Cause-deleted health-adjusted life expectancy of Canadians with selected chronic conditions

Health-adjusted life expectancy (HALE) is life expectancy weighted or adjusted for the level of health-related quality of life (HRQOL). Cause-deleted probabilities of dying were derived using the cause-eliminated life table technique and death data from vital statistics for Canada in 1998/99. Life expectancy for men and women in Canada was 76.0 and 81.5 years respectively; HALE was 67.9 years for men and 71.1 years for women. Cancer represented the greatest burden of disease in the population, and eliminating it would increase men's life expectancy to 79.6 years and women's to 85.1 years. HALE would rise to 70.7 years for men and 73.6 for women. The gain in life expectancy would be very small if osteoarthritis were eliminated, but there would be an overall gain in HALE of approximately 1.0 years for men and 2.5 years for women. HALE estimated for chronic conditions using a utility-based measure of HRQOL from population health surveys should be regarded as a valuable component of population health surveillance.     

Regional variations in cardiovascular mortality in Canada

BACKGROUND: Cardiovascular disease (CVD) is the leading cause of death in Canada with wide, unexplained regional variations in heart disease mortality. However, no studies to date have explored the relationship between a number of health region characteristics and regional variation in heart disease mortality rates across Canada. INTRODUCTION: We studied the contribution of various traditional cardiac risk factors, social determinants of health and other community characteristics to regional variations in heart disease mortality rates across Canada. METHODS: Cardiovascular disease and ischemic heart disease (IHD) age-standardized mortality rates were obtained from Statistics Canada for three years - 1995 to 1997. Health region characteristics were taken from the 2000/2001 Canadian Community Health Survey, and the 1996 Canadian Census and the Labour Force Survey. Linear regression analyses and analyses of variance were employed to identify relationships between these health region characteristics and CVD and IHD mortality rates. RESULTS: Significant regional variations in CVD mortality rates per 100,000 population were observed. Newfoundland and Labrador had the highest CVD and IHD mortality rates, while Nunavut and the Northwest Territories had the lowest CVD and IHD mortality rates. Health region smoking and unemployment rates were identified as the most important factors associated with CVD and IHD mortality at the health region level. CONCLUSIONS: Significant regional variations in age-standardized CVD and IHD mortality were noted both at the provincial/territorial level and the health region level. Efforts to reduce CVD and IHD mortality in Canada require attention to both traditional risk factors (eg, smoking) and broader determinants of health (eg, unemployment rates).     

Smoking-attributable mortality and expected years of life lost in Canada 2002: conclusions for prevention and policy

Cigarette smoking is one of the most important risk factors for burden of disease. Our objective was to estimate the smoking-attributable deaths and the years of life lost for Canada 2002. For Canada in 2002, 37,209 of all deaths aged 0 to 80+ years were attributable to smoking, 23,766 in men and 13,443 in women. This constituted 16.6 percent of all deaths in Canada, 21 percent for men and 12.2 percent for women. Main causes of smoking-attributable death were malignant neoplasms (17,427), cardiovascular diseases (CVD) (10,275) and respiratory diseases (8,282). Lung cancer (13,401) and chronic obstructive pulmonary disease (COPD) (7,533) were the single largest disease contributors to deaths caused by smoking. 515,608 years of life were lost prematurely in Canada in that year, 316,417 years in men and 199,191 years in women. Cigarette smoking is a major contributor to mortality in Canada and its impact on Canadian society continues to be an unacceptable burden.     

Risk factors for cardiovascular disease in Canada

BACKGROUND: This paper provides an update of the prevalence of important cardiovascular disease (CVD) risk factors in subgroups of the Canadian population. To improve awareness of the impact of CVD risk factor variations on disease burden, smoking-attributable mortality (SAM) has been estimated for the first time for each health region in Canada. METHODS: The 2000/01 Canadian Community Health Survey (CCHS) was used to estimate the prevalence of current smoking, obesity, physical inactivity, low income, diabetes and hypertension. Combining smoking prevalence data from the 2000/01 CCHS, mortality data from the 1995 to 1997 Canadian Mortality Database, and relative risk estimates (relating smoking and smoking-associated deaths) from the American Cancer Society's Cancer Prevention Study II, SAM values were generated using population-attributable risk techniques. RESULTS: Based on self-reported data, the 2000/01 CCHS shows that 26.0% of Canadians currently smoke, 14.9% are obese, 53.5% are physically inactive, 11.3% have low income, 13.0% have hypertension and 4.2% have diabetes. Cardiovascular and all-cause SAM were estimated at 18,209 and 44,271 annual deaths, and contributed to 23% and 22% of total CVD and all-cause mortality in Canada, respectively. There are large variations in the prevalence of CVD risk factors and in SAM estimates between sexes and across age groups and geographic regions. CONCLUSIONS: The high prevalence of potentially modifiable CVD risk factors and the large variation that exists between subgroups of the Canadian population suggest that the burden of CVD could be reduced through risk factor modification. While prevalence data for risk factors in a population give an initial understanding of some of the contributing causes of a disease, the actual burden of disease caused by a risk factor is also modified by the magnitude of the increased risk to mortality and morbidity, and is best represented by its estimated attributable mortality and morbidity.     

Regional variation in self-reported heart disease prevalence in Canada

BACKGROUND: Cardiovascular disease is the leading cause of death in Canada. OBJECTIVE: To provide an analysis of the self-reported prevalence of heart disease and three specific cardiac conditions--myocardial infarction (MI), angina and congestive heart failure (CHF)--in subgroups of the Canadian population. METHODS: Data from the Public Use Microdata File from Statistics Canada's 2000/2001 Canadian Community Health Survey (CCHS) were used to estimate the crude self-reported prevalence of heart disease, MI, angina and CHF in Canada. The data are reported by age and sex groups, as well as by province or territory and health region. RESULTS: Based on the 2000/2001 CCHS data, it was estimated that among Canadians 12 years of age and older, 5.0% (n=1,286,000) have heart disease, 2.1% (n=537,000) have had a heart attack, 1.9% (n=483,000) have angina and 1.0% (n=264,000) have CHF. Marked variation in the prevalence of heart disease and the other specific cardiac conditions exists across age and sex groups, and across geographical regions. The prevalence of heart disease is low among those younger than 50 years; thereafter, the prevalence of heart disease increases and is more common among men than among women. By 70 years of age, at least one in four men and one in five women report having heart disease. Large differences in the burden of heart disease were observed across provinces, territories and health regions. Comparison of the highest and lowest prevalence rates among provinces and territories revealed a 1.9-fold difference for heart disease, a 2.8-fold difference for MI, a 2.3-fold difference for angina and a 3.3-fold difference for CHF. CONCLUSIONS: Large regional differences in the prevalence of heart disease and other specific cardiac conditions were observed across Canada. These data may assist health system planners to identify those regions and population subgroups most affected by heart disease, and to support the development of heart disease prevention and treatment programs.     

Associations of diabetes mellitus with total life expectancy and life expectancy with and without cardiovascular disease

BACKGROUND: Diabetes mellitus is a recognized risk factor for cardiovascular disease (CVD) and mortality. However, limited information exists on the association of diabetes with life expectancy with and without CVD. We aimed to calculate the association of diabetes after age 50 years with life expectancy and the number of years lived with and without CVD. METHODS: Using data from the Framingham Heart Study, we built life tables to calculate the associations of having diabetes with life expectancy and years lived with and without CVD among populations 50 years and older. For the life table calculations, we used hazard ratios for 3 transitions (healthy to death, healthy to CVD, and CVD to death), stratifying by the presence of diabetes at baseline and adjusting for age and confounders. RESULTS: Having diabetes significantly increased the risk of developing CVD (hazard ratio, 2.5 for women and 2.4 for men) and of dying when CVD was present (hazard ratio, 2.2 for women and 1.7 for men). Diabetic men and women 50 years and older lived on average 7.5 (95% confidence interval, 5.5-9.5) and 8.2 (95% confidence interval, 6.1-10.4) years less than their nondiabetic equivalents. The differences in life expectancy free of CVD were 7.8 and 8.4 years, respectively. CONCLUSIONS: The increase in the risk of CVD and mortality from diabetes represents an important decrease in life expectancy and life expectancy free of CVD. Prevention of diabetes is a fundamental task facing today's society in the pursuit of healthy aging.     

Epidemiology of valvular heart disease in Canada

The purpose of this study was to examine mortality trends for valvular heart disease in Canada. Mortality data and population data were obtained from Statistics Canada publications and analyzed according to the diagnostic criteria established by the International Classification of Diseases (ICD) of the World Health Organization. Because of the changes in ICD classification over the years, attempts were made to analyze data only when a relevant and comparable diagnostic class was available. Mortality data were collected over time, therefore they tended to be strongly autocorrelated and statistical methods were utilized to minimize this factor. In addition, statistical methods for switching regression models were applied to evaluate trends for possible changes. For chronic rheumatic heart disease ICD 393-398, there was a significant trend of a decrease in death rate of about 0.22 per 100,000 population per year. These trends were observed for both men and women although the death rates for women were consistently greater than those for men. Switching regression models suggested a switchover point, but only for men, indicating a flattening or decrease in the downward trend after 1978. For rheumatic mitral valve disease there was a significant decrease in death rate of 0.026 deaths per 100,000 per year and for rheumatic aortic valve disease of 0.036 per 100,000 per year. For nonrheumatic mitral valve disease there was a significant decrease in death rates of 0.01 per 100,000 per year, but there was no trend for nonrheumatic aortic valve disease.(ABSTRACT TRUNCATED AT 250 WORDS)     

Alcohol-attributable mortality and potential years of life lost in Canada 2001: implications for prevention and policy

BACKGROUND: Alcohol is one of the most important risk factors for burden of disease. OBJECTIVE: To estimate the number of deaths and the years of life lost attributable to alcohol for Canada 2001 using different ways to measure alcohol exposure. METHODS: Distribution of exposure was taken from a major national survey of Canada, the Canadian Addiction Survey, and corrected for per capita consumption from production and sales. For chronic disease, risk relations were taken from the published literature and combined with exposure to calculate age- and sex-specific alcohol-attributable fractions (AAFs). For injury, AAFs were taken directly from available statistics. Information on mortality, with cause of death coded according to the International Classification of Diseases version 10 (ICD-10) was obtained from Statistics Canada. RESULTS: For Canada in 2001, 4,010 of all deaths in the group below 70 years of age were attributable to alcohol, 3,132 in men and 877 in women. This constituted 6.0% of all deaths in Canada in this age group, 7.6% for men, and 3.5% for women. The 4,010 deaths are a net figure, already taking into account the deaths prevented by moderate consumption of alcohol. Main causes of alcohol-attributable death were unintentional injuries, malignant neoplasms and digestive diseases. Ischaemic heart disease (IHD) was the biggest cause of death prevented by alcohol, with 78.7% of all alcohol-attributable prevented deaths in the age groups of 70 years and above. A total of 144,143 years of life were lost prematurely in Canada in that year, 113,079 years in men and 31,063 years in women. DISCUSSION: Regardless of the assumptions made, alcohol is a major contributor to mortality in Canada. The impact of alcohol on social life is not confined to mortality, as other studies indicated that alcohol is linked even more strongly to disability and social harm. Alcohol-attributable harm could be substantially reduced, however, if known effective policies were introduced.     

MORBIDITY AND MORTALITY DUE TO AIDS: A STUDY OF BURDEN OF DISEASE AT A MUNICIPAL LEVEL

Introduction:

The purpose of measuring the burden of disease involves aggregating morbidity and mortality components into a single indicator, the disability-adjusted life year (DALY), to measure how much and how people live and suffer the impact of a disease.

Objective:

To estimate the global burden of disease due to AIDS in a municipality of southern Brazil.

Methods:

An ecological study was conducted in 2009 to examine the incidence and AIDS-related deaths among the population residing in the city of Tubarao, Santa Catarina State, Brazil. Data from the Mortality Information System in the National Health System was used to calculate the years of life lost (YLL) due to premature mortality. The calculation was based on the difference between a standardized life expectancy and age at death, with a discount rate of 3% per year. Data from the Information System for Notifiable Diseases were used to calculate the years lived with disability (YLD). The DALY was estimated by the sum of YLL and YLD. Indicator rates were estimated per 100,000 inhabitants, distributed by age and gender.

Results:

A total of 131 records were examined, and a 572.5 DALYs were estimated, which generated a rate of 593.1 DALYs/100,000 inhabitants. The rate among men amounted to 780.7 DALYs/100,000, whereas among women the rate was 417.1 DALYs/100,000. The most affected age groups were 30-44 years for men and 60-69 years for women.

Conclusion:

The burden of disease due to AIDS in the city of Tubarao was relatively high when considering the global trend. The mortality component accounted for more than 90% of the burden of disease.     

Cardiovascular mortality in Korea: a country experiencing epidemiologic transition

BACKGROUND: The pattern of morbidity and mortality of cardiovascular disease (CVD) changes with epidemiologic transition. An understanding of this pattern in rapidly developing countries might provide important clues for the understanding of the epidemiological trends in CVD mortality. The objective of this paper was to address the changing pattern of CVD mortality in Korea during the period 1984-1999, and to examine the significant changes in associated major risk factors for CVD over a similar period. METHODS: For the purpose of this study, three main categories in CVD were reviewed: hypertensive heart disease, ischaemic heart disease, and cerebrovascular disease (stroke).The analyses of mortality were based on nationwide mortality data published by the National Statistical Office from 1984 to 1999. All the mortality rates were adjusted for age using the direct method. Changes in major CVD risk factors (blood pressure, cigarette smoking, serum total cholesterol and diet) were also reviewed during similar periods. FINDINGS: During the 15-year period investigated, the age-adjusted mortality from CVD decreased markedly. It decreased by 57% in males (from 172.2 to 73.0/100,000) and 48% in females (from 135.5 to 70.2/100,000). The age-adjusted mortality from stroke decreased while the proportion of ischaemic strokes among total stroke deaths increased. The proportion increased about 5.2 times in men and 4.9 times in women. The age-adjusted mortality from hypertensive heart disease decreased markedly. It decreased by 92% in men (from 51.6 to 4.1/100,000) and 84% in women (from 34.1 to 5.3/100,000). Also the age-adjusted mortality from ischaemic heart disease increased significantly. In 1999, the rates for men and women were 11.9 and 7.5/100,000, respectively. These rates were 3.8 and 3.6 times higher than the rates in 1984 for men and women, respectively. The changes of CVD risk factors in Korea observed during a similar period were a decrease in hypertension prevalence, although still present at a high level, an increase in serum total cholesterol level and intake of total fat along with a high, although decreasing, prevalence of cigarette smoking. INTERPRETATION: The mortality changes in Korea are consistent with the change that occurs during the transition from the age of receding pandemics to the age of degenerative and man-made diseases. This study has indicated that the change of CVD mortality was closely associated with the change in CVD risk factors. In order to avert the ongoing epidemic of CVD in developing countries, prevention and treatment of modifiable risk factors must become a high health priority.     

Joint impact of smoking and hypertension on cardiovascular disease and all-cause mortality in Japan: NIPPON DATA80, a 19-year follow-up.

Hypertension and smoking are major risk factors for death due to cardiovascular disease (CVD). These attributions for CVD mortality should be higher in the countries where obesity-related conditions are uncommon. However, the joint effect of these risk factors on CVD and all-cause mortality have not been described. We followed a representative 8,912 Japanese men and women without a history of stroke and heart disease. Participants were categorized into 4 groups as follows: a group of individuals who neither smoked nor had hypertension (HT), a group of current smokers, a group with HT, and a group of current smokers with HT. We further calculated population-attributable fractions (PAF) of CVD and all-cause mortality based on relative hazards assessed by proportional hazard regression models. After 19 years of follow-up, we observed 313 and 291 CVD and 948 and 766 all-cause deaths for men and women, respectively. The PAF of CVD mortality due to smoking or HT were 35.1% for men and 22.1% for women. The PAF of CVD mortality was higher in participants <60 years of age (57.4% for men and 40.7% for women) vs. those who were older (26.3% for men and 18.1% for women). Aggressive attempts to discourage smoking and to curb HT could yield large health benefits in Japan and throughout Asia, particularly for those aged <60 years. Efforts to warn about the adverse consequence of HT and smoking during adolescence and youth could yield the greatest health benefits, since positive behaviors adopted early are more easily continued into middle adulthood and later life.     

江苏省农村监测人群1985～1990年心血管病发病动态观察

按照ＷＨＯ－Ｍｏｎｉｃａ方案要求，对江苏省农村海门地区进行了心血管病的发病监测，结果显示１９８５～１９９０年间该地区２５～７４岁年龄段人群急性心肌梗塞年均发病率男女分别为３．６／１０万和０．９／１０万；脑卒中年均发病率分别为９８．３／１０万和６８．２／１０万；心血管病年均死亡率分别为１３９．９／１０万和１００．８／１０万，显示男性发病率、死亡率均较女性为高。该地区的心血管病发病情况在国内各监测区中处于低发之列，分析认为同该地区人群心血管病危险因素水平相对较低有关。     

A cardiovascular life history. A life course analysis of the original Framingham Heart Study cohort.

AIMS The objective of this paper is to measure the potential burden of cardiovascular disease within the original Framingham Heart Study cohort by transforming its well-described epidemiological measures into time-based health policy measures, such as life years lost to or lived with the disease. METHODS AND RESULTS We constructed multi-state life tables of the Framingham Heart Study cohort to calculate dwelling times with a history of cardiovascular disease. Age-specific probabilities determined transitions from healthy through disease to death. For this synthetic cohort, from age 50 men (women) live on average 26 (32) years; 20 (26) free of cardiovascular disease. Allowing occupancy of more than one disease state, 50-year-old males (females) live 2 X 9 (1 X 2) years with a history of myocardial infarction, 0 X 93 (1 X 2) with a history of stroke, and 0 X 67 (0 X 93) with congestive heart failure. Having ever suffered acute myocardial infarction, stroke or congestive heart failure, life expectancy is reduced by 9 (13), 12 (15) or 16 (16) years, respectively in 60-year-old men (women). CONCLUSIONS Transforming occurrence probabilities into time-based health measures, the prevalence of cardiovascular disease is remarkable: from age 50, 20% of remaining life expectancy is lived with the disease. Such measures are integral to appropriate health planning and assessment of the potential population health value of various treatment and prevention strategies.     

低心血管病危险人群死亡的相对危险及期望寿命

目的：探讨低心血病危险与冠心病、脑卒中、恶性肿瘤死亡及总死亡的关系,以及对平均期望寿命的影响。方法：1982－1985年在我国不同地区的10组人群（年龄35－59岁）共3万余人中进行心血管病危险因素调查,并随访至2000年底,登记并核实其全部残因情况。结果：24900人中（男性12497人,女性12403人）,7．7％的男性,28．9％的女性基线心血管病危险因素处于低危险水平,在其后平均15．2年的随访过程中,总死亡、冠心病死亡（女性）、脑卒中死亡明显低于其他人群,男性和女性平均期望寿命分别延长2．6年和4．0年。结论：低心血管危险人群,不仅心血管病死亡减少,且总病死率降低,平均期望寿命延长。     

Vida saludable perdida por discapacidad aguda,crónica y muerte prematura en hipertensión arterial

Objective:

To determine the disability adjusted life years in arterial hypertension without diabetes mellitus.

Method:

Disability adjusted life years was determined from chronic disability (chronic kidney disease, heart disease and cerebral vascular event), acute disability (hypertensive crisis and hypertensive emergency) and premature death. Age of diagnosis, age of the complication, prevalence of the complication, duration of the acute event, number of acute events, time lived with hypertension, age of death and life expectancy were identified. In all cases a 3% discount rate was applied, the estimate was made per 100,000.

Results:

When the total of women was used as a reference, the disability adjusted life years in women is 198,498.28. In men, using the total number of men as a reference, the value is 204,232.13. If the referent is the total population, in women the disability adjusted life years is 102,028.11 and in men 99,256.98.

Conclusions:

The disability adjusted life years in arterial hypertension without diabetes is different for men and women; the topic has many edges that must be studied.Key words: Disability adjusted life, Disability, Life expectancy, Arterial hypertension, Mortality     

Contributions of Cardiovascular Mortality to Spanish Life Expectancy From 1980 to 2009

Introduction and objectives

This article describes the contribution of the decrease in cardiovascular mortality to the increase in life expectancy at birth in Spain from 1980 to 2009. We explain the demographic factors underlying the decrease in mortality from cardiovascular diseases at older ages and the effect of this decrease on lifespan.

Methods

The contribution of these decreases to Spanish life expectancy at birth was calculated using decomposition methods for life expectancy. We calculated standardized mortality rates by sex and 3 causes of death (cerebrovascular disease, ischemic heart disease, and other heart disease) for 3 age groups: 65 to 79 years, 80 to 89 years, and ≥90 years.

Results

From 1980 to 2009, life expectancy at birth in Spain increased by more than 6 years for both sexes. The contribution of the decrease in cardiovascular mortality to the total increase in life expectancy at birth was 63% among women and 53% among men. Among the ≥65-year-old age group, this contribution was 93% among women and 87% among men.

Conclusions

The decrease in cardiovascular mortality, mainly at older ages, has been the main contributor to increased Spanish life expectancy at birth during the last 3 decades.     

Health and demographic surveillance in rural western Kenya: a platform for evaluating interventions to reduce morbidity and mortality from infectious diseases

We established a health and demographic surveillance system in a rural area of western Kenya to measure the burden of infectious diseases and evaluate public health interventions. After a baseline census, all 33,990 households were visited every four months. We collected data on educational attainment, socioeconomic status, pediatric outpatient visits, causes of death in children, and malaria transmission. The life expectancy at birth was 38 years, the infant mortality rate was 125 per 1000 live births, and the under-five mortality rate was 227 per 1,000 live births. The increased mortality rate in younger men and women suggests high human immunodeficiency virus/acquired immunodeficiency syndrome-related mortality in the population. Of 5,879 sick child visits, the most frequent diagnosis was malaria (71.5%). Verbal autopsy results for 661 child deaths (1 month to <12 years) implicated malaria (28.9%) and anemia (19.8%) as the most common causes of death in children. These data will provide a basis for generating further research questions, developing targeted interventions, and evaluating their impact.     

Sex differences in the epidemiology and outcomes of heart disease: population-based trends.

We examined trends in heart disease (HD) mortality and the delivery of cardiac in Olmsted County, MN. Between 1979 and 1994, women experienced 51% of the total number of HD (ICD9 codes 390-398,402,404-429) deaths (3095). Age-adjusted HD mortality rate declined from 123 per 100,000 (95%CI 102, 144) in 1979 to 81 (67,95) in 1994. The risk ratio (RR) of HD death in 1994 compared to 1979 was 0.69 for women vs 0.53 for men (P = 0.06). This equates to a decline in HD mortality of 2.5%/y in women and 4.2%/y in men. The decline in HD mortality was less pronounced in older age groups (P < 0.001), reflecting a shift of the burden of HD towards women and the elderly. Compared to men, there was less use of stress tests among women, of cardiology visits after stress testing, and of cardiac procedures among women presenting to the emergency room with unstable angina. Further studies are needed to examine causal links between these trends.     

A new population-based measure of the economic burden of mental illness in Canada

This paper presents a comprehensive measure of the incremental economic burden of mental illness in Canada which incorporates the use of medical resources and productivity losses due to long-term and short-term disability, as well as reductions in health-related quality of life (HRQOL), for the diagnosed and undiagnosed population with mental illness. The analysis was based on the population-based Canadian Community Health Survey Cycle 2.1 (2003). For all persons, we measured all health services utilization, longterm and short-term work loss, and health-related quality of life and their dollar valuations, with the economic burden being the difference in dollar measures between the populations with and without mental health problems. In total, the economic burden was $51 billion in 2003. Over one-half was due to reductions in HRQOL. The current accepted practice in economic assessments is to include changes in medical resource use, work loss, and reductions in HRQOL.     

Early-Onset Cardiovascular Disease From Cocaine,Amphetamines, Alcohol,and Marijuana

Cardiovascular disease (CVD), a disease typically associated with aging and the definitive leading cause of death worldwide, now threatens young and middle-aged populations. Recreational abuse of alcohol, marijuana, cocaine, and amphetamine-type stimulants has been an escalating public health problem for decades, but now use of these substances has become a significant contributor to early-onset CVD. While this remains a global phenomenon, the epicentre of substance abuse is rooted in North America, where it has been exacerbated by the response to the COVID-19 pandemic. For the first time in history, the United States crossed 100,000 overdose-related deaths in a calendar year. Sadly, Canada’s recreational drug abuse problem closely mirrors that of the US. This is indicative of the larger public health crisis, as we now know that these substances are cardiotoxic and are contributing to the rising levels of premature chronic CVD, including hypertension, arrhythmias, heart failure, stroke, myocardial infarction, arterial dissection, sudden cardiac death, and early mortality.