Public health– is the health of the population, caused by the complex influence of biological and social factors environment, with the determining significance of the socio-political and economic system and the living conditions of society depending on it. Conditions affecting health:
Lifestyle (50%);
Heredity (20%);
External environment (20%);
Healthcare (10%).
The health of the population is determined by the complex influence of factors that determine a person’s lifestyle, his environment, heredity and the state of the health care system.
The following classification of factors determining the health status of the population is generally accepted:
Socio-economic (lifestyle, working conditions, housing conditions, material well-being, etc.);
Socio-biological (age, gender, heredity, etc.);
Ecological and climatic (state of air, water, soil, level of solar radiation, etc.);
Medical and organizational (quality, efficiency, availability of medical and social care, etc.)
Basic principles of protecting the health of citizens of the Russian Federation ( Federal law dated November 21, 2011 No. 323 “On the fundamentals of protecting the health of citizens in the Russian Federation”).
The basic principles of protecting the health of citizens of the Russian Federation are a set of political, legal and medical measures aimed at preserving and strengthening the physical and mental health of citizens of the Russian Federation and providing assistance in case of loss of health.
State (research part of hospitals);
Municipal (clinics);
Private (about 15%).
The basic principles of protecting the health of citizens are:
1) respect for human and civil rights in the field of health protection and provision of state guarantees related to these rights;
2) priority preventive measures in the field of protecting the health of citizens;
3) availability of medical and social assistance;
4) social protection of citizens in case of loss of health;
5) responsibility of government and management bodies, enterprises, institutions and organizations, regardless of the form of ownership, and officials for ensuring the rights of citizens in the field of health protection;
6) inadmissibility of refusal to provide medical care;
7) maintaining medical confidentiality;
8) priority of the patient’s interests.
Human health and primary risk factors.
Human health– this is a state of complete socio-biological and mental well-being, when the functions of all organs and systems of the human body are balanced with the natural and social environment, there are no diseases, painful conditions and physical defects.
There are primary risk factors that depend on socio-economic, political, natural conditions, and secondary risk factors that contribute to the occurrence of pathological conditions and the development of diseases.
The most adequate criterion of public health is the category of lifestyle, and the indicator is the medical and social potential of working capacity. Research on public health, especially the health of healthy people, is of strategic importance in preventing diseases and improving public health.
Health levels:
1)Individual;
2) Group;
3) Regional;
4) Public;
Individual health indicators:
1) Anthropometric;
2) Somatoscopic (constitution, condition skin etc);
3) Functional (muscle strength, vital capacity, heart rate, etc.);
Factors affecting health:
Socio-economic;
Sanitary and hygienic;
Natural-ecological;
Hereditary;
Bad habits.
Risk factors.
Primary:
Alcohol;
Poor nutrition;
Physical inactivity;
Psycho-emotional stress;
Secondary:
Lipodemia, cholesterolemia;
Rheumatism;
Allergy;
Immunodeficiencies.
At-risk groups:
Age;
Social;
Prof. risk;
Functional, pathological condition;
Low standard of living;
With deviant behavior
Methods for studying population health.
According to WHO definition, “health is a state of complete physical, spiritual and social well-being, and not merely the absence of disease or infirmity.”
There is also a so-called third (or intermediate) state, which is close to either health or disease, but is neither one nor the other. This includes: neurasthenia, loss of appetite, irritability, headache, fatigue, etc.
Human health is studied and measured at various levels. If we're talking about If we talk about individuals, we talk about individual health; if we talk about their communities, we talk about group health; if we talk about the health of the population living in a certain territory, we talk about population health.
Population health is also studied at the sociological level, that is, at the level of public health. Public health reflects the health of the individuals who make up society. This is not only a medical concept, but to a large extent a social, socio-political and economic category, since the external social and natural environment is mediated through specific living conditions - work and life.
Population health status includes:
Demographic phenomena;
Morbidity and disability;
Physical development;
Which are characterized by medical-demographic and sanitary-(medical)-statistical indicators.
Demographic phenomena:
Population - the original basic indicator, the number of people in the population that defines them (region, etc.)
n – birth rate;
N x – total number of live births per year;
P x – average annual population.
Mortality is the process of natural reduction in the number of people due to deaths.
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m=M x /P x *1000 |
M – overall mortality rate;
M x - number of deaths for a given year;
P x – average annual population.
Infant mortality rate.
m 0 - number of deaths aged 0 to 1 year;
M -1 - the number of children who died under the age of one year from among those born in the previous year;
N 0 - number of births in the reporting year;
N -1 - number of births in the previous year;
Total population growth
P1 - P0 = Ppr
P0 - population at the beginning of the period (usually a year)
P1 - at the end of the period
Natural population growth
N - total number of births
M - total number of deaths
The value of the indicator can be negative if there is a natural population decline (in Russia since 1992)
Medical and statistical indicators:
Morbidity is an indicator that determines the totality of diseases registered for the first time in the current calendar year among the population living in a specific territory.
Primary morbidity is the ratio of the number of newly emerging diseases to the average population size and X 1000
The number of diseases detected for the first time in life/average number of the population X1000 Characterizes the frequency of occurrence and dynamics of newly emerging diseases.
Morbidity is the ratio of the number of initial visits to the average population. Number of all diseases per year/average population.
Pathological prevalence characterizes a set of diseases and pathological conditions identified through active medical examinations per 1000 population. The number of diseases identified during medical examination. examinations/average number of population examined X1000
Indicators of individual physical development
Anthropometric indicators (height, weight, etc.)
Somatoscopic (constitution, skin condition, etc.)
Functional (muscle strength, vital capacity, heart rate)
Methods for studying population morbidity
The following sources are used to study morbidity:
Negotiability
Medical examinations
By cause of death
According to socio-hygienological and clinical-statistical studies
Visit - every visit to the doctor.
The visit is the first visit regarding this disease.
General morbidity –
Unit of observation is the patient’s primary visit to a doctor regarding 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/u).
The “statistical coupon” is filled out for each case of an acute disease (with a “+” sign), for each case of a chronic disease identified for the first time in one’s life (with a “+” sign), as well as for the first visit in the current calendar year regarding a previously identified chronic disease (with a “–”) sign.
Chronic diseases are counted only once a year, exacerbations of chronic diseases in
this year again as diseases are not taken into account. Based on the development of data from the “Statistical Coupons”, the “Morbidity Report” is filled out (form 12).
When studying the primary morbidity of the population based on the appeal data, “Statistical coupons” filled out only for newly diagnosed diseases (with a “+” sign) are taken into account.
When studying the prevalence of diseases based on negotiability data, all statistical coupons filled out during the year are taken into account, both in cases of newly established diagnoses with a “+” sign, and those transferred from previous years with a “–” sign.
When analyzing general morbidity, it is customary to calculate the following indicators.
Primary incidence:
number of diseases newly identified per year x 1000 (10,000, 100,000) / average annual population.
Prevalence:
number of diseases newly identified in a year and re-registered from previous years x 1000 (10,000, 100,000) / average annual population.
Overall incidence rates provide only a general idea of the incidence rate. Special indicators (age-sex, diagnosis, profession, etc.) characterize the general morbidity more accurately.
Age-sex morbidity rates:
the number of diseases identified per year in persons of a given sex and age x 1000 (10,000, 100,000) / average annual population of this sex and age.
Overall morbidity rate by diagnosis:
number of diseases with a given diagnosis identified per year x 1000 (10,000, 100,000) / average annual population.
Special prevalence indicators are calculated similarly by gender, age, diagnosis, etc.
The following indicators allow us to assess the severity of the disease.
Structure of general morbidity (proportion of certain diseases in the overall morbidity):
number of diseases with this diagnosis identified per year x 1000 / total number of diseases.
Death rate:
number of deaths from of this disease per year x 1000(10,000, 100,000)/average annual population.
Case fatality rate:
number of deaths from a given disease per year x 1000 / number of patients with a given disease.
Mortality and mortality rates can also be calculated by gender, age, profession, etc.
When analyzing morbidity based on access data, it should be remembered that it depends on the population’s access to medical care. The uptake, in turn, is influenced by the availability of medical care, the medical activity of the population, material well-being, the qualifications of doctors and other factors.
Morbidity study scheme. Methods for studying morbidity:
1)Applicability:
a) General morbidity (outpatient medical card, registration sheet, outpatient coupon);
b) With VUT (coupon for a completed case with VUT);
c) Hospitalization or hospital rehabilitation (card of a person leaving the hospital);
d) Acute disease infectious diseases(EMERGENCY notification of a newly identified infectious disease);
e) Incidence of the most important non-epidemic diseases (notification of a patient diagnosed with newly registered active tuberculosis).
2)Method of medical examinations:
a) Preliminary;
b) Periodic;
c) Target. (Medical card of an outpatient; card of a person subject to periodic medical examination; List of persons subject to periodic medical examination).
3) Method by cause of death (Medical death certificate; Medical certificate of perinatal death)
4) Sample study or socio-hygienic study (Free-form document).
6. Types of morbidity in the population
5 types of information about population morbidity:
General morbidity rate of the population is the level of diseases among population groups over a certain period.
Incidence of infectious diseases. Accounting is carried out by counting each disease if it is suspected
Incidence of the most important non-epidemic diseases. This is tuberculosis venereal diseases, tumors, fungal and others, first registered in given year. Diseases are recorded at the dispensary.
Diseases with temporary disability.
Hospital morbidity
7. General and primary morbidity, pathological involvement.
Primary incidence This is the first time the disease has been registered this year. It is calculated as the ratio of the number of newly emerging diseases (diseases diagnosed for the first time) to the average population, multiplied by 1000.
Soreness- characterizes the prevalence of registered diseases, both newly emerging and pre-existing, for which there were initial complaints in the calendar year. The calculation is made per 1000 inhabitants. Number of all diseases per year / average population x 1000.
General morbidity – This is a set of diseases (acute and chronic) among certain population groups for a certain calendar year. The study of general morbidity is carried out based on data from outpatient clinics. General morbidity data are necessary to fully characterize the health of the population.
Pathological affection - all diseases, all anatomical defects, all functional abnormalities identified during medical examinations. (all diseases identified during medical examinations / average size of the examined population X 1000).
8. Morbidity with temporary disability.
The study of morbidity with temporary disability has been conducted in the Russian Federation since 1925. Morbidity with temporary disability is the frequency of all cases and days of disability as a result of the disease. The unit of observation is each completed case of temporary disability during the year. Documentation - certificate of incapacity for work (for workers), certificate (for students) and coupon. Dates of issue sick leave for child care under 15 years old for 3 days. Up to 2 - for the entire period. Up to 7 for the entire period. From 7 to 15 years - 15 days. Inpatient care for a child for the entire duration of the child’s stay.
Indicators are calculated:
Number of cases of temporary disability per 100 workers:
N/Rrab X100,
where N is the total number of cases with temporary disability,
Рrab – average annual number of workers
Number of days of incapacity for work per 100 workers:
Dnetrud/RrabX100
Average duration of one case of illness with VUT:
Dnetrud/N
Morbidity structure with VUT in the following cases:
Nx - the number of cases of diseases with VUT in connection with a specific disease
Structure of morbidity with VUT in days:
Dx/Dnetrud X100
Dx - number of days of incapacity due to a specific disease
Percentage of conditionally unemployed people during the reporting period (percentage of disabled people)
Dnetrud/(Rrab x 365) x 100
Day of work - days of incapacity for work
Pwork - average annual number of employees
It is known that public health depends on the influence of various factors: social and biological, material and spiritual, internal and external. Among them, the decisive ones are the social, industrial and geographical environment. In recent years, the state of health has been aggravated by the growing ecological tension of the environment and the low level of adaptation of the population to market forms socio-economic relations. The study of the state of population health should now be based on a combination, an integral expression of social and natural factors that form and determine the level of population health.
Therefore, population health indicators should be considered as the end result of an interconnected interdepartmental system of its protection at the level of the state, large region, region, district.
It is well known that one of the main criteria for the health of the population is morbidity. In the current changed socio-economic conditions, establishing the level and structure of general morbidity is a certain difficulty, which is explained by a number of reasons: first of all, the rise in prices medical services And drug provision, deterioration social population, paid services during some laboratory tests, as well as restrictions on medical care in rural areas.
In social and hygienic studies, as an overview of the health status of the population, as a rule, indicators of general morbidity are used, differentiated by its main structural components (classes, nosological forms and groups of diseases). Taking into account the ethnopathogenetic mechanisms of formation various types pathology, a statistical description of morbidity as a socio-biological phenomenon, was carried out according to the largest statistical groups - 19 classes of diseases, injuries and causes of death. WHO, 1995
An analysis of research results in the regions of the Kyzylorda region for the period 2006-2010 (Tables 19-23) shows that the morbidity level in the region according to the population's visits to medical institutions varies within varying limits from 64799.9 ± 62 in 2006. up to 32539.2±59.6 – in 2010 per 100 thousand population. A similar pattern is observed in the context of the analyzed regions of the region. At the same time, a very interesting feature was revealed: appeal for medical assistance residents of settlements where there are no medical centers, in 2006 in the Aral region amounted to 54182.9 ± 190 per 100 thousand population, more high level incidence was detected in settlements where central district hospitals– 91355.3±107 (Kazalinsky district).
An analysis of literary sources published over the past twenty years also confirms different level the population's seeking medical care. In particular, V.A. Medic, 1991, gives an indicator of general morbidity rural population Novgorod region, equal to 731.6 requests per 1000 population.
Moreover, a high incidence rate was detected in settlements where central district hospitals are located (840.5%). Low level The author established this indicator in settlements where local or medical outpatient clinics are located (652.5%).
Research by A.P. Airiyana et al., 1990. It was found that the frequency of outpatient visits of the rural population of the Ararat region of Armenia was 748 per 1000 population, and for men this figure was higher (801.0%) than for women (699.0%).
In the conditions of Kazakhstan, an in-depth study of the general morbidity of the rural population based on three-year data on visits to health care facilities in 11 rural areas was carried out by T.K. Kalzhekov (1990). According to his data, the incidence rate was 872.1 cases per 1000 population (oral and dental diseases excluded), including 832.7 in men, 821.9 in women. Along with this, when calculating the morbidity rate based on the negotiability data, the author used materials from paramedic registration of diseases carried out in populated areas
(Aralsky, Kazalinsky districts).
The research results we obtained in this work are identical and closer to the data of S.Kh. Dushmanov (1984), who conducted similar studies in the Taipak district of the West Kazakhstan region, located in the same climatic geographical zone with the base territory of our observation. According to his data, the incidence rate according to appeal was equal to 668.7 per 1000 population. At the same time, the incidence rate in men was 597.5%, in women – 734.9% per 1000 population.
The morbidity data we obtained on the number of visits coincides with the results of the studies of the above-mentioned authors and they confirm the dependence of the level of access to medical care on the population’s access to medical care. In other words, the level of turnover is inversely proportional to the distance to medical institution. Besides this indicator also depends on the level of staffing with doctors of narrow specialties.
In the structure of morbidity according to the visits of rural residents living in the Aral Sea region in 2010, the leading place is occupied by pathologies respiratory organs, the share of which amounted to 28.7% of all diseases from the total number of requests - 19625.6 per 100 thousand people. In second place is the appeal for diseases of the digestive system (12.4% or 8505.5 per 100 thousand population) with the same frequency of appeal for both men and women. However, if we do not exclude diseases of the hard tissues of teeth from the class of the digestive system, then diseases of this system come out on top in almost all ecologically disadvantaged areas. In third place are diseases of the blood and hematopoietic organs, which account for 10% of total number calls or 6789.3 per 1000 population (Table 13, 14,15,16).
Table 13 Morbidity by appeal by main classes of diseases in the regions of the Kyzylorda region for 2006-2007 (indicators per 100 thousand population)
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Disease classes |
Kyzylorda region |
Kyzylorda |
Aral region |
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Indicators |
Indicators |
indicators |
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Adult population |
Teenagers |
Adult population |
Teenagers |
Adult population |
Teenagers |
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New image. |
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Endocr. diseases, diss. Pete |
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Diseases nervous system |
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Diseases of the eye and its appendages |
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Respiratory diseases |
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Digestive diseases |
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Diseases genitourinary system |
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Table 14 Morbidity by appeal by main classes of diseases in the regions of the Kyzylorda region for 2008-2009 (indicators per 100 thousand population)
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Disease classes |
Kyzyl. region |
Kyzylorda |
Aral region |
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Indicators |
Indicators |
indicators |
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Adult population |
Teenagers |
Adult population |
Teenagers |
Adult population |
Teenagers |
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Neoplasms |
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Blood diseases, beds. organs |
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Endocr. diseases, diss. Pete |
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Mental distances and dist. behavior |
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Nervous system diseases |
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Diseases of the eye and its appendages |
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Ear and mastitis diseases. process |
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Diseases circulatory organs |
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Respiratory diseases |
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Digestive diseases |
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Skin diseases and subcutaneous tissue |
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Musculoskeletal diseases. systems and connections fabrics |
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Diseases of the genitourinary system |
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Congenital defects called and chrome. anomalies |
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Symptoms, signs, deviation. from normal |
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Injuries, poisoning and others last. external reasons |
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Table 15 - Morbidity by appeal by main classes of diseases in the regions of the Kyzylorda region for 2010 (indicators per 100 thousand population)
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Disease classes |
Kyzyl. region |
Kyzylorda |
Aral region |
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Indicators |
Indicators |
indicators |
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Adult population |
Teenagers |
Adult population |
Teenagers |
Adult population |
Teenagers |
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Neoplasms |
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Blood diseases, beds. organs |
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Endocr. diseases, diss. Pete |
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Mental distances and dist. behavior |
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Nervous system diseases |
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Diseases of the eye and its appendages |
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Ear and mastitis diseases. process |
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Diseases of the circulatory system |
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Respiratory diseases |
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Digestive diseases |
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Diseases of the skin and subcutaneous tissue |
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Musculoskeletal diseases. systems and connections fabrics |
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Diseases of the genitourinary system |
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Congenital defects called and chrome. anomalies |
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Symptoms, signs, deviation. from normal |
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Injuries, poisoning and others last. external reasons |
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Table 16 - Morbidity according to medical examinations in some areas of the Kyzylorda region in the context of the main classes of diseases. Average data for 2006-2010 (rates per 1000 population)
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Disease classes |
Aral region |
Kazalinsky district |
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abs. number |
showing for 1000 of us. |
specific gravity |
abs. number |
showing for 1000 of us. |
specific gravity |
abs. number |
showing for 1000 of us. |
specific gravity |
abs. number |
showing for 1000 of us. |
specific gravity |
abs. number |
showing for 1000 of us. |
specific gravity |
abs. number |
showing for 1000 of us. |
specific gravity |
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Neoplasms |
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Blood diseases, beds. organs |
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Endocr. diseases, diss. Pete |
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Mental distances and dist. behavior |
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Nervous system diseases |
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Diseases of the eye and its appendages |
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Ear and mastitis diseases. process |
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Diseases of the circulatory system |
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Respiratory diseases |
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Digestive diseases |
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Diseases of the skin and subcutaneous tissue |
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Musculoskeletal diseases. systems and connections Fabrics |
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Diseases of the genitourinary system |
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Congenital defects called and chrome. anomalies |
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Symptoms, signs, deviation. from normal |
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Injuries, poisoning and others last. external reasons |
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Observations recent years in the region under study convince us that chemical composition water is not only an indicator of its quality, adversely affecting the sanitary living conditions of the population, but also negative factor, which has a negative effect on human health. This is evidenced by diseases of the genitourinary system, which occupy fourth place in the structure of morbidity in terms of visits in the Kyzylorda region: 8.6% of the total number of visits (5837.9 for the same population). The fifth and sixth places are occupied, respectively, by diseases of the skin and eye, its appendages, and the seventh, eighth and ninth places are occupied by diseases of the nervous system and circulatory system, trauma and poisoning. The listed 9 classes of diseases account for 83.5% of all diseases for which in 2010 visits to treatment and prevention institutions (HCI) of the region were registered.
In the structure of morbidity in the population of individual regions, the above classes of diseases are found in most cases, but the rank order of different classes of diseases may not be the same.
At the same time, it should also be noted that the incidence of illness in children in almost all analyzed areas of the region is higher than in the adult population. This difference is especially clearly expressed in such areas as Aral and Kazalinsky.
Thus, the analysis of morbidity materials based on outpatient visits made it possible to identify a certain pattern and regional features of the nature of the pathology of the rural population in the Aral Sea region. The data obtained clearly indicate sharp fluctuations levels of circulation in different territories, which, in our opinion, is due to varying degrees completeness of accounting, level of accessibility and specialization of medical care, especially in rural areas. In other words, this indicator largely depends on a number of factors, both objective and subjective. In particular, P.P. Petrov, T.K. Kalzhekov (1990), based on a large amount of factual material, convincingly showed that some patients who need medical care do not go to doctors even after a three-year period of observation of the population's visits to health care facilities. The listed disadvantages to a certain extent make it difficult objective assessment morbidity indicators according to the data of appeal to health care facilities and dictate the advisability of supplementing it through in-depth comprehensive medical examinations rural residents.
Therefore, in order to establish the true level of morbidity and determine the number of patients who have not sought medical help for a long time, an in-depth comprehensive medical examination (CME) of the rural population living in the Aral Sea zone and at control observation sites was carried out.
From the standpoint of protecting public health and preventing morbidity, the greatest hygienic importance, in our opinion, is living conditions determined by the increased mineralization of natural water sources. It is common knowledge that natural waters with increased mineralization have a wide area of distribution, and in a number of areas of the Kyzylorda region they are the only source of water supply.
According to the results hygienic assessment water quality, the population of the studied areas of the region were divided into two groups: the population of the first group: Aral, Kazalinsky districts consumed water of high mineralization, the second group (control - Zhambyl) consumed water of optimal salt composition, corresponding to SanPiN 3.01.067.97. Of the number examined in the Aral region, 99.4% were women (35,401), 99.5% were men (35,770). In other districts, these ratios were as follows: Kazalinsky - women 35828 or 99.3%, men - 36344 people (99.4%). The study was conducted in the period 2006-2010.
At the same time, data on morbidity based on appeal were significantly supplemented mainly by diseases of the digestive system, diseases of the nervous system and sensory organs, diseases of the circulatory system, respiratory organs, diseases of the genitourinary system, birth defects development and chromosomal abnormalities.
An analysis of morbidity based on medical examination data in the region under study indicates its similarity with that based on outpatient visits, and also allows us to identify some of its features. Noteworthy is the very high level of morbidity, according to medical examination data, in almost all environmentally disadvantaged areas. It is enough to note that the incidence rates per 1000 population in the Aral and Kazalinsky districts exceed the control level of the Zhambyl district; in the group, both sexes are by 40, 35, 32.5%, respectively (2800±8.4; 2700±8.0; 2650±9 .4; control – 2000±5.3) (Table 17).
High performance morbidity according to comprehensive medical examinations in comparison with the same level of appeal convincingly indicate the low availability of specialized medical care at the level of rural medical districts for patients with chronic diseases with high prevalence various pathologies. On the other hand, it is also necessary to remember that many diseases proceed silently and asymptomatically for a certain period of time, without causing much concern in the patient, which to a certain extent disorients the latter. In addition, the explanation for the high proportion of pathology additionally identified during medical examinations should obviously be sought in the inattention of the population to their health and to preventive examinations. It is interesting to note the research of V.A. Medic, (1991) among rural residents of the Novgorod region of the Russian Federation, she obtained the following results: 27.9% of respondents rated their health as good, 59.8% considered it satisfactory, and only 12% rated their health as bad or very bad. Moreover, 62.4% of respondents were convinced that they did not have any chronic diseases.
Table 17 - Comparative morbidity rates in the study areas according to medical examinations. Average data for 2006-2010 (rates per 1000 population)
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Disease classes |
Aral region | Kazalinsky | Zhambylsky | Reliability - "R" | |||||||
| Abs. number | Show- | Abs. number | Show- | Abs. number | Show- | 1072 | 14.8± | 965 | 12.2± | <0,05 | <0,05 |
| Neoplasms | 2891 | 40.6± | 2825 | 39.1± | 1500 | 23.7± | <0,001 | <0,001 | |||
| Diseases of the circulatory system | 30398 | 427.1± | 29715 | 411.7± | 21212 | 257.3± | <0,001 | <0,001 | |||
| Respiratory diseases | 30903 | 439.2± | 30204 | 418.5± | 18314 | 261.3± | <0,001 | <0,001 | |||
| Digestive diseases | 32391 | 455.1± | 30689 | 423.2± | 15260 | 228.7± | <0,001 | <0,001 | |||
| Diseases of the genitourinary system | 10469 | 147.0± | 8769 | 121.5± | 5400 | 79.2± | <0,001 | <0,001 | |||
| Congenital defects develop. and chrome. anomalies | 996 | 14.0± | 974 | 13.7± | 520 | 8.7±0.1 | <0,001 | <0,001 | |||
| Injuries, poisoning and others last. external reasons | 12407 | 174.3± | 17052 | 236.3± | 10707 | 162.6± | <0,05 | <0,001 | |||
As a result of the work, a high level of morbidity among the rural population in the study area was established, not only in the “both sexes” group, but also in each study group. Moreover, the detected levels of diseases in these areas are close to each other. For example, the incidence rate per 1000 population for men in the Aral region was 2747.6 ± 11.6, in Kazalinsky - 2670.7 ± 11. A similar pattern is also observed in women (respectively – 2853±12.2, 2729.7±2749±14.1). At the same time, this indicates the homogeneity of the selected group for studying the health of the population, taking into account socio-economic, natural-climatic, sanitary-hygienic, environmental and demographic risk factors for the development of pathology in the population.
In the structure of this morbidity, the first ranking place in the main observation group belongs to diseases of the digestive organs, the share of which in the Aral region was 16.3% of all registered diseases or 455.1 cases per 1000 population, in Kazalinsky - 15.7% (425.2 per 1000 people) for the same population.
The most common pathologies in this class of disease are: gastric and duodenal ulcers, gastritis and duodenitis, cholelithiasis, cholecystitis, cholangitis, pancreatic diseases, etc.
The second place in the structure of morbidity according to medical examinations is occupied by respiratory diseases (specific weight, respectively, 15.5%, 15.5%, 15% and indicators per 1000 population - 434.2 ± 1.8, 418.5 ± 1.8, 397.5±2.2). Diseases of the circulatory system are in third place: respectively, 15.3%, 15.2%, 14.7% of the total number of visits or 427.1, 411.7, 403.9 per 1000 inhabitants. Then, successively, diseases of the nervous system with a specific gravity: 8-7.3-8%, diseases of the eye and its appendages - (6.5-6.3-7.3%). These five classes of diseases account for 61.6-60-61.5% of all diseases in the main regions, respectively.
Incidence rates in women are generally higher than in men, consistent with the literature. At the same time, morbidity rates in men of the musculoskeletal system and connective tissue, as well as injuries and poisonings, significantly exceed those in women.
Summarizing these data, we are convinced by a specific example that the problem of establishing the true level and structure of morbidity can only be solved by conducting in-depth comprehensive medical examinations. A careful analysis of Table 24 draws attention to almost all analyzed classes of diseases, very high incidence rates in the main group, which far exceed similar levels in the control area. In the overwhelming percentage of cases, the differences between the compared pathologies are statistically significant (P<0,001).
Table 18 shows comparative indicators of the leading classes of diseases in three ecologically disadvantaged areas of the Kyzylorda region, depending on the nature of the salt composition of the consumed water.
For control, we took the Zhambyl district of the Almaty region, where the average level of water mineralization over the past five years was 900 ± 95 mg/l. From the data presented in the above table, it is clear that the data for the leading classes of diseases in the main group of districts do not differ much from each other. However, when compared with the control group (Zhambyl district), this difference is significant with a very high degree of confidence (P<0,001). В контрольном районе анализируемые классы болезней по своим показателям примерно в 1,5 раза ниже аналогичных уровней основной группы наблюдения.
Table 18 - Comparative morbidity rates for the population of the study areas depending on the nature of the salt composition of consumed water (indicators per 1000 population)
| Names of leading classes of diseases |
Aral region |
Kazalinsky district |
Zhambyl district (kont) | Significance criteria “P” | |
|
Mineralization level |
|||||
| 1210±106mg/l | |||||
|
We get sick. M±t |
We get sick. M±t |
We get sick. M±t |
|||
|
Digestive diseases |
228.7±0.3 | <0,001 | <0,001 | ||
|
Respiratory diseases |
261.3±0.8 | <0,001 | <0,001 | ||
|
Diseases of the circulatory system |
257.3±0.7 | <0,001 | <0,001 | ||
|
Diseases of the genitourinary system |
79.2±0.4 | <0,001 | <0,001 | ||
|
Congenital defects develop. and chrome. anomalies |
14.0±0.4 | 13.7±0.4 | 8.7±0.1 | <0,001 | <0,001 |
|
Injuries, poisoning |
162.6±1.1 | <0,05 | <0,001 | ||
It is currently considered proven that water with a high degree of mineralization causes a number of disorders of water-salt metabolism, the functional activity of the cardiovascular and digestive systems, and contributes to the development of atherosclerosis, arterial hypertension and cholelithiasis. This is convincingly confirmed by the materials of medical examinations of our studies, as shown in Table 26.
A comparative assessment of morbidity rates indicates that residents of the first group had the highest level. In this group, the level of individual analyzed nosological forms of diseases was from 1.4 to 2 times higher than in the second group.
We have established a high functional relationship between the above-mentioned nosological forms of diseases and the level of water mineralization. This is convincingly shown in Table 19 using the example of the Aral region. As can be seen from the data in this table, hypertension, coronary heart disease, cholelithiasis, urolithiasis and bronchial asthma have a high close relationship with the level of mineralization.
Table 19 - Influence of the level of mineralization on some indicators of population morbidity (per 1000 inhabitants)
|
Name of diseases |
Aral region |
Zhambylsky II-gr. (control) |
Reliability criteria “R” |
|
|
Mineralization level |
||||
|
1250±115 mg/l |
||||
|
Disease rates M±t |
Disease rates M±t |
|||
|
Hypertension |
||||
|
Coronary heart disease |
||||
|
Gallstone disease |
||||
|
Urolithiasis |
||||
|
Bronchial asthma |
||||
|
Incidence per 1000 population |
||||
The above values of correlation coefficients indicate the presence of a stable connection between the compared phenomena. Unfortunately, such dependencies have so far been assessed visually without determining qualitative parameters, which significantly reduces the objectivity of the analyzed material. In our opinion, it is precisely the parameters of the qualitative dependence of changes in population health indicators from exposure to various factors risk, allow you to select a certain range of significant evaluation indicators, which can significantly simplify the system of monitoring the state of public health.
The results of assessing the health status of the population living in the Aral Sea region indicate the great importance of the salt composition of water in the ethnopathogenesis of many diseases. The endemicity of the spread of the disease in those settlements of the region whose water supply is supplied from the river. Syrdarya, as well as the unique physical and chemical composition of urinary stones confirms the role of the water factor in the pathogenesis of many diseases of the digestive system. In this regard, it was considered appropriate to analyze diseases of the digestive organs in the Kyzylorda region over a long period of observation and determine the prognosis of this pathology for the short and long term.
Analysis of the incidence data given in table 20 indicates a steady increase in the pathology being studied over the past 17 years in the Kyzylorda region. By 2008, the incidence of diseases of the digestive system had increased by 1.6 times compared to 2006. This to a certain extent coincides with the intensity of environmental degradation of the human environment in the Aral Sea region. In the future, the trend of further increase in the incidence of digestive organs persists until 2008.
For forecasting, we used the extrapolation method, which is based on the assumption that previous trends will continue in the future and its logical basis is the assumption that the influencing factors will remain unchanged. Forecasting using this method is carried out in several successive stages, when, based on the available data on morbidity for the study period 2006-2010, estimated theoretical indicators were calculated using calculated coefficients.
The applied extrapolation method showed that the incidence of digestive diseases in the observed region will remain stable in the near future with a tendency to further increase and in 2012 will amount to 16,419 cases, and in 2015 it will probably increase by 1.3 times compared to 2006 and will amount to 16,841 cases (Table 20).
Table 20 - Calculations of the forecast of morbidity of the digestive organs in the Kyzylorda region for the near and long term
In total (I fact.xX): amount XxX
Theoret.=Iav.+InxX
I fact.-I theory.
Moving average
Forecast: I avg.+VxH
Thus, the validity of the statement about the existence of a connection between the prevalence of diseases of the digestive system and the level of mineralization of drinking water is beyond doubt. Here we can talk about the quantitative parameters of this connection, which may be different in different regions.
Despite a slight decrease in the incidence rate of malignant neoplasms (from 266.5 in 2007 to 261.3 in 2008), the proportion of advanced forms was 20.9% (2007 - 19.1%), and mortality from malignant neoplasms took third position (12.8%) in the structure of causes of overall mortality. Among the measures to improve the functioning of screening programs for detecting malignant neoplasms, it is necessary to sufficiently equip the oncology service and primary health care organizations with the necessary equipment and tools for collecting material (SVA, primary health care centers), training obstetricians-gynecologists and midwives, additional training of cytologists and radiologists. To bring preventive examinations as close as possible to the female population, it is necessary to install a sufficient number of mammographs in cities and districts of the region where there are x-ray rooms. Since 2006, one of the modern methods for diagnosing and treating breast cancer has been actively used in the Aral region - immunohistochemical research for the Hercept test and targeted therapy with the drug Herceptin - for overexpression of HER-2/neu. For further immunohistochemical research, it is necessary to provide for it in the 2009 budget 2011 additionally about 45 million tenge for two dispensaries.
Over the past 5 years, the region has seen a decrease in the incidence rate from tuberculosis ( from 153.2 to 128.8 per 100,000 population), however, the epidemiological situation remains tense. In comparison with the republican average (RK for 2008 – 125.6), the tuberculosis incidence rate is 2.5% higher.
Despite the trend towards stabilization of epidemiological indicators, there is a further rejuvenation of the incidence of tuberculosis (76.4% - people from 18 to 55 years old), an increase in the proportion of patients from among the unemployed and socially maladjusted groups, and an increase in the incidence of drug resistance is noted. In the Aral region, the mortality rate from tuberculosis increased from 23.9 to 25.7, which is 1.5 times higher than the rate in the Republic of Kazakhstan - 17.2 per 100,000 population. In 2008, the morbidity rate for children was 27.3 per 100 thousand population, for adolescents - 106.3 (in Kazakhstan, the morbidity rate for children was 26.4, among adolescents - 122.7). Isolation of children from foci of tuberculosis infection is carried out only in a quarter of cases, as a result of which children with an advanced form of tuberculosis are identified annually, while an increase in tuberculosis among contacts is noted from 23.7% (2007) to 27.5% (2008). There are not enough preschool sanatorium groups in the region, while more than 50% of children from foci of infection need isolation and rehabilitation, and more than 90% from “at-risk” groups. The epidemiological situation in the Aral region is complicated by the presence of a large number of correctional institutions and a significant number of tuberculosis patients in them. The incidence of active tuberculosis among this contingent is more than 6.3 times higher than among the civilian population of the region. The mortality rate in these institutions remains high and amounts to 126.8 per 100 thousand. prison population. In addition, in 2008, 108 convicted tuberculosis patients were released to the Kyzylorda region (99 in 2007).
For timely detection of the disease, institutions in the general medical network of the region are not sufficiently provided with high-resolution binocular microscopes; 11 institutions in the region need to purchase microscopes. To provide treatment for tuberculosis patients on an outpatient basis, 16.5 chemical specialist rates were introduced into the staff of family medical outpatient clinics and independent city and village clinics by the beginning of 2008, which is clearly not enough for today (23.0 rates in 2007).
The Aral region is in a concentrated stage of the HIV/AIDS epidemic (0.17% of the population compared to the world average of 1.1%). As of January 1, 2009, 1059 HIV-infected people were registered. An analysis of the dynamics of the incidence of HIV infection indicates a pronounced tendency towards an increase in incidence, the average annual growth rate is 33.3%. In order to stabilize the spread of HIV infection at the concentrated stage of the epidemic, the implementation of the Program to combat the AIDS epidemic in the Kyzylorda region until 2010 will be continued, providing for the expansion of preventive measures, as well as the provision of full antiretroviral therapy to AIDS patients in need.
To diagnose HIV infection in pregnant women who were not registered with a dispensary, a rapid testing technique has been introduced in maternity institutions in the region since August 2007. In 2008, 3,305,000 tenge were allocated and spent from local budget subventions for the implementation of this task. In 2008, the need for rapid tests for pregnant women was recalculated; all obstetric institutions were provided with tests in the required volume. 2165 pregnant women were examined using the express method for HIV/AIDS, two women with HIV positive results were identified (37 in 2007).
The situation in the Kyzylorda region regarding drug use remains tense. The number of people with drug addiction under the supervision of narcologists is increasing. In 2006 - 4499, in 2007 - 4809, in 2008 - 4881. Due to the growth of drug addiction, the number of patients treated inpatients is increasing. According to the analytical report on “Monitoring the drug addiction situation in the Republic of Kazakhstan for 2007,” the Kyzylorda region ranks fourth in the number of people treated for drug addiction, which amounted to 1012 people. In the region there is one Center for the treatment and rehabilitation of drug addicts, in which, due to the unsuitability of the premises, it is not possible to separate the stages of treatment and rehabilitation, which affects the quality of the care provided. The region's drug treatment service is insufficiently equipped with computer and multimedia equipment, and regional medical associations of the region are not sufficiently equipped with tests to detect drugs. In addition, it is necessary to purchase a separate building with territory for the Center for Medical and Social Rehabilitation of Drug Addicts.
Analyzing the indicators for the psychiatric service for 2008, it can be noted that in terms of nosologies registered at the dispensary, organic disorders, mental retardation and neurotic disorders account for a greater number. It is these nosological groups that determine a large percentage of morbidity among the population, the cause of which is the high level of injuries and the prevalence of diseases of the cardiovascular system, leading to vascular encephalopathies. The causes of mental retardation are unfavorable environmental conditions, congenital and hereditary pathologies. The increase in the number of neurotic disorders is a worldwide trend, which is associated with many non-medical factors of a socio-economic nature leading to stress in everyday life, in the family and at work.
The urgent task remains to further stabilize the sanitary and epidemiological situation and improve public health. In the Aral region there is a high incidence of hepatitis B (more than 10 cases per 100 thousand population), which is one of the highest in the republic. In the coming years, a high infectious potential of the causative agent of viral hepatitis “A” is predicted, which, along with the presence of a large number of people susceptible to infection, will support the unfavorable situation with this disease. There remains a risk of complications in the epidemiological situation associated with the threat of importation of particularly dangerous and other infectious diseases, although no outbreaks have been registered in border areas (SARS, bird flu, enterovirus infection type 71, etc.).
The development of most chronic non-infectious and socially significant diseases (diseases of the cardiovascular system, diabetes mellitus, etc.) is associated with a person’s lifestyle. In this regard, it becomes important to form a healthy lifestyle for Kazakhstanis living in an environmental disaster zone and to develop physical culture. The implementation of measures in the field of promoting a healthy lifestyle would help strengthen intersectoral interaction, especially in such issues as limiting the sale of alcohol and tobacco products and road safety.
The low level of quality of medical services, insufficient availability and quality of medicines cause an insufficient level of quality of medical care.
To improve the quality of medical services, it is necessary to constantly train qualified personnel, standardize medical care, accreditation of health care organizations; to resolve this issue, periodic protocols for the diagnosis and treatment of diseases have been introduced in all health care facilities in the region, which has been confirmed in 56 verified medical organizations in the region.
At the same time, the number of complaints from the population about poor quality medical care in healthcare facilities in the Kyzylorda region is increasing. Every year, about 63% of complaints are recognized as justified.
The personnel shortage at the beginning of 2009 was: 564 doctors, 98 paramedics, including 197 doctors and 24 paramedics in rural areas. Despite the increase in the population's supply of medical personnel of all specialties with other departments (from 37.7 in 2004 to 40.5 per 10,000 population in 2008), the supply of practical doctors has been declining over the years. The staffing of medical organizations with doctors is decreasing from 78.1% in 2004 to 70.2% in 2008. In rural regions these figures are even lower.
There is a trend of “aging” of the medical workforce: people over 50 years old already make up 36.4%, under 30 years old only 11.6%. The proportion of specialists with more than 25 years of experience is increasing, which indicates a decrease in the influx of young personnel. The situation is aggravated by the lack of a concept for human resource development.
Data on population morbidity is collected, processed and analyzed using medical statistics methods. Population morbidity is studied by three methods:
A) according to the population’s requests for medical help, the basis was laid by zemstvo doctors who offered cards; allows you to identify clinically significant diseases and seek medical help. awns
B) according to medical examinations - the initial forms of the disease are revealed, as well as latent, hidden forms.
C) based on data on the causes of death - latent diseases that were not diagnosed during life, masked diseases (if there is a discrepancy between the clinical and post-mortem diagnoses) are identified.
The completeness of disease detection is influenced by:
1) the completeness of the population’s visits to medical institutions - determined by remoteness, the availability of transport connections, the need for sick leave, the presence of self-medication, the fashion for diagnoses
2) completeness of recording of disease detection
3) equipping the medical institution with diagnostic equipment and qualified personnel
4) the possibility of patients applying to non-governmental institutions
5) qualifications and integrity of the doctor
6) organization of medical examinations
In foreign countries, data from disease registers, results of special sample studies, and sociological methods (surveys, questionnaires, interviews) are used to study morbidity.
Statistical study of morbidity population can be carried out:
A) Continuous method– allows you to get Exhaustive materials about the morbidity of the population; is based on a summary of reported data on population morbidity for all medical institutions.
B) Selective method– allows you to obtain data on the incidence of various population groups Taking into account the influence of various factors, conditions and lifestyles of people; The research is carried out according to special programs at certain periods of time in specific territories.
Each method has its own source of information, statistical accounting document, and analysis algorithm. For statistical analysis, both a) officially established medical records and b) specially developed forms can be used.
An important methodological point in characterizing, describing and analyzing morbidity is the correct use of terms and the same understanding of them.
Study of population morbidity By circulation for medical care in health care facilities - the leading method that, as a rule, identifies acute diseases and chronic diseases in the acute stage.
Consists of the study of general and primary morbidity, as well as 4 types of special morbidity recording:
1) acute infectious diseases
2) important non-epidemic diseases
3) hospitalized diseases
4) diseases with temporary disability - they are isolated because they have medical, social and economic significance.
Methodology for studying general and primary morbidity
The general morbidity of the population is being studied Based on a complete record of all initial requests for medical care in medical institutions. Unit of account– first visit to a doctor for this disease this year. Main accounting document in outpatient clinics – “Statistical coupon for registration of final (refined) diagnoses” (f. 025-2/u), which is filled out for all cases of acute diseases and the first visits in a given calendar year for chronic diseases. For each acute disease, a statistical form is filled out and a plus sign (+) is placed in the column “diagnosis established for the first time in life.” For chronic diseases, the statistical coupon is filled out only once a year at the first visit. The “+” sign is placed if a chronic disease is detected in a patient for the first time in his life. When a patient first contacts this year for an exacerbation of a chronic disease identified in previous years, a minus sign (–) is placed. For repeated visits in a given year for exacerbations of chronic diseases, the diagnosis is not recorded. The doctor writes down all updated diagnoses in “Sheet for recording final (refined) diagnoses” in the “Medical record of an outpatient” (f. 025/u), which allows you to see the dynamics of diseases.
At the end of the appointment, all coupons with registered diagnoses of diseases are transferred to the medical statistics office, encrypted and used for statistical summaries, reporting and calculation of morbidity rates. Information on cases of diseases among the population is contained in “Report on the number of diseases registered in patients living in the service area of the medical institution for... a year” (f. 12).
Some outpatient clinics use a new disease recording system for a completed case of service with automated processing of primary medical documentation. For this purpose, the “Outpatient Card” is used. This accounting document is filled out for each completed case of outpatient care (SPO) for a patient in an outpatient clinic (i.e., a case of recovery, remission, hospitalization or death of the patient). All visits made regarding the disease are entered into it, this document is stored in the doctor’s office until the SPO is completed, after which it is signed by the doctor and transferred to the medical statistics office. Information on repeat visits is used to characterize the volume of medical care.
Indicators of general and primary morbidity.
1) frequency of primary morbidity
Average annual population = (number of inhabitants on January 1 + number of inhabitants on December 31)/2
2) frequency of general morbidity
3) special intensive indicators - calculated by age, sex groups, nosological forms of diseases, professional, social, territorial and other characteristics:
4) morbidity structure
Current levels of general and primary morbidity and their structure in the Republic of Belarus.
Primary incidence: 74,000 per 100 thousand population, increased by 40% since 1990, growth is observed in all classes, except infectious and endocrine diseases
1st place: respiratory diseases (49%)
2nd place: injuries and poisonings (10%)
3rd place: diseases of the musculoskeletal system (5%)
4th place: diseases of the skin and subcutaneous fat (5%)
5th place: infectious diseases
6th place: diseases of the genitourinary system
General morbidity: 130,000 per 100 thousand population, increased by 18% over 10 years
– the accumulation index is calculated (total morbidity/ primary morbidity)
– in children the incidence is 3 times higher, in adolescents it is 2 times higher than in adults
– in women the incidence is higher, because they are more often treated
– urban residents have a higher morbidity rate than the rural population, since the availability of medical facilities is higher
1st place: respiratory diseases
2nd place: diseases of the circulatory system
3rd place: diseases of the digestive system
4th place: diseases of the musculoskeletal system
The most common diseases in the world are:
2nd place: anemia (2 billion cases annually)
3rd place: external diseases - injuries, poisoning, occupational diseases
4th place: mental disorders.
Morbidity is one of the criteria for assessing the health status of the population. Under morbidity imply an indicator that characterizes the level (prevalence), structure and dynamics of registered diseases among the population as a whole or in its individual groups (age, gender, territorial, professional, etc.) and serves as one of the criteria for assessing the work of a doctor, medical institution, or health care authority.
The disease is mainly available for registration when the patient seeks medical help. Materials on the morbidity of the population in the practical activities of a doctor are necessary for: operational management of the work of healthcare institutions; assessing the effectiveness of ongoing medical and health measures, including medical examinations; assessing public health and identifying risk factors contributing to increased morbidity; planning the scope of preventive examinations; determining the patient population for dispensary observation, hospitalization, sanatorium-resort treatment, employment, etc.; current and future workforce planning, networks of various health services and departments; morbidity forecast.
Population morbidity is the most important indicator of public health, a criterion for assessing the quality and effectiveness of health-improving work, and the most objective and sensitive indicator of medical and social well-being. Reducing the level of morbidity among the population is of great social and economic importance, constitutes one of the key social and hygienic problems and requires the active participation of legislative and executive authorities in the preparation and implementation of special programs to improve the health and social protection of the population. Studying the causes and risk factors of morbidity, determining the consequences of the influence of diseases on health, and developing ways to prevent diseases are the priority professional tasks of workers in medical institutions.
Thus, morbidity data is a tool for operational guidance and health management. Moreover, morbidity indicators reflect the real picture of the life of the population and make it possible to identify problematic situations for the development of specific measures to protect public health and improve it on a national scale.
According to WHO definition, morbidity– is any subjective or objective deviation from the normal physiological state of the body. Thus, the concept of “morbidity” is broader than the concept of “disease”.
An important direction in the study of morbidity is the assessment of the influence of risk factors of conditions and lifestyle, analysis of the relationships between medical, social, hygienic, genetic, organizational, clinical and other factors that contribute to the formation of the most common forms of diseases.
The use of modern statistical techniques has made it possible to establish that a higher level of morbidity in the population depends not only on the adverse effects of environmental factors, but also on a number of biological, socio-economic factors, lifestyle, and social conditions.
One of the principles of modern healthcare is the preservation of the health of healthy people, which makes it possible to give priority to state and public activities in the field of disease prevention. The disease is mainly available for registration when the patient seeks medical help.
Main statistical indicators of morbidity:
1. Primary morbidity (morbidity itself).
2. Pain (prevalence).
3. Pathological damage.
4. True morbidity.
Primary morbidity (morbidity itself)– this is a set of newly emerging diseases that have not been taken into account anywhere before and were identified among the population for the first time in a given year (relapses of chronic pathology that occur during the year are not taken into account). It is calculated as the ratio of the number of newly emerging diseases to the average population, multiplied by 1000. It is registered using statistical coupons (account f. 025-2/u) of updated diagnoses with a sign (+).
Diagnoses of acute diseases are recorded whenever they occur; chronic diseases are recorded only once a year.
During the period 1992–2008 in the Russian Federation, the primary morbidity rate of the population had a steady upward trend and in 2008 amounted to 771.7 per 1000 population (adults - 559.7; children - 1838.9 per 1000 of the corresponding population). The complex analysis carried out made it possible to establish that an 80% increase in the primary morbidity rate is associated with an increase in the availability of medical care to the population, and above all with the expansion of the diagnostic capabilities of the healthcare system, and 20% is associated with a true increase in morbidity.
In the structure of primary morbidity among the adult population, respiratory diseases are in first place (26.4%), injuries and poisonings are in second (15.6%), and diseases of the genitourinary system are in third (9.3%).
Morbidity (prevalence of diseases)- this is the totality of all diseases existing among the population, both first identified in this calendar year, and registered in previous years, but for which the patient returned again in a given year (registered according to all statistical coupons of updated diagnoses, account f. 025-2 /y). Statistically expressed as the ratio of the number of all diseases in the population per year to the average population, multiplied by 1000.
There is a significant difference between the concepts of primary morbidity and morbidity. Morbidity is always higher than the level of morbidity itself. The indicator of primary morbidity, in contrast to morbidity, indicates dynamic processes occurring in the health of the population and is more preferable for identifying causal relationships. The morbidity indicator gives an idea of both new cases of the disease and previously diagnosed cases, but with an exacerbation of which the population came forward in a given calendar year. The morbidity (prevalence) indicator is more stable in relation to various environmental influences, and its increase does not mean negative changes in the health status of the population. This increase may occur as a result of advances in medical science and practice in treating patients and prolonging their lives, which leads to the “accumulation” of contingents registered at dispensaries. Primary morbidity is an indicator that is more sensitive to changes in environmental conditions in the year under study. By analyzing this indicator over a number of years, one can obtain the most correct idea of the incidence and dynamics of morbidity, as well as the effectiveness of a set of social, hygienic and therapeutic measures aimed at reducing it.
Recently in the specialized literature the term “ accumulated morbidity”, which should be understood as the totality of all cases of primary diseases registered over a number of years when seeking medical help.
The cumulative incidence rate per 1000 population of the corresponding age is calculated. This morbidity indicator most reliably reflects the health of the population studied by the appeal method.
“Pathological affection”– a set of diseases and pathological conditions identified by doctors through active medical examinations of the population. Statistically expressed as the ratio of the number of diseases currently present to the average population, multiplied by 1000.
These are mainly chronic diseases, but currently existing acute diseases can also be taken into account.
The term “pathological involvement” is used to determine the frequency of pathology among the population (or its individual groups), which is established during medical examinations that take into account not only diseases, but also premorbid forms, morphological or functional abnormalities, which may subsequently cause the disease, but by the time examinations have not yet forced their carriers to seek medical help. In practical healthcare, this term can be used to define the results of medical examinations of the population.
Periodic and mass medical examinations make it possible to identify previously unknown chronic diseases for which the population does not actively seek medical attention. Cases of initial (hidden) manifestations of certain diseases must be taken into account. The advantage of the method of active medical examinations is also the clarification of the diagnosis of certain chronic diseases and pathological abnormalities. Reliable information about the size and nature of morbidity for various population groups (age, gender, social, occupational, etc.) is necessary to assess trends in the health of the population, the effectiveness of medical and social measures, planning various types of specialized care, rational use of material and human resources healthcare.
Data from primary and general morbidity, pathological incidence, and analysis of causes of mortality are used to calculate the indicator of exhausted (true) morbidity of the population.
– this is the general morbidity rate based on visits, supplemented by cases of diseases identified during medical examinations and data on causes of death.
* Diseases for which no complaints to health care organizations have been registered are taken into account.
** The indicator can be calculated for individual age and sex groups, classes of diseases, and nosological forms.
For example, this indicator (2005) for residents of the Novgorod region was 3811.0‰, while the overall morbidity rate by appeal was 1954.24‰.
In addition, a number of disease incidence indicators are calculated for individual age and sex groups. Depending on the purpose of the study, various statistical materials and accounting documents are used (medical records, emergency notices, certificates of incapacity for work, cards of those leaving the hospital, medical death certificates, other special forms and questionnaires). When choosing the main diagnosis, you should be guided by the “International Classification of Diseases and Related Health Problems” (10th revision, 1993, WHO), which includes 21 classes of diseases, which are divided into blocks, headings, terms and diagnostic formulations.
When diagnosing and coding morbidity, preference should be given to: 1) the underlying disease rather than the complication; 2) a more severe and fatal disease; 3) infectious rather than non-infectious diseases; 4) acute form of the disease, not chronic; 5) a specific disease associated with certain working and living conditions.
Name | Definition | Calculation method | ||||||||||||||||
indicator | ||||||||||||||||||
Number for the first time in my life | ||||||||||||||||||
Primary | disease- | diagnosed | ||||||||||||||||
identified) | diseases |
|||||||||||||||||
identified diseases | diagnosed | per year x 1000 | ||||||||||||||||
(actually | identified in | |||||||||||||||||
Average annual | ||||||||||||||||||
morbidity) | diseases in | number | population, |
|||||||||||||||
Incidence (WHO term) | resident | |||||||||||||||||
designed for 1000 | activities of the clinic |
|||||||||||||||||
population | ||||||||||||||||||
Prevalence, | primary |
|||||||||||||||||
diseases, | strangeness | |||||||||||||||||
morbidity | diseases | diseases | ||||||||||||||||
(pain) - | identified | chronic), | ||||||||||||||||
Prevalence (WHO term) | registered | |||||||||||||||||
(primary | ||||||||||||||||||
morbidity), | (negotiability | |||||||||||||||||
chronic | medical examinations) | |||||||||||||||||
diseases, | Average annual | |||||||||||||||||
previously identified | population | |||||||||||||||||
patients contacted | ||||||||||||||||||
identified | ||||||||||||||||||
inspections. | ||||||||||||||||||
Structure | individual | individual | ||||||||||||||||
morbidity | diseases | diseases x 100 | ||||||||||||||||
Total cases of diseases | ||||||||||||||||||
Morbidity rates are calculated by medical statisticians for individual medical districts, departments and the entire institution (over time). Physicians, heads of departments and heads of healthcare institutions analyze established features and trends based on established dependencies and patterns of influence of factors, plan activities and make the necessary management decisions.
In the context of the functioning of the health insurance system and the development of automation of the work of medical statisticians, various information statistical programs and computer
technologies. Advanced information technologies provide for mandatory control over the implementation of the rules for coding information about the patient and his diseases.
Features of parallel analysis of primary incidence and prevalence indicators
Parallel analysis of indicators and dynamics (prospectively or retrospectively) allows us to identify factors influencing the value of indicators. So, for example, if prevalence rates are trending upward, then it is important to look at the trend in primary incidence rates. If the latter indicator also tends to increase, it should be concluded that the increase in prevalence reflects a deterioration in the health of the population, because the accumulation of “contingents” is due to the growth of “primary morbidity”.
An increase in primary incidence means that there are “culprits” for such an increase. This circumstance of in-depth analysis of factors requires the development and implementation of a set of treatment and preventive measures, and ultimately - improvement of conditions and lifestyle, economic improvement of the external environment, etc. (targeted programs, prevention programs).
If the primary morbidity has a favorable tendency - to decrease, then the increase in prevalence reflects the longer life expectancy of patients and due to this, an “accumulation” of diseases occurs. This prevalence trend reflects the presence of “favorable” factors - improving the quality of life of patients, including through improving the quality of medical care.
The importance for doctors and health care facilities of simultaneous analysis of indicators
Based on trends in growth, stabilization or reduction in primary incidence and prevalence over time (trends), reflecting the influence of factors and the subsequent application of statistical methods of proof and justification, it is possible to determine priorities for the implementation of technical
arterial hypertension, etc.) in the clinic’s service area may be associated with:
- with the influence of etiological risk factors for these diseases;
- with improving the level and quality of diagnostics;
The increase in predominantly acute diseases is due to the increasing influence of risk factors for these diseases, since their diagnosis is not as difficult as chronic diseases.
When analyzing trends in primary morbidity and the prevalence of chronic diseases, doctors and health care facilities will need an in-depth study of the circumstances that led to the increase:
- whether the conditions and lifestyle of the population have worsened;
- whether the influence of environmental risk factors has increased;
- whether the availability or provision of diagnostic equipment has deteriorated;
- whether availability and qualifications have decreased medical specialists. The simultaneous increase in the prevalence of chronic diseases with
The trend of increasing incidence may be due, firstly, to an increase in newly identified diseases, and secondly, to an increase in the number of exacerbations (relapses) of previously registered chronic diseases with a low level of organization of preventive work.
In recent years, the preventive activities of clinic doctors have intensified. With the introduction of targeted programs for the prevention of chronic
diseases, as well as active visits to patients during dispensary observation may also influence the increase in prevalence rates.
The doctor will need an in-depth study of the circumstances that led to the increase in incidence: whether the conditions and lifestyle of patients, the ecological environment, etc. have worsened, as well as whether the provision of diagnostic equipment, the availability and qualifications of specialists diagnosing diseases have worsened.
The simultaneous increase in the prevalence of chronic diseases with an increase in incidence may be due, firstly, to an increase in new diseases and early identified diseases (their exacerbations or active dispensary work of doctors).
A decrease in primary morbidity with stabilization or increase in prevalence may be due, first of all, to improved conditions and lifestyle of the population, a decrease in the influence of risk factors through preventive measures. At the same time, an increase in the prevalence rate indicates an exacerbation of chronic diseases, or better organization and implementation of preventive measures to prevent relapses.
Hospitalized morbidity - this is the frequency of all cases of diseases registered in patients leaving the hospital for a given year.
The observation unit is the main case of illness of a patient who left the hospital (discharged or died). Typically, the primary diagnosis is the discharge diagnosis.
Accounting document: - “Statistical card of a person leaving the hospital” (form No. 066/u-04 and form no. 066/u-02), which is filled out or controlled by the attending physician on the basis of the “Medical record of an inpatient” (medical history - f . No. 003/у). Data on diseases from the “Statistical cards of those leaving the hospital” are summarized in the “Report on the activities of the hospital” (form No. 14), which provides information on the composition of patients in the hospital according to
nosological groups, age groups (adults and adolescents, children).
Based on the development of data from the summary record of hospitalized patients by disease and annual information, the following indicators can be calculated (Table 3.4):
Table 3.4
Indicators of hospitalized morbidity and their methods
calculations | |||||||
Indicator name | Calculation method | ||||||
Structure | Number of cases of individual diseases in |
||||||
hospitalized | people leaving the hospital x 100 | ||||||
incidence (in%) | Total number of diseases in retired patients | ||||||
from hospital in a year | |||||||
Hospitalized | Number of cases of illness among retirees |
||||||
morbidity (in general, by | patients from hospital x 1000 | ||||||
separate | diseases, | ||||||
Average annual | number | population, |
|||||
half a year, year) | |||||||
Incidence rates can be calculated both for individual nosological forms and for classes of diseases. The analysis can be carried out over time, as well as depending on gender, age and other characteristics.
Infectious morbidity is the frequency of all cases of infectious diseases recorded in a population during a specified period of time.
Special recording of all infectious diseases, despite the fact that they are reflected in the general morbidity rate, is caused by the need to develop urgent anti-epidemic measures carried out by both treatment and preventive institutions and institutions of the Rospotrebnadzor service.
Unit of observation- each case of a registered infectious disease over a specified period of time.
Accounting document- in addition to accounting forms (outpatient coupon, or “Unified coupon”), an “Emergency notification of
infectious disease, food poisoning, acute occupational poisoning, unusual reaction to vaccination" (form No. 058/u). It is filled out by the doctor within the first 12 hours from the moment of diagnosis, sent to the Federal State Institution “Center for Hygiene and Epidemiology”, and the summary data is transferred to the territorial department of Rospotrebnadzor.
Each “Emergency Notice” is registered in a special journal (form No. 060/u) in a medical institution and an institution of the Rospotrebnadzor service.
Subsequently, data on reported infectious diseases is used to compile monthly and annual reports. For efficiency, in some cities, information about infectious diseases is transmitted via multi-channel telephone to health authorities and Rospotrebnadzor service institutions.
To assess and analyze infectious morbidity, the following main indicators are calculated (Table 3.5):
Table 3.5
Indicators of infectious morbidity and methods for calculating them
Name | Calculation method | |||||
indicator | ||||||
Structure | identified | |||||
infectious | diseases of one nosological form x |
|||||
incidence (in%) | ||||||
cases of all infectious | ||||||
diseases | ||||||
Number of infectious cases | ||||||
infectious | diseases x 1000 | |||||
morbidity (in general, by | ||||||
Average annual population, |
||||||
certain diseases) | living in this area | |||||
Incidence rates can be calculated both in general, for individual classes of diseases, and for nosological forms. The analysis is carried out over time, as well as among children, adolescents and adults.
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