Transcript Slide 1

Major Patterns of Life, Death
and Wellbeing
a lightning tour of some interesting aspects of population health
Learning Objectives
• Overview
• Major causes of death
• Life expectancy
• Life course epidemiology
• Infant mortality
• Road traffic injuries
• Ageing
• Cross cutting issues
•
•
•
•
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Alcohol
Obesity
Smoking
Ethnicity
Major patterns of life, death and wellbeing
Inequalities
Which of the following currently causes
most deaths in England?
a)
b)
c)
d)
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Cancer
Respiratory disease
Circulatory disease
Infections
Major patterns of life, death and wellbeing
Male Age-Standardised Mortality Rates, for 3
Categories of Cause of Death, 2002-2012
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Major patterns of life, death and wellbeing
Female Age-Standardised Mortality Rates, for 3
Categories of Cause of Death, 2002-2012
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Major patterns of life, death and wellbeing
Age-Standardised Mortality Rates for CVD, 1961
to 2009, Great Britain
Males
Females
A
B
C
1961
2009
Years
A
B
C
Source: BHF
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Major patterns of life, death and wellbeing
1961
2009
Percentage of Deaths from Cancer by CCGs in
the South West
Source: NEoLCIN
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Major patterns of life, death and wellbeing
Percentage of Deaths for the 10 leading causes
of Death for Males and Females, 2002-2012
Females
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Major patterns of life, death and wellbeing
Males
Age Standardised Mortality Rates by Sex,
UK and Constituent Countries
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Major patterns of life, death and wellbeing
Percentage Distribution of all Deaths by
Age Group for Selected Years, UK
10
Major patterns of life, death and wellbeing
Age Distribution of the Population in the
UK, Actual (2010) and Projected (2035)
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Major patterns of life, death and wellbeing
What can you see as the potential issues
with an ageing population?
1. Increase in the dependency ratio.
2. Increased government spending on health care and pensions.
3. Those in work may have to pay higher taxes.
4. Shortage of workers.
5. Changing sectors within the economy.
6. Higher savings for pensions may reduce capital investment.
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Major patterns of life, death and wellbeing
In England, what is the current life
expectancy at birth for females?
83 years
… and what was life expectancy at
birth for females in 1900?
50 years
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Major patterns of life, death and wellbeing
Life Expectancy at Birth: by Gender, 1900 to 2011
100
Life Expectancy at Birth (Years)
80
60
Females
Males
40
20
0
1900
14
1926
Major patterns of life, death and wellbeing
1950
1976
2001
2007
2009
2011
But the variations in life expectancy in
England are unacceptable…
Life Expectancy for males at birth by local authority
district in England and Wales, 2010-12
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Major patterns of life, death and wellbeing
Life Expectancy for females at birth by local
authority district in England and Wales, 2010-12
Major Causes of Death by Age: Numbers
of Deaths, England 2006
Males
0 - 14
15-19
20-24
25-29
infections
16
Females
30-34
cancers
35-39
40-44
45-49
nervous system
Major patterns of life, death and wellbeing
50-54
55-59
60-64
circulatory diseases
65-69
70-74
75-79
respiratory diseases
80-84
85-89
external
90-94
others
95+
Major Causes of Death by Age: Percentage
Deaths in each Age-Group
Males
0 - 14
15-19
20-24
25-29
infections
17
30-34
cancers
35-39
Females
40-44
45-49
nervous system
Major patterns of life, death and wellbeing
50-54
55-59
60-64
circulatory diseases
65-69
70-74
75-79
respiratory diseases
80-84
85-89
external
90-94
others
95+
been replaced by Public Health
ANow
Fewhas
Targets…
Outcomes
Framework
(PHOF)
 Our Healthier Nation targets
◦ Reduce deaths under 75 from cardiovascular disease
Vision:
To improve and protect the nation’s health and
and cancers
wellbeing,
improve
the health
of the poorest
fastest
◦ Reduce and
deaths
in all ages
from accidents
and suicides
 Inequalities
Outcome 1:targets
Increased
healthy life expectancy
◦ Reduce inequalities in life expectancy
◦ Reduce inequalities in infant mortality
 Outcome 2: Reduced differences in life expectancy
and healthy life expectancy between communities
http://www.phoutcomes.info/
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Major patterns of life, death and wellbeing
Life Course Epidemiology – Approach to Prevention
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Major patterns of life, death and wellbeing
Infant Mortality Rates in England and
Wales, 1981 to 2011
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Major patterns of life, death and wellbeing
Neonatal, Postneonatal, Childhood, and Under-5
Mortality in Western Europe, 1970-2010
“When you get these low levels of child mortality seen in
the high income countries, healthcare probably is an
important component in the variation. Most of the deaths
in places like the UK are neonatal and you would have to
look in more detail at what aspects of healthcare might
explain the difference.”
Dr Christopher Murray – study leader
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Major patterns of life, death and wellbeing
Male Deaths from Motor Vehicle Traffic Accidents, all
ages, UK, EU-15 Countries and Selected Averages
Source: WHO
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Major patterns of life, death and wellbeing
Total World Population 65+
Egypt
Nigeria
Sudan
Ethiopia
Tanzania
South Africa
Source: http://www.worldmapper.org/posters/worldmapper_map2_ver5.pdf
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Major patterns of life, death and wellbeing
Compression of Morbidity: Two Possible Scenarios
Poor health
habits
Good health
habits
Fries and Crapo: Vitality and Aging (San Francisco: WH Freeman 1981)
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Major patterns of life, death and wellbeing
Compression of Morbidity: Dynamic Equilibrium
Pressures increasing health needs
• Obesity and alcohol related morbidity
• Healthy life expectancy is increasing,
but slightly less fast than life
expectancy
• More disabled children surviving and
for longer
• No observed change in need for e.g.
hips, knees, cataracts means more
procedures in an ageing population
• Not enough funding for preventive
medicine
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Major patterns of life, death and wellbeing
Pressures decreasing health needs
• Improved adaptive technology
decreases dependency
• Decreasing smoking
• Decreasing lung cancer and
cardiovascular disease
• Many chronic diseases could be
prevented, deferred or managed
better resulting in lower care costs
and better health
Projected Increases in the Number of People with
Dementia in the UK, 2012-2051
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Major patterns of life, death and wellbeing
Health and Social Care Costs of Major Diseases
2008 Prices
821,884 people in the
UK live with dementia
(about one third of all
people over 90)
http://dementiachallenge.dh.gov.uk/map/?map=3
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Major patterns of life, death and wellbeing
Social Inequalities Persist as Health
Inequalities in Old Age
 Lower occupational grades – physical health
deteriorates quicker
 High grade position – better average physical health
especially in later years
 Mental health – slower rate of improvement in lower
grades
BMJ, doi:10.1136/bmj.39167.439792.55 (published 27 April 2007)
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Major patterns of life, death and wellbeing
Cross-Cutting Issues
• Lifestyle-related Conditions
• Smoking
• Alcohol
• Obesity
• Ethnicity
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Major patterns of life, death and wellbeing
What is the current prevalence of
cigarette smoking among adults in
Great Britain…
20%
…and what was it in 1972?
45%
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Major patterns of life, death and wellbeing
Prevalence of Cigarette Smoking by Sex, 1974 to
2012, Great Britain
60
50
Percentage (%)
40
Males
30
Females
20
10
0
1974
31
1978
1982
1986
1990
Major patterns of life, death and wellbeing
1994
1998
1998
2002
2006
2010
2012
Smoking Rates Throughout Pregnancy by
Type of Job, England, 2000-2010
Source: NHS
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Major patterns of life, death and wellbeing
Which of the following are risk factors for
harmful alcohol consumption?
• Males from lower socio-economic groups
• Women in professional occupations
• Young people 18-24
• People with mental health problems
• Refugee populations
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Major patterns of life, death and wellbeing
Groups at Risk of Harmful Drinking
• Males from lower socio-economic groups
• African-Caribbeans, especially males
• Women in professional occupations
• Young people 18-24
• Homeless people
• People using illegal drugs
• People with mental health problems
• Refugee populations
Source: Purser et al (2001)
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Major patterns of life, death and wellbeing
Age-Standardised Mortality Rate
Standardised Death Rate, Chronic Liver Disease
and Cirrhosis, all ages, per 100,000
Source: WHO/Europe, European HFA Database, April 2014
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Major patterns of life, death and wellbeing
Rank the following counties in order of prevalence
of adult obesity (highest prevalence first)
• USA
• Scotland
Mexico
• Mexico
Scotland
• Spain
England
• England
Spain
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Major patterns of life, death and wellbeing
Worldwide Adult Obesity Prevalence
United States
35.9%
Mexico
30.0%
Hungary
28.5%
New Zealand
27.8%
Scotland
27.7%
England
24.8%
Australia
24.6%
Luxembourg
23.5%
Northern Ireland
23.0%
Wales
22.0%
Spain
16.0%
Poland
15.8%
Finland
15.6%
Portugal
15.4%
Ireland
14.0%
Belgium
13.8%
Denmark
13.4%
Switzerland
8.1%
Korea
Japan
http://www.oecd.org/health/
4.1%
3.5%
0%
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Percentage of total
population who have a
BMI greater than 30
5%
10%
15%
Major patterns of life, death and wellbeing
20%
25%
30%
35%
40%
Trend in the Prevalence of Obesity and Excess
Weight in Children aged 2-15 years, 1995-2012
40%
35%
30%
Excess weight
25%
20%
15%
10%
5%
Obesity
Child excess weight BMI ≥ 85th centile, child obesity BMI ≥ 95th
centile of the UK90 growth reference. 95% confidence intervals
are displayed on the chart
0%
1995 1996 1997 1998 1999 2000 2001 2002 2003 2004 2005 2006 2007 2008 2009 2010 2011 2012
Source: HSE
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Major patterns of life, death and wellbeing
Trend inof Obesity
Prevalence
among
Adults,
Probability
Females aged
21-60 belonging
to a Specific
BMI
Group
in a given Year
[95% average)
Confidence Intervals]
1993-2012
(3-year
30%
Women
Men
Prevalence of obesity
25%
20%
15%
10%
Adult (aged 16+) obesity: BMI ≥ 30
5%
0%
Source:
Source:
HSE Foresight Report
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Major patterns of life, death and wellbeing
What do you think the obesity prevalence
would show by socioeconomic status?
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Major patterns of life, death and wellbeing
Obesity Prevalence of Children in Year 6 (aged
10-11 years) by Region, 2012/13
25%
22.4%
20%
20.9% 20.6%
Obesity prevalence
18.9%
19.6%
19.0% 18.4%
15%
17.0% 16.6%
16.0%
10%
5%
0%
ENGLAND
London
North East
Source: NCMP
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Major patterns of life, death and wellbeing
West
North West Yorkshire
Midlands
and The
Humber
East
Midlands
East of
England
South West South East
Child obesity: BMI ≥ 95th centile of the UK90 growth reference
Prevalence of Overweight (including Obese) in
the South West compared to England, 2012-13
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Major patterns of life, death and wellbeing
Infographics
• Up and coming tool for data
presentation
• Data visualisation – more
meaningful than numbers
• Example from World Health
Organisation on better health for
people with disabilities
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Major patterns of life, death and wellbeing
Prevalence of Doctor-Diagnosed Diabetes, 16+
England 1994-2006
6
5
percentage
4
3
2
men
women
1
0
Source: HSE
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1994
1998
Major patterns of life, death and wellbeing
2003
2006
(2003 and 2006 are
unweighted for
consistency)
Prevalence of Diabetes Compared to Other
Diseases
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Major patterns of life, death and wellbeing
Prevalence of Diabetes in England and the
Projected Figures for 2020 and 2030 by PCT
2010
2020
Source: ONS
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Major patterns of life, death and wellbeing
2030
Ethnicity or Lifestyle?
• Migrant studies
First wave, or subsequent settlers?
• Don’t confuse ethnicity with socio-economic
issues
47
Major patterns of life, death and wellbeing
Rank the following minority ethnic groups in order
of prevalence of ‘bad/very bad’ self reported
health (highest prevalence first)
• Bangladeshi
• Black
Caribbean
Chinese
• Chinese
Black Caribbean
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Major patterns of life, death and wellbeing
Prevalence of ‘Bad’ or ‘Very Bad’ Self-reported
Health aged 16 or over, England 2004
Source: HSE
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Major patterns of life, death and wellbeing
Percentage of 19 year olds Attaining Level 2,
Level 2 with Maths and English, and Level 3 by
Ethnicity, England 2013
Source: Department of Education
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Major patterns of life, death and wellbeing
CHD Risk
Effect of Employment and Health
Whitehall Study: http://www.ucl.ac.uk/whitehallII/pdf/Whitehallbooklet_1_.pdf
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Major patterns of life, death and wellbeing
CHD Mortality Rates by Socioeconomic Status,
England and Wales 2001/03
Source: BHF
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Major patterns of life, death and wellbeing
Learning Objectives Revisited
• Overview
• Major causes of death
• Life expectancy
• Life course epidemiology
• Infant mortality
• Road traffic injuries
• Ageing
• Cross cutting issues
•
•
•
•
53
Alcohol
Obesity
Smoking
Ethnicity
Major patterns of life, death and wellbeing
Inequalities
References
Child and Maternal Health Intelligence Network (CHIMAT) http://www.chimat.org.uk/
Department of Health (DoH) https://www.gov.uk/
Donaldson & Donaldson: Essential Public Health, second edition (2000) Petroc Press
Health and Social Care Information Service (HSCIC) http://www.hscic.gov.uk/
Health Survey for England (HSE) http://www.hscic.gov.uk/article/3741/Health-Survey-for-England-Health-social-care-andlifestyles
National Child Measurement Programme (NCMP) http://www.hscic.gov.uk/ncmp
National End of Life Care & Intelligence Network (NEoLCIN) http://www.endoflifecare-intelligence.org.uk/home
National Health Service (NHS) http://www.nhs.uk/Pages/HomePage.aspx
Office for National Statistics (ONS) http://www.ons.gov.uk/ons/index.html
Public Health England (PHE) http://datagateway.phe.org.uk/
Wanless: Securing Good Health for the Whole Population - Population Health Trends
www.doh.gov.uk/wanless/wanless_health_trends.pdf
Wilkinson & Marmot: Social Determinants of Health: The Solid Facts
World Health Organisation (WHO) http://www.who.int/en/
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Major patterns of life, death and wellbeing
Any Questions?
55
Major patterns of life, death and wellbeing