Wk2 Measuring Health of Population Flashcards
Why measure the health of the population?
- Find out how common a disease is (prevalence) and incidence of a disease
- Identify longitudinal trends in disease
- Are interventions or policies to improve health and reduce ill-health having any effect?
- Identify differences in disease patterns between different population groups or locations
- Service planning: do we have the right services, in the right place for the right people
Most common causes of male death in 2018?
- Cerebrovascular diseases
- Chronic lower respiratory diseases
- Dementia and Alzheimers disease
- Influenze and pneumonia
- Ischaemic heart diseases
- Malignant neoplasm of trachea, bronchus and lung
Most common causes of female death in 2018?
- Cerebrovascular diseases
- Chronic lower respiratory diseases
- Dementia and Alzheimers disease
- Influenze and pneumonia
- Ischaemic heart diseases
Top ten causes of deaths in high-income countries in 2016?
- Ischaemic heart disease
- Stroke
- Alzheimer disease and other dementia
- Trachea, bronchus and lung cancers
- Chronic obstructive pulmonary disease
- Lower respiratory infections
- Colon and rectum cancers
- Diabetes mellitus
- Kidney diseases
- Breast cancer
Top ten causes of deaths in low-income countries in 2016?
- Lower respiratory infections
- Diarrhoeal diseases
- Ischaemic heart disease
- HIV/AIDS
- Stroke
- Malaria
- Tuberculosis
- Preterm birth complications
- Birth asphyxia and birth trauma
- Road injury
What data sources are used to measure health status?
- Death certification (legal requirement to register health - includes cause of death - international classification of diseases (ICD-10) codes)
- Census (every 10 years since 1851)
- Health Survey for England (HSE) - Annual population survey since 1990. containing questions on smoking status, self-report info on heath, additional info on key theme every year (e.g. CVD)
- General Lifestyle Survey
- Hospital Episode Statistics (health service usage - details of all admissions to NHS hospitals in England and all outpatient appointments (Started 1989)
- General Practice Research Database :
Clinical Practice Research Database (CPRD)
The Health Information Network (THIN) - Health protection reports of notifiable infectious diseases
- Cancer registration
- National/regional/local audits or surveys
What is the clinical practice research datalink used for?
Anonymised longitudinal data from 625 general practices serving approx 5 million patients.
- Clinical research planning
- Drug utilisation
- Studies of treatment patterns
- Clinical epidemiology
- Drug safety
- Health outcomes
- Health service planning
What does the general lifestyle survey include?
Sample from whole of Britain, formally called General Household Survey
- Demographic information about households, families and people
- Housing tenure and household accommodation
- Access to vehicles
- Employment
- Education
- Health and use of health services
- Smoking and drinking
- Family information, marriage, cohabitation and fertility
What are notifiable diseases?
- Certain infectious diseases notified by doctors
- Laboratory results for some infectious diseases notified
- Cancers registered in cancer registries and linked to mortality data
What are the advantages of mortality data as a measure of population health?
- Legal requirement in UK to register each death
- Little delay in collection of data
- International classification of diseases ensures comparability
- Cheap source of health data
What are the disadvantages of mortality data as a measure of population health?
- Potential for error (diagnosis, certification, coding, processing, interpretation etc.)
- Death may result from many diseases acting in conjunction
- Some diseases have high mortality rate and death occurs quickly - others are long-term, resource-intensive but rarely cause death
How might we use mortality or morbidity rates?
Compare areas:
- To identify areas where people experience poor health
- Identify need for preventative services
- May raise hypotheses about cause of a disease
Look at change over time
What is direct standardisation?
- Direct: age-specific death rates from a study population are applied to a standard population structure
- Used to answer the question - “what would be the death rate in the standard population if it had the age and sex-specific death rates experienced by the population I am looking at?”
What are the advantages of direct standardisation?
- Can be used to compare disease rates across areas and time
- Can be used to assess the relative burden of different diseases in a population
What are the disadvantages of direct standardisation?
- Requires age-specific rates which are not always available at a local level
- Rates may not be stable for small number of events (<100)
What is indirect standardisation?
Age-specific rates from a standard population are applied to a study population structure (standardised mortality ratio)
- SMR = observed no. of deaths for study population/expected no. of deaths for study population
- SMR of 150% (or 1.5) means that your study population has 1.5 times as many deaths as you would expect
What are the advantages of indirect standardisation?
- Does not require local rates, only absolute number of events
- Easier to interpret rates (always comparing to 100 or 1)
What are the disadvantages of indirect standardisation?
- Areas cannot be directly compared
- Does not give an idea of the actual burden of disease
What are the pitfalls in interpreting health and disease?
- Different criteria is used to define the disease between areas
- Not all the cases of disease have been identified in each area
- Use of hospital data to describe disease or death in an area (omits people who are treated in general practice or die in the community)
Why might health be associated with socioeconomic deprivation?
- An artefact of measurement error
- Social selection
- Behavioural/cultural
- Psychosocial
- Material/structural conditions
What is the artefact theory?
Observed associations are not genuine, but exist because of the ways in which we measure health and deprivation
What is the social selection theory?
Health determines socio-economic status (i.e. is you are in poor health you are less likely to be able to work, and therefore are more ‘deprived’) rather than socio-economic status determining health
What is the behavioural/cultural theory?
People in deprived areas are more likely to smoke, have poor diets and not take exercise
What is the psychological theory?
The stress of working in poorly paid, low status jobs with little autonomy creates biological changes in the body which in turn creates path-physical changes
What is the material theory?
The direct effects of poverty
Which are the most important theories?
- Artefact and social selection contribute relatively little to differences in health observed between rich and poor
- Continuing debate about importance of other three
What are more recent theories?
Importance of area context
- Physical environment, availability of goods and facilities, social capital (the amount to which people are connected within their community through relationships and have a shared sense of identity)
Role of lifecourse
- Biological and social pathways between childhood and adulthood that accumulate risk for health, behaviours and social circumstances
