3 - Excess Mortality Flashcards
What is excess mortality?
The number of deaths being recorded is greater than the number of expected on the basis of past data.
Why is EM higher in Scotland?
This is due to socioeconomic deprivation (e.g. overcrowding, social class) and poverty - health issues are more impactful due to less accessible resources.
Why is the WCS so heavily impacted?
Ischaemic heart disease is a big health issue in Scotland - eating habits. Even when deprivation controlled for, rates are still higher. It is improving more slowly here than the rest of Scotland.
What are the leading killers of this phenomenon?
CVD, cancer, T2D/obesity, alcohol/drugs/suicide.
In what way can two factors be associated? (5)
1 - X causes Y
2 - Y causes X
3 - X and Y are caused by Z
4 - X and Y are associated by artefact (as a result of investigative procedure (not natural))
5 - X and Y are associated by chance
What is a risk factor and its two types?
A risk factor is something that increases your likelihood of getting disease:
1 - modifiable: smoking, diet, physical activity, high bp.
2 - non-modifiable: age, family history, ethnicity.
Is there a determined cause for EM?
The cause of EM is still theorised, as there is many factors which could cause this phenomenon - we do not fully know why it exists.
What is physical activity?
Any bodily movement produced by skeletal muscles that result in energy expenditure - exercise is only a small subset.
What are the current physical activity guidelines?
- 8,000 steps
- 150-300 moderate intensity activity per week or 75-150 of vigorous intensity activity per week.
- muscle strengthening once or twice a week
- limit sedentary time
What are the benefits of physical activity?
- maintains healthy body and mind (bone health, cognitive function, weight etc)
- lower risk of mortality
- decreases risk of developing diseases and health conditions
- aids mental health
- improves quality of sleep and life
What are the two ways we can measure physical activity?
1 - questionnaire: based on personal opinion, 50% achieve guidelines.
2 - accelerometer: <10% achieve guidelines.
What do the terms objective and self-reported measurements imply?
Self-reported measurements usually there will be bias in the data returned, whereas objective ensures accuracy.
What benefit does muscle strengthening have?
We should do a combination of aerobic activity and muscle strengthening.
Grip strength is an indicator of overall strength and can lower your risk of mortality significantly per 5kg/grip strength. Improves prediction of risk of CVD too.
Why is cardiorespiratory fitness important?
- 50% genetic component
- higher cardiorespiratory fitness gives higher life expectancy
- benefits on health outcomes are greatness in those with low fitness
- people with high fitness and strength appear to be protected even if inactive
Why is dietary intake important?
A lack of fruit, seafood, fibre, and nuts/seeds are significant in increasing your risk of mortality.
The eat well plate provides an easy way of measuring food proportions and whether you are eating healthily.
How is socioeconomic status measured in different nations?
Different nations put more weight on different indices of SED like income and employment.
What is the Carstairs index and its pros/cons?
1981 - focuses on male unemployment, lack of car ownership, overcrowding and low occupational social class. It is simple and has no health measures, but has unfair implications such as lack of car and only considering men.
How does alcohol influence EM?
- modifiable
- unit gives guide to consumption and MUP has increased over the years in an effort to intervene - more inaccessible
- 82% reported as low risk or non-drinkers, and 18% as high risk.
- ARLD as a result
- can increase atrial fibrillation
- most ARD seen in men, and are due to cirrhosis of liver or mental effects.
How does deprivation influence ARD?
- least deprived = stable number of ARD, lowest number of non-drinkers and highest number of hazardous drinkers.
= Reasons for this trend - those with higher income have a higher proportion of people exceeding the weekly guideline, but those with a lower income have less, but more people who exceed the limit to a higher extreme. - lower income = higher mortality to ARD.
- ARDs are beginning to drop, less vulnerable society created over generations.
How does smoking influence EM?
- modifiable
- most deprived = highest prevalence of smoking
- causes lung cancer, COPD, CHD, CVD.
- increases rates of lung cancer could be due to lag effect (pollution, better data records)
- smokers have a higher risk in comparison to those who have never smoked in terms of smoking-associated conditions
- If you quit smoking, your risk of conditions will begin and continue to decline over time
What are the challenges faced with modifying behavioural risk factors and how is this being tackled?
- tricky due to the addictive tendencies of these substances, and their prevalence in society (everywhere).
- public health interventions like signage, MUP, increase in minimum buying age, pricing and images on packaging.
How do we use a multidisciplinary approach towards this?
Dahlgreen and Whitehead model - Using legislative, intervention, individual, cultural, and environmental approaches/methods such as Alcohol Framework 2018 and MESAS.
What are two other behavioural risk factors?
- drug use - high in scotland
- suicide - highest in men, and typically occurs between 35-50 for both sexes. It has higher rates in more deprived areas.
What does more risk factors do to your likelihood of developing disease?
The more risk factors, the higher your likelihood of developing chronic diseases as they have an additive effect.
What are blue zones and their causes?
They are regions known for high life expectancy and concentrations of centenarians - like Japan, Greece and Italy.
They eat mainly a plant-based diet and eat meat sparingly.
How does age increase mortality?
The prevalence of health conditions increases with old age. This is a non-modifiable risk factor, but it can be controlled and reduced by making lifestyle changes.
No risk factors at a young age will result in less at old age, whereas one or more will result in an increased chance of more developing with age - could reduce risk of excess biological risk factors.
How does ethnicity influence disease risk?
Prevalence of diabetes increases depending on your race - lower in white, higher in south asians. We also see a higher trend in those from US than UK.
People can have a higher risk despite lower BMI (all down to ethnicity and other risk factors).
Some ethnicities store fat in different areas and so this impacts our disease prevalence.
How do biological risk factors affect COVID-19?
Age is a big risk factor for COVID-19 - older adults and those above 60 face an increased chance and susceptibility to COVID-19 due to the additive effect of risk factors over their life.
How is genetics a risk factor - use FTO as an example.
The FTO gene is associated with higher body weight and so linked to obesity.
FTO carriers will eat more calories per day, and even if this is a small amount more daily it adds up to a significant amount over the year.
How is sex a risk factor?
Women live longer than men due to CVD being more prevalent in men and they overall have an increased risk to more conditions. Fat and muscle distribution also differs, and due to women storing more fat at their hips it is away from vital organs.
How is family history a risk factor?
History of CVD in either parent once you reach the age of around 60 will come into play - the risk of it affecting our health increases. A BMI of ~30 and history of diabetes increases your chance of type 2.
