07/02/021

Mortality (07/02/02)Morbidity (21/02/02)

(Dr JL Botha)

Director, Trent Cancer Registry

Hon Senior Lecturer

Hannes Botha

blj@le.ac.uk

Vital statistics

07/02/022

Mortality data

• Death Registration– Video– Other issues

• Uses of mortality data– Historical– Current

• Problems

• Trends

07/02/023

International Classification of DiseasesICD 10 ICD 9

I Certain Infectious and Parasitic Diseases A00-B99 000-136II Neoplasms C00-D48 140-239

III Diseases of the blood and blood-forming organs and certain disorders involving the immune mechanism D50-D89 280-289

IV Endocrine, nutritional and metabolic diseases E00-E90 240-279V Mental and behavioural disorders F00-F99 290-315

VI Diseases of the nervous system G00-G99 320-389VII Diseases of the eye and adnexa H00-H59

VIII Diseases of the ear and mastoid process H60-H95IX Diseases of the circulatory system I00-I99 390-458X Diseases of the respiratory system J00-J99 460-519

XI Diseases of the digestive system K00-K93 520-579XII Diseases of the skin and subcutaneous tissue L00-L99 680-709

XIII Diseases of the musculoskeletal system and connective tissue M00-M99 710-738XIV Diseases of the genitourinary system N00-N99 580-629XV Pregnancy, childbirth and the puerperium O00-O99 630-678

XVI Certain conditions originating in the perinatal period P00-P96 760-779XVII Congenital malformations, deformations and chromosomal abnormalities Q00-Q99 740-759

XVIII Symptoms, signs and abnormal clinical and laboratory findings, not elsewhere classified R00-R99 780-796

XIX Injury, poisoning and certain other consequences of external causes S00-T98 800-999XX External causes of morbidity and mortality V01-Y98 E888-E999

XX1 Factors influencing health status and contact with health services Z00-Z99

ICD chapters

07/02/024

Uses of Mortality Data

Variation by

• Person

• Time

• Place

Snow/Current

07/02/025

“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.”

Cholera - Snow (1854)

07/02/026

P Pump Deaths from cholera

Map of cholera cases

07/02/027

“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 …”

Cholera ctd

“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.”

07/02/028

“… 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.’

Cholera ctd

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, …”

07/02/029

Number of Deaths from Deaths per

houses cholera 10,000 houses "IRR"

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

Cholera ctd

• Broad Street pump’s handle removed

- epidemic already declining

- understanding of disease causation

07/02/0210

Uses of Mortality Data

Variation by

• Person

• Time

• Place

Snow/Current

07/02/0211

18% Ischaemic heart disease

15% Other cancers

3% Cerebrovascular disease

3% Other circulatory disease

5% Lung cancer

10% Motor vehicle traffic accidentsOther accidental deaths 6%

Suicide 7%

Motor vehicle traffic accidents 10%

Respiratory diseases 7%

Other diseases 22%

Distribution of years of life lost up to age 65 years*

By cause of death, England & Wales, 1988

Males

* Deaths under 28 days excludedSource: OPCS

07/02/0212

11% Breast cancer

6% Ischaemic heart disease

4% Lung cancer

7% Genitourinary cancer

15% Other cancers

3% Cerebrovascular diseaseOther accidental deaths 3%

Suicide 3%

Motor vehicle traffic accidents 5%

Sudden infant deaths 6%

Other diseases 25%

Distribution of years of life lost up to age 65 years*

By cause of death, England & Wales, 1988

Females

* Deaths under 28 days excludedSource: OPCS

Respiratory disease 6%

Other circulatory 3%

07/02/0213

Distribution of total deathsBy cause & age, England & Wales

Males

Accidents and violence

Other diseases

Genitourinary diseases

Respiratory diseases

Circulatory diseases

Neoplasms

Infectious diseases

100

75

50

25

0

100

75

50

25

00-4 20-24 40-44 60-64 90+0-4 20-24 40-44 60-64 90+

age age

Percentage of total deathsPercentage of total deaths

Source: Registrar General’s annual report 1931OPCS mortality statistics 1988

1931 1988Causes of death

07/02/0214

Distribution of total deathsBy cause & age, England & Wales

Females

Accidents and violence

Other diseases

Maternal causes

Genitourinary diseases

Respiratory diseases

Circulatory diseases

Neoplasms

Infectious diseases

100

75

50

25

0

100

75

50

25

00-4 20-24 40-44 60-64 90+0-4 20-24 40-44 60-64 90+

age age

Percentage of total deathsPercentage of total deaths

Source: Registrar General’s annual report 1931OPCS mortality statistics 1988

1931 1988Causes of death

07/02/0215

East Midlands Local

Authorities

Male life expectancy, 1997/99

76.7 to 78.175.2 to 76.773.7 to 75.272.2 to 73.7

Courtesy of

Trent PH Obs

Trent GIS Unit

Male Life Expectancy 1997-99

Corby

Rutland

07/02/0216

Saving Lives: Our Healthier Nation – July 1999

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

Government targets based on mortality

e.g.

07/02/0217

Problems with Mortality Data

• Numerator– Death certification– ICD coding

• Denominator– Census, estimation, projection

07/02/0218

Diabetes Mellitus Death RatesUSA Females aged 35-44

0

2

4

6

8

1920 1930 1940 1950 1960 1970 1980 1990

Rat

e p

er 1

00,0

00 p

y

Insulin

ICD 6: <1949 DM always

>1949 DM not

07/02/0219

Interpretation of trends

• Chance• Artefactual

– Numerator– Denominator

• Real– ‘Natural’ (epidemiological)– Medical care effects