1. 03/20121 Back to Basics, 2012 POPULATION HEALTH : Vital & Health Statistics Presented by N. Birkett, MD Epidemiology & Community Medicine

2. 03/20122 78.1: 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 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)

3. 03/20123 TOPICS Demography, population dynamics Mortality Morbidity Summary measures of population health Aboriginal health

4. 03/20124 Population Dynamics, 2007 CanadaNfldNunavut % aged >6514%15%3% Total fertility1.71.53.0 Birth rate11.38.925.8 Death rate7.38.94.3 Rate of Natural Increase 4.0021.5

5. 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) Canada31,9581.04517.51.5806 USA295,4101.05016.52.0788 France60,2570.45320.91.9805 Japan127,9230.25025.61.3824 China1,315,4090.84210.81.77231 Afghan- istan 28,5743.9974.47.442257

6. 03/20126 Population Pyramids Canada, 1901-2001 Ontario 1901-2001 Ontario 1956-2006 Newfoundland 1949-2001 Yukon 1901-2001

7. General (All-Causes) Mortality 03/20127

8. 8 # deaths in Canada from 1979-2004; men and women.

9. 03/20129 Mortality RATES in Canada from 1979-2004; men and women.

10. 03/201210 Infant Mortality, 1935-2005

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12. 03/201212

13. 03/201213

14. Cause-Specific Mortality 03/201214

15. 03/201215 Leading causes of death (2004) –Cancer: 30% Lung cancer: 9% (M); 8% (W) Breast cancer: 5% (W) Prostate cancer: 3% (M) –Cardiovascular disease: 28% Ischemic heart disease: 17% Other circulatory disease: 5% Stroke 6% –Respiratory Disease: 7% –Injuries: 4% –Diabetes: 4% –Alzheimer’s: 2%

16. 03/201216 CANCER: 30.3% Circ Disease: 27.6% † † Pneumonia & influenza grouped with respiratory disease. Would increase infectious % to about 3.4%.

17. 03/201217 CANCER: 29.8% Circ Disease: 29.0% † † † Pneumonia & influenza grouped with respiratory disease. Would increase infectious % to about 3.5%. { EXTERNAL CAUSES: 4.8%+

18. 03/201218 CANCER: 31.6% Circ Disease: 27.3% † † † Pneumonia & influenza grouped with respiratory disease. Would increase infectious % to about 3.3%. { EXTERNAL CAUSES: 3.4%+

19. 03/201219

20. 03/201220 Overall trends in mortality from Cancer 1976-2005: MALES

21. 03/201221 Overall trends in mortality from Cancer 1976-2005: FEMALES

22. 03/201222 Cancer and Age Age-Specific Mortality Rates for All Cancers by Sex, Canada, 2003 Surveillance Division, CCDPC, Public Health Agency of Canada

23. 03/201223 Cancer and Age Age-Specific Incidence Rates for All Cancers by Sex, Canada, 2003 Surveillance Division, CCDPC, Public Health Agency of Canada

24. 03/201224 Time trends in Males IncidenceMortality

25. 03/201225 Time trends in Females IncidenceMortality

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27. 03/201227

28. 03/201228

29. 03/201229

30. Income Inequalities in Health 03/201230

31. 03/201231

32. 1 2 3 4 5 1 2 3 4 5 Income adequacy quintiles Men Women Remaining Life Expectancy at age 25. Based on 10-year follow-up to 1991 census 03/201232

33. Remaining life expectancy at age 25 (conditional on surviving to age 25), 1991-2001 MenWomen Total, all quintiles53.759.3 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-Q15.33.3 03/2012 33

34. Probability of survival to age 75 (conditional on surviving to age 25), 1991-2001 MenWomen Total, all quintiles66.980.1 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-Q117.210.3 03/2012 34

35. Summary Measures of Population Health Combine mortality and a measure of morbidity 03/201235

36. 03/201236 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)

37. 03/201237 2001 Life Expectancy and Health-Adjusted Life Expectancy Gender Indicator MalesFemalesDifference LE76.982.05.1 HALE68.370.82.5 Difference8.612.8 HALE always < LE Females live longer (but gap is narrowing) Females suffer more morbidity

38. 03/201238 Disability-Adjusted Life-Years Lost

39. 03/201239 Impact of Chronic Diseases CategoryMortalityMorbidity Cancer85%15% Cardiovascular79%21% Diabetes37%63% Respiratory33%67% Neuropsychiatric8%92% Musculoskeletal7%93% Sense organs0%100%

40. 03/201240 Which Chronic Diseases?

41. 03/201241 Deaths vs Prevalence, Canada

42. Aboriginal Health 03/201242

43. Population Pyramids 03/201243

44. Age-specific Fertility Rates 03/201244

45. Percentage of Live Births by Age Group of Mother 03/201245

46. Crude Mortality Rate 03/201246

47. Age-adjusted Mortality Rate 03/201247

48. Age-specific Mortality Ratio 03/201248

49. Life Expectancy at Birth in Years, by Sex 03/201249

50. Leading Causes of Death (age- standardized) 03/201250

51. Potential Years of Life Lost (PYLL) 03/201251 First NationsCanada