Morbidity and mortality indicators update

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Morbidity and mortality indicators update

• Jane Buxton Andrew Tu
• Tim Stockwell and Lorissa Martens

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Outline

• Alcohol
• Should report include cases prevented?
• Acute versus chronic
• Age breakdown
• Illicit drugs
• HCV 60 attributable is this realistic?
• Data is by residence
• Hospitalizations vs. deaths
• Tobacco-
• Effect changes prevalence rates

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Estimated substance use hospital admissions
2003-07
Estimated substance use deaths 2002-06
78
55
15
36
6
9
N 29,217
N 245,887
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Alcohol Attributable fraction

• To what extent is a substance responsible for
  causing a problem
• The proportion of disease that would disappear if
  there had been no alcohol/tobacco/illegal drug
  consumption
• Moderate drinking may prevent hospitalizations/dea
  ths
• Should we subtract prevented / just report those
  caused by?

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Estimated Hospitalizations
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Age and sex standardized rates of alcohol
attributable hospitalizations (Net)
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Chronic / Acute Conditions

• Chronic
• Cancers (oral, oesophageal, liver, laryngeal,
  etc.)
• Diabetes
• Neuro-psychiatric (dependence, abuse, psychoses,
  etc.)
• Cardiovascular (hypertension, IHD, stroke, etc.)
• Digestive (cirrhosis, pancreatitis,
  cholelithiasis, etc.)
• Perinatal (LBW, FAD)
• Acute
• Unintentional injuries (MVA, poisonings, falls,
  fires, etc.)
• Intentional injuries (suicides, homicides, etc.)

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Hospitalization Indicators
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Alcohol age specific rates/10,000
(hospitalization)
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Age specific rates, 2005 (hospitalization)
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Alcohol age specific rates/10,000 (deaths)
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Hospitalization rate attributable to alcohol by HA
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Conclusion re alcohol

• Alcohol hospitalization/death rates fairly
  stable,
• ex. NHA
• Is it more meaningful to consider caused by?
• Ignores 18 overall prevented
• Chronic conditions eg alcohol psychoses
  cirrhosis correspond with total ?Use as
  indicator
• Overall hospitalization/death rates increase with
  age
• High rate of acute conditions in 15-24 75
  males

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Illicit drugs

• General increase hospitalization (esp NHA)
• HCV currently 60 attributed
• Disparity mortality vs. morbidity by HSDA
• Data is by residence

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Rate hospitalization attributable to illicit drugs
49 increase 2002 to 2007
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IDD attributable hospitalization rates 2007
IDD attributable death rates 2007
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Why the difference?

• In 2006
• Hospitalizations
• Mental and behavioural disorders (58)
• Drugs causing adverse affect in therapeutic use
  (13)
• Suicides (8.5)
• Mortality
• Accidental overdose (59)
• Code X42 accidental poisoning by/ exposure to
  narcotics psychodyleptics i.e. not drug
  specific
• Infection (24)

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IDD 2006 using BC Coroners data

• Cocaine identified in 80 deaths
• Opiates identified in 60 deaths
• 79 all deaths 2 or more substances
• Opiates more frequently identified in Vancouver

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Tobacco

• Estimate new mortality and morbidity burden using
  BC data
• BC prevalence data from CTUMS (3-year rolling
  average)
• Adjust for latency period (General social survey
  1985)

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BC Smoking prevalence
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Conclusion re Tobacco

• Using static prevalence does not tell full story
• Should we adjust for latency period? If so, how
  long? Impossible to tell cant directly
  associate death or hospitalization with smoking