epi 5240: introduction to epidemiology mortality in canada: trends and causes november 2, 2009

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

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?

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)

11/2009 44


• 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

11/2009 55


• 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

11/2009 66

Mortality in General

Source:Statistics Canada

11/2009 77

# deaths in Canada from 1979-2004; men and women.

11/2009 88

Mortality RATES in Canada from 1979-2004; men and women.

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%.

11/2009 10

Mortality (2004) - Canada, MEN onlyAge standardized: 1991 population

Stroke (5.3%)

IHD (18.8%)



Cancer: Prostate (3.3%)




Diabetes (3.5%)

Infections (1.1%)

Respiratory (7.2%)

Other (20.8%)


10

CANCER: 29.8%

Circ Disease:29.0%

††


11/2009 11

Mortality (2004) - Canada, WOMEN onlyAge standardized: 1991 population

Stroke (7.0%)

IHD (14.5%)



Cancer: Breast (5.0%)




Diabetes (3.4%)

Infections (1.0%)

Respiratory (6.5%)

Other (22.7%)


11

CANCER: 31.6%

Circ Disease:27.3%

††


11/2009 1212

Sex ratio (M/F) in Canada from 1979-2004.

11/2009 1313

CHD and cancer deaths in Canada from 1979-2004.% of death due to each group of causes.

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

11/2009 1515

Age/sex-specific Mortality.Canada, 2005

log-scale for mortality


0 20 40 60 80

Rat

e/10

0,00

0

1

10

100

1000

10000CombinedMalesFemales

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

11/2009 1717

Leading Causes of death by age

1-4 10-14 20-24 40-44

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)

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


Respiratory System

Respiratory System

Respiratory System

Suicide Diabetes Diabetes Unintentional injuries

Digestive system (liver)



Diabetes

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

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

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


11/2009 2222

Leading Causes of death, sex

1-4: M 1-4: F 10-14: M 10-14: F





Cancer Congenital anomalies

Cancer Cancer


Cancer Suicide Suicide

Circulatory System

Homicide Congenital anomalies


Homicide Circulatory System

Circulatory System

Circulatory System

11/2009 2323


20-24: M 20-24: F 40-44: M 40-44: F



Cancer Cancer

Suicide Suicide Unintentional injuries

Circulatory System

Homicide Cancer Circulatory System


Cancer Circulatory system

Suicide Suicide

Circulatory system

Homicide Infections (mainly HIV)

Liver

11/2009 2424


50-54: M 50-54: F 60-64: M 60-64: F

Cancer Cancer Cancer Cancer

Circulatory System

Circulatory System

Circulatory System

Circulatory System



Respiratory System

Respiratory System

Suicide Suicide Diabetes Diabetes

Digestive System (liver)

Diabetes Digestive System (liver)

Unintentional

11/2009 2525


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



Diabetes Unintentional injuries

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


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


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


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


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


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


11/2009 3232

Age 1-4 Age 10-14 Age 15-19

Age 20-24 Age 30-34


Age 1-4 Age 10-14 Age 15-19

Age 20-24 Age 30-34


MALES FEMALES

Proportional mortality, age 1-39, Canada, 2001

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


Age 40-44 Age 50-54 Age 60-64

Age 70-74 Age 80-84


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+

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.

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

11/2009 3737

PYLL’s for various conditions, 2001

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

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

11/2009 4013/7/2008 40

11/2009 4113/7/2008 41

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

11/2009 4343

Injury Mortality in Canada, 2004


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

11/2009 4444

Injury Mortality in Canada, 2004Excluding poeple over age 80


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

11/2009 4545

Pattern of Injury deaths, Canada, 2004Age 1 to 10.

MVA FallsSuffocationOther unintentionalHomicide

11/2009 4646


MVA FallsSuffocationOther unintentionalSuicideHomicide

11/2009 4747

Pattern of Injury deaths, Canada, 2004Age 80 and over.

MVAFallsSuffocationOther unintentionalSuicideHomicde

11/2009 4848


MVA FallsSuffocationOther unintentionalHomicide



Pattern of Injury deaths, Canada, 2004Age 80 and over.

MVAFallsSuffocationOther unintentionalSuicideHomicde

11/2009 4949

Males.


Females

Sex-specific Injury Mortality, Canada, 2004

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

11/2009 5151

11/2009 5252

11/2009 5353

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

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

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


Estimated

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


Estimated

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


Estimated

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)

epi 5240: introduction to epidemiology mortality in canada: trends and causes november 2, 2009

Documents

cancer mortality

leading causes of death

epidemiology mortality

statistics canada

mortality rates

expected age

s injury mortality

cancer deaths