Medical Advances Affecting Morbidity and Mortality

Transcription

1 Medical Advances Affecting Morbidity and Mortality The institute of Actuaries of Japan October 13, 2005 By Dr. Philip Smalley Vice President and Medical Director RGA International

2 Toronto, Canada St. Louis, USA

3 Agenda Longevity trends Trends in Cardiovascular Disease Obesity and Diabetes epidemic Trends in Cancer Infection disease threats

4 Trends in All-Cause Death Rates, Australian Institute of of Health and and Welfare 2004 ABS Cat. Cat. No. No ; AIHW National Population Database

5 Life Expectancy in Japan

6 Oldest Human Jeanne Calment lived 122 years 164 days between February 21, 1875 and died August 4,

7 Genetics of Longevity 1/4 of variation in longevity can be attributed to genetic factors Longevity genes found in yeast, flies, and worms Longevity gene(s) linked to chromosome 4

8 Werner Syndrome Incidence 1-20 per 1,000,000 Autosomal Recessive Genetic defect on chromosome 8 Accelerated ageing beginning in adolescence Picture from National Centre for Biotechnology Information Genes and Disease

9 Pharmocogenetics Recombinant DNA to make pure proteins Tailored drug therapies Block the abnormal gene product protein Give patient a therapeutic gene

10 Doctors Are the Third Leading Cause of Death in the U.S. Deaths per Year 106,000 80,000 45,000 12,000 7, ,000 Cause Non-error, negative effects of drugs Infections in hospitals Other errors in hospitals Unnecessary surgery Medication errors in hospitals Total deaths per year from iatrogenic causes

11 Disease Trends in Japan Cancer Statistics in Japan 2003

12 Age Adjusted Disease Trends in Japan Cancer Statistics in Japan 2003

13 Atherosclerosis

14 Cardiovascular Risk Lipids HTN Diabetes Behavioral -Smoking -Inactivity Hemostatic Thrombotic Inflammatory Genetic

15 Smoking Trends in Japan

16 New JNC VII Blood Pressure Guidelines Chobanian, AV et al. JAMA. May 21, 2003 Vol. 289 No. 19, pg

17 Hormone Replacement Therapy Table from Hulley SB et al, JAMA. 2004;291:

18 Obesity

19 Global Prevalence of Obesity India Ghana China Philippines Japan Morocco Tunisia Togo Mauritius Kyrgyzstan Seychelles Malaysia Hong Kong Norway France Italy Netherlands Switzerland Sweden Brazil Denmark Austria Turkey South Africa Mexico Spain Belgium Canada New Zealand Kuwait Hungary Uruguay Germany United Saudi Arabia Australia Neth Antilles United Finland Jordan Samoa % Men Women U S A Swinburn B et al. WHO (2001)

20 Annual Increase in Prevalence of Obesity, Samoa Kuwait United Kingdom New Zealand Mauritius United States Australia Germany Switzerland Netherlands Brazil Finland South Africa Sweden Canada China Japan France India Italy Malaysia Average % increase per annum Swinburn B et al. WHO (2001)

21 Prevalence of Obesity & Diabetes Source - JAMA. 2003;289:76-79

22 Observed and Projected Life Expectancy at Age 65 for U.S. Females (1900 to 2000) Figure from Olshansky, SJ et al, NEJM, March 17,2005;352 (11):1138

23 Observed and Projected Life Expectancy at Age 65 for U.S. Females (1980 to 2050) Figure from Olshansky, SJ et al, NEJM, March 17,2005;352 (11):1138

24 Age and Amount Requirements 1986 in North America Age Para-M Blood ECG CXR Stress M 400,000 1 M M 200, , , , ,000 2 M 2 M , , ,000 2 M 2 M , , ,000 1 M 1 M , , ,000 1 M 1 M , ,000 50, , ,000

25 Where is the Fat??

26 CHD Waist Circumference versus BMI Rexrode KM, et al, JAMA 1998;280:

27 New International Definition for Metabolic Syndrome Lancet, Sept ;366;

28 Prognosis of Metabolic Syndrome Sattar N et al. Circulation July 2003;108: Sattar N et al. Circulation July 2003;108:

29 C-Reactive Protein with Metabolic Syndrome CHD Figure from Sattar N et al. Circulation July 2003;108:

30 Old Heart Attack Definition Chest pain ECG changes Cardiac enzymes leak into blood stream

31 New Heart Attack Definition: American ACC/European ESC 2000 Clinical context compatible with ischemic myocardial damage Elevated Cardiac Troponin

32 Impact of New MI Definition Pell et al showed that The new criteria increased admissions for myocardial infarction by 58% Pell JP, BMJ January 18; 326 (7381):

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34 Age Adjusted Cancer Mortality Trends in Females

35 Lung Cancer

36 Lung Cancer Risks Smoking and Second-hand smoke Asbestos exposure Pollution

37 Thyroid Cancer 37

38 Thyroid Cancer Trends More screening being done Antiselection potential Educated public know risk factors Can be self detected Seeing more thyroid cancer critical illness claims in Asia then breast cancer claims

39 Thyroid ultrasound

40 Thyroid Cancer Screening 697 women who presented for breast U/S with no thyroid history 246 (35.3%) were found to have thyroid nodules 21 (3.0%) found to have thyroid cancer Sensitivity of U/S: 80% to 100% Specificity: 91.7% to 33.3% Lee HK et al, Yonsei Med J Dec 30;44(6):1040-4

41 Singapore Cancer Exclusions Melanomas of less than 1.5mm Breslow thickness, or less than Clark Level 3 Prostate Cancers histologically described as TNM Classification T1a or T1b or Prostate cancers of another equivalent or lesser classification T1N0M0 papillary micro-carcinoma of the Thyroid less than 1 cm in diameter Papillary micro-carcinoma of the Bladder Chronic Lymphocytic Leukemia less than RAI Stage 3 All tumors in presence of HIV 41

42 Breast Cancer

43 Trends in Breast Carcinoma In-Situ ~ 17% of all new breast cancers

44 More prevention Better screening New treatments Cures Vaccines Cancer Advances New Cancer insurance products

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46 Screening 30%-50% have not had a mammogram in past 2 years 27% of women over the age of 65 have never had a PAP smear screen for cervical cancer 70% of at risk public not getting colon cancer screening

47 47

48 Prostate Cancer Incidence Rates

49 PSA Screening Started in USA Prostate Cancer Incidence Figure from Oliver SE el al, Lancet 2000 May 20;355(9217):1788-9

50 Proteomic Screening PSA misses about 1/3 of prostate cancers NMP48 Increased specificity and sensitivity compared to PSA with a 91% predictive value detected 92% of the PSA missed cancers

51 St. Jude s Children s Research Hospital Cancer Survival Rates 51

52 Infection Trends Successes: Pneumonia HIV Hepatitis B Threats: Antibiotic Resistance Infections Hepatitis C New Infections such as variant Creutzfeld Jacob disease, SARS, Avian Flu, etc

53 Global Emerging and Re-emerging Infectious Diseases Figure from Morens, DM et al, Nature Jul 8;430(6996):242-9

54 Avian Flu Influenza A (H5N1) is a subtype of the type A influenza virus Wild birds are the natural hosts of the virus Virus was first isolated from terns in South Africa in 1961 Most infections due to exposure to sick birds Rare human to human transmission

55 Outbreak Among Poultry in Asia

56 Avian Influenza in Asia

57 WHO Cumulative Number of Confirmed Human Cases of Avian Influenza A (H5N1) since 28 January 2004 Date of onset Indonesia Viet Nam Thailand Cambodi a Total: Case s Deaths Cases Deaths Cases Deaths Cases Deaths Cases Deaths to date Total: WHO Communicable Disease Surveillance & Response (CSR), September 29, 2005

58 Risk of Epidemic Birds are endemically infected and starting in cats H5N1 viruses could gain the ability for efficient and sustained transmission between humans Little preexisting natural immunity to H5N1 in the human population Resistance to the antiviral medications amantadine and rimantadine Leaves 2 remaining antiviral medications (oseltamavir and zanamavir) that should still be effective against currently circulating strains of H5N1

59 Better Prepared Less Mortality In 1918, US population was 105,000,000 and flu killed 500,000 = 0.5% In 1957, US population was 170,000,000 and flu killed 70,000 = 0.04% Antibiotics ICU Vaccines (now 58% of elderly get vaccinated) Better Surveillance

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61 Deaths from Infections 1918 Source:

62 Impact of a Future Pandemic??? In World:? 2-7 M deaths + In Australia: 25% get infected with mortality %.4M cases. 15, ,000 deaths In Japan???

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64 Transplantations 64 Liver Kidney Heart Lung Pancreas Islet Cell Xenotransplant Stem Cell

65 Tissue Regeneration

66 Summary More screening and prevention New therapies and cures Obesity and diabetes epidemic poses threat Opportunity to fine tune underwriting Living longer and better quality lives due to medical advances and public health initiatives

67 Arigato-go-za-ee-ma-shi-ta!! Thank you!!