Avoidable mortality in the Russian regions

Stanovništvo

关键词: avoidable mortality;    preventable causes of death;    health care system;    the regional heterogeneity of mortality;    Russia;   

DOI  :  10.2298/STNV1102001S

来源: DOAJ

【 摘 要 】

The current trends of avoidable mortality, which is an integral indicator ofhealth system performance, were analyzed. The paper discusses the regionalheterogeneity of levels and trends in avoidable mortality in the RussianFederation. Also, it contains the analysis of impact of the financial costsof public health on avoidable mortality in regions with different levels ofeconomic development. The last 20-years period was studied, which includes astage of crisis as well as a social recovery phase. The official data of theState Statistics Committee were analyzed. In Russia, all death cases areregistered in accordance to the international classification ICD-10. Specialcomputer program summarizes death cases from preventable causes, andcalculates the standardized rates for the population aged from 5 to 64 years.The old European standard of population age structure is used. Estimates ofavoidable mortality were made in accordance with the European approach, underwhich avoidable mortality accumulates deaths of persons aged from 5 to 64years due to 34 causes and 4 classes of causes. These 38 causes are dividedinto 3 groups according to three levels of diseases prevention. The level ofavoidable mortality in the different regions varies up to 8 times. That iscomparable to the difference between Russia and the countries of EuropeanUnion in 1994. This gap is due to the coexistence of different stages ofepidemiological development among the regions in Russia. When death ratesincreased, it is shown that mortality from causes which are preventable bymeasures of primary and tertiary prevention increased to a greater extentthan mortality from the causes which depend from measures of secondaryprevention. Therein, the largest growth of observed mortality was due to lowquality of medical care in case of males (group 3), and due to causes whichare preventable by measures of primary prevention in case of females (group1). When mortality was reduced, the rates of change for causes in groups 1and 3 were approximately the same for both sexes. Avoidable mortality due tolate detection of malignant tumors (group 2) has been changed the least.Preventable component defines over 80% of the regional differences in deathrates. In 2009, the level of avoidable mortality differed more than fourfoldamong different regions of the Russia. Similarly, the difference in the levelof unavoidable mortality was 1.3-fold and 1.7-fold, for males and femalesrespectively. Proportion of deaths from preventable causes in the total sumof death cases varies from 40% till 75%. Funding for comprehensive programsof public health to a greater extent stimulates the reduction in mortalityfrom preventable causes of the first group. Mortality connected with qualityof medical care is more determined by socio-political situation in thecountry than by regional health care expenses. Based on these results, it isconcluded that the action plans to reduce mortality in Russia must have astrong regional specificity, different targets and indicators. Using theproportion of preventable causes, it is possible to separate the regions intogroups with different ratios of death determinants, which, therefore, requiredifferent approaches to reduce mortality.

【 授权许可】

Unknown