Before or after Diagnosis? Comparing Improvements in Disease Incidence and Disease Survival across Major Diseases in Sweden

Anna-Kathleen Piereth , Max Planck Institute for Demographic Research
Katharina Schmidt-Mende, Karolinska Institutet
Karin Modig, Karolinska Institutet
Marcus Ebeling, Max Planck Institute for Demographic Research

Medical progress is currently one of the most important drivers of population change. Primary prevention prevents the onset of diseases, resulting in fewer diseases (declining incidence rates). Secondary and tertiary prevention reduce the impact of diseases, increasing life years with the disease (improved disease survival). It is unclear which of these two forces experienced greater improvements and how this has shaped the population composition. This is the first study to investigate the dynamics of incidence and survival across several major diseases, and to examine whether their interplay leads to rising or falling disease prevalence. Drawing on Swedish register data including 57 birth cohorts of the total population, we traced disease events of myocardial infarction, stroke, hip fracture, and cancer over the last three decades for the ages 60 to 90. We analysed incidence rates, one- and five-year survival and compared their changes across cohorts. Preliminary results show that the decreases in incidence were larger than the increases in survival, except for cancer, where only survival improved and incidences rose. The prevalence of myocardial infarction, stroke and hip fracture declined, whereas the prevalence of cancer increased over time. The decreasing prevalences of acute conditions stand in contrast to the rise in multimorbidity. The results raise questions about how disease burden is increasingly characterised by an accumulation of milder conditions. Despite Sweden's relatively exemplary performance in managing modifiable risk factors, cancer has emerged as an important condition shaping the disease panorama in a low-mortality population, highlighting the disease-specific patterns of medical progress.

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 Presented in Session 47. Healthcare Access, Utilization and Care Needs