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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