3 - Excess Mortality Flashcards
(79 cards)
1
Q
What is excess mortality?
A
The number of deaths being recorded is greater than the number of expected on the basis of past data.
2
Q
Why is EM higher in Scotland?
A
This is due to socioeconomic deprivation (e.g. overcrowding, social class) and poverty - health issues are more impactful due to less accessible resources.
3
Q
Why is the WCS so heavily impacted?
A
Ischaemic heart disease is a big health issue in Scotland - eating habits. Even when deprivation controlled for, rates are still higher. It is improving more slowly here than the rest of Scotland.
4
Q
What are the leading killers of this phenomenon?
A
CVD, cancer, T2D/obesity, alcohol/drugs/suicide.
5
Q
In what way can two factors be associated? (5)
A
1 - X causes Y
2 - Y causes X
3 - X and Y are caused by Z
4 - X and Y are associated by artefact (as a result of investigative procedure (not natural))
5 - X and Y are associated by chance
6
Q
What is a risk factor and its two types?
A
A risk factor is something that increases your likelihood of getting disease:
1 - modifiable: smoking, diet, physical activity, high bp.
2 - non-modifiable: age, family history, ethnicity.
7
Q
Is there a determined cause for EM?
A
The cause of EM is still theorised, as there is many factors which could cause this phenomenon - we do not fully know why it exists.
8
Q
What is physical activity?
A
Any bodily movement produced by skeletal muscles that result in energy expenditure - exercise is only a small subset.
9
Q
What are the current physical activity guidelines?
A
- 8,000 steps
- 150-300 moderate intensity activity per week or 75-150 of vigorous intensity activity per week.
- muscle strengthening once or twice a week
- limit sedentary time
10
Q
What are the benefits of physical activity?
A
- maintains healthy body and mind (bone health, cognitive function, weight etc)
- lower risk of mortality
- decreases risk of developing diseases and health conditions
- aids mental health
- improves quality of sleep and life
11
Q
What are the two ways we can measure physical activity?
A
1 - questionnaire: based on personal opinion, 50% achieve guidelines.
2 - accelerometer: <10% achieve guidelines.
12
Q
What do the terms objective and self-reported measurements imply?
A
Self-reported measurements usually there will be bias in the data returned, whereas objective ensures accuracy.
13
Q
What benefit does muscle strengthening have?
A
We should do a combination of aerobic activity and muscle strengthening.
Grip strength is an indicator of overall strength and can lower your risk of mortality significantly per 5kg/grip strength. Improves prediction of risk of CVD too.
14
Q
Why is cardiorespiratory fitness important?
A
- 50% genetic component
- higher cardiorespiratory fitness gives higher life expectancy
- benefits on health outcomes are greatness in those with low fitness
- people with high fitness and strength appear to be protected even if inactive
15
Q
Why is dietary intake important?
A
A lack of fruit, seafood, fibre, and nuts/seeds are significant in increasing your risk of mortality.
The eat well plate provides an easy way of measuring food proportions and whether you are eating healthily.
16
Q
How is socioeconomic status measured in different nations?
A
Different nations put more weight on different indices of SED like income and employment.
17
Q
What is the Carstairs index and its pros/cons?
A
1981 - focuses on male unemployment, lack of car ownership, overcrowding and low occupational social class. It is simple and has no health measures, but has unfair implications such as lack of car and only considering men.
18
Q
How does alcohol influence EM?
A
- modifiable
- unit gives guide to consumption and MUP has increased over the years in an effort to intervene - more inaccessible
- 82% reported as low risk or non-drinkers, and 18% as high risk.
- ARLD as a result
- can increase atrial fibrillation
- most ARD seen in men, and are due to cirrhosis of liver or mental effects.
19
Q
How does deprivation influence ARD?
A
- least deprived = stable number of ARD, lowest number of non-drinkers and highest number of hazardous drinkers.
= Reasons for this trend - those with higher income have a higher proportion of people exceeding the weekly guideline, but those with a lower income have less, but more people who exceed the limit to a higher extreme. - lower income = higher mortality to ARD.
- ARDs are beginning to drop, less vulnerable society created over generations.
20
Q
How does smoking influence EM?
A
- modifiable
- most deprived = highest prevalence of smoking
- causes lung cancer, COPD, CHD, CVD.
- increases rates of lung cancer could be due to lag effect (pollution, better data records)
- smokers have a higher risk in comparison to those who have never smoked in terms of smoking-associated conditions
- If you quit smoking, your risk of conditions will begin and continue to decline over time
21
Q
What are the challenges faced with modifying behavioural risk factors and how is this being tackled?
A
- tricky due to the addictive tendencies of these substances, and their prevalence in society (everywhere).
- public health interventions like signage, MUP, increase in minimum buying age, pricing and images on packaging.
22
Q
How do we use a multidisciplinary approach towards this?
A
Dahlgreen and Whitehead model - Using legislative, intervention, individual, cultural, and environmental approaches/methods such as Alcohol Framework 2018 and MESAS.
23
Q
What are two other behavioural risk factors?
A
- drug use - high in scotland
- suicide - highest in men, and typically occurs between 35-50 for both sexes. It has higher rates in more deprived areas.
24
Q
What does more risk factors do to your likelihood of developing disease?
A
The more risk factors, the higher your likelihood of developing chronic diseases as they have an additive effect.
25
What are blue zones and their causes?
They are regions known for high life expectancy and concentrations of centenarians - like Japan, Greece and Italy.
They eat mainly a plant-based diet and eat meat sparingly.
26
How does age increase mortality?
The prevalence of health conditions increases with old age. This is a non-modifiable risk factor, but it can be controlled and reduced by making lifestyle changes.
No risk factors at a young age will result in less at old age, whereas one or more will result in an increased chance of more developing with age - could reduce risk of excess biological risk factors.
27
How does ethnicity influence disease risk?
Prevalence of diabetes increases depending on your race - lower in white, higher in south asians. We also see a higher trend in those from US than UK.
People can have a higher risk despite lower BMI (all down to ethnicity and other risk factors).
Some ethnicities store fat in different areas and so this impacts our disease prevalence.
28
How do biological risk factors affect COVID-19?
Age is a big risk factor for COVID-19 - older adults and those above 60 face an increased chance and susceptibility to COVID-19 due to the additive effect of risk factors over their life.
29
How is genetics a risk factor - use FTO as an example.
The FTO gene is associated with higher body weight and so linked to obesity.
FTO carriers will eat more calories per day, and even if this is a small amount more daily it adds up to a significant amount over the year.
30
How is sex a risk factor?
Women live longer than men due to CVD being more prevalent in men and they overall have an increased risk to more conditions. Fat and muscle distribution also differs, and due to women storing more fat at their hips it is away from vital organs.
31
How is family history a risk factor?
History of CVD in either parent once you reach the age of around 60 will come into play - the risk of it affecting our health increases. A BMI of ~30 and history of diabetes increases your chance of type 2.
32
What are the two types of data?
1 - observational (variables do not change)
2 - experimental (variation in extremities of variables)
33
What is epidemiology?
The study of the distribution and determinants of health-related states or events in specified populations and the application of this study to control health problems.
34
What is a cross-sectional study?
population sectioned into variables, exposure and outcome measured simultaneously.
35
What is a case-control study?
comparison of exposure variable between two groups - risk factors can be studied, and control choice important for bias reduction.
36
What is a prospective cohort study?
strongest form - divide a baseline population into extremities and follow up on cohorts years later (longitudinal) - establishes causality as exposure measured before outcome.
37
What is confounding and how do we minimise it?
Confounders affect both exposure and outcome - can affect results (we can control for these confounders in studies to take them into account).
38
What is reverse causality and how do we minimise it?
Reverse causality is when Y causes X.
Landmark analysis can help with this as you start counting events after a delay - exclude data where an external variable skewed results.
39
What is the criteria for causality? (7)
appropriately sequenced, plausibility, consistency, strength, dose-response, reversibility and strong study design.
40
What is a randomised controlled trial?
We randomise the exposure within a group, and these outcomes are compared between the two randomised groups (confounders are typically equally distributed so bias eliminated). Difficult to assess mortality as would have to be done over a long period - but we can look at inferred causal link.
41
What is the WHO definition of health?
Health is a state of complete and physical, mental and social wellbeing, and not merely the absence of disease or infirmity.
42
What is the limitations of the WHO definition surrounding chronic diseases and modern healthcare (4)?
1 - medicalising society as it implies most of us are always unhealthy - unnecessary production of drugs, screening minor things, redefining diseases.
2 - population demographic and nature of disease have significantly changed - chronic on rise, change in disease patterns.
3 - implies that those with chronic conditions are definitively ill and cannot function in life with fulfilment.
4 - WHO has developed classifications and systems to describe health, disability, functioning and quality of life, but the use of complete doesn't connote operational or measurable (overall bad definition).
43
How would we alternatively define health and why?
Health is the ability to adapt and self manage:
> more dynamic
> doesn't create limitations in the health policy
> surrounds resilience and capacity to cope and maintain/restore integrity.
44
What are the fundamental conditions of health (8)?
Peace, shelter, education, food, income, stable ecosystem, sustainability, and social equity.
45
What is physical health and examples?
A healthy organism is capable of allostasis, and should be able to mount a protective response to stress to reduce potential harm and restore equilibrium - if unsuccessful allostatic load will cause illness.
e.g. CVD, T2D (insufficient or defective insulin), cancer (via hyperplasia and dysplasia), and respiratory diseases such as asthma, CF and COPD.
46
What is mental health and examples?
The sense of coherence is a factor that contributes to a successful capability to cope, recover from stress and prevent PTSD. A strong ability to adapt and manage yourself can improve your overall wellbeing, and subjective faculties help you deal with a difficult situation.
e.g. depression, dementia, Alzheimer's (build-up of plaques (beta-amyloidcoherence is a factor that contributes to a successful capability to cope, recover from stress and prevent PTSD. A strong ability to adapt and manage yourself can improve your overall wellbeing, and subjective faculties help you deal with a difficult situation.
e.g. depression, dementia, Alzheimer's (build-up of plaques (beta-amyloid) and tangles (tau)) and vascular dementia.) and tangles (tau)) and vascular dementia.
47
What is social health?
The capacity to fulfil your potential and obligations, and the ability to manage life with a degree of independence - despite condition. It is also the ability to participate in social activities.
48
Why is measuring health important?
- useful for management and policies
- supports doctors in communicating with patients
- effective tools include methods for assessing functional status, quality of life and sense of wellbeing - ensure opinions of patient taken into account.
49
What are the two markers of obesity?
1. BMI - relationship between weight and height
2. Waist circumference - obesity associated is 102cm for men and 88cm for women.
50
What cannot be identified by BMI and why is this key?
Internal fat cannot be identified by BMI e.g. location of storage - and individuals of similar characteristics like body fat % can all differ in fat distribution.
51
Why may a higher BMI not be lethal in older adults?
The relationship between BMI and mortality risk changes with age, and it may provide a protective effect in older adults with a slightly higher BMI - may be due to extra body fat reserves being used when fighting illness or during recovery.
52
What is the optimal amount of PA a day and fruit consumption - and what effects occur when we stray from these?
- 20 mins PA a day
- 400g of fruit/veg a day (5 portions)
> 10 portions = significant decrease in risk
> 20 = only slight change
53
Why should we focus on vegetables more than fruit?
- lower sugar content and calories
- essential nutrients, fibre, and antioxidants.
54
What are the four primary dietary contributors to excess mortality?
- red meat
- sugary drinks
- salt (sodium)
- processed foods
55
What are ultra-processed foods?
Those which have been modified and produced with substances extracted from foods or synthesised like dyes - typically contain high sodium.
56
What is the link between diet and income?
A natural diet is less accessible to those in lower income areas due to processed versions being cheaper.
An unhealthy diet has a greater impact in deprived areas as they tend to experience worse health outcomes compared to those in affluent areas - even with same lifestyle.
57
How does air pollution increase mortality?
Exposure to air pollution is linked with increased all-cause mortality and serious health issues.
58
How do micro/nano-plastics increase mortality?
- can be found in bloodstreams via packaging
- emerging issue
- higher risk of CVD
- respiratory/digestive issues
- toxic chemical exposure
- immune system impact
- cellular damage
59
Give two public health strategies to reduce excess mortality.
Alcohol - increase MUP
Smoking - ban sale of tobacco in younger generations
60
What are the BMI weight categories and subcategories?
Underweight - <18.5
Healthy - 18.5 to <25
Overweight - 25 to <30
Obese:
Class 1 - 30 to <35
Class 2 - 35 to <40
Class 3 - 40 and above
61
What is the difference between white and brown adipose tissue?
White - excess energy is stored (weight gain)
Brown - close to muscle so can be expended easily via heat (weight loss)
62
What is Bronfenbrenner's model?
Contains five domains which capture health influences and can be useful for designing health interventions like the sugar tax.
63
What is the dose-response effect, using BMI as an example?
If a population of varying BMIs are all given the same activity, it will yield differing effects - follows dose-response curve.
64
What is the emerging view on weight loss and what does it mean?
To improve overall health, irrespective of weight loss. This means individuals are recommended to maintain weight status but change their body composition via lifestyle changes.
65
What is the issue with visceral fat?
This is the fat which builds around our organs - risk. The distribution of fat is directly linked with an increased risk of health conditions and mortality.
66
What is the issue with a weight centric approach?
May cause a futile cycle of weight loss and gain, yielding no health benefits overall.
67
What are individual-level interventions and give two tests used.
These are in a controlled environment - how much energy is provided and the amount of exercise completed is controlled - and waste for calories is measured.
MRI - visualise fat distribution to show intervention results.
Oral glucose tolerance test - insensitive insulin common with obesity, all energy will be stored as a result (weight gain).
68
Describe how group-level interventions work.
The trial categories are randomly assigned including the control - this could be a group which maintains their weight.
69
Give a real-world intervention application.
Football Fans in Training
- targeted those categorically obese
- lose weight over mutual love and passion for football
- successful via respect for community built and leaders
70
Why is there gender disparity in weight loss programmes?
Men yield less results from weight interventions due to the stigma surrounding slimming and diet culture - tailored to women.
71
What are natural experiments?
These include policy and environmental changes at a national level. It could be the walkability of an area and the food environments - direct impact on obesity indicators.
72
What is adjustable gastric band surgery?
Most common, band goes on entry to stomach with a device to control pressure - open/close.
73
What is Roux-en-Y gastric bypass?
Stomach is cut to allow for bypass creation.
74
What is a vertical sleeve gastrectomy?
The stretchy area of the stomach is cut to limit storage space - less expandable.
75
What do all obesity surgeries have in common and what is used for T2D?
- All are effective and irreversible
- T2D favours bariatric surgery due to possibility of condition reversal
- More risk associated with gastric surgery
76
What are the two primary drug groups for obesity and their uses?
1. sodium-glucose co-transporter-2 (SGLT-2)
2. Glucagon-like peptide-1 (GLP-1)
- combined to make semi-glutide drug
- work on brain by preventing feeling of hunger
- work on gastric emptying
- weight loss
- increase of dose is linear with effect
- more favourable than surgery
77
What are the two major demographic processes and their impact on the growing population.
1. Population ageing
2. Population migration
Growing population due to more births than deaths, and more immigration than emigration.
78
How do population changes impact future health?
- As we age, we require more healthcare due to increased chronic, prolonged health conditions
- More money must be funded for older generation
> e.g. home, care home users (private/public) and direct payments (via local council).
79
Give two health conditions associated with age.
1. Frailty - state of increased vulnerability to poor resolution of homeostasis after a stressor event, and an increased risk of adverse outcomes like falls.
2. Sarcopenia - loss of muscle mass and strength - wheelchair.
