Deaths in New Zealand: History, Projections
and Challengesfor Palliative Care
Genesis Lecture Series
5 June 2014
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Historic Births and Deaths 1876-2012
Baby Boomers are usually regarded as those born in the years 1946–65
Source: Statistics New Zealand data, 1876 to 2012 2
The great majority of survivorship
improvements occurred at childhood
and young adult ages.
Age by Which Selected
Percentage Have Died, by Birth Cohorts
Source: Statistics New Zealand (2006). A History of Survival in New Zealand: Cohort life tables 1876–2004.
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Deaths in New Zealand 2000-2010
30.1% of all deaths are over age 85; 60.1% are over age 75 and 77.4% are
over age 65.
Source: Analysis of Ministry of Health MORT data 2000 to 2010 4
Historic Deaths and Future Projections by Age Band
Deaths will change in their distribution across age groups. Expected to be
a continued decline in deaths under age 65 and age 65-74, with a dramatic
increase in the number of deaths over age 85.
Source: Palliative Care Council, Working Paper No. 1, July 2013. Drawn using data from Statistics New Zealand; personal communication Joanna Broad. 5
Trajectories at the End of Life
Accidents
Cancer
Organ failure
Frailty and dementia
Source: Palliative Care Australia (2010). Health System Reform and Care at the End of Life: a Guidance Document. 2010. Canberra: Palliative Care Australia.Diagram from Lynn, J., & Adamson, D. M. (2003). Living Well at the End of Life. Adapting Health Care to Serious Chronic Illness in Old Age. 2003. RAND Health.
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Trajectories at the End of Life
The three characteristic trajectories are roughly sequential
in relation to the ages afflicted
with cancer (trajectory 1) peaking around age 65
fatal chronic organ system failure (trajectory 2) about a
decade later, and
frailty and dementia (trajectory 3) afflicting those who live
past their mid-eighties.
Source: Palliative Care Australia (2010). Health System Reform and Care at the End of Life: a Guidance Document. 2010. Canberra: Palliative Care Australia. 7
Total Deaths 1948 to 2010
Source: Analysis of Ministry of Health data: “Mortality: Historical summary
1948–2010”, published online May 2014. 8
Implications of Older Deaths
The major challenge for palliative care will be that not only will
the number of deaths be increasing, but they will be
increasing in older age bands.
These deaths are likely to be occurring to people with more
co-morbidities and a high prevalence of dementia.
If current patterns of end-of-life care continue most of these
deaths over age 85 will occur in residential aged care facilities
after an extended period of care.
Will challenge existing models of care.
Will challenge the way end of life care is funded.
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Regional and Ethnic Projections2014 to 2026
February 2014
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Projections of Population, Births and Deaths: 2014 to 2026
Prepared annually by Statistics New Zealand, using assumptions
specified by the Ministry of Health. Usually available from late October.
Projections by prioritised ethnicity: Māori, Pacific, Asian, Other
Source: Palliative Care Council, Working Paper No. 1, July 2013.
Period of projections
2014 to 2026
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New Zealand Population 2014
The population has a relatively flat structure from childhood to age 55,
with a steep decline in numbers thereafter.
Source: Analysis of projections produced by Statistics New Zealand
according to assumptions specified by the Ministry of Health 12
Major differences between ethnic groups. Māori and Pacific have high
proportion in childhood and young adult years. Asian very high in early
working years. Other highest from age 45, with many more elderly.
Source: Analysis of projections produced by Statistics New Zealand
according to assumptions specified by the Ministry of Health
Standardised Age Profiles by Ethnicity
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Ethnicity New Zealand 2014
The population has a relatively flat structure from childhood to age 55,
with a steep decline in numbers thereafter.
Source: Analysis of projections produced by Statistics New Zealand
according to assumptions specified by the Ministry of Health 14
Ethnicity New Zealand 2014
Significant bulge in the Asian population in the early working years. High
proportion of children for Māori and Pacific. At oldest ages, predominantly
Other (non- Māori, non-Pacific, non-Asian).
Source: Analysis of projections produced by Statistics New Zealand
according to assumptions specified by the Ministry of Health 15
Expected Births in New Zealand FY 2014
Māori make up 28.4% of births. Māori, Pacific and Asian together make up
more than half of births, 52.8%.
Source: Analysis of projections produced by Statistics New Zealand
according to assumptions specified by the Ministry of Health 16
Expected Population New Zealand FY 2014
Māori make up 15.3% of the population, with Other (non- Māori, non-
Pacific, non-Asian) making up 65.8%.
Source: Analysis of projections produced by Statistics New Zealand
according to assumptions specified by the Ministry of Health 17
Expected Deaths in New Zealand FY 2014
Māori make up 10.3% of deaths, with Other (non- Māori, non-Pacific, non-
Asian) making up 82.9%.
Source: Analysis of projections produced by Statistics New Zealand
according to assumptions specified by the Ministry of Health 18
Expected Deaths in New Zealand by DHB, financial year 2014
T
Source: Analysis of projections produced by Statistics New Zealand
according to assumptions specified by the Ministry of Health 19
Projected Ageing of Deaths
by Ethnicity
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Projected Deaths 2014 to 2026All Deaths in New Zealand
Over the period, the proportion of deaths over age 85 is expected to
increase from 35.7% to 40.7%.
Source: Analysis of projections produced by Statistics New Zealand
according to assumptions specified by the Ministry of Health 21
Projected Deaths 2014 to 2026Māori Deaths
Source: Analysis of projections produced by Statistics New Zealand
according to assumptions specified by the Ministry of Health
Māori deaths tend to be at much younger ages. Deaths below age 65 are
expected to decline with those at older ages increasing.
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Projected Deaths 2014 to 2026Pacific Deaths
Source: Analysis of projections produced by Statistics New Zealand
according to assumptions specified by the Ministry of Health
Pacific deaths are also at younger ages. Like Māori deaths, deaths below
age 65 are expected to decline with those at older ages increasing.
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Projected Deaths 2014 to 2026Asian Deaths
Source: Analysis of projections produced by Statistics New Zealand
according to assumptions specified by the Ministry of Health
Asian deaths are expected to show the most rapid ageing over the period,
with deaths over age 85 increasing from 18.5% to 36.5%.
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Projected Deaths 2014 to 2026Other Deaths
Source: Analysis of projections produced by Statistics New Zealand
according to assumptions specified by the Ministry of Health
Deaths of the Other group, including NZ European, already occur at much
older ages and there are very few deaths under age 65. Deaths over age 85
are expected to increase from 40.7% to 46.1%.
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Deaths in New Zealand 2000-2010
30.1% of all deaths are over age 85. But 39.3% of female deaths are over age
85, while only 21.0% of male deaths are in that age band,
Source: Analysis of Ministry of Health MORT data 2000 to 2010 26
Place of Deathin New Zealand 2000 to 2010
April 2014
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Place of Death 2000-2010
34.2% in hospital, 30.7% in residential care and 22.3% in private residence.
Note that this seriously undercounts hospice involvement as only hospice
inpatient unit available as a place of death.
Source: Analysis of Ministry of Health MORT data 2000 to 2010 28
Place of Death 2010 after Hospice Adjustment
The patterns (not actual data) from the hospice benchmarking data in 2012
have been applied by indexing the deaths of clients in other settings to deaths
in hospice inpatient units. The patterns were then applied to this MORT data.
Source: Analysis of Ministry of Health MORT data 2000 to 2010; with
data from Hospice NZ29
Place of Death 2000-2010
Residential care accounts for 37.5% of female deaths but only 24.0 % of male
deaths. Private residence accounts for only 18.4% of female deaths but 26.1%
of male deaths.
Source: Analysis of Ministry of Health MORT data 2000 to 2010 30
Place of Death 2000-2010
Note expanding funnel shape for residential care with age. Greater proportion
of deaths of elderly women are in residential care, compared to elderly men.
Source: Analysis of Ministry of Health MORT data 2000 to 2010 31
Place of Death 2000-2010 Age 85+
For deaths over age 85, 54.8% in residential care and only 9.9% in private
residence. Some deaths in public hospital likely to be after transfer from
residential care.
Source: Analysis of Ministry of Health MORT data 2000 to 2010 32
Cause of Death and Place of Death
Work-in-progress
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Cause of Death 2000-2010
65% of deaths are from conditions other than neoplasms or external causes.
Source: Analysis of Ministry of Health MORT data 2000 to 2010 34
Cause of Death 2000-2010
Females account for 49.9% of deaths from all causes.
Source: Analysis of Ministry of Health MORT data 2000 to 2010 35
Place of Death 2000-2010Neoplasms
The largest proportion died in a private residence (28.2%), followed by hospital
(26.5%), residential care (24.1%) and hospice inpatient unit (18.6%).
Source: Analysis of Ministry of Health MORT data 2000 to 2010 36
Place of Death 2000-2010Other Conditions
The largest proportion died in hospital (38.5%), followed by residential care
(35.9%) and a private residence (19.1%). Hospice inpatient unit was under 1%
(0.9%) of deaths from other conditions.
Source: Analysis of Ministry of Health MORT data 2000 to 2010 37
Place of Death 2000-2010
18.6% of deaths from Neoplasms in hospice inpatient unit. 68.4% of deaths
from mental, behavioural and nervous system conditions are in residential care.
Source: Analysis of Ministry of Health MORT data 2000 to 2010 38
Need for Palliative Care
Work in progress …
Need for palliative care by diagnosis
Neoplasms
Paediatric, adolescents and young adults
Proportions needing palliative care in each setting
Residential care
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Prof Heather McLeod
Senior Analyst, Palliative CareCancer Control New Zealand
Office of the Chief Medical OfficerMinistry of Health
www.cancercontrolnz.govt.nz/palliative-care
Email: [email protected] Mobile: 0210 279 7425
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