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1 Knud Juel

2 Causes of social inequality

3 Determinants of illness

4 80 Life expectancy in Denmark (years) Women Men Juel & Christensen. UFL 07

5 Denmark Norway Sweden Finland UK Ireland Belgium The Netherlands Germany Austria France Switzerland Portugal Spain Greece Italy Canada US Australia New Zeeland

6 Life expectancy. Denmarks rank among OECD countries Men - Women Top Bottom

7 Life expectancy, 09 Denmark Chile Costa Rica Cuba Ireland North Korea Slovenia United Arabic Emirates M W Life expectancy (years)

8 75-100% of the gap in life expectancy between Denmark and Sweden can be attributed to smoking and alcohol

9 Life expectancy in municipalities. Difference from the average (79,2 years), Koch et al. Middellevetid i kommuner og bydele.. SIF, 14

10 Life expectancy in municipalities. Difference from the average (79,2 years), N o. O f m u n i c i p a l i t i e s <-1,25-1,25 til -0,5-0,5 til 0 0 til 0,5 0,5 til 1,25 >1, Life expectancies Koch et al. Middellevetid i kommuner og bydele.. SIF, 14

11 Life expectancy in municipalities without deaths related to smoking and alcohol. Difference from the average (83,4 years), Koch et al. Middellevetid i kommuner og bydele.. SIF, 14

12 Life expectancy in municipalities without deaths related to smoking and alcohol. Difference from the average (83,4 years), N o. O f m u n i c i p a l i t i e s <-1,25-1,25 til -0,5-0,5 til 0 0 til 0,5 0,5 til 1,25 >1, Life expectancies without smoking and alcohol Koch et al. Middellevetid i kommuner og bydele.. SIF, 14

13 Colorectal cancer, men, years Age standardized mortality rates per Denmark Norway Sweden Finland

14 Breast cancer, women, years Age standardized mortality rates per Denmark Norway Sweden Finland

15 Lung cancer, women, years Age standardized mortality rates per Denmark Norway Sweden Finland

16 Why cancer deaths???

17 Lung cancer, men 1 year age standardized relative survival (%), age Denmark Norway Sweden Finland

18 Lung cancer, women 1 year age standardized relative survival (%), age Denmark Norway Sweden Finland

19 Colorectalcancer, men 1 year age standardized relative survival (%), age Denmark Norway Sweden Finland

20 Colorectalcancer, women 1 year age standardized relative survival (%), age Denmark Norway Sweden Finland

21 IHD, men, years Age standardized mortality rates per Denmark Norway Sweden Finland

22 Mortality from AMI. Age standardized rates per Average Men Women Hovedstaden Sjælland Syddanmark Midtjylland Nordjylland - Hovedstaden Sjælland Syddanmark Midtjylland Nordjylland Koch et al. Akut myokardieinfarkt. Dødelighed og overlevelse. Regional sammenligninger. SIF, 14

23 50 Mortality from AMI at hospital. Age standardized rates per Average Men 35 Women Hovedstaden Sjælland Syddanmark Midtjylland Nordjylland - Hovedstaden Sjælland Syddanmark Midtjylland Nordjylland Koch et al. Akut myokardieinfarkt. Dødelighed og overlevelse. Regional sammenligninger. SIF, 14

24 Mortality from AMI outside hospital. Age standardized rates per Average Men Women Hovedstaden Sjælland Syddanmark Midtjylland Nordjylland - Hovedstaden Sjælland Syddanmark Midtjylland Nordjylland Koch et al. Akut myokardieinfarkt. Dødelighed og overlevelse. Regional sammenligninger. SIF, 14

25 30 days mortality after AMI admission. Proportion (%) Men Women Hovedstaden Sjælland Syddanmark Midtjylland Nordjylland Hovedstaden Sjælland Syddanmark Midtjylland Nordjylland år år år 85+ år år år år 85+ år Koch et al. Akut myokardieinfarkt. Dødelighed og overlevelse. Regional sammenligninger. SIF, 14

26 Primary PCI (percutaneous coronary intervention) at 4 Danish Heart Centres Mortality 13 (%) days mortality RH Odense Skejby Aalborg 1 year mortality RH Odense Skejby Aalborg DANISH HEART REGISTER. ANNUAL REPORT. 13

27 New cases of cardiovascular diseases Age standardized rates per Grundskole Erhvervsfaglig Kort eller mellemlang Women Lang Koch et al. Hjertekarsygdomme i Danmark. SIF, 11

28 Heavy smoking Sex- and age adjusted Odds Ratios 0,0 1,0 2,0 3,0 4,0 Basic school Upper secondary/vocational Short higher education Medium-length higher Long higher education 2,6 % 14,4 % Employed Unemployed Early retirements pensioners Married Separated, divorced Widowhood DANSKERNES SUNDHED DEN NATIONALE SUNDHEDSPROFIL 13

29 Age standardized rates per Absolute difference in mortality short/long education. Women 30 years, agest. rates per Other Smoking Smoking and alcohol Alcohol Koch et al. BMJ Open 15

30 Activity limitation Health & quality of life Good self perceived health Bad dental health Relative risk Pain in the muscosceletel system Headache Tiredness Sleep problems Mental symptoms Nogen aktivitetsbegrænsning Alvorlig aktivitetsbegrænsning Stress No sexual intercourse Dissatisfied with sexlife Johnsen et al. Sundhedsprofil for voksne med helbredsrelateret aktivitetsbegrænsning og fysisk funktionsnedsættelse. SIF, 14

31 Activity limitation Health behaviour and overweight Relative risk No daily intake of vegetables Weekly intake of fastfood Daily smoking Nogen aktivitetsbegrænsning Alvorlig aktivitetsbegrænsning Heavy smoking Alcohol intake over the low limits Alcohol over the high limits Sedentary acticvity in leisure time Moderate/hard physical acticity in leisure time Overweight Heavy overweight Johnsen et al. Sundhedsprofil for voksne med helbredsrelateret aktivitetsbegrænsning og fysisk funktionsnedsættelse. SIF, 14

32 Excess mortality Mental deficient, register based study All cause mortality compared to the general population, Kvinder Mænd years shorter life expectancy Age Flachs et al. Sundhedstilstanden blandt voksne med udviklingshæmning. SIF, 14

33 Homeless people (questionaire based) Excess mortality compared to the general population Excess mortality Total 7 Excess mortality Total 7 Men 7 Women years years years years 3 Davidsen et al. Dødeligheden blandt socialt udsatte i Danmark SIF, 13 Alcohol abuser 10 Mentally ill 10 Homeless 8 Drug abuser 12 Poor 10 Other 5 22 years shorter life expectancy

34 Residents at homeless shelters (register based) Excess mortality compared to the general population SMR Tuberculosis 47 AIDS 19 Lung cancer 3 Pneumonia 9 COPD 6 Alcohol, natural death 19 Drugs, natural death 40 Alcohol, non natural death 36 Drugs, non natural death 30 Davidsen et al. Dødelighed og dødsårsager blandt brugere af herberger, forsorgshjem mv. i Danmark SIF, 13

35 Concluding points Be careful with comparisons Health behaviour and social position means a lot To the citizens: Visit the GP in time and do not smoke About the health care system: Listen to the other speakers