EPI 5240: Introduction to Epidemiology Mortality in Canada: trends and causes November 2, 2009
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Transcript of EPI 5240: Introduction to Epidemiology Mortality in Canada: trends and causes November 2, 2009
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11/2009 1
EPI 5240:Introduction to Epidemiology
Mortality in Canada: trends and causes November 2, 2009
Dr. N. Birkett,Department of Epidemiology & Community
Medicine,University of Ottawa
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11/2009 22
Section Overview
• What are the leading causes of death in Canada?
• What are the trends in mortality in Canada?
• Is there more than one way to assess the relative ‘importance’ of different causes of death?
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11/2009 33
Outcome measures (1)
• Mortality– Number of deaths (not that useful)– Crude rates– Age-standardized rates
• Controls for the aging population (more on Friday)
• Incidence– Other than cancer, not much available
• Other measures– PYLLs (Potential-years of life lost)
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11/2009 44
Outcome measures (2)
• PYLLs– Standard mortality measures ignore the age
of death– Our society ‘values’ a death of a child ‘more’
than the death of an older person– PYLL’s weight deaths by the age they occur
to show impact in a different way.– Generally, PYLLs rate acute illnesses and
injuries, to younger people, as more important than chronic diseases
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11/2009 55
Outcome measures (3)
• PYLLs– For each death, establish the ‘expected’ age
at death• Life expectancy• A fixed age (e.g. 75) [The most common approach]
– Determine how many years of life have been ‘lost’ due to the death
– Sum up over all deaths.– Died at age 30 75-30 = 45 PYLL’s
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11/2009 66
Mortality in General
Source:Statistics Canada
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11/2009 77
# deaths in Canada from 1979-2004; men and women.
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11/2009 88
Mortality RATES in Canada from 1979-2004; men and women.
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11/2009 99
Mortality (2004) - Canada, both sexesAge standardized: 1991 population
Stroke (6.1%)
IHD (16.1%)
CHD:other (5.4%)Cancer: Lung (8.1%)
Cancer: Colon (3.3%)
Cancer: Breast (2.2%)
Cancer: Other (16.7%)
Accidents:MVA (1.5%)
Accidents:Other (2.8%)
Diabetes (3.5%)
Infections (1.2%)
Respiratory (6.7%)
Other (21.8%)
Alzheimer's (2.2%)Suicide (1.9%)
CANCER: 30.3%
Circ Disease:27.6%
†††
† Pneumonia & influenza grouped with respiratory disease. Would increase infectious % to about 3.4%.
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11/2009 10
Mortality (2004) - Canada, MEN onlyAge standardized: 1991 population
Stroke (5.3%)
IHD (18.8%)
CHD:other (4.9%)Cancer: Lung (8.5%)
Cancer: Colon (3.3%)
Cancer: Prostate (3.3%)
Cancer: Other (14.7%)
Accidents:MVA (1.8%)
Accidents:Other (3.0%)
Diabetes (3.5%)
Infections (1.1%)
Respiratory (7.2%)
Other (20.8%)
Alzheimer's (1.5%)Suicide (2.3%)
10
CANCER: 29.8%
Circ Disease:29.0%
††
† Pneumonia & influenza grouped with respiratory disease. Would increase infectious % to about 3.5%.
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11/2009 11
Mortality (2004) - Canada, WOMEN onlyAge standardized: 1991 population
Stroke (7.0%)
IHD (14.5%)
CHD:other (5.8%)Cancer: Lung (7.8%)
Cancer: Colon (3.2%)
Cancer: Breast (5.0%)
Cancer: Other (15.6%)
Accidents:MVA (1.0%)
Accidents:Other (2.4%)
Diabetes (3.4%)
Infections (1.0%)
Respiratory (6.5%)
Other (22.7%)
Alzheimer's (2.9%)Suicide (1.1%)
11
CANCER: 31.6%
Circ Disease:27.3%
††
† Pneumonia & influenza grouped with respiratory disease. Would increase infectious % to about 3.3%.
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11/2009 1212
Sex ratio (M/F) in Canada from 1979-2004.
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11/2009 1313
CHD and cancer deaths in Canada from 1979-2004.% of death due to each group of causes.
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11/2009 1414
Age/sex-specific Mortality.Canada, 2005
Age at death (years)
0 20 40 60 80
Rat
e/10
0,00
0
0
2000
4000
6000
8000
10000
12000
14000CombinedMalesFemales
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11/2009 1515
Age/sex-specific Mortality.Canada, 2005
log-scale for mortality
Age at death (years)
0 20 40 60 80
Rat
e/10
0,00
0
1
10
100
1000
10000CombinedMalesFemales
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11/2009 1616
Age-specific mortality: male:female mortality ratioCanada, 2005
1.0=same mortality in both sexes; > 1.0 -> higher male mortality
Age (years)
0 20 40 60 80
Rat
io (
M:F
)
1.0
1.2
1.4
1.6
1.8
2.0
2.2
2.4
2.6
2.8
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11/2009 1717
Leading Causes of death by age
1-4 10-14 20-24 40-44
Unintentional injuries
Unintentional injuries
Unintentional injuries
Cancer
Cancer Cancer Suicide Circulatory system
Congenital anomalies
Suicide Cancer Unintentional injuries
Homicide Congenital anomalies
Homicide Suicide
Circulatory system
Circulatory system
Circulatory system
Infections (mainly HIV)
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11/2009 1818
Leading Causes of death by age
50-54 60-64 70-74 Combined
Cancer Cancer Cancer Circulatory System
Circulatory System
Circulatory system
Circulatory system
Cancer
Unintentional injuries
Respiratory System
Respiratory System
Respiratory System
Suicide Diabetes Diabetes Unintentional injuries
Digestive system (liver)
Unintentional injuries
Unintentional injuries
Diabetes
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11/2009 1919
Cause/age-specific mortality rates,Canada, 2001, all
All ages
Age (years)
0 20 40 60 80
Rat
e /1
00,0
00
0
500
1000
1500
2000
2500
3000
Cause/age-specific mortality rates,Canada, 2001, all
Age 0 to 55
Age (years)
0 10 20 30 40 50 60
Rat
e /1
00,0
00
0
20
40
60
80
100
120
140
160
180
Cancer Circulatory disDiabetesRespiratory disLiver disUnintentional Suicide Homicde Infections
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11/2009 2020
Age 1-4 Age 10-14 Age 15-19
Age 20-24 Age 30-34
CancerCirc diseasesRespiratoryDiabetesLiverUnintentionalSuicideHomicideInfectionsOther causes
Age/cause specific proportional mortality; age 0-39. Canada, 2001
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11/2009 2121
Age/cause specific proportional mortality; age 40+. Canada, 2001
Age 40-44 Age 50-54 Age 60-64
Age 70-74 Age 80-84
CancerCirc diseasesRespiratoryDiabetesLiverUnintentionalSuicideHomicideInfectionsOther causes
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11/2009 2222
Leading Causes of death, sex
1-4: M 1-4: F 10-14: M 10-14: F
Unintentional injuries
Unintentional injuries
Unintentional injuries
Unintentional injuries
Cancer Congenital anomalies
Cancer Cancer
Congenital anomalies
Cancer Suicide Suicide
Circulatory System
Homicide Congenital anomalies
Congenital anomalies
Homicide Circulatory System
Circulatory System
Circulatory System
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11/2009 2323
Leading Causes of death, sex
20-24: M 20-24: F 40-44: M 40-44: F
Unintentional injuries
Unintentional injuries
Cancer Cancer
Suicide Suicide Unintentional injuries
Circulatory System
Homicide Cancer Circulatory System
Unintentional injuries
Cancer Circulatory system
Suicide Suicide
Circulatory system
Homicide Infections (mainly HIV)
Liver
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11/2009 2424
Leading Causes of death, sex
50-54: M 50-54: F 60-64: M 60-64: F
Cancer Cancer Cancer Cancer
Circulatory System
Circulatory System
Circulatory System
Circulatory System
Unintentional injuries
Unintentional injuries
Respiratory System
Respiratory System
Suicide Suicide Diabetes Diabetes
Digestive System (liver)
Diabetes Digestive System (liver)
Unintentional
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11/2009 2525
Leading Causes of death, sex
70-74: M 70-74: F Overall: M Overall: F
Cancer Cancer Circulatory System
Circulatory System
Circulatory system
Circulatory system
Cancer Cancer
Respiratory System
Respiratory System
Respiratory system
Respiratory system
Diabetes Diabetes Unintentional injuries
Diabetes
Unintentional injuries
Unintentional injuries
Diabetes Unintentional injuries
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11/2009 2626
Cause/age-specific mortality rates,Canada, 2001, males only
All ages
Age (years)
0 20 40 60 80
Rat
e /1
00,0
00
0
1000
2000
3000
4000
Cause/age-specific mortality rates,Canada, 2001, males only
Age 0 to 55
Age (years)
0 10 20 30 40 50 60
Rat
e /1
00,0
00
0
20
40
60
80
100
120
140
160
180
Cancer Circulatory disDiabetesRespiratory disLiver disUnintentional Suicide Homicde Infections
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11/2009 2727
Age/cause specific proportional mortality; age 0-39. MALES only. Canada, 2001
Age 1-4 Age 10-14 Age 15-19
Age 20-24 Age 30-34
CancerCirc diseasesRespiratoryDiabetesLiverUnintentionalSuicideHomicideInfectionsOther causes
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11/2009 2828
Age/cause specific proportional mortality; age 40+. MALES only. Canada, 2001
Age 40-44 Age 50-54 Age 60-64
Age 70-74 Age 80-84
CancerCirc diseasesRespiratoryDiabetesLiverUnintentionalSuicideHomicideInfectionsOther causes
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11/2009 2929
Cause/age-specific mortality rates,Canada, 2001, females only
All ages
Age (years)
0 20 40 60 80
Rat
e /1
00,0
00
0
500
1000
1500
2000
2500
Cause/age-specific mortality rates,Canada, 2001, females only
Age 0 to 55
Age (years)
0 10 20 30 40 50 60
Rat
e /1
00,0
00
0
20
40
60
80
100
120
140
160
180
Cancer Circulatory disDiabetesRespiratory disLiver disUnintentional Suicide Homicde Infections
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11/2009 3030
Age/cause specific proportional mortality; age 0-39. FEMALES only. Canada, 2001
Age 1-4 Age 10-14 Age 15-19
Age 20-24 Age 30-34
CancerCirc diseasesRespiratoryDiabetesLiverUnintentionalSuicideHomicideInfectionsOther causes
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11/2009 3131
Age/cause specific proportional mortality; age 40+. FEMALES only. Canada, 2001
Age 40-44 Age 50-54 Age 60-64
Age 70-74 Age 80-84
CancerCirc diseasesRespiratoryDiabetesLiverUnintentionalSuicideHomicideInfectionsOther causes
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11/2009 3232
Age 1-4 Age 10-14 Age 15-19
Age 20-24 Age 30-34
CancerCirc diseasesRespiratoryDiabetesLiverUnintentionalSuicideHomicideInfectionsOther causes
Age 1-4 Age 10-14 Age 15-19
Age 20-24 Age 30-34
CancerCirc diseasesRespiratoryDiabetesLiverUnintentionalSuicideHomicideInfectionsOther causes
MALES FEMALES
Proportional mortality, age 1-39, Canada, 2001
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11/2009 3333
MALES FEMALES
Proportional mortality, age 40+, Canada, 2001
Age 40-44 Age 50-54 Age 60-64
Age 70-74 Age 80-84
CancerCirc diseasesRespiratoryDiabetesLiverUnintentionalSuicideHomicideInfectionsOther causes
Age 40-44 Age 50-54 Age 60-64
Age 70-74 Age 80-84
CancerCirc diseasesRespiratoryDiabetesLiverUnintentionalSuicideHomicideInfectionsOther causes
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11/2009 34
Proportion of Mortality, Canada, 2001by five year age groups
Under 11-45-910-1415-1920-2425-2930-3435-3940-4445-4950-5455-5960-6465-6970-7475-7980-8485-8990+
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11/2009 35
Overall
Age
0 20 40 60 80 1000
2000
4000
6000
8000
10000
12000
Males
Age
0 20 40 60 80 1000
2000
4000
6000
8000
10000
12000
CancerCHD
Females
Age
0 20 40 60 80 1000
2000
4000
6000
8000
10000
12000
Cancer and CHD mortality by five year age groups.Canada, 2001.
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11/2009 36
Mortality Trends, Cancer and CHDCanada, age 75-79 only
Year
1999 2000 2001 2002 2003 2004 2005
/10
0,0
00
1150
1200
1250
1300
1350
1400
1450
1500
1550
CancerCHD
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11/2009 3737
PYLL’s for various conditions, 2001
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11/2009 3838
PYLLs, Selected causes of deathMales, Canada, 1979 to 1999
Year
1980 1985 1990 1995
PY
LLs
(1,0
00's
)
0
50
100
150
200
250
300
350
Unintentional injuriesMISuicideLung cancerColon cancerCerebrovascularAll strokeProstate cancer
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11/2009 3939
PYLLs, Selected causes of deathFemales, Canada, 1979 to 1999
Year
1980 1985 1990 1995
PY
LLs
(1
,00
0's)
0
20
40
60
80
100
120
Unintentional injuriesBreast cancerMICerebrovascularAll strokesSuicideLung cancerColon cancer
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11/2009 4013/7/2008 40
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11/2009 4113/7/2008 41
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11/2009 4242
Injury Mortality and Incidence
Source: PHAC
URL: http://dsol-smed.phac-aspc.gc.ca/dsol-smed/is-sb/c_ind_e.
html
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11/2009 4343
Injury Mortality in Canada, 2004
Age at death (years)
0 20 40 60 80
Rat
e/10
0,00
0
0
50
100
150
200
250
300
350
Total MVA FallsSuffocation Other unintentional Suicide Homicide
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11/2009 4444
Injury Mortality in Canada, 2004Excluding poeple over age 80
Age at death (years)
0 20 40 60 80
Rat
e/10
0,00
0
0
10
20
30
40
50
60
70
Total MVA FallsSuffocation Other unintentional Suicide Homicide
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11/2009 4545
Pattern of Injury deaths, Canada, 2004Age 1 to 10.
MVA FallsSuffocationOther unintentionalHomicide
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11/2009 4646
Pattern of Injury deaths, Canada, 2004Age 16 to 20.
MVA FallsSuffocationOther unintentionalSuicideHomicide
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11/2009 4747
Pattern of Injury deaths, Canada, 2004Age 80 and over.
MVAFallsSuffocationOther unintentionalSuicideHomicde
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11/2009 4848
Pattern of Injury deaths, Canada, 2004Age 1 to 10.
MVA FallsSuffocationOther unintentionalHomicide
Pattern of Injury deaths, Canada, 2004Age 16 to 20.
MVA FallsSuffocationOther unintentionalSuicideHomicide
Pattern of Injury deaths, Canada, 2004Age 80 and over.
MVAFallsSuffocationOther unintentionalSuicideHomicde
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11/2009 4949
Males.
MVA FallsSuffocationOther unintentionalSuicideHomicide
Females
Sex-specific Injury Mortality, Canada, 2004
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11/2009 5050
Injury Mortality by sex, Canada, 2004
Cause of death
N.a.N. MVA Falls Suffocate Other unint Suicide Homicide
Rat
e /1
00,0
00
0
2
4
6
8
10
12
14
16
18
20
Male Female
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11/2009 5151
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11/2009 5252
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11/2009 5353
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11/2009 5454
Cancer Mortality and Incidence
Source: Canadian Cancer Society
URL: http://www.cancer.ca/Canada-wide/About%20cancer/Cancer%20statistics.aspx?sc_lang=en
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5555
Time trends in incidence - MalesTime trends in incidence - Males
Age-Standardized Incidence Rates (ASIR) for Selected Cancer Sites, Males, Canada, 1978-2007
Surveillance and Risk Assessment Division, CCDPC, Public Health Agency of Canada
1975 1980 1985 1990 1995 2000 2005
0
20
40
60
80
100
120
140
160
Prostate
Lung
Colorectal
Bladder
NHLStomach
Melanoma
Larynx
Liver
Thyroid
Estimated
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5656
1980 1985 1990 1995 2000 2005
AS
MR
(/1
00
,00
0)
0
20
40
60
80
100
Prostate
Lung
Colorectal
NHL
Stomach
Oral
Larynx
Hodgkin's
Time trends in mortality - MalesTime trends in mortality - Males
Age-Standardized Incidence Rates (ASIR) for Selected Cancer Sites, Males, Canada, 1978-2007
Surveillance and Risk Assessment Division, CCDPC, Public Health Agency of Canada
Estimated
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5757
1975 1980 1985 1990 1995 2000 2005
0
20
40
60
80
100
120
140
160
Breast
Lung
Colorectal
NHLStomach
Cervix
Larynx
Thyroid
Time trends in incidence - FemalesTime trends in incidence - Females
Age-Standardized Incidence Rates (ASIR) for Selected Cancer Sites, Females, Canada, 1978-2007
Surveillance and Risk Assessment Division, CCDPC, Public Health Agency of Canada
Estimated
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5858
1980 1985 1990 1995 2000 2005
AS
MR
(/1
00,
000)
0
20
40
60
80
100
Breast
Lung
Colorectal
NHL
Stomach
Cervix
Time trends in mortality - FemalesTime trends in mortality - Females
Age-Standardized Incidence Rates (ASIR) for Selected Cancer Sites, females, Canada, 1978-2007
Surveillance and Risk Assessment Division, CCDPC, Public Health Agency of Canada
Estimated
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11/2009 5959
Summary• Chronic diseases (mainly cancer and
cardiovascular) are the main causes of death in Canada.
• Non-fatal chronic diseases (e.g. diabetes, arthritis) are major causes of disability and health care costs.
• Causes of death vary by age and sex.• CHD mortality is trending down in men and
women• Lung cancer is rising rapidly in women but is
declining in men (smoking patterns)