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

Vital statistics. Mortality (07/02/02) Morbidity (21/02/02). Hannes Botha. (Dr JL Botha) Director, Trent Cancer Registry Hon Senior Lecturer. blj @ le.ac.uk. Mortality data. Death Registration Video Other issues Uses of mortality data Historical Current Problems Trends.

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

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  1. Vital statistics Mortality (07/02/02)Morbidity (21/02/02) Hannes Botha (Dr JL Botha) Director, Trent Cancer Registry Hon Senior Lecturer blj@le.ac.uk

  2. Mortality data • Death Registration • Video • Other issues • Uses of mortality data • Historical • Current • Problems • Trends

  3. International Classification of Diseases

  4. Uses of Mortality Data Variation by • Person • Time • Place Snow/Current

  5. 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 takea list, at the General Register Office, of thedeaths 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 deathsfrom cholera were registered, during the week, in the three subdistricts.”

  6. Map of cholera cases P Pump Deaths from cholera

  7. 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 areallowed a certain quantity of malt liquor, and Mr. Huggins believesthey do not drink water at all; and he is quite certain that the workmen never obtained water from the pump in the street. There isa deep well in the brewery, in addition to the New River water.”

  8. Cholera ctd “… the followingdeath 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 wasthe 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, …”

  9. Cholera ctd • Broad Street pump’s handle removed • epidemic already declining • understanding of disease causation

  10. Uses of Mortality Data Variation by • Person • Time • Place Snow/Current

  11. 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

  12. 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% 6% Ischaemic heart disease Other accidental deaths 3% 3% Cerebrovascular disease Motor vehicle traffic accidents 5% Other circulatory 3% * Deaths under 28 days excluded Source: OPCS

  13. Distribution of total deaths By cause & age, England & Wales Males 1931 1988 Causes of death Percentage of total deaths Percentage of total deaths 100 75 50 25 0 100 75 50 25 0 Accidents and violence Other diseases Genitourinary diseases Respiratory diseases Circulatory diseases Neoplasms Infectious diseases 0-4 20-24 40-44 60-64 90+ 0-4 20-24 40-44 60-64 90+ age age Source: Registrar General’s annual report 1931 OPCS mortality statistics 1988

  14. Distribution of total deaths By cause & age, England & Wales Females 1931 1988 Causes of death Percentage of total deaths Percentage of total deaths 100 75 50 25 0 100 75 50 25 0 Accidents and violence Other diseases Maternal causes Genitourinary diseases Respiratory diseases Circulatory diseases Neoplasms Infectious diseases 0-4 20-24 40-44 60-64 90+ 0-4 20-24 40-44 60-64 90+ age age Source: Registrar General’s annual report 1931 OPCS mortality statistics 1988

  15. Male Life Expectancy 1997-99 East Midlands Local Authorities Rutland Corby Courtesy of Trent PH Obs Trent GIS Unit

  16. 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 agedunder 75 years by at leastone fifth DoH website: http://www.doh.gov.uk/ohn.htm

  17. Problems with Mortality Data • Numerator • Death certification • ICD coding • Denominator • Census, estimation, projection

  18. Diabetes Mellitus Death Rates ICD 6: <1949 DM always >1949 DM not Insulin

  19. Interpretation of trends • Chance • Artefactual • Numerator • Denominator • Real • ‘Natural’ (epidemiological) • Medical care effects

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