Germany & Global Health Stats: Population, Life Expectancy, Causes of Death, Prevention, Slides of Public Health

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Vitale Gesellschaft Health and disease in Germany, Europe and worldwide: Facts, predictions and chances for prevention Growing of the world population According to the UN the world population reached 6 billion on October 12, 1999. 1804 1 billion people 1926 2 billion people 1960 3 billion people 1999 6 billion people prognosis for 2050 9 billion people 122 years 34 years 39 years Altersaufbau der Bevélkerung in Deutschland 1910 (in %) Alter in Jahren Frauen Frauen- 60 iborschuss 10 Qo 2520 15 10 05 0 O O85 Prozent 10 15 20 25 Proze nt Altersaufbau der Bevélkerung in Deutsch land 1998 (in %) Alter in Jahren 25 20 15 Prozert 10 05 0 0 O5 10 15 20 25 Prozent Prognostizierter Altersaufbau der Bevé Ikerung in Deutschland 2050(in %) Alter in Jahren Frauen Frauen- iiberschuss Manner: iberschuss 25 20 15 Prorent 10 O05 0 0 o5 10 15 20 25 Prozent Population of Germany by age groups 1950–1998 Age groups in % Year <20 years 20–29 years 30–59 years ≥60 years 1950 30.4 14.1 40.9 14.6 1970 30.0 12.9 37.1 19.9 1990 21.7 16.7 41.2 20.4 1998 21.4 12.3 43.9 22.4 Source: Statistisches Bundesamt Anzahl in 1000 900 800 700 600 500 400 300 200 100 0 -100 -200 Be volkerungsentwicklung in Deutschland, 1990 - 1998 MB Zuwanderungstiberschuss HS Sterbefall iiberschuss === Bevolkerungszu- oder -abnahme i iL T 1990 1991 T T T 1992 1993 1994 Jahre Datenquel ia: Statistishe s Bundesamt, eiganeBerechnungen T T T 1995 1996 1997 1998 Contribution to gap in life expectancy between central and eastern Europe and rest of European region for men and women by age and cause of death in 1992 Figures are difference in years between West minus East Age group (years) Cause of death < 1 1–34 35–64 ≥ 65 All ages Infectious and parasitic diseases 0.30 0.10 0.08 – 0.01 0.47 Cancer 0 0.05 0.25 – 0.35 – 0.05 Cardiovascular diseases 0 0.07 1.36 1.85 3.28 Respiratory diseases 0.68 0.20 0.15 – 0.05 0.97 Digestive diseases 0.02 0.03 0.08 – 0.04 0.09 External causes 0.04 0.64 0.71 0.03 1.41 Ill defined conditions – 0.10 0.01 0.04 0.18 0.12 Other diseases 0 0 – 0.02 –0.20 – 0.22 All causes 0.93 1.09 2.63 1.40 6.06 Source: Bobak, M and Marmot, M. East-West mortality divide and its potential explanations. BMJ 1996; 312: 421–25 JAPAN 1993 — USA 1997 le me eects melt] “REBT e CN ee TT wo 15 20 25 30 35 40 45 50 55 60 65 70 75 80 85 90 95 100 105 110 D7 Ld) Change in rank order of leading causes of death (world) 1990 Disease or injury 2020* Disease or injury 1 Ischaemic heart disease 2 Cerebrovascular disease 3 Chronic obstructive pulmonary disease 4 Lower respiratory infections 5 Trachea, bronchus and lung cancers 6 Road traffic accidents 7 Tuberculosis 8 Stomach cancer 9 HIV 10 Self-inflicted injuries 11 16 27 * baseline scenarios Source: Murray CJL, Lopez AD. The Global Burden of Disease. Cambridge: Harvard University Press, 1996. Ischaemic heart disease 1 Cerebrovascular disease 2 Lower respiratory infections 3 Diarrhoeal diseases 4 Conditions arising during the perinatal period 5 Chronic obstructive pulmonary disease 6 Tuberculosis 7 Measles 8 Road traffic accidents 9 Trachea, bronchus and lung cancers 10 12 14 30 Causes of death (ICD-10) Deaths (men and women) Pneumonia (J10–J18) 18,757 COPD (J40–J47) 25,798 Chronic liver disease and -zirrhosis (K70–K77) 18,428 Diabetes mellitus (E10–E14) 21,180 Suicide (X60–X84) 11,065 Traffic accidents (V01–V99) 7,747 Falls (W00–W19) 7,404 HIV / AIDS (B20–B24) 580 Sudden infant death syndrome (SIDS) (R95) 482 Severe acute respiratory syndrome (SARS) 0 Most frequent causes of death in Germany in 2000 (2) Source: StBA, Statistisches Jahrbuch (2002) Prevalence of gross obesity (BMI ≥30) German National Health Survey 1998 (n= 7124) 0 10 20 30 40 50 18 -1 9 20 -2 9 30 -3 9 40 -4 9 50 -5 9 60 -6 9 70 -7 9 18 -1 9 20 -2 9 30 -3 9 40 -4 9 50 -5 9 60 -6 9 70 -7 9 Age % West East Men Women Source: Bergmann KE, Mensink GBM. Körpermaße und Übergewicht. Gesundheitswesen 1999; 61:S115–S120 Sports activity in hours per week by age groups German National Health Survey 1998 Source: Mensink GBM. Körperliche Aktivität. Gesundheitswesen 1999; 61:S128–S131 0% 20% 40% 60% 80% 100% 18 -1 9 20 -2 9 30 -3 9 40 -4 9 50 -5 9 60 -6 9 70 -7 9 18 -1 9 20 -2 9 30 -3 9 40 -4 9 50 -5 9 60 -6 9 70 -7 9 Age none <1 1-2 2-4 >4 West EastMen hours per week: Relative risks (95% CI) of CHD mortality per 20 mg/dL cholesterol increase* in 6 cohorts of the Seven Countries Study (n = 12,467 men aged 40–59 years) * Adjusted for age, smoking, and systolic blood pressure; $ Based on average regression dilution factor of 1.4 Source: Verschuren et al. JAMA 1995; 274: 131–136 Cohort Unadjusted for regression dilution Adjusted for regression dilution Northern Europe 1.12 (1.08–1.15) 1.18 United States 1.15 (1.10–1.19) 1.21 Southern Europe, Inland 1.10 (1.04–1.16) 1.14 Southern Europe, Mediterranean 1.12 (1.04–1.22) 1.18 Serbia 1.11 (0.97–1.28) 1.14 Japan 0.96 (0.77–1.18) Not available Overall 1.12 (1.09–1.16) 1.17$ 25 year CHD mortality rates* in six cohorts of the Seven Countries Study per baseline cholesterol quartile (n = 12,467 men aged 40–59 years) *Adjusted for age, cigarette smoking, and systolic blood pressure Source: Verschuren et al. JAMA 1995; 274: 131–136 Serum total cholesterol, mg/dL 100 125 150 175 200 225 250 275 300 325 350 C H D m or ta lit y ra te s % 0 5 10 15 20 25 30 35 Northern Europe United States Serbia Southern Europe, Inland Southern Europe, Mediterranean Japan Cretan Dietary Habits (six commandments) • More bread • More vegetables and legumes • More fish • Replace meat (beef, pork, lamb) by poultry • No day without a fruit • Replace butter and cream by a special canola (rapeseed) oil margarine*, rich in α linolenic acid * This margarine contains 5% of 18:3n -3 instead of 0,6% in olive oil. Source: Renaud SC. Prostagl. Leukotr. Essent. Fatty Acids 1997; 57: 423–427 Indo-Mediterranean Diet Heart Study – a randomised single blind trial, n=1000 patients, 2 years follow-up Numbers and rate ratios for separate and combined cardiac endpoints Control (n=501) person-weeks 46554 Experim. (n=499) person-weeks 49238 Adjusted* rate ratios (Cox Model) events (n) (%) events (n) (%) HRR 95% CI Non-fatal MI 43 (8.6) 21 (4.2) 0.47 0.28–0.79 Fatal MI 17 (3.4) 12 (2.4) 0.67 0.31–1.42 Sudden cardiac death 16 (3.2) 6 (1.2) 0.33 0.13–0.86 Total cardiac endpoints 76 (15.2) 39 (7.8) 0.48 0.33 –0.71 Total deaths 38 (8.0) 24 (5.0) р<0.0640 * Adjusted for baseline age, gender, BMI, cholesterol and blood pressure. Source: Singh RB et al. Lancet 2002; 360: 1455–1461 Physical activity Physical activity (e.g. brisk walking, jogging, bicycling, swimming) preferably daily and at least 30–45 minutes, reduces the risk in men and women for cardiovascular diseases by ~45% and for all cause mortality by 30–50%. Sources: Physical activity and health: a report of the Surgeon General. Centre for Disease Control and Prevention. Atlanta, 1996 Blair SN et al. Influences of cardiorespiratory fitness and other precursors on cardiovascular disease and all-cause mortality in men and women. JAMA 1996; 276: 205–210 Smoking – Non Smoking Relative and attributable risks of mortality from lung cancer and CHD among cigarette smokers in a prospective study of 34,000 male British doctors, 1951–1971 Source: Doll R, Peto R. Mortality in relation to smoking: 20 years' observations on male British doctors. BMJ 1976; 2: 1525–36 Annual mortality rates per 100,000 Lung cancer Coronary heart disease Cigarette smokers 140 669 Nonsmokers 10 413 Relative risk = 14.0 = 1.6 Attributable risk 130 / 105 / year 256 / 105 / year 140 / 105 10 / 105 669 / 105 413 / 105 Effects of cigarette smoking on survival to age 70 and to age 85, in 40-year prospective study of 34,000 male British doctors, 1951–1991 Source: Doll R, Peto R, Wheatley K et al. Mortality in relation to smoking. BMJ 1994; 309: 901–911 Age 40 55 70 85 100 0 20 40 60 80 100 1–14 / day 15–24 / day 25+ / day Never smoked regularly 33% 8% 80% 50% Cigarette smokers:         Smoking-attributed numbers of deaths per year All ages, Germany 1955–1995 Source: Peto, Lopez et al. 1992, 1994 7,6 1 7,1 11 17 20 44 89 109 100 95 88 0 20 40 60 80 100 120 1955 1965 1975 1985 1990 1995 Males Females Annual smoking deaths (1000s) Smoking – Cancer, cardiovascular diseases, and life expectancy • Smoking has caused more cancer than medicine has even cured Richard Peto • Smoking reduces life expectancy by 8 years Richard Peto • Smoking is responsible for more deaths from cardiovascular diseases than from lung cancer Ulrich Keil {y'- ALTERNATIVE PBEOA SAN: TOR TORA DJ. STEVE SPINNER t SATURDAY. DANCE SUNDAY = COME AS YOU ARE ee crs UU ih be sis Primary prevention of coronary heart disease in women through diet and lifestyle (2) Low-risk-subjects • non-smoking • BMI < 25 kg/m2 • moderate-to-vigorous physical activity ≥ 30 minutes/day • scored in the highest 40% of the cohort for a diet high in cereal fiber, marine n–3 fatty acids, and folate, with a high P/S ratio, and low in trans fat and glycemic load • alcohol ≥5 g/day Source: Stampfer MJ et al. N Engl J Med 2000; 343: 16–22 Risk of coronary heart disease (CHD) in low-risk groups in the Nurses’ Health Study 1980–1994 Source: Stampfer MJ et al. N Engl J Med 2000; 343: 16–22 Group % of women in group Number of CHD events Rel. Risk (95% CI) Attributable Risk (95% CI) % Three low-risk factors Diet in upper 40% Nonsmoking, exercise ≥ 30 min/day 12.7 62 0.43 (0.33 – 0.55) 54 (42 – 64) Four low-risk factors Diet in upper 40% Nonsmoking, exercise ≥ 30 min/day, BMI < 25 7.2 24 0.34 (0.23 – 0.52) 64 (46 – 76) Five low-risk factors Diet in upper 40% Nonsmoking, exercise ≥ 30 min/day, BMI < 25 Alcohol ≥ 5 g/day 3.1 5 0.17 (0.07 – 0.41) 82 (58 – 93) THE CONFERENCE ON THE DECLINE IN CORONARY HEART DISEASE MORTALITY NATIONAL HEART, LUNG, AND BLOOD INSTITUTE NATIONAL INSTITUTES OF HEALTH BETHESDA (U.S.A.) October 24–25, 1978 Z uschauen (to watch) E ntspannen (to relax) N achdenken (to contemplate) Der Mensch ist, was er isst. Ludwig Feuerbach 1804 – 1872 Die größten Sünden werden in der Küche begangen Friedrich Nietzsche 1844 – 1900 The primary determinants of disease are mainly economic and social, and therefore its remedies must also be economic and social. Medicine and politics cannot and should not be kept apart. Geoffrey Rose The Strategy of Preventive Medicine, 1992 Die Medizin ist eine soziale Wissenschaft und die Politik ist weiter nichts als eine Medizin im Großen. Rudolf Virchow 1821 – 1902 Geoffrey Rose The Strategy of Preventive Medicine, 1992 It is better to be healthy than ill or dead. That is the beginning and the end of the only real argument for preventive medicine. It is sufficient. The most frequent cancers as a percentage of all cancers Germany1998 Source: AG Bevölkerungsbezogener Krebsregister in Deutschland. Krebs in Deutschland. 3. Ausgabe, Saarbrücken, 2002, S. 9 Incident cases ICD-9 Diagnosis groups / reasons for treatment n 410 + 414 Akuter Myokardinfarkt und chronische ischämische Herzkrankheiten 466.695 550 Leistenbruch 166.989 780 Allgemeine Symptome (Schwindel, Schlafstörung, Asthenie) 153.255 427 Herzrhythmusstörungen 137.511 303 Alkoholabhängigkeit 130.393 162 Bösartige Neubildungen der Luftröhre, Bronchien und Lunge 123.825 850 Commotio cerebri (Gehirnerschütterung) 113.965 428 Herzinsuffizienz 107.344 474 Chronische Affektionen der Tonsillen und des adenoiden Gewebes 103.104 717 Innere Kniegelenkschädigung (Meniskusschäden) 102.895 715 Osteoarthrose und entsprechende Affektionen 102.386 592 Nieren- und Harnleitersteine 95.439 The most frequent hospital discharge diagnoses for male patients Germany 1999 Source: Statistisches Bundesamt. Gesundheitswesen. Fachserie 12, Reihe 1, 1999, S. 109 Source: Statistisches Bundesamt. Gesundheitswesen. Fachserie 12, Reihe 1, 1999, S. 159 Early retirement (Berufs- und Erwerbsunfähigkeit) by cause and gender Germany 1999 0 10 20 30 40 early retirements in thousands Men Women Neoplasms (ICD-9 140–208) Cardiovascular diseases (ICD-9 390–459) Respiratory diseases (ICD-9 460–519) Accidents and poisonings (ICD-9 800–999)