A MODEL FOR ISCHAEMIC HEART DISEASE AND STROKE III: APPLICATIONS. By T. Chatterjee, A. S. Macdonald and H. R. Waters. abstract.

Size: px
Start display at page:

Download "A MODEL FOR ISCHAEMIC HEART DISEASE AND STROKE III: APPLICATIONS. By T. Chatterjee, A. S. Macdonald and H. R. Waters. abstract."

Transcription

1 1 A MODEL FOR ISCHAEMIC HEART DISEASE AND STROKE III: APPLICATIONS By T. Chatterjee, A. S. Macdonald and H. R. Waters abstract This is the third in a series of three papers. In the first paper we describe a comprehensive stochastic model of an individual s lifetime that includes diagnosis with ischaemic heart disease and stroke and also the development of the major risk factors for these conditions. The second paper discusses in some detail models for changes in body mass index (BMI) and also the effects of these changes, in particular the current trend towards increasing prevalence of obesity, on diabetes, cardiovascular diseases and expected future lifetime. This paper is devoted to the following applications of the model described in the first paper: (a) quantifying the effects of smoking and of changes in smoking habits, and, (b) quantifying the effects of treatment with statins (drugs designed to lower cholesterol). keywords Diabetes, Framingham Heart Study, hypercholesterolaemia, hypertension, ischaemic heart disease, Markov model, mortality, smoking, statins, stroke.

2 2 1. Introduction This paper is the third in a series of three papers. In the first paper, Chatterjee et al. (2007a), we describe the structure and parameterisation of a stochastic model for an individual s lifetime, incorporating the occurrence of ischaemic heart disease (IHD) and stroke and the development of the following major risk factors for these events: (a) Age, (b) Sex, (c) Smoking, (d) Body Mass Index (BMI), (e) Diabetes, (f) Hypertension, and, (g) Hypercholesterolaemia. The model is a continuous-time, finite-state-space Markov model. Age is the continuous variable which plays the rôle of time. Sex and Smoking are deterministic factors, so that we assume we know an individual s smoking status throughout his/her life. The remaining risk factors, (d) to (g), are discretised into a small number of categories between which our individual can move. In the second paper in the series, Chatterjee et al. (2007b), we discuss in detail three models for changes in an individual s BMI and the effects of these changes on the prevalence of diabetes and cardiovascular diseases and on life expectancy. These models, labelled Models I, II and III, can be summarised as follows: Model I: This is parameterised using data from the Framingham Heart Study, Offspring & Spouses Cohort (OS) data, with the parameters adjusted so that the model produces prevalence rates for BMI categories at adult ages which match those of the population of England in 2003 as given by Sproston & Primatesta (2004). Model I does not allow for changes in the prevalence of obesity over calendar time. Model II: This is an adjusted version of Model I which allows for the intensities of moving to higher categories of BMI to increase for 20 years starting from a given time point. The rate of increase is chosen to match the increase in obesity in England from 1994 to Model III: This is the same as Model II except that there is no time limit on increases in the transition intensities. The models predict future levels of obesity in increasing order, with Model III being the most extreme; starting with 20 year old males in 2003, Model III predicts that over 96% of those who survive to age 80 will be obese. The models predict, in the order I then II then III, increasing prevalence of diabetes and cardiovascular diseases and also decreasing future life expectancy. However, while the effects on the prevalence of diabetes are significant, the effects on cardiovascular diseases and future life expectancy are much less significant. See Chatterjee et al. (2007b) for details. In this paper we discuss applications of the model specified in the first paper, Chatterjee et al. (2007a) to: (a) quantifying the effects of smoking and of changes in smoking habits, and, (b) quantifying the effects of treatment with statins (drugs designed to lower cholesterol).

3 3 The effects in which we are interested are the prevalence of ischaemic heart disease (IHD) and stroke and future life expectancy. The model used in this paper incorporates Model I for changes in categories of BMI, rather than Models II or III. Since our main focus here is on IHD, stroke and future life expectancy, the choice of BMI model has little effect on our results and conclusions. In Section 2 we review the rôle of smoking in our model, calculate the prevalence of IHD and stroke for individuals with different smoking profiles and then calculate the effects on these quantities of smokers giving up smoking at given future ages. These last calculations are particularly relevant in view of recent bans on smoking in enclosed public places introduced in the Republic of Ireland (2004), Scotland (2006), England and Wales (2007) and in other territories. Hypercholesterolaemia is a major risk factor for IHD. See Stanner (2005). Statins are a class of drug designed to lower the level of cholesterol. They were first licenced in the UK in the late 1980s and increasingly prescribed through the 1990s into the present century. In Section 3 we describe the effect of statins on hypercholesterolaemia and hence on IHD. In Section 4 we discuss briefly current thresholds for recommending treatment for hypercholesterolaemia and in Section 5 we show results quantifying the effect of prescribing statins. Acknowledgements are given at the end of this paper. The full list of references for all three papers is included at the end of Chatterjee et al. (2007a). Further details of the research underlying this paper and its two companion papers can be found in Chatterjee (2007). 2. Smoking, IHD, stroke and future life expectancy 2.1 The effect of smoking on IHD, stroke and mortality Our model for an individual s future lifetime, as set out in Chatterjee et al (2007a), incorporates smoking in a number of different ways: (a) Smoking is a direct risk factor for myocardial infarction (MI). Current smokers have a relative risk of MI times that of those who have never smoked. (b) Smoking is a direct risk factor for hard stroke (HS), but not for transient ischaemic attack (TIA). Current smokers have a relative risk of HS times that of those who have never smoked. (c) Smoking is not a direct risk factor for diabetes, hypertension or hypercholesterolaemia. (d) Smoking does have a small effect on BMI: giving up smoking tends to increase BMI and resuming smoking tends to decrease BMI. (e) Independently of its effect on MI and HS, smoking is a direct risk factor for mortality. Current smokers have a relative risk of dying times that of those who have never smoked. (f) The effects on MI, HS and mortality do not depend on sex, the number of cigarettes smoked or the number of years the individual smoked. See Chatterjee et al. (2007a) for details. The literature contains the following, not wholly consistent, points which, on balance, support our model in relation to the effect of smoking on IHD and stroke:

4 4 (i) The effects of smoking are both long and short term. Giving up smoking should, in principle, eliminate almost immediately the acute effects, but the atherosclerotic damage persists even after quitting. See Negri et al. (1994) and Lightwood and Glantz (1997). (ii) The odds ratio of acute MI for current smokers relative to non-smokers is 3.4. See Negri et al. (1994). (iii) The odds ratios for MI or coronary death among current smokers are 2.71 for men and 4.70 for women, compared to individuals who have never smoked. See Dobson et al. (1991). (iv) Cook et al. (1986) state that there is no trend in risk of IHD or stroke with the number of cigarettes smoked per day. This view is consistent with Lightwood and Glantz (1997), who modelled the effect of smoking, and of quitting, without taking account of the number of cigarettes smoked. However, Negri et al. (1994) found that the risk estimates for former smokers are higher at younger ages and directly related to the number of cigarettes smoked. (v) Men who have given up smoking in the last 5 years have a risk of IHD virtually identical to current smokers. The risk goes down to about twice that of never-smokers for men who have given up smoking for more than 5 years. But this risk does not go down further even after a 20-year follow-up. See Cook et al. (1986). (vi) The odds ratios of MI or coronary death among ex-smokers are similar to those of current smokers for the first year and then they decrease. After about 3 years the risk is not significantly elevated beyond that for never-smokers. See Dobson et al. (1991). (vii) The odds ratio of acute MI for ex-smokers relative to never-smokers is 1.4 for subjects who have given up smoking for one year, 1.5 for two to five years and 1.1 for six to ten years. The relative risk tends to decrease with the time since quitting and to become close to that of never-smokers after 10 years without smoking. See Negri et al. (1994). 2.2 The effect of giving up smoking The model set out in Chatterjee et al. (2007a) deals with individuals who never smoke and those who continue to smoke for the rest of their lives. We need to model the effects on IHD, stroke and mortality of giving up smoking. Our model for the relative risk of MI for current and ex smokers, relative to those who have never smoked, is as follows: and the model for the relative risk of HS is: RR(t) = ( )e t/ (1) RR(t) = ( )e t/ (2) where t is the time in years since giving up smoking. These models have exactly the same form as models proposed by Lightwood and Glantz (1997) in respect of acute MI and stroke, though some of our parameter values are different. Note that: (a) These models do not depend on sex, age, number of years as a smoker or the number of cigarettes smoked each day. This agrees with Lightwood and Glantz s model, except that their model for MI does depend on sex.

5 5 (b) The parameters and are taken from Chatterjee et al. (2007a, Table 9); they are the relative risks for current smokers estimated from the Framingham data and appropriate to the OS cohort. Lightwood and Glantz s values are 2.88 (MI, males), 3.85 (MI females) and 2.80 (stroke). (c) The parameter 1.1 for the residual effect on the relative risk of MI and HS of having smoked has been chosen taking account of Lightwood and Glantz s own values, (1.17 (MI, males), 1.40 (MI, females) and 1.42 (stroke)), the values reported in points (v), (vi) and (vii) above, and our own values for the relative risk for ex smokers estimated from the Framingham data. These last values, which do not take account of time since giving up smoking, are (MI) and (HS). (d) The parameters and 1.35, which control the rate of decay of the relative risk, are taken directly from Lightwood and Glantz s model. Numerically, formulae (1) and (2) tell us that the relative risks of MI and HS for current and ex-smokers are: 1. independent of age, sex and all other explanatory variables, 2. higher by a factor (resp ) for current smokers in respect of MI (resp. HS), 3. ultimately higher by a factor 1.1 for ex-smokers who stopped smoking a long time ago, 4. higher by factors 2.346, and in respect of MI (resp , and for HS) for someone who stopped smoking 1, 2 or 3 years ago. Our model for the relative risk of mortality for current and ex-smokers is as follows: RR(t) = (exp(0.5689) 1.09)e t (3) Apart from the parameter exp(0.5689) (= ), which is the relative risk of mortality for current smokers and is taken from Chatterjee et al. (2007a, Table 11), this formula has been chosen by fitting a curve to data in Kawachi et al. (1993). Details can be found in Chatterjee (2007). 2.3 Trends in the prevalence of smoking Table 1 shows the prevalence of smoking in the UK for selected years, split by sex and age band. The prevalence of smoking in the UK has declined slowly from 1974 to Table 2 shows the prevalence of current and ex-smokers in the UK in 2003 split by sex and the age at which they started smoking. A feature of Table 2 is that it indicates that almost all smokers start smoking before age 25. Many countries have imposed a ban on smoking in enclosed public places, among them the Republic of Ireland (2004), Scotland (2006), Wales (2007) and England (2007). The effect of the ban on the prevalence of smoking in the Republic of Ireland, introduced on 29 March 2004, can be seen in figures produced by The Office for Tobacco Control, OTC (2007). These figures, 12 month moving averages, show that the overall prevalence of smoking fell from around 25.5% when the ban was introduced, to a low point of just over 23% in February 2005, from where it has risen and stabilised at about 24.4% in June The effects on some age groups are very different from the overall pattern. The prevalence of smoking among those aged 15 to 18 rose sharply from February 2006 to 21.5% in June 2007 it had been a little over 18% in April For those aged 71+ the prevalence of smoking has dropped from around 13% when the ban was introduced to less than 10% in June 2007.

6 6 Table 1: Prevalence of smoking (%) in the UK. Source: Rickards (2003). Age Male and over All aged 16 and over Female and over All aged 16 and over Table 2: Percentages of smokers and ex-smokers in 2003 in the UK, classified by age at which they started smoking regularly. Source: Rickards (2003). Age Current Smoker Ex Smoker Male Under and over 5 4 Female Under and over 7 8 It is clearly of interest to use our model to investigate the effect of smoking, particularly giving up smoking, on expected future lifetime and on the prevalence of IHD and stroke.

7 7 2.4 Numerical results Table 3 shows values for the expected future lifetime and the expected future Event free lifetime for males and females, starting from ages 20 and 40 for different smoking profiles. These profiles are Non-smokers (people who never smoke at any time), Current smokers (people who smoke from before age 20 and continue as smokers for their remaining lifetime) and Given up smoking (people who smoke from before age 20, give up smoking at the age indicated and then never smoke again). Event free future lifetime is the time until the diagnosis of IHD or HS or death, whichever occurs first. Table 4 shows the prevalence of IHD, HS and IHD or HS at ages 60 and 80 for starting ages 20 and 40 and for different smoking profiles. For both Tables 3 and 4 the starting population has an HSE 2003 profile (see Chatterjee et al. (2007a, Section 12.2) with the extra condition that for the Event free calculations in Table 3 and all the calculations in Table 4, they have not been diagnosed with either IHD or HS before the starting age of 20 or 40. Tables 3 and 4 show that: (a) Smoking reduces expected future lifetime (EFL) and expected future Event free lifetime considerably. For a male aged 20 the difference in EFL is 7.1 years and for a female aged 20 it is 6.3 years. (b) The prevalence of IHD and stroke at ages 60 and 80 is considerably greater for smokers than for those who never smoke. These facts are well known. What is perhaps more interesting is that giving up smoking, no matter how late in life, can significantly implove EFL and reduce the probability of IHD and/or stroke. For example, for females age 80 who smoked from before age 20 until they were 60 and then gave up, the percentage with IHD and/or stroke is 21.1, but among those still alive at age 80 who continued smoking until at least age 80, the percentage is 29.3.

8 8 Table 3: Effect of giving up smoking at different ages. Expected future lifetime from Expected future Event free lifetime Age 20 Age 40 Age 20 Age 40 Smoking profile Male Female Male Female Male Female Male Female Non smoker Given up smoking at age Current smoker

9 9 Table 4: Effect on prevalence of giving up smoking at different ages. Age 20 Age 40 Age 20 Age 40 Smoking profile Male Female Male Female Male Female Male Female Prevalence of IHD at age 60 Prevalence of IHD at age 80 Non smoker Given up smoking at age Current smoker Prevalence of stroke at age 60 Prevalence of stroke at age 80 Non smoker Given up smoking at age Current smoker Prevalence of IHD/stroke at age 60 Prevalence of IHD/stroke at age 80 Non smoker Given up smoking at age Current smoker

10 10 3. Statins Statins are drugs designed to lower cholesterol, in particular low density lipoprotein (LDL). They were first licenced for use in the UK in 1987 and have been developed at intervals since then, with one of the most recent, rosuvastatin, being licenced in the UK in They have attracted considerable attention in recent years in both the popular press and the medical literature. For example: A new pill for all ills. The Independent 26 April Wider use of statins could save thousands of lives. The Independent 27 September Could the heart disease wonder drug save your life? The Mirror 26 January A statin is one of the components of the Polypill proposed by Wald and Law (2003) in an article entitled A strategy to reduce cardiovascular disease by more than 80% published in the British Medical Journal. This article was the basis for an Editorial in the same issue of BMJ entitled The most important BMJ for 50 years? (Smith (2003)). The dose of the statin proposed for the Polypill would reduce LDL by 1.8 mmol/l (Wald and Law (2003)). While this reduction in LDL takes place very quickly within about 6 months the effect on IHD takes longer. Based on a meta analysis, Law et al. (2003) claim that the effect on fatal and non fatal MI of this reduction in LDL is a reduction in the relative risk of MI, as shown in Table 5, and that this relative reduction does not depend on the starting concentration of LDL. It should be noted that most of the studies included in this meta analysis lasted less than 5 years. Reliable data on the long term effects of statins, in particular for the most recently developed statins, are not yet available. Table 5: Percentage reduction in risk of fatal and non-fatal MI by duration of treatment. % Reduction in risk for Duration of treatment a reduction in LDL of 1.8 mmol/l 1st year 19 2nd year 39 3rd-5th years 51 6th and subsequent years 55 Law et al. (2003) also claim that statins have beneficial effects on stroke, with an immediate and lasting reduction of 17% in the relative risk of stroke for a 1.8 mmol/l reduction in LDL. This is interesting because hypercholesterolaemia is not a direct risk factor for stroke, see Chatterjee et al. (2007a, Section 9), though there is evidence in the literature that statins have benefits beyond lowering LDL. See Vaughan et al. (1996), Palinski (2001) and Wannamethee et al. (2000).

11 11 4. Treatment thresholds for hypercholesterolaemia Various thresholds have been proposed, and are used, to determine when to prescribe statins. These treatment thresholds are typically based on the concentration of LDL, the presence of other risk factors, for example smoking and diabetes, and the calculated risk of IHD over a given time period. See McElduff et al. (2006) for a survey of these protocols. McElduff et al. (2006) surveyed 1653 men aged between 49 and 65 to determine what percentage would be eligible for treatment with statins given each of five protocols. The answers ranged from 14% to 77%, with all but one protocol covering 58% or more of the surveyed population. Wald and Law (2003) propose that the Polypill should be taken by everyone over age 55. This has some justification since age is a major risk factor for IHD and stroke and since there are beneficial effects from taking statins whatever the initial concentration of LDL. A UK Government adviser, Professor Roger Boyle, has been reported as saying there are benefits in giving statins to all men over age 50 and all women over age 60 (Times (2007)), although he is also reported as saying that people are not yet ready for mass medication. 5. The effects of treatment with statins 5.1 Numerical results In this section we use the model described in the first paper in this series, Chatterjee et al. (2007a), to quantify the effect of statins on future expected lifetime and future expected event free lifetime, i.e. expected time until the first of IHD, stroke or death. To simplify the presentation, we use age as the threshold for treatment with statins. Calculations based on other thresholds can be found in Chatterjee (2007). We will assume initially that the effect of treatment with statins from any age is a reduction in the intensity of MI as shown in Table 5 and a reduction of 17% in the intensity of HS. The figures in Table 6 show the future expected lifetimes and future expected event free lifetimes from age 20 for males/females, non smokers/smokers assuming statins are not available ( Untreated ) and then assuming statins are taken by everyone reaching the different ages indicated ( Treated at age... ). The difference between the Treated at age... and Untreated figures measures the beneficial effect of statins. The starting point for these calculations is an HSE 2003 profile (assuming no prior IHD or stroke in the case of the event free calculations). The figures in Table 6 show that the benefits from taking statins are greater for men than for women and greater for smokers than for non smokers, i.e. greater for those at greater risk of IHD and stroke. The figures in Table 7 show the effects from age 50 of treatment with statins on future expected lifetime and future expected event free lifetime for different starting profiles relating to diabetes, hypercholesterolaemia and hypertension. In each case Low refers to the lowest and High to the highest category of the risk factor, as defined in Chatterjee et al. (2007a, Section 2). The starting point is an HSE 2003 profile in all respects except for the three risk factors and for the smoking pattern, as shown. These figures show in general terms that the benefits of statins are greater if the risk of IHD or stroke is higher.

12 12 Table 6: Effect of treatment with statins on expected future lifetime and expected future Event free lifetime from age 20 by age of treatment. Future Expected future lifetime from age 20 Male Female Never Smoked Current Smoker Never Smoked Current Smoker Treated from age Treated from age Treated from age Treated from age Treated from age Untreated Expected future event free lifetime from age 20 Male Female Never Smoked Current Smoker Never Smoked Current Smoker Treated from age Treated from age Treated from age Treated from age Treated from age Untreated

13 13 Table 7: Effect of treatment with statins on expected future lifetime and expected future event free lifetime for individuals with different risk profiles from age 50. Expected future lifetime from age 50 Expected future event free lifetime from age 50 Male Female Male Female Never Current Never Current Never Current Never Current Diab. H Chol. H tens. Smoked Smoker Smoked Smoker Smoked Smoker Smoked Smoker Treated Low Low Low Untreated Difference Treated Low Low High Untreated Difference Treated Low High Low Untreated Difference Treated High Low Low Untreated Difference Treated Low High High Untreated Difference Treated High Low High Untreated Difference Treated High High Low Untreated Difference Treated High High High Untreated Difference

14 Sensitivity testing In the first paper in this series, Chatterjee et al. (2007a, Section 13), we discussed the uncertainty of values for expected future lifetime, where this uncertainty arises from the variability of the estimates of the many parameters in the model described in that paper. For example, the standard deviation associated with the value of 58.6 in Table 6 for the Untreated expected future lifetime from age 20 for a male who never smokes is 0.6. See Chatterjee et al. (2007a, Table 15). The estimated expected future lifetime from age 20 for males treated with statins from age 50, 59.2 (Table 6), is thus within one standard error of the estimated Untreated expected future lifetime. This prompts questions about the statistical significance of this increase in expected future lifetime. However, by using the same sets of simulated parameters to calculate the Untreated and Treated from age 50 expected future lifetimes, we can estimate the standard error of the estimated difference, 0.6 years, directly. The standard error of this difference is 0.08 years. Further details can be found in Chatterjee (2007). The standard deviation of the difference between the Treated from age... and Untreated future lifetimes discussed in the previous paragraph takes account only of the variability of the parameters of our model set out in Chatterjee et al. (2007a). In particular, it does not take account of any uncertainty relating to the reduction in the intensity of MI as set out in Table 5 or the figure of 17% for the reduction in the intensity of stroke resulting from treatment with statins. These estimates of the reduction in intensities are key parameters in assessing the effects of statins and we can assess their numerical significance by scenario testing arbitrarily assuming the reductions will be 30% higher (High scenario) or 30% lower (Low scenario) than the values shown in Table 5. These revised estimates are shown in Table 8, with the values for MI from Table 5 shown as the Standard scenario. Table 8: Percentage reduction in risk by duration of treatment High and Low scenarios. % Reduction in risk Event Duration of treatment High scenario Standard Low scenario Myocardial 1st year Infarction 2nd year rd-5th years th and subsequent years Stroke All durations Figures for expected future lifetime and expected future event free lifetime from age 50 using these three different scenarios for the effect of statins are shown in Table 9. The Treated figures assume everyone is treated with statins from age 50. It can be seen from Table 9 that moving from the Low to the High scenario approximately doubles the increase in expected future ( Event free ) lifetime from age 50 in every case.

15 15 Table 9: Sensitivity testing for the effect of treatment with statins on expected future lifetime and expected future event free lifetime from age 50. Expected future lifetime from age 50 Expected future Event free lifetime from age 50 Male Female Male Female Never Current Never Current Never Current Never Current Smoked Smoker Smoked Smoker Smoked Smoker Smoked Smoker Treated High scenario Untreated Difference Treated Standard scenario Untreated Difference Treated Low scenario Untreated Difference

16 16 6. Conclusions Since reliable data on the long term benefits of statins are not yet available, figures coming from models such as ours which incorporate assumptions about these long term effects will necessarily be revised in the future when more reliable data do become available. Nevertheless, it seems clear from the figures presented in Section 5 that statins will have a significant impact on future life expectancy for some time to come. It is a sobering observation that even with our more optimistic assumption about the effect of statins, their effect on future life expectancy is considerably less than the effect for smokers of giving up smoking, cf Table 9 ( High scenario ) and Table 3.

Underwriting Critical Illness Insurance: A model for coronary heart disease and stroke

Underwriting Critical Illness Insurance: A model for coronary heart disease and stroke Underwriting Critical Illness Insurance: A model for coronary heart disease and stroke Presented to the 6th International Congress on Insurance: Mathematics and Economics. July 2002. Lisbon, Portugal.

More information

Ethnic Minorities, Refugees and Migrant Communities: physical activity and health

Ethnic Minorities, Refugees and Migrant Communities: physical activity and health Ethnic Minorities, Refugees and Migrant Communities: physical activity and health July 2007 Introduction This briefing paper was put together by Sporting Equals. Sporting Equals exists to address racial

More information

UNIVERSITY OF BIRMINGHAM AND UNIVERSITY OF YORK HEALTH ECONOMICS CONSORTIUM (NICE EXTERNAL CONTRACTOR) Health economic report on piloted indicator(s)

UNIVERSITY OF BIRMINGHAM AND UNIVERSITY OF YORK HEALTH ECONOMICS CONSORTIUM (NICE EXTERNAL CONTRACTOR) Health economic report on piloted indicator(s) UNIVERSITY OF BIRMINGHAM AND UNIVERSITY OF YORK HEALTH ECONOMICS CONSORTIUM (NICE EXTERNAL CONTRACTOR) Health economic report on piloted indicator(s) Pilot QOF indicator: The percentage of patients 79

More information

Quantifying Life expectancy in people with Type 2 diabetes

Quantifying Life expectancy in people with Type 2 diabetes School of Public Health University of Sydney Quantifying Life expectancy in people with Type 2 diabetes Alison Hayes School of Public Health University of Sydney The evidence Life expectancy reduced by

More information

Now we ve weighed up your application for our protection products, it s only fair we talk you through our assessment process. More than anything, we

Now we ve weighed up your application for our protection products, it s only fair we talk you through our assessment process. More than anything, we how we assess your application UNDERWRITING EXPLAINED. Now we ve weighed up your application for our protection products, it s only fair we talk you through our assessment process. More than anything,

More information

National Life Tables, United Kingdom: 2012 2014

National Life Tables, United Kingdom: 2012 2014 Statistical bulletin National Life Tables, United Kingdom: 2012 2014 Trends for the UK and constituent countries in the average number of years people will live beyond their current age measured by "period

More information

Fewer people with coronary heart disease are being diagnosed as compared to the expected figures.

Fewer people with coronary heart disease are being diagnosed as compared to the expected figures. JSNA Coronary heart disease 1) Key points 2) Introduction 3) National picture 4) Local picture of CHD prevalence 5) Mortality from coronary heart disease in Suffolk County 6) Trends in mortality rates

More information

Absolute cardiovascular disease risk assessment

Absolute cardiovascular disease risk assessment Quick reference guide for health professionals Absolute cardiovascular disease risk assessment This quick reference guide is a summary of the key steps involved in assessing absolute cardiovascular risk

More information

STATEMENT ON ESTIMATING THE MORTALITY BURDEN OF PARTICULATE AIR POLLUTION AT THE LOCAL LEVEL

STATEMENT ON ESTIMATING THE MORTALITY BURDEN OF PARTICULATE AIR POLLUTION AT THE LOCAL LEVEL COMMITTEE ON THE MEDICAL EFFECTS OF AIR POLLUTANTS STATEMENT ON ESTIMATING THE MORTALITY BURDEN OF PARTICULATE AIR POLLUTION AT THE LOCAL LEVEL SUMMARY 1. COMEAP's report 1 on the effects of long-term

More information

Body Mass Index as a measure of obesity

Body Mass Index as a measure of obesity Body Mass Index as a measure of obesity June 2009 Executive summary Body Mass Index (BMI) is a person s weight in kilograms divided by the square of their height in metres. It is one of the most commonly

More information

International Task Force for Prevention Of Coronary Heart Disease. Clinical management of risk factors. coronary heart disease (CHD) and stroke

International Task Force for Prevention Of Coronary Heart Disease. Clinical management of risk factors. coronary heart disease (CHD) and stroke International Task Force for Prevention Of Coronary Heart Disease Clinical management of risk factors of coronary heart disease and stroke Economic analyses of primary prevention of coronary heart disease

More information

ADVANCE: a factorial randomised trial of blood pressure lowering and intensive glucose control in 11,140 patients with type 2 diabetes

ADVANCE: a factorial randomised trial of blood pressure lowering and intensive glucose control in 11,140 patients with type 2 diabetes ADVANCE: a factorial randomised trial of blood pressure lowering and intensive glucose control in 11,140 patients with type 2 diabetes Effects of a fixed combination of the ACE inhibitor, perindopril,

More information

Culture and experience Health

Culture and experience Health 48 Culture and experience Health Health The health of a population reflects both the lives of citizens and the health system's ability to prevent and cure diseases. With regard to health and welfare, there

More information

African Americans & Cardiovascular Diseases

African Americans & Cardiovascular Diseases Statistical Fact Sheet 2013 Update African Americans & Cardiovascular Diseases Cardiovascular Disease (CVD) (ICD/10 codes I00-I99, Q20-Q28) (ICD/9 codes 390-459, 745-747) Among non-hispanic blacks age

More information

Scottish Diabetes Survey 2014. Scottish Diabetes Survey Monitoring Group

Scottish Diabetes Survey 2014. Scottish Diabetes Survey Monitoring Group Scottish Diabetes Survey 2014 Scottish Diabetes Survey Monitoring Group Contents Table of Contents Contents... 2 Foreword... 4 Executive Summary... 6 Prevalence... 8 Undiagnosed diabetes... 21 Duration

More information

Chapter 2: Health in Wales and the United Kingdom

Chapter 2: Health in Wales and the United Kingdom Chapter 2: Health in Wales and the United Kingdom This section uses statistics from a range of sources to compare health outcomes in Wales with the remainder of the United Kingdom. Population trends Annual

More information

Design and principal results

Design and principal results International Task Force for Prevention Of Coronary Heart Disease Coronary heart disease and stroke: Risk factors and global risk Slide Kit 1 (Prospective Cardiovascular Münster Heart Study) Design and

More information

AMODEL FOR CORONARY HEART DISEASE AND STROKE WITH APPLICATIONS TO CRITICAL ILLNESS INSURANCE UNDERWRITING I: THE MODEL

AMODEL FOR CORONARY HEART DISEASE AND STROKE WITH APPLICATIONS TO CRITICAL ILLNESS INSURANCE UNDERWRITING I: THE MODEL AMODEL FOR CORONARY HEART DISEASE AND STROKE WITH APPLICATIONS TO CRITICAL ILLNESS INSURANCE UNDERWRITING I: THE MODEL Angus S. Macdonald,* Howard R. Waters, and Chessman T. Wekwete ABSTRACT In Part I

More information

Chronic Disease and Health Care Spending Among the Elderly

Chronic Disease and Health Care Spending Among the Elderly Chronic Disease and Health Care Spending Among the Elderly Jay Bhattacharya, MD, PhD for Dana Goldman and the RAND group on medical care expenditure forecasting Chronic Disease Plays an Increasingly Important

More information

NICE made the decision not to commission a cost effective review, or de novo economic analysis for this guideline for the following reasons:

NICE made the decision not to commission a cost effective review, or de novo economic analysis for this guideline for the following reasons: Maintaining a healthy weight and preventing excess weight gain in children and adults. Cost effectiveness considerations from a population modelling viewpoint. Introduction The Centre for Public Health

More information

Pricing the Critical Illness Risk: The Continuous Challenge.

Pricing the Critical Illness Risk: The Continuous Challenge. Pricing the Critical Illness Risk: The Continuous Challenge. To be presented at the 6 th Global Conference of Actuaries, New Delhi 18 19 February 2004 Andres Webersinke, ACTUARY (DAV), FASSA, FASI 9 RAFFLES

More information

Critical Illness Insurance

Critical Illness Insurance Critical Illness Insurance The Actuaries Club of the Southwest November, 11 2004 Presented By: Steve Pummer, Towers Perrin Agenda Background Product Design Pricing Risk Management The Regulatory Environment

More information

Trend tables. Health Survey for England. A survey carried out on behalf of the Health and Social Care Information Centre. Joint Health Surveys Unit

Trend tables. Health Survey for England. A survey carried out on behalf of the Health and Social Care Information Centre. Joint Health Surveys Unit Health Survey for England 2013 Trend tables 2 A survey carried out on behalf of the Health and Social Care Information Centre Joint Health Surveys Unit Department of Epidemiology and Public Health, UCL

More information

NHS Diabetes Prevention Programme (NHS DPP) Non-diabetic hyperglycaemia. Produced by: National Cardiovascular Intelligence Network (NCVIN)

NHS Diabetes Prevention Programme (NHS DPP) Non-diabetic hyperglycaemia. Produced by: National Cardiovascular Intelligence Network (NCVIN) NHS Diabetes Prevention Programme (NHS DPP) Non-diabetic hyperglycaemia Produced by: National Cardiovascular Intelligence Network (NCVIN) Date: August 2015 About Public Health England Public Health England

More information

Optimal levels of alcohol consumption for men and women at different ages, and the all-cause mortality attributable to drinking

Optimal levels of alcohol consumption for men and women at different ages, and the all-cause mortality attributable to drinking Optimal levels of alcohol consumption for men and women at different ages, and the all-cause mortality attributable to drinking Ian R. White, Dan R. Altmann and Kiran Nanchahal 1 1. Summary Background

More information

PRESCRIBING GUIDELINES FOR LIPID LOWERING TREATMENTS for SECONDARY PREVENTION

PRESCRIBING GUIDELINES FOR LIPID LOWERING TREATMENTS for SECONDARY PREVENTION Hull & East Riding Prescribing Committee PRESCRIBING GUIDELINES FOR LIPID LOWERING TREATMENTS for SECONDARY PREVENTION For guidance on Primary Prevention please see NICE guidance http://www.nice.org.uk/guidance/cg181

More information

Statistics on Smoking: England, 2009

Statistics on Smoking: England, 2009 Statistics on Smoking: England, 2009 Copyright 2009, The Health and Social Care Information Centre. All Rights Reserved. Copyright 2009, The Health and Social Care Information Centre. All Rights Reserved.

More information

RR833. The joint effect of asbestos exposure and smoking on the risk of lung cancer mortality for asbestos workers (1971-2005)

RR833. The joint effect of asbestos exposure and smoking on the risk of lung cancer mortality for asbestos workers (1971-2005) Health and Safety Executive The joint effect of asbestos exposure and smoking on the risk of lung cancer mortality for asbestos workers (1971-2005) Prepared by the Health and Safety Laboratory for the

More information

Child Obesity and Socioeconomic Status

Child Obesity and Socioeconomic Status NOO data factsheet Child Obesity and Socioeconomic Status September 2012 Key points There are significant inequalities in obesity prevalence for children, both girls and boys, and across different age

More information

Statistical Bulletin. National Life Tables, United Kingdom, 2011-2013. Key Points. Summary. Introduction

Statistical Bulletin. National Life Tables, United Kingdom, 2011-2013. Key Points. Summary. Introduction Statistical Bulletin National Life Tables, United Kingdom, 2011-2013 Coverage: UK Date: 25 September 2014 Geographical Area: Country Theme: Population Key Points A newborn baby boy could expect to live

More information

Chronic diseases in low and middle income countries: more research or more action? Shah Ebrahim London School of Hygiene & Tropical Medicine

Chronic diseases in low and middle income countries: more research or more action? Shah Ebrahim London School of Hygiene & Tropical Medicine Chronic diseases in low and middle income countries: more research or more action? Shah Ebrahim London School of Hygiene & Tropical Medicine More action needed Overview Growing burden of chronic diseases

More information

Appendix: Description of the DIETRON model

Appendix: Description of the DIETRON model Appendix: Description of the DIETRON model Much of the description of the DIETRON model that appears in this appendix is taken from an earlier publication outlining the development of the model (Scarborough

More information

National Insurance Fund - Long-term Financial Estimates

National Insurance Fund - Long-term Financial Estimates Social Security Administration Act 1992 National Insurance Fund - Long-term Financial Estimates Report by the Government Actuary on the Quinquennial Review for the period ending 5 April 1995 under Section

More information

Smoking in the United States Workforce

Smoking in the United States Workforce P F I Z E R F A C T S Smoking in the United States Workforce Findings from the National Health and Nutrition Examination Survey (NHANES) 1999-2002, the National Health Interview Survey (NHIS) 2006, and

More information

Cardiovascular Endpoints

Cardiovascular Endpoints The Malmö Diet and Cancer Study Department of Clinical Sciences Skåne University Hospital, Malmö Lund University The Malmö Diet and Cancer Study CV-cohort Cardiovascular Endpoints End of follow-up: 30

More information

Alcohol Guidelines Review Report from the Guidelines development group to the UK Chief Medical Officers

Alcohol Guidelines Review Report from the Guidelines development group to the UK Chief Medical Officers Alcohol Guidelines Review Report from the Guidelines development group to the UK Chief Medical Officers January 2016 2 Alcohol Guidelines Review Report from the Guidelines development group to the UK Chief

More information

Malmö Preventive Project. Cardiovascular Endpoints

Malmö Preventive Project. Cardiovascular Endpoints Malmö Preventive Project Department of Clinical Sciences Malmö University Hospital Lund University Malmö Preventive Project Cardiovascular Endpoints End of follow-up: 31 Dec 2008 * Report: 21 June 2010

More information

What are the PH interventions the NHS should adopt?

What are the PH interventions the NHS should adopt? What are the PH interventions the NHS should adopt? South West Clinical Senate 15 th January, 2015 Debbie Stark, PHE Healthcare Public Health Consultant Kevin Elliston: PHE Consultant in Health Improvement

More information

Prognostic impact of uric acid in patients with stable coronary artery disease

Prognostic impact of uric acid in patients with stable coronary artery disease Prognostic impact of uric acid in patients with stable coronary artery disease Gjin Ndrepepa, Siegmund Braun, Martin Hadamitzky, Massimiliano Fusaro, Hans-Ullrich Haase, Kathrin A. Birkmeier, Albert Schomig,

More information

Article from: Product Matters! November 2002 Issue No. 54

Article from: Product Matters! November 2002 Issue No. 54 Article from: Product Matters! November 2002 Issue No. 54 What Is Critical Illness Insurance? by Susan Kimball Editor s Note: This article has been adapted from an article on the same topic that Ms. Kimball

More information

Your Future by Design

Your Future by Design Retirement Research Series Your Future by Design Health, money, retirement: The different needs of men and women This research report is one of several reports in the Your Future by Design Retirement Research

More information

Malmö Preventive Project. Cardiovascular Endpoints

Malmö Preventive Project. Cardiovascular Endpoints Malmö Preventive Project Department of Clinical Sciences Skåne University Hospital, Malmö Lund University Malmö Preventive Project Cardiovascular Endpoints End of follow-up: 30 June 2009 Report: 7 October

More information

SUMMARY OF CHANGES TO QOF 2015/16 - ENGLAND CLINICAL

SUMMARY OF CHANGES TO QOF 2015/16 - ENGLAND CLINICAL SUMMARY OF CHANGES TO QOF 2015/1 - ENGLAND KEY No change Retired/replaced Wording and/or change Point or threshold change Indicator ID change 14/15 QOF ID 15/1 QOF ID NICE ID Indicator wording Changes

More information

Cohort Studies. Sukon Kanchanaraksa, PhD Johns Hopkins University

Cohort Studies. Sukon Kanchanaraksa, PhD Johns Hopkins University This work is licensed under a Creative Commons Attribution-NonCommercial-ShareAlike License. Your use of this material constitutes acceptance of that license and the conditions of use of materials on this

More information

NCDs POLICY BRIEF - INDIA

NCDs POLICY BRIEF - INDIA Age group Age group NCDs POLICY BRIEF - INDIA February 2011 The World Bank, South Asia Human Development, Health Nutrition, and Population NON-COMMUNICABLE DISEASES (NCDS) 1 INDIA S NEXT MAJOR HEALTH CHALLENGE

More information

UK application rates by country, region, constituency, sex, age and background. (2015 cycle, January deadline)

UK application rates by country, region, constituency, sex, age and background. (2015 cycle, January deadline) UK application rates by country, region, constituency, sex, age and background () UCAS Analysis and Research 30 January 2015 Key findings JANUARY DEADLINE APPLICATION RATES PROVIDE THE FIRST RELIABLE INDICATION

More information

THE NHS HEALTH CHECK AND INSURANCE FREQUENTLY ASKED QUESTIONS

THE NHS HEALTH CHECK AND INSURANCE FREQUENTLY ASKED QUESTIONS THE NHS HEALTH CHECK AND INSURANCE FREQUENTLY ASKED QUESTIONS Introduction The following document has been produced by the Department of Health in partnership with the Association of British Insurers,

More information

MANAGEMENT OF LIPID DISORDERS: IMPLICATIONS OF THE NEW GUIDELINES

MANAGEMENT OF LIPID DISORDERS: IMPLICATIONS OF THE NEW GUIDELINES MANAGEMENT OF LIPID DISORDERS: IMPLICATIONS OF THE NEW GUIDELINES Robert B. Baron MD MS Professor and Associate Dean UCSF School of Medicine Declaration of full disclosure: No conflict of interest EXPLAINING

More information

Scottish Diabetes Survey 2013. Scottish Diabetes Survey Monitoring Group

Scottish Diabetes Survey 2013. Scottish Diabetes Survey Monitoring Group Scottish Diabetes Survey 2013 Scottish Diabetes Survey Monitoring Group Contents Contents... 2 Foreword... 4 Executive Summary... 6 Prevalence... 8 Undiagnosed diabetes... 18 Duration of Diabetes... 18

More information

Health and Longevity. Global Trends. Which factors account for most of the health improvements in the 20th century?

Health and Longevity. Global Trends. Which factors account for most of the health improvements in the 20th century? 8 Health and Longevity The health of a country s population is often monitored using two statistical indicators: life expectancy at birth and the under-5 mortality rate. These indicators are also often

More information

Scottish Diabetes Survey

Scottish Diabetes Survey Scottish Diabetes Survey 2011 Scottish Diabetes Survey Monitoring Group Foreword The Scottish Diabetes Survey 2011 data reflects many aspects of the quality of diabetes care across the whole of Scotland.

More information

Drawdown Pensions: A technical guide

Drawdown Pensions: A technical guide For Financial Adviser use only Drawdown Pensions: A technical guide March 2013 News and information from MetLife s Technical Team In this bulletin: Drawdown has been an alternative to annuity purchase

More information

Getting the most from blood pressure medicines

Getting the most from blood pressure medicines P R E S S U R E P O I N T S S E R I E S : NO. 4 Getting the most from blood pressure medicines B L O O D P R E S S U R E A S S O C I AT I O N Pressure Points series Pressure Points is a series of booklets

More information

RR887. Changes in shift work patterns over the last ten years (1999 to 2009)

RR887. Changes in shift work patterns over the last ten years (1999 to 2009) Health and Safety Executive Changes in shift work patterns over the last ten years (999 to 009) Prepared by Office for National Statistics for the Health and Safety Executive 0 RR887 Research Report Crown

More information

Does smoking impact your mortality?

Does smoking impact your mortality? An estimated 25% of the medically underwritten, assured population can be classified as smokers Does smoking impact your mortality? Introduction Your smoking habits influence the premium that you pay for

More information

Changing the way smoking is measured among Australian adults: A preliminary investigation of Victorian data

Changing the way smoking is measured among Australian adults: A preliminary investigation of Victorian data Changing the way smoking is measured among Australian adults: A preliminary investigation of Victorian data Robyn Mullins Ron Borland 163 Quit Evaluation Studies No 9 1996 1997 Introduction In 1997, the

More information

Journal Club: Niacin in Patients with Low HDL Cholesterol Levels Receiving Intensive Statin Therapy by the AIM-HIGH Investigators

Journal Club: Niacin in Patients with Low HDL Cholesterol Levels Receiving Intensive Statin Therapy by the AIM-HIGH Investigators Journal Club: Niacin in Patients with Low HDL Cholesterol Levels Receiving Intensive Statin Therapy by the AIM-HIGH Investigators Shaikha Al Naimi Doctor of Pharmacy Student College of Pharmacy Qatar University

More information

HEALTH RISK ASSESSMENT (HRS) QUESTIONNAIRE

HEALTH RISK ASSESSMENT (HRS) QUESTIONNAIRE HEALTH RISK ASSESSMENT (HRS) QUESTIONNAIRE The Health Risk Assessment (HRA) questionnaire provides participants with an evaluation of their current health and quality of life. The assessment promotes health

More information

DISCLOSURES RISK ASSESSMENT. Stroke and Heart Disease -Is there a Link Beyond Risk Factors? Daniel Lackland, MD

DISCLOSURES RISK ASSESSMENT. Stroke and Heart Disease -Is there a Link Beyond Risk Factors? Daniel Lackland, MD STROKE AND HEART DISEASE IS THERE A LINK BEYOND RISK FACTORS? D AN IE L T. L AC K L AN D DISCLOSURES Member of NHLBI Risk Assessment Workgroup RISK ASSESSMENT Count major risk factors For patients with

More information

Understanding diabetes Do the recent trials help?

Understanding diabetes Do the recent trials help? Understanding diabetes Do the recent trials help? Dr Geoffrey Robb Consultant Physician and Diabetologist CMO RGA UK Services and Partnership Assurance AMUS 25 th March 2010 The security of experience.

More information

Cardiovascular Disease Risk Factors

Cardiovascular Disease Risk Factors Cardiovascular Disease Risk Factors Risk factors are traits and life-style habits that increase a person's chances of having coronary artery and vascular disease. Some risk factors cannot be changed or

More information

The American Cancer Society Cancer Prevention Study I: 12-Year Followup

The American Cancer Society Cancer Prevention Study I: 12-Year Followup Chapter 3 The American Cancer Society Cancer Prevention Study I: 12-Year Followup of 1 Million Men and Women David M. Burns, Thomas G. Shanks, Won Choi, Michael J. Thun, Clark W. Heath, Jr., and Lawrence

More information

Obesity in the United States Workforce. Findings from the National Health and Nutrition Examination Surveys (NHANES) III and 1999-2000

Obesity in the United States Workforce. Findings from the National Health and Nutrition Examination Surveys (NHANES) III and 1999-2000 P F I Z E R F A C T S Obesity in the United States Workforce Findings from the National Health and Nutrition Examination Surveys (NHANES) III and 1999-2000 p p Obesity in The United States Workforce One

More information

Risk factors and public health in Denmark Summary report

Risk factors and public health in Denmark Summary report Risk factors and public health in Denmark Summary report Knud Juel Jan Sørensen Henrik Brønnum-Hansen Prepared for Risk factors and public health in Denmark Summary report Knud Juel Jan Sørensen Henrik

More information

Diabetes in the United Kingdom: Analysis of QRESEARCH data

Diabetes in the United Kingdom: Analysis of QRESEARCH data Diabetes in the United Kingdom: Analysis of QRESEARCH data Authors: Professor Julia Hippisley-Cox Ronan Ryan Professor of Clinical Epidemiology and General Practice Research Fellow/Program Institution

More information

on a daily basis. On the whole, however, those with heart disease are more limited in their activities, including work.

on a daily basis. On the whole, however, those with heart disease are more limited in their activities, including work. Heart Disease A disabling yet preventable condition Number 3 January 2 NATIONAL ACADEMY ON AN AGING SOCIETY Almost 18 million people 7 percent of all Americans have heart disease. More than half of the

More information

Cardiovascular Endpoints

Cardiovascular Endpoints The Malmö Diet and Cancer Study Department of Clinical Sciences Malmö University Hospital Lund University The Malmö Diet and Cancer Study CV-cohort Cardiovascular Endpoints End of follow-up: 31 Dec * Report:

More information

Psoriasis Co-morbidities: Changing Clinical Practice. Theresa Schroeder Devere, MD Assistant Professor, OHSU Dermatology. Psoriatic Arthritis

Psoriasis Co-morbidities: Changing Clinical Practice. Theresa Schroeder Devere, MD Assistant Professor, OHSU Dermatology. Psoriatic Arthritis Psoriasis Co-morbidities: Changing Clinical Practice Theresa Schroeder Devere, MD Assistant Professor, OHSU Dermatology Psoriatic Arthritis Psoriatic Arthritis! 11-31% of patients with psoriasis have psoriatic

More information

HIGH BLOOD PRESSURE AND YOUR KIDNEYS

HIGH BLOOD PRESSURE AND YOUR KIDNEYS HIGH BLOOD PRESSURE AND YOUR KIDNEYS www.kidney.org About the Information in this Booklet Did you know that the National Kidney (NKF) Foundation offers guidelines and commentaries that help your healthcare

More information

2. Incidence, prevalence and duration of breastfeeding

2. Incidence, prevalence and duration of breastfeeding 2. Incidence, prevalence and duration of breastfeeding Key Findings Mothers in the UK are breastfeeding their babies for longer with one in three mothers still breastfeeding at six months in 2010 compared

More information

EXPANDING THE EVIDENCE BASE IN OUTCOMES RESEARCH: USING LINKED ELECTRONIC MEDICAL RECORDS (EMR) AND CLAIMS DATA

EXPANDING THE EVIDENCE BASE IN OUTCOMES RESEARCH: USING LINKED ELECTRONIC MEDICAL RECORDS (EMR) AND CLAIMS DATA EXPANDING THE EVIDENCE BASE IN OUTCOMES RESEARCH: USING LINKED ELECTRONIC MEDICAL RECORDS (EMR) AND CLAIMS DATA A CASE STUDY EXAMINING RISK FACTORS AND COSTS OF UNCONTROLLED HYPERTENSION ISPOR 2013 WORKSHOP

More information

Is the Apparent Cardioprotective Effect of Recent Alcohol Consumption Due to Confounding by Prodromal Symptoms?

Is the Apparent Cardioprotective Effect of Recent Alcohol Consumption Due to Confounding by Prodromal Symptoms? American Journal of Epidemiology Copyright 2000 by The Johns Hopkfns University School of Hygiene and Public Health Allrightsreserved Vol. 151, No. 12 Printed In USA. Is the Apparent Cardioprotective Effect

More information

High Blood Cholesterol

High Blood Cholesterol National Cholesterol Education Program ATP III Guidelines At-A-Glance Quick Desk Reference 1 Step 1 2 Step 2 3 Step 3 Determine lipoprotein levels obtain complete lipoprotein profile after 9- to 12-hour

More information

EUROASPIRE II. European Action on Secondary and Primary Prevention through Intervention to Reduce Events

EUROASPIRE II. European Action on Secondary and Primary Prevention through Intervention to Reduce Events II European Action on Secondary and Primary Prevention through Intervention to Reduce Events Euro Heart Survey Programme European Society of Cardiology-ESC 1 2 Priorities of Coronary Heart Disease Prevention

More information

Exercise Answers. Exercise 3.1 1. B 2. C 3. A 4. B 5. A

Exercise Answers. Exercise 3.1 1. B 2. C 3. A 4. B 5. A Exercise Answers Exercise 3.1 1. B 2. C 3. A 4. B 5. A Exercise 3.2 1. A; denominator is size of population at start of study, numerator is number of deaths among that population. 2. B; denominator is

More information

Draft comprehensive global monitoring framework and targets for the prevention and control of noncommunicable diseases

Draft comprehensive global monitoring framework and targets for the prevention and control of noncommunicable diseases SIXTY-SIXTH WORLD HEALTH ASSEMBLY A66/8 Provisional agenda item 13.1 15 March 2013 Draft comprehensive global monitoring framework and targets for the prevention and control of noncommunicable diseases

More information

Written Example for Research Question: How is caffeine consumption associated with memory?

Written Example for Research Question: How is caffeine consumption associated with memory? Guide to Writing Your Primary Research Paper Your Research Report should be divided into sections with these headings: Abstract, Introduction, Methods, Results, Discussion, and References. Introduction:

More information

Achieving Quality and Value in Chronic Care Management

Achieving Quality and Value in Chronic Care Management The Burden of Chronic Disease One of the greatest burdens on the US healthcare system is the rapidly growing rate of chronic disease. These statistics illustrate the scope of the problem: Nearly half of

More information

Course Notes Frequency and Effect Measures

Course Notes Frequency and Effect Measures EPI-546: Fundamentals of Epidemiology and Biostatistics Course Notes Frequency and Effect Measures Mat Reeves BVSc, PhD Outline: I. Quantifying uncertainty (Probability and Odds) II. Measures of Disease

More information

International comparisons of obesity prevalence

International comparisons of obesity prevalence International comparisons of obesity prevalence June 2009 International Comparisons of Obesity Prevalence Executive Summary Obesity prevalence among adults and children has been increasing in most developed

More information

How To Track Life Expectancy In England

How To Track Life Expectancy In England Recent Trends in Life Expectancy at Older Ages February 2015 About Public Health England Public Health England exists to protect and improve the nation's health and wellbeing, and reduce health inequalities.

More information

The Scottish Health Survey

The Scottish Health Survey The Scottish Health Survey The Glasgow Effect Topic Report A National Statistics Publication for Scotland The Scottish Health Survey The Glasgow Effect Topic Report The Scottish Government, Edinburgh

More information

Stroke: Major Public Health Burden. Stroke: Major Public Health Burden. Stroke: Major Public Health Burden 5/21/2012

Stroke: Major Public Health Burden. Stroke: Major Public Health Burden. Stroke: Major Public Health Burden 5/21/2012 Faculty Prevention Sharon Ewer, RN, BSN, CNRN Stroke Program Coordinator Baptist Health Montgomery, Alabama Satellite Conference and Live Webcast Monday, May 21, 2012 2:00 4:00 p.m. Central Time Produced

More information

What is a P-value? Ronald A. Thisted, PhD Departments of Statistics and Health Studies The University of Chicago

What is a P-value? Ronald A. Thisted, PhD Departments of Statistics and Health Studies The University of Chicago What is a P-value? Ronald A. Thisted, PhD Departments of Statistics and Health Studies The University of Chicago 8 June 1998, Corrections 14 February 2010 Abstract Results favoring one treatment over another

More information

4. Does your PCT provide structured education programmes for people with type 2 diabetes?

4. Does your PCT provide structured education programmes for people with type 2 diabetes? PCT Prescribing Report Drugs used in Type 2 Diabetes Discussion Points 1. Does your PCT have a strategy for prevention of type 2 diabetes? Does your PCT provide the sort of intensive multifactorial lifestyle

More information

3.5% 3.0% 3.0% 2.4% Prevalence 2.0% 1.5% 1.0% 0.5% 0.0%

3.5% 3.0% 3.0% 2.4% Prevalence 2.0% 1.5% 1.0% 0.5% 0.0% S What is Heart Failure? 1,2,3 Heart failure, sometimes called congestive heart failure, develops over many years and results when the heart muscle struggles to supply the required oxygen-rich blood to

More information

Pitcairn Medical Practice New Patient Questionnaire

Pitcairn Medical Practice New Patient Questionnaire / / *Areas are mandatory. Failure to complete may delay the time taken to process your registration *Surname: *Forename(s): *Address: *Date of Birth/CHI: / Marital Status: Sex: Male / Female (delete as

More information

Diabetic nephropathy is detected clinically by the presence of persistent microalbuminuria or proteinuria.

Diabetic nephropathy is detected clinically by the presence of persistent microalbuminuria or proteinuria. Kidney Complications Diabetic Nephropathy Diabetic nephropathy is detected clinically by the presence of persistent microalbuminuria or proteinuria. The peak incidence of nephropathy is usually 15-25 years

More information

THE RISK OF HEART ATTACK IN LONE MOTHERS by Asma Al Bulushi. I had been working as a nurse in the cardiology intensive care unit at Hamad Hospital

THE RISK OF HEART ATTACK IN LONE MOTHERS by Asma Al Bulushi. I had been working as a nurse in the cardiology intensive care unit at Hamad Hospital Al Bulushi, A. (2010). The risk of heart attack in lone mothers. UCQ Nursing Journal of Academic Writing, Winter 2010, 19 27. THE RISK OF HEART ATTACK IN LONE MOTHERS by Asma Al Bulushi I had been working

More information

Annual Update of Key Results 2014/15. New Zealand Health Survey

Annual Update of Key Results 2014/15. New Zealand Health Survey Annual Update of Key Results 21/1 New Zealand Health Survey Released 21 health.govt.nz Citation: Ministry of Health. 21. Annual Update of Key Results 21/1: New Zealand Health Survey. Wellington: Ministry

More information

Critical Illness Insurance. Simplified Second Chance 6 covered illnesses and surgeries

Critical Illness Insurance. Simplified Second Chance 6 covered illnesses and surgeries Critical Illness Insurance Simplified Second Chance 6 covered illnesses and surgeries Simplified Second Chance Covers added expenses that come along with a critical illness Being diagnosed with cancer,

More information

"Statistical methods are objective methods by which group trends are abstracted from observations on many separate individuals." 1

Statistical methods are objective methods by which group trends are abstracted from observations on many separate individuals. 1 BASIC STATISTICAL THEORY / 3 CHAPTER ONE BASIC STATISTICAL THEORY "Statistical methods are objective methods by which group trends are abstracted from observations on many separate individuals." 1 Medicine

More information

T he first Whitehall study of British civil servants, begun in

T he first Whitehall study of British civil servants, begun in 922 RESEARCH REPORT Change in health inequalities among British civil servants: the Whitehall II study J E Ferrie, M J Shipley, G Davey Smith, S A Stansfeld, M G Marmot... J Epidemiol Community Health

More information

Serious-illness insurance

Serious-illness insurance Serious-illness insurance for independent information About us We are an independent watchdog set up by the Government to: regulate firms that provide financial services; and help you make informed decisions

More information

Medical Costs of Childhood Obesity in Maine November 2012 MEDICAL COSTS OF CHILDHOOD OBESITY IN MAINE. SOE Staff Paper 603 November 2012

Medical Costs of Childhood Obesity in Maine November 2012 MEDICAL COSTS OF CHILDHOOD OBESITY IN MAINE. SOE Staff Paper 603 November 2012 MEDICAL COSTS OF CHILDHOOD OBESITY IN MAINE SOE Staff Paper 603 November 2012 Todd Gabe* Professor of Economics School of Economics, University of Maine Executive Summary: The purpose of this study is

More information

Preventive Medicine and the Need for Routine Hearing Screening in Adults

Preventive Medicine and the Need for Routine Hearing Screening in Adults Preventive Medicine and the Need for Routine Hearing Screening in Adults Brian Taylor Au.D., Director of Practice Development & Clinical Affairs, Unitron, Plymouth, MN Robert Tysoe, Marketing Consultant,

More information

HEART DISEASE AND STROKE

HEART DISEASE AND STROKE GENETICS AND CRITICAL ILLNESS INSURANCE UNDERWRITING: MODELS FOR BREAST CANCER AND OVARIAN CANCER AND FOR CORONARY HEART DISEASE AND STROKE By Chessman Tavarwisa Wekwete Submitted for the Degree of Doctor

More information

Hormones and cardiovascular disease, what the Danish Nurse Cohort learned us

Hormones and cardiovascular disease, what the Danish Nurse Cohort learned us Hormones and cardiovascular disease, what the Danish Nurse Cohort learned us Ellen Løkkegaard, Clinical Associate Professor, Ph.d. Dept. Obstetrics and Gynecology. Hillerød Hospital, University of Copenhagen

More information

National Rheumatoid Arthritis Society. THE ECONOMIC BURDEN OF RHEUMATOID ARTHRITIS March 2010

National Rheumatoid Arthritis Society. THE ECONOMIC BURDEN OF RHEUMATOID ARTHRITIS March 2010 National Rheumatoid Arthritis Society THE ECONOMIC BURDEN OF RHEUMATOID ARTHRITIS March 2010 ABOUT NRAS NRAS provides support, information, education and advocacy for people with rheumatoid arthritis (RA)

More information

Apixaban for the prevention of stroke and systemic embolism in people with non-valvular atrial fibrillation

Apixaban for the prevention of stroke and systemic embolism in people with non-valvular atrial fibrillation Apixaban for the prevention of stroke and systemic embolism in people with non-valvular atrial fibrillation ERRATUM This report was commissioned by the NIHR HTA Programme as project number 11/49 This document

More information