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Health and health status
 

Health and health status

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    Health and health status Health and health status Presentation Transcript

    • Public Health andDono Widiatmoko Epidemiology Health and Health Status
    • Measuring Health Not Healthy Healthy Continuum of health status
    • A doctor diagnoses his patient Generic’• ‘ measurement•Function specific•Condition/Disease specific•Symptoms, signs, tests
    • We diagnose the healthof a population
    • Which Parameters? How?• How do you measure health?• Or should we rather measure illness?• How do you measure population health status?• How can people put a value on health?
    • Which Parameters?• Deaths• Illness/diseases• Healthy days/years• Others?How?• Registers• Life tables
    • Deaths / MortalityTotal Mortality: annual number of deaths from a disease or in general, in a defined population. It is usually expressed in number of deaths per 100,000 populationProblems? Comparability
    • Death rate• An estimate of the portion of population that dies during a specified period. Number of death n 10 Number of person at risk• The death rate per 10n person-years
    • Crude death rates• The number of occurrences for a whole population• Often expressed as a rate per 1,000 population, but can be per 100,000 or per 1,000,000 (10n)• For example “The total annual death rate in Town X was 11 per 1,000”• Convenient, since only one figure to deal with
    • Comparing Death Rates• Problems? Comparability• Different groups are likely to have different age/sex structure, making direct like-for- like comparisons difficult
    • Specific Death RatesSolutions:• Age / Sex• Disease /condition specific• Standardisation
    • Standardisation• Standardised Death Rate represents what the crude rate would have been if the population had the same age distribution as a ‘reference population’• Methods: Direct vs Indirect Standardisation Methods
    • Adult mortality rate (15 to 60yrs) per1000 population both sexes Country 1990 2000 2006 United Kingdom 104 88 80 Denmark 126 100 88 Ukraine 199 257 264 Brazil 212 192 176 Canada 102 81 72 Egypt 218 200 186 Ghana 272 298 331 Senegal 310 293 271 Bangladesh 319 254 254 China 172 135 116 Philippines 234 223 219 New Zealand 119 86 75
    • Age Standardised Mortality Rates (2002) Non- Country Cancer CVD Injuries Communicable Diseases United Kingdom 143 182 26 434 Denmark 167 182 40 503 Ukraine 139 637 135 891 Brazil 142 341 81 712 Canada 138 141 34 388 Egypt 84 560 35 959 Ghana 138 404 97 786 Senegal 146 426 125 832 Bangladesh 111 428 101 762 China 148 291 79 665 Philippines 91 336 58 642 New Zealand 139 175 37 423
    • Other indicators of mortality• Infant Mortality Rates Measure of yearly rate of deaths in children less than one year old No of deaths of children 1 yr in a year 1000 Number of life births in the same year• Child Mortality Rates Measure of yearly rate of deaths in children under 5  Measure the burden of preventable diseases in children
    • • Perinatal Mortality Measures the mortality around the time of birth Fetal deaths postnatal deaths 1000 Fetal deaths live birthsFetal deaths: 28 weeks + of gestationPostnatal deaths: 1st week
    • Infant Mortality Rates, both sexes Country 1990 2000 2006 United Kingdom 8 6 5 Denmark 7 5 3 Ukraine 22 19 20 Brazil 48 27 19 Canada 7 5 5 Egypt 67 40 29 Ghana 76 72 76 Senegal 72 66 60 Bangladesh 100 66 52 China 37 30 20 Philippines 41 30 24 New Zealand 9 6 5
    • Disease specific death rates amongchildren under 5, 2000 Diarrhoeal NeonatalCountry HIV/AIDS Injuries Malaria Measles Diseases CausesUnited Kingdom 0.9 0 4.4 0 0 59.1Denmark 0.3 0 5.5 0 0 73.8Ukraine 1.2 4.9 14.5 0 0 42.3Brazil 12 0.3 3.2 0.5 0 38Canada 0.2 0 7.2 0 0 58.5Egypt 12.8 0 2.1 0.4 0.1 44.3Ghana 12.2 5.7 3 33 2.9 28.5Senegal 17.1 1 2.6 27.6 8.1 22.8Bangladesh 20 0 2.7 0.7 2 45.4China 11.8 0.1 8.4 0.4 0.4 49.2Philippines 12 0 2.7 0.4 1.2 36.9New Zealand 0.2 0 11.4 0 0 48.3
    • • Maternal Mortality Rate The risk of dying from causes associated with childbirth. No of deaths from from puerperal causes in a year 1000 Number of life births in the same yearPuerperal causes: deaths occuring during and/or due to deliveries, complicationsof pregnancy, childborth, and the puerperium (normally 42 days after delivery).
    • Life Expectancy• .....is the number of years that a person can expect to live on average in a given population. Commonly used as a summary measure based on death rates of the population in a given year. Usually reported as life expectancy at birth although other base years are also used (1, 15, 45 and 65)• Use Life Tables to calculate life expectancy. See: http://www.ehemu.eu/pdf/Sullivan_guide_final_jun2007.pdf
    • Life Expectancy, both sexes Country 1990 2000 2006 United Kingdom 76 78 79 Denmark 75 77 79 Ukraine 70 67 67 Brazil 67 70 72 Canada 77 79 81 Egypt 62 66 68 Ghana 58 58 57 Senegal 55 57 59 Bangladesh 55 61 63 China 68 71 73 Philippines 65 67 68 New Zealand 75 79 80
    • Life expectancy at birth, 2006 Country Female Male Both United Kingdom 81 77 79 Denmark 81 76 79 Ukraine 73 61 67 Brazil 75 68 72 Canada 83 78 81 Egypt 70 66 68 Ghana 58 56 57 Senegal 61 57 59 Bangladesh 63 63 63 China 75 72 73 Philippines 71 64 68 New Zealand 82 78 80
    • Problems with death rates andlife expectancy?• Only concern about the length of life• Data are difficult to find in less developed world• Do not bother about quality of life
    • Morbidity MeasuresIncidence Rates:• Estimate of the risk of developing a disease during a specified period of time• To calculate the incidence rate per 1,000: Number of new cases of a disease in X 1,000 the population during a specified time• Number of persons exposed to risk of developing the disease during that period of time
    • Prevalence Rates• Measures number of cases that are present at, or during, a specified period of time• To calculate prevalence rate per 1,000: Number of cases of a disease present in the population at a specified period of time x 1,000 Number of persons at risk of having the disease at that specified time• Point prevalence – number of cases present at specified moment in time• Period prevalence – number of cases that occur during a specified period of time
    • WHO Global Health Observatory• http://apps.who.int/ghodata/
    • Composite Measure• Disability Adjusted Life Years• Healthy Life Year• Health-Adjusted Life Expectancy• Quality Adjusted Life Years
    • Disability Adjusted Life Years(DALY) – Murray et al• YLL : Years Life Lost due to Premature Mortality• YLD : Years Life Lost due to Disability DALY = YLL + YLD• One DALY  one lost year of healthy life and the burden of disease as a measure of the gap between current health status and an ideal situation where everyone lives into old age free from disease and disability.
    • Healthy Life Year (HeaLY)• Composite measure combining the amount of healthy life lost due to morbidity with that lost due to death. Healthy Death Disability Disease onset Death Expected Death
    • Health-Adjusted Life Expectancy• Composite summary measure in which Life expectancy is weighted for health status• Average amount of time a person is expected to live in a given health state if current patterns of mortality and health states continue to apply
    • HALE at birth, 2003Country Female Male BothUnited Kingdom 72 69 71Denmark 71 69 70Ukraine 64 55 59Brazil 62 57 60Canada 74 70 72Egypt 60 58 59Ghana 50 49 50Senegal 49 47 48Bangladesh 53 55 54China 65 63 64Philippines 62 57 59New Zealand 72 69 71
    • Quality Adjusted Life Years • Taking into account both quantity and the quality of life generated by health care interventionsBest Health = 1Lowest Health = 0 1 yr 2 yr Time