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Transcript of The 2003 Healthcare Conference Actuaries Adding Value 5-7 October 2003 Scarman House, The University...
The 2003 Healthcare Conference
Actuaries Adding Value
5-7 October 2003
Scarman House, The University of Warwick
Workshop Session A1 :
Trends in Critical Illness Risk Costs
Research Group Progress Report
Neil Robjohns Dr Richard Croxson Joanne Wells
Trends in Critical Illness Risk CostsAn update from the Critical Illness Trends Research Group
Update and analysis of cancer trends Cancer screening
Recent and future developments in cardiovascular medicine
Update and analysis of trends in heart attack, coronary artery bypass grafts and angioplasty
Trends in non-Critical-Illness mortality
Critical Illness Trends Research Group
Our Aims :
To examine underlying trends in the factors influencing UK Insured Critical Illness claim rates, and from these, to assess : The historic trend in incidence and death rates for the major
CI’s Any pointers for future trends in Standalone CI, Mortality and
hence Accelerated CI.
Formed in March 2001
Group Members and our Current Focus
Heart Attack MS, TPDCancer & Stroke & non-CI morty
ActuariesAzim Dinani Scott Reid Sue ElliottRichard Morris Joanne Wells Hamish GallowayNeil Robjohns
Medical ExpertsProfessor Rubens Richard CroxsonConsultant Oncologist Consultant Cardiologist
Links : Actuaries Panel on Medical Advances CMIB CI experience investigation ABI CI definitions group
Trends in Critical Illness Risk CostsAn update from the Critical Illness Trends Research Group
Update and analysis of cancer trends Cancer screening
Recent and future developments in cardiovascular medicine
Update and analysis of trends in heart attack, coronary artery bypass grafts and angioplasty
Trends in non-Critical-Illness mortality
Cancer Incidence and Mortality Rates, 1971 - 2000All Ages (standardised), England & Wales
See Legend All CIEngland & Wales
Rates per 10,000
See LegendSee Legend
Cancer Trends 1971 - 2000
Country Sex Event Cancer Site Age Band
F_Q_Std_AllNot in UseNot in Use Not in Use Not in Use Not in Use Not in Use M_Q_Std_All
Not in Use M_I_Std_All Not in Use F_I_Std_AllNot in Use Not in Use Not in Use Not in Use
-
5.0
10.0
15.0
20.0
25.0
30.0
35.0
40.0
45.0
50.0
1971 1973 1975 1977 1979 1981 1983 1985 1987 1989 1991 1993 1995 1997 1999
Cancer Incidence and Mortality Rates, 1971 - 2000Ages 40 – 59 (standardised), England & Wales
See Legend All CIEngland & Wales
Rates per 10,000
See LegendSee Legend
Cancer Trends 1971 - 2000
Country Sex Event Cancer Site Age Band
F_Q_Std_40_59Not in UseNot in Use Not in Use Not in Use Not in Use Not in Use M_Q_Std_40_59
Not in Use M_I_Std_40_59 Not in Use F_I_Std_40_59Not in Use Not in Use Not in Use Not in Use
-
5.0
10.0
15.0
20.0
25.0
30.0
35.0
40.0
45.0
50.0
1971 1973 1975 1977 1979 1981 1983 1985 1987 1989 1991 1993 1995 1997 1999
Trend in Cancer Incidence and Mortality Rates1971 – 2000, Index 1971 = 100, England & Wales, Men
Men See Legend All CI
Cancer Trends 1971 - 2000
See LegendEngland & Wales
Index YearIndex ( 1971 = 100 )
Country Sex Event Cancer Site Age Band
I_Std_20_39 Not in Use I_Std_40_59 Not in Use Not in Use I_Std_60+ Not in Use Not in Use
Q_Std_20_39 Not in Use Q_Std_40_59 Not in Use Not in Use Q_Std_60+ Not in Use Not in Use
0
20
40
60
80
100
120
140
160
1971 1973 1975 1977 1979 1981 1983 1985 1987 1989 1991 1993 1995 1997 1999
1971
Trends in Cancer Incidence and MortalityBest Estimate Avg Change % pa, England & Wales, by cancer site Men, aged 40 - 59, 1971-2000
-6%
-4%
-2%
0%
2%
4%
6%
8%
10%
-8% -6% -4% -2% 0% 2% 4% 6%
Change in Mortality %pa
Ch
ang
e in
Inci
den
ce %
pa
LungOtherBowelBladderLymphomaProstateOralStomachKidneyMelanomaOesophagusBrainPancreasLeukemiaLarynxTestesDummy
Size of balls represents relative importance of cancer site measured by incidence rates
Trends in Cancer Incidence and MortalityBest Estimate Avg Change % pa, England & Wales, by cancer site Men, aged 40 - 59, for the 1970’s
-6%
-4%
-2%
0%
2%
4%
6%
8%
10%
-8% -6% -4% -2% 0% 2% 4% 6%
Change in Mortality %pa
Ch
ang
e in
Inci
den
ce %
pa
LungOtherBowelBladderLymphomaProstateOralStomachKidneyMelanomaOesophagusBrainPancreasLeukemiaLarynxTestesDummy
Size of balls represents relative importance of cancer site measured by incidence rates
Trends in Cancer Incidence and MortalityBest Estimate Avg Change % pa, England & Wales, by cancer site Men, aged 40 - 59, for the 1980’s
-6%
-4%
-2%
0%
2%
4%
6%
8%
10%
-8% -6% -4% -2% 0% 2% 4% 6%
Change in Mortality %pa
Ch
ang
e in
Inci
den
ce %
pa
LungOtherBowelBladderLymphomaProstateOralStomachKidneyMelanomaOesophagusBrainPancreasLeukemiaLarynxTestesDummy
Size of balls represents relative importance of cancer site measured by incidence rates
Trends in Cancer Incidence and MortalityBest Estimate Avg Change % pa, England & Wales, by cancer site Men, aged 40 - 59, for the 1990’s
-6%
-4%
-2%
0%
2%
4%
6%
8%
10%
-8% -6% -4% -2% 0% 2% 4% 6%
Change in Mortality %pa
Ch
ang
e in
Inci
den
ce %
pa
LungOtherBowelBladderLymphomaProstateOralStomachKidneyMelanomaOesophagusBrainPancreasLeukemiaLarynxTestesDummy
Size of balls represents relative importance of cancer site measured by incidence rates
Trends in Cancer Incidence and MortalityBest Estimate Avg Change % pa, England & Wales, by cancer site Men, aged 40 - 59, 1971-2000
1990's
-6%
-4%
-2%
0%
2%
4%
6%
8%
10%
-8% -6% -4% -2% 0% 2% 4% 6%
Change in Mortality %paC
han
ge
in In
cid
ence
%p
a
1980's
-6%
-4%
-2%
0%
2%
4%
6%
8%
10%
-8% -6% -4% -2% 0% 2% 4% 6%
Change in Mortality %pa
Ch
ang
e in
Inci
den
ce %
pa
1970's
-6%
-4%
-2%
0%
2%
4%
6%
8%
10%
-8% -6% -4% -2% 0% 2% 4% 6%
Change in Mortality %pa
Ch
ang
e in
Inci
den
ce %
pa
Size of balls represents relative importance of cancer site measured by incidence rates
Trend in Cancer Incidence and Mortality Rates1971–2000, Index 1971 = 100, England & Wales, Women
Women See Legend All CI
Cancer Trends 1971 - 2000
See LegendEngland & Wales
Index YearIndex ( 1971 = 100 )
Country Sex Event Cancer Site Age Band
I_Std_20_39 Not in Use I_Std_40_59 Not in Use Not in Use I_Std_60+ Not in Use Not in Use
Q_Std_20_39 Not in Use Q_Std_40_59 Not in Use Not in Use Q_Std_60+ Not in Use Not in Use
0
20
40
60
80
100
120
140
160
1971 1973 1975 1977 1979 1981 1983 1985 1987 1989 1991 1993 1995 1997 1999
1971
Trends in Cancer Incidence and MortalityBest Estimate Avg Change % pa, England & Wales, by cancer site Women, aged 40 - 59, 1971-2000
-6%
-4%
-2%
0%
2%
4%
6%
-6% -4% -2% 0% 2% 4%
Change in Mortality %pa
Ch
ang
e in
Inci
den
ce %
pa
BreastOtherBowelOvaryLungUterusCervixMelanomaLymphomaBrainKidneyLeukemiaOralBladderPancreasStomachDummy
Size of balls represents relative importance of cancer site measured by incidence rates
Trends in Cancer Incidence and MortalityBest Estimate Avg Change % pa, England & Wales, by cancer site Women, aged 40 - 59, for the 1970’s
-6%
-4%
-2%
0%
2%
4%
6%
-6% -4% -2% 0% 2% 4%
Change in Mortality %pa
Ch
ang
e in
Inci
den
ce %
pa
BreastOtherBowelOvaryLungUterusCervixMelanomaLymphomaBrainKidneyLeukemiaOralBladderPancreasStomachDummy
Size of balls represents relative importance of cancer site measured by incidence rates
Trends in Cancer Incidence and MortalityBest Estimate Avg Change % pa, England & Wales, by cancer site Women, aged 40 - 59, for the 1980’s
-6%
-4%
-2%
0%
2%
4%
6%
-6% -4% -2% 0% 2% 4%
Change in Mortality %pa
Ch
ang
e in
Inci
den
ce %
pa
BreastOtherBowelOvaryLungUterusCervixMelanomaLymphomaBrainKidneyLeukemiaOralBladderPancreasStomachDummy
Size of balls represents relative importance of cancer site measured by incidence rates
Trends in Cancer Incidence and MortalityBest Estimate Avg Change % pa, England & Wales, by cancer site Women, aged 40 - 59, for the 1990’s
-6%
-4%
-2%
0%
2%
4%
6%
-6% -4% -2% 0% 2% 4%
Change in Mortality %pa
Ch
ang
e in
Inci
den
ce %
pa
BreastOtherBowelOvaryLungUterusCervixMelanomaLymphomaBrainKidneyLeukemiaOralBladderPancreasStomachDummy
Size of balls represents relative importance of cancer site measured by incidence rates
Trends in Cancer Incidence and MortalityBest Estimate Avg Change % pa, England & Wales, by cancer site Women, aged 40 - 59, 1971-2000
1990's
-6%
-4%
-2%
0%
2%
4%
6%
-6% -4% -2% 0% 2% 4%Change in Mortality %pa
Ch
ang
e in
Inci
den
ce %
pa
1980's
-6%
-4%
-2%
0%
2%
4%
6%
-6% -4% -2% 0% 2% 4%Change in Mortality %pa
Ch
ang
e in
Inci
den
ce %
pa
1970's
-6%
-4%
-2%
0%
2%
4%
6%
-6% -4% -2% 0% 2% 4%Change in Mortality %pa
Ch
ang
e in
Inci
den
ce %
pa
Size of balls represents relative importance of cancer site measured by incidence rates
Trends in Critical Illness Risk CostsAn update from the Critical Illness Trends Research Group
Update and analysis of cancer trends Cancer screening
Recent and future developments in cardiovascular medicine
Update and analysis of trends in heart attack, coronary artery bypass grafts and angioplasty
Trends in non-Critical-Illness mortality
Healthy
Latent … . Cancer
Diagnosed
Cancer
Modelling the impact of cancer screeningOutline of the model
Ht
LC0 LC1 LC2 LCn
DC0 DC1 DC2 DCn
CuredFrom Cancer
DeadFrom Cancer
Ht+1
Modelling the impact of cancer screeningOutline of the model
Key transition rates to be estimated : Hx,t to LC0,x+1,t+1
The probability of ‘starting’ cancer aged x in year t
LCn,x,t to DCn,x+1,t+1
The probability of latent cancer being diagnosed at duration n, for age x in year t
This transition rate changes on introduction of a screening programme
DCn,x+N,t+N to Dead The probability a life diagnosed with cancer from state LCn,x,t dies
from cancer N years later, aged x+N in year t+N (and also estimate transition to cured)
Breast Cancer ScreeningResults from the modelTrend in breast cancer registrations, by age group
0
5
10
15
20
25
30
1 2 3 4 5 6 7 8 9 10 11 12 13 14 15 16 17 18 19 20
Year
Reg
istr
atio
ns
per
10,
000 40 - 44
45 - 49
50 - 54
55 - 59
60 - 64
65 - 69
70 - 74
Breast Cancer ScreeningActual Outcome, 1971 to 2000Trend in breast cancer registrations, by age group
See Legend BreastEngland & Wales
Rates per 10,000
See LegendWomen
Cancer Trends 1971 - 2000
Country Sex Event Cancer Site Age Band
Q_65-69Q_60-64Q_30-34 Q_35-39 Q_40-44 Q_45-49 Q_50-54 Q_55-59
I_50-54 I_55-59 I_60-64 I_65-69I_30-34 I_35-39 I_40-44 I_45-49
-
5.0
10.0
15.0
20.0
25.0
30.0
35.0
1971 1973 1975 1977 1979 1981 1983 1985 1987 1989 1991 1993 1995 1997 1999
Breast Cancer ScreeningResults from the modelChange over time in breast cancer registrations by age
0
5
10
15
20
25
30
40 - 44 45 - 49 50 - 54 55 - 59 60 - 64 65 - 69 70 - 74
Age Band
Reg
istr
atio
ns
per
10,
000
year 5
year 6
year 7
year 8
year 9
year 10
year 11
Breast Cancer ScreeningActual Outcome, 1971 to 2000Change over time in breast cancer registrations by age
0
5
10
15
20
25
30
35
40 - 44 45 - 49 50 - 54 55 - 59 60 - 64 65 - 69 70 - 74
Age Band
Reg
istr
atio
ns
per
10,
000
1987
1989
1990
1991
1992
1993
1995
Prostate Cancer “Screening”Results from the modelTrend in prostate cancer registrations, by age group
0
50
100
150
200
250
1 2 3 4 5 6 7 8 9 10 11 12 13 14 15 16 17 18 19 20
Year
Reg
istr
atio
ns
per
10,
000 50 - 54
55 - 59
60 - 64
65 - 69
70 - 74
75 - 79
80 - 84
Prostate Cancer “Screening”Actual Outcome, USA, 1973 to 1998Trend in prostate cancer registrations, by age group
See Legend ProstateUSA
Rates per 10,000
See LegendMen
Cancer Trends 1971 - 1998
Country Sex Event Cancer Site Age Band
Not in UseQ_75-79Q_50-54 Q_55-59 Q_60-64 Q_65-69 Not in Use Q_70-74
Not in Use I_70-74 I_75-79 Not in UseI_50-54 I_55-59 I_60-64 I_65-69
-
20.0
40.0
60.0
80.0
100.0
120.0
140.0
160.0
180.0
200.0
1971 1973 1975 1977 1979 1981 1983 1985 1987 1989 1991 1993 1995 1997
Prostate Cancer “Screening”Results from the modelChange over time in prostate cancer registrations by age
0
50
100
150
200
250
50 - 54 55 - 59 60 - 64 65 - 69 70 - 74 75 - 79 80 - 84
Age Band
Reg
istr
atio
ns
per
10,
000
year 5
year 6
year 7
year 8
year 9
year 10
year 11
Prostate Cancer “Screening”Actual Outcome, USA, 1973 to 1998Change over time in prostate cancer registrations by age
0
20
40
60
80
100
120
140
160
180
200
50 - 54 55 - 59 60 - 64 65 - 69 70 - 74 75 - 79 80 - 84
Age Band
Reg
istr
atio
ns
per
10,
000
1989
1990
1991
1992
1993
1995
1999
Prostate Cancer “Screening”Results from the modelIndexed trend in prostate cancer rates, by age group, Year 1 = 100
0
50
100
150
200
250
300
350
400
1 2 3 4 5 6 7 8 9 10 11 12 13 14 15 16 17 18 19 20
Year
Reg
istr
atio
ns
Ind
ex %
v Y
ear
1
50 - 54
55 - 59
60 - 64
65 - 69
70 - 74
75 - 79
80 - 84
Prostate Cancer “Screening”Actual Outcome, England & Wales, 1971 to 2000Indexed trend in prostate cancer rates, by age group, 1971 = 100
Men See Legend Prostate
Cancer Trends 1971 - 2000
See LegendEngland & Wales
Index YearIndex ( 1972 = 100 )
Country Sex Event Cancer Site Age Band
I_45-49 I_50-54 I_55-59 I_60-64 I_65-69 I_70-74 I_75-79 I_80-84
Q_45-49 Q_50-54 Q_55-59 Q_60-64 Q_65-69 Q_70-74 Q_75-79 Q_80-84
0
50
100
150
200
250
300
350
400
450
500
1971 1973 1975 1977 1979 1981 1983 1985 1987 1989 1991 1993 1995 1997 1999
1972
Cancer Screening Programmes in the NHS
Breast Cancer Currently ages 50 to 64 ; extend to 70 in 2004 Trials underway for ‘high-risk’ women aged 35 to 49
Prostate Cancer No plans for formal screening But PSA test is widely available
Cervical Cancer Currently ages 20 to 64
Colorectal Cancer Pilot study for men and women aged 50 to 69
Cancer Incidence and Mortality Rates, 1971 - 2000Men, Ages 40–59 (standardised), England & Wales, by cancer site
I_Lung_ I_CoRec_ I_Prost_ I_Bladd_ I_Lymph_ I_Oral_ I_Melan_ I_Stoma_
Q_Stoma_Q_Melan_Q_Lung_ Q_CoRec_ Q_Prost_ Q_Bladd_ Q_Lymph_ Q_Oral_
Cancer Trends 1971 - 2000
Country Sex Event Cancer Site Age BandSee Legend See LegendEngland & Wales
Rates per 10,000
40-59 standardisedMen
-
2.0
4.0
6.0
8.0
10.0
12.0
1971 1973 1975 1977 1979 1981 1983 1985 1987 1989 1991 1993 1995 1997 1999
Trends in Critical Illness Risk CostsAn update from the Critical Illness Trends Research Group
Update and analysis of cancer trends Cancer screening
Recent and future developments in cardiovascular medicine
Update and analysis of trends in heart attack, coronary artery bypass grafts and angioplasty
Trends in non-Critical-Illness mortality
Recent & ? Future Developments in Cardiovascular Medicine
Dr. R. S. Croxson MB ChB. FRACP
DiagnosticsTreatmentScreening
Factors Affecting CI Claims
True Increase / Decrease in “Disease” Incidence /
Prevalence
Earlier Diagnosis / Presentation
Treatment: Lower incidence and severity of disease
Postpone presentation
Treatments: Reduce T.P.D (I.P.B)
Bloods
Lipids C Reactive Protein (CRP) – High Sensitivity (HST) TroponinsBrain Natriuretic Peptides BNPGenetic
eFigure 1.3.6 Plaques may enlarge by repeated episodes of rupture and repair. (From Weissberg PL. Atherosclerosis involves more than just lipids: plaque dynamics. Eur Heart J 1991;1:T13–T18, with permission.)
eFigure 1.3.4 Smooth muscle–inflammatory cell interactions in atherosclerosis. IFN-, interferon-; IL-1, interleukin-1; MMP, matrix metalloproteinase; PDGF, platelet-derived growth factor; TNF-, tumor necrosis factor-.
Consensus Document
Myocardial infarction redefined – A consensus document of The Joint European Society of Cardiology / American College of Cardiology Committee for the Redefinition of Myocardial Infarction
European Heart Journal (2000) 21. 1502-1513
Definition of MICriteria for acute, evolving or recent MI. Either one of the following criteria satisfies the diagnosis for an acute, evolving or recent MI:
(1) Typical rise & gradual fall or more rapid rise & fall of biochemical markers of myocardial necrosis with at least one of the following:
(a) ischaemic symptoms
(b) development of pathologic Q waves on the ECG
(c) ECG changes indicative of ischaemia (ST segment elevation or depression)
(d) coronary artery intervention (eg coronary angioplasty)
(2) Pathologic findings of an acute MI
Definition of MI
Criteria for established MI
Any one of the following criteria satisfies the diagnosis of forestablished MI:
1) Development of new pathologic Q waves on serial ECGs. The patient may or may not remember previous symptoms. Biochemical markers of myocardial necrosis may have normalised, depending on the length of time that has passed since the infarction developed.
2) Pathologic findings of a healed or healing MI
TROPONIN IN DIAGNOSIS OF MYOCARDIAL INFARCTION
INSURANCE QUESTIONSINSURANCE QUESTIONS–What about lack of standardisationlack of standardisation ?
–What about false positives ?false positives ?
–WhichWhich specific Troponin assays should be used ?assays should be used ?
–What about analytical variability ?analytical variability ?
–What about troponin values near the referencevalues near the reference limit ? limit ?
–Is this compatible with insurance principles ?insurance principles ?
–Do all clinicians support the troponin infarction definition ? Do all clinicians support the troponin infarction definition ?
Genetics
Coronary Artery Disease: LDL Chol ReceptorsThrombosis / Haemostasis: Factor V LeidenHypertrophic Cardiomyopathy: Sarcomeric ProteinsCardiac Arrhythmias: Long QT Syndrome, VF/VTHypertension: PolymorphismsConnective Tissue Disorders: Marfan Syndrome, FBNI
Imaging
X-RaysComputed Tomography (CT)Magnetic Resonance (MR)EchocardiographyNuclear Imaging (Radioisotopes)Coronary Angiography (Invasive)
Medical Therapy
Lipid Lowering – “Statins” etc
Anti coagulants, Anti Thrombotics, Fibrinolytics, e.g aspirin, clopidogrel, abciximab
Antihypertensives: Diuretics, ACE Inhibitors, Angiotensin II blockers
Heart Failure Treatment.
Interventions
Heart rhythm disorders Radio frequency ablation - “Cures”Automatic implantable defibrillators (ICD)Pacemakers (heart block, CHF treatment)
Interventions
Coronary artery bypass grafting – arterial grafts, “off pump” surgeryPercutaneous transluminal coronary angioplasty (PTCA)Stenting – drugs eluting stents, restenosisTranscatheter closure of cardiac defects
Screening & Prevention
Primary Prevention: General population
At Risk population
Pre symptomatic
Secondary Prevention: Reduction in ”relapses”
4 5 6 7 8 4 5 6 7 8
180/105
160/95 AGE
140/75 70
120/75
180/105
160/95 AGE
140/75 60
120/75
180/105
160/95 AGE
140/75 50
120/75
180/105
160/95 AGE
140/75 40
120/75
180/105
160/95 AGE
140/75 30
120/75
Very high >4%High 3-4%Moderate 2-3%Mild 1-2%Low .5-1%Very low <0.5%
Total Chol:HDL-CholNonsmoker Smoker
Men - no diabetes
Risk levelPercent chance of a CV event per
annum
4 5 6 7 8 4 5 6 7 8
180/105
160/95 AGE
140/75 70
120/75
180/105
160/95 AGE
140/75 60
120/75
180/105
160/95 AGE
140/75 50
120/75
180/105
160/95 AGE
140/75 40
120/75
180/105
160/95 AGE
140/75 30
120/75
Very high >4%High 3-4%Moderate 2-3%Mild 1-2%Low .5-1%Very low <0.5%
Total Chol:HDL-CholSmokerNonsmoker
Women - no diabetes
Risk levelPercent chance of a CV event per annum
Polypill
Statin, Aspirin, Folic Acid,
3 Anti hypertensives (half dose);
Thiazide, Betablocker, ACE Inhibitor
Everyone age 55 and over
Everyone with existing cardiovascular disease
Polypill
4 Risk Factors: LDL C
Intervened BP
Platelets
HomocysteineOutcome measures 88% heart attack
Reduction in 80% Stokes
1 in 3 Benefit Gaining 11/12 years life
without heart attack / stroke
Evaluations
Evidence Based Medicine (EBM)Meta-AnalysesDatabase – Cochrane LibraryGuidelines – NICE, NSF, SIGN, BCS, AHAAudit, Peer Review, RevalidationContinuing Professional Development.
Trends in Critical Illness Risk CostsAn update from the Critical Illness Trends Research Group
Update and analysis of cancer trends Cancer screening
Recent and future developments in cardiovascular medicine
Update and analysis of trends in heart attack, coronary artery bypass grafts and angioplasty
Trends in non-Critical-Illness mortality
Heart Related Conditions
Update on trends in incidence
heart attack
coronary artery bypass
angioplasty (1 and more or 2 and more vessels)
Breaking down trends
by age
different time periods
Trends in Population Incidence RatesHeart Attack (First and Subsequent) Age 35-64
60%
65%
70%
75%
80%
85%
90%
95%
100%
105%
89/89 90/89 91/89 92/89 93/89 94/89 95/89 96/89 97/89 98/89 99/89 00/89
Female
Male
Trends in Population Incidence RatesCoronary Artery Bypass Graft Age 35-64
60%
80%
100%
120%
140%
160%
180%
200%
89/89 90/89 91/89 92/89 93/89 94/89 95/89 96/89 97/89 98/89 99/89 00/89
Female
Male
Trends in Population Incidence RatesAngioplasty 2+Vessels Age 35-64
60%
110%
160%
210%
260%
310%
360%
410%
89/89 90/89 91/89 92/89 93/89 94/89 95/89 96/89 97/89 98/89 99/89 00/89
Female
Male
Trends in Population Incidence RatesAngioplasty 1+Vessels Age 35-64
60%
110%
160%
210%
260%
310%
360%
89/89 90/89 91/89 92/89 93/89 94/89 95/89 96/89 97/89 98/89 99/89 00/89
Female
Male
Trends in Population Incidence RatesCABG and Angioplasty 2+ Age 35-64
60%
80%
100%
120%
140%
160%
180%
200%
89/89 90/89 91/89 92/89 93/89 94/89 95/89 96/89 97/89 98/89 99/89 00/89
Female
Male
Trends in Population Incidence RatesCABG and Angioplasty 1+Vessels Age 35-64
60%
80%
100%
120%
140%
160%
180%
200%
89/89 90/89 91/89 92/89 93/89 94/89 95/89 96/89 97/89 98/89 99/89 00/89
Female
Male
Trends in Population Incidence RatesHA, CABG, Stroke and Angioplasty 2+ Age 35-64
70%
75%
80%
85%
90%
95%
100%
105%
110%
89/89 90/89 91/89 92/89 93/89 94/89 95/89 96/89 97/89 98/89 99/89 00/89
Female
Male
MalesHA
Angio2plus
CABG
Stroke
FemalesHA
Angio2plus
CABG
Stroke
Percentage Change p.a. in Incidence Rates1989-2000 Non-smoker model
Coronary Artery Bypass Graft Males
-20.00%
-10.00%
0.00%
10.00%
20.00%
30.00%
40.00%
50.00%
25
_2
9
30
_3
4
35
_3
9
40
_4
4
45
_4
9
50
_5
4
55
_5
9
60
_6
4
65
_6
9
70
_7
4
75
_7
9
80
_8
4
85
_8
9
p.a % change
LCI
UCI
Percentage Change p.a. in Incidence Rates1989-2000 Non-smoker model
Coronary Artery Bypass Graft Females
-10.00%
0.00%
10.00%
20.00%
30.00%
40.00%
50.00%
30_34
35_39
40_44
45_49
50_54
55_59
60_64
65_69
70_74
75_79
80_84
85_89
p.a % change
LCI
UCI
Percentage Change p.a. in Incidence Rates1989-2000 Non-smoker model
HA, CABG and Angioplasty 2+ Males
-6.00%
-4.00%
-2.00%
0.00%
2.00%
4.00%
6.00%
8.00%
25
_2
9
30
_3
4
35
_3
9
40
_4
4
45
_4
9
50
_5
4
55
_5
9
60
_6
4
65
_6
9
70
_7
4
75
_7
9
80
_8
4
85
_8
9
p.a % change
LCI
UCI
Percentage Change p.a. in Incidence Rates1995-2000 Non-smoker model
HA, CABG and Angioplasty 2+ Males
-6.00%
-4.00%
-2.00%
0.00%
2.00%
4.00%
6.00%
8.00%
25
_2
9
30
_3
4
35
_3
9
40
_4
4
45
_4
9
50
_5
4
55
_5
9
60
_6
4
65
_6
9
70
_7
4
75
_7
9
80
_8
4
85
_8
9
p.a % change
LCI
UCI
Percentage Change p.a. in Incidence Rates1989-2000 Non-smoker model
HA, CABG and Angioplasty 2+ Females
-6.00%
-4.00%
-2.00%
0.00%
2.00%
4.00%
6.00%
8.00%
30_34
35_39
40_44
45_49
50_54
55_59
60_64
65_69
70_74
75_79
80_84
85_89
p.a % change
LCI
UCI
Percentage Change p.a. in Incidence Rates1995-2000 Non-smoker model
HA, CABG and Angioplasty 2+ Females
-6.00%
-4.00%
-2.00%
0.00%
2.00%
4.00%
6.00%
8.00%
30_34
35_39
40_44
45_49
50_54
55_59
60_64
65_69
70_74
75_79
80_84
85_89
p.a % change
LCI
UCI
Summary Heart Related Conditions
Heart attack incidence is no longer reducing at historical rates Potentially explained by the use of troponin to assist in the diagnosis
of heart attacks Full impact of troponin not yet in data
Operations CABG
stabilising/reducing less 60 increasing over 60
Angioplasty operations increasing at all ages
Combined effect Flat incidence at younger ages Increases in incidence at older ages Before troponin and other medical advances
Trends in Critical Illness Risk CostsAn update from the Critical Illness Trends Research Group
Update and analysis of cancer trends Cancer screening
Recent and future developments in cardiovascular medicine
Update and analysis of trends in heart attack, coronary artery bypass grafts and angioplasty
Trends in non-Critical-Illness mortality
Importance of Non-CI Mortality
Accelerated CI Incidence Rate Formula ix + (1-kx)qx or ix + q’x where q’x represents non-CI related
mortality Non CI Mortality as a %age of CIBT93
Age 25 Age 55Male 54.7% 24.6%Female 27.4% 13.4%
Biggest Single Component of Male ACI to Age 502nd Biggest Single Component of Female ACI throughout
Age 15-39 Age 40-64 Age 65+All Mortality Male 0.30% 2.70% 1.70%
Female 1.10% 2.10% 1.20%
Cancer, HA and Stroke Male 3.30% 3.70% 2.20%Female 2.20% 2.40% 1.80%
Non CI Mortality Male -0.40% 1.10% 1.10%Female 0.30% 1.50% 0.60%
Population Mortality Improvements 1979-2000
Deaths by Cause, Males 15-39
0
0.00005
0.0001
0.00015
0.0002
0.00025
0.0003
0.00035
0.000419
79
1981
1983
1985
1987
1989
1991
1993
1995
1997
1999
Dea
th R
ate
AccidentsVehicular AccidentsCancer (CI)Cardio (Non-CI)Heart Attack CIMental / NervousEverything else
Deaths by Cause - Males 40-64
0
0.0005
0.001
0.0015
0.002
0.0025
0.003
0.0035
Dea
th R
ate
Cancer (CI)
Heart Attack CI
Cardio (Non-CI)
Respiratory
Stroke CI
Accidents
Everything Else
Deaths by Cause - Males 65+
00.0020.0040.0060.0080.01
0.0120.0140.0160.0180.02
Dea
th R
ate
Cancer (CI)
Cardio (Non-CI)
Heart Attack CI
Respiratory
Stroke CI
Everything Else
Deaths by Cause - Female ages 15-39
0
0.00005
0.0001
0.00015
0.0002
0.00025
0.0003
Dea
th R
ate
Cancer (CI)
Accidents
Vehicular Accidents
Mental Nervous
Respiratory
Cardio (Non-CI)
Stroke CI
Everything Else
Death by Cause - Females 40-64
0
0.0005
0.001
0.0015
0.002
0.0025
0.00319
79
1981
1983
1985
1987
1989
1991
1993
1995
1997
1999
Dea
th R
ate
Cancer (CI)
Cardio (Non-CI)
Heart Attack CI
Stroke CI
Respiratory
Everything Else
Death by Cause - Females 65+
00.0010.0020.0030.0040.0050.0060.0070.0080.009
0.01
De
ath
Ra
te
Cardio (Non-CI)Cancer (CI)RespiratoryStroke CIHeart Attack CIEverything Else
Further Work and Application to Insured Lives
Need to understand non-CI cardio
CMI cause of Death survey discontinued 1994
Link to deprivation codes