Age and cause contributions of lower life expectancy
           in Inuit Nunangat, 1989-2003


   National Aboriginal Heal...
Outline


 Objective
      • To measure the contributions of age groups and
        causes of death to differences life e...
November 24, 2009   3/19
Data sources


 Deaths:
      • Canadian Mortality Database
      • Three 5-year periods:
             Centred on census...
Methods
- Analytic techniques
 Life expectancy
      • Standard abridged life tables (Chiang adjusted)
 Cause decomposit...
Methods
- Causes of death
 Global Burden of Disease
      • Causes of death aggregated in a way that underpins
        hu...
Results
     - Life expectancy
                                  Inuit Nunangat                              Canada       ...
Results
- Cause contributions (male)
                                                                 15
         Contribu...
Results
- Cause contributions (years, male)
Cause of death                                          1989-1993    1994-1998...
Results
- Cause contributions (female)
                                                                 15
         Contri...
Results
- Cause contributions (years, female)
Cause of death                                          1989-1993    1994-19...
Results
- Attributable cause contributions
                                                                               ...
Results
- Attributable cause contributions
                                                                               ...
Contribution to difference in life
                                                        expectancy (%)




November 24,...
Contribution to difference in life
                                                        expectancy (%)




November 24,...
Discussion


 Life expectancy difference appears to be
  increasing between Inuit Nunangat & Canada
 Difference is relat...
Discussion


 Difference is concentrated in specific age groups
      • Males – mortality between 15 and 29 is key
      ...
Limitations


 Limits to geographic approach
      • For all residents of Inuit Nunangat, not just Inuit
      • Unequal ...
Acknowledgements


 Contact:
      • Paul A. Peters, PhD
        Health Analysis Division
        Statistics Canada
     ...
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Age and cause contributions of lower life expectancy in Inuit Nunangat, 1989-2003

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Paul A. Peters, PhDHealth Analysis Division, Statistics Canada

NAHO 2009 National Conference

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Age and cause contributions of lower life expectancy in Inuit Nunangat, 1989-2003

  1. 1. Age and cause contributions of lower life expectancy in Inuit Nunangat, 1989-2003 National Aboriginal Health Organisation November 24th, 2009 Ottawa, ON Paul A. Peters, PhD Health Analysis Division, Statistics Canada
  2. 2. Outline  Objective • To measure the contributions of age groups and causes of death to differences life expectancy between residents of Inuit Nunangat and the rest of Canada  Rationale • Life expectancy for residents of Inuit Nunangat is lower than for residents in the rest of Canada  Specific causes of death in certain age groups are thought to contribute to this difference November 24, 2009 2/19
  3. 3. November 24, 2009 3/19
  4. 4. Data sources  Deaths: • Canadian Mortality Database • Three 5-year periods:  Centred on census years 1991, 1996, 2001 (1989-2003) • Census subdivision code for usual place of residence  Population (person-years) • Multiplied by factor of five for each mid-period census • Mid-year population counts from census November 24, 2009 4/19
  5. 5. Methods - Analytic techniques  Life expectancy • Standard abridged life tables (Chiang adjusted)  Cause decomposition • What cause-specific mortality differences contribute to total differences in life expectancy?  Contribution of specific causes of death to the total years of difference between life expectancies • Arriaga (1989) method from discrete life tables November 24, 2009 5/19
  6. 6. Methods - Causes of death  Global Burden of Disease • Causes of death aggregated in a way that underpins human development rather than the body system  I – Communicable, maternal, perinatal, and nutritional  II – Noncommunicable diseases  III – Injuries  Attributable Causes of Death • Mackenbach et al. 2008 NEJM.  Smoking-related  Alcohol-related  Medically amenable deaths (appendicitis, diabetes, etc…) November 24, 2009 6/19
  7. 7. Results - Life expectancy Inuit Nunangat Canada Difference Years (A) 95% confidence Years (B) 95% confidence A-B 1989-1993 interval interval Males 66.5 (65.1 to 67.9) 74.2 (74.2 to 74.2) -7.7 Females 71.5 (70.0 to 73.1) 80.6 (80.6 to 80.7) -9.1 1994-1998 Males 64.7 (63.3 to 65.7) 74.6 (74.6 to 74.6) -10.1 Females 70.7 (69.4 to 72.1) 79.8 (79.7 to 79.8) -9.0 1999-2003 Males 64.7 (63.4 to 65.9) 76.6 (76.5 to 76.6) -11.9 Females 69.9 (68.7 to 71.1) 81.8 (81.8 to 81.9) -11.9 Sources: Statistics Canada, Vital Statistics - Deaths Database; Statistics Canada, Census of Population November 24, 2009 7/19
  8. 8. Results - Cause contributions (male) 15 Contribution to difference in life expectancy (years) 10 7.5 5.6 5 4.1 1.9 3.1 2.8 1.2 0.9 0.7 0 1989-1993 1994-1998 1999-2003 Communicable, maternal, perinatal, nutritional Noncommunicable Injuries November 24, 2009 8/19
  9. 9. Results - Cause contributions (years, male) Cause of death 1989-1993 1994-1998 1999-2003 Total difference 7.7 10.1 11.9 I. Communicable, maternal, perinatal, and nutritional 1.2 0.9 0.7 Respiratory infections 0.6 0.4 0.2 Perinatal conditions 0.3 0.4 0.2 Other communicable, maternal, and nutritional 0.3 0.2 0.4 II. Noncommunicable diseases 1.9 3.1 2.8 Malignant neoplasms 1.2 1.2 1.4 Colon and rectum cancers 0.0 0.1 0.2 Trachea, bronchus, and lung 1.1 0.6 1.0 Other malignant neoplasms 0.6 0.8 0.4 Neuro-psychiatric conditions 0.3 0.3 0.2 Cardiovascular diseases 0.1 0.9 0.5 Ischaemic heart disease -0.7 0.3 -0.1 Cerebrovascular disease 0.2 0.4 0.2 Other cardiovascular diseases 0.9 0.7 0.6 Respiratory diseases 0.5 0.7 0.7 COPD 0.5 0.5 0.5 Other respiratory diseases 0.1 0.2 0.2 Congenital abnormalities 0.2 0.2 0.2 Other noncommunicable diseases 0.1 0.1 0.2 III. Injuries 4.1 5.6 7.5 Unintentional injuries 1.6 2.6 2.3 Intentional injuries 2.4 3.0 5.3 Self-inflicted injuries 2.1 2.9 5.0 Other intentional injuries 0.4 0.2 0.3
  10. 10. Results - Cause contributions (female) 15 Contribution to difference in life expectancy (years) 2.9 10 1.8 2.4 8.0 5 6.1 5.1 1.0 1.0 1.4 0 1989-1993 1994-1998 1999-2003 Communicable, maternal, perinatal, nutritional Noncommunicable Injuries November 24, 2009 10/19
  11. 11. Results - Cause contributions (years, female) Cause of death 1989-1993 1994-1998 1999-2003 Total difference 9.1 9.0 11.9 I. Communicable, maternal, perinatal, and nutritional 1.0 1.0 1.4 Respiratory infections 0.3 0.4 0.5 Perinatal conditions 0.3 0.2 0.3 Other communicable, maternal, and nutritional 0.4 0.5 0.6 II. Noncommunicable diseases 6.1 5.1 8.0 Malignant neoplasms 1.4 2.0 3.6 Colon and rectum cancers 0.2 0.2 0.6 Trachea, bronchus, and lung 1.1 1.7 2.1 Other malignant neoplasms 1.1 1.0 1.4 Neuro-psychiatric conditions 0.3 0.3 0.3 Cardiovascular diseases 1.5 0.5 1.3 Ischaemic heart disease -0.1 -0.2 0.1 Cerebrovascular disease 0.6 0.1 0.7 Other cardiovascular diseases 1.4 1.0 0.5 Respiratory diseases 2.9 1.9 2.1 COPD 2.4 1.6 1.8 Other respiratory diseases 0.5 0.4 0.3 Congenital abnormalities 0.3 0.1 0.3 Other noncommunicable diseases 0.5 0.8 0.6 III. Injuries 1.8 2.4 2.9 Unintentional injuries 0.9 1.3 1.5 Intentional injuries 0.7 1.1 1.4 Self-inflicted injuries 0.5 0.9 1.3 Other intentional injuries 0.3 0.2 0.1
  12. 12. Results - Attributable cause contributions Males 5 Contribution to life expectancy difference (years) 4 3 2 1.9 1.7 1.5 1 0.9 0.7 0.5 0.2 0.1 0.1 0 1989-1993 1994-1998 1999-2003 Smoking Alcohol Amenable November 24, 2009 12/19
  13. 13. Results - Attributable cause contributions Females 5 Contribution to life expectancy difference (years) 4.0 4.1 4 3.6 3 2 1.7 1.0 1 0.6 0.2 0.2 0.3 0 1989-1993 1994-1998 1999-2003 Smoking Alcohol Amenable November 24, 2009 13/19
  14. 14. Contribution to difference in life expectancy (%) November 24, 2009 -5 0 5 10 15 20 <1 Results 1-4 5-9 10-14 15-19 20-24 25-29 1991 30-34 35-39 1996 40-44 45-49 Age group 2001 50-54 55-59 60-64 65-69 70-74 75-79 80-84 85-89 90+ - Age contributions (males, percent) 14/19
  15. 15. Contribution to difference in life expectancy (%) November 24, 2009 -5 0 5 10 15 20 <1 Results 1-4 5-9 10-14 15-19 20-24 25-29 1991 30-34 35-39 1996 40-44 45-49 Age group 2001 50-54 55-59 60-64 65-69 70-74 75-79 80-84 85-89 90+ 15/19 - Age contributions (females, percent)
  16. 16. Discussion  Life expectancy difference appears to be increasing between Inuit Nunangat & Canada  Difference is related to specific causes of death • Males – injury & suicide are major contributors  Injury and suicide account for 7.5 years of difference • Females – chronic diseases are major contributors  Lung cancer and COPD account for 4 years of difference  Specific causes differ between sexes • Smoking-related diseases for females • Alcohol-related diseases are not major contributors November 24, 2009 16/19
  17. 17. Discussion  Difference is concentrated in specific age groups • Males – mortality between 15 and 29 is key  1/3 of difference due to mortality between 15 and 29 years  This is largely due to injury and suicide • Females – mortality after age 60 contributes most  50% of difference due to mortality after 60 years of age  This is largely due to chronic diseases November 24, 2009 17/19
  18. 18. Limitations  Limits to geographic approach • For all residents of Inuit Nunangat, not just Inuit • Unequal access to health services • Older population may move “south” for care  Reliability of vital statistics • Cause of death coding may vary between periods  Use of a comparable population • Comparison to other isolated communities, other Aboriginal groups, or other countries November 24, 2009 18/19
  19. 19. Acknowledgements  Contact: • Paul A. Peters, PhD Health Analysis Division Statistics Canada Ottawa, ON (613) 951-0616 paul.a.peters@statcan.gc.ca  Thanks to: Health Canada FNIHB (Jennifer Pennock, Neil Goedhuis) November 24, 2009 19/19
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