Population Mortality and Morbidity in Ireland

							Population Mortality and Morbidity in Ireland



April 2001

Irish Population Mortality 1962-1996
Age Standardised Mortality Rates - Ireland Population
1400 1200
Deaths per 100,000

1962-1996

1000 800 600 400 200 0
1962 1964 1966 1968 1970 1972 1974 1976 1978 1980 1982 1984 1986 1988 1990 1992 1994 1996

m f

Year

Mortality Improvement by Age Group
Males Females % Reduction % Reduction 80% 77% 51% 73% -13% 37% 3% 47% 38% 57% 42% 52% 34% 42% 19% 36% 15% 32% 18% 23%

Age-band 0-4 5-14 15-24 25-34 35-44 45-54 55-64 65-74 75-84 85+

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 2% 7% 3% 75% 33% 25% 1% 16% 13%

Males Females Females 25-34 15-24 25-34 1% 9% 7% 66% 24% 26% 1% 15% 19% 7% 10% 11% 44% 16% 15% 0% 12% 28% 1% 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% 150% 120% 90% 60% 30% 0% 1 3 5 7 9 11 13 15 year 17 19 21 23 25 27 29 15-24 25-34 35-44 45-54 55-64

Mortality Rates from Suicide 1962 - 1996
Trend in m ortality rates from suicide - m ales 1976 to 1996 400% 350% 300% 250% 200% 150% 100% 50% 0% 1 2 3 4 5 6 7 8 9 10 11 12 13 14 15 16 17 18 19 20 21 year 15-24 25-34 35-44 45-54 55-64

Mortality rates by cause for 35-64 year olds
Males 35-44 20% 2% 3% 0% 0% 15% 24% 15% 3% 5% 35% 21% Males 45-54 30% 6% 5% 0% 0% 19% 40% 29% 5% 6% 13% 16% Males Females Females Females 55-64 35-44 45-54 55-64 35% 9% 7% 0% 0% 18% 45% 33% 4% 8% 5% 15% 52% 4% 3% 14% 9% 22% 16% 4% 6% 6% 14% 18% 56% 6% 5% 19% 2% 24% 17% 6% 5% 5% 7% 20% 47% 6% 7% 14% 1% 19% 30% 15% 7% 7% 4% 20%

Cause Malignant Neoplasms Lung Digestive Breast Cervical Other All Circulatory Diseases Heart Disease Stroke Other Injury and Poisoning All Other Diseases

Mortality Rates from Circulatory Diseases 1962 - 1996
Trend in mortality rates from all circulatory diseases - females 1962 to 1996

140% 120% 35-44 100% 80% 60% 40% 20% 0% 1 3 5 7 9 11 13 15 17 19 21 23 25 27 29 31 33 35 year 45-54 55-64 65-74 75-84 85 and over

Mortality Rates from Circulatory Diseases 1962 - 1996
Trend in mortality rates from all circulatory diseases - males 1962 to 1996

140% 120% 35-44 100% 80% 60% 40% 20% 0% 1 3 5 7 9 11 13 15 17 19 21 23 25 27 29 31 33 35 year 45-54 55-64 65-74 75-84 85 and over

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 30% 9% 6% 0% 0% 16% 46% 31% 6% 9% 3% 2% 19% Males 75-84 22% 5% 4% 0% 0% 13% 46% 27% 9% 11% 8% 1% 22% Males Females Females Females 85+ 65-74 75-84 85+ 14% 2% 2% 0% 0% 10% 48% 24% 11% 13% 13% 1% 23% 33% 6% 5% 5% 1% 16% 41% 22% 8% 10% 4% 1% 21% 20% 3% 4% 2% 0% 10% 49% 24% 13% 12% 8% 1% 21% 9% 1% 2% 1% 0% 5% 53% 24% 14% 16% 15% 2% 22%

Mortality Rates from Lung Cancer 1962 - 1996
Trend in m ortality rates from lung cancer - m ales 1962 to 1996

1000% 800% 600% 400% 200% 0% 1 3 5 7 9 11 13 15 17 19 21 23 25 27 29 31 33 35 year 35-44 45-54 55-64 65-74 75-84 85 and over

Mortality Rates from Lung Cancer 1962 - 1996
Trend in m ortality rates from lung cancer - fem ales 1962 to 1996

1000% 800% 600% 400% 200% 0% 1 3 5 7 9 11 13 15 17 19 21 23 25 27 29 31 33 35 year 35-44 45-54 55-64 65-74 75-84 85 and over

Mortality Rates from Pneumonia 1962 - 1996
Trend in m ortality rates from pneum onia - fem ales 1962 to 1996

300% 270% 240% 210% 180% 150% 120% 90% 60% 30% 0% 1 3 5 7 9 11 13 15 17 19 21 23 25 27 29 31 33 35 year 65-74 75-84 85 and over

Mortality Rates from Pneumonia 1962 - 1996
Trend in m ortality rates from pneum onia - m ales 1962 to 1996

300% 270% 240% 210% 180% 150% 120% 90% 60% 30% 0% 1 3 5 7 9 11 13 15 17 19 21 23 25 27 29 31 33 35 year 65-74 75-84 85 and over

Male mortality improvements by decade & age group
Male mortality improvements Ireland Population split by decade & age group
0.05 0.04

annual rate of mortality improvement

0.03 0.02 0.01 0 -0.01 -0.02 -0.03 -0.04 25-34 35-44 45-54 1 990-1 996 1 -1 981 990 1 -1 971 980 55-64 65-74 1 962-1 970 75-84 85+

decade

age group

Female mortality improvements by decade & age group
Female mortality improvements - Ireland population split by decade & age group

0.035 0.03

annual rate of mortality improvement

0.025 0.02 0.01 5 0.01 0.005 0 -0.005 -0.01 -0.01 5 25-34 35-44 45-54 1 990-1 996 1 -1 981 990 1 -1 971 980 decade 55-64 65-74 1 962-1 970 75-84 85+

age group

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

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Males Cause of Death versus Years’ Lost
Male age standardised rate split by cause Ireland population 1996
Infectious and Parasitic Diseases Lung Digestive Breast Cervical Other Heart Disease Stroke Other circulatory Pneumonia. Bronchitis Asthma Nephrosis. All Injury/Poisoning Road Traffic Accidents Suicide Homicide Other Injury All Other Diseases 0 50 100 150 200 250 300 350
0 Infectious and Parasitic Diseases

Male years lost split by cause Ireland population deaths 1996
All Malignant Neoplasm

All Malignant Neoplasm
Breast Cervical

Lung Digestive

All Diseases of Circulatory System
Stroke Other circulatory Pneumonia. Bronchitis Asthma Nephrosis.

Other Heart Disease

All Diseases of Circulatory System

All Injury/Poisoning Road Traffic Accidents Suicide Homicide Other Injury All Other Diseases 10,000 20,000 30,000 40,000 50,000

Deaths per 100,000

Years Lost

Females Cause of Death versus Years’ Lost
Female age standardised rate split by cause Ireland population 1996
Infectious and Parasitic Diseases Lung Digestive Breast Cervical Other Heart Disease Stroke Other circulatory Pneumonia. Bronchitis Asthma Nephrosis. All Injury/Poisoning Road Traffic Accidents Suicide Homicide Other Injury All Other Diseases 0 50 100 150 200 250
0 10,000 20,000 30,000 Cervical Infectious and Parasitic Diseases

Female years lost split by cause Population deaths 1996
All Malignant Neoplasm

All Malignant Neoplasm

Lung Digestive Breast Other Heart Disease Stroke Other circulatory Pneumonia. Bronchitis Asthma Nephrosis. All Injury/Poisoning Road Traffic Accidents Suicide Homicide Other Injury All Other Diseases 40,000

All Diseases of Circulatory System

All Diseases of Circulatory System

50,000

Deaths per 100,000

Years Lost

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 Diseases of the digestive system Intentional injuries 0 100 200 300 400 500 600 700

YLL YLD

Total DALYs ('000)

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
 

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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% 100% 80% 60% 40% 20% 0% 35-44 45-54 55-64 65-74 75-84 85 and over

1

3

5

7

9

11

13

15

17

19

21

23

25

27

29

31

33

year

35

Cardiovascular - Stroke
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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% 120% 100% 80% 60% 40% 20% 0% 35-44 45-54 55-64 65-74 75-84 85 and over

1

3

5

7

9

11

13

15

17

19

21

23

25

27

29

31

33

year

35

Cancer
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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
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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% 210% 180% 150% 120% 90% 60% 30% 0% 1 3 5 7 9 11 13 15 17 19 21 23 25 27 29 31 33 35 ye ar 35-44 45-54 55-64 65-74 75-84 85 and over

Road Traffic Accidents


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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
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Significant differences between countries These differences also are by age group
Suicide
40

Deaths per 100,000

35 30 25 20 15 10 5 0

Germany

Denmark

Japan

US

Greece

France

Ireland

Eng & Wales

Australia

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

Scotland

Sweden

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 80
Number of Cases

70 60 50 40 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

Cases Deaths

Year

AIDS


Same picture reflected internationally
Cases of and Deaths from AIDS in the US, 1982 to 1999

90000 80000
Number of Cases

70000 60000 50000 40000 30000 20000 10000 0
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

Cases Deaths

Be for e

Year

AIDS
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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
400 350

Number of Cases

300 250 200 150 100 50 0 1985 1986 1987 1988 1989 1990 1991 1992 1993 1994 1995 1996 1997 1998 1999 2000 Year of diagnosis Cases

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

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Smoking
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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
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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
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Continuation of past trends

Reasons for this
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Continuation of past trends Cohort Effect

Reasons for this
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Continuation of past trends Cohort Effect Increasing Wealth

Reasons for this
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Continuation of past trends Cohort Effect Increasing Wealth Screening

Reasons for this
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Continuation of past trends Cohort Effect Increasing Wealth Screening Smoking behaviour

The Even Better News
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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
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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
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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
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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
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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
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As a state we are aware of the “problems” We have the financial resources

Can we fix it --- Yes We Can
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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