NDPHS PYLL-2 Study on-line Seminar 14.05.2021 BELARUS & NORT-WEST RUSSIA & Northern Dimension (ND) average Preventable premature mortality in Northern Dimension Partnership countries 2003-2017 Mikko Vienonen ([email protected]) Terveyden ja hyvinvoinnin laitos Finnish National Institute for Health & Welfare BELARUS BELARUS 9,5 14.5.2021 2 INTRODUCTION Overview of 10 NDPHS countries’ record on amenable mortality (POTENTIAL YEARS OF LIFE LOST = PYLL) Methods: Preventable premature deaths were described by Potential Years of Life Lost (PYLL). 1. PYLL data consisted of death registers for 2003, 2009, 2013 and 2017; 2. PYLL-rates were age-standardized by using standard OECD population from 1980; 3. PYLL-rates were expressed as sum of lost life years per 100 000 citizens, from the age of death until they would have lived until 70 years of age. Mikko Vienonen/ NCD EG14.5.2021 3 CONTENTS: • BACKGROUND: Why to monitor premature death ? • METHODOLOGY: Definition of PYLL, ICD-10 classification and age-standardization • DATA: Death and population data applied • RESULTS: Quantitative: 1/ International situation now 2/ Development 2003 --> 2017 by 2 countries (BELARUS & NW-RUSSIA) 3/ Loss of human capital by countries Qualitative: 1/ Country specific successes in feedback seminars 2/ Questions for NDPHS on PYLL-monitoring • CONCLUSIONS: What to do and what not to do ? Mikko Vienonen/ NCD EG14.5.2021 4 PART 1: Overview 2003 – 2009 – 2013 – 2017 10 NDPHS countries’ record on amenable/ avoidable mortality (PYLL-2) PYLL: Helps to understand the size of losses in human life = YEARS !!! Life expectancy Mortality rate Incidence of diseases Prevalence of diseases … 88 European core health indicators ECHI etc. etc. Mikko Vienonen/ NCD EG14.5.2021 5 METHODOLOGY Amer Journal of Public Health, Vol 40, 1950 (17-26) Mikko Vienonen/ NCD EG14.5.2021 6 PYLL-definition: Simple calculation “standard expected length of life ” – before which a death is premature 70 A Pavel died of heart attack at age of 55 years years Pavel’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 = Elisabeth died of brain hemorage at age of 71 years Elisabeth’s PYLL = 70 – 71 = 0 years Mikko Vienonen/ NCD EG14.5.2021 7 WHY ARE PREMATURE DEATHS MONITORED AND PYLL IS CALCULATED ? From Haenszel 1950: Mikko Vienonen/ NCD EG14.5.2021 8 EQUATIONS: Calculation of age-standardized PYLL-rate Equations: Age-standardized PYLL=100000/N x (sum a=0 -> L-1 ((L-a) x (da/na) x Na)) Variance PYLL = (100000/N)**2 x (sum a=0 -> L-1 ((L-a)**2 x (Na/na)**2 x (da/na) x (na-da))) 95 % Confidence interval = age-standardized PYLL +/- 1,96 x square-root (variance PYLL) If CI95 % minimum is <0 ==> lower limit = 0 where (L-a) = lost years of dead at time of death in age group a da = number of dead in age-group a na = person years in age-group a Na = a of age-group in the whole standard population N = size of standard population, x is sign of multiplication and/where **2 means into power of 2 Age-groups are 0 yrs, 1-4 yrs, 5-9 yrs, 10-14 yrs, 15-19 yrs, 20-24 yrs, 25-29 yrs, 30-34 yrs, 35-39 yrs, …, 65- 69 yrs. When the target age 70 is reached, the lost years of a dead one (=L-a) by age-groups are 69.5, 67.0, 62.5, 57.5, 52.5, 47.5, 42.5, 37.5, 32.5, 27.5, 22.5, 17.5, 12.5, 7.5, 2.5 As a standard population the OECD 1980 population is applied; 140669, 547645, 700764, 719340, 741611, 710404, 676832, 660553, 546359, 505176, 481914, 473148, 440361, 337337, 336354 Mikko Vienonen/ NCD EG14.5.2021 9 Preventable Causes of Death by WHO Preventable causes (1-28 categories) 19= 'Diseases of circulatory system (I00-I425,I427-I99)’ 20= 'Ischemic heart disease (I20-I25)’ 1 = 'All causes (A00-R99,V01-Y89)' 21= 'Acute myocardial infarction (I21,I22)’ 2 = 'Infectious, parasitic diseases (A00-B99,J65)' 22= 'Cerebrovascular diseases (I60-I69)’ 3 = 'HIV-disease (B20-B24)’ 23= 'Diseases of respiratory system (J00-J64,J66-J99)’ 4 = ’Hepatitis C (B18.2)’ 24= 'Pneumonia & influenza (J09-J18,J849)’ 5 = 'Malignant neoplasms (C00-C97)’ 25= 'Bronchitis, asthma & emphysema (J40-J47)’ 6= 'Malignant neoplasm of colon, rectum, anus (C18-C21)’ 26= 'Diseases of digestive system 7 = 'Malignant neoplasm of trachea, bronchus, lung (C33-C34)’ (K00-K291,K293-K67,K71-K851,K853- K859,K861- 8= 'Malignant neoplasm of female breast (C50)’ K93)’ 10= ‘Malignant neoplasm of stomach (C16.9)’ 27= 'Chronic liver disease and cirrhosis (K73,K74,K76)’ 11= ‘Malignant neoplasm of prostate (C61)’ 12 = ‘Malignant melanoma of skin (C43.9)’ 28= 'Alcohol related diseases and accidental poisoning by 13 = 'Endocrine, nutritional, metabolic diseases (E00-E90)’ alcohol (F10, G312, 14 = 'Diabetes mellitus (E10-E14)’ G621,G721,I426,K292,K70,K852,K860,O354,P043,Q860,X45)' +( 15 = Diseases of blood & blood forming organs (D50-D89)’ G4051 in Finland) 16 = 'Mental disorders (F00,F02,F04-F09,F11-F99)’ 29= 'External causes of injury & poisoning (V01-X44,X46-Y89)’ 17 = 'Dementia, Alzheimers disease (F01,F03,G30,R54)’ 30= 'Land traffic accidents (V01-V89*)’ 18 = 'Other dis. of nervous system & sense organs 31= 'Other land transport accidents (V01-V89*)’ (G00-G29,G31.0-G311,G31.8-G620,G622-G720,G722-H95)‘ 32= 'Accidental falls (W00-W19)’ 33= 'Suicide (X60-X84,Y870)' Preventable causes continuedMikko Vienonen/ … NCD EG14.5.2021 10 Table 1. PYLL-RATES IN 2017 in the ND-countries COUNTRY TOTAL PYLL WOMEN PYLL MEN PYLL BELARUS 8 890 9. 4 377 9. 13 981 9. ESTONIA 4 986 5. 2 712 5. 7 411 5. FINLAND 3 247 4. 2 139 3.* 4 336 4. GERMANY 3 240 3. 2 349 4.* 4 124 3. LATVIA 7 469 8. 4 074 8. 11 227 8. LITHUANIA 6 880 7. 3 708 7. 10 406 7. NORWAY 2 473 1. 1 921 1. 3 001 1. POLAND 5 286 6. 3 029 6. 7 610 6. NW RUSSIA 9 502 10. 5 363 10. 14 267 10. SWEDEN 2 569 2. 1 955 2. 3 159 2. All ND countries 4 618 2 898 6 371 Arithmetic average of ND 10 5454 3163 7952 Mikko Vienonen/ NCD EG14.5.2021 11 PART 2: Overview of the record of amenable mortality of Belarus & North-West Russia Think of the strategic role of: Health Literacy? Healthy Aging? Human Capital ? Mikko Vienonen/ NCD EG14.5.2021 12 ALL CAUSES M & W Progress of amenable mortality BLR-RUS/NW-POL-SWE 25000 and NDPHS population (Potential Years of Life Lost PYLL ) 20000 15000 10000 PYLL / 100.000 / PYLL 5000 0 2003 2009 2013 2017 All NDPHS countries Belarus Russia Poland Sweden Mikko Vienonen/ NCD EG14.5.2021 13 ALL CAUSES WOMEN Progress of amenable mortality BLR-RUS/NW-POL-SWE and NDPHS population (Potential Years of Life Lost PYLL ) 12000 10000 8000 6000 PYLL/100.000 4000 2000 0 2003 2009 2013 2017 All NDPHS countries Belarus Russia Poland Sweden Mikko Vienonen/ NCD EG14.5.2021 14 ALL CAUSES MEN Progress of amenable mortality BLR-RUS/NW-POL-SWE and NDPHS population 35000 (Potential Years of Life Lost PYLL) 30000 25000 20000 15000 PYLL / 100.000 / PYLL 10000 5000 0 2003 2009 2013 2017 All NDPHS countries Belarus Russia Poland Sweden Mikko Vienonen/ NCD EG14.5.2021 15 Diseases of the circulatory system (I00-I99) M & W 8000 Progress of amenable mortality BLR-RUS/NW- POL-SWE and NDPHS population 7000 (Potential Years of Life Lost PYLL ) 6000 5000 4000 PYLL / 100.000 / PYLL 3000 2000 1000 0 2003 2009 2013 2017 All NDPHS countries Belarus Russia Poland Sweden Mikko Vienonen/ NCD EG14.5.2021 16 Diseases of the circulatory system (I00-I99) WOMEN Progress of amenable mortality BLR-RUS/NW- POL-SWE 4000 and NDPHS population 3500 (Potential Years of Life Lost PYLL ) 3000 2500 2000 PYLL / 100.000 / PYLL 1500 1000 500 0 2003 2009 2013 2017 All NDPHS countries Belarus Russia Poland Sweden Mikko Vienonen/ NCD EG14.5.2021 17 Diseases of the circulatory system (I00-I99) MEN 12000 Progress of amenable mortality BLR-RUS/NW- POL-SWE and NDPHS population 10000 (Potential Years of Life Lost PYLL ) 8000 6000 PYLL / 100.000 / PYLL 4000 2000 0 2003 2009 2013 2017 All NDPHS countries Belarus Russia Poland Sweden Mikko Vienonen/ NCD EG14.5.2021 18 Malignant neoplasms / Cancer (C00-C97) M & W Progress of amenable mortality BLR - RUS/NW – SWE - POL and ND population (Potential Years of Life Lost PYLL ) 2500 2000 1500 1000 PYLL/ 100.000 PYLL/ 500 All ND countries Belarus Poland Russia Sweden 0 2003 2009 2013 2017 Akselin otsikko Mikko Vienonen/ NCD EG14.5.2021 19 Malignant neoplasms / Cancer (C00-C97) WOMEN Progress of amenable mortality BLR-RUS/NW-SWE-POL and ND population (Potential Years of Life Lost PYLL ) 1800 1600 1400 1200 1000 800 PYLL/ 100.000 PYLL/ 600 400 All ND countries Belarus Poland Russia Sweden 200 0 2003 2009 2013 2017 Akselin otsikko Mikko Vienonen/ NCD EG14.5.2021 20 Malignant neoplasms / Cancer (C00-C97) MEN Progress of amenable mortality BLR-RUS/NW- SWE-POL and ND population (Potential Years of Life Lost PYLL ) 3000 2500 2000 1500 1000 500 All ND countries Belarus Poland Russia Sweden 0 2003 2009 2013 2017 Mikko Vienonen/ NCD EG14.5.2021 21 External causes of mortality (V01--Y89) M & W Progress of amenable mortality BLR-RUS/NW- POL-SWE 7000 and ND population 6000 (Potential Years of Life Lost PYLL ) 5000 4000 3000 PYLL/100.000 2000 1000 0 2003 2009 2013 2017 All ND countries Belarus Poland Russia Sweden Mikko Vienonen/ NCD EG14.5.2021 22 3000 External causes of mortality (V01--Y89) WOMEN Progress of amenable mortality BLR-RUS/NW- POL-SWE and ND population 2500 (Potential Years of Life Lost PYLL ) 2000 1500 PYLL/100.000 1000 500 0 2003 2009 2013 2017 All ND countries Belarus Poland Russia Sweden Mikko Vienonen/ NCD EG14.5.2021 23 External causes of mortality (V01--Y89) MEN Progress of amenable mortality BLR-RUS/NW- POL-SWE 12000 and ND population (Potential Years