Knud Juel
Causes of social inequality
Determinants of illness
80 Life expectancy in Denmark (years) 70 60 Women Men 50 40 30 1845 1855 1865 1875 1885 1895 1905 1915 1925 1935 1945 1955 1965 1975 1985 1995 05 Juel & Christensen. UFL 07
Denmark Norway Sweden Finland UK Ireland Belgium The Netherlands Germany Austria France Switzerland Portugal Spain Greece Italy Canada US Australia New Zeeland
Life expectancy. Denmarks rank among OECD countries Men - Women Top 0 1 2 3 4 5 6 7 8 9 10 11 12 13 14 15 16 17 18 19 Bottom 1950-1959 1960-1969 1970-1979 1980-1989 1990-1999 00-09
Life expectancy, 09 Denmark Chile Costa Rica Cuba Ireland North Korea Slovenia United Arabic Emirates M W 70 75 80 85 Life expectancy (years)
75-100% of the gap in life expectancy between Denmark and Sweden can be attributed to smoking and alcohol
Life expectancy in municipalities. Difference from the average (79,2 years), 07-11. Koch et al. Middellevetid i kommuner og bydele.. SIF, 14
Life expectancy in municipalities. Difference from the average (79,2 years), 07-11 N o. O f m u n i c i p a l i t i e s 25 15 10 5 0 <-1,25-1,25 til -0,5-0,5 til 0 0 til 0,5 0,5 til 1,25 >1,25 23 21 16 16 9 10 Life expectancies Koch et al. Middellevetid i kommuner og bydele.. SIF, 14
Life expectancy in municipalities without deaths related to smoking and alcohol. Difference from the average (83,4 years), 07-11 Koch et al. Middellevetid i kommuner og bydele.. SIF, 14
Life expectancy in municipalities without deaths related to smoking and alcohol. Difference from the average (83,4 years), 07-11 N o. O f m u n i c i p a l i t i e s 30 25 15 10 5 0 <-1,25-1,25 til -0,5-0,5 til 0 0 til 0,5 0,5 til 1,25 >1,25 26 23 18 3 5 Life expectancies without smoking and alcohol Koch et al. Middellevetid i kommuner og bydele.. SIF, 14
Colorectal cancer, men, 35-74 years Age standardized mortality rates per 100 000 60 50 40 30 10 0 Denmark Norway Sweden Finland 1952 1957 1962 1967 1972 1977 1982 1987 1992 1997 02 07 12
Breast cancer, women, 35-74 years Age standardized mortality rates per 100 000 80 70 60 50 40 30 10 0 Denmark Norway Sweden Finland 1952 1957 1962 1967 1972 1977 1982 1987 1992 1997 02 07 12
Lung cancer, women, 35-74 years Age standardized mortality rates per 100 000 80 60 40 Denmark Norway Sweden Finland 0 1952 1957 1962 1967 1972 1977 1982 1987 1992 1997 02 07 12
Why cancer deaths???
http://www-dep.iarc.fr/nordcan/dk/frame.asp Lung cancer, men 1 year age standardized relative survival (%), age 0-89 100 80 60 Denmark Norway Sweden Finland 40 0 1964-1968 1969-1973 1974-1978 1979-1983 1984-1988 1989-1993 1994-1998 1999-03 04-08 09-12
http://www-dep.iarc.fr/nordcan/dk/frame.asp Lung cancer, women 1 year age standardized relative survival (%), age 0-89 100 80 60 Denmark Norway Sweden Finland 40 0 1964-1968 1969-1973 1974-1978 1979-1983 1984-1988 1989-1993 1994-1998 1999-03 04-08 09-12
http://www-dep.iarc.fr/nordcan/dk/frame.asp Colorectalcancer, men 1 year age standardized relative survival (%), age 0-89 100 80 60 40 Denmark Norway Sweden Finland 0 1964-1968 1969-1973 1974-1978 1979-1983 1984-1988 1989-1993 1994-1998 1999-03 04-08 09-12
http://www-dep.iarc.fr/nordcan/dk/frame.asp Colorectalcancer, women 1 year age standardized relative survival (%), age 0-89 100 80 60 40 Denmark Norway Sweden Finland 0 1964-1968 1969-1973 1974-1978 1979-1983 1984-1988 1989-1993 1994-1998 1999-03 04-08 09-12
IHD, men, 35-74 years Age standardized mortality rates per 100 000 800 700 600 500 400 Denmark Norway Sweden Finland 300 0 100 0 1952 1957 1962 1967 1972 1977 1982 1987 1992 1997 02 07 12
Mortality from AMI. Age standardized rates per 100.000. Average 07-11 Men Women 140 140 1 1 100 100 80 80 60 60 40 40 - Hovedstaden Sjælland Syddanmark Midtjylland Nordjylland - Hovedstaden Sjælland Syddanmark Midtjylland Nordjylland Koch et al. Akut myokardieinfarkt. Dødelighed og overlevelse. Regional sammenligninger. SIF, 14
50 Mortality from AMI at hospital. Age standardized rates per 100.000. Average 07-11 Men 35 Women 45 40 30 35 25 30 25 15 15 10 10 5 5 - Hovedstaden Sjælland Syddanmark Midtjylland Nordjylland - Hovedstaden Sjælland Syddanmark Midtjylland Nordjylland Koch et al. Akut myokardieinfarkt. Dødelighed og overlevelse. Regional sammenligninger. SIF, 14
Mortality from AMI outside hospital. Age standardized rates per 100 000. Average 07-11 Men Women 90 50 80 45 70 60 50 40 30 40 35 30 25 15 10 10 5 - Hovedstaden Sjælland Syddanmark Midtjylland Nordjylland - Hovedstaden Sjælland Syddanmark Midtjylland Nordjylland Koch et al. Akut myokardieinfarkt. Dødelighed og overlevelse. Regional sammenligninger. SIF, 14
30 days mortality after AMI admission. Proportion (%) 07-11 Men Women Hovedstaden Sjælland Syddanmark Midtjylland Nordjylland Hovedstaden Sjælland Syddanmark Midtjylland Nordjylland 40 40 35 35 30 30 25 25 15 15 10 10 5 5 0 35-64 år 65-74 år 75-84 år 85+ år 0 35-64 år 65-74 år 75-84 år 85+ år Koch et al. Akut myokardieinfarkt. Dødelighed og overlevelse. Regional sammenligninger. SIF, 14
Primary PCI (percutaneous coronary intervention) at 4 Danish Heart Centres Mortality 13 (%) 0 2 4 6 8 10 12 30 days mortality RH Odense Skejby Aalborg 1 year mortality RH Odense Skejby Aalborg DANISH HEART REGISTER. ANNUAL REPORT. 13
New cases of cardiovascular diseases Age standardized rates per 100.000 1.000 00-04 05-09 800 600 400 0 0 Grundskole Erhvervsfaglig Kort eller mellemlang Women Lang Koch et al. Hjertekarsygdomme i Danmark. SIF, 11
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
Age standardized rates per 100.000 Absolute difference in mortality short/long education. Women 30 years, agest. rates per 100.000 400 Other Smoking Smoking and alcohol Alcohol 350 300 250 0 150 100 50 0 1985-1989 1990-1994 1995-1999 00-04 05-09 Koch et al. BMJ Open 15
Activity limitation Health & quality of life Good self perceived health Bad dental health Relative risk 0 1 2 3 4 5 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
Activity limitation Health behaviour and overweight Relative risk 0 1 2 3 4 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
Excess mortality Mental deficient, register based study All cause mortality compared to the general population, 03-12 Kvinder Mænd 14 12 10 15 years shorter life expectancy 8 6 4 2 0-29 30-39 40-44 45-49 50-54 55-59 60-64 65-69 70-74 75-79 80-84 85-89 90-99 Age Flachs et al. Sundhedstilstanden blandt voksne med udviklingshæmning. SIF, 14
Homeless people (questionaire based) Excess mortality compared to the general population Excess mortality Total 7 Excess mortality Total 7 Men 7 Women 9 16-34 years 25 35-44 years 22 45-54 years 9 55-79 years 3 Davidsen et al. Dødeligheden blandt socialt udsatte i Danmark 07-12. SIF, 13 Alcohol abuser 10 Mentally ill 10 Homeless 8 Drug abuser 12 Poor 10 Other 5 22 years shorter life expectancy
Residents at homeless shelters (register based) Excess mortality compared to the general population SMR 0 10 30 40 50 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 1999-11. SIF, 13
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