MORTALITY RATES, indicators of demographic statistics that measure the level of mortality of the population, regardless of its size. Absolute data on the number of deaths cannot give a complete picture of the intensity and dynamics of the mortality process; these data also cannot be compared across individual countries and regions for different periods. Mortality rates are to a certain extent devoid of these shortcomings.
In demography, various kinds of mortality rates are used (see Demographic Coefficients). The most common indicator is the crude mortality rate (m), calculated as the ratio of the total number of deaths during a certain period (M) to the average population (P), as a rule, expressed in ppm (o / oo):
m =1/T * (M/P) * 1000,
where T is the length of the period in years. The dynamics of this coefficient over a number of years makes it possible to judge the change in the overall level of mortality. The dynamics of the general mortality rate depends on changes in the age and sex structure of the population. Thus, the growth of this indicator may be associated with the aging of the population, as well as shifts in mortality levels by sex and age. If the analysis of the mortality rate is limited only to the general mortality rate, then one can fall into error and draw wrong conclusions.
More accurate conclusions can be drawn from the analysis of the mortality rate by sex and age. Age-specific mortality rates (mx,x + τ - 1) measure the mortality rate for individual age groups (1-year-old, 5-year-old and others). They are calculated as the ratio of the absolute number of deaths in a given age group (Mx,x + τ) for a period T (usually 1 or 2 years) to its average number (Px,x + τ), expressed in ppm (o / oo):
mx,x+τ-1 = 1/T * Mx,x+τ/Px,x+τ *1000.
The age-specific mortality rate according to the calculation method is similar to the tabular one and is used in the construction of mortality tables. The analysis of age-specific mortality rates allows us to identify differences in the level of mortality by department. age groups. Therefore, when studying mortality, it is necessary first of all to study the dynamics of age-specific mortality rates and only then to establish the conditionality of the mortality rate by other factors.
Of particular importance is the calculation of the mortality rate for children under the age of 1 year - the infant mortality rate. The more children under 1 year old in the population, the higher (ceteris paribus) the overall mortality rate, since mortality in infancy significantly exceeds the mortality rate in other ages, except for the oldest. To eliminate the effect of infant mortality on the overall mortality rate, the mortality rate of the population older than 1 year is calculated:
where m1+ is the mortality rate of the population older than 1 year: M1+ is the number of deaths aged 1 year and older, P1+ is the average annual population of 1 year and older, which is calculated as the difference between the average population and the average annual number of children under 1 year old. This indicator can also be obtained on the basis of the birth rate (n), mortality (m) and infant mortality (m0):
m1+ = (m - nm0)/(1 - n(1 - km0)) ,
where k is a multiplier showing how much of infant mortality is due to the deaths of children born in a given calendar year.
Among the population older than 1 year, the mortality of children aged 1-2 years is quite high. If the population is dominated by children and the elderly, then overall mortality rates and mortality rates for the population over 1 year of age can be high. To eliminate the influence of age structure on the values of crude mortality rates, standardized mortality rates are calculated by applying various standardization methods (see Standardization of Demographic Rates). When comparing the mortality rates of different population groups or populations of individual countries, the use of standardized mortality rates gives the most reliable results.
In the analysis of mortality, mortality rates by cause of death are important, which are calculated for certain groups of causes of death (usually for certain ages).
G. Sh. Bakhmetova.
Demographic encyclopedic dictionary. - M.: Soviet Encyclopedia. Chief editor D.I. Valentey. 1985.
Literature:
Novoselsky S. A., Mortality and life expectancy in Russia, P., 1916;
Merkov A. M., Demographic statistics, 2nd ed., M., 1965;
Reproduction of the population of the USSR, M., 1983;
Population of the countries of the world, 3rd ed., M., 1984.
A system of indicators is used to measure mortality. The simplest of them - absolute number of deaths. Statistical authorities collect and publish data on the number of deaths per year and for shorter periods of time. This indicator strongly depends on both the total population and its structure, primarily age and sex.
The relative indicator of the death rate, depending on the size of the population, is crude death rate(Table 5.1, Fig. 5.1):
where D- number of deaths during the period T; R - average population for period D, i.e. the total number of person-years lived by the population during the period T.
table 5.1
Dynamics of crude mortality rates in Russia, 1980-2014 one
1 Russia in numbers. 2015. Brief statistical collection.
The end of the table. 5.1
Rice. 5.1.
As in the case of assessing the birth rate, B. Ts. Urlanis proposed an approximate scale for the values of the total mortality rate (Table 5.2).
Table 5.2
Mortality Scale 1
Among the private mortality rates, the most important place belongs to age-specific mortality rates, which are calculated separately for men and women as the ratio of the number of deaths at a particular age to the average annual number of men or women at that age:
where n D x - the number of deaths in the age interval (X + P); n P x - average annual population (male or female) in the age interval (,X + P).
Analysis of age-specific mortality rates makes it possible to identify differences in mortality levels for individual age groups. The analysis of mortality should begin precisely with the identification of the role and dynamics of age-specific mortality rates, and only then - other factors 1 .
Age-specific mortality rates are the best tool for analyzing this demographic process. The disadvantage of using them is their large (up to hundreds) number and some susceptibility to the influence of age accumulation. These shortcomings are eliminated by calculating the coefficients not for one-year, but for five-year age intervals. Five-year coefficients are free from the shortcomings of one-year coefficients, and their accuracy is quite sufficient for most practical purposes.
Among the age-specific mortality rates, a special place is occupied by infant mortality rate, i.e. an indicator that measures the mortality of children under the age of one year.
Mortality at the age of less than one year sharply exceeds mortality at other ages, except for the oldest. The infant mortality rate is a powerful and highly informative indicator of the level of socio-economic development of a country.
The calculation of the infant mortality rate differs from the calculation of other age-specific rates. The infant mortality rate is not a coefficient, but a probability, since when calculating it, the number of deaths of children under the age of 1 year is divided not by their average annual number, but by the number of births. The fact is that for this age group the concept of the average annual population is practically indefinable and the probabilities of death at the beginning and at the end of the first year of life are very different from each other.
If only general data on the numbers of births and deaths in a given year are known, and greater accuracy in estimating the value of the infant mortality rate is not needed, then an estimate of the infant mortality rate can be obtained by simply dividing the number of deaths by the number of births in the same year. However, this estimate will be the most rough and approximate. Moreover, this can be done only when the annual fluctuations in both the numbers of births and the numbers of deaths are small.
If neighboring years differ greatly from each other in this respect, then the magnitude of the estimation error may go beyond the permissible limits. In this case, resort to Ratz formula, named after the German statistician and demographer I. Rats who proposed it. The Rats formula looks like this:
where IMC is the infant mortality rate; D0- the number of children under the age of 1 who died in a given year; B_ x - the number of births in the last year; V (- the number of births in a given year; a and P are weights, and a + p = 1.
Calamus weights are selected based on the distribution of deceased children by months of the first year of life. If this distribution were uniform, i.e. if the probability of dying was the same for everyone
months of the first year of life, then a = P = -. In fact, this is not so: the probability of death decreases with age. The older the child, the less likely it is that he will die before reaching the age of one. At the same time, along with a decrease in infant mortality, it shifts to the earliest ages. Therefore, over time, the weighting coefficients in the Rats formula have to be changed.
Rats accepted a = -, P = -. At present, these weights are most often 3 3 3 1
are taken equal to - and -, respectively. In some countries where infant mortality rates are low, the weights are taken to be
a = - and p = - or even more distant from each other.
The Rats formula is used when only the numbers of births in the given and previous years and deaths in the first year of life are known, but the distribution of deaths by generation is unknown. The Rats formula is also used for educational purposes 1 .
To assess the level of infant mortality, the scale for assessing the levels of infant mortality rates developed by Urlanis is used (Table 5.3).
Table 53
Infant Mortality Scale 2
- 1 Mednoe V. M. Demography: textbook, allowance.
- 2 Romashova T.V. Economic and social geography of Russia: textbook.-method. allowance.
The end of the table. 53
The infant mortality rate can also be calculated as the sum of two independent coefficients, the first of which is equal to the ratio of the number of deaths in a given year out of the total number of births in the past, and the second is equal to the ratio of the number of deaths in a given year out of the total number of births also in a given year: 
Infant mortality in Russia 1
|
Deaths under the age of 1 year, people |
Deaths under the age of 1 year, people per 1000 live births |
|||||
|
boys |
boys |
|||||
where Do and Z)q are children who died at the age of 0 years, respectively, from among those born in the past (V_ () and given (In d) years.
Rosstat uses exactly this formula for calculating the infant mortality rate (Table 5.4).
Table 53
Quantitative indicators of the level of mortality and its dynamics are an important tool for analyzing the demographic situation in the country. However, quantitative indicators alone, even though extremely accurate and independent of the demographic structure of the population, are completely insufficient to fully characterize both the mortality itself and the general socio-economic situation, working and living conditions of the population, its lifestyle, behavior associated with health and life expectancy, ecological and sanitary-hygienic conditions.
Therefore, quantitative indicators of mortality should be supplemented by qualitative indicators characterizing the causes of death: what people die from at a particular age.
- Russian statistical yearbook. 2014. Statistical compendium.
maternal mortality.
The most important demographic indicator that characterizes the state of health of the female population and the level of medical care for them in the maternity system is the maternal mortality rate (Diagram 4; Table 5 of the Appendix).
maternal mortality- death of women due to pregnancy, occurring during pregnancy, childbirth or within 42 days after childbirth, from a cause directly related to pregnancy, aggravated by it, or its management.
Structure of causes of maternal death in Russia:
§ abortions (24%);
§ obstetric bleeding (11%);
§ preeclampsia (10%);
§ ectopic pregnancy (8.5%);
§ sepsis during childbirth (4.7%);
§ other complications of pregnancy and childbirth (40%).
Diagram 4.
Despite the fact that the maternal mortality rate in Russia is constantly decreasing, its level in comparison with Western European countries is still quite high. The current level of maternal mortality in Russia corresponds to the indicators observed in the countries of the European Union, the USA and Japan in the mid-1970s.
Due to the decline in the birth rate and the number of abortions, over the past decade, the absolute number of deaths from causes of maternal death has decreased by more than half from 727 cases in 1995 to 388 cases in 2009. At the same time, the maternal mortality rate, calculated per 100,000 live births, has fallen by almost a third.
natural increase.
The final stage in assessing the natural movement of the population is the determination of the reproduction of the population.
natural increase The population is the most general characteristic of population growth and is calculated as a coefficient of natural population growth, as the difference between the birth and death rates, or from absolute numbers - as the ratio of the difference between births and deaths to the average annual population:
It is necessary to estimate the rate of natural population growth taking into account the birth and death rates from which it was obtained, since the same growth rates can be obtained with high and low birth and death rates (diagram 5).
A high natural increase can be assessed as a favorable phenomenon only with low mortality. Low growth with high mortality characterizes the unfavorable situation with the reproduction of the population. Low growth with low mortality indicates a low birth rate, and therefore it cannot be considered as a positive phenomenon either. Negative natural increase in all cases indicates a clear trouble in society (Table 5 of the Appendix.)
Diagram 5.
A high natural increase can be assessed as a favorable phenomenon only with low mortality. Low growth with high mortality characterizes the unfavorable situation with the reproduction of the population. Low growth with low mortality indicates a low birth rate, and therefore it cannot be considered as a positive phenomenon either. Negative natural increase in all cases indicates a clear trouble in society (Table 6).
The unfavorable demographic processes in the country, manifested in the reduction of natural population growth, are due to the negative interaction of several main factors:
§ the country's focus on small families;
§ the entry into the main childbearing age (20-29 years) of small contingents of women born in the late 70s, early 80s;
§ Crisis state of the socio-economic sphere.
All this contributes to a significant reduction in the number of births in young families, and hence the depopulation or extinction of the nation.
For a more objective assessment of public health, reflecting the demographic situation in society, average life expectancy(ALE), calculated on the basis of age-specific mortality rates.
Under indicator average life expectancy should be understood as the hypothetical number of years that, on average, a generation of simultaneously born or peers could live, provided that throughout their life the mortality in each age group will be the same as it was in the year of compiling the mortality table (diagram 6).
Diagram 6.
According to the Russian State Statistics Committee, from 2004 to 2009, life expectancy in Russia at birth has been steadily increasing (from 64.9 years in 2004 to 68.7 years in 2009). According to Rosstat, life expectancy in Russia in 2008 was 67.9 years (61.8 for men and 74.2 for women).
Morbidity.
Morbidity, along with medical and demographic indicators and indicators of physical development, is one of the most important criteria characterizing the health of the population.
Data on the incidence and structure of morbidity, as well as the spread of diseases, are of great importance in various areas of health management, in particular they are required for:
1) training and proper placement of personnel;
2) bed capacity planning;
3) rational organization of various types of medical and social assistance;
4) carrying out preventive and health-improving measures;
5) control over the quality of medical care.
With the help of population morbidity indicators, the activities of doctors, medical institutions, and health authorities are evaluated.
Under morbidity refers to data on the prevalence, structure and dynamics of various diseases registered among the population as a whole or in its individual groups (territorial, age, gender, occupational, etc.).
When studying morbidity, it is necessary to use a single methodological basis, including the correct use of terms and their common understanding, a unified system of accounting, collection and analysis of information.
Incidence(primary morbidity) - a set of new, nowhere previously recorded and first detected diseases in a given calendar year. Registered according to statistical coupons (ac.f.025-2 / y) of updated diagnoses with a (+) sign.
Prevalence(morbidity) - the totality of all existing diseases, both first detected in a given year and in previous years, for which the patient again sought medical help in a given calendar year (all statistical coupons for updated diagnoses, account form 025-2 / y).
Pathological affection – a set of diseases, as well as premorbid forms and conditions identified during medical examinations.
Accumulated incidence – all cases of registered diseases for a number of years.
True incidence – the sum of all diseases identified according to the data of appeals and medical examinations in a given year.
There are three main methods for studying morbidity (Table 7 of the Appendix):
1. morbidity according to the data on seeking medical care, including:
1.1. general morbidity;
1.2. infectious disease;
1.3. incidence of major non-epidemic diseases;
1.4. hospitalized morbidity;
1.5. morbidity with temporary disability;
2. morbidity according to medical examinations;
3. morbidity according to the causes of death.
When studying morbidity, it is necessary to know the basics of statistics, in particular, the standardization method, which allows for an accurate comparative analysis of indicators. In addition, it is customary to calculate a number of indicators characterizing various types of morbidity.
1. Morbidity according to attendance data:
General morbidity.
General morbidity – it is a set of diseases (acute and chronic) among certain groups of the population for a certain calendar year. The study of general morbidity is carried out according to the data of outpatient clinics. General morbidity data are needed to fully characterize the health of the population.
Unit of observation is the initial visit of the patient to the doctor about a specific disease in a given calendar year. The main accounting document is the “Statistical coupon for registration of final (refined) diagnoses” (f.025-2 / y).
The "statistical coupon" is filled out for each case of an acute disease (with a "+" sign), for each case of a chronic disease diagnosed for the first time in life (with a "+" sign), as well as for the first visit in the current calendar year for a previously diagnosed chronic disease (with the sign "-").
Chronic diseases are taken into account only once a year; exacerbations of chronic diseases are not taken into account again this year as diseases. Based on the development of data on "Statistical coupons"
the “Report on the incidence” is filled out (f. 12).
When studying the primary morbidity of the population, according to the data on appeal, “Statistical coupons” filled out only for newly diagnosed diseases (with a “+” sign) are taken into account.
When studying the prevalence of diseases, according to the data on appealability, all statistical coupons filled out during the year are taken into account, both in cases of newly diagnosed diagnoses with a “+” sign, and those that have been transferred from previous years with a “-” sign.
When analyzing the overall incidence, it is customary to calculate the following indicators:
1) incidence rate :
General incidence rates give only a general idea of the incidence rate. More accurately characterize the general incidence of special indicators (age and sex, according to diagnoses, professions, etc.):
When analyzing the morbidity rate according to the data on seeking medical care, it should be remembered that it depends on the population's seeking medical care. The accessibility, in turn, is influenced by the availability of medical care, the medical activity of the population, material well-being, the qualifications of medical personnel and other factors.
To get a complete picture of the state of mortality of the population, the following indicators are calculated and analyzed:
Crude death rate;
maternal mortality rate;
Child mortality rates;
Perinatal mortality rate;
Stillbirth rate;
Lethality rate.
Crude death rate calculated as the ratio of the total number of deaths per year to the average annual population. This ratio is multiplied by 1000 and measured in ppm (?).
Since the 1990s, this indicator has maintained an upward trend and amounted to 14.6 per 1,000 population in 2008 (see Fig. 1.3). On the scale given in table. 1.2, the mortality rate of the population in the Russian Federation is estimated as average.
Table 1.2. Mortality Rate Estimation Scheme
In addition to the crude death rate, the mortality rates from individual diseases: coronary heart disease, injuries and poisoning, malignant neoplasms, etc. For example, mortality from acute myocardial infarction is calculated as the ratio of the number of deaths from this disease to the average annual population and is expressed in ppm (?).
Of great importance in the development and implementation of a set of measures to reduce the mortality of the population is the analysis of the indicator of the structure of the causes of death, which is shown in fig. 1.4.
Rice. 1.4. Structure of causes of death in the population of the Russian Federation (2008)
In the first place among all causes of death - diseases of the circulatory system (56.8%), in the second - neoplasms (13.7%), in the third - external causes (11.8%). These diseases account for more than 80% of all causes of death in the Russian Federation.
Along with the overall mortality rate, accounting and analysis of maternal mortality is of great importance. Due to its low level, it does not have a significant impact on the demographic situation as a whole, but it is one of the main characteristics in assessing the organization of the obstetric service.
maternal mortality is the death of a woman during pregnancy, regardless of its duration and location, or within 42 days after its termination, from any cause associated with pregnancy, aggravated by her or her management, but not from an accident or a sudden onset of a cause .
Maternal deaths are divided into two groups:
1) death directly related to obstetric causes (death as a result of a complicated course of pregnancy, childbirth and the postpartum period, as well as as a result of diagnostic interventions and improper treatment);
2) death indirectly related to obstetric causes (death as a result of a previously existing or developed during pregnancy disease, not related to direct obstetric
sher cause, but aggravated by the physiological effects of pregnancy). Maternal mortality rate is calculated using the following formula and is measured in centi-milles (0 / 0000).
This indicator allows you to evaluate all losses of pregnant women (from abortions, ectopic pregnancy, obstetric extragenital pathology during the entire gestation period), as well as women in labor and puerperas within 42 days after the end of pregnancy. Over the past two decades in Russia, this indicator has decreased from 47.4 to 21.0 cases (per 100,000 live births) (Fig. 1.5).
Rice. 1.5. Dynamics of maternal mortality in the Russian Federation (1990-2008)
Abortion is one of the leading causes of maternal death. More than 1/4 of those who die from abortions die before the age of 25. In the structure of causes of death of women from abortions, sepsis and bleeding play a leading role.
The decrease in the abortion rate from 55.0 in 2000 to 32.0 in 2008 (per 1,000 women of childbearing age) played a positive role in the dynamics of maternal mortality.
Child mortality
Child mortality rates characterize not only the state of health of the child population, but also the level of socio-economic well-being of society as a whole. A correct and timely analysis of child mortality makes it possible to develop a number of specific measures to improve the health of pregnant women and children, evaluate the effectiveness of ongoing preventive measures, and the work of local health authorities to protect motherhood and childhood.
Child mortality has a complex structure, which is determined mainly by the causes of death and the age of the deceased children. In the statistics of child mortality, it is customary to distinguish the following groups of indicators:
Mortality rates of children in the 1st year of life (infant mortality);
Mortality rates for children aged 1 to 17 years inclusive.
infant mortality- this is the most important component of child mortality, it is calculated according to the following formula and expressed in ppm (?).
Over the past two decades, this indicator in the Russian Federation has a stable downward trend and amounted to 8.5 in 2008 (Fig. 1.6).
Antenatal (from the 22nd week of pregnancy to childbirth);
Intranatal (period of childbirth);
Early neonatal (first 168 hours of a child's life).
Mortality of children in the perinatal period is characterized by perinatal mortality rate, which is calculated as the ratio of the sum of the number of stillborns and the number of deaths in the first 168 hours of life to the number of liveborn and stillborn.
Rice. 1.6. Dynamics of the infant mortality rate in the Russian Federation (1990-2008)
This figure also tends to decrease in recent years and amounted to 8.3? in 2008. The analysis of perinatal mortality makes it possible to assess the continuity in the work of obstetric and pediatric services.
Mortality in the antenatal and intranatal periods in the amount give stillbirth, the coefficient of which is calculated by the following formula.
The main causes of stillbirth in the Russian Federation are complications from the placenta and umbilical cord, complications of pregnancy and childbirth in the mother, infections, congenital anomalies in the development of the fetus, as well as maternal conditions not associated with a real pregnancy.
To register death in the perinatal period, the “Medical certificate of perinatal death” (form 106-2 / y-08) is filled out.
In addition to mortality rates, in assessing the health of the population living in certain administrative territories, mortality rates from certain diseases, which are calculated differently. So, if the population is taken as an environment for calculating the mortality rate, then patients serve as such an environment when calculating the mortality rate. For example, lethal
The risk from acute myocardial infarction is calculated using the following formula and is expressed as a percentage (%).
To analyze the quality of treatment of patients in hospitals, use a different, different from the previous indicators of mortality and mortality, mortality rate in the hospital. It is calculated using the following formula and is expressed as a percentage (%).
* The indicator is calculated for individual nosological forms and age and sex groups of patients.
The mortality rate in a hospital allows a comprehensive assessment of the level of organization of medical and diagnostic care in a hospital, the use of modern medical technologies, continuity in the work of outpatient clinics and hospitals.
3. Rate of natural population growth represents the most general characteristic of the demographic situation and is calculated as the difference between the birth and death rates according to the following formula.
Negative natural increase indicates a clear trouble in society and is commonly called unnatural decline in population. Such a demographic situation is usually characteristic of a period of wars, economic crises and other upheavals.
In the entire history of Russia (not counting the period of wars), for the first time in 1992, a negative natural increase (unnatural decline) of the population was noted in the country, which has been preserved to this day and amounted to 2.5 in 2008? (see fig. 1.3). Negative natural growth (unnatural decline) leads to a reduction in the country's permanent population and other unfavorable demographic phenomena.
The most important task of society is to create the necessary socio-economic conditions for the reproduction of the population, the excess of the birth rate over the death rate.
4. One of the indicators used for a comprehensive assessment of public health is average life expectancy (LEP). This indicator should be understood as the hypothetical number of years that a given generation of births or the number of people living at a certain age will have to live, provided that throughout life the mortality in each age group will be the same as it was in the year for which the calculation was made. This indicator characterizes the viability of the population as a whole, it does not depend on the characteristics of the age structure of the population and is suitable for analysis in dynamics and comparison of data for different administrative territories and countries. It should not be confused with the average age of the deceased or the average age of the population.
Life expectancy is calculated on the basis of available age-specific mortality rates by constructing special mortality tables (survival) for a real or hypothetical generation. In 2008, this indicator in the Russian Federation for men was 61.8 years, for women - 74.2 years.
Thus, the demographic situation in Russia at the end of the last and the beginning of this century is characterized by depopulation processes. Moreover, there is a depopulation of the main ethnic group of the country - Russians, and this is not only an ethnic, but also a nationwide political, social and economic problem.
With this in mind, Decree of the President of the Russian Federation No. 1351 dated October 9, 2007 approved the "Concept of the Demographic Policy of the Russian Federation for the period up to 2025", which is aimed at increasing life expectancy, reducing mortality, increasing the birth rate, regulating internal and external migration, maintaining and strengthening the health of the population and, on this basis, improving the demographic situation in the country.
INCIDENCE
Morbidity of the population is the most important component of a comprehensive assessment of public health. Morbidity records are maintained by almost all medical institutions. Analysis of morbidity is necessary for the development of managerial decisions both at the federal, regional and municipal levels of health care management. It is only on its basis that correct planning and forecasting of the development of a network of health care institutions, an assessment of the need for various types of resources is possible. Morbidity rates serve as one of the criteria for assessing the quality of work of medical institutions, the health care system as a whole.
The main sources of information on the incidence of the population are as follows:
Registration of cases of the disease when the population seeks medical care in a healthcare organization;
Registration of cases of disease during medical examinations;
Registration of cases of diseases and causes of death according to pathoanatomical and forensic studies.
Accounting for morbidity according to the population’s access to medical care in a healthcare organization is carried out on the basis of the development of an “Outpatient Coupon” (f. 025-6 (7) / y-89; 025-10 / y-97; 025-11 / y-02 ; 025-12 / y-04) or the “Single Coupon for Outpatients” (f. 025-8 / y-95). Coupons are filled in for all diseases and injuries (except for acute infectious diseases), in all clinics, outpatient clinics in cities and rural areas.
Depending on the system of organizing work in the polyclinic, coupons are filled out at the end of the appointment by doctors or nurses at the direction of doctors or centrally by the statistician of the institution according to the data transferred to him from the reception of the "Medical records of the outpatient", "History of the development of the child", etc. Currently, healthcare organizations are implementing a new method for recording morbidity for a completed service case with automated processing of primary medical documentation based on the data of the Outpatient Coupon.
However, the data on the morbidity of the population (according to the appeals) for medical care are not always objective, therefore, for a more complete assessment of public health, the incidence rates according to the data on the appeals must be clarified and
to complement. For this, data on the incidence of the population obtained as a result of ongoing medical examinations are used.
The results of medical examinations are recorded in the "Card subject to periodic examination" (f. 046 / y) - for persons undergoing mandatory periodic examinations, in the "Medical record of an outpatient" (f. 025 / y-87, 025 / y-04), in the "History of the development of the child" (f. 112 / y), "Medical record of the child" (f. 026 / y), in the "Medical record of a university student."
Depending on the tasks and organizational technologies used, medical examinations are divided into:
Preliminary medical examinations;
Periodic medical examinations;
Targeted medical examinations.
Preliminary medical examinations are carried out upon admission to work or study in order to determine whether the state of health meets the requirements of the profession or training, as well as to identify diseases that can progress under conditions of work with occupational hazards or in the process of study.
Target periodic medical examinations- dynamic monitoring of the health status of workers exposed to occupational hazards, timely identification of the initial signs of occupational diseases, identification of common diseases that prevent the continuation of work with harmful hazardous substances and production factors.
Targeted medical examinations are carried out, as a rule, to detect early forms of socially significant diseases (malignant neoplasms, tuberculosis, diabetes mellitus, and others) and cover various groups of organized and unorganized population.
The best way of mass medical examination in terms of quality is to conduct it by a team of specialists. However, such inspections are associated with the need to attract significant human, financial, and material resources.
That is why the desire to cover the largest possible part of the population with medical examinations with the involvement of a limited amount of resources led to the development and implementation of various organizational forms of examination using a variety of tests. These organizational forms are collectively referred to as screening. The very concept of "screening" originates from the English word screening, which in translation means sifting, screening, selection.
Screening- this is a mass examination of the population and the identification of persons with diseases or initial signs of diseases. The main purpose of the screening is to conduct a primary selection of individuals who require an in-depth examination, consultations of narrow specialists, and the formation of groups at an increased risk of contracting a certain pathology. As a rule, targeted (screening) medical examinations are carried out in several stages.
As a result of medical examinations, pathological indicator.
With well-planned and conducted medical examinations, an additional 2000-2500 cases of diseases (per 1000 population) are established, that is, an average of 2-2.5 diseases per person, which were not the reason for patients to go to medical institutions. These diseases additionally identified during medical examinations are taken into account for the calculation indicator of exhausted morbidity of the population. In addition, in order to obtain a complete and objective picture of the incidence of the population, cases of diseases that led to the death of the patient, but did not cause him to go to medical diagnostic institutions during his lifetime, should be taken into account. These cases are recorded during pathoanatomical and forensic examinations.
When registering diseases, the following rules must be followed. When studying primary morbidity, a case of a disease registered for the first time in a patient's life in a given year is taken as the unit of observation. Diagnoses of acute diseases are recorded each time they occur again during the year, chronic diseases are taken into account only once a year, exacerbations of chronic diseases are not taken into account. Thus, to calculate the primary morbidity rate, all diseases that occurred in a patient for the first time during the year and are marked in the forms of primary medical records (“Outpatient Coupon” or “Unified Outpatient Coupon”) with a sign (+) are taken.
When studying general morbidity take into account all cases of diseases registered with the sign (+) and the sign (-). With the sign (+) all diseases classified as primary morbidity are recorded. With a sign (-), the first in a given year appeals are registered for a chronic disease identified in previous years.
Among the working population, there are incidence of occupational diseases and morbidity with temporary disability(MTD), which occupy a special place in the incidence statistics due to their great socio-economic significance.
The main normative document used in all countries of the world to study morbidity and causes of death is the International Statistical Classification of Diseases and Related Health Problems (ICD). ICD is a system of grouping diseases and pathological conditions that is reviewed and approved by WHO approximately every 10 years. At present, in our country, as well as throughout the world, the International Classification of the Tenth Revision - ICD-10 (Table 1.3) is in force.
Table 1.3. Disease classes (ICD-10)
The end of the table. 1.3
Taking into account the sources and methods of obtaining data in the incidence statistics, the following main indicators are calculated:
Primary morbidity;
General morbidity (prevalence, morbidity);
Exhausted (true) morbidity.
Primary incidence- this is a set of new, nowhere previously recorded and for the first time in a given year, registered cases of diseases when the population applied for medical help.
The primary incidence rate is calculated using the following formula.
The level of primary morbidity in the adult population of the Russian Federation ranges from 500-600?. The level of primary morbidity in children significantly exceeds that in adults and is in the range of 1800-1900?.
General morbidity (prevalence, morbidity)- this is a set of primary in a given year cases of people seeking medical help for diseases identified both in a given year and in previous years.
The indicator of general morbidity by negotiability is calculated according to the following formula.
The level of general morbidity of the adult population of the Russian Federation averages 1300-1400?. The overall morbidity rate of the child population also significantly exceeds the morbidity rate of the adult population and is in the range of 2300-2400?. Over the past decade, there has been a trend towards an increase in primary and general morbidity in both adults and children. Information about the population seeking medical care, information obtained as a result of medical examinations, and the development of data on the causes of death characterize only various aspects of a multifaceted morbidity indicator and, taken separately, do not provide an opportunity for its comprehensive assessment. That is why the most complete characteristic of the incidence of the population is the indicator exhausted (true) morbidity, which includes diseases registered when the population applied for medical care in a healthcare organization, additionally identified during medical examinations and data on the causes of death that were not registered in healthcare organizations during the life of the patient. Calculated using the following formula.
* Diseases are taken into account, for which there was no registered appeal to a healthcare organization.
On fig. 1.7 this indicator is presented in the form of an “iceberg”, where the “above-water” part is the diseases for which the population turns to medical institutions, and the “underwater” part is those cases of diseases that are established only during medical examinations or that caused the death of the patient. Taking into account the fact that medical examinations reveal a significant number of chronic diseases (45% of the “exhausted” morbidity of the population), it is necessary to pay special attention to the careful organization and conduct of medical examinations. According to the results of a specially conducted study of residents of the Novgorod region, this figure was 3812.0?.
Rice. 1.7."Exhausted" (true) incidence of the population of the Novgorod region (the number of cases of diseases per 1000 inhabitants) according to the results of specially conducted studies
Similarly, these indicators can be calculated for individual classes of diseases and nosological forms. Then the numerator is not the total number of all diseases, but only the number of cases for a given class of diseases or nosological form. For example, the indicator of the general morbidity of the population with diseases of the circulatory system can be calculated using the following formula.
To analyze the incidence, it is important to know not only the level of the indicator, but also its structure for individual diseases and age and sex groups.
The structure of the general morbidity of the adult population is shown in fig. 1.8.
Rice. 1.8. The structure of the general morbidity of the adult population of the Russian Federation in 2008
The structure of the general morbidity of the child population differs from that of the adult (Fig. 1.9). In the structure of the overall morbidity of the child population, respiratory diseases are in first place - 50.2%, diseases of the digestive system are in second place - 6.6%, and diseases of the skin and subcutaneous tissue are in third place - 5.0%.
Rice. 1.9. The structure of the general morbidity of the child population of the Russian Federation in 2008
DISABILITY
Not all diseases can be cured, therefore, in some cases, the disease leads a person to disability. Disability indicators serve as important medical and social indicators of public health, characterize the ecological state of the territory, the quality of preventive measures, the level of socio-economic development of society.
According to WHO experts, disabled people make up about 10% of the world's population, of which more than 100 million are children.
In the Russian Federation, over 10 million disabled people are registered with the social protection authorities. Every year, more than 1 million people are recognized as disabled for the first time.
The word "disabled" comes from the Latin "invalidus"- weak, infirm. Disabled It is customary to consider a person who has a health disorder with a persistent disorder of body functions due to diseases, the consequences of injuries or defects, which limits life and necessitates social protection.
Recognition of a person as a disabled person is possible only with a medical and social examination, which is carried out by federal state institutions - the Bureau of Medical and Social Expertise (ITU Bureau). Depending on the degree of impairment of body functions and vital activity, three groups of disability have been established.
I group: Persistent and significantly pronounced violations of the functions of the body, causing the need for constant outside help, care or supervision. In some cases, disabled people of group I can perform certain types of labor in specially created conditions.
II group: persistent pronounced functional disorders that do not necessitate constant outside assistance. Patients are completely and permanently disabled; in some cases, patients are allowed to work in specially created conditions or at home.
III group: persistent and slightly pronounced disorders of body functions, leading to a decrease in working capacity. Such patients need to change working conditions.
In the structure of disability, group I is 15%; II group - 60%; Group III - 25% of cases.
Depending on the circumstances of the onset of disability, the following causes of disability are determined during the medical and social examination.
Disability due to general illness. A general illness is the most common cause of disability, with the exception of cases directly related to occupational diseases, work injury, military injury, etc.
Disability due to work injury."Labor injury" as a cause of disability is established for citizens whose disability has occurred as a result of damage to health associated with an accident at work.
Disability due to occupational disease is established for citizens whose disability has come as a result of acute and chronic occupational diseases.
disability since childhood. A person under the age of 18 who is recognized as disabled is given the status of a “child with a disability”. Upon reaching the age of 18 years and older, these persons are established "disability since childhood".
Disability in former military personnel. It is established for diseases and injuries associated with the performance of military duties.
Disability due to radiation disasters. It is established for citizens whose disability has occurred as a result of the liquidation of accidents at the Chernobyl nuclear power plant (PA "Mayak", etc.).
In order to dynamically monitor the state of health and predict the development of compensatory and adaptive capabilities of disabled people, they are systematically re-examined. Disabled people of groups II and III undergo this procedure annually, disabled people of group I - once every two years. Without specifying the re-examination period, disability is established for men over 60 years old and women over 55 years old, disabled people with persistent irreversible morphological changes and impaired functions and systems of the body, as well as in case of ineffective rehabilitation measures for at least 5 years.
If there are indications for referring the patient to the ITU, medical institutions draw up a "Referral for medical and social examination" (f. 088 / y-97).
For the analysis of disability, the following main indicators are calculated:
primary disability;
The structure of primary disability by disease.
The level of disability of the population is estimated by the indicator of primary disability, which is calculated using the following formula.
In 2008, in the Russian Federation, this figure was 78.5 per 10,000 population.
To analyze disability by cause, calculate indicator of the structure of primary disability by disease.
In the structure of primary disability of the adult population, diseases of the circulatory system occupy the first place, followed by malignant neoplasms, diseases of the musculoskeletal system and connective tissue, injuries of all localizations, mental disorders, which account for more than 80% in the structure of all causes of primary disability of the population (Fig. 1.10 ).
Rice. 1.10. The structure of the causes of primary disability in the adult population of the Russian Federation (2008)
PHYSICAL HEALTH
physical health is an important sign that determines the level of health of the population. Physical health indicators are used to identify anthropometric markers of the risk of a number of diseases, control the physical development of children and evaluate the effectiveness of ongoing recreational activities. They are necessary to determine the mode of life and physical activity of the child, to assess school maturity, and sports opportunities for children. Indicators of physical health serve as important criteria in determining the fitness for military service and type of troops, are widely used in forensic practice.
Physical health is studied both at the population and at the individual level, separately for children and adults.
Physical health of the individual- this is an integral indicator of the vital activity of an individual, characterized by such a level of adaptive capabilities of the organism, which ensures the preservation of the main parameters of its homeostasis under the influence of environmental factors.
homeostasis- the ability of the body to maintain the relative constancy of the internal environment (blood, lymph, intercellular fluid) and the stability of the basic physiological functions (circulation, respiration, metabolism, and others) within the limits that ensure its normal life.
The level of physical health of the population largely speaks of social well-being in society. Under the influence of long-term adverse factors, the level of physical health decreases, and vice versa, the improvement of conditions, the normalization of lifestyle contribute to an increase in the level of physical health.
The main methods of studying the physical health of a person:
Anthroposcopy (description of the body as a whole and its individual parts);
Anthropometry (measuring the size of the body and its individual parts);
Anthropophysiometry (determination of the physiological state, functional capabilities of the body).
Anthroposcopy is carried out on the basis of the analysis of data from a visual inspection of a person. The type of physique, the state of the musculoskeletal system, skin, the degree of development of muscles, fat deposits, the development of secondary sexual
signs, etc. The state of the musculoskeletal system is visually assessed by the width of the shoulders, posture, massiveness. The degree of puberty is determined by the totality of secondary sexual characteristics: hairiness on the pubis and in the axillary region, the development of the mammary glands and the time of the onset of menstruation in girls.
Anthropometry carried out with the help of special tools (anthropometer, stadiometer, centimeter tape, various compasses, etc.). There are basic and additional anthropometric indicators. The main ones include height, weight, surface area, body volume, chest circumference (with maximum inspiration, pause and maximum exhalation). Additional anthropometric indicators include sitting height, circumference of the neck, abdomen, waist, thigh and lower leg, shoulder size, sagittal and frontal chest diameters, arm length, subcutaneous fat mass, etc.
For the analysis of anthropometric data, estimated coefficients are used, derived by comparing various anthropometric features. These coefficients are used to assess the physical health of individuals, a comprehensive assessment of the health of the population, selection for sports sections, etc.
Anthropophysiometry is carried out using special anthropophysiometric methods of research and is evaluated by a number of indicators that characterize the strength of the hand and back strength, vital capacity of the lungs, physical performance of a person, etc. They are measured using special devices (dynamometers, goniometers, bicycle ergometers, spirographs, etc.).
When measuring physical health parameters, in order to obtain accurate results, a number of standard conditions must be observed: measurements must be carried out in the morning, with optimal lighting, the presence of serviceable instruments, the use of a unified measurement methodology and technique.
Assessment of the physical health of an individual or population group is carried out by comparing their performance with regional standards and determining the degree of deviation from the average values. To obtain regional standards of physical health, a survey of large groups of practically healthy people of various ages and genders is carried out. It should be remembered that generally accepted
there are no physical health standards. Different living conditions in different climatic and geographical zones, in cities and rural areas, ethnic characteristics largely determine the differences in the level of physical health of the population.
Different methodological approaches in assessing the morphological and functional characteristics of the human body have led to the creation of numerous classifications of constitutional types. In medical practice, the most widely used classification, according to which there are three main body types:
normostenic type, characterized by proportional body size and harmonious development of the musculoskeletal system;
12. Main indicators of mortality
Total mortality rate:
total number of deaths per year X
However, the overall mortality rate is hardly suitable for any comparison, since its value largely depends on the characteristics of the age composition of the population. Thus, the increase in the overall mortality rate in recent years in some economically developed countries does not so much indicate an actual increase in mortality as it reflects an increase in the proportion of elderly people in the age structure of the population.
Mortality rates of individual age and sex groups:
the number of persons of a given sex and age who died in a year X 1000 / number of persons of a given age and sex.
Mortality from this disease(intensive indicator):
the number of deaths from this disease per year x x 1000 / average annual population.
Structure of causes of death(extensive indicator):
the number of deaths from a given cause X 1000 / total number of deaths.
The development of materials on the mortality of the population by cause is based on the data of the “Medical death certificate” (f. 106 / y), “Paramedic death certificate” (f. 106-1 / y), “Medical certificate of perinatal death” (f. 106-2/y). Completion of death certificates and selection of the original cause of death are made in accordance with existing rules.
Natural increase is expressed as an absolute number as the difference between the number of births and the number of deaths in a year. Moreover, it can be calculated as the difference between birth and death rates.
A high natural increase can be considered as a positive phenomenon only if the mortality rate is low. High growth with high mortality characterizes the unfavorable situation with the reproduction of the population, despite the relatively high birth rate.
Low growth with high mortality indicates an unfavorable demographic situation. Low growth with low mortality indicates a low birth rate.
Negative natural growth indicates trouble in society, which is typical for a period of war, economic crises and other shocks and is associated with the negative influence of three main factors, such as:
1) continuation in our country of the global global process of the demographic transition to a small family;
2) change in the age composition of the population - at present, the age group of the highest fertility (20-29 years) has entered a small contingent of women;
3) the crisis state of the socio-economic sphere.
Average life expectancy indicator shows how many years, on average, a given generation of those born will have to live if, throughout the life of this generation, the mortality rates remain the same as they are at the moment, and is calculated on the basis of age-specific mortality rates by constructing mortality tables.
This text is an introductory piece.BASIC PRINCIPLES OF EXAMINATION OF CHILDREN WITH DYSARTRIA (BASIC INDICATORS OF DIAGNOSIS OF DYSARTRIA)
11. Basic indicators of fertility Indicator of general fertility (fertility): total number of live births per year x 1000 / / average number of women aged 15-49 years. This indicator depends on the proportion of women of childbearing age in the total population and
13. Indicators of infant mortality Infant mortality characterizes the death of newborn children from birth to the age of one. It stands out from the general problem of population mortality due to its special social significance. Its level is used to evaluate
14. Infant mortality and perinatal mortality rate Infant mortality rate from a given cause: the number of deaths under the age of one year from a given cause? 1000 / 2/3 live births in this year + 1/3 live births last year.
15. Maternal mortality rate As defined by WHO, maternal mortality refers to the death of a woman due to pregnancy (regardless of its duration and location) and occurring during pregnancy or within 42 days after its termination.
30. Indicators of disability If there are indications for referral of a patient to a medical and social examination (MSE), health facilities issue a “Referral to ITU” (f.088 / y). The following documents are filled out in the ITU Bureau: “The Certificate of Inspection in the ITU”, “Book of Minutes of ITU Meetings”,
31. Rehabilitation indicators Assessment of rehabilitation measures is carried out on the basis of three groups of indicators: 1) medical and professional rehabilitation of disabled people; 2) stability of disability groups during repeated examination; 3) weighting of groups
44. Statistical indicators of morbidity, labor losses. Hospitalization rates Statistical morbidity indicators Overall frequency (level) of primary morbidity (%0): number of all initial visits h1000 / average annual number of attached
Immunological indicators Immunodeficiency is an integral part of protein-energy malnutrition. Damage to the immune function occurs already in the early stages of malnutrition of the body: the total number of T-cells decreases, their differentiation, function
Mortality Curve An insurance statistician named Benjamin Gompertz noticed in 1825 that mortality statistics have some peculiarities. The age-related mortality curve had an elegant "U" shape. The risk of dying at birth was very high, then decreased significantly
An ominous mortality curve and the aggressiveness of survival History is an alliance between the dead, the living, and the unborn. Edmund Burke As we can see, human curiosity and its avant-garde, science, put at the service of creation and survival, it would seem, until recently unthinkable for
Chapter 4 Causes of Maternal and Infant Mortality You should only get acquainted with these unpleasant statistics in order to know the most dangerous complications of pregnancy, childbirth and the postpartum period. The maternal mortality rate in Russia is 2–3 times
Annex 1 Milestones and indicators of fetal development and other useful information Table 1 Hereditary traits determined by dominant and recessive genes Table 2 Key indicators of fetal development depending on gestational age
Anthropometric indicators Anthropometric indicators include the level of physical development, muscle strength, body weight, coordination of movements. Body weight indicators are one of the signs of fitness. Various methods are used to determine body weight.
How to Calculate Basic Heart Rates I suggest you do some calculations because, despite their simplicity, they are very important. First, subtract your age from 220. Let's say you are sixty, then the answer is 160.
