. Would increase infectious % to about 3.3%. { EXTERNAL CAUSES: 3.4%+

03/ Cancer Cluster Cardio- vascular Cluster ‘Other’ Cluster Suicide Crime

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03/ Cancer and Age Age-Specific Mortality Rates for All Cancers by Sex, Canada, 2003 Surveillance Division, CCDPC, Public Health Agency of Canada

03/ Cancer and Age Age-Specific Incidence Rates for All Cancers by Sex, Canada, 2003 Surveillance Division, CCDPC, Public Health Agency of Canada

03/ Time trends in Males IncidenceMortality

03/ Time trends in Females IncidenceMortality

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Income Inequalities in Health 03/201328

Income Inequalities SES (socio-economic status) –Lower  worse health Life expectancy 6.6 years lower in the poorest group. –Complex causal pathway Nutrition Race Habits Environmental/occupational Access to/use of health/preventive services Political isolation Others 29 10/7/2012

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Income adequacy quintiles Men Women Remaining Life Expectancy at age 25. Based on 10-year follow-up to 1991 census 03/201331

Remaining life expectancy at age 25 (conditional on surviving to age 25), MenWomen Total, all quintiles Quintile 1 (lowest) Quintile Quintile Quintile Quintile 5 (highest) Difference Q5-Q /

Probability of survival to age 75 (conditional on surviving to age 25), MenWomen Total, all quintiles Quintile 1 (lowest) Quintile Quintile Quintile Quintile 5 (highest) Difference Q5-Q /

Summary Measures of Population Health Combine mortality and a measure of morbidity 03/201334

03/ Impact of Chronic Diseases CategoryMortalityMorbidity Cancer85%15% Cardiovascular79%21% Diabetes37%63% Respiratory33%67% Neuropsychiatric8%92% Musculoskeletal7%93% Sense organs0%100%

03/ Summary Measures of Population Health Indicator Type Life (Survival)Health-Adjusted Life (Survival) GapYears of Life Lost (YLL) Disability-Adj Life Years (DALY) ExpectancyLife Expectancy (LE) Health-Adj Life Expectancy (HALE)

03/ Life Expectancy and Health-Adjusted Life Expectancy Gender Indicator MalesFemalesDifference LE HALE Difference HALE always < LE Females live longer (but gap is narrowing) Females suffer more morbidity

03/ Disability-Adjusted Life-Years Lost

03/ Which Chronic Diseases? Cancer CHD Diabetes Respiratory Neuro-Psych Musculoskeletal Sensory

03/ Deaths vs Prevalence, Canada

Aboriginal Health 03/201341

Population Pyramids 03/201342

Age-specific Fertility Rates 03/201343

Percentage of Live Births by Age Group of Mother 03/201344

Crude Mortality Rate 03/201345

Age-adjusted Mortality Rate 03/201346

Age-specific Mortality Ratio 03/201347

Life Expectancy at Birth in Years, by Sex 03/201348

Leading Causes of Death (age- standardized) 03/201349

Potential Years of Life Lost (PYLL) 03/ First NationsCanada

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