Excess Mortality Flashcards
What is the Glasgow effect?
Life expectancy is generally improving but is consistently worse in Glasgow compared to other European cities. This rate is still higher when controlled for deprivation.
What are Glasgow’s biggest killers?
Cardiovascular disease/stroke, cancer,
type two diabetes, alcohol/drugs, suicide. Many of these are related to poverty and social deprivation.
What are the determinants of health?
The personal, social, economic and environmental factors which effect health. Genetics and lifestyle factors play the biggest role but a individuals social and community networks, and the environment they live in or grew up in play a role.
Why is social deprivation thought to be driving its low life expectancy in Scotland?
Scotland has higher social deprivation than England and Wales.
What conclusions can we draw from a variable associated with a disease?
Each may cause the other or a third independent factor could be influencing both.
What is a risk factor, and what is the difference between a modifiable and non modifiable risk factors?
A risk factor is something that increases the chance of developing a health condition, can be modifiable meaning it can be changed: smoking, weight, or non-modifiable meaning it cant be changed: age, family history.
What is meant by the term health?
Health is defined as a state of complete physical, mental and social wellbeing and not merely absence of disease or infirmity. (WHO)
Why does the WHO’s definition of health face criticism?
It is impossible to retain this over the course of your whole life, nobody is healthy all the time. Implies people are unhealthy most of the time.
How does WHO’s definition of health allow pharmaceutical companies to benefit?
Seeing as the requirement for health leaves most people unhealthy all the time, this allows pharmaceutical. It allows drugs to be created for conditions not previously defined as health problems and leads to the medicalization of society.
Why may WHO’s definition be outdated with current developments in health?
The nature of disease in more developed countries has changed in the last 50 years. When the definition was created infectious diseases were the primary cause of mortality, but now lifestyle related chronic conditions have the highest mortality rates. Many people with chronic illnesses can function normally, but WHO labels them as always ill.
Why is it hard to measure health with WHO’s definition?
A complete state of health is not measurable, this is the reference state so it is hard to classify who exactly is healthy and who isn’t.
What is an alternative, more relevant definition of health?
The ability to adapt and to self manage. This relates to resilience or capacity to cope with challenges, including illness.
What are the three domains of health?
- Physical health
- Mental health
- Social health
What is meant by physical health?
An individuals ability to cope with physiological stress using protective responses. The ability to maintain homeostasis is the body. A healthy individual should be able to mount a protective response against a physiological stressor and avoid or reduce illness.
What is meant by mental health?
The ability to cope and recover from psychological stress. The ability to manage difficult situations and maintain a state of coherence. A healthy individual should have control over cognitive-emotional functioning in demanding situations.
What is meant by social health?
Peoples capacity to fulfil their potential and obligations. The standard level interpersonal functioning. A healthy individual should be able to work, and manage their life with some degree of independence.
What is the number one killer?
Ischemic heart disease is the number one killer in the world and in the UK,
Why is life expectancy much lower in deprived areas in cities?
Higher levels of pollution, higher drug and alcohol use.
What types of research evidence allows us to evaluate exposures on health?
- Observational- measuring people within a population without changing any variables. This can establish associations between exposures and diseases.
- Experimental- changing a variable and measuring the effect on individuals. This data can be used to establish causality.
What is epidemiology?
The study of the distribution and determents of health and disease in a specified population, and how this can be applied to control health problems.
What do ecological (correlational) studies show?
These study the association between two variables within populations. This type of research focuses on populations, not people e.g. air pollution and respiratory diseases across cities.
What are cross-sectional surveys?
Cross sectional studies split a group of people into different levels of the exposure variable (physical activity) and measure an outcome (BMI). The exposure and outcome variables are measured simultaneously. This means you cannot determine causality from these studies as each variable could cause the other.
What is a case-control study?
Comparing a group of people with a health condition to a group of healthy controls. These are useful for understanding rare health conditions and identifying risk factors associated with the disease. Multiple control groups can be used to eliminate confounding variables such as age or sex.
What is a prospective cohort study?
Similar to a cross sectional study but follows different cohorts over a period of time to determine associations. This can help establish causality as exposure is measured before the outcome so outcome cant influence the exposure. A set period of time should be left between exposure measurement and observed measurement incase the outcome was already present.
What are confounding variables?
A variable that we are not measuring which effects the result. A confounding variable effects both the exposure and observed variable. You can statistically adjust for confounding variables during analysis.
What is reverse causality?
Reverse causality is when you expect one variable to cause the other but it is actually the opposite. This may occur when exposure and outcome variables are measured around the same time. Landmark analysis excludes a period of time after the initial measurement to minimize this.
What is a randomized control trial?
A randomized control trial is when you randomize the exposures across a sample of people. This gets rid of sources of bias as confounders are equally distributed amongst the groups.
What are the advantages and disadvantages of randomized control trials?
Randomized control trials get rid of confounders, can establish causality, is the gold standard.
But is very expensive and time consuming to follow up individuals after a period of time, is not appropriate for all exposure variables (immoral to refuse treatment).
How can inferred links help lower the time needed for a randomized control trial?
A related factor can be used to infer a link and lower the overall time and cost of the experiment. For examples if lower blood pressure is known to reduce risk of CVD, and you establish a causal link between increased physical activity and lower blood pressure, you can conclude that increasing physical activity decreases CVD risk. This is quicker and easier to measure.
Why are associated risk factors dangerous?
Associated risk factors, such as smoking and BMI, are dangerous as combining risk factors accumulates total risk of diseases.
What are examples of non-modifiable risk factors and how can these be controlled?
Genetics, sex, ethnicity, age, family history. Non-modifiable risk factors cant be changed but they can have their effect reduced by making lifestyle changes.
What genes are typically related to genetic diseases?
Genes that are related to lifespan are typically also related to genetic diseases.
What is the FTO gene?
The FTO gene is a genotype related with a higher body weight as it is responsible for secreting the hunger hormone. People with these allele produce more hunger hormone, so typically eat more calories a day. This is an example of a gene which has an effect on another risk factor.
What is the biggest non-modifiable risk factor of disease?
Aging is the biggest non-modifiable risk factor- 85% of deaths are attributed to this. People age at different rates so not completely related to years old.
What is meant by aging popuation?
Healthcare is improving and elderly people are living longer. There is a decline in young people being born meaning there are more people unable to work and more elderly people to look after. The focus has shifted towards increasing healthy life expectancy.
What are blue zones?
Blue zones are areas where life expectancy is abnormally high. People who are born there and live there tend to live longer. This is mainly in areas with a plant based diet and low meat intake.
What type of diseases are strongly related with aging?
Non-communicable diseases that cannot be spread e.g. dementia.
Why do woman tend to live longer than men?
Men have a higher risk than woman for many mortality related conditions e.g. CVD. Men store fat in the center of the body close to all the organs where as woman store fat in the hips so have less chance of damaging organs.
