Hospital and primary care emergency services in Asturias [Spain]: variations among health areas and trends between 1994-2001

OBJECTIVE: To describe primary care and hospital emergency utilization rates in Asturias health districts from 1994 to 2001 and to analyse their variability. METHODS: Hospital and primary care rates from 1994 to 2001 in the 8 Asturias health districts were estimated. Their variability was analysed using indirect standardisation and small area variation statistics. RESULTS: Almost 6.5 million of emergencies (hospitals: 43.8%) were attended in Asturias from 1994 to 2001. The average annual growth was 6.2% (primary care: 7.8%; hospitals: 5.1%) with differences among districts. Primary care variability was higher (variation coefficient: 0.38 and 0.27 in 1994 and 2001) than hospital variability (variation coefficient: 0.14 and 0.11) and it decreased in the period. CONCLUSIONS: Emergency Health Services utilization growth between 1994 and 2001, with strong variability among health districts.     

Drinking in transition: trends in alcohol consumption in Russia 1994-2004

Background  

Heavy alcohol consumption is widespread in Russia, but studying changes in drinking during the transition from Communism has been hampered previously by the lack of frequent data. This paper uses 1-2 yearly panel data, comparing consumption trends with the rapid concurrent changes in economic variables (notably around the "Rouble crisis", shortly preceding the 1998 survey round), and mortality.     

Temporal and regional trends in the prevalence of healthy lifestyle characteristics: United States, 1994-2007

Objectives. We examined temporal and regional trends in the prevalence of health lifestyles in the United States.Methods. We used 1994 to 2007 data from the Behavioral Risk Factor Surveillance System to assess 4 healthy lifestyle characteristics: having a healthy weight, not smoking, consuming fruits and vegetables, and engaging in physical activity. The concurrent presence of all 4 characteristics was defined as a healthy overall lifestyle. We used logistic regression to assess temporal and regional trends.Results. The percentages of individuals who did not smoke (4% increase) and had a healthy weight (10% decrease) showed the strongest temporal changes from 1994 to 2007. There was little change in fruit and vegetable consumption or physical activity. The prevalence of healthy lifestyles increased minimally over time and varied modestly across regions; in 2007, percentages were higher in the Northeast (6%) and West (6%) than in the South (4%) and Midwest (4%).Conclusions. Because of the large increases in overweight and the declines in smoking, there was little net change in the prevalence of healthy lifestyles. Despite regional differences, the prevalence of healthy lifestyles across the United States remains very low.In developed countries, and increasingly in developing countries, chronic diseases account for the majority of the population disease burden in terms of mortality, morbidity, and medical expenditures.1 Most major chronic diseases share multiple, common lifestyle characteristics or behaviors, particularly smoking, inadequate fruit and vegetable consumption, physical inactivity, and obesity.^2,3 There is now an overwhelming body of clinical and epidemiological evidence illustrating the dramatic impact of a healthy lifestyle on reducing all-cause mortality and preventing chronic diseases such as coronary heart disease, stroke, diabetes, and cancer.^4–9The definition of a healthy lifestyle varies across studies but generally includes a combination of healthy lifestyle characteristics such as having a healthy weight, not smoking, and engaging in regular physical activity. Despite the known benefits of following a healthy lifestyle, the available data consistently show that very few Americans are able to do so. Previous work has shown, depending on the definition of healthy lifestyle used, that only between 3% and 10% of US residents have a healthy lifestyle^10,11 despite the presence of substantial public health investments in programs designed to promote healthy lifestyles over the past few decades.^12–14 Some of these investments have resulted in sustained improvements in individual healthy lifestyle characteristics, particularly tobacco use,^14,15 whereas others, such as physical activity promotion and obesity prevention programs, have met with limited success.^16,17In the United States, strong temporal trends in individual healthy lifestyle characteristics—particularly declines in tobacco use and increases in obesity—have been described.^14,16,17 Marked regional differences in the prevalence of certain individual healthy lifestyle characteristics have also been demonstrated. For example, in 2007 the prevalence of cigarette smoking ranged from 9% to 31% across states, and the prevalence of recommended physical activity ranged from 31% to 61%.¹⁸Although much information exists on individual healthy lifestyle characteristics, there has been little reported on temporal and regional differences in the prevalence of individuals with healthy lifestyles. Using Reeves and Rafferty''s definition of a healthy lifestyle¹⁰—the presence of 4 modifiable healthy lifestyle characteristics—we examined temporal and regional US trends in the prevalence of healthy lifestyles as well as these 4 individual characteristics from 1994 to 2007.     

East Timor in transition: health and health care.

East Timor was liberated from 400 years of conquest and exploitation in an armed struggle that ended, in September 1999, in a conflagration that destroyed its social and physical infrastructures. For two years the territory has been under United Nations administration. Political conditions remain unstable as the result of many intrinsic and external factors. Its economy continues to depend upon infusions of funds from multilateral, bilateral, and private sources. Efforts by expatriates to introduce Euro-American cultural and technical models have been applied to the factors that determine health, with modest results. East Timor expects to be totally independent of foreign control early in 2002. Its future health will depend upon continuing collaboration between international and local leadership in evolving effective government, economy, and health services designed, managed, and executed by Timorese.     

Health care expenditure and mortality from amenable conditions in the European Community

This paper addresses the question whether within the European Community a higher national level of health care expenditure is associated with a larger degree of success in eliminating mortality from preventable and curable conditions. An aggregate measure of mortality from 12 amenable conditions was derived, incorporating an adjustment for the level of socio-economic development. In 1980-84, between country variation in this measure was almost 2-fold and showed surprising patterns. Rates are relatively low in Greece, The Netherlands and Denmark, and relatively high in Portugal, Italy and Germany. There was no association at all between this measure and the level of health care expenditure. These disturbing findings, which suggest substantial variation in the cost-effectiveness of different health service systems, warrant further investigation.     

Post-1950 mortality trends and medical care: gains in life expectancy due to declines in mortality from conditions amenable to medical intervention in The Netherlands

In order to assess the impact of medical care innovations on post-1950 mortality in The Netherlands, we analysed trends in mortality from a selection of conditions suggested by Rutstein et al.'s lists of "unnecessary untimely mortality". This selection covers 11 types of innovation, and includes 35 conditions which have become amenable to medical care. Loglinear regression analysis shows that for most of these conditions mortality declined during each of two subperiods (1950-1968; 1969-1984). Mortality decline accelerated in the second subperiod for many conditions. Reductions in mortality from these conditions between 1950/54 and 1980/84 added 2.96 and 3.95 years to life expectancy at birth of Dutch males and Dutch females respectively. A priori evidence indicates that these mortality reductions are due to some extent to 'spontaneous' incidence declines. Although the exact contribution of medical care innovations to these changes in mortality thus cannot be determined, the impact of medical care on post-1950 mortality in The Netherlands could well have been substantial.     

Racial/ethnic variations in women's health: the social embeddedness of health

This article provides an overview of the magnitude of and trends in racial/ethnic disparities in health for women in the United States. It emphasizes the importance of attending to diversity in the health profiles and populations of minority women. Socioeconomic status is a central determinant of racial/ethnic disparities in health, but several other factors, including medical care, geographic location, migration and acculturation, racism, and exposure to stress and resources also play a role. There is a need for renewed attention to monitoring, understanding, and actively seeking to eliminate racial/ethnic disparities in health.     

The effect of health services on mortality: amenable and non-amenable causes in Spain

Recent work has demonstrated the usefulness of employing 'avoidable' deaths as an outcome measure for assessing and comparing the effectiveness and quality of health care systems. This paper considers the relevance of 'avoidable' deaths as an outcome measure for the Spanish health system. Mortality data for 1960 to 1984, were examined and the results, with the exception of cancer of the cervix, show a marked decline in 'avoidable' deaths, consistent with studies elsewhere. This pattern of 'avoidable' deaths may reflect either a decrease in the incidence of disease or better medical management of disease leading to fewer deaths. The 'avoidable' mortality may well be a sensitive indicator of the efficacy of a country's health care system.     

Educational differences in self-rated health during the Russian transition. Evidence from Taganrog 1993-1994

In the beginning of 1992, in order to do away with the ruins of the old communist system once and for all, radical economic reforms--'shock therapy'--were introduced in Russia. However, there are winners and losers in the Russian transition from communism to market economy and democracy. The aim of the study is to investigate whether there are educational differences in self-rated health among the citizens of Taganrog in 1993-94. If there are indeed differences, the second aim is to investigate whether they can be explained by variations in specific social, economic and psychological circumstances, which are known to be affected by the present social and economic transformation in Russia. The analysed survey was carried out in a middle-sized Russian city, Taganrog, in late 1993 and early 1994. It was conducted by means of face-to-face interviews, with a sampling frame consisting of dwellings selected from an official register and stratified by type and size. The analysed sample consists of 2372 respondents, aged 25-54 years, in 1414 households. Data were analysed in logistic regressions with self-rated health as a dichotomised outcome variable. The results show that those with less than compulsory education reported poor health twice as often as the highest-educated group. Material prosperity and relations within the family were important for self-rated health and explained to a certain degree the educational health differences. Lower educational groups now live under conditions often characterised by economic hardship, family conflicts, etc., and consequently also poor health.     

Epidemiologic transition interrupted: a reassessment of mortality trends in Thailand, 1980-2000

BACKGROUND: In the late 1980s and early 1990s a generalized HIV epidemic affected Thailand which was relatively well controlled by an intensive national campaign by the mid 1990s. The extent to which the epidemic has slowed or possibly reversed the epidemiological transition in Thailand is relatively unknown. METHODS: Under-five mortality rates (U5MR) were determined from various sources and weighted least squares regression conducted to determine U5MR over the years 1980-2000. Direct and indirect estimates of the completeness of death registration were used to estimate mortality levels in those aged more than 5 years for the 1980-90 and 1990-2000 periods. Life tables were constructed using the various estimates to determine changes in life-expectancy between the two time periods. RESULTS: U5MR in Thailand is estimated to have been 58/1000 live births in 1980, declining to 30 in 1990 and to 23 in 2000. The vital registration system clearly underestimates U5MR. Successive surveys of Population Change (SPC) imply coverage of death registration improving from 75-77% in 1985-86 to 95% in 1995-96, partly due to a reliance on self-reported registration in the latter survey. In contrast, the General Growth Balance-Synthetic Extinction Generations (GGB-SEG) method suggests coverage worsening from 78-85% in 1980-90 to 64-72% in 1990-2000. Life tables based on SPC adjustments show continued declines in female, and to a lesser extent, male adult mortality with corresponding increases in life-expectancy at birth of around 6 years for both sexes from 1980-90 to 1990-2000. In contrast, the indirect adjustments suggest a substantial increase in male adult mortality with female adult mortality unchanged; life expectancy decreased by 4 years for males and was only marginally higher in females. CONCLUSION: Given the conflicting evidence a definitive assessment of mortality change in Thailand between 1980 and 2000 is difficult to make. Indirect adjustments, based on demographic methods point to a major reversal in mortality decline among males, and a slowing in females. If adult mortality registration has declined, and given the continued under-registration of infant and child deaths, remedial measures are urgently required if the mortality system is to better inform and monitor health development in Thailand.     

Mortality amenable to health care in the United States: the roles of demographics and health systems performance

This article examines associations of socio-demographic and health-care indicators, and the statistic 'mortality amenable to health care' (amenable mortality) across the US states. There is over two-fold variation in amenable mortality, strongly associated with the percentages of state populations that are poor or black. Controlling for poverty and race with bi- and multi-variate analyses, several indicators of health system performance, such as hospital readmission rates and preventive care for diabetics, are significantly associated with amenable mortality. A significant crude association of 'uninsurance' and amenable mortality rates is no longer statistically significant when poverty and race are controlled. Overall, there appear to be opportunities for states to focus on specific modifiable health system performance indicators. Comparative rates of amenable mortality should be useful for estimating potential gains in population health from delivering more timely and effective care and for tracking the health outcomes of efforts to improve health system performance.     

Health services resources and their relation to mortality from causes amenable to health care intervention: a cross-national study

Gross national product has been found to be negatively associated with age-specific mortality, and the prevalence of medical doctors positively associated with mortality in younger age groups. We studied the relationship between mortality and its determinants among people aged 64 years or less in 25 developed countries. Age-adjusted mortality rates from causes of death amenable to interventions by health services were calculated for the period 1975-8, and, likewise, rates from partly amenable causes, non-amenable causes, and violent causes of death. In regression analysis, log mortality from amenable causes was significantly negatively associated with gross domestic product (GDP) but not with the numbers of medical doctors, nurses and midwives, hospital beds, alcohol consumption, tobacco consumption, or military expenditure. It is argued that cross-sectional comparisons disguise the effects of health services on mortality.