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ISSN: 0022-9032 e-ISSN: 1897-4279
Fifteen-year mortality trends due to cardiovascular diseases in Poland using standard expected years of life lost, 2000-2014
Authors: Małgorzata Pikala, Irena Maniecka-Bryła
DOI: 10.5603/KP.a2017.0124 Article type: Original articles Submitted: 2017-03-07 Accepted: 2017-06-08 Published online: 2017-06-28
This article has been peer reviewed and published immediately upon acceptance. It is an open access article, which means that it can be downloaded, printed, and distributed freely, provided the work is properly cited. Articles in "Polish Heart Journal" are listed in PubMed.
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Fifteen-year mortality trends due to cardiovascular diseases in Poland using standard expected years of life lost, 2000-2014 Małgorzata Pikala, Irena Maniecka-Bryła Department of Epidemiology and Biostatistics, Medical University of Lodz, Poland
Address for correspondence: Małgorzata Pikala, PhD, Department of Epidemiology and Biostatistics, Medical University of Lodz, Poland, e-mail:
[email protected]
Abstract Background: Measures presenting a number of years of lost life point out social and economic aspects of premature mortality. Aim: The aim of the study was to determine trends and pace of changes in years of life lost, in inhabitants of Poland, in 2000-2014 due to cardiovascular diseases. Methods: The study material was a database including 2,587,141 death certificates of Polish inhabitants who died of cardiovascular diseases in 2000-2014. We applied the standard expected years of life lost (SEYLL) indicators per living person (SEYLLp) and per death (SEYLLd) to calculate life years lost. We also estimated annual percentage changes (APC) and average annual percentage changes (AAPC) in the SEYLL indicators. Results: In 2000 the SEYLLp index due to cardiovascular diseases was 860.3 years per 10,000 males and 586.9 years per 10,000 females. In 2000-2004 the indices were decreasing and the average annual rate was -0.8% in the male group and -1.2% in the female group. Eventually, in 2014 its values were 721.4 years per 10,000 males and 475.6 years per 10,000 females. The respondents were losing years of life due to ischemic heart disease most rapidly (AAPC=-3.3% in the male group and -3.2% in the female group) and due to cerebrovascular diseases (AAPC=-2.5% in the male group and -3.3% in the female group). On the other hand, there was an increase in the number of years of life lost due to heart failure (AAPC=5.7% in the male group and 4.4% in the female group). In 2014 SEYLLp due to ischemic heart disease were 207.3 per 10,000 males and 99.1 per 10,000 females, due to cerebrovascular diseases – 124.3 and 102.2, due to heart failure – 155.3 i 104.9. Each male who died of cardiovascular diseases lost on average 19.1 years in the year 2000 and 17.0 years in the year 2014 (AAPC=0.5%). With regards to women, SEYLLd values were 12.6 years in 2000 and 10.4 years in
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2014 (AAPC=-1.4%). A decrease in the SEYLLd value was observed in all analysed causes of mortality, in both males and females. Conclusions: Among cardiovascular diseases, ischemic heart disease and cerebrovascular diseases contribute to the highest number of years of life lost in inhabitants of Poland. Constant decline in the average number of years of life, lost by each person who died of cardiovascular diseases, might result from implementation of more effective prophylaxis and more effective treatment which extend lifespan. Key words: years of life lost; cardiovascular diseases; premature mortality; trends; Poland
15-letnie trendy umieralności z powodu chorób układu krążenia przy użyciu standardowych oczekiwanych utraconych lat życia w Polsce w latach 2000–2014 Małgorzata Pikala, Irena Maniecka-Bryła Zakład Epidemiologii i Biostatystyki, Uniwersytet Medyczny w Łodzi
Adres do korespondencji: dr n. o zdrowiu Małgorzata Pikala, Zakład Epidemiologii i Biostatystyki, Uniwersytet Medyczny w Łodzi, e-mail:
[email protected]
Streszczenie Wstęp: Ocena udziału poszczególnych chorób będących przyczynami zgonów w krajach wysoko rozwiniętych przy użyciu współczynników umieralności wskazuje na największy udział chorób układu krążenia. Ponieważ jednak ta klasa chorób jest w dużej części odpowiedzialna za zgony osób w wieku starszym, skutki społeczne i ekonomiczne są mniejsze niż w przypadku tych przyczyn, które są odpowiedzialne za zgony osób młodszych. Użycie mierników oceniających przedwczesną umieralność w jednostkach utraconego czasu życia pozwala lepiej scharakteryzować to istotne zjawisko w stanie zdrowia mieszkańców Polski. Cel: Celem badania jest określenie kierunku i tempa zmian w utraconych latach życia mieszkańców Polski w latach 2000-2014 z powodu chorób układu krążenia, w tym w szczególności choroby niedokrwiennej serca, chorób naczyń mózgowych, chorób tętnic, tętniczek i naczyń włosowatych oraz niewydolności serca.
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Metody: Materiałem badawczym jest baza danych utworzona na podstawie 2,587,141 kart zgonów z powodu chorób układu krążenia mieszkańców Polski w latach 2000-2014. Do obliczenia utraconych lat życia zastosowano wskaźniki SEYLLp (Standard Expected Years of Life Lost per living person) oraz SEYLLd (per death). Analiza trendów przeprowadzona została za pomocą modeli joinpoint. Policzone zostały współczynniki APC (Annual Percentage Change) and AAPC (Average Annual Percentage Change). Wyniki: Współczynnik SEYLLp z powodu cardiovascular diseases wynosił w 2000 roku 860.3 lat na 10 tys. mężczyzn i 586.9 na 10 tys. kobiet. W latach 2000-2004 współczynniki zmniejszały się w przeciętnym rocznym tempie wynoszącym -0.8% w grupie mężczyzn i 1.2% w grupie kobiet, by w 2014 roku osiągnąć wartość 721.4 lat na 10 tys. mężczyzn i 475.6 na 10 tys. kobiet. W najszybszym tempie zmniejszała się liczba utraconych lat z powodu ischaemic heart disease (AAPC=-3.3% w grupie mężczyzn i -3.2% w grupie kobiet) oraz z powodu cerebrovascular diseases (AAPC=-2.5% w grupie mężczyzn i -3.3% w grupie kobiet). Niewielki i nieistotny statystycznie spadek dotyczył SEYLLp z powodu disaeases of arteries, arterioles and capillaries. Zwiększała się natomiast liczba utraconych lat z powodu heart failure (AAPC=5.7% w grupie mężczyzn i 4.4% w grupie kobiet). W 2014 roku współczynniki SEYLLp osiągnęły następujące wartości: z powodu ischaemic heart disease 207.3 na 10 tys. mężczyzn i 99.1 na 10 tys. kobiet, z powodu cerebrovascular diseases odpowiednio 124.3 i 102.2, z powodu heart failure 155.3 i 104.9, z powodu disaeases of arteries, arterioles and capillaries 83.1 i 92.3. Każdy mężczyzna zmarły z powodu cardiovascular diseases stracił przeciętnie 19.1 lat w 2000 roku i 17.0 lat w 20014 roku (AAPC=-0.5%). W grupie kobiet wartości SEYLLd wyniosły 12.6 lat w 2000 roku i 10,4 lat w 2014 roku (AAPC=-1.4%). We wszystkich spośród analizowanych grup przyczyn zgonów u obu płci zaobserwowano istotny statystycznie spadek wartości SEYLLd. W 2014 roku wskaźniki SEYLLd dla poszczególnych grup przyczyn wynosiły: z powodu ischaemic heart disease 18.3 lat wśród mężczyzn i 11.3 lat wśród kobiet, z powodu cerebrovascular diseases odpowiednio 17.3 i 11.5, z powodu heart failure 16.6 i 10.3, zaś z powodu disaeases of arteries, arterioles and capillaries 11.0 i 7.7. Wnioski: W redukcji liczby utraconych lat życia mieszkańców Polski z powodu chorób układu krążenia największy udział mają choroba niedokrwienna serca oraz choroby naczyń mózgowych. W okresie ostatnich 10 lat wzrasta systematycznie liczba utraconych lat życia z powodu niewydolności serca. Zaobserwowano stały spadek przeciętnej liczby utraconych lat życia przez każdą osobę zmarłą z powodu chorób układu krążenia ogółem oraz w każdej z
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analizowanych grup przyczyn zgonów, mogący świadczyć o lepszych efektach działań profilaktycznych i bardziej skutecznym leczeniu wydłużającym życie chorych. Słowa kluczowe: utracone lata życia, choroby układu krążenia, przedwczesna umieralność, trendy, Polska
INTRODUCTION Mortality statistics are the most reliable, indirect source of information on health of a population. The register of deaths and their causes, held in the form, which is in compliance with WHO standards, has existed in Poland since 1959. The data gathered in the register was obtained from death certificates. The register of death certificates, unlike the register of diseases, is almost complete. An analysis of particular diseases which cause mortality in most developed countries, conducted with the use of the aforementioned mortality indices, indicates that it is cardiovascular diseases which contribute to the highest death rate [1]. Since these diseases contribute to death mostly in elderly people, social and economic implications are less severe than for causes which are responsible for death of younger people. Hence, authors of studies on international epidemiology more and more frequently use measures which express premature mortality in units of lost time [2-6]. In 2014, deaths due to cardiovascular diseases made up 40.3% of the total number of male deaths and 50.3% of the total number of female deaths [7]. Lost years of life due to cardiovascular diseases constituted respectively 31.9% and 35.6% of the total number of lost years of life in all inhabitants of Poland [8]. It should be pointed out that ischemic heart disease and cerebrovascular diseases, due to their high incidence, contributed to the highest number of lost years of life in all Polish inhabitants. However, considering the average number of years of life lost by one male, due to a particular cause, heart disease and cerebrovascular diseases took only the 11th and 13th positions, respectively. With regards to the average number of years of life lost by one female, these two above diseases took only the 16th and 17th positions, respectively [8]. Despite many advances in prophylaxis and treatment of cardiovascular diseases, prognoses reveal that these diseases will still be the main cause of mortality in Polish people for many years ahead. Yet, the improvement will regard extension of lifespan, expressed by measures of years of life lost. It should also be emphasized that years of lost life, calculated according to the methodology used in this study (as the SEYLL index – Standard Expected Years of Life Lost) 4
are one of two components of the synthetic of DALY index (Disability-Adjusted Life Years). DALY refers to a number of years of life lost due to premature mortality and years of life lived with partial disability and one DALY corresponds to one lost year of healthy life. WHO estimates that about 26% of DALY is caused by cardiovascular diseases, which corresponds to 106.5 DALY per 1,000 Polish males and 74.2 DALY per 1,000 Polish females. The values are more than two-fold higher in Poland in comparison to the ones observed in Ireland and France and with regards to males, also higher than in Holland, Spain or Denmark [9]. The aim of the study was to determine trends and pace of changes in years of life lost, in inhabitants of Poland, in 2000 – 2014 due to cardiovascular diseases, particularly including ischemic heart disease, cerebrovascular diseases, diseases of arteries, arterioles and capillaries and heart failure.
METHODS The study material includes a database which contains information gathered from 5,601,568 death certificates of inhabitants of Poland, who died between 2000 and 2014, provided by the Department of Information of the Polish Central Statistical Office. Cardiovascular diseases were the cause of 2,587,141 of these deaths (46.2%). Years of life lost were counted and analyzed by the method described by Christopher Murray and Alan Lopez in Global Burden of Disease (GBD) [10]. The SEYLL index (Standard Expected Years of Life Lost) is calculated from the expected remaining years, as specified by a normative survivorship that is derived from model life tables for the referential (standard) population. There are a few methods of calculating the number of lost years of life and the main difference between them is a reference point, i.e. a mortality level which is considered „ideal”. In the study Global Burden of Disease (GBD) 2010 WHO experts developed a new reference standard life table by identifying the lowest observed death rate for any age-group in countries with more than five million in population - to avoid chance fluctuations in death [11]. In this study the SEYLL index was calculated according to the following formula:
where: – the number of expected years of life for each age, based on GBD 2010 life table 5
dx – the number of deaths in age x x – the age at which the person died l – the last year of age till the population lives
The authors also calculated the SEYLLp (per living person) index, where the absolute SEYLL number was compared with the size of the Polish population in particular years and SEYLLd (per death) index, which relate absolute SEYLL numbers to the number of subjects who died due to the analysed cause [12]. Death causes are coded according to the International Statistical Classification of Diseases and Health Related Problems – Tenth Revision – ICD-10. The authors of the study analysed diseases of the circulatory system in total (I00-I99), including ischemic heart diseases (I20-I25), heart failure (I50), cerebrovascular diseases (I60-I69) and diseases of arteries, arterioles and capillaries (I70-I79). The analysis of time trends has been carried out with joinpoint models and Joinpoint Regression Program (version 4.0.3 April 2013; Statistical Research and Applications Branch, National Cancer Institute). This method is an advanced version of linear regression, where time trend is expressed with a broken line, which is a sequence of segments joined in joinpoints. In these points, the change of the value is statistically significant (P
