The Burden of Lung Disease in Hong Kong - fmshk.org · The Burden of Lung Disease in Hong Kong...

The Burden of Lung Disease in Hong Kong

Moira Chan-Yeung on behalf of the Hong Kong Thoracic Society and

Hong Kong Lung Foundation

Co-authorsKS Chan Fanny W KoHS Chan Christopher LaiAmy Cheung WK Lam CM Chu CY TamAlice SS Ho KS Tsang JC Ho PC WongDavid Hui Loretta Y YamMary S Ip TJ Yao

WC Yu

Specific aims

• To determine mortality and hospitalization rates of lung diseases in 2005 in Hong Kong

• The trend in mortality and hospitalization rates of lung diseases from 1997 to 2005

• To find out the prevalence/incidence of major lung diseases and their risk factors

• To provide comprehensive data of lung diseases to authorities for informed policy making

Respiratory diseasesAll respiratory diseasesSpecific respiratory diseases

Acute respiratory infections: pneumonia, influenzaTuberculosisCOPDAsthmaRespiratory tract cancersBronchiectasisObstructive sleep apneaPneumoconiosis

Defined by ICD code

Local data sources - 1

Census and Statistics Department• Local population Department of Health• Local mortality (ICD-9 before ICD-10 after 2001)• Notification of tuberculosis

Local data sources-2

Hospital Authority: ICD-9 throughout study period• Hospitalization (principal diagnosis and head counts )• In-patient bed-days Cancer Registry• Mortality and incidence of respiratory tract cancersLocal research studies• Prevalence of asthma, COPD

Other data source - 3

World Health Organization:• Global mortality data – 2002• World population data - 2002British Thoracic Society • Mortality of respiratory diseases in UK- 2004

Hong Kong in 2005

Population: 6.81 MMortality: 38,683 (568)Hospitalization: 568,266* (8341)Inpatient bed days: 7.78 M* (114,000)

*public hospitals only( ) rate/100,000

Mortality and hospitalization rates of major diseases in 2005 in Hong Kong

Crude mortality rates of major diseases in 2005 in Hong Kong

Crude mortality rate(100,000) %

Respiratory 163 28.7Cardiovascular 148 26.1Neoplasm 126 22.3Digestive 21 3.7

All 568 100.0

Hong Kong

External causes / Injuries5.5%

Others14.9%

Respiratory 18.8%

CVS 33.3%

Neoplasm(excluding lung)

22.3%

Digestive5.3%

UK

Respiratory 27.8%

Others13.3%


Digestive 3.7%

Neoplasm(excluding lung)

22.3%CVS

24.4%

Respiratory 18.4%

Others29.2%


Digestive 3.5%

Neoplasm (excluding lung )10.6%

CVS 29.3%

Global

Proportion of Deaths from Different Diseases –age-standardized

Utilization of hospital beds and cost in 2005 in Hong Kong

% Bed-days Cost (HKD)

Respiratory 16.0 1242x103 4,075x106

CVS 11.6 903 2,961Neoplasm 7.2 560 1,838Digestive 5.1 396 1,298Others 4679 15,344

Total 100.0 7,780x103 25,517x106

Based on $3280/day (HA) for public hospitals

Mortality and hospitalization rates of major respiratory diseases in 2005 in Hong Kong

Mortality (%) of different respiratory diseases in 2005 in Hong Kong

All Male FemaleRespiratory infections 39.0 33.2 48.5Respiratory tract cancer 33.2 36.3 28.2COPD 17.9 21.6 11.7TB 2.4Bronchiectasis 1.7Asthma 0.9

Others 4.9Total 100.0

Respiratory infections37.3%

COPD & bronchiectasis18.5%

TB2.4%

Lung cancer34.7%

Asthma1.0%

Others 6.1%

Hong Kong



TB0.4%

Lung cancer31.7%

Asthma1.5%

Others 16.4%

UK



TB15%

Lung cancer11.9%

Asthma2.3%

Others6.9%

Global

Proportion of deaths from major respiratory diseases – age standardized

Utilization of hospital beds and cost in 2005 in Hong Kong

Bed days Cost (HKD)Respiratory infections 462.5x103 1,517x106

COPD 254.1 833.6 Respiratory tract cancer 114.6 375.8 TB 88.8 291.2Asthma 32.4 106.1Bronchiectasis 21.7 71.1

Others 259.5 851.2Total 1242.4 4,075.0

Trends in mortality, hospitalization and incidence/prevalence of major respiratory diseases in Hong Kong, 1997-2005

050

100150200250300350400

1997 1998 1999 2000 2001 2002 2003 2004 2005Year

per 1

00,0

00

Male Female To tal

0500

1000150020002500300035004000

1997 1998 1999 2000 2001 2002 2003 2004 2005

Yearpe

r 100

,000

Male Female To tal

Mortality Hospitalization

ALL RESPIRATORY DISEASES in HONG KONG(Age Standardized Rate/100,000) 1997-2005

% annual change: -2.3 (-3.5 to -1.2)* -0.3 (-2.3 to 1.7)

0

10

20

30

40

50

60

70

80

90

100

1997 1998 1999 2000 2001 2002 2003 2004 2005

Year

per

100,

000

Male Female Total

0

100

200

300

400

500

600

700

800

900

1000

1997 1998 1999 2000 2001 2002 2003 2004 2005

Ye a r

Male Female To ta l

PNEUMONIA (age standardized rates/100,000) 1997-2005


% annual change: 1997-2005 -3 (-6.3 to 0.3)1997-2001 -13.5 (-18.4 to -8.2) *2001-2005 4.1 (0.3 to 8.2) *

2.8 (-1.8 to 7.7)16.7 (9.1 to 24.9) *-6.5 (-11.2 to -1.5)*

0.0

0.2

0.4

0.6

0.8

1.0

1.2

1.4

1.6

1.8

2.0

1997 1998 1999 2000 2001 2002 2003 2004 2005

Year

pe

r 10

0,00

0Male Female Total

0

10

20

30

40

50

60

70

80

90

100

1997 1998 1999 2000 2001 2002 2003 2004 2005

per 1

00,00

0

Year

Male Female Total


INFLUENZA (age standardized rates/100,000) 1999-2005

% annual change: 39 (2.9 to 87.9)* 14.6 (0.2 to 31.1)*

No. of specimens submitted for viral culture and no positive

0

5000

10000

15000

20000

25000

30000

35000

40000

45000

50000

1997 1998 1999 2000 2001 2002 2003 2004 2005

Year

No.

of s

peci

men

s

Negative Positive


COPD ( age standardized rates /100,000) 1997-2005

0

10

20

30

40

50

60

70

80

90

100

1997 1998 1999 2000 2001 2002 2003 2004 2005

Year

per

100

000

Male Female Total

0

50

100

150

200

250

300

350

400

450

500

1997 1998 1999 2000 2001 2002 2003 2004 2005

Yearpe

r 100

000

Male Female Total

% annual change: -3.9 (-5.2 to -2.7)* -2.8 (-4.8 to – 0.7)*

Prevalence of COPD according to GOLD criteria in Hong Kong

%

%

Stage 1: FEV1/FVC<70%; FEV1 % predicted > 80%

0

10

20

30

40

50

60

70

80

90

100

1997 1998 1999 2000 2001 2002 2003 2004 2005Year

per

100

,000

Male Female Total

0

20

40

60

80

100

120

140

160

180

200

1997 1998 1999 2000 2001 2002 2003 2004 2005

Year

pe

r 100

,000

Male Female Total

0

20

40

60

80

100

120

1997 1998 1999 2000 2001 2002 2003 2004 2005Year

Rat

e pe

r 10

0,00

0

MaleFemaleBoth


Incidence

Respiratory Tract Cancers (age standardized rate/100,000)1997-2005

% annual change: -0.91 (-1.4 to - 0.4)* -3.4 (-4.3 to -2.6)*

-1.7 (-2.3 to -1.1)*

0

2

4

6

8

10

12

14

16

18

20

1997 1998 1999 2000 2001 2002 2003 2004 2005Year

pe

r 100

,000

Male Female Total

0

20

40

60

80

100

120

140

160

180

200

1997 1998 1999 2000 2001 2002 2003 2004 2005

Year

per 1

00,0

00

Male Female Total

0

50

100

150

200

250

300

350

400

450

500

1997 1998 1999 2000 2001 2002 2003 2004 2005

per 1

00,0

00

Year

MaleFemaleTotal


Incidence

Tuberculosis (age standardized rates /100,000) 1997- 2005

% annual change: -2.9 (-4.8 to -1.0)* -6.4 (-7.8 to -5.0)*

-3.8 (-5 to -2.6)*

0.0

0.5

1.0

1.5

2.0

2.5

3.0

3.5

4.0

4.5

5.0

1997 1998 1999 2000 2001 2002 2003 2004 2005

Year

per

100

,000

Male Female Total

0

20

40

60

80

100

120

140

160

180

200

1997 1998 1999 2000 2001 2002 2003 2004 2005

Year

per 1

00,0

00

Male Female Total


Asthma – age standardized rates/100,000 1997-2005

% annual change: -2.0 (-4.8 to 1.0) -6.2 (-9.9 to -2.4)*

Time trends of asthma in 13/14 years old schoolchildren in HK

05

1015202530

12-m

whe

eze

(WQ

)

12-m

whe

eze

(VQ

)

Dia

gnos

edas

thm

a

curr

ent

rhin

o-co

njun

ctiv

itis

curr

ent

flexu

ral

ecze

ma

%

1995 2002

GWK Wong & CKW Lai, 2002

p<0.0001 nsp<0.0001

p<0.01

ns

Summary -1

• Respiratory diseases ranked first as a cause of mortality, and hospital utilization in Hong Kong in 2005;

• There was a significant reduction in respiratory mortality but not in hospital utilization in the past decade;

• Respiratory diseases are responsible for the largest share of health care cost

Summary and recommendations-2• Respiratory infection was the most common cause

of respiratory mortality and hospital utilization in 2005

• No reduction in mortality and hospital utilization from respiratory infection in the past decade

• Influenza vaccination program provided by the government should be supported and promoted

• Pneumococcal vaccination should be considered

Summary and recommendations-3• COPD ranked 3rd as a cause of respiratory

mortality but 2nd in hospital utilization• Respiratory tract cancer ranked 2nd as a cause

of respiratory mortality and 3rd in hospital utilization

• TB ranked 4th as a cause of respiratory mortality and hospital utilization

• The major risk factor of the above diseases is tobacco smoking.

• Primary prevention of these diseases lies in tobacco control, anti-smoking, and smoke cessation

September 2007

• Air pollution is a major risk factor for acute exacerbations of asthma and COPD locally and hospitalization for these 2 diseases

Summary - 4

• Tighter air pollution control to reduce acute exacerbations and the cost of hospitalization

Recommendation

Summary and recommendations - 5

• Ideal respiratory specialist /population = 1/69,000• Hong Kong 1/95,000

72 in active practice: 43 in acute 29 in non-acute

• Need altogether 100 – especially in acute care

Acknowledgements

Hospital Authority – Dr. Vivian WongDr. S.V. LoEdwina ShungPK MakDavid Wong

Department of Health – Dr. CM TamWally Tse

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