Studying mortality trends: The IMPACT CHD Policy Model Prof Simon Capewell Chair of Clinical...

Studying mortality trends:The IMPACT CHD Policy ModelProf Simon Capewell Chair of Clinical Epidemiology DIVISION OF PUBLIC HEALTHLIVERPOOL UNIVERSITY UK14th January 2008

Particular thanks to: Julia Critchley, Kath Bennett Martin OFlaherty, Robin Ireland, Ann CapewellCharity No: 1110067

Source:BHF Heartstats (WHO statistics Men aged 35 - 74, Standardised)International mortality trends 1968-2003 men, coronary heart disease [CHD]

Per 100,000

Ireland

UK

USA

Netherlands

Finland

Italy

France

3

Death rates from CHD have been falling in the UK since the late 1970s. But decrease in mortality rates were relatively less than some other developed countries which had high rates. These falls need to be explained to better predict the future trends and to find better policy options. Modelling is one of the ways to do it.

Update this slide with latest death rates:WHO England 1997=118.7Scotland1997=150.4 /1USA1997=106.5Finland 1996=143.8New Zealand1996=127.3

Source:BHF Heartstats (WHO statistics Men aged 35 - 74, Standardised)International mortality trends 1968-2003 men, coronary heart disease [CHD]Why have CHD mortality rates halved?

Per 100,000

Ireland

UK

USA

Netherlands

Finland

Italy

France

3



Explaining the fall in coronary heart disease deaths in England & Wales 1981-2000 20001981?68,230 fewer deaths in 2000 Unal, Critchley & Capewell Circulation 2004 109(9) 1101 Why did CHD mortality halve in spite of population ageing??

Explaining the fall in coronary heart disease deaths in England & Wales 1981-2000 Risk Factors worse +13%

Risk Factors better -71%

Treatments -42%

20001981Unal, Critchley & Capewell Circulation 2004 109(9) 1101 68,230 fewer deathsin 2000

Explaining the fall in coronary heart disease deaths in England & Wales 1981-2000 Risk Factors worse +13% Obesity (increase) +3.5% Diabetes (increase) +4.8% Physical activity (less) +4.4%Risk Factors better -71%Smoking -41%Cholesterol -9%Population BP fall -9%Deprivation -3%Other factors -8%Treatments -42%AMI treatments -8%Secondary prevention -11%Heart failure -12%Angina:CABG & PTCA -4%Angina: Aspirin etc -5%Hypertension therapies -3%

20001981Unal, Critchley & Capewell Circulation 2004 109(9) 1101 68,230 fewer deathsin 2000

Risk Factors obviously powerful

but was it tablets or lifestyles??

CHD prevention in England & Wales 1981-2000: Population v. High Risk StrategiesDeaths prevented or postponed (Sensitivity analysis )C h o l e s t e r o lPopulation dietPopulation secular trendsHigh Risk StatinsTreatingHigh RiskDiet in CHD patientsStatins CHD patientsBlood PressureSecular trendsCHDpatientsUnal et al BMJ 2005 331 614

Chart

329045659650

64512052455

45145410

130519904180

3125534511740

84018902785

285520940

Number of deaths prevented or postponed

Sheet1

MinimumBestMaximum

ALL PRIMARY PREVENTION242353662561005

ALL SECONDARY PREVENTION5335874515830

SmokingPrimary169352468036420

Cessation CHD patients310050358255

CholesterolDiet 1' prevention329045659650

Diet in CHD patients64512052455

Statins 1' prevention45145410

Statins CHD patients130519904180

BPBP secular trends3125534511740

Hypertension treatments84018902785

BP secular trends CHD patients285520940

Smoking65.479663194432.510447777348.2132912079

Cholesterol27.08345457688.57277757979.5929566468

Population BP20.57807654455.52633017979.5206610712

Deprivation5.17370871791.72456957263.4491391452

Obesity-4.1977050728-2.1729746574-3.4018411314

Physical Inactivity-5.6142353493-2.4184398428-4.3186425764

Diabetes-7.6024124859-4.1657054717-4.6864186557

Sheet1

4.52116348411.36365727923.0625742283

5.66997900271.92650492743.7645362461

13.45096855675.23561108467.7520334432

20.61017620167.469162974411.1943225192

22.10701871136.769455012812.585897931

55.156591419525.013184378141.8621545026

76.126692411437.568249461658.1378454974

65.479663194432.510447777348.2132912079

27.08345457688.57277757979.5929566468

20.57807654455.52633017979.5206610712

5.17370871791.72456957263.4491391452

-4.1977050728-2.1729746574-3.4018411314

-5.6142353493-2.4184398428-4.3186425764

-7.6024124859-4.1657054717-4.6864186557

Maximum

Minimum

Best

% of total deaths prevented or postponed

000

000

000

000

000

000

000

000

000

000

000

Number of deaths prevented or postponed

Explaining the fall in CHD deaths in USA 1980-2000 : RESULTS341,745 fewer deathsin 2000 Risk Factors worse +17% Obesity (increase) +7% Diabetes (increase) +10%Risk Factors better -65%Population BP fall -20%Smoking -12%Cholesterol (diet) -24%Physical activity -5%Treatments -47%AMI treatments -10%Secondary prevention -11%Heart failure -9%Angina:CABG & PTCA -5%Hypertension therapies -7% Statins (primary prevention) -5%Unexplained -9%20001980NEJM 2007; 356: 2388.

Comparisons with other studies: % CHD mortality falls attributed toNEJM 2007; 356: 2388.

EXPLOITING THE IMPACT MODELReplication in other populationsPopulations with RISING CHDCalculating life-years gained Cost effectivenessWHAT IF treatment uptakes increased?WHAT IF risk factors reduced further?

WHAT IF Treatment Uptakes in England & Wales Increased? Actual Uptakes 50%25,805 Deaths prevented or postponed (DPPs)

IF Uptakes at least 80%20,910 additional DPPsCapewell et al Heart 2006 92 521[ Capewell, Pell et al et al Eur Heart J 1999 20 1836 ]

IF Treatment Uptakes Increased in England & Wales Actual Uptakes 50%25,805 Deaths prevented/postponed (DPPs)

IF Uptakes at least 80%20,910 additional DPPsCapewell et al Heart 2006 92 521

EXPLOITING THE IMPACT MODELReplication in other populationsPopulations with RISING CHDCalculating life-years gained Cost effectivenessWHAT IF treatment uptakes increased?WHAT IF risk factors reduced further?

Estimating the potential changes in CHD mortality in England & Wales between 2000 and 2010 WHAT IF risk factors

a) continue recent trends ?

b) undergo additional reductions ? (as already achieved in Australia, USA, Sweden, Finland etc)Unal et al J Clin Epid 2005 58 733Kelly & Capewell HDA 2004 www

Potential changes in CHD mortality in England & Wales between 2000 and 2010 IF risk factors a) continue recent trends b) additional reductions already achieved elsewhereUnal et al J Clin Epid 2005 58 733

E&W 2010

current trendadditionalminmax

Cholesterol-2525-22500-7000-6100

Smoking-8879-8260701713556

Blood Pressure-5135-1370-3002-2629

Diabetes4200-485-8400-1900

Obesity2080-85014397177

Inactivity705-1055-2700-750

E&W 2010

1-7000-6100

701713556

-3002-2629

-8400-1900

14397177

-2700-750

current trend

additional

risk factor

deaths prevented or postponed in 2010

Modest additional risk factor reductions already achieved in USA & Scandinavia could prevent or postpone over 50,000 deaths by 2010 halving current CHD deaths (100,000) in UKThe IMPACT Model Thus, to reduce CHD mortality in UKUnal et al J Clin Epid 2005 58 733

Key Targets: Healthier food Smoking reduction hence:Heart of Mersey CHD primary prevention programme

Is the party over?

US Trends in age-adjusted CHD mortality rates: men & women aged 35 years Ford & Capewell JACC 2007 50 2128

US Trends in AGE-SPECIFIC CHD mortality rates: men & women aged 35 years Ford & Capewell JACC 2007 50 2128

Chart3

11.252.2

10.751

10.547.5

9.745.1

9.543.5

9.242.1

8.941

8.438.3

835.2

7.433.4

7.132.3

7.631.6

7.931.1

7.930.6

7.929.6

7.929.6

828.2

7.426.8

7.726.7

7.926.6

7.625.8

8.125.5

8.226.1

Women

Men

Year

Per 100,000 population

35-44 years

Sheet1

CHD mortality rates for ages 25+ years

Total

YearDeath CountPopulationAge Adjusted RateCrude Death Rate

1979617,137130,668,000524.4472.3472.3050%0.0215816005

1980635,330132,768,638533.7478.5478.50-1.3%51%0.0229614867

1981623,891136,009,066509.5458.7458.704.1%

1982620,454138,690,289495.3447.4447.402.5%

1983624,571141,303,090488.644244201.2%

1984612,846143,881,783470.1425.9425.903.6%

1985607,943146,398,041457.9415.3415.302.5%

1986592,932149,041,120438.1397.8397.804.2%

1987584,299151,539,755423.4385.6385.603.1%

1988582,148153,897,145415.1378.3378.301.9%

1989568,651156,206,784398.136436403.8%

1990558,029157,843,690385.9353.5353.502.9%

1991554,535161,231,105371.9343.9343.902.7%

1992548,762163,875,074359.6334.9334.902.6%

1993562,445166,358,177360.5338.1338.10-1.0%

1994552,438168,791,121347327.3327.303.2%

1995552,213171,332,456339.7322.3322.301.5%

1996544,404173,893,568327.9313.1313.102.9%

1997532,822176,251,758314.7302.3302.303.4%

1998526,400178,366,837304.7295.1295.102.4%0.0206506365

1999529,429180,408,769300.8293.5293.50.5%

2000514,977181,984,640288.72832833.6%

2001501,923184,413,685274.8272.2272.23.8%

2002494,162187,132,490264.1264.1264.13.0%

Males

1979339,63161,436,000703552.8552.8052%0.0234255787

1980344,37062,417,211710.8551.7551.7052%0.0236673147

1981337,09363,994,132680.5526.8526.80

1982333,28465,295,382661.4510.4510.40

1983332,16966,573,597650.14994990

1984323,66467,840,425624.2477.1477.10

1985320,19569,079,726608.6463.5463.50

1986309,02770,397,389577.14394390

1987302,53571,636,664556.1422.3422.30

1988299,62772,802,521544.4411.6411.60

1989291,91073,955,379521.6394.7394.70

1990286,43074,754,104507.4383.2383.20

1991283,82376,485,691488.9371.1371.10

1992280,78777,843,217473.1360.7360.70

1993286,21679,095,623472.6361.9361.90

1994280,82680,325,041454.3349.6349.60

1995279,95781,617,773442.93433430

1996276,39382,914,201428333.3333.30

1997270,89284,115,895410.53223220

1998267,03085,206,175395.8313.4313.40

1999267,11186,285,677388.3309.6309.6

2000260,42687,120,538373.2298.9298.9

2001253,82088,389,810353.2287.2287.2

2002252,60989,801,783340.7281.3281.3

1979277,50669,232,000395400.8400.8048%0.0216915995

1980290,96070,351,427406.8413.6413.6049%0.0223808885

1981286,79872,014,934387398.2398.20

1982287,17073,394,907376.8391.3391.30

1983292,40274,729,493373.8391.3391.30

1984289,18276,041,358360.8380.3380.30

1985287,74877,318,315351372.2372.20

1986283,90578,643,731338.73613610

1987281,76479,903,091328.6352.6352.60

1988282,52181,094,624323.1348.4348.40

1989276,74182,251,405309.9336.5336.50

1990271,59983,089,586299.7326.9326.90

1991270,71284,745,414288.8319.4319.40

1992267,97586,031,857278.7311.5311.50

1993276,22987,262,554280.3316.5316.50

1994271,61288,466,0802703073070

1995272,25689,714,683264.9303.5303.50

1996268,01190,979,367255.6294.6294.60

1997261,93092,135,863245284.3284.30

1998259,37093,160,662238278.4278.40

1999262,31894,123,092236.4278.7278.70

2000254,55194,864,102226.4268.3268.30

2001248,10396,023,875216.3258.4258.40

2002241,55397,330,707206.5248.2248.20

YearMenWomen

1979703395

1980710.8406.8

1981680.5387

1982661.4376.8

1983650.1373.8

1984624.2360.8

1985608.6351

1986577.1338.7

1987556.1328.6

1988544.4323.1

1989521.6309.9

1990507.4299.7

1991488.9288.8

1992473.1278.7

1993472.6280.3

1994454.3270

1995442.9264.9

1996428255.6

1997410.5245

1998395.8238

1999388.3236.4

2000373.2226.4

2001353.2216.3

2002340.7206.5

Sheet1

00

00

00

00

00

00

00

00

00

00

00

00

00

00

00

00

00

00

00

00

00

00

00

00

Sheet2

00

00

00

00

00

00

00

00

00

00

00

00

00

00

00

00

00

00

00

00

00

00

00

00

Men

Women

Year


Sheet3

CHD mortality rates for ages 25-74 years

ICD9: 410-414; ICD10: I20-I25

Total


1979432,971128,471,000345.333749%0.021090671

1980438,842130,528,571345.4336.249%0.0220561141

1981428,502133,659,891329.9320.6

1982425,023136,253,582321.4311.9

1983420,660138,784,655312.5303.1

1984410,184141,287,142299.9290.3

1985402,920143,730,769289.7280.3

1986388,522146,299,072274.6265.6

1987378,765148,716,725263.3254.7

1988373,254151,011,885255.4247.2

1989361,966153,239,040244236.2

1990353,057154,822,265235.4228

1991346,985158,041,966226.6219.6

1992340,329160,560,414218.4212

1993342,196162,912,611216.2210

1994333,321165,230,089207.5201.7

1995330,437167,651,734202.5197.1

1996325,280170,098,676196.1191.2

1997314,900172,346,282186.8182.7

1998307,897174,334,302180.1176.6

1999350,053176,254,751202.1198.6

2000337,658177,745,053193190

2001327,614180,009,926184.3182

2002320,774182,539,421177.8175.7

Males

1979265,25860,760,000494.7436.650%0.0218841459

1980266,26061,735,686492.1431.350%0.0227596017

1981260,42363,293,600471.8411.5

1982257,31764,578,768458.7398.5

1983253,39265,841,270444.8384.9

1984246,00967,093,583426366.7

1985242,25668,318,382412.9354.6

1986231,74369,618,620388.5332.9

1987225,20470,838,443371.6317.9

1988221,15271,992,302359.7307.2

1989214,53073,124,241343.6293.4

1990209,39273,912,877331.8283.3

1991205,84875,602,687318.4272.3

1992202,45176,927,594307263.2

1993203,65478,143,684303.3260.6

1994198,47179,338,817290.1250.2

1995197,16280,594,187282.8244.6

1996193,81381,854,270272.6236.8

1997188,59983,015,716260.3227.2

1998184,17684,059,350249.9219.1

1999209,38585,092,367279246.1

2000202,73685,893,540266.8236

2001196,71487,090,702253.9225.9

2002194,16388,411,975245.7219.6

Females

1979167,71367,711,000231.7247.747%0.0203223809

1980172,58268,792,885234.5250.947%0.0215351812

1981168,07970,366,291222.8238.9

1982167,70671,674,814217.8234

1983167,26872,943,385212.9229.3

1984164,17574,193,559205221.3

1985160,66475,412,387197.1213

1986156,77976,680,452188.8204.5

1987153,56177,878,282181.7197.2

1988152,10279,019,583177192.5

1989147,43680,114,799168.9184

1990143,66580,909,388162.7177.6

1991141,13782,439,279156.9171.2

1992137,87883,632,820151164.9

1993138,54284,768,927149.6163.4

1994134,85085,891,272143.9157

1995133,27587,057,547140.4153.1

1996131,46788,244,406136.6149

1997126,30189,330,566129.5141.4

1998123,72190,274,952125.4137

1999140,66891,162,384141.3154.3

2000134,92291,851,513134.4146.9

2001130,90092,919,224128.8140.9

2002126,61194,127,446123.4134.5

Sheet4

CHD mortality rates for ages 25-74 years

ICD9: 410-414, 429.2; ICD10: I20-I25


1979478,924128,471,000382.7372.8

1980486,535130,528,571383.7372.7

1981475,304133,659,891366.6355.6

1982470,854136,253,582356.6345.6

1983469,246138,784,655349.1338.1

1984458,122141,287,142335.2324.2

1985450,525143,730,769324.1313.5

1986436,687146,299,072308.8298.5

1987427,100148,716,725297287.2

1988421,816151,011,885288.8279.3

1989409,619153,239,040276.3267.3

1990399,672154,822,265266.6258.1

1991393,611158,041,966257.1249.1

1992386,527160,560,414248.2240.7

1993390,818162,912,611247239.9

1994381,051165,230,089237.3230.6

1995377,675167,651,734231.5225.3

1996370,803170,098,676223.6218

1997359,446172,346,282213.3208.6

1998352,303174,334,302206.1202.1

1999350,053176,254,751202.1198.6

2000337,658177,745,053193190

2001327,614180,009,926184.3182

2002320,774182,539,421177.8175.7

Males

1979291,30060,760,000544.6479.4

1980292,95361,735,686542.9474.5

1981286,87563,293,600521.1453.2

1982283,24764,578,768506.1438.6

1983280,93265,841,270494.2426.7

1984273,22267,093,583473.6407.2

1985269,36368,318,382459.6394.3

1986259,69869,618,620435.6373

1987253,23570,838,443418357.5

1988249,50471,992,302405.8346.6

1989242,41073,124,241388.1331.5

1990236,89473,912,877375.2320.5

1991233,53775,602,687360.9308.9

1992230,00676,927,594348.5299

1993232,76278,143,684346.3297.9

1994227,13979,338,817331.7286.3

1995225,55280,594,187323.2279.9

1996221,41381,854,270311270.5

1997215,72383,015,716297.3259.9

1998211,38084,059,350286.3251.5

1999209,38585,092,367279246.1

2000202,73685,893,540266.8236

2001196,71487,090,702253.9225.9

2002194,16388,411,975245.7219.6

Females

1979187,62467,711,000259.5277.1

1980193,58268,792,885263.3281.4

1981188,42970,366,291249.9267.8

1982187,60771,674,814243.8261.7

1983188,31472,943,385239.8258.2

1984184,90074,193,559231249.2

1985181,16275,412,387222.3240.2

1986176,98976,680,452213.2230.8

1987173,86577,878,282205.7223.3

1988172,31279,019,583200.6218.1

1989167,20980,114,799191.6208.7

1990162,77880,909,388184.4201.2

1991160,07482,439,279178194.2

1992156,52183,632,820171.4187.2

1993158,05684,768,927170.8186.5

1994153,91285,891,272164.3179.2

1995152,12387,057,547160.3174.7

1996149,39088,244,406155.3169.3

1997143,72389,330,566147.4160.9

1998140,92390,274,952143156.1

1999140,66891,162,384141.3154.3

2000134,92291,851,513134.4146.9

2001130,90092,919,224128.8140.9

2002126,61194,127,446123.4134.5

Sheet5

http://wonder.cdc.gov/mortSQL.html

All ages


1999529,659279,203,823190194.6189.7

2000515,204281,675,072183186.7182.94.1%3.6%

2001502,189284,789,072176177.8176.34.8%3.6%

2002494,382288,356,713171170.9171.43.9%2.8%

2003164.1166.30.043.0%

2004157.5161.3

2005151.2156.4

2006145.2151.7

2007139.3147.2

2008133.8142.8

2009128.4138.5

2010424494316,000,000134123.3134.3

fall 2000-2010 all ages

90,710

Aged 25-84


1999350,053176,254,751199202.1198.6

2000337,658177,745,0531901931904.3%0.0%

2001327,614180,009,926182184.31824.2%0.0%

2002320,774182,539,421176177.8175.73.5%0.0%

2003170.7170.40.043.0%

2004163.9165.3

2005157.3160.4

2006151.0155.5

2007145.0150.9

2008139.2146.4

2009133.6142.0

2010278161202,000,000138128.3137.7

fall 2000-2010 all ages

59,497

Base (no change)

383800

19992002

GenderAgeDeath CountPopulationCrude Death RateGenderAgeDeath CountPopulationCrude Death Rate

DescriptionDescription

F25-34 years27519,945,0901.41.3787854555F25-34 years25519,725,5281.31.29274106122.1%

F35-44 years1,78122,669,6047.97.8563348526F35-44 years1,84322,550,1008.28.1729127587-1.3%

F45-54 years5,71418,632,30530.730.6671665154F45-54 years6,02420,407,61629.529.51839156521.2%

F55-64 years14,25412,378,763115.1115.1488238364F55-64 years13,60613,817,41598.598.46993811794.8%

F65-74 years36,65310,125,424362361.989779391F65-74 years30,7319,973,210308.1308.13549499115.0%

F75-84 years81,9917,411,1981,106.301106.3123667726F75-84 years74,1527,653,577968.9968.85417106284.1%

M25-34 years73920,233,3163.73.6523919263M25-34 years74120,202,7763.73.6678127798-0.1%

M35-44 years5,97022,407,07326.626.6433728314M35-44 years5,84022,366,50626.126.1104707190.7%

M45-54 years19,06117,945,514106.2106.2159601558M45-54 years19,55119,676,32199.499.36308723572.2%

M55-64 years34,12311,399,263299.3299.3439137249M55-64 years33,65612,784,311263.3263.26017882394.0%

M65-74 years62,1878,293,485749.8749.8295348698M65-74 years53,1368,301,005640.1640.11526315194.9%

M75-84 years87,3054,813,7161,813.701813.6716000695M75-84 years81,2395,081,0561,598.901598.86055182233.9%

2000

GenderAgeDeath CountPopulationCrude Death Rate

Description

F25-34 years23119,771,1951.2

F35-44 years1,73222,700,7297.6

F45-54 years5,74119,180,72229.9

F55-64 years13,94212,629,328110.4

F65-74 years34,33110,087,712340.3

F75-84 years78,9457,481,8271,055.20

M25-34 years70420,120,5293.5

M35-44 years5,78722,447,79825.8

M45-54 years19,14918,497,230103.5

M55-64 years33,79511,645,356290.2

M65-74 years58,5548,303,274705.2

M75-84 years84,7474,879,3531,736.80

2001

GenderAgeDeath CountPopulationCrude Death Rate

Description

F25-34 years28619,593,7341.5

F35-44 years1,82222,615,7568.1

F45-54 years5,93219,952,10729.7

F55-64 years13,56813,154,612103.1

F65-74 years32,39110,015,772323.4

F75-84 years76,9017,587,2431,013.60

M25-34 years83020,013,5724.1

M35-44 years5,71222,402,91125.5

M45-54 years19,14119,236,08599.5

M55-64 years33,00612,153,966271.6

M65-74 years55,0728,297,451663.7

M75-84 years82,9534,986,7171,663.50

Age 35-44 years

GenderYearDeath CountPopulationCrude Death Rate

F19791,41012,801,00011

F19801,35113,064,99110.3

F19811,33213,442,8879.9

F19821,40314,264,2939.8

F19831,33114,885,2488.9

F19841,35315,505,5408.7

F19851,36216,097,0388.5

F19861,36016,748,4578.1

F19871,32317,349,5287.6

F19881,28517,818,0577.2

F19891,23618,423,0386.7

F19901,20618,925,1156.4

F19911,31919,861,2126.6

F19921,41520,173,6747

F19931,43120,635,1376.9

F19941,43721,083,5656.8

F19951,48321,521,8096.9

F19961,54421,936,5087

F19971,42322,266,2786.4

F19981,49822,516,7746.7

M19796,15812,313,00050

M19806,12112,569,71948.7

M19816,13012,951,50347.3

M19826,05313,766,05744

M19835,97114,382,05941.5

M19845,96514,997,39339.8

M19856,05115,593,97638.8

M19866,05816,260,53837.3

M19875,80116,876,88134.4

M19885,50817,362,37931.7

M19895,31717,991,41429.6

M19905,26918,509,65228.5

M19915,39619,468,25427.7

M19925,37419,802,66027.1

M19935,34920,276,41326.4

M19945,28420,735,30125.5

M19955,40921,188,95925.5

M19965,20621,614,75524.1

M19975,00321,962,13722.8

M19985,03722,231,58022.7

YearWomenMen

410-41419791150

198010.348.7

19819.947.3

19829.844

19838.941.5

19848.739.8

19858.538.8

19868.137.3

19877.634.4

19887.231.7

19896.729.6

19906.428.5

19916.627.7

1992727.1

19936.926.4

19946.825.5

19956.925.5

1996724.1

19976.422.8

19986.722.7

I20-I2519997.926.6

20007.625.8

20018.125.5

20028.226.1

414-414 PLUS 429.2


F19791,51012,801,00011.8

F19801,46413,064,99111.2

F19811,44213,442,88710.7

F19821,49614,264,29310.5

F19831,44414,885,2489.7

F19841,46715,505,5409.5

F19851,47416,097,0389.2

F19861,49216,748,4578.9

F19871,45617,349,5288.4

F19881,42317,818,0578

F19891,36318,423,0387.4

F19901,35118,925,1157.1

F19911,50019,861,2127.6

F19921,59320,173,6747.9

F19931,62820,635,1377.9

F19941,66221,083,5657.9

F19951,69721,521,8097.9

F19961,75021,936,5088

F19971,64422,266,2787.4

F19981,74022,516,7747.7

M19796,61712,313,00053.7

M19806,56412,569,71952.2

M19816,60512,951,50351

M19826,54213,766,05747.5

M19836,48614,382,05945.1

M19846,52614,997,39343.5

M19856,56715,593,97642.1

M19866,67116,260,53841

M19876,47116,876,88138.3

M19886,11517,362,37935.2

M19896,00717,991,41433.4

M19905,97318,509,65232.3

M19916,14819,468,25431.6

M19926,15719,802,66031.1

M19936,19920,276,41330.6

M19946,12920,735,30129.6

M19956,26721,188,95929.6

M19966,10321,614,75528.2

M19975,88221,962,13726.8

M19985,94322,231,58026.7

F19991,78122,669,6047.9

F20001,73222,700,7297.6

F20011,82222,615,7568.1

F20021,84322,550,1008.2

M19995,97022,407,07326.6

M20005,78722,447,79825.8

M20015,71222,402,91125.5

M20025,84022,366,50626.1

YearWomenMen

410-414, 429.2197911.853.7

198011.252.2

198110.751

198210.547.5

19839.745.1

19849.543.5

19859.242.1

19868.941

19878.438.3

1988835.2

19897.433.4

19907.132.3

19917.631.6

19927.931.1

19937.930.6

19947.929.6

19957.929.6

1996828.2

19977.426.8

19987.726.7

I20-I2519997.926.6

20007.625.8

20018.125.5

20028.226.110.8%-2.6%

Age 45-54 years


F19796,27611,868,00052.9

F19806,15611,790,86852.2

F19816,07011,653,22452.1

F19825,72811,556,57449.6

F19835,53611,507,04848.1

F19845,20511,510,37045.2

F19855,03011,542,76243.6

F19864,72411,632,80640.6

F19874,73811,843,52540

F19884,57312,268,19837.3

F19894,37012,611,52834.7

F19904,31412,824,34933.6

F19914,40013,208,75433.3

F19924,42914,075,70931.5

F19934,51814,741,97130.6

F19944,67915,396,12230.4

F19954,67716,066,64129.1

F19964,99916,734,52529.9

F19974,77217,427,69527.4

F19984,62317,958,69125.7

M197924,93511,067,000225.3

M198023,91811,008,919217.3

M198122,87810,926,311209.4

M198221,76910,868,735200.3

M198320,49810,848,423188.9

M198419,42010,875,053178.6

M198518,62210,916,542170.6

M198617,16211,026,121155.6

M198716,66811,252,355148.1

M198815,80711,681,050135.3

M198915,63112,021,662130

M199015,14312,232,301123.8

M199115,02312,611,398119.1

M199215,39113,472,009114.2

M199315,67914,121,978111

M199415,93914,756,639108

M199516,32115,413,598105.9

M199616,14616,065,440100.5

M199716,12916,749,81396.3

M199815,54217,273,16690

F19995,71418,632,30530.7

F20005,74119,180,72229.9

F20015,93219,952,10729.7

F20026,02420,407,61629.5

M199919,06117,945,514106.2

M200019,14918,497,230103.5

M200119,14119,236,08599.5

M200219,55119,676,32199.4

YearWomenMen

410-414197952.9225.3

198052.2217.3

198152.1209.4

198249.6200.3

198348.1188.9

198445.2178.6

198543.6170.6

198640.6155.6

198740148.1

198837.3135.3

198934.7130

199033.6123.8

199133.3119.1

199231.5114.2

199330.6111

199430.4108

199529.1105.9

199629.9100.5

199727.496.3

199825.790

I20-I25199930.7106.2

200029.9103.5

200129.799.5

200229.599.4

414-414 PLUS 429.2


F19796,91311,868,00058.2

F19806,81911,790,86857.8

F19816,64111,653,22457

F19826,25011,556,57454.1

F19836,09211,507,04852.9

F19845,72311,510,37049.7

F19855,52011,542,76247.8

F19865,28211,632,80645.4

F19875,28811,843,52544.6

F19885,16012,268,19842.1

F19894,98112,611,52839.5

F19904,97212,824,34938.8

F19915,01713,208,75438

F19925,07314,075,70936

F19935,26914,741,97135.7

F19945,46415,396,12235.5

F19955,47616,066,64134.1

F19965,76416,734,52534.4

F19975,57417,427,69532

F19985,42017,958,69130.2

M197927,17011,067,000245.5

M198026,02311,008,919236.4

M198124,98910,926,311228.7

M198223,66710,868,735217.8

M198322,60510,848,423208.4

M198421,33910,875,053196.2

M198520,57810,916,542188.5

M198619,24511,026,121174.5

M198718,79311,252,355167

M198817,96811,681,050153.8

M198917,92912,021,662149.1

M199017,48312,232,301142.9

M199117,46112,611,398138.5

M199217,95313,472,009133.3

M199318,43514,121,978130.5

M199418,90414,756,639128.1

M199519,27215,413,598125

M199619,20616,065,440119.5

M199719,24716,749,813114.9

M199818,79117,273,166108.8

YearWomenMen

410-414, 429.2197958.2245.5

198057.8236.4

198157228.7

198254.1217.8

198352.9208.4

198449.7196.2

198547.8188.5

198645.4174.5

198744.6167

198842.1153.8

198939.5149.1

199038.8142.9

199138138.5

199236133.3

199335.7130.5

199435.5128.1

199534.1125

199634.4119.5

199732114.9

199830.2108.8

I20-I25199930.7106.2

200029.9103.5

200129.799.5

200229.599.4

Age 55-64 years


F197921,54711,407,000188.9

F198021,83511,551,120189

F198121,57311,663,739185

F198221,11411,722,330180.1

F198320,90211,759,260177.7

F198420,17411,772,191171.4

F198519,33311,751,158164.5

F198618,40611,674,307157.7

F198717,63711,536,984152.9

F198816,97111,399,649148.9

F198915,84711,238,141141

F199015,10611,157,583135.4

F199114,73411,089,269132.9

F199213,95511,040,886126.4

F199313,69411,036,850124.1

F199413,28411,088,628119.8

F199512,94911,161,349116

F199612,75811,285,267113.1

F199712,35811,534,771107.1

F199812,05211,989,847100.5

M197960,17510,041,000599.3

M198058,99210,151,755581.1

M198157,37710,250,084559.8

M198255,89010,307,563542.2

M198353,91010,352,622520.7

M198451,94210,381,976500.3

M198549,83010,383,963479.9

M198646,63010,319,584451.9

M198743,71210,213,704428

M198841,29610,114,072408.3

M198939,27610,002,857392.6

M199037,3759,955,069375.4

M199135,7879,956,592359.4

M199234,2149,957,172343.6

M199333,5409,991,621335.7

M199432,28310,070,509320.6

M199531,39610,158,673309.1

M199630,84310,304,719299.3

M199729,72210,564,540281.3

M199828,91611,021,108262.4


F199914,25412,378,763115.1

F200013,94212,629,328110.4

F200113,56813,154,612103.1

F200213,60613,817,41598.5

M199934,12311,399,263299.3

M200033,79511,645,356290.2

M200133,00612,153,966271.6

M200233,65612,784,311263.3

YearWomenMen

410-4141979188.9599.3

1980189581.1

1981185559.8

1982180.1542.2

1983177.7520.7

1984171.4500.3

1985164.5479.9

1986157.7451.9

1987152.9428

1988148.9408.3

1989141392.6

1990135.4375.4

1991132.9359.4

1992126.4343.6

1993124.1335.7

1994119.8320.6

1995116309.1

1996113.1299.3

1997107.1281.3

1998100.5262.4

I20-I251999115.1299.3

2000110.4290.2

2001103.1271.6

200298.5263.3

414-414 PLUS 429.2


F197923,65211,407,000207.3

F198024,10211,551,120208.7

F198123,67111,663,739202.9

F198223,22211,722,330198.1

F198323,14911,759,260196.9

F198422,45411,772,191190.7

F198521,50611,751,158183

F198620,59411,674,307176.4

F198719,81311,536,984171.7

F198819,13811,399,649167.9

F198918,02911,238,141160.4

F199017,23211,157,583154.4

F199116,67211,089,269150.3

F199215,97011,040,886144.6

F199315,87711,036,850143.9

F199415,32511,088,628138.2

F199514,96911,161,349134.1

F199614,76011,285,267130.8

F199714,33911,534,771124.3

F199814,03311,989,847117

M197965,55210,041,000652.8

M198064,37810,151,755634.2

M198162,65510,250,084611.3

M198261,06910,307,563592.5

M198359,48910,352,622574.6

M198457,54210,381,976554.2

M198555,40410,383,963533.6

M198652,43210,319,584508.1

M198749,36710,213,704483.3

M198847,12110,114,072465.9

M198944,97310,002,857449.6

M199042,9029,955,069431

M199141,2659,956,592414.4

M199239,6859,957,172398.6

M199339,2589,991,621392.9

M199437,80510,070,509375.4

M199536,78010,158,673362.1

M199636,25710,304,719351.8

M199735,07310,564,540332

M199834,14511,021,108309.8

YearWomenMen

410-414, 429.21979207.3652.8

1980208.7634.2

1981202.9611.3

1982198.1592.5

1983196.9574.6

1984190.7554.2

1985183533.6

1986176.4508.1

1987171.7483.3

1988167.9465.9

1989160.4449.6

1990154.4431

1991150.3414.4

1992144.6398.6

1993143.9392.9

1994138.2375.4

1995134.1362.1

1996130.8351.8

1997124.3332

1998117309.8

I20-I251999115.1299.3

2000110.4290.2

2001103.1271.6

200298.5263.3

Ages 65-74


F197957,0488,690,000656.5

F198059,1168,824,103669.9

F198157,8179,000,646642.4

F198257,2639,145,145626.2

F198357,1479,287,321615.3

F198456,1849,401,244597.6

F198554,6219,519,833573.8

F198653,0229,662,377548.7

F198751,9429,812,004529.4

F198850,7199,916,415511.5

F198948,55510,040,330483.6

F199047,38210,138,681467.3

F199146,27610,253,227451.3

F199245,33310,341,223438.4

F199345,38910,428,798435.2

F199443,56310,458,903416.5

F199542,95110,470,931410.2

F199641,33110,426,193396.4

F199739,01810,326,142377.9

F199837,83910,236,956369.6

M197998,7216,648,0001,485.00

M1980100,1326,756,5021,482.00

M198198,1766,889,2241,425.10

M198297,2147,002,7551,388.20

M198396,4757,126,1151,353.80

M198492,8857,225,3451,285.50

M198591,8557,338,8271,251.60

M198688,7157,474,8821,186.80

M198786,6687,614,6761,138.20

M198885,3507,709,8901,107.00

M198982,0567,823,7721,048.80

M199080,0947,906,8141,013.00

M199178,9618,040,677982

M199277,0298,144,796945.7

M199377,3538,263,821936

M199475,0058,330,888900.3

M199573,3408,395,157873.6

M199670,1738,398,295835.6

M199767,0158,357,732801.8

M199864,4018,333,291772.8


F199936,65310,125,424362

F200034,33110,087,712340.3

F200132,39110,015,772323.4

F200230,7319,973,210308.1

M199962,1878,293,485749.8

M200058,5548,303,274705.2

M200155,0728,297,451663.7

M200253,1368,301,005640.1

YearWomenMen

410-414, 429.21979656.51,485.00

1980669.91,482.00

1981642.41,425.10

1982626.21,388.20

1983615.31,353.80

1984597.61,285.50

1985573.81,251.60

1986548.71,186.80

1987529.41,138.20

1988511.51,107.00

1989483.61,048.80

1990467.31,013.00

1991451.3982

1992438.4945.7

1993435.2936

1994416.5900.3

1995410.2873.6

1996396.4835.6

1997377.9801.8

1998369.6772.8

I20-I251999362749.8

2000340.3705.2

2001323.4663.7

2002308.1640.1

Ages 75-84


F197998,2434,769,0002,060.00

F1980101,8294,861,8672,094.40

F198198,5825,023,4491,962.40

F198299,1275,164,2761,919.50

F1983100,2165,307,8641,888.10

F198498,8255,452,3491,812.50

F198597,7455,598,1281,746.00

F198696,2945,744,8851,676.20

F198795,0615,894,5631,612.70

F198895,5846,034,2901,584.00

F198993,9816,171,7971,522.70

F199091,5666,267,2501,461.00

F199190,2996,441,7071,401.80

F199288,2356,562,6501,344.50

F199389,5766,672,7811,342.40

F199487,5636,784,0951,290.70

F199586,7096,905,9251,255.60

F199685,4827,057,5051,211.20

F199782,8417,206,8971,149.50

F199881,5947,306,1661,116.80

M197992,1212,829,0003,256.30

M198094,8192,866,8883,307.40

M198193,3992,958,3033,157.20

M198293,6213,038,5983,081.10

M198394,8013,120,9383,037.60

M198493,8933,203,9282,930.60

M198593,8803,292,1192,851.70

M198691,5513,383,4052,705.90

M198790,8843,481,8932,610.20

M198891,9603,577,7522,570.30

M198990,4693,678,1132,459.70

M199089,5253,744,7252,390.70

M199188,7713,886,8742,283.90

M199288,2343,992,6652,209.90

M199390,5824,090,8452,214.30

M199488,4194,195,8852,107.30

M199588,9754,316,5692,061.20

M199688,7734,466,1641,987.70

M199787,6604,605,3141,903.50

M199887,3184,710,2111,853.80


F199981,9917,411,1981,106.30

F200078,9457,481,8271,055.20

F200176,9017,587,2431,013.60

F200274,1527,653,577968.9

M199987,3054,813,7161,813.70

M200084,7474,879,3531,736.80

M200182,9534,986,7171,663.50

M200281,2395,081,0561,598.90

YearWomenMen

410-414, 429.219792,060.003,256.30

19802,094.403,307.40

19811,962.403,157.20

19821,919.503,081.10

19831,888.103,037.60

19841,812.502,930.60

19851,746.002,851.70

19861,676.202,705.90

19871,612.702,610.20

19881,584.002,570.30

19891,522.702,459.70

19901,461.002,390.70

19911,401.802,283.90

19921,344.502,209.90

19931,342.402,214.30

19941,290.702,107.30

19951,255.602,061.20

19961,211.201,987.70

19971,149.501,903.50

I20-I2519981,116.801,853.80

19991,106.301,813.70

20001,055.201,736.80

20011,013.601,663.50

2002968.91,598.90

Ages 85+


F197989,8821,521,0005,909.40

F198097,3781,558,5426,248.00

F198198,3691,648,6435,966.70

F198299,5631,720,0935,788.20

F1983104,0881,786,1085,827.60

F1984104,2821,847,7995,643.60

F1985106,5861,905,9285,592.30

F1986106,9161,963,2795,445.80

F1987107,8992,024,8095,328.80

F1988110,2092,075,0415,311.20

F1989109,5322,136,6065,126.40

F1990108,8212,180,1984,991.30

F1991110,6382,306,1354,797.60

F1992111,4542,399,0374,645.80

F1993118,1732,493,6274,739.00

F1994117,7002,574,8084,571.20

F1995120,1332,657,1364,521.10

F1996118,6212,734,9614,337.20

F1997118,2072,805,2974,213.70

F1998118,4472,885,7104,104.60

M197948,331676,0007,149.60

M198051,417681,5257,544.40

M198150,218700,5327,168.60

M198250,037716,6146,982.40

M198351,237732,3276,996.50

M198450,442746,8426,754.00

M198550,832761,3446,676.60

M198649,329778,7696,334.20

M198749,300798,2216,176.20

M198850,123810,2196,186.40

M198949,500831,1385,955.70

M199049,536841,2275,888.50

M199150,286883,0045,694.90

M199250,781915,6235,546.10

M199353,454951,9395,615.30

M199453,687986,2245,443.70

M199554,4051,023,5865,315.10

M199654,9801,059,9315,187.10

M199755,1691,100,1795,014.50

M199855,6501,146,8254,852.50


F1999121,6502,960,7084,108.80

F2000119,6293,012,5893,971.00

F2001117,2033,104,6513,775.10

F2002114,9423,203,2613,588.30

M199957,7261,193,3104,837.50

M200057,6901,226,9984,701.70

M200157,1061,299,1084,395.80

M200258,4461,389,8084,205.30

YearWomenMen

410-414, 429.219795,909.407,149.60

19806,248.007,544.40

19815,966.707,168.60

19825,788.206,982.40

19835,827.606,996.50

19845,643.606,754.00

19855,592.306,676.60

19865,445.806,334.20

19875,328.806,176.20

19885,311.206,186.40

19895,126.405,955.70

19904,991.305,888.50

19914,797.605,694.90

19924,645.805,546.10

19934,739.005,615.30

19944,571.205,443.70

19954,521.105,315.10

19964,337.205,187.10

19974,213.705,014.50

19984,104.604,852.50

I20-I2519994,108.804,837.50

20003,971.004,701.70

20013,775.104,395.80

20023,588.304,205.30

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Age 35-44

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Age 45-54 years

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Age 55-64

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Age 55-64 years; ICD9 410-414, 429.2; ICD10 I20-I25

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Age 35-44: ICD9 410-414, 429.2; ICD10: I20-I25

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Ages 45-54 years: ICD9 410-414, 429.2; ICD 10 I20-I25

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Ages 65-74 years; ICD9 410-414, 429.2; ICD10 I20-I25

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Women

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Ages 75-84; ICD9 410-414, 429.2; ICD10 I20-I25

00

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Women

Men

Ages 85+ years: ICD9 410-414, 429.2; ICD10 I20-I25

ICD-9 410-414, 429.2 and ICD-10 I20-I25

35-44 years45-54 years55-64 years65-74 years75-84 years85+ years

YearWomenMenWomenMenWomenMenWomenMenWomenMenWomenMen

198011.252.257.8236.4208.7634.2669.91482.02094.43307.46248.07544.4

198110.751.057.0228.7202.9611.3642.41425.11962.43157.25966.77168.6

198210.547.554.1217.8198.1592.5626.21388.21919.53081.15788.26982.4

19839.745.152.9208.4196.9574.6615.31353.81888.13037.65827.66996.5

19849.543.549.7196.2190.7554.2597.61285.51812.52930.65643.66754.0

19859.242.147.8188.5183.0533.6573.81251.61746.02851.75592.36676.6

19868.941.045.4174.5176.4508.1548.71186.81676.22705.95445.86334.2

19878.438.344.6167.0171.7483.3529.41138.21612.72610.25328.86176.2

19888.035.242.1153.8167.9465.9511.51107.01584.02570.35311.26186.4

19897.433.439.5149.1160.4449.6483.61048.81522.72459.75126.45955.7

19907.132.338.8142.9154.4431.0467.31013.01461.02390.74991.35888.5

19917.631.638.0138.5150.3414.4451.3982.01401.82283.94797.65694.9

19927.931.136.0133.3144.6398.6438.4945.71344.52209.94645.85546.1

19937.930.635.7130.5143.9392.9435.2936.01342.42214.34739.05615.3

19947.929.635.5128.1138.2375.4416.5900.31290.72107.34571.25443.7

19957.929.634.1125.0134.1362.1410.2873.61255.62061.24521.15315.1

19968.028.234.4119.5130.8351.8396.4835.61211.21987.74337.25187.1

19977.426.832.0114.9124.3332.0377.9801.81149.51903.54213.75014.5

19987.726.730.2108.8117.0309.8369.6772.81116.81853.84104.64852.5

19997.926.630.7106.2115.1299.3362.0749.81106.31813.74108.84837.5

20007.625.829.9103.5110.4290.2340.3705.21055.21736.83971.04701.7

20018.125.529.799.5103.1271.6323.4663.71013.61663.53775.14395.8

20028.226.129.599.498.5263.3308.1640.1968.91598.93588.34205.3

-0.1263833992-1.20276679840-1.3223320158-6.19130434780-4.9726284585-16.80237154150-15.9977272727-37.41996047430-48.8744071146-75.78537549410-111.1033596838-136.3346837945

197911.853.758.2245.5207.3652.8656.51485.02060.03256.35909.47149.6

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Year


35-44 years

00

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Year


45-54 years

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Year


55-64 years

00

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Men

Year


65-74 years

00

00

00

00

00

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Year


75-84 years

00

00

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Year


85+ years


YearWomenMenWomenMenWomenMenWomenMenWomenMenWomenMen

198011.252.257.8236.4208.7634.2669.91482.02094.43307.46248.07544.4

198110.7-4.5%51.0-2.3%57.0-1.4%228.7-3.3%202.9-2.8%611.3-3.6%642.4-4.1%1425.1-3.8%1962.4-6.3%3157.2-4.5%5966.7-4.5%7168.6-5.0%

198210.5-1.9%47.5-6.9%54.1-5.1%217.8-4.8%198.1-2.4%592.5-3.1%626.2-2.5%1388.2-2.6%1919.5-2.2%3081.1-2.4%5788.2-3.0%6982.4-2.6%

19839.7-7.6%45.1-5.1%52.9-2.2%208.4-4.3%196.9-0.6%574.6-3.0%615.3-1.7%1353.8-2.5%1888.1-1.6%3037.6-1.4%5827.60.7%6996.50.2%

19849.5-2.1%43.5-3.5%49.7-6.0%196.2-5.9%190.7-3.1%554.2-3.6%597.6-2.9%1285.5-5.0%1812.5-4.0%2930.6-3.5%5643.6-3.2%6754.0-3.5%

19859.2-3.2%42.1-3.2%47.8-3.8%188.5-3.9%183.0-4.0%533.6-3.7%573.8-4.0%1251.6-2.6%1746.0-3.7%2851.7-2.7%5592.3-0.9%6676.6-1.1%

19868.9-3.3%41.0-2.6%45.4-5.0%174.5-7.4%176.4-3.6%508.1-4.8%548.7-4.4%1186.8-5.2%1676.2-4.0%2705.9-5.1%5445.8-2.6%6334.2-5.1%

19878.4-5.6%38.3-6.6%44.6-1.8%167.0-4.3%171.7-2.7%483.3-4.9%529.4-3.5%1138.2-4.1%1612.7-3.8%2610.2-3.5%5328.8-2.1%6176.2-2.5%

19888.0-4.8%35.2-8.1%42.1-5.6%153.8-7.9%167.9-2.2%465.9-3.6%511.5-3.4%1107.0-2.7%1584.0-1.8%2570.3-1.5%5311.2-0.3%6186.40.2%

19897.4-7.5%33.4-5.1%39.5-6.2%149.1-3.1%160.4-4.5%449.6-3.5%483.6-5.5%1048.8-5.3%1522.7-3.9%2459.7-4.3%5126.4-3.5%5955.7-3.7%

19907.1-4.1%32.3-3.3%38.8-1.8%142.9-4.2%154.4-3.7%431.0-4.1%467.3-3.4%1013.0-3.4%1461.0-4.1%2390.7-2.8%4991.3-2.6%5888.5-1.1%

19917.67.0%31.6-2.2%38.0-2.1%138.5-3.1%150.3-2.7%414.4-3.9%451.3-3.4%982.0-3.1%1401.8-4.1%2283.9-4.5%4797.6-3.9%5694.9-3.3%

19927.93.9%31.1-1.6%36.0-5.3%133.3-3.8%144.6-3.8%398.6-3.8%438.4-2.9%945.7-3.7%1344.5-4.1%2209.9-3.2%4645.8-3.2%5546.1-2.6%

19937.90.0%30.6-1.6%35.7-0.8%130.5-2.1%143.9-0.5%392.9-1.4%435.2-0.7%936.0-1.0%1342.4-0.2%2214.30.2%4739.02.0%5615.31.2%

19947.90.0%29.6-3.3%35.5-0.6%128.1-1.8%138.2-4.0%375.4-4.5%416.5-4.3%900.3-3.8%1290.7-3.9%2107.3-4.8%4571.2-3.5%5443.7-3.1%

19957.90.0%29.60.0%34.1-3.9%125.0-2.4%134.1-3.0%362.1-3.5%410.2-1.5%873.6-3.0%1255.6-2.7%2061.2-2.2%4521.1-1.1%5315.1-2.4%

19968.01.3%28.2-4.7%34.40.9%119.5-4.4%130.8-2.5%351.8-2.8%396.4-3.4%835.6-4.3%1211.2-3.5%1987.7-3.6%4337.2-4.1%5187.1-2.4%

19977.4-7.5%26.8-5.0%32.0-7.0%114.9-3.8%124.3-5.0%332.0-5.6%377.9-4.7%801.8-4.0%1149.5-5.1%1903.5-4.2%4213.7-2.8%5014.5-3.3%

19987.74.1%26.7-0.4%30.2-5.6%108.8-5.3%117.0-5.9%309.8-6.7%369.6-2.2%772.8-3.6%1116.8-2.8%1853.8-2.6%4104.6-2.6%4852.5-3.2%

19997.92.6%26.6-0.4%30.71.7%106.2-2.4%115.1-1.6%299.3-3.4%362.0-2.1%749.8-3.0%1106.3-0.9%1813.7-2.2%4108.80.1%4837.5-0.3%

20007.6-3.8%25.8-3.0%29.9-2.6%103.5-2.5%110.4-4.1%290.2-3.0%340.3-6.0%705.2-5.9%1055.2-4.6%1736.8-4.2%3971.0-3.4%4701.7-2.8%

20018.16.6%25.5-1.2%29.7-0.7%99.5-3.9%103.1-6.6%271.6-6.4%323.4-5.0%663.7-5.9%1013.6-3.9%1663.5-4.2%3775.1-4.9%4395.8-6.5%

20028.21.2%26.12.4%29.5-0.7%99.4-0.1%98.5-4.5%263.3-3.1%308.1-4.7%640.1-3.6%968.9-4.4%1598.9-3.9%3588.3-4.9%4205.3-4.3%


YearWomen: 35-44 yMen: 35-44 yWomen:45-54 yMen: 45-54 y

1981-4.5%-2.3%-1.4%-3.3%-0.0277910877-0.0361084831-0.0410509031-0.0383940621-0.0630252101-0.0454133156-0.0450224072-0.0498117809

1982-1.9%-6.9%-5.1%-4.8%-0.0236569739-0.0307541305-0.0252179328-0.0258929198-0.0218609865-0.0241036361-0.029916034-0.0259743883

1983-7.6%-5.1%-2.2%-4.3%-0.0060575467-0.0302109705-0.0174065794-0.024780291-0.0163584267-0.01411833440.00680695210.002019363

1984-2.1%-3.5%-6.0%-5.9%-0.031488065-0.0355029586-0.0287664554-0.0504505835-0.0400402521-0.0352251778-0.0315738898-0.0346601872

1985-3.2%-3.2%-3.8%-3.9%-0.0403775564-0.0371706965-0.0398259705-0.0263710618-0.0366896552-0.0269228144-0.0090899426-0.0114598756

1986-3.3%-2.6%-5.0%-7.4%-0.0360655738-0.0477886057-0.0437434646-0.0517737296-0.0399770905-0.0511273977-0.0261967348-0.0512835875

1987-5.6%-6.6%-1.8%-4.3%-0.0266439909-0.0488092895-0.0351740477-0.040950455-0.0378833075-0.0353671606-0.0214844467-0.024943955

1988-4.8%-8.1%-5.6%-7.9%-0.0221316249-0.0360024829-0.0338118625-0.0274117027-0.0177962423-0.015286185-0.00330280740.0016515009

1989-7.5%-5.1%-6.2%-3.1%-0.0446694461-0.0349860485-0.0545454545-0.0525745257-0.0386994949-0.0430299965-0.0347943967-0.0372914781

1990-4.1%-3.3%-1.8%-4.2%-0.0374064838-0.0413701068-0.0337055418-0.0341342487-0.0405201287-0.0280522015-0.0263537765-0.0112833084

19917.0%-2.2%-2.1%-3.1%-0.0265544041-0.0385150812-0.0342392467-0.0306021718-0.0405201916-0.0446731083-0.0388075251-0.0328776429

19923.9%-1.6%-5.3%-3.8%-0.0379241517-0.0381274131-0.0285840904-0.0369653768-0.0408760166-0.0324007181-0.0316408204-0.0261286414

19930.0%-1.6%-0.8%-2.1%-0.0048409405-0.0143000502-0.0072992701-0.0102569525-0.00156191890.00199104030.02006113050.0124772363

19940.0%-3.3%-0.6%-1.8%-0.0396108409-0.0445405956-0.04296875-0.0381410256-0.0385131108-0.0483222689-0.035408314-0.0305593646

19950.0%0.0%-3.9%-2.4%-0.0296671491-0.0354288759-0.0151260504-0.0296567811-0.0271945456-0.0218763346-0.010959923-0.0236236383

19961.3%-4.7%0.9%-4.4%-0.0246085011-0.0284451809-0.0336421258-0.0434981685-0.0353615801-0.0356588395-0.0406759417-0.0240823315

1997-7.5%-5.0%-7.0%-3.8%-0.0496941896-0.0562819784-0.0466700303-0.0404499761-0.0509412153-0.0423605172-0.0284745919-0.0332748549

19984.1%-0.4%-5.6%-5.3%-0.0587288817-0.0668674699-0.0219634824-0.0361686206-0.0284471509-0.0261097977-0.0258917341-0.0323063117

19992.6%-0.4%1.7%-2.4%-0.0162393162-0.0338928341-0.0205627706-0.0297619048-0.0094018625-0.02163124390.0010232422-0.0030911901

2000-3.8%-3.0%-2.6%-2.5%-0.0408340573-0.0304042766-0.0599447514-0.0594825287-0.0461900027-0.0423995148-0.0335377726-0.0280723514

20016.6%-1.2%-0.7%-3.9%-0.0661231884-0.0640937285-0.0496620629-0.0588485536-0.0394238059-0.0422040534-0.0493326618-0.0650615735

20021.2%2.4%-0.7%-0.1%-0.0446168768-0.0305596465-0.047309833-0.0355582341-0.0441002368-0.0388337842-0.0494821329-0.0433368215

YearWomen:55-64 yMen:55-64 yWomen:65-75 yMen:65-75 y

1981-2.8%-3.6%-4.1%-3.8%

1982-2.4%-3.1%-2.5%-2.6%

1983-0.6%-3.0%-1.7%-2.5%

1984-3.1%-3.6%-2.9%-5.0%

1985-4.0%-3.7%-4.0%-2.6%

1986-3.6%-4.8%-4.4%-5.2%

1987-2.7%-4.9%-3.5%-4.1%

1988-2.2%-3.6%-3.4%-2.7%

1989-4.5%-3.5%-5.5%-5.3%

1990-3.7%-4.1%-3.4%-3.4%

1991-2.7%-3.9%-3.4%-3.1%

1992-3.8%-3.8%-2.9%-3.7%

1993-0.5%-1.4%-0.7%-1.0%

1994-4.0%-4.5%-4.3%-3.8%

1995-3.0%-3.5%-1.5%-3.0%

1996-2.5%-2.8%-3.4%-4.3%

1997-5.0%-5.6%-4.7%-4.0%

1998-5.9%-6.7%-2.2%-3.6%

1999-1.6%-3.4%-2.1%-3.0%

2000-4.1%-3.0%-6.0%-5.9%

2001-6.6%-6.4%-5.0%-5.9%

2002-4.5%-3.1%-4.7%-3.6%

YearWomen: 75-84 yMen: 75-84 yWomen: 85+ yMen: 85+ y

1981-6.3%-4.5%-4.5%-5.0%

1982-2.2%-2.4%-3.0%-2.6%

1983-1.6%-1.4%0.7%0.2%

1984-4.0%-3.5%-3.2%-3.5%

1985-3.7%-2.7%-0.9%-1.1%

1986-4.0%-5.1%-2.6%-5.1%

1987-3.8%-3.5%-2.1%-2.5%

1988-1.8%-1.5%-0.3%0.2%

1989-3.9%-4.3%-3.5%-3.7%

1990-4.1%-2.8%-2.6%-1.1%

1991-4.1%-4.5%-3.9%-3.3%

1992-4.1%-3.2%-3.2%-2.6%

1993-0.2%0.2%2.0%1.2%

1994-3.9%-4.8%-3.5%-3.1%

1995-2.7%-2.2%-1.1%-2.4%

1996-3.5%-3.6%-4.1%-2.4%

1997-5.1%-4.2%-2.8%-3.3%

1998-2.8%-2.6%-2.6%-3.2%

1999-0.9%-2.2%0.1%-0.3%

2000-4.6%-4.2%-3.4%-2.8%

2001-3.9%-4.2%-4.9%-6.5%

2002-4.4%-3.9%-4.9%-4.3%

0000

0000

0000

0000

0000

0000

0000

0000

0000

0000

0000

0000

0000

0000

0000

0000

0000

0000

0000

0000

0000

0000

Women: 35-44 y

Men: 35-44 y

Women:45-54 y

Men: 45-54 y

Year

Percent change

0000

0000

0000

0000

0000

0000

0000

0000

0000

0000

0000

0000

0000

0000

0000

0000

0000

0000

0000

0000

0000

0000

Women: 35-44 y

Men: 35-44 y

Women:45-54 y

Men: 45-54 y

Year

Percent change

0000

0000

0000

0000

0000

0000

0000

0000

0000

0000

0000

0000

0000

0000

0000

0000

0000

0000

0000

0000

0000

0000

Women:55-64 y

Men:55-64 y

Women:65-75 y

Men:65-75 y

Year

Percent change

0000

0000

0000

0000

0000

0000

0000

0000

0000

0000

0000

0000

0000

0000

0000

0000

0000

0000

0000

0000

0000

0000

Women:55-64 y

Men:55-64 y

Women:65-75 y

Men:65-75 y

Year

Percent change

0000

0000

0000

0000

0000

0000

0000

0000

0000

0000

0000

0000

0000

0000

0000

0000

0000

0000

0000

0000

0000

0000

Women: 75-84 y

Men: 75-84 y

Women: 85+ y

Men: 85+ y

Year

Percent change

0000

0000

0000

0000

0000

0000

0000

0000

0000

0000

0000

0000

0000

0000

0000

0000

0000

0000

0000

0000

0000

0000

Women: 75-84 y

Men: 75-84 y

Women: 85+ y

Men: 85+ y

Year

Percent change

Waist circumference

Men

20-29 y4.287.84.8%

30-39 y2.793.62.9%

40-49 y2.197.72.1%

50-59 y2.5100.52.5%

60-69 y3.7101.73.6%

70+3.199.33.1%

Women

20-29 y5.680.57.0%

30-39 y486.54.6%

40-49 y2.389.72.6%

50-59 y2.494.42.5%

60-69 y2.894.53.0%

70+1.293.11.3%

Diabetes

20-39 y1.62.237.5%

40-59 y8.99.23.4%

60+ y1919.31.6%

Metabolic syndrome

20-39 y

40-59 y

60+ y

Cholesterol

Trends in age-specific CHD mortality rates England & Wales 1984-2004 [lines indicate 5 year moving averages]Heart~ July 2007 doi: 10.1136/hrt.2007.118323

CHD mortality: big falls in UK & elsewhere 25%-50% due to evidence-based therapies50% -75% due to risk factor reductions(especially smoking & cholesterol)

Using IMPACT to explain CHD trends and examine future policy options

Conclusions

CHD mortality: big falls in UK & elsewhere 25%-50% due to evidence-based therapies50% -75% due to risk factor reductions(especially smoking & cholesterol)

small reductions in UK risk factors could Halve CHD deaths Healthy diet & Tobacco controlremain top policy prioritiesUsing IMPACT to explain CHD trends and examine future policy options

Conclusions

Reserve slides

IMPACT Model: Main Components

RISK F FACTORS

Patient Groups

TREATMENTS

OUTCOMES CholesterolSmokingAge & SexPhysical ActivityBMI & DiabetesMedicalCABG/PTCAsurgeryBlood PressureSurvivalDeath Ford et al NEJM 2007 356 2388

Modelling UK trends to 2010 Unal, Critchley & Capewell Circulation 2004 109 (9) 1101; J Clin Epid 2005 58 733; Heart 2006 92 5212010predicted

Per 100,000

3



Modelling UK trends to 2010 predictedIF additional treatmentsper 100,000 If more treatments for more patients 21,000 fewer deathsUnal, Critchley & Capewell Circulation 2004 109 (9) 1101; Heart 2006 92 521; J Clin Epid 2005 58 733

Per 100,000

3



Modelling UK trends to 2010 predictedIF additional treatmentsper 100,000 IF modest risk factor reductionsAdditional risk factor reductions 50,000 fewer deathsIf more treatments for more patients 21,000 fewer deathsUnal, Critchley & Capewell Circulation 2004 109 (9) 1101; Heart 2006 92 521; J Clin Epid 2005 58 733

Per 100,000

3



Natural Course of CHDThe Natural History of CHD Atheroma Atheroma & ThrombosisHanlon, Capewell et al 1997

CHD Prevention optionsNatural Course of CHDHanlon, Capewell et al 1997

US Trends in AGE-SPECIFIC CHD mortality rates: men & women aged 35 years Ford & Capewell JACC 2007 50 2128

Biological Risk FactorsPopulation Policies & BehavioursCombinedCVD RiskCVD PatientGroupsIMPACT2 CVD Policy ModelOUTPUTS

Combined CVD RiskUnstableAnginaChronic AnginaEarly Heart FailureSevere Heart FailureMIsurvivorsFirstMIStrokeOther CVDFromany StatePopulations: UK>E&W>Regions>PCTsOutputs: Population-based incidence, prevalence; Deaths prevented; Life-Years; Life expectancy; Costs; Cost-effectiveness ratiosPopulation Policies & BehavioursBiological Risk FactorsCombinedCVD RiskCVD PatientGroupsCHD DeathNon-CHD DeathRecurrentMISUDSNON-SUDSOUTPUTS

PhysicalActivityDietSmokingDeprivationObesity(BMI)Diabetesor IGTCholesterol LDL(& HDL)Blood PressureCombined CVD RiskUnstableAnginaChronic AnginaEarly Heart FailureSevere Heart FailureMIsurvivorsAcuteMIStrokeOther CVDAdditional CVD Risk FactorsFromany StatePopulations: UK>E&W>Regions>PCTsOutputs: Population-based incidence, prevalence; Deaths prevented; Life-Years; Life expectancy; Costs; Cost-effectiveness ratiosPopulation Policies & BehavioursBiological Risk FactorsCombinedCVD RiskCVD PatientGroupsOUTPUTSCHD DeathNon-CHD DeathRecurrentMISUDSNON-SUDS

IMPACT2 structure

Primary Prevention

E.g. Bayesian network

Generator

Stochastic matrices

Posterior density over states, age, gender and costs

Generator

Markov simulated patient numbers

Generator

Relative risksUptakesCostsQALYs

Generator

Incidenceandcosts

Intervention 1

Generator

Costs and QALYs

Generator

Discount rates

Intervention 2

Generator

Economicandstatistical

Generator

Baselinematrices

...

Additional risk factor reductions achieved elsewhere UK 2000 level TARGET in 2010SMOKING 26% 17% (USA 2002)

CHOLESTEROL 5.6 5.2 (mmol/l) Gothenberg (Sweden), Stanford (USA) & Perth (Australia) BLOOD PRESSURE (Diastolic BP mmHg) 77 73 (4 mmHg fall) New Zealand (4.4 ) Finland (5.2 ) & France (6.0 )

OBESITY USA: 15% prevalence reduction by 2010 (??)

PHYSICAL ACTIVITY increase prevalence by 5% (?) [best]

DIABETES No successful community reductionsAssume 5% decrease in prevalence (??)Unal et al J Clin Epid 2005 58 733

*Greeting:Good afternoon and thank you for coming to this presentation! Today I would like to talk about our research project titled Before starting my presentation I would like to thank Simon and Julia for their valuable scientific and social support.

Guven araliklarini koyarsan iyi olur results tablosunaCHD icin akis semasini koyDegiskenlerin tanimlarini koy********

Studying mortality trends: The IMPACT CHD Policy Model Prof Simon Capewell Chair of Clinical...

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Transcript of Studying mortality trends: The IMPACT CHD Policy Model Prof Simon Capewell Chair of Clinical...