Epidemiology of death and population based palliative care

Question 1

Incidence

Answer 1

• Number of new cases / total population at risk
• over specified time interval

Question 2

Prevalence

Answer 2

• Number of cases / total population at a given time
• proportion of individuals in a population who have the disease at specific instant.
• estimate of probability that an individual will be ill at a point in time

Question 3

Mortality data sources (Global Burden of Disease)

Answer 3

• Death registration systems
• Epidemiological assessments (deduction of fatality rates)
• Cause of death models

Question 4

Factors affecting Life Expectancy

Answer 4

• social determinants of health
• resources
• low infant mortality
• occupation
• politics /government
• cultural
• lifestyle

Question 5

Leading Causes of Death Globally

Answer 5

1. Ischemic heart disease
2. Stroke
3. Lower respiratory infection
4. COPD
5. Diarrheal disease
6. HIV/AIDS
7. Lung cancer
8. Diabetes
9. Road accident
10. Prematurity

Question 6

Projections for future leading causes of death globally

Answer 6

• LOW income countries
  
  • Stroke
  • LRTI
  • IHD
  • HIV/AIDS
• UPPER MIDDLE income countries
  
  • Stroke
  • IHD
  • COPD
  • Lung cancers
  • diabetes
• HIGH income countries
  
  • IHD
  • Stroke
  • Alzheimer’s
  • lung cancer
  • LRTIs
  • COPD
  • Colon cancer

Question 7

Place of death data reporting

Answer 7

• high income countries only
• hospital care not an option in many low income settings
• high income 50% hospital death
• people indicate preference for home death

Question 8

Methodological limitations to data collection globally

Answer 8

• defining population difficult
• subjectivity of pain and symptom measurement
• accuracy of data
• mulitdimensional symptom experience difficult to compare across cultures

Question 9

Trajectories at end of life

Answer 9

1. Sudden death
2. Organ failure (up and down)
3. Terminal illness (relatively high functional level with steep decline)
4. Frailty (low functional level with slow decline over time)

Question 10

NNT

Answer 10

• Number needed to treat
• # patients that would need to be given treatment for one of them to achieve desired outcome

Question 11

NNH

Answer 11

• number needed to harm
• number of people who received intervention would lead to just one person being harmed
• absolute risk of bad outcomes