Mortality Due to Circulatory Diseases

Key Messages

Putting mortality due to circulatory diseases in context

Circulatory system disease accounted for one-third of all deaths in Canada (71,749 deaths) in 2005—the last year of published data.¹ It remains the leading cause of hospitalization in the country, accounting for 14 per cent of the total.²

There are many types of circulatory diseases. More than half of circulatory system deaths in Canada are due to ischemic heart disease, also known as coronary artery disease, which is a condition that affects the supply of blood to the heart. The blood vessels are narrowed, reducing the supply of oxygen and nutrients to the heart, which can eventually result in a heart attack. Deaths due to cerebrovascular diseases (known as strokes) account for about 20 per cent of circulatory disease deaths in Canada.³

How does the Canadian mortality rate due to circulatory diseases compare to those of its peers?

Canada ranks 4th out of the 16 peer countries, and earns an “A” grade. The most recent year of published data on circulatory disease mortality rates for Canada is 2004, with 161 deaths per 100,000 population. The estimated mortality rate for 2009 was 131 deaths per 100,000 population.⁴

The top three performing countries on this indicator are Japan, France, and Australia. In 2009, top-ranking Japan had a mortality rate due to circulatory diseases of 107 per 100,000 people. Finland is the worst performer on this indicator, with 204 deaths per 100,000 people.

Has Canada’s mortality rate due to circulatory diseases decreased?

Canada reduced deaths due to circulatory diseases from 584 per 100,000 population in 1960 to an estimated 131 in 2009—an average decline of 3 per cent per year. Only Australia managed a larger cut in its mortality rates—by 3.3 per cent, on average, per year.

The decline in the Canadian mortality rate is attributed to medical advances, new pharmaceuticals, and reductions in major risk factors, such as a decline in tobacco use.

Has Canada’s relative performance improved?

Canada has been a “B” performer since the 1970s.

France has been the only country to consistently earn an “A” over five decades. Japan improved to an “A” grade in the 1980s.

Other countries are losing ground: Germany fell to a “D” in the 1990s and 2000s; and Italy and the Netherlands fell to “C”s in the 2000s.

Finland has been a consistent “D” grade performer over the past five decades.

What are circulatory system diseases?

Circulatory system diseases encompass abnormalities of the heart and vessel system. They include cardiovascular diseases, such as heart disease and stroke, and hypertensive diseases.

Circulatory system diseases can be genetic or acquired. Lifestyle factors, such as diet and smoking, are hugely influential on the likelihood of developing a circulatory disease. Circulatory system diseases are also largely age-related.

The leading conditions contributing to circulatory system disease burden and mortality are hypertension (high blood pressure), stroke, and ischemic heart disease (coronary heart disease).

What are the risk factors for circulatory diseases?

Risk factors for circulatory diseases include tobacco consumption, physical inactivity, unhealthy diet, and heavy alcohol consumption. According to the World Health Organization, behavioural risk factors are responsible for about 80 per cent of coronary heart disease and strokes.⁵

These behavioural risk factors, in turn, may result in metabolic risk factors such as hypertension, raised blood glucose (possibly leading to type 2 diabetes), raised blood lipids, and obesity. Hypertension affects more than one in five people and is one of the major risk factors for heart disease.⁶

Other determinants of circulatory diseases include socio-economic determinants such as poverty (which affect behavioural factors) and heredity.

Physicians believe circulatory system diseases are mostly preventable. To prevent ischemic heart disease—the most prevalent cardiovascular disease in Canada and other industrialized countries, and the leading cause of death worldwide—the renowned Mayo Clinic in the U.S. recommends five strategies:^7, 8

Addressing the modifiable risk factors that exist in a large proportion of the population would make a significant positive impact on the economic and emotional cost of circulatory disease.

A number of countries have developed health promotion policies to help prevent circulatory disease through behaviour modification. The U.K., for example, developed a program in partnership with the food and drink manufacturing industry to reduce salt content in about a quarter of manufactured foods.⁹

The U.S. government recently introduced a measure to promote healthy eating by replacing the food pyramid, which highlighted healthy foods to eat throughout the day, with the food plate, which provides an image of a plate divided into the major food groups (fruit, vegetables, grains, protein, dairy) that people should consume in each meal. A benefit of the new plate design is that it indicates the relative proportions that should be consumed from each of the food groups. The new guide encourages Americans to dedicate half of their meal plates to fruit and vegetables.¹⁰

What are the costs to individuals and society of circulatory diseases?

Because of recent treatment advances, many individuals who would have died of circulatory disease in the past are now living with the disease. But although a reduction in mortality due to circulatory disease has increased life expectancy for Canadians, a longer life lived in poor health is not necessarily indicative of improved health outcomes.

Circulatory disease has a major impact on a patient’s quality of life. According to a survey conducted by the Heart and Stroke Foundation in 2000, 90 per cent of the population with no history of circulatory disease reported “good, very good, or excellent” health. Meanwhile, respondents with self-reported heart disease or who had suffered a stroke claimed much lower levels of “good, very good, or excellent health,” at 51 per cent and 37 per cent respectively.

Besides causing considerable difficulties for patients and affecting quality of life, circulatory system diseases have a significant economic cost. In Canada, total costs for three types of circulatory disease (coronary heart disease, stroke, and hypertensive heart disease) were estimated to be $21 billion in 2005.¹¹ These costs include both direct costs (drugs, hospitals, physicians) and indirect costs. Indirect costs include mortality costs (costs associated with forgone income), long-term and short-term disability costs, and federal and provincial fiscal losses resulting from premature mortality.¹² Not only do circulatory system diseases affect the health system, they also affect the overall economy through missed work and lower productivity.

Footnotes

1 Public Health Agency of Canada, “Leading Causes of Death and Hospitalization in Canada” (accessed January 23, 2012).

2 Ibid.

3 Organisation for Economic Co-operation and Development, OECD Health Data 2011.

4 Missing data up to 2009 were obtained by projecting the most recent year of data using a 10-year average annual growth rate. This was done for the following countries: Australia, Belgium, Canada, Denmark, France, Germany, Italy, Sweden, Switzerland, and the United States.

5 World Health Organization, “Cardiovascular Diseases”, September 2011 (accessed January 10, 2012).

6 Public Health Agency of Canada, “Hypertension Facts and Figures” (accessed January 10, 2012).

7 Public Health Agency of Canada, “Six Types of Cardiovascular Disease” (accessed January 10, 2012).

8 Mayo Clinic, “Five Medication-Free Strategies to Prevent Heart Disease” (accessed January 10, 2012).

9 Clifton Coles, “Lifestyle diseases strike new targets: Fat, salt contribute to Third World health woes,” The Futurist, March–April 2003 (accessed September 23, 2009).

10 United States Department of Agriculture, “ChooseMyPlate.gov” (accessed January 10, 2012).

11 Louis Thériault, Carol Stonebridge, and Sabrina Browarski, The Canadian Heart Health Strategy: Risk Factors and Future Cost Implications (Ottawa: The Conference Board of Canada, January 2010), 2. Note: the 2005 figure is in constant 2008 dollars.

12 Ibid., 1.