FROM SHADOW to LIGHT Objectives

Potential Years of Life Lost “PYLL” A MAP FOR HEALTH OF THE POPULATION

Mikko Vienonen [email protected]

“PYLL”

FROM SHADOW TO LIGHT Objectives

1. To assess the problems of early deaths.

2. To direct preventive measures.

3. To evaluate the performance of prevention and treatment. Starting point: simple calculation

Standard-life to which all preventable deaths are reflected 70 y

A = Ivan died of coronary heart attack at age of 55 years Ivan’s PYLL = 70 -55 = 15 years

B = Anna died of alcohol poisoning at age of 28 years Anna’s PYLL = 70 – 28 = 42 years

C = Pelagiya died of stroke at age of 71 years Pelagiya’s PYLL = 70 – 71 = 0 years Methods • The method compares a person’s age at the time of death to his/her expected length of life (=70 yrs).

• Calculation of the index is based on the ICD-10 main cause of death (28 preventable causes).

• The index is age-standardized, and it is calculated as a sum per 100 000 human years. 28 diagnostic groups used calculating the Potential Years of Life Lost (PYLL) rate Käytetyt diagnoosiryhmät (28) laskettaessa ennenaikaisesti menetetyt elinvuodet Nr. Diagnostic groups 1 All causes of death 2 Infectious & parasitic diseases 3 Human Immunodeficiency Virus (HIV) disease 4 Malignant neoplasms 5 Malignant neoplasms of colon, rectum, rectosigmoid junction and anus 6 Malignant neoplasm of trachea, bronchus, lung/

7 Malignant neoplasm of the female breast 8 Endocrine, nutritional and metabolic diseases and immunity disorders 9 Diabetes mellitus 10 Diseases of blood & blood forming organs

Table 1/3 PYLL diagnoses 1-10

(continued…) 28 diagnostic groups used calculating the Potential Years of Life Lost (PYLL) rate Käytetyt diagnoosiryhmät (28) laskettaessa ennenaikaisesti menetetyt elinvuodet

11 Mental and behavioral disorders (continued…) 12 Dementia, Alzheimer’s disease 13 Diseases of nervous system and sense organs 14 Diseases of circulatory system 15 Ischaemic heart disease 16 Acute myocardial infarction, subsequent myocardial infarction 17 Cerebrovascular diseases 18 Diseases of respiratory system 19 Influenza and pneumonia 20 Bronchitis, asthma and emphysema

Table 2/3 PYLL diagnoses 11-20 28 diagnostic groups used calculating the Potential Years of Life Lost (PYLL) rate

(continued…) 21 Diseases of the digestive system 22 Chronic liver disease and cirrhosis 23 Alcohol-related diseases and alcoholic myopathy 24 External causes of injury and poisoning 25 Motor vehicle accidents/ 26 Other transport accidents 27 Accidental falls 28 Suicide and self-inflicted injury

(end)

Table 3/3 PYLL diagnoses 21 -28 Fig. 1 Prematurely lost life years (PYLL) in international comparison 2006

Sweden 3000 Norway 3500 Canada 3600 Finland 4000 Denmark 4100 USA 5200 Russia ?

0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 1 2 3 4 5 6 PYLL (years per 100 000) Fig. 2 International Comparison between Regions in Canada and Finland (PYLL 1999 - 2004)

[1] Vancouver (inh. 570 000) 4984

[2] Helsinki (inh. 560 000) 4436

[1] Prince George Island (inh. 76 000) 5585

[2] Jyväskylä (inh. 84 000) 4087

[1] Victoria (inh. 78 000) 4851

[2] Pori (inh. 76 000) 4575

[1] Prince Rupert Island (inh.15 000) 5995

[2] Pietarsaari (inh. 19 000) 4851 [1] Canada 0 2000 4000 6000 8000 [2] Finland PYLL (years per 100 000) All deaths in Pitkyaranta years 2002 – 2004

N All deaths in Pitkyaranta years 2002 – 2004 Females (red) and Males (blue)

N PYLL per 100.000 population. / year Comparison Pitkyaranta and Iisalmi Pitkäranta/Karelia/ Russian Federation Iisalmi/Finland DIAGNOSTIC GROUPS (20.622 inh. 2007) PR>IS (22.298 inh. 2007) X All causes 26.724 5.5 4.872 Malignant neoplasms 2.240 2.4 924 Diseases of circulatory system 7.203 8.8 817 Diseases of respiratory system 2.291 14.2 161 Diseases of digestive system 1.043 16.3 64 Alcohol related diseases and accidental poisoning by alcohol and chronic liver disease and cirrhosis 924 1.5 627 Fig. 1 Prematurely lost life years (PYLL) in international comparison 2006

Sweden 3000 Norway 3500 Canada 3600 Finland 4000 Denmark 4100 USA 5200 Pitkaranta, Rep. Karelia Russia 26700 23200 SR 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 1 2 3 4 5 6 PYLL (years per 100 000) 2001 average PYLL Canada 5202/100,000 Prematurely lost life years (PYLL) in selected Can adian regions in 2001

5100 7400 Canada av. 7500 Labradoro ntari 9100 O . ab W h N /At 10600 ill Pitkyaranta tan we hurch 13100 23200 a C t m / vu Ma od na 21000 two k Nu vi un Br na Nu 0 5000 10000 15000 20000 25000 PYLL (years per 100 000) Prematurely lost life years (PYLL) in selected Can adian regions Cardiovascular diseases in 2001

501 Canada av. 1195

554 Peer group -F 1146

909 Nunavut -F 1047 Pitkyaranta 5530 851 Nunavik -F 1371

0 500 1000 1500 Women PYLL (years per 100 000) Men Prematurely lost life years (PYLL) in selected Canadian regions Suicides in 2001 Circumpolar viewpoint

175 Canada av. 610

904 Peer group -F 2462

1557 Nunavut -F 7365 3388 Nunavik -F 11656

0 5000 10000 15000

Women PYLL (years per 100 000) Men 28 Preventive causes of death (WHO) B. 1. Statistic. Bureau CALCULATION A. Univ. Kuopion Mortality registry Figures for municipalities 1983-1987 Age standard. FOLLOW UP 1993-1997 (comparability to 2003-2007 nat. average) AND NEW PYLL W & M & All after 2-3 years 1. ANALYSIS

MAKE NEW PLAN OF ACTION/ INTERVENTION STRATEGY C. Referees Municipal council PYLL PROCESS Exec. management F. At least 2 Church, Police Prematurely lost independently School manag. 84 tables Road maintenance etc. lives Summary CONSENSUS

Politicial commitment & publicity 1. MEETING 2. MEETING (public hearing) D. In municipality: leading local Local expertise politicians Other experts according to findings LOCAL consulted health & social care ->Fine tuned 2. ANALYSIS PROFESSIONALS E. assessment Thinking together Practical PYLL-Excercise Case KUOPIO (92.000 inh)

1.What are their main public health problems? 2.What are your suggestions for action? ALL MEN WOMEN compared with national average ALL causes

Malign. neopl

ALL causes

Malign. neopl

Resp. cancer Breast cancer Endocr. & metabolic Diabetes Mental health Circulatory system Ischemic H.D. Acute Cardiac infarct. Stroke Resp. syst. Influenza Chr.lung dis. Alcohol related Accidents Road accidents Suicides All causes men & women All causes men All causes women Accidents & poisoning men suicides men Road-traffic accidents men Falls men Alcohol related diseases & alc. poisoning men Circulatory system men stroke men Malignant tumours/ Cancer men Respiratory system cancer men Malignant tumours/ Cancer women Breast cancer women Respiratory system malignant tumours / women Accidents & poisoning women suicides women Falls women Circulatory system diseases women stroke women Alcohol related diseases & alc. poisoning women PYLL-Excercise wrap-up & conclusions Conclusions

1. PYLL is an objective and sensitive measurement.

2. PYLL is based on international and chronological comparisons.

3. PYLL provides precise objectives and evaluation for reduction of NCDIs by evidence based prevention and treatment. Examples of actions taken at municipal level in Finland in order to reduce immature deaths (PYLL) 1. Planning safe 2. In PHC change 3. Enforcing satisfactory highway crossings treatment practice so treatment of blood- (under or over that as routine early preassure and made into passages). Prevention identification, brief item for remuneration of of identified road-traffic intervention on GPs (Follow-up of accidents (Children! hazardous and outcome). near schools). City- harmful use of 4. Organize low- planning! alcohol is practiced threshold treatment by GPs and public Bike-paths will be built facility for alcohol health nurses at in town centres dependent persons in least once per year especially near schools PHC setting. Facilitation (”EIBI”). It will be and shops. City- of rehabilitation. one quality criteria planning! and item for 5. Organize with PHC, Biking helmets made remuneration of GPs social care, NGOs, compulsory and (Follow-up of police and church ENFORCEMENT put in outcome). initiative to intervene place for biking children and reduce the and adults. production and sale of Collaboration with home-made ”and illegal police. sale. Examples of actions taken at municipal level in Finland in order to reduce immature deaths (PYLL)

6. Reconstruction of 8. Chronic 9. Organize for lonely traffic arrangements alcoholics’ men in country side near an elderly home, employment and possibility for musical where going to a shop rehabilitation activities (choire and made them to cross a programme , whereby orchestra), to overcome dangerous road. they take care of loneliness, excessive Solution: underpassage. maintenance of uncontrolled alcohol use public places meant and 7. Building a fence to for recreation (parks, prevent moose of 10. Reorganize sports-fields, play coming on the highway ambulance –emergency grounds). The in places where there services so that patients purpose is to had frequently been with stroke will have promote their re- serious accidents by access to care adjustment into car hitting a moose. (fibrinolysis) within 15 – society and regular 20 min already during way of life . transport In this way permanent cerebral damage and stroke will be effectively prevented and mortality is reduced. Examples of actions to be taken at municipal level in Finland in order to reduce immature deaths (PYLL) DUE TO ALCOHOL 1. Zero tolerance to 5. In PHC change 8. Restaurants, pubs etc. teenage (under 18) treatment practice so close at 02.00 A.M. alcohol use that as routine early (Note: many stay open identification, brief now until 04 A.M) 2. Use of alcohol among intervention on youth discussed openly 9. Organize low- hazardous and with teacher-parent threshold treatment harmful use of sessions. facility for alcohol alcohol is practiced dependent persons in 3. Alcohol by GPs and public PHC setting. Facilitation advertisements not health nurses at of rehabilitation. allowed in city owned least once per year connection (bus-stops, (”EIBI”). It will be 10. Organize with PHC, municipal buses one quality criteria social care, NGOs, and item for police and church 4. City/ municipal events remuneration of GPs initiative to intervene not allowed to serve free and reduce the alcohol with tax money 6. “Responsible production and sale of (except if there is a full pubs” initiative. home-made ”and illegal 3-course dinner served) 7. Control of sale to sale. underaged(“fake purchasers”) What will happen when you do not look around…. What will happen when you do not look ahead….

Alkoholi tsunami… What will happen when you do not plan together…. – especially in health and social sectors Let’s meet again on health gain - business!

Mikko At least myself and Martha we want a full life! …it might suit to me, as well !