Eksempler på anvendelse af registre og surveys til forskning om social ulighed i middellevetid og forventet levetid med godt helbred

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1 Temadag om danske sundhedsregistre 28 juni 2012 Eksempler på anvendelse af registre og surveys til forskning om social ulighed i middellevetid og forventet levetid med godt helbred Henrik Brønnum-Hansen

2 Register data Sociale faktorer Uddannelse Fast gruppering Kvartiler Indkomst Husstandsækvivaleret disponibel indkomst Helbred Dødsrater Dødsårsager Social ulighed i middellevetid Survey data Selvrapporteret helbred Selvvurderet helbred Langvarig sygdom Specifikke sygdomme Social ulighed i sygdomsbyrde Tobak og muskelog skeletsygdom Andre selvrapporterede oplysninger Livsstil (tobak, alkohol, inaktivitet etc.)

3 Middellevetid og forventet restlevetid

4 Survival probability Department of Public Health Survival curve Age

5 Survival probability Department of Public Health Life expectancy Life years Age

6 Survival probability Department of Public Health Life expectancy at age Age

7 Survival probability Department of Public Health Life expectancy at age Life years Age

8 Register data Sociale faktorer Uddannelse Fast gruppering Kvartiler Indkomst Husstandsækvivaleret disponibel indkomst Helbred Dødsrater Dødsårsager Social ulighed i middellevetid Survey data Selvrapporteret helbred Selvvurderet helbred Langvarig sygdom Specifikke sygdomme Social ulighed i sygdomsbyrde Tobak og muskelog skeletsygdom Andre selvrapporterede oplysninger Livsstil (tobak, alkohol, inaktivitet etc.)

9 Life expectancy by educational level at age 30 Years Women Educational level 53 Higher education Skilled worker 51 Post-secondary schooling or voccational training Unskilled worker

10 Life expectancy by educational level at age 30 Years Women Educational level 53 Higher education Skilled worker Post-secondary schooling or voccational training Unskilled worker Years Men Educational level 50 Higher education Post-secondary schooling or voccational training Skilled worker Unskilled worker

11 Antal danskere med lang videregående uddannelse Alder: år

12 Antal danskere med lang videregående uddannelse Alder: år

13 Antal danskere med lang videregående uddannelse Alder: år

14 Andel ufaglærte, kvinder Pct Pct Alder

15 Fordeling af uddannelseslængde Pct ,5 år 14,7 år år 60 år år Antal måneder

16 Life expectancy by educational level at age 30 Years Men Educational level 50 Higher education 48 Post-secondary schooling or voccational training Years Men Educational quartile Highest Second highest Second lowest 46 Skilled worker Unskilled worker 46 Lowest

17 Life expectancy by educational level at age 30 Years Women Educational quartile Highest Second highest Second lowest Lowest Years Men Educational quartile Highest Second highest Second lowest Lowest

18 Life expectancy at birth by equivalent disposable income quartiles Years Women Income High Mean high Mean low Low Years Men Income High Mean high Mean low Low

19 Age specific contributions to changes between 1987 and 2011 in life expectancy in the highest and lowest quartile of equivalent disposable income Age group Income quartile Total Men High income Low income Difference Women High income Low income Difference

20 Social ulighed i sygdomsbyrden (cancer, hjertekarsygdomme og muskel- og skeletsygdomme)

21 Survival probability Life expectancy and health expectancy Healthy life years lost Healthy life years Age

22 Metode: Effekt af eliminering af specifik sygdom

23 Survival probability Life expectancy and expected lifetime with and without long-standing, limiting illness before elimination of a specific disease Years with longstanding illness Years without long-standing illness Age

24 Survival probability Life expectancy and expected lifetime with and without long-standing, limiting illness after elimination of a specific disease Years with longstanding illness Years without long-standing illness Age

25 Survival probability Department of Public Health Life expectancy and expected lifetime with and without long-standing, limiting illness at age Years without long-standing illness Age Years with longstanding illness

26 Register data Sociale faktorer Uddannelse Fast gruppering Kvartiler Indkomst Husstandsækvivaleret disponibel indkomst Helbred Dødsrater Dødsårsager Social ulighed i middellevetid Survey data Selvrapporteret helbred Selvvurderet helbred Langvarig sygdom Specifikke sygdomme Social ulighed i sygdomsbyrde Tobak og muskelog skeletsygdom Andre selvrapporterede oplysninger Livsstil (tobak, alkohol, inaktivitet etc.)

27 Department of Public Health

28 Data sources Mortality, register linkage (Statistics Denmark) Educational, sex- and age-specific numbers of persons at risk and the numbers of deaths from selected causes during the period Health interview survey 2000 (National Institute of Public Health) Educational, sex- and age-specific prevalence of long-standing, limiting illness

29 Long-standing, limiting illness Interview question: Do you suffer from any long-standing illness, long-standing aftereffect of injury, any disability, or other long-standing condition? If yes questions were asked to clarify: the nature of the disease(s) (up to four diseases) whether the disease implied restrictions to daily life or at work

30 Methods Construction of life tables (by sex) Disease elimination Construction of cause-deleted life tables Elimination of specific diseases from prevalence of long-standing, limiting illness Health expectancy estimates Expected lifetime with and without long-standing, limiting illness Observed Hypothetical after disease elimination

31 Gain in partial life expectancy and changes in expected lifetime with and without long-standing, limiting illness due to elimination of cancer at age 30 Eliminated disease: Neoplasms Educational level Men Gain in life expectancy at age 30 Women Gain in life expectancy at age 30 High Medium Low All Years Years Added lifetime without long-standing illness Added lifetime with long-standing illness More years w ith long-standing illness

32 Gain in partial life expectancy and changes in expected lifetime with and without long-standing, limiting illness due to elimination of diseases of the circulatory system at age 30 Eliminated disease: Diseases of the circulatory system Educational level Men Gain in life expectancy at age 30 Women Gain in life expectancy at age 30 High Medium Low All ,0-0,5 0,0 0,5 1,0 1,5 2,0 Years -1,0-0,5 0,0 0,5 1,0 1,5 2,0 Years Added lifetime without long-standing illness Added lifetime with long-standing illness Few er years w ith long-standing illness

33 Gain in partial life expectancy and changes in expected lifetime with and without long-standing, limiting illness due to elimination of diseases of the musculoskeletal system at age 30 social gradient Eliminated disease: Diseases of the musculoskeletal system Educational level High Men Gain in life expectancy at age Women Gain in life expectancy at age Medium Low All Years Years Added lifetime without long-standing illness Added lifetime with long-standing illness

34 Rygning og den sociale gradient i forventet restlevetid med muskel- og skelet sygdomme

35 Smoking Musculoskeletal disease Social position

36 Formål: at estimere forskelle mellem uddannelsesgrupper i forventet restlevetid uden og med muskelog skeletsygdomme blandt aldrigrygere og rygere

37 Register data Sociale faktorer Uddannelse Fast gruppering Kvartiler Indkomst Husstandsækvivaleret disponibel indkomst Helbred Dødsrater Dødsårsager Social ulighed i middellevetid Survey data Selvrapporteret helbred Selvvurderet helbred Langvarig sygdom Specifikke sygdomme Social ulighed i sygdomsbyrde Tobak og muskelog skeletsygdom Andre selvrapporterede oplysninger Livsstil (tobak, alkohol, inaktivitet etc.)

38 Data sources: Life tables ( ) and cause specific death rates by sex, age and educational level ( ) established from Statistics Denmark by register linkage on the basis of a unique personal identification code Lung cancer death rates among never smokers and smokers and relative risks for death from specific causes for smokers versus never smokers estimated at the second prospective Cancer Prevention Study (CPS-II) of the American Cancer Society Prevalence of health status by sex, age, educational level and smoking category established from the Danish Health Interview Survey 2000 Relative risks for death from all causes for smokers versus never smokers estimated from the Danish National Cohort Study (DANCOS) established by linking data from the Danish Health Interview Survey for 1987, 1991 and 1994, the Cause of Death Register and other national registers

39 The Danish Health Interview Survey 2000 Interviews of adult Danes (age: 16+) Long-standing illness "Do you suffer from any long-standing illness, long-standing after-effect of injury, any disability, or other long-standing condition?" (no / yes) Musculoskeletal disease clarified by means of an open question Arthritis Arthrosis Low-back pain and other musculoskeletal disorders

40 The Danish Health Interview Survey 2000 Smoking prevalence "Do you smoke? (yes daily; yes, but some days I don't smoke; no) "Have you ever been a smoker?" (to identify ex-smokers) Questions on amount of tobacco smoked Smoking categories Never smoker Ex-smoker Moderate smoker (1-14 gram of tobacco per day) Heavy smoker ( 15 gram of tobacco per day)

41 Educational level Information about schooling, vocational training and further education Register information (Statistics Denmark) Questions in the health interview survey Danish adaptation of UNESCO s International Standard Classification of Education grouped into three levels: Low Medium High

42 Construction of life tables by smoking category on the basis of the method of Peto et al. L ~ Danish lung cancer death rates A ~ lung cancer death rates among never smokers, CPS-II C ~ lung cancer death rates among smokers, CPS-II L is sex-, age- and educational level-specific A and C are sex- and age-specific *) Then PC (1- P ) A L or P (L - A) (C / - A) where P is the synthetic smoking prevalence P is sex-, age- and educational level-specific *) Assumption: A and C do not differ between educational levels

43 Construction of life tables by smoking category on the basis of the method of Peto et al., continued The etiological fraction for smoking-related causes of death other than lung cancer (upper aerodigestive cancers, other cancers, chronic obstructive lung disease, other diseases of the respiratory system, vascular diseases and other natural causes): P(RR 1) 1 P(RR 1) where RR is the relative risk (CPS-II). The conservative estimate P(RR 1) 2 P(RR 1) was used.

44 Construction of life tables by smoking category on the basis of the method of Peto et al., continued Estimation of sex-, age- and educational level-specific mortality rates due to smoking Estimation of sex-, age- and educational level-specific death rates and a life table for never smokers Calculation of (sex-, age- and educational level-specific) death rates for ex-smokers, moderate smokers and heavy smokers by multiplying deaths rates for never smokers with relative risk estimates for death Construction of life tables for ex-smokers, moderate smokers and heavy smokers

45 Years Department of Public Health Life expectancy by educational level and smoking category 60 High educational level 30-year-old men Medium educational level Low educational level years 8.5 years 8.9 years Never smoker Ex-smoker Moderate smoker Heavy smoker Never smoker Smoking category Ex-smoker Moderate smoker Heavy smoker Never smoker Ex-smoker Moderate smoker Heavy smoker

46 Years Department of Public Health Life expectancy and expected lifetime without musculoskeletal disease by educational level and smoking category 60 High educational level 30-year-old men Medium educational level Low educational level 50 Life expectancy Expected lifetime without musculoskeletal disease 10 0 Never smoker Ex-smoker Moderate smoker Heavy smoker Never smoker Smoking category Ex-smoker Moderate smoker Heavy smoker Never smoker Ex-smoker Moderate smoker Heavy smoker

47 Years Department of Public Health Life expectancy and expected lifetime with and without musculoskeletal disease by educational level and smoking category 60 High educational level 30-year-old men Medium educational level Low educational level 50 Life expectancy Expected lifetime without musculoskeletal disease Expected lifetime with musculoskeletal disease 0 Never smoker Ex-smoker Moderate smoker Heavy smoker Never smoker Smoking category Ex-smoker Moderate smoker Heavy smoker Never smoker Ex-smoker Moderate smoker Heavy smoker

48 Years Department of Public Health Life expectancy and expected lifetime with and without musculoskeletal disease by educational level and smoking category High educational level Life expectancy 30-year-old men Medium educational level Low educational level High educational level Life expectancy 30-year-old women Medium educational level Low educational level Expected lifetime without musculoskeletal disease 30 Expected lifetime without musculoskeletal disease Expected lifetime with musculoskeletal disease Expected lifetime with musculoskeletal disease 0 Never smoker Ex-smoker Moderate smoker Heavy smoker Never smoker Smoking category Ex-smoker Moderate smoker Heavy smoker Never smoker Ex-smoker Moderate smoker Heavy smoker 0 Never smoker Ex-smoker Moderate smoker Heavy smoker Never smoker Smoking category Ex-smoker Moderate smoker Heavy smoker Never smoker Ex-smoker Moderate smoker Heavy smoker

49 Konklusion På trods af at rygning reducerer levetiden, forkortes forventet levetid med muskel- og skeletsygdomme ikke hverken blandt dem med højt eller dem med lavt uddannelsesniveau Rygning øger risikoen for knogleskørhed påvirker iltforsyningen til muskelvævet, da risikoen for åreforkalkning forøges og dermed blodets evne til at transportere ilt reduceres etc.

50 God sommer