Transcript No Slide Title

Vital statistics
Mortality (07/02/02)
Morbidity (21/02/02)
Hannes Botha
(Dr JL Botha)
Director, Trent Cancer Registry
Hon Senior Lecturer
[email protected]
07/02/02
1
Mortality data
• Death Registration
– Video
– Other issues
• Uses of mortality data
– Historical
– Current
• Problems
• Trends
07/02/02
2
International Classification of Diseases
ICD chapters
I Certain Infectious and Parasitic Diseases
II Neoplasms
III Diseases of the blood and blood-forming organs and certain disorders
involving the immune mechanism
IV Endocrine, nutritional and metabolic diseases
V Mental and behavioural disorders
VI Diseases of the nervous system
VII Diseases of the eye and adnexa
VIII Diseases of the ear and mastoid process
IX Diseases of the circulatory system
X Diseases of the respiratory system
XI Diseases of the digestive system
XII Diseases of the skin and subcutaneous tissue
XIII Diseases of the musculoskeletal system and connective tissue
XIV Diseases of the genitourinary system
XV Pregnancy, childbirth and the puerperium
XVI Certain conditions originating in the perinatal period
XVII Congenital malformations, deformations and chromosomal abnormalities
XVIII Symptoms, signs and abnormal clinical and laboratory findings,
not elsewhere classified
XIX Injury, poisoning and certain other consequences of external causes
XX External causes of morbidity and mortality
XX1 Factors influencing health status and contact with health services
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ICD 10
A00-B99
C00-D48
ICD 9
000-136
140-239
D50-D89
E00-E90
F00-F99
G00-G99
H00-H59
H60-H95
I00-I99
J00-J99
K00-K93
L00-L99
M00-M99
N00-N99
O00-O99
P00-P96
Q00-Q99
280-289
240-279
290-315
320-389
R00-R99
S00-T98
V01-Y98
Z00-Z99
780-796
800-999
E888-E999
390-458
460-519
520-579
680-709
710-738
580-629
630-678
760-779
740-759
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Uses of Mortality Data
Variation by
• Person
• Time
• Place
Snow/Current
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Cholera - Snow (1854)
“I found, moreover, that the water varied, during the next
two days, in the amount of organic impurity, visible to the
naked eye, on close inspection, in the form of small
white, flocculent particles; and I concluded that, at the
commencement of the outbreak, it might possibly have
been still more impure.”
“I requested permission, therefore, to take a list, at the
General Register Office, of the deaths from cholera,
registered during the week ending 2nd September, in the
subdistricts of Golden Square, Berwick Street, and St
Ann’s, Soho, which was kindly granted. Eighty-nine
deaths from cholera were registered, during the week,
in the three subdistricts.”
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Map of
cholera
cases
P
Pump
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Deaths from cholera
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Cholera ctd
“There is a Brewery in Broad Street, near to the pump
and on perceiving that no brewer’s men were registered
as having died of cholera, I called on Mr. Huggins, the
proprietor. He informed me that there were above
seventy workmen employed in the brewery, and that
none of them had suffered from cholera, - at least in a
severe form, - only two having been indisposed, and
that not seriously …”
“The men are allowed a certain quantity of malt liquor,
and Mr. Huggins believes they do not drink water at all;
and he is quite certain that the workmen never obtained
water from the pump in the street. There is a deep well
in the brewery, in addition to the New River water.”
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Cholera ctd
“… the following death is recorded as occurring in
the Hampstead district. ‘At West End ….the widow
of a percussion-cap maker, aged 59 years,
diarrhoea two hours, cholera epidemica sixteen
hours.’
I was informed by this lady’s son that she had not been
in the neighbourhood of Broad Street for many months.
A cart went from Broad Street to West End every day,
and it was the custom to take out a large bottle of the
water from the pump in Broad Street, as she preferred
it. The water was taken on Thursday, 31st August, and
she drank of it in the evening, and also on Friday. She
was seized with cholera on the evening of the latter day,
and died on Saturday, …”
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Cholera ctd
Number of
Deaths from
Deaths per
houses
cholera
Southwark and Vauxhall Company
40,046
1,263
315
5.3
Lambeth Company
26,107
98
37
0.6
Rest of London
256,423
1,422
59
1
10,000 houses "IRR"
• Broad Street pump’s handle removed
- epidemic already declining
- understanding of disease causation
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Uses of Mortality Data
Variation by
• Person
• Time
• Place
Snow/Current
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Distribution of years of life lost
up to age 65 years*
By cause of death, England & Wales, 1988
Males
18% Ischaemic heart disease
Other diseases 22%
3% Cerebrovascular disease
3% Other circulatory disease
Respiratory diseases 7%
5% Lung cancer
Motor vehicle
traffic accidents 10%
Suicide 7%
15% Other cancers
Other accidental deaths 6%
10% Motor vehicle traffic accidents
* Deaths under 28 days excluded
Source: OPCS
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Distribution of years of life lost
up to age 65 years*
By cause of death, England & Wales, 1988
Females
11% Breast cancer
Other diseases 25%
4% Lung cancer
7% Genitourinary cancer
Suicide 3%
15% Other cancers
Sudden infant deaths 6%
Respiratory disease 6%
Other accidental deaths 3%
Motor vehicle traffic accidents 5%
Other circulatory 3%
6% Ischaemic heart disease
3% Cerebrovascular disease
* Deaths under 28 days excluded
Source: OPCS
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Distribution of total deaths
By cause & age, England & Wales
Males
1931
1988
Causes of death
Percentage of total deaths
100
Accidents
and violence
Percentage of total deaths
100
Other diseases
75
75
Genitourinary
diseases
Respiratory
diseases
50
Circulatory
diseases
25
50
25
Neoplasms
Infectious
diseases
0
0-4
20-24
40-44
60-64
90+
0
0-4
age
20-24
40-44
age
60-64
90+
Source: Registrar General’s annual report 1931
OPCS mortality statistics 1988
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Distribution of total deaths
By cause & age, England & Wales
Females
1931
1988
Causes of death
Percentage of total deaths
100
Accidents
and violence
Percentage of total deaths
100
Other diseases
75
75
Maternal causes
Genitourinary
diseases
50
50
Respiratory
diseases
25
Circulatory
diseases
25
Neoplasms
0
0-4
20-24
40-44
60-64
90+
Infectious
diseases
age
0
0-4
20-24
40-44
age
60-64
90+
Source: Registrar General’s annual report 1931
OPCS mortality statistics 1988
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Male Life Expectancy 1997-99
East Midlands
Local
Authorities
Rutland
Corby
Courtesy of
Male life expectancy, 1997/99
76.7 to 78.1
75.2 to 76.7
73.7 to 75.2
72.2 to 73.7
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Trent PH Obs
Trent GIS Unit
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Saving Lives: Our Healthier Nation – July 1999
Government targets based on mortality
e.g.
By the year 2010:
• CANCER.
– Target: to reduce the death rate from cancer amongst
people aged under 75 years by at least one fifth
DoH website: http://www.doh.gov.uk/ohn.htm
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Problems with Mortality Data
• Numerator
– Death certification
– ICD coding
• Denominator
– Census, estimation, projection
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Diabetes Mellitus Death Rates
USA Females aged 35-44
Rate per 100,000 py
8
ICD 6: <1949 DM always
>1949 DM not
6
4
2
Insulin
0
1920
1930
1940
1950
1960
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1970
1980
1990
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Interpretation of trends
• Chance
• Artefactual
– Numerator
– Denominator
• Real
– ‘Natural’ (epidemiological)
– Medical care effects
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