Morbidity and Mortality

1. Morbidity and Mortality Marcela Frazier OD,MPH, FAAO

2. 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

3. 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

4. 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

5. Main Health risk factors • Smoking • Overweight • Diabetes • High Blood Pressure • Risky Behaviors (alcohol and drug use, promiscuity, etc)

6. Heart Disease

7. Cancer

8. Cancer AL

9. Stroke

10. Leading causes of Death Worldwide • Vary depending on stage in development of the country • Affected by income, education, and availability of health services

11. High-income countries • Coronary heart disease • Cancer • Stroke • Chronic obstructive pulmonary disease • Diabetes

12. Middle-income countries • Stroke • Coronary heart disease • Chronic obstructive pulmonary disease • Lower respiratory infection • HIV/AIDS

13. Low-income countries • Coronary heart disease • Lower respiratory infections • HIV/AIDS • Perinatal conditions • Stroke

14. Childhood mortality

15. Epidemiology of Eye Problems Marcela Frazier OD,MPH

16. 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!)

17. 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.

18. 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.

19. 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

20. 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.

21. Causes of Visual Impairment worldwide

23. 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?

24. 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

25. 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?)

26. Glaucoma in The US • 2.2 million ages 50 and older have POAG • Glaucoma is the leading cause of blindness among African Americans

27. 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?

28. 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

29. Prevalence of Blindness in the US

30. 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

31. 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 Academyof Ophthalmology in June 2004

32. 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

33. Causes of Visual Impairment for children • Developed Countries • Perinatal (ROP) • Genetic (albinism) • Traumatic • Developing Countries • Xerophthalmia • Onchocerciasis • Measles • Trachoma

34. 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

35. 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).

36. "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.