morbidity and mortality
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Morbidity and Mortality. Marcela Frazier OD,MPH, FAAO. Important Terms. Sporadic : disease occurs occasionally, irregularly Endemic : disease stays in population at low frequency Epidemic : sudden outbreak in disease above typical level - PowerPoint PPT PresentationTRANSCRIPT
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Morbidity and Mortality
Marcela Frazier OD,MPH, FAAO
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Important Terms
• Sporadic: disease occurs occasionally, irregularly • Endemic: disease stays in population at low frequency • Epidemic: sudden outbreak in disease above typical
level • Pandemic: epidemic over wide area (may be entire
world). • Morbidity: all reported cases of disease, illness, and
disability • Mortality: reported deaths due to a disease
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Mortality Rate in the US
• Number of deaths: 2,423,712 per year
• Death rate: 803.6 deaths per 100,000 population
• Life expectancy: 77.9 years
• Infant Mortality rate: 6.75 deaths per 1,000 live births
http://www.cdc.gov/nchs/fastats/deaths.htm
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Main causes of death in the US
• Heart disease: 616,067
• Cancer: 562,875
• Stroke (cerebrovascular diseases): 135,952
• Chronic lower respiratory diseases: 127,924
• Accidents (unintentional injuries): 123,706
• Alzheimer's disease: 74,632
• Diabetes: 71,382
• Influenza and Pneumonia: 52,717
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Main Health risk factors
• Smoking
• Overweight
• Diabetes
• High Blood Pressure
• Risky Behaviors (alcohol and drug use, promiscuity, etc)
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Heart Disease
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Cancer
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Cancer AL
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Stroke
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Leading causes of Death Worldwide
• Vary depending on stage in development of the country
• Affected by income, education, and availability of health services
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High-income countries
• Coronary heart disease
• Cancer
• Stroke
• Chronic obstructive pulmonary disease
• Diabetes
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Middle-income countries
• Stroke
• Coronary heart disease
• Chronic obstructive pulmonary disease
• Lower respiratory infection
• HIV/AIDS
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Low-income countries
• Coronary heart disease
• Lower respiratory infections
• HIV/AIDS
• Perinatal conditions
• Stroke
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Epidemiology of Eye Problems
Marcela Frazier OD,MPH
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Causes of Visual Impairment
• 161 million people in the world are Visually impaired (BCVA 20/70 or worse in the better eye)
• 124 low vision, 37 blind• 259 million estimated when you include the
people who have uncorrected refractive error with VAs worse than 20/70 in the better eye (if they have no access to refractive correction, they are still visually impaired!)
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Distribution of visual impairment
• By age: Visual impairment is unequally distributed across age groups. – More than 82% of all people who are blind are
50 years of age and older, although they represent only 19% of the world's population.
– Due to the expected number of years lived in blindness (blind years), childhood blindness remains a significant problem, with an estimated 1.4 million blind children below age 15.
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Distribution of visual impairment
• By gender: Available studies consistently indicate that in every region of the world, and at all ages, females have a significantly higher risk of being visually impaired than males.
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Distribution of visual impairment
• Geographically: Visual impairment is not distributed uniformly throughout the world. More than 90% of the world's visually impaired live in developing countries.
• Comparisons among countries are difficult due to different examination techniques and different data gathering capabilities
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Causes of Visual Impairment worldwide
• Cataracts are the leading cause of blindness globally
• Glaucoma is the second leading cause of blindness globally
• Age-related macular degeneration (AMD) ranks third on the global scale.
• However, in developed countries, AMD is becoming the leading cause of blindness, due to the growing number of people over 70 years of age.
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Causes of Visual Impairment worldwide
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Cataracts Worldwide
• Leading cause of blindness• Higher Prevalence in countries near the equator
an in countries where farm labor is more common
• Difficulty in access to health care in developing countries
• Found to be associated with diabetes, smoking, steroid, and dietary factors, but no cause-effect relationship established
• High altitude= higher prevalence?
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Cataracts in The US
• Leading cause of blindness • 20.5 million ages 40 and older (17.2 %) in
one or both eyes• 30.1 million Americans will have cataracts by
2020 • 6.1 million (5.1%) have had cataract surgery• By age 80, more than half of all Americans
have cataracts • Center for Disease Control and Prevention, 2006
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Glaucoma Worldwide
• Countries with higher number of black inhabitants have a higher prevalence of POAG
• Diabetes=Higher prevalence, or higher detection rates (more eye exams?)
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Glaucoma in The US
• 2.2 million ages 50 and older have POAG
• Glaucoma is the leading cause of blindness among African Americans
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AMD Worldwide
• Age-related macular degeneration (AMD) ranks third on the global scale.
• leading cause of legal blindness for people over 50 in the Western world
• 25-30 million are affected worldwide, and this figure is projected to triple in 25 years. (AMD Alliance International)
• Reasons?
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AMD In the US
• Approximately 1.8 million Americans age 40 and older have macular degeneration,
• 7.3 million are at substantial risk of developing AMD because they have large macular drusen
• AMD is the leading cause of permanent impairment of central vision (used for reading and for seeing road signs) among Americans age 65 and older
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Prevalence of Blindness in the US
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DM and Diabetic Retinopathy
• 20.8 million people in the US (7%) have DM
• prevalence of DM is at least 2 to 4 times higher among minorities
• 12,000 to 24,000 new cases of blindness/yr
• leading cause of new cases of blindness in adults 20-74 years of age in the US
• 4.1 million Americans are affected by diabetic retinopathy
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Eye Injuries in the US
• 9,000 fireworks-related injuries/yr• 2,000 U.S. workers experience job-related eye
injuries/day!!! • 90% of occupational eye injuries could be
prevented with protective eyewear• 42,000 eye injuries from sports and recreation
/yr (more than 70 % of them involving people younger than age 25)
• U.S. Consumer Product Safety Commission, as reported by the American Academy of Ophthalmology in June 2004
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Access to Care
• Among 61 million adults >65 yo at high risk:– 50% had had a dilated EE within the past 12m– 5 million could not afford eye care
• 15% were uninsured
• High Risk defined as >65 yo, with predisposing systemic condition, poor vision, or ocular disease
• Zhang, Et al. Arch Ophthalmol 2007; 124:411-418
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Causes of Visual Impairment for children
• Developed Countries– Perinatal (ROP)– Genetic (albinism)– Traumatic
• Developing Countries– Xerophthalmia– Onchocerciasis– Measles– Trachoma
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Poverty and Visual impairment
• Poverty underlies not only the causes, but also the perpetuation of ill health, including eye health.
• Blindness remains a key barrier to development. • Health is the centrepiece of development and
poverty alleviation; continuing to eliminate avoidable blindness among the poorest of the poor is a moral imperative.
• http://www.who.int/tdr/media/video/productions.htm
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Prevention
• Cataract, glaucoma, corneal opacity, diabetic retinopathy, onchocerciasis, childhood blindness, trachoma, and some other causes of blindness can potentially all be prevented and/or treated.
• WHO estimates that, globally, up to 75% of all blindness is avoidable. However, the proportion of the specific causes of blindness varies considerably from region to region, depending on local circumstance.
• Only about half the cases of childhood blindness are avoidable (Genetic disorders).
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"VISION 2020: The Right to Sight"
• Increased public awareness and utilization of eye health care services
• Increased availability and affordability of eye health care services • Increased global political commitment to prevention of visual
impairment • Increased professional commitment to prevention of visual
impairment • Commitment and support of non-governmental organizations • Involvement and partnership with the corporate sector • More effective primary eye care activities as an integral part of the
primary health care system which have contributed to the decline in vision loss from trachoma, onchocerciasis, vitamin A deficiency and even from cataract through better services including outreach case finding and eye health education.