Download Document

Morbidity and Mortality
Marcela Frazier OD,MPH, FAAO
Important Terms
• Sporadic: disease occurs occasionally, irregularly
• Endemic: disease stays in population at low frequency
• Epidemic: sudden outbreak in disease above typical
level
• Pandemic: epidemic over wide area (may be entire
world).
• Morbidity: all reported cases of disease, illness, and
disability
• Mortality: reported deaths due to a disease
Mortality Rate in the US
• Number of deaths: 2,423,712 per year
• Death rate: 803.6 deaths per 100,000
population
• Life expectancy: 77.9 years
• Infant Mortality rate: 6.75 deaths per 1,000
live births
http://www.cdc.gov/nchs/fastats/deaths.htm
Main causes of death in the US
•
•
•
•
•
•
•
•
Heart disease: 616,067
Cancer: 562,875
Stroke (cerebrovascular diseases): 135,952
Chronic lower respiratory diseases: 127,924
Accidents (unintentional injuries): 123,706
Alzheimer's disease: 74,632
Diabetes: 71,382
Influenza and Pneumonia: 52,717
Main Health risk factors
•
•
•
•
•
Smoking
Overweight
Diabetes
High Blood Pressure
Risky Behaviors (alcohol and drug use,
promiscuity, etc)
Heart Disease
Cancer
Cancer AL
Stroke
Leading causes of Death
Worldwide
• Vary depending on stage in development
of the country
• Affected by income, education, and
availability of health services
High-income countries
•
•
•
•
•
Coronary heart disease
Cancer
Stroke
Chronic obstructive pulmonary disease
Diabetes
Middle-income countries
•
•
•
•
•
Stroke
Coronary heart disease
Chronic obstructive pulmonary disease
Lower respiratory infection
HIV/AIDS
Low-income countries
•
•
•
•
•
Coronary heart disease
Lower respiratory infections
HIV/AIDS
Perinatal conditions
Stroke
Childhood mortality
Epidemiology of Eye
Problems
Marcela Frazier OD,MPH
Causes of Visual Impairment
• 161 million people in the world are Visually
impaired (BCVA 20/70 or worse in the better
eye)
• 124 low vision, 37 blind
• 259 million estimated when you include the
people who have uncorrected refractive error
with VAs worse than 20/70 in the better eye
(if they have no access to refractive
correction, they are still visually impaired!)
Distribution of visual impairment
• By age: Visual impairment is unequally
distributed across age groups.
– More than 82% of all people who are blind are
50 years of age and older, although they
represent only 19% of the world's population.
– Due to the expected number of years lived in
blindness (blind years), childhood blindness
remains a significant problem, with an
estimated 1.4 million blind children below age
15.
Distribution of visual impairment
• By gender: Available studies consistently
indicate that in every region of the world,
and at all ages, females have a
significantly higher risk of being visually
impaired than males.
Distribution of visual impairment
• Geographically: Visual impairment is not
distributed uniformly throughout the world.
More than 90% of the world's visually
impaired live in developing countries.
• Comparisons among countries are difficult
due to different examination techniques
and different data gathering capabilities
Causes of Visual Impairment
worldwide
• Cataracts are the leading cause of blindness
globally
• Glaucoma is the second leading cause of
blindness globally
• Age-related macular degeneration (AMD) ranks
third on the global scale.
• However, in developed countries, AMD is
becoming the leading cause of blindness, due to
the growing number of people over 70 years of
age.
Causes of Visual Impairment
worldwide
Cataracts Worldwide
• Leading cause of blindness
• Higher Prevalence in countries near the equator
an in countries where farm labor is more
common
• Difficulty in access to health care in developing
countries
• Found to be associated with diabetes, smoking,
steroid, and dietary factors, but no cause-effect
relationship established
• High altitude= higher prevalence?
Cataracts in The US
• Leading cause of blindness
• 20.5 million ages 40 and older (17.2 %) in
one or both eyes
• 30.1 million Americans will have cataracts by
2020
• 6.1 million (5.1%) have had cataract surgery
• By age 80, more than half of all Americans
have cataracts
•
Center for Disease Control and Prevention, 2006
Glaucoma Worldwide
• Countries with higher number of black
inhabitants have a higher prevalence of
POAG
• Diabetes=Higher prevalence, or higher
detection rates (more eye exams?)
Glaucoma in The US
• 2.2 million ages 50 and older have POAG
• Glaucoma is the leading cause of
blindness among African Americans
AMD Worldwide
• Age-related macular degeneration (AMD)
ranks third on the global scale.
• leading cause of legal blindness for people
over 50 in the Western world
• 25-30 million are affected worldwide, and
this figure is projected to triple in 25 years.
(AMD Alliance International)
• Reasons?
AMD In the US
• Approximately 1.8 million Americans age
40 and older have macular degeneration,
• 7.3 million are at substantial risk of
developing AMD because they have large
macular drusen
• AMD is the leading cause of permanent
impairment of central vision (used for
reading and for seeing road signs) among
Americans age 65 and older
Prevalence of Blindness in the
US
DM and Diabetic Retinopathy
• 20.8 million people in the US (7%) have DM
• prevalence of DM is at least 2 to 4 times
higher among minorities
• 12,000 to 24,000 new cases of blindness/yr
• leading cause of new cases of blindness in
adults 20-74 years of age in the US
• 4.1 million Americans are affected by
diabetic retinopathy
Eye Injuries in the US
• 9,000 fireworks-related injuries/yr
• 2,000 U.S. workers experience job-related eye
injuries/day!!!
• 90% of occupational eye injuries could be
prevented with protective eyewear
• 42,000 eye injuries from sports and recreation
/yr (more than 70 % of them involving people
younger than age 25)
•
U.S. Consumer Product Safety Commission, as reported by the American Academy of
Ophthalmology in June 2004
Access to Care
• Among 61 million adults >65 yo at high
risk:
– 50% had had a dilated EE within the past 12m
– 5 million could not afford eye care
• 15% were uninsured
• High Risk defined as >65 yo, with predisposing
systemic condition, poor vision, or ocular disease
• Zhang, Et al. Arch Ophthalmol 2007; 124:411-418
Causes of Visual Impairment for
children
• Developed Countries
– Perinatal (ROP)
– Genetic (albinism)
– Traumatic
• Developing Countries
– Xerophthalmia
– Onchocerciasis
– Measles
– Trachoma
Poverty and Visual impairment
• Poverty underlies not only the causes, but also
the perpetuation of ill health, including eye
health.
• Blindness remains a key barrier to development.
• Health is the centrepiece of development and
poverty alleviation; continuing to eliminate
avoidable blindness among the poorest of the
poor is a moral imperative.
• http://www.who.int/tdr/media/video/productions.htm
Prevention
• Cataract, glaucoma, corneal opacity, diabetic
retinopathy, onchocerciasis, childhood
blindness, trachoma, and some other causes of
blindness can potentially all be prevented and/or
treated.
• WHO estimates that, globally, up to 75% of all
blindness is avoidable. However, the proportion
of the specific causes of blindness varies
considerably from region to region, depending
on local circumstance.
• Only about half the cases of childhood blindness
are avoidable (Genetic disorders).
"VISION 2020: The Right to Sight"
• Increased public awareness and utilization of eye health care
services
• Increased availability and affordability of eye health care services
• Increased global political commitment to prevention of visual
impairment
• Increased professional commitment to prevention of visual
impairment
• Commitment and support of non-governmental organizations
• Involvement and partnership with the corporate sector
• More effective primary eye care activities as an integral part of the
primary health care system which have contributed to the decline in
vision loss from trachoma, onchocerciasis, vitamin A deficiency and
even from cataract through better services including outreach case
finding and eye health education.