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21/02/02 1
Mortality (07/02/02)Morbidity (21/02/02)
(Dr JL Botha)
Director, Trent Cancer Registry
Hon Senior Lecturer
Hannes Botha
Vital statistics
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Morbidity - Outline
• Sources– Birth to death– Illness episodes
• Uses– Interpretation of trends– Clues to causes– Identification of health/care needs
• Handout
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Sources
Birth Death
Decennial Census
Birth registration
Marriage registration
Death registration
Child healthVaccinationsCongenital malformations
General Household Survey
Social security
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Sources
Onset OutcomeSymptoms Diagnosis Treatment
Screening
GP: Age- sex registers Consultations Prescriptions
Hospitals: Activity Performance
Disease registration/notification: Cancer Communicable diseases
Community services
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Information on the WWW
• National Statistics– Population– Morbidity data
• Department of Health– Waiting lists– Performance
• Others
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Interpretation of trendsIncidence of Childhood Diabetes in
Leicestershire 1950-1996
0
5
10
15
20
25
1950
1955
1960
1965
1970
1975
1980
1985
1990
1995
Calendar year
Rate per 100,000/year
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Interpretation of trends
• Chance
• Artefactual– Numerator– Denominator
• Real– ‘Natural’ (epidemiological)– Medical care effects
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CHD trends
0
20
40
60
80
100
120
140
160
180
1935
1937
1939
1941
1943
1945
1947
Year
Rate/100,000
Sweden
USA
Clues to causes
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Consumption in Sweden
0
5
10
15
20
25
1935
1936
1937
1938
1939
1940
1941
1942
1943
1944
1945
1946
1947
1948
Year
Kilograms
Total fat Milk and cream Eggs
Clues to causes
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Health / Care needs (i)
• Self reported long standing illness - GHS
• NHS expenditure
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27% Musculoskeletal system
17% Heart & circulatory
Ear complaints 5%
Digestive system 7%
Other complaints 18%
Self reported long standing illness
Great Britain, all persons, 1988
* Data used are of self-reported illnessPercentages may not add up to 100 due to rounding
Source: General Household survey
Respiratory system 16%
By condition *
Eye complaints 5%
Nervous system 6%
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20% Mental
13% Circulatory
Digestive 5%
Cancer 7%
Pregnancy 5%
NHS expenditure
England and Wales, all persons
Source: OPCS (HIPE 1982) Routine NHS costing returns 1986/7National Morbidity Survey 1981/2
Ill-defined 7%
By diagnostic group
Respiratory 6%
Musculoskeletal 7%
9% Nervous system
7% Injury etc
Genitourinary 4%
Other 10%
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Health / Care needs (ii)
Cancer Registration data
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Cancer Registrations E&W 1997
0 5 10 15 20 25 30 35
Oesophagus
Stomach
Colorectal
Pancreas
Lung
Melanoma of skin
Breast
Cervix
Uterus
Ovary
Prostate
Bladder
NHL, Myeloma
Other
Maj
or
tum
ou
r si
tes
Thousands
Males
Females
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Female breast cancer incidence in England
0
50
100
150
200
250
300
350
1971
1973
1975
1977
1979
1981
1983
1985
1987
1989
1991
1993
1995
1997
Year of diagnosis
Rat
e pe
r 10
0,00
0
35-39 40-4445-49 50-5455-59 60-6465-69 70-74
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Lung cancer incidence in Trent
0
20
40
60
80
100
120
Middle Year
Age s
tandard
ised r
ate
per
100,0
00
Female
Male
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Female breast cancer in Trent
0
20
40
60
80
100
Derby CN Leics CN MTCN NTCN
Cancer network
% 5
-yr
Re
lati
ve s
urv
ival
1985-87 1986-88 1987-89 1988-901989-91 1990-92 1991-93
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Male lung cancer in Trent
0
20
40
60
80
100
DerbyCN LeicsCN MTCN NTCN
Cancer network
% 1
-yr
Re
lati
ve s
urv
ival
1985-87 1986-88 1987-89 1988-901989-91 1990-92 1991-93
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Breast cancer in Trent Women
0
20
40
60
80
100
1971-75 1976-80 1981-85 1986-90
Incidence cohort
% 5
-year
Rela
tive S
urv
ival
Af f luent 2 3 4 Deprived
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• ‘2.7 …… a move towards an electronic record ……’
• ‘2.10 Electronic Patient Record (EPR) …… record of periodic care provided mainly by one institution ……’
• ‘2.11 …… Electronic Health Record (EHR) …… a longitudinal record of patient’s health and healthcare from cradle to grave…’
An Information Strategy for the Modern NHS 1998–2005
NHS Information Authority: http://www.nhsia.nhs.uk/
