Avrupa'da Kardiyovasküler Hastalıklar: Epidemiyolojik Güncelleme 2016

Özet (abstract)

This is the fourth in a series of papers describing the burden of cardiovascular disease (CVD) within Europe.1–3 CVD remains the most common cause of death worldwide, with the 2013 Global Burden of Disease (GBD) study estimating that CVD caused 17.3 million deaths globally. It accounted for 31.5% of all deaths and 45% of all non-communicable disease deaths, more than twice that caused by cancer, as well as more than all communicable, maternal, neonatal and nutritional disorders combined. The 2013 GBD also reported that CVD caused a greater number of deaths and was responsible for a greater percentage of all deaths than in 1990 when 12.3 million deaths were attributed to CVD, corresponding to 25.9% of total deaths.4 Previous publications in this series have reported that despite the decreases in CVD mortality in Europe more than 4 million people die from CVD across the continent every year, with more than 1.4 million dying prematurely, before the age of 75 years.1–3 In this article we present an updated overview of the burden of CVD in Europe, including new statistics for mortality, morbidity, and treatment. Where possible we provide statistics for all CVD and for coronary heart disease (CHD) and stroke in particular. All data included here are updated from previous publications and we present prevalence statistics for the first time. This series of publications describing the current burden and distribution of CVD and CHD in Europe has been based on the European Cardiovascular Disease Statistics 2012 report,5 the fourth in a series of Europe-wide compendia, which was published jointly by the European Heart Network and the European Society of Cardiology. Throughout this article, we present statistics from a number of data sources chosen with consideration of data quality, date of most recent update, and coverage of the European region. Rather than collected data from individual countries we utilized major data sources which make their statistics publically available. Specifically, we aimed to obtain data for as many European countries as possible from as recently as possible. In order to present data on CVD throughout Europe, with a particular focus on the two most common forms of CVD: CHD and stroke, we identified international sources that collect and report comparable data for a number of countries. Commonly, such sources are updated through routine and administrative data collections and provide an overview of the burden and distribution of CVD in Europe through the mortality, morbidity, and treatment associated with CVD across the continent. However, these data sources generally rely on individual countries to provide the data they collate, this means that in some cases the data that we obtain from a central source, in order to be consistent and comparable between countries and across Europe, may not be as up to date as could be obtained from some individual countries’ own databases. In this article, we define Europe as the 53 member states of the World Health Organization (WHO) European region. There were no ‘ideal’ data sources that provided complete, up-to-date, high-quality, and representative information for all 53 countries for any topic in this overview and comparability and quality of the data varies by topic. We also present data for EU-15 countries, those in the European Union (EU) prior to the accession of 10 candidate countries on 1 May 2004: Austria, Belgium, Denmark, Finland, France, Germany, Greece, Ireland, Italy, Luxembourg, the Netherlands, Portugal, Spain, Sweden, UK, and the EU-28 countries which include these 15 countries and the 13 additional countries which have subsequently joined the EU: Bulgaria, Croatia, Cyprus, Czech Republic, Estonia, Hungary, Latvia, Lithuania, Malta, Poland, Romania, Slovakia, Slovenia. Mortality data come from the WHO Mortality Database using the most recent (25 November 2015) update of age- and cause-specific mortality data, and age-specific population data, by country.6 All analyses, interpretations, and conclusions are those of the authors, not the WHO, which is responsible only for the provision of the original information. The WHO database collates data reported by national authorities based on their civil registration systems and contains data for 52 of 53 European countries, with no data available for Andorra. Age-standardized rates can only be calculated where data on the absolute number of an outcome and the population are available in comparable age-specific aggregates. Where rates are presented for the ‘most recent year’, this relates to the most recent data for which both mortality and population data were available. Mortality data for Turkmenistan, for example, are now available for 2013, but the most recent population data come from 1998, hence rates for this country are from the earlier year. For one country (Monaco), although mortality data were available, no population data were. These could not, therefore, be used in the presentation of age-standardized death rates (ASDRs) but were included in the calculations for total number of deaths and premature deaths in Europe. In order to calculate rates, population data from the same database were applied to these mortality data and were standardized using the 2013 European Standard Population (ESP). The 2013 ESP was developed by the European Commission for the EU27 + European Free Trade Association countries as an update to the 1976 ESP, to reflect the current age structure of the present European population.7 On average, when using the same data, CHD ASDRs for European countries calculated using the 2013 ESP are around twice as large as those calculated using the previous (1976) ESP.8 This means that although comparisons can be made within this study between countries in which ASDRs have been calculated using the same 2016 ESP, comparisons cannot be made to other studies, including earlier papers from this series, which have used the 1976 ESP to calculate standardized rates. WHO mortality and population data are relatively up to date, with the most recent data for only 11 of the 52 countries dating from 2010 or before; however, data from five countries were not available for any years more recent than 2005: Albania (2004), San Marino (2005), Tajikistan (2004), Turkmenistan (1998), and Uzbekistan (2005). Mortality rates are presented for CVD and CHD for all ages and for those under the ages of 65 and 75 years separately; deaths before these ages are often described as premature or preventable. Morbidity data come from the WHO9 and the European Social Survey.10 Disability-adjusted life years (DALYs) are available for the entire WHO European Region from the WHO’s Health Statistics and Information Systems11 and allow for a comparison of disease burden between both countries and conditions. One DALY is equivalent to 1 year of healthy life lost and is a composite measure of years of life lost due to death from a condition and years lived with disability due to a condition. The WHO has calculated DALYs for all conditions and all countries using estimates that draw on the methods used by the GBD project.9 Prevalence data come from the European Social Survey.10 This is a European Commission-funded cross-sectional survey that is repeated every 2 years with face-to-face data collection. Using random probability methods, samples are drawn from each participating country and aim to be representative of all people aged 15 and over in that country. Data are only available for selected countries that participated in the 2014 survey. The question relating to CVD prevalence was included in 2014 in the ‘health inequalities’ module and asked people to recall if they had had any health problems listed on a showcard in the last 12 months; with heart or circulation problems as an option. Hospital discharge data come from the WHO European Region’s Health for All Database.12 Data are sourced from the national registries of each country and provide an indication of the burden of CVD on health services within European countries. In addition to discharge data, the average length of stay in hospitals (ALOS) is often regarded as a good indicator of health service efficiency. The Organization for Economic Co-operation and Development (OECD) presents the ALOS as the mean number of days that patients spend in hospital.13 ALOS is generally measured by dividing the total number of days stayed by all patients during a year by cause-specific admissions or discharges. The data cover all inpatient cases with the exception of the Netherlands where data refer to curative acute care only, resulting in an under estimation. The OECD also presents 30-day case-fatality rate as a percentage of people aged 45 and over who die within 30 days following admission to hospital for acute myocardial infarction (AMI) and ischaemic stroke (IS), which represents around 85% of all cerebrovascular disease cases. The OECD presents case fatality through ‘admission-based’ and ‘patient-based’ data.13 Admission-based data refer to deaths occurring in the same hospital as the initial admission. Rates based on patient data refer to a death occurring in the same hospital, a different hospital, or out of hospital. This indicator is more robust because it captures fatalities more comprehensively. More countries can report the same-hospital ‘admission-based’ measure, with ‘patient-based’ data requiring a unique patient identifier and linked data which are not currently available in all countries. Admissions resulting in a transfer were excluded for some countries. This exclusion generally increases the case-fatality rate compared with those countries which do not exclude these transfers.13 Using the latest available data, CVD causes more than 4 million deaths each year across Europe, accounting for 45% of all deaths. CHD and cerebrovascular disease were the most common causes of CVD deaths, accounting for 1.8 million and 1.0 million deaths, respectively. The number of deaths from CVD is higher in women (2.2 million) than men (1.8 million), with CVD accounting for 49% of all deaths in women and 40% of all deaths in men. With similar numbers of men and women dying from CHD, these sex differences arise from a greater number of women dying from cerebrovascular disease and ‘other cardiovascular diseases’ (Table1, Figure1). Proportion of all deaths due to major causes in Europe, latest available year, among men (A) and women (B). Note: No data are available for Andorra. Source: WHO Mortality Database. Number and percentage of deaths from CVDs in Europe—latest available yeara Latest available years for each country are the same as those presented in Table2, except for: Albania (2009), Lithuania (2013), Monaco (1987), Slovakia (2014), Tajikistan (2005), and Turkmenistan (2013). No data are available for Andorra. Source: WHO Mortality Database. Although more than three-fifths of all CVD deaths occur in those over the age of 75 years, 1.4 million people under the age of 75 and just under 700 000 under the age of 65 die from CVD in Europe each year. More men (0.9 million) than women (0.5 million) die from CVD before the age of 75, however due to the greater number of total premature deaths in men CVD accounts for a similar proportion of deaths before 75 years in both sexes. The observed sex differences in number of deaths are greater at younger ages, with more than twice as many men than women dying from CVD under the age of 65. The greatest differences between the sexes in number of premature deaths are found for CHD, despite similar numbers of CHD deaths for all ages in men and women (Table1). Large differences in the burden of CVD between countries in the European Region remain. Of the 3.8 million total deaths in the EU-15 countries, 33% of these were caused by CVD (1.3 million), compared with 38% of deaths in the EU-28 countries (1.9 million) and 54% of deaths in non-EU member countries (2.1 million). In countries of the EU-15, ASDRs for CVD in men, calculated using the 2013 ESP (ESP13), ranged from 275.2/100 000 men in to 000 in and women from 000 women in to 000 in In the additional countries to the EU-15 ASDRs ranged from 000 men in to 000 men in and in women from 000 women in to 000 in of the to those which had data from 2010 or had the of rates. CVD ASDRs for men in these countries ranged from 000 in to 000 in For CVD ASDRs in non-EU countries ranged from 000 in to 000 in All countries for which data from 2010 were not available were from the ASDRs from CVD and CHD by country and sex 000 rate for most recent year of data and percentage in rates over 10 years Rates are not available for Monaco due to population No mortality data are available for Andorra. Age-standardized to the 2013 European Standard not available. in rates for is over 11 years due to data for the year 10 years Source: WHO Mortality Database. in rates were found for premature In the EU-15, of deaths under the age of 75 years were from CVD million with ASDRs for this age in men from 000 men in to 000 in and in women from 000 women in to 000 in In the of deaths under the age of 75 years were from CVD million with ASDRs from additional countries to the EU-15 from 000 men in to 000 men in and from 000 women in to 000 women in In non-EU countries, of deaths under the age of 75 (1.3 million were from CVD, with ASDRs countries which had data from 2010 or from 000 men in to 000 in For women CVD ASDRs in non-EU countries ranged from 000 women in to 000 in the of CVD mortality rates under 65 years similar but at rates ASDRs calculated for the most recent year to those for 10 years as a percentage of the earlier year, most of the countries in the European decreases in ASDRs for CVD and CHD from The were which reported an in CHD ASDRs over 10 years for both sexes and the Czech that a in CHD Although other countries reported increases in rates for both CVD and CHD these were within countries recent data, latest available year of data was before such as The decreases in ASDRs over 10 years between countries. In the EU-15, decreases the latest year in CVD ASDRs in men ranged from in to in and in women from in to in In the decreases in CVD from additional countries to the EU-15 ranged from in Slovakia to in and in women from in Slovakia to in the Czech In non-EU countries, CVD decreases ranged from in to in and in women from in to in a of the observed decreases in CVD, a number of countries now a greater number of deaths from than from CVD despite accounting for than the number of deaths than CVD in Europe as a to the most recent data more men die from than CVD in 12 countries and in two countries for All of these countries are in Europe as by the GBD with of the 12 countries from the This from CVD to as the most common cause of death for men was first in in 1998, with the only other country to it before the year There were two countries in which more than CVD for both with this occurring in the same year in and years in countries in which CVD as the most common cause of death also now have higher of to CVD deaths, that of an burden of mortality compared with CVD mortality this The year the higher absolute number of deaths from CVD to by of to CVD deaths, by sex and European country. Note: and same year and similar are only included for countries in which the number of deaths from is greater than the number of deaths from CVD for women as well as and Data for all other countries, those a are for men Source: WHO Mortality Database. European countries where the number of deaths the number of deaths from CVD for men and women Disability-adjusted life years are a composite measure of years of life lost due to death from a condition and years lived with disability due to a condition. One DALY is equivalent to 1 year of healthy life rates of WHO estimates for the number of DALYs to CVD in 2012 for European countries were in the with only five countries CVD DALYs population of more than and countries had DALYs attributed to CVD of and More DALYs were attributed to CVD and CHD in men than women in all countries, with Tajikistan the only country in which women greater DALYs due to CVD than men. No country reported more DALYs for women than men for however this not for stroke, with similar number of countries higher DALYs for each of the sexes DALYs population for all cardiovascular coronary heart disease and stroke, WHO European Region Source: World Health Health Statistics and Information DALYs population by cause and WHO European Region 2012 Source: World Health Health Statistics and Information prevalence of people heart or circulation problems in the last 12 in the European Social for all countries was the same for both sexes at There were five countries in which more than of men reported heart or circulation the Netherlands and This was the case for women in and countries reported a prevalence for men, and the Czech and for the Czech and of population heart or circulation problems in the last 12 by country and sex Note: to for for Source: European Social Data Data Social Data and of data for of population heart or circulation problems in the last 12 by country and sex 2014 Note: to for for Source: European Social Data Data Social Data and of data for The WHO collates data on rates of hospital for CVD, CHD, and The rates of were in available year with hospital for CVD 000 this a from The of countries had an in rates from the year For CHD, the was with around of countries an in rates and the other a For stroke, of the 52 countries increases in rates. It be that the data are not therefore, in rates over and differences between countries could be due to differences and in population age Hospital for CVD, CHD, and cerebrovascular disease 000 by to latest year to Cardiovascular disease data and to CHD and cerebrovascular disease data countries from Source: World Health Organization for Europe. European Health for All Database.12 had the case standardized to the 2010 OECD population aged for both and measured through and Although were greater than for all countries and both disease countries not provide data and one country not present any data The case fatalities for were found in and and the was found in two other countries had an case fatality for and and were the only countries to have case fatality for and all reported case fatalities On average, case fatality was for than However, countries had case fatalities that were greater for than the Netherlands, UK, Spain, Finland, Germany, and rates and stroke, latest year, by country rate the percentage of people aged 45 and over who die within 30 days following admission to hospital for a acute condition. rates have been standardized to the 2010 OECD population Admission-based rates refer to death occurring in the same hospital as the initial admission. rates refer to death occurring in the same hospital as the initial a different hospital, or out of hospital. average for and Admissions resulting in a transfer are Source: OECD Health Statistics OECD European countries the average length of stay (ALOS) following was with the ALOS found in and with Slovakia the only other country to report an ALOS than days ALOS following was in Germany, the only country to report an ALOS of more than 10 days and were the only other countries to report ALOS of than days length of hospital stay following latest year, by country length of stay (ALOS) the mean number of days the patients spend in hospital. cases. Data cover all inpatient cases with the exception of the admission cases are not all inpatient cases. Source: OECD Health Statistics Mortality statistics that CVD remains the most common cause of death in Europe, accounting for 45% of all 49% of deaths among women and 40% among men. More than 4 million people die from CVD across Europe every year, with 1.4 million of these deaths before the age of 75 There remains of across Europe in the burden of CVD mortality and the in rates of death from these In this article we that with the higher rates found in Europe, as in the member countries, on average, a burden from CVD mortality, with EU-15 countries that have been of the the on average the In addition the 12 countries in which the mortality burden from CVD such that the number of deaths from CVD is than that from in men, with the two countries in which this has in are all found in Europe. Although death rates for all countries were age-standardized for and across it be that these rates are only standardized for the age structure of the population and do not other of these For example, and other of population structure may between countries and across the years of data presented but these are not accounted for when using the The burden of CVD in Europe is not to mortality and this is the first in this series of papers that we present data on DALYs and presented here as population rates, were higher in European however, as these rates are not standardized for age or some differences may be due to different population between countries. The European Social data from on they have heart or circulation problems and large in prevalence between countries. It be that prevalence estimates can be to recall and higher prevalence may also be an indication of more and of these conditions in the such that it not for CVD, which may cause a large burden to countries. In although the European Social to report they have these problems in the 12 it may not for who have CVD which provide a more measure of those who have from heart or circulation or who are it may report that they do not currently such In as is no measure of the problems in the 12 or this cannot be used as a measure of With such prevalence and data from a central the survey the data we have rates an burden of CVD in health systems despite mortality rates. between countries in rates of discharge may be a of health service and as well as CVD It is by not only the quality of care provided in hospitals but also differences in hospital average length of and of condition on number of can to including to acute of and health for and can differences between countries in length of stay following CVD In addition to the of the these are also to reflect differences in and In order to ALOS many countries have a number of including of in hospital methods, and for hospitals to the of care across treatment and The average length of stay (ALOS) in hospitals is often regarded as a good indicator of health as in a burden on the health service of that country. However, although a has been found between average hospital and ALOS following an ALOS could also cause on health that of may only or In a such as can have a on patients and they may not be for discharge at if no have In addition to the of the data described in the and the of this article is that it to be a data on CVD in Europe, to provide an overview of the burden of CVD across the continent. It therefore, some of the in CVD that are presented throughout In as the study not have to the data on many we are not to present on the of all the statistics we present In where we do report data and using or age-standardized population rates, we cannot for and other of population This latest update on the of CVD within Europe presents new on the in CVD described through mortality, morbidity, and treatment throughout Europe. This for more in and countries and the of data to make comparisons on mortality and between countries, in order that can be to In particular and prevalence data across Europe are in comparison to mortality statistics and these with data on the burden of CVD, CVD conditions that are currently not identified by health services or within national be to and those in is available at European Heart and from the Heart is by an of

Yazarların özeti; kaynağından alınmıştır. European Heart Journal, 2016 · DOI ↗