Download Population Mortality and Morbidity in Ireland (slides)

Population Mortality and
Morbidity in Ireland

April 2001
Irish Population Mortality 1962-1996
Age Standardised Mortality Rates - Ireland Population
1962-1996
1400
1000
800
m
600
f
400
200
Year
1996
1994
1992
1990
1988
1986
1984
1982
1980
1978
1976
1974
1972
1970
1968
1966
1964
0
1962
Deaths per 100,000
1200
Mortality Improvement by Age Group
Age-band
0-4
5-14
15-24
25-34
35-44
45-54
55-64
65-74
75-84
85+
Males
Females
% Reduction % Reduction
80%
77%
51%
73%
-13%
37%
3%
47%
38%
57%
42%
52%
34%
42%
19%
36%
15%
32%
18%
23%
Mortality rates by cause for 15-34 year olds
Cause
Infectious and Parasitic
Diseases
Malignant Neoplasms
All Circulatory Diseases
Injury and Poisoning
Road Traffic Accidents
Suicide
Homicide
Other
All Other Diseases
Males
15-24
Males Females Females
25-34 15-24 25-34
2%
1%
7%
1%
7%
3%
75%
33%
25%
1%
16%
13%
9%
7%
66%
24%
26%
1%
15%
19%
10%
11%
44%
16%
15%
0%
12%
28%
23%
10%
40%
18%
12%
3%
7%
26%
Mortality Rates from Road Traffic Accidents 1962 - 1996
Trend in m ortality rates from rtas - m ales 1968 to 1996
240%
210%
180%
15-24
150%
25-34
120%
35-44
45-54
90%
55-64
60%
30%
0%
1
3
5
7
9
11
13
15
year
17
19
21
23
25
27
29
Mortality Rates from Suicide 1962 - 1996
Trend in mortality rates from suicide - males 1976 to 1996
400%
350%
300%
15-24
250%
25-34
200%
35-44
150%
45-54
100%
55-64
50%
0%
1 2 3 4 5 6 7 8 9 10 11 12 13 14 15 16 17 18 19 20 21
year
Mortality rates by cause for 35-64 year olds
Cause
Malignant Neoplasms
Lung
Digestive
Breast
Cervical
Other
All Circulatory
Diseases
Heart Disease
Stroke
Other
Injury and Poisoning
All Other Diseases
Males
35-44
Males
45-54
Males Females Females Females
55-64
35-44
45-54
55-64
20%
2%
3%
0%
0%
15%
24%
30%
6%
5%
0%
0%
19%
40%
35%
9%
7%
0%
0%
18%
45%
52%
4%
3%
14%
9%
22%
16%
56%
6%
5%
19%
2%
24%
17%
47%
6%
7%
14%
1%
19%
30%
15%
3%
5%
35%
21%
29%
5%
6%
13%
16%
33%
4%
8%
5%
15%
4%
6%
6%
14%
18%
6%
5%
5%
7%
20%
15%
7%
7%
4%
20%
Mortality Rates from Circulatory Diseases 1962 - 1996
Trend in mortality rates from all circulatory diseases - females 1962 to
1996
140%
120%
35-44
100%
45-54
55-64
80%
65-74
60%
75-84
85 and over
40%
20%
0%
1
3
5
7
9 11 13 15 17 19 21 23 25 27 29 31 33 35
year
Mortality Rates from Circulatory Diseases 1962 - 1996
Trend in mortality rates from all circulatory diseases - males 1962 to
1996
140%
120%
35-44
100%
45-54
55-64
80%
65-74
60%
75-84
85 and over
40%
20%
0%
1
3
5
7
9 11 13 15 17 19 21 23 25 27 29 31 33 35
year
Mortality rates by cause for over 65 year-olds
Cause
Malignant Neoplasms
Lung
Digestive
Breast
Cervical
Other
All Circulatory
Diseases
Heart Disease
Stroke
Other
Pneumonia
Injury and Poisoning
All Other Diseases
Males
65-74
Males
75-84
Males Females Females Females
85+
65-74
75-84
85+
30%
9%
6%
0%
0%
16%
46%
22%
5%
4%
0%
0%
13%
46%
14%
2%
2%
0%
0%
10%
48%
33%
6%
5%
5%
1%
16%
41%
20%
3%
4%
2%
0%
10%
49%
9%
1%
2%
1%
0%
5%
53%
31%
6%
9%
3%
2%
19%
27%
9%
11%
8%
1%
22%
24%
11%
13%
13%
1%
23%
22%
8%
10%
4%
1%
21%
24%
13%
12%
8%
1%
21%
24%
14%
16%
15%
2%
22%
Mortality Rates from Lung Cancer 1962 - 1996
Trend in mortality rates from lung cancer - males 1962 to 1996
1000%
35-44
800%
45-54
55-64
600%
65-74
400%
75-84
85 and over
200%
0%
1 3 5 7 9 11 13 15 17 19 21 23 25 27 29 31 33 35
year
Mortality Rates from Lung Cancer 1962 - 1996
Trend in mortality rates from lung cancer - females 1962 to 1996
1000%
35-44
800%
45-54
55-64
600%
65-74
400%
75-84
85 and over
200%
0%
1 3 5 7 9 11 13 15 17 19 21 23 25 27 29 31 33 35
year
Mortality Rates from Pneumonia 1962 - 1996
Trend in mortality rates from pneumonia - females 1962 to 1996
300%
270%
240%
210%
180%
65-74
150%
75-84
120%
85 and over
90%
60%
30%
0%
1
3
5
7
9 11 13 15 17 19 21 23 25 27 29 31 33 35
year
Mortality Rates from Pneumonia 1962 - 1996
Trend in mortality rates from pneumonia - males 1962 to 1996
300%
270%
240%
210%
180%
65-74
150%
75-84
120%
85 and over
90%
60%
30%
0%
1
3
5
7
9 11 13 15 17 19 21 23 25 27 29 31 33 35
year
Male mortality improvements by decade & age group
Male mortality improvements Ireland
Population
split by decade & age group
0.05
annual rate of mortality
improvement
0.04
0.03
0.02
0.01
0
-0.01
-0.02
-0.03
1990-1996
1981-1990
-0.04
25-34
35-44
1971-1980
45-54
55-64
age group
65-74
1962-1970
75-84
85+
decade
Female mortality improvements by decade & age group
Female mortality improvements - Ireland population
split by decade & age group
0.035
annual rate of mortality
improvement
0.03
0.025
0.02
0.015
0.01
0.005
0
-0.005
-0.01
1990-1996
1981-1990
1971-1980
decade
-0.015
25-34
35-44
45-54
55-64
age group
65-74
1962-1970
75-84
85+
International Experience Comparisons
Irish male age standardised mortality rates expressed
as percentage of average sample country rates
Homicide
Suicide
RTAs
Ext ernal causes
Liver Diseases
Digest ive Diseases
Bronchit is/ ast hma
Respirat ory Diseases
Cerebro-vascular disease
Heart diseases
Circulat ory Diseases
Prost at e Cancer
Breast Cancer
Lung Cancer
St omach Cancer
M alignant neoplasms
Inf ect ious and parasit ic
diseases
-80%
-60%
-40%
-20%
0%
20%
40%
60%
80%
Source – Calculated from WHO Statistical Information System Mortality Data. Countries: Ireland,
Scotland, Denmark, Germany, US, England & Wales, Australia, France, Greece, Sweden, Japan. 1996
for all except Australia 1995.
International Experience Comparisons
Irish fe male age standardise d rate s e xpre sse d as a
pe rce ntage of av e rage sample country rate s
Homicide
Suicide
RTA s
Ext ernal causes
Liver Diseases
Digest ive Diseases
B ronchit is/ ast hma
Respirat ory Diseases
Cerebro-vascular disease
Heart diseases
Circulat ory Diseases
Prost at e Cancer
B reast Cancer
Lung Cancer
St omach Cancer
M alignant neoplasms
Inf ect ious and parasit ic
diseases
-80%
-30%
20%
70%
120%
Source – Calculated from WHO Statistical Information System Mortality Data. Countries: Ireland,
Scotland, Denmark, Germany, US, England & Wales, Australia, France, Greece, Sweden, Japan. 1996
for all except Australia 1995.
Assessing impact of diseases on
population health

Cause of death analysis

Years’ lost analysis

Disability years’ lost analysis
Males
Cause of Death versus Years’ Lost
Male years lost split by cause
Ireland population deaths 1996
Male age standardised rate split by cause
Ireland population 1996
Infectious and
Parasitic Diseases
Infectious and Parasitic
Diseases
All Malignant Neoplasm
Lung
Digestive
Lung
Digestive
Breast
Cervical
Breast
Cervical
Other
Heart Disease
Other
All Diseases of Circulatory
System
Stroke
Other circulatory
Other circulatory
Pneumonia.
Bronchitis Asthma
Nephrosis.
All Injury/Poisoning
Road Traffic Accidents
Suicide
Homicide
Other Injury
Pneumonia.
Bronchitis Asthma
Nephrosis.
All Injury/Poisoning
Road Traffic Accidents
Suicide
Homicide
Other Injury
All Other Diseases
50
All Diseases of
Circulatory System
Heart Disease
Stroke
0
All Malignant
Neoplasm
100
150
200
Deaths per 100,000
All Other Diseases
250
300
350
0
10,000
20,000
30,000
Years Lost
40,000
50,000
Females
Cause of Death versus Years’ Lost
Female years lost split by cause
Population deaths 1996
Female age standardised rate split by cause
Ireland population 1996
Infectious and
Parasitic Diseases
Infectious and Parasitic
Diseases
All Malignant Neoplasm
Lung
Digestive
Lung
Digestive
Breast
Breast
Cervical
Cervical
Other
Other
All Diseases of Circulatory
System
Heart Disease
Stroke
Other circulatory
Pneumonia.
Bronchitis Asthma
Nephrosis.
All Injury/Poisoning
Road Traffic Accidents
Suicide
Homicide
Other Injury
All Other Diseases
50
All Diseases of
Circulatory System
Heart Disease
Stroke
Other circulatory
Pneumonia.
Bronchitis Asthma
Nephrosis.
All Injury/Poisoning
Road Traffic Accidents
Suicide
Homicide
Other Injury
0
All Malignant
Neoplasm
100
150
200
All Other Diseases
250
0
Deaths per 100,000
10,000
20,000
30,000
Years Lost
40,000
50,000
DALYs for Australia 1996
Main disease groups
Cardiovascular disease
Malignant neoplasms
Mental disorders
Chronic respiratory diseases
Unintentional injuries
Nervous system/sense disorders
Musculoskeletal diseases
Diabetes mellitus
YLL
YLD
Diseases of the digestive system
Intentional injuries
0
100
200
300
400
Total DALYs ('000)
500
600
700
Part 2

Impact of particular causes and lifestyle
on Mortality
Agenda

Causes
– Cardiovascular conditions
– Cancer
– Road Traffic Accidents
– Suicide
– AIDS

Risk factors
– Smoking
– Diet & Lifestyle
Cardiovascular diseases







43% of all deaths are due to such conditions
Covers many illness types such as heart failure,
diseases of the arteries, stroke and hypertension related
diseases
Mortality varies significantly by age and gender
Certain types of these disease are affected by
geographic area of residence
Main cause of death for those over 65 years of age
Trend in EU is downwards in relation in to incidence of
such diseases
Though need to consider each individual cause
separately
Cardiovascular - Heart disease



For heart disease, trend is downwards for both males and
females
Mirrors international experience, though fall is at a faster
rate than EU average
However, is still higher than EU average
Tre nd in mortality rate s from he art dise ase - male s 1962 to 1996
140%
120%
35-44
100%
45-54
55-64
80%
65-74
60%
75-84
85 and over
40%
20%
year
35
33
31
29
27
25
23
21
19
17
15
13
11
9
7
5
3
1
0%
Cardiovascular - Stroke



Trend is downwards for incidence of death due to a stroke
for both males and females
Fall again is at a faster rate than EU average
So, much so that there is no statistical difference between
Ireland and EU average experience
Tre nd in mortality rate s from stroke - fe male s 1962 to 1996
200%
180%
160%
140%
35-44
120%
45-54
55-64
100%
65-74
80%
75-84
60%
85 and over
40%
20%
year
35
33
31
29
27
25
23
21
19
17
15
13
11
9
7
5
3
1
0%
Cancer






Like cardiovascular conditions many different
forms of cancer (Over 200 known)
Not all cancers cause death
Second largest cause of death in Ireland
Incidence rate varies significantly between
males and females
Also, within geographic areas depending upon
the form of cancer
In international terms, Ireland’s cancer mortality
rates are higher than the average
Cancer – Breast cancer





Ireland has one of the highest rates of breast cancer in the EU
Trend for incidence at younger ages is downwards
For older lives, trends appears to be upward
Could be explained by differences in screening programmes
Western world has significantly higher incidence of breast
cancer than developing world
Tre nd in m ortality rate s from bre as t cance r - fe m ale s 1962 to 1996
300%
270%
240%
35-44
210%
45-54
180%
55-64
150%
65-74
120%
75-84
90%
85 and over
60%
30%
0%
1
3
5
7
9
11 13 15 17 19 21 23 25 27 29 31 33 35
ye ar
Road Traffic Accidents


Road Safety performance over last 30 years has
shown considerable improvement
However:
– Still one of main cause of deaths within 15-34 age
group
– By international standards relatively high


At all ages, higher incidence among males than
females
By number of deaths largest number within 1524, 25-34 and 65+ age groups
Suicide


Rate of suicide has risen sharply over the last 20
years
Possible reasons for the increase include:
– Underlying rate has increased significantly
– Reporting may have increased
– Coding may be more accurate



One of main cause of deaths within 15-34 age
group
Significantly higher incidence among males than
females
Particularly high incidence rate among young
males
Suicide


Significant differences between countries
These differences also are by age group
Suicide
Deaths per 100,000
40
35
30
25
20
15
10
Scotland
Ireland
Denmark
Germany
US
Eng &
Wales
France
Greece
Australia
Sweden
0
Japan
5
M ale M ortality Rate s
Standardised All Ages
15-24
25-34
• Unable to find any conclusive reason to explain this
variation though climate is a possibilty
AIDS
Pattern for AIDS:
 Low number of cases and deaths in 1980’s followed
by a rapid increase in mid-1990’s
 Appears to have been dramatic fall since late 1990’s
Cases of and Deaths from AIDS in Ireland, 1982 to 2000
90
70
60
50
Cases
40
Deaths
30
20
10
0
19
82
19
83
19
84
19
85
19
86
19
87
19
88
19
89
19
90
19
91
19
92
19
93
19
94
19
95
19
96
19
97
19
98
19
99
20
00
Number of Cases
80
Year
AIDS
Same picture reflected internationally

90000
Cases of and Deaths from AIDS in the US,
1982 to 1999
Number of Cases
80000
70000
60000
Cases
50000
Deaths
40000
30000
20000
10000
Be
for
e
19
81
19
81
19
82
19
83
19
84
19
85
19
86
19
87
19
88
19
89
19
90
19
91
19
92
19
93
19
94
19
95
19
96
19
97
19
98
19
99
0
Year
AIDS


However, the AIDS pattern is not reflected in HIV rates
Upwards trend since mid-1990’s
Ireland HIV infected persons by year of HIV diagnosis
400
Number of Cases
350
300
250
Cases
200
150
100
50
0
1985 1986 1987 1988 1989 1990 1991 1992 1993 1994 1995 1996 1997 1998 1999 2000
Year of diagnosis
AIDS

Could be explained by a change in the development
times between onset of HIV, onset of full-blown AIDS
and death due to AIDS

Working Party believes significant health issue around
increase in HIV levels

However, caution needed in predicting doom as theory
that death is only deferred is open to debate

If people are living longer then heretofore increased cost
of treatment of AIDS needs to be considered
Smoking




Lifestyle factor with most widely known impact
on health
Peto has completed extensive research on
smoking patterns between countries
SOA study on Irish Assured Lives has found that
mortality for smokers was appproximately twice
that for non-smokers
Experience from Peto suggests it is could be as
high as three times that of non-smokers
Smoking




6,000 people die each year as a result of
causes attributed to smoking
Certain causes affected more than others from
smoking e.g. lung disease, heart disease
By international standards, Irish smoking rates
comparatively low for males but high for
females
Continued innovative ‘no-smoking’ campaigns
are to be encouraged
Diet & Nutrition



No data for working party to consider effects of
diet explicity
Long term relationship between health status
and diet
International studies have found that there is a
change in mortality depending upon the in-take
of certain food groups
I have good news
…and even better news
The good news is

mortality will, we believe, improve over
the immediate future
Reasons for this
Reasons for this

Continuation of past trends
Reasons for this


Continuation of past trends
Cohort Effect
Reasons for this



Continuation of past trends
Cohort Effect
Increasing Wealth
Reasons for this




Continuation of past trends
Cohort Effect
Increasing Wealth
Screening
Reasons for this





Continuation of past trends
Cohort Effect
Increasing Wealth
Screening
Smoking behaviour
The Even Better News

The scope for improvement is
considerable
Reasons for this
Reasons for this

Many of the areas where we have been
performing comparatively poorly are
fixable
Reasons for this


Many of the areas where we have been
performing comparatively poorly are
fixable
Suicide levels can be brought to the
levels of our neighbours
Reasons for this



Many of the areas where we have been
performing comparatively poorly are
fixable
Suicide levels can be brought to the
levels of our neighbours
Similarly RTA
Reasons for this




Many of the areas where we have been
performing comparatively poorly are
fixable
Suicide levels can be brought to the
levels of our neighbours
Similarly RTA
Heart Disease can be brought down to
Swedish Levels
Reasons for this





Many of the areas where we have been
performing comparatively poorly are
fixable
Suicide levels can be brought to the
levels of our neighbours
Similarly RTA
Heart Disease can be brought down to
Swedish Levels
Breast Cancer can be detected earlier
Reasons for this

Smoking levels can be reduced
Can we fix it
Can we fix it --- Yes We Can
Can we fix it --- Yes We Can

As a state we are aware of the
“problems”
Can we fix it --- Yes We Can


As a state we are aware of the
“problems”
We have the financial resources
Can we fix it --- Yes We Can



As a state we are aware of the
“problems”
We have the financial resources
Do we have the collective will?
“Rage, rage against the dying of
the Light”
Dylan Thomas