21. Across all ages, the most common causes of death amongst women are diseases of the circulatory system and cancer. They account for 43 percent and 26 percent respectively of all female deaths in Europe. Diseases of the respiratory system are responsible for 6 percent of deaths amongst women, and suicide and accidents for 5 percent. The remaining 20 percent of deaths are due to other causes. Diseases of the circulatory system cause approximately half of all deaths in women over 65. Cancer, particularly breast and cervical cancer, is the main cause of death for women aged 35 to 64 years. Furthermore, the incidence of lung cancer amongst women is increasing rapidly and is now also one of the most common cancers.
Smoking Related Deaths
22. The World Health Organisation (WHO) estimates that there are approximately 1.1 thousand million smokers in the world, which represents approximately one-third of the global populati00on aged 15 and over, and who have an average consumption of 14 cigarettes per day. In 1995, there were 1.2 million smoking-related deaths in Europe, which approximates 13 percent of all deaths. By 2020, it is estimated that there will be a staggering 10 million smoking-related deaths per year. In Northern EU countries, female smoking prevalence appears to have peaked; however, Southern EU countries are still marked by sharply rising prevalence (Graham, 1996).
23. Besides contributing to lung cancer and cardiovascular disease, smoking poses specific risks to women. It increases the risk of cervical cancer, miscarriage and low birthweight babies (Craft, 1997). There is also an increased risk of early menopause.
24. Recent evidence has indicated that the adverse effects of alcohol could be greater for women than for men because of differences in their metabolism (North, 1996). Even when differences in body weight are taken into consideration, women will attain higher blood alcohol levels than men with the same amount of alcohol. Furthermore, women are more prone to liver damage after a comparatively shorter episode of heavy drinking and at a lower level of daily drinking than men.
SDR for drinking related causes per 100,000 of the total female population
Source: WHO (2000) European Region. Health For All Database.
25. There has been a substantial increase in the total number of older people suffering from dementia. At present, 29 million people are estimated to have this condition world-wide, with the prediction that by 2020, this figure may reach 55 million. In Europe, 1 in 20 people aged over 65 has Alzheimer’s disease. (EIWH, 1999). The incidence of dementia is now 2.5 percent per 1,000 people at 65 years of age, increasing to 85.6 percent for those 90 years of age and older (Launer et al. 1999).
26. Older women are more at-risk of developing dementia. Although the risk is generally greater for men up to 75 years, women are more likely to develop the condition for the simple reason that they live longer (Hofman et al. 1991).
Prevalence of dementia by gender
27. The most common cardiovascular diseases are hypertension, ischaemic heart disease and cerebrovascular disease. It is estimated that cardiovascular diseases are the cause of 20 percent of all deaths world-wide and are responsible for around 14 million deaths. In developed countries, cardiovascular disease is the principal cause for almost 50 percent of all deaths.
SDR for ischaemic heart disease per 100,000 of the population
Source: WHO (2000) European Region. Health For All Database
29. With one million new cases in the world each year, breast cancer is one of the most common malignancies in women in the European Union (Siliman and Baeke 1998). It is estimated that 1 in every 12 women will develop breast cancer at some point in their lifetime. Risk factors for breast cancer can include genetic predisposition, hormonal effects and age. Age is in fact the most significant risk factor in breast cancer, as the incidence of breast cancer increases with age, doubling about every 10 years until menopause, when the rate of increase slows dramatically (McPherson et al, 2000).
SDR malignant neoplasms of female breast 0-64, per 100000
WHO (2000) European Region. Health For All Database.
30. A normal part of ageing for every woman, menopause is a natural physiological event, not an ‘oestrogen deficiency disease’. It happens to all women, but affects every woman uniquely. Because of population ageing, women’s health after the menopause has assumed greater importance than ever before. In Western countries the menopause occurs at a median age of 51.4 years, with a Gaussian distribution ranging from 40 to 58 years. At the start of the last century, few women lived beyond the menopause; at the beginning of this century, many women are spending over one-third of their lives post-menopause
Percentage not well informed about HRT,
Women 35+years, EU 15 (1996)
Source: Eurobarometer 44.3/1996
31. Up to 75 percent of post-menopausal women get symptoms of the menopause and approximately 30 percent seek some sort of medical help. Post-menopausal women have several risk factors for osteoporosis. Osteoporosis is a skeletal disease that is characterised by low density and generation of bone tissue. The three major fracture sites are the hip, vertebra and wrist. The main risk factors for osteoporosis include genetics, lifestyle, a lack of oestrogen caused by early menopause (before the age of 45), early hysterectomy (before the age of 45 and if both ovaries have been removed) and of course, age.
32.Although age-related osteoporosis occurs in both women and men, the incidence is greater in women due to the acceleration of bone loss which occurs both during and after the menopause. From an incidence of about 0.5 percent in the age range of 70-74 years, it rises to nearly 1.5 percent a decade later and remains very high in women over 85 years. In Western countries a 50 year old woman has a 15 percent lifetime probability of suffering a hip fracture at an average age of 79 years, and it has been estimated that every 30 seconds, someone within Europe has a fracture as a result of osteoporosis (WHO 1999).
Projected Increase in the Incidence of Hip Fractures in European Women over 65 (1990-2050)
Source: Cooper C, Campion G, Melton LJ. (1992) Hip fractures in the elderly: a world-wide projection. Osteoporosis International. Vol.2, pp 285-289.