Indicators of the natural movement of the population. Public Health and Healthcare: Incidence, morbidity, incidence 2 per 100 thousand population
Calculation of incidence rates
adult population
The incidence rates included in Table 2.2 and related to the main group are calculated on the basis of primary data. Some other additional indicators are also calculated. Sometimes, in order to identify the causes of morbidity in the region under study and confirm the relationship between diseases and unfavorable environmental conditions, additional studies can be carried out in which specific diseases are studied that are etiologically related to the nature of the pollution of the territory: genetic disorders, namely, an increase in the frequency of genetic disorders in human cells (chromosomal aberrations, DNA breaks, etc.); the content in human biosubstrates (blood, urine, hair, teeth, saliva, placenta, human milk, etc.) of toxic chemicals that exceeds permissible biological levels; change in immune status: an increase in the number of people with pronounced changes in the immunogram in terms of morphological and humoral parameters.
The indicators can be calculated both in relation to the number of persons (the number of persons, for example, those who first applied to a medical institution, injured, deceased, etc.) and in relation to the number of cases (the number of cases of treatment to a medical institution are taken into account) (Antonenko T N. et al., 1997; Health of the population ..., 1999).
1. Primary incidence(see Table 2.1), i.e. the frequency of newly diagnosed diseases, represents the first time in a lifetime diagnosed diseases over a certain period, for example, within one year. Primary incidence Ifr defined as the ratio of the number of newly registered patients Nfr or the number of newly diagnosed diseases to the average population N per 1000 people (f.2.1):
2. The same formula is used to calculate prevalence Pm other types of diseases N m such as: morbidity, general morbidity, frequency of all diseases. At the same time, all diseases (acute, chronic, new and previously registered) of the population for a certain period, for example, for a year (f.2.2) are taken into account:
. (2.2)
General morbidity- the totality of all diseases among the population, first detected in a given year and registered in previous years, for which patients again applied in a given year, per 1000 people.
Total cumulative incidence- the number of diseases registered during the last year, supplemented by cases of chronic diseases registered in the previous 2 years and for which there was no appeal in this year per 1,000 population.
The same is calculated pathological affection or the frequency of disease detected on examination. This includes those diseases that are registered in the population on a certain date (a contingent of patients on a certain date).
3. When calculating the indicator Pi incidence of certain i- of the same nosological form in the numerator only persons N i patients with this disease (f.2.3):
. (2.3)
4. Incidence P c malignant neoplasms N c(see Table 2.2) is calculated per 100,000 population relative to the total population of the territory, including children aged 0–14 years (clause 1.3.1 of Table 2.2) per 100,000 children relative to the number of children of a specified age is calculated by the formula ( 2.4):
. (2.4)
The same formula is used to calculate the prevalence of malignant neoplasms (among men, women), however, the numerator takes into account the number of patients with cancer (men women), and the denominator, respectively, the number of male and female population.
According to the same formula, indicators of respiratory disease are calculated (see clause 1.5 of Table 2.2), such as: bronchitis and emphysema (clause 1.5.1), bronchial asthma (clause 1.5.2).
5. Structure Si the prevalence of diseases determines the proportion (percentage) of patients with a specific nosological form in the total number of registered patients. It is defined as the ratio of N i registered patients i-that nosological form to the number of registered patients N r(f.2.5):
. (2.5)
Incidence is one of the criteria for determining the state of health of the population. Materials on the incidence of the population in practical activities doctors are needed for:
assessment of public health and identification of risk factors contributing to the reduction of morbidity;
Evaluation of the effectiveness of ongoing medical and recreational activities, including medical examinations;
Planning the volume of preventive examinations;
determination of the contingent for dispensary observation, hospitalization, sanatorium treatment, employment of a certain contingent of patients, etc.;
· current and long-term planning of personnel, a network of various services and health departments;
operational management of health care institutions;
morbidity forecast.
Analysis of the state of health of the population or its individual groups is mandatory in the activities of a doctor. The main elements of a comprehensive analysis are:
1) collection of information about the state of health;
2) processing and analysis of health information;
3) putting forward a hypothesis about the relationship of environmental factors with the state of health;
5) health characteristics;
6) identification of quantitative relationships between environmental factors and health characteristics;
7) making a decision on recovery environment for primary prevention of diseases;
8) implementation of the decisions made;
9) verification of the effectiveness of the decisions made.
Depending on the purpose of the study, various statistical materials are used and accounting documents(medical cards, emergency notifications of infectious diseases, sick leave certificates, cards of patients who left the hospital, statistical coupons for registering updated diagnoses, medical death certificates, other special forms and questionnaires).
The study of morbidity includes a quantitative (morbidity rate), qualitative (morbidity structure) and individual (frequency rate of diseases transferred per year) assessment.
Distinguish: actual incidence - newly registered diseases in the reporting year; morbidity - the prevalence of diseases (diseases that reappeared in a given year and passed from previous years to this moment) and pathological damage.
Primary incidence- This is the number of first-ever diagnosed diseases within 1 year. All acute diseases and chronic diseases established for the first time in life are taken into account upon the first visit to a medical institution (relapses of chronic pathology occurring during the year are not taken into account).
Incidence rate \u003d (Number of newly diagnosed patients per year / Average annual population) x 1000
Seeking medical care- this is the absolute number of patients for the first time in a calendar year who applied to medical institutions for the disease. All primary and repeated appeals are characterized by attendance.
General morbidity of the population is studied according to the data of all primary requests for medical care in medical institutions. The main accounting document in outpatient clinics is medical card. The unit of observation in the study of general morbidity is the primary appeal of the patient in the current calendar year for this disease. When studying general morbidity, general and special indicators are calculated.
The indicator of general morbidity is determined by the number of primary applications for medical care to medical institutions in a given year per 1,000 or 10,000 inhabitants.
The overall indicator is the ratio of the number of cases per year to the total population. The number of requests for medical care for diseases, for example, in St. Petersburg has now significantly decreased and is: the total incidence of the adult population is about 900 requests per 1000, and the primary incidence is about 500 requests per 1000 inhabitants. Morbidity of the child population: general - 1800, primary - 1500 appeals per 1000 children.
Special morbidity indicators: morbidity by sex, age, nosological forms, administrative territories. In the structure of the general incidence of the adult population of St. Petersburg, the first places are occupied by:
respiratory diseases (about 25%),
diseases of the circulatory system (about 16%),
diseases of the nervous system and sensory organs (about 12%),
injury and poisoning (about 12%).
The study of various types of morbidity is explained by certain reasons, for example:
Infectious morbidity - requires rapid anti-epidemic measures;
hospital morbidity - information about it is used to plan the bed fund
morbidity with temporary disability - determines the economic costs;
The most important non-epidemic morbidity - provides information on the prevalence of socially conditioned diseases.
To assess the incidence of the population, coefficients are used that are calculated as the ratio of the number of diseases to the number of population groups and converted to a standard (per 100, 1000, 10000 people). These coefficients make it possible to estimate the probability of the risk of occurrence of any diseases in the population.
To obtain indicative ideas about the incidence of the population, the calculation of general coefficients (extensive intensive) is provided.
To identify causal relationships, special coefficients taking into account gender, age, profession, etc.
There are the following methods for studying morbidity:
· solid,
selective.
The continuous method is acceptable for operational purposes.
Sampling method - used to identify the relationship between incidence and environmental factors. The sampling method was used during the years of the population census, for example, the study of morbidity in certain areas. The choice of method for studying the incidence of the population in a particular territory or its individual groups is determined by the purpose and objectives of the study. Indicative information about the levels, structure and dynamics of morbidity can be obtained from the reports of medical institutions and reports from the central administration using the continuous method.
Identification of patterns, morbidity, relationships is possible only with a selective method by copying passport and medical data from primary accounting documents onto a statistical map.
When assessing the level, structure and dynamics of the incidence of the population and its individual groups, it is recommended to compare with indicators for Russian Federation, city, district, region.
The unit of observation in the study of general morbidity is the initial appeal of the patient in the current calendar year about the disease. The main accounting documents for the study of general morbidity are: a medical card and a statistical coupon for an updated diagnosis.
The overall incidence is calculated per 1000, 10000 population. In the structure of general morbidity in Russia, respiratory diseases occupy the first place, diseases of the nervous system and sensory organs are in second place, circulatory organs are in third place, diseases of the skin and subcutaneous tissue are fourth, and diseases of the nervous system and sensory organs are fifth.
The incidence of infectious diseases is studied by counting each infectious disease or suspicion of it. The record document is an emergency notification of an infectious disease. An emergency notification is drawn up for each infectious disease or suspicion of a disease and is sent within 12 hours to the center of Rospotrebnadzor (sanitary and epidemiological supervision). An emergency notice prior to departure is recorded in the journal of infectious diseases (form No. 060). Based on the entries in this journal, a report is compiled on the dynamics of infectious diseases for each month, quarter, half year and year. The analysis of infectious morbidity is carried out using general and special indicators. The total infectious disease rate is the number of infectious diseases registered per year per 10,000 inhabitants divided by the population. Special indicators - age and sex, depending on the profession, work experience, etc.
The structure of infectious diseases (in %) is the share of infectious diseases among the total number of registered diseases. The mortality rate is calculated and estimated (the number of deaths per 10,000 registered patients with infectious diseases). With a deeper study of infectious diseases, seasonality, sources of infection, the effectiveness of preventive vaccinations, etc. are analyzed, which makes it possible for doctors to develop measures to combat infectious diseases.
The number of registered infectious diseases (diphtheria, whooping cough, tick-borne encephalitis, salmonellosis) has increased. The incidence of venereal diseases and tuberculosis has increased.
In the Russian Federation, the highest incidence falls on the group of acute respiratory viral infections, which in the structure of the total infectious incidence is 87%. The incidence of influenza per 100,000 population is 3721, acute upper respiratory tract infection 20.
The incidence of measles increased by 4 times, whooping cough by 63%. Diphtheria is epidemic in a number of regions. In general, the incidence of diphtheria increased by 4 times. The highest incidence rate is in St. Petersburg (more than 5 times higher than in Russia).
The incidence of acute intestinal infections remains high. Per last years more than 1 million 100 thousand were ill with dysentery, typhoid fever, salmonella. About 60% are children under 14. Unfavorable areas for dysentery: Korelia, Komi, Arkhangelsk, Kostroma, Penza regions.
Soreness or the prevalence of diseases is the totality of all acute and all chronic diseases registered in a given calendar year. Morbidity is always higher than the level of actual morbidity. The indicator of morbidity, in contrast to morbidity, indicates the dynamic processes taking place in the health of the population and is more preferable for identifying causal relationships.
The indicator of morbidity gives an idea of both new cases of diseases, previously diagnosed cases, and exacerbations of chronic diseases, about which the population applied in a given calendar year.
Pain score = ( The number of patients with this disease registered per year - the number of patients deregistered + the number of patients newly registered) / Average annual population x 1000
Pathological affection- a set of diseases and pathological conditions identified by doctors through active medical examinations of the population; expressed statistically as the ratio of the number of diseases currently present to the average population, multiplied by 1000. These are mainly chronic diseases, but acute diseases present at the moment can also be taken into account. In practical public health, this term can be used to define the results of medical examinations of the population. It is calculated as the ratio of the number of diseases detected during a medical examination to the number of examined persons, multiplied by 1000.
Incidence with temporary disability (TD) occupies a special place in the incidence statistics due to its high economic importance. Morbidity with TD is one of the types of morbidity in terms of negotiability, it is a priority characteristic of the state of health of workers. Morbidity with VUT characterizes the prevalence of those cases of morbidity among workers that resulted in absence from work.
The unit of observation in the study of morbidity is each case of temporary disability due to illness or injury in a given year. The accounting document is a certificate of incapacity for work, which is not only a medical statistical, but also a legal document certifying temporary release from work, and financial, on the basis of which benefits are paid from the funds social insurance. In addition to passport data (last name, first name, patronymic, gender, age), the disability certificate contains information about the place of work of the sick person, the duration of treatment.
According to the generally accepted methodology, a number of indicators can be calculated based on the data of form 16-VN: 1) the number of cases of temporary disability per 100 employees (on average 80-100 cases per 100 employees); 2) the number of days of MST per 100 employees (average 800-1200 per 100 employees); 3) the average duration of one case of MTD (the ratio of the total number of days of disability to the number of cases of disability) is about 10 days.
When analyzing MTD, the structure of temporary disability in cases and days is also determined (first place - diseases of acute respiratory infections, then - diseases of the nervous system and sensory organs, hypertension, diseases of the musculoskeletal system, etc.). MTD can be analyzed according to nosological forms.
By health groups, workers can be divided into 5 main groups:
1) healthy (who did not have a single case of disability in a year);
2) practically healthy (who had 1-2 cases of disability per year due to acute forms of diseases);
3) who had 3 or more cases of disability in a year due to acute forms of diseases;
4) having chronic diseases, but not having cases of loss of ability to work;
5) those who have chronic diseases and who had cases of loss of ability to work due to these diseases.
Hospital morbidity rates. The incidence of hospitalized patients is a record of persons treated in a hospital during the year. Information on hospitalized morbidity makes it possible to judge the timeliness of hospitalization, the duration and outcome of treatment, the coincidence or discrepancy between diagnoses, the amount of medical care provided, etc. Data on hospitalized morbidity are taken into account when planning the bed fund, determining the need for various types of inpatient care. The unit of observation in the study of hospitalized morbidity is each case of hospitalization. The accounting statistical form is the card of the person who left the hospital. The overall hospitalization rate is about 150 cases per 1,000 people. In the structure of hospitalized patients, the main share is made up of patients with diseases of the circulatory system, digestion, chronic respiratory diseases, patients with injuries.
When studying the morbidity and mortality of the population, the International Statistical Classification of Diseases and Related Health Problems14 (10th revision, 1995, WHO) is used, which includes 21 classes of diseases, which are divided into a block of headings, terms and diagnostic formulations.
Morbidity structure - the share of diseases of a particular body system in the total incidence, taken as 100% (an example of the incidence structure on the example of the Krasnoyarsk Territory is shown in Fig. 4.3.). In the first place - diseases of the respiratory system (36%), in the second - injuries and poisonings (13%), in the third - diseases of the genitourinary system (7%), in the fourth - diseases of the eye and its accessory apparatus (6%), in the fifth - diseases of the musculoskeletal system and connective tissue (5%).
Rice. 4.4. Morbidity structure
Currently, there is a change in the structure of morbidity and mortality. So, if until the middle of the twentieth century, infectious diseases were the most common, which became the main cause of death of the population, now non-communicable diseases (chronically occurring cardiovascular, oncological, neuropsychiatric, endocrine diseases and injuries) predominate. This fact is explained by certain achievements in the field of medical science and the development of a preventive direction in public health: vaccination, labor protection measures, the elimination of natural foci of malaria, plague, health education.
Some researchers speak of a public health crisis. The manifestations of the crisis include the growth of non-communicable epidemics, an increase in the number of deaths due to cardiovascular, respiratory, and oncological diseases. On average, cardiovascular diseases cause 25% of deaths worldwide. AT developed countries- 40-50%, in developing countries - 16%. Mortality from cancer over the past 20 years has increased in the 28 most developed countries by 19% (including from lung cancer - by 76% in men and 135% in women). The crisis is generated, according to experts, by a sharp drop in the level of the mental component of health (mental disorders - in 2% of the population, taking into account mild forms, alcoholism and drug addiction - in 5-10%, suicide - 40-200 per 100 thousand of the population) and especially - spiritual: the growth of crime, selfishness, the cult of violence, drug addiction, the loss of a sense of happiness, self-satisfaction, etc. The threat of a crisis is in the deterioration of the gene pool: more and more people with a poor gene pool survive and give offspring.
Epidemiological evidence strongly suggests that men have a higher incidence than women. Men die from myocardial infarction 7.5 times more often between the ages of 40 and 49; 5.5 times - at the age of 50 to 55 years and 2.5 times - at the age of over 60 years. The unequal life expectancy of men and women is also explained by genetic differences in the chromosomal apparatus of the cell nucleus, the presence of a double set of X chromosomes in women, which determines the higher reliability of important mechanisms of biological regulation of the cell.
One of the main features of the current medical and demographic situation in the country is the high incidence of all categories of the population, including women and children - contingents that determine the reproductive potential of the country for the future. Thus, according to the results of the All-Russian medical examination of children in 2002, only 32.1% of children can be recognized as healthy. Violations of the somatic health of women, their high gynecological morbidity and the frequency of obstetric complications during pregnancy and childbirth are the leading factors in reducing the quality of health of the offspring.
Task 1
Some subject of the Russian Federation is 1,223,735 people. During the year, 1,615,660 cases of diseases were registered in medical institutions, of which 778,525 were diagnosed for the first time in their lives.
During selective medical examinations of 85,662 people (7% of the population), 119,925 cases of diseases were identified.
Among all registered diseases, 354,075 cases were identified associated with diseases of the respiratory system, 252,450 - of the circulatory system, 132,200 - of the musculoskeletal system and connective tissue, 116,195 - of the genitourinary system. During the year, 64,910 cases of infectious diseases were detected. Calculate and analyze indicators:
1) primary morbidity;
2) general morbidity;
Answer to problem 1)
Primary incidence = *1000
Average annual population
General morbidity = *1000
Average annual population
*1000
Number of people examined
Specific gravity diseases = Number of cases*100%
The total number of cases
Then the proportion of diseases of the respiratory system is 21.9%, diseases of the circulatory system 15.6%, diseases of the musculoskeletal system 8.2%, diseases of the genitourinary system 7.2%
*1000
Average annual population
= 53.04‰
Task 2
The average annual population of a certain subject of the Russian Federation is 521,210 people. During the year, 802,145 cases of diseases were registered in medical institutions, of which 457,172 were diagnosed for the first time in their lives.
During selective medical examinations of 26,060 people (5% of the population), 35,180 cases of diseases were identified.
Among all registered diseases, 188,970 cases were identified related to diseases of the respiratory system, 87,065 - of the circulatory system, 50,190 - of the musculoskeletal system and connective tissue, 124,285 - of the digestive system. During the year, 25,693 cases of infectious diseases were detected. Calculate and analyze indicators:
1) primary morbidity;
2) general morbidity;
3) pathological affection;
4) structures of general morbidity;
5) infectious morbidity.
Answer to problem 2) You must use the following formulas:
Primary incidence = Number of newly diagnosed diseases__ *1000
Average annual population
General morbidity = Number of all identified diseases__ *1000
Average annual population
Pathological affection = Number of diseases detected on examination__ *1000
Number of people examined
Proportion of disease = Number of cases*100%
The total number of cases
Then the proportion of diseases of the respiratory system is 23.6%, diseases of the circulatory system 10.9%, diseases of the musculoskeletal system 6.3%, diseases of the digestive system 15.5%
Infectious incidence = Number of infectious diseases identified__ *1000
Average annual population
= 49.3‰
Task 3
The average annual population of a certain subject of the Russian Federation is 706,680 people. During the year, 1,053,600 cases of diseases were registered in medical institutions, of which 575,872 were diagnosed for the first time in their lives.
During selective medical examinations of 70,668 people (10% of the population), 65,020 cases of diseases were identified.
Among all registered diseases, 249,560 cases were identified associated with diseases of the respiratory system, 116,208 - of the circulatory system, 87,026 - of the musculoskeletal system and connective tissue, 79,698 - with injuries, poisoning and some other consequences of external causes. During the year, 31,223 cases of infectious diseases were detected. Calculate and analyze indicators:
1) primary morbidity;
2) general morbidity;
3) pathological affection;
4) structures of general morbidity;
5) infectious morbidity.
Answer to problem 3) You must use the following formulas:
Primary incidence = Number of newly diagnosed diseases__ *1000
Average annual population
General morbidity = Number of all identified diseases__ *1000
Average annual population
Pathological affection = Number of diseases detected on examination__ *1000
Number of people examined
Proportion of disease = Number of cases*100%
The total number of cases
Then the proportion of diseases of the respiratory system is 23.7%, diseases of the circulatory system 11%, diseases of the musculoskeletal system 8.3%, injuries and external causes 7.6%
Infectious incidence = Number of infectious diseases identified__ *1000
Average annual population
The basis for analyzing trends in mortality and life expectancy, as in the case of fertility, is two kinds of data. First, these are the absolute numbers of deaths with distribution by age, sex and causes of death. Secondly, these are the absolute numbers of population groups (the entire population as a whole, as well as women and men of a certain age), with which these numbers are correlated. Based on this information, an entire system of indicators is deployed that measures the level of mortality and is used to calculate life expectancy.
Mortality as the frequency of deaths among the population is studied using a system of coefficients (Table 1.1).
In the formulas of Table 1.1, S is the average annual population; Si - average annual number of men (women); - the number of deaths at a certain age; M x S x - average annual population at a certain age.
The total and private numbers of the dead reflect the absolute scale of mortality, but say nothing about its intensity. The overall mortality rate, with all the simplicity of calculation and clarity, should be recognized as a rough estimate due to the serious dependence on the structure of the population (primarily sex and age).
Table 1.1 - Main indicators of population mortality statistics.
In the formulas of Table. 1.1 S - average annual population; Si - average annual number of men (women); - the number of deaths at a certain age; MxSx is the average annual population at a certain age.
The private mortality rate repeats all the advantages and disadvantages of the general coefficient. The age-specific mortality rate acts as the most accurate indicator of the intensity of mortality. If it is calculated differentially by sex, then it eliminates the influence of the sex and age structures of the population.
To qualitatively characterize the level of the general mortality rate in population statistics, a special scale is used. If up to 10 people die per thousand of the population per year, then this is a low level; from 10 to 15 people - the average level; from 15 to 25 people - high level; from 25 people or more - a very high mortality rate.
The main indicators of mortality of the population are interrelated:
1) the crude mortality rate is equal to the arithmetic mean of the partial mortality rates, weighted by the proportion of men and women in society.
2) the overall mortality rate is equal to the arithmetic mean of the age-specific mortality rates, weighted by the proportion of residents of certain age groups in the total population: (by analogy, the mortality rates for men and women can be calculated separately).
With the help of each of the relationships (identical to fertility), you can build your own system of factor indices in order to determine both the relative and absolute influence of individual components on the performance indicator.
Among the mortality indicators of the population, a group of specific parameters stands out, which characterize specific relevant aspects of the process under study. These include, first of all, the infant mortality rate. Infant mortality refers to the death of children in the first year of life. For its quantitative characteristics, the coefficient of the same name is calculated, which shows the number of children who died under the age of 1 year, per 1000 people born. If we take into account that of all the children who died under the age of 1 year, in a given calendar year, some boys and girls were born in the previous year, then we can use the infant mortality rate calculated using the Rats method.
Death always comes at the wrong time, but for very specific reasons. In this regard, population statistics examines the main classes of causes of death (infectious diseases, malignant neoplasms, diseases of the cardiovascular system, accidents, poisoning, injuries, etc.) and quantifies them. The mortality rate by cause of death reflects the number of deaths due to a particular disease per 100,000 people in the population.
Holding comparative analysis general mortality rates in practice requires their standardization, since these parameters are highly dependent on the structure of the population (especially age).
Standardization is a conditional technique aimed at eliminating the influence of population structure on the level of the crude mortality rate. There are several versions of standardization: direct, indirect and reverse. Due to its logical clarity, direct standardization has become most widespread. Its essence is reduced to the use of the same unchanged (standard) age structure of the population. This makes it possible to exclude from consideration the role of the dynamics of the age composition of society when calculating various general mortality rates.
As a standard population (standard), indicators characteristic of one of the compared groups of society or for the country as a whole can be used.
For the purpose of a detailed study of the sequence of extinction of generations of people in population statistics, special probabilistic tables are built, which are called tables of mortality (survival). The mortality table is a system of interrelated indicators characterizing the distribution of the initial population of births by life expectancy. For the first time in the modern sense, the mortality table was built by the English scientist D. Graunt in 1662.
All mortality tables in population statistics are divided into several types:
1) depending on the coverage of age groups of the population - full (built on one-year age groups) and short (built on five-year or ten-year age groups);
2) depending on the sex of the inhabitants - male, female, or for the population as a whole;
3) depending on the nature of the information - general (all mortality) and special (by cause of death).
The mortality table includes eight main indicators, interconnected both horizontally (within the same age) and vertically (between adjacent ages).
1. Age - x. Considered in the range from 0 to 100 years. 0 - initial age of the mortality table. 100 is the age limit of the mortality table, by which theoretically (and often practically) the entire initial population of births dies out.
2. The number of those who live to age x - l. It characterizes how many people from the initial population of those born live to each specific age. It is a descending sequence of numbers. The initial number of births, or the root of the mortality table (l), is taken to be 10,000 or 100,000 people. x0
3. The number of deaths at the age of x years - d x . It characterizes how many people out of those who survived to the age of x years will not live to the age of x + 1 years. It is found according to the formula:
where l x is the number of surviving to the age of x years out of 100,000 simultaneously born; l x + 1 - the number of surviving to the age of x + 1 years out of 100,000 simultaneously born.
4. Probability of survival - Px. Characterizes the probability of surviving to the age of x + 1 years for those who lived to the age of x years. It is found according to the formula:
where l x + 1 - the number of surviving to the age of x + 1 years out of 100,000 simultaneously born; l x - the number of surviving to the age of x years out of 100,000 simultaneously born.
5. Probability of death - qx. Characterizes the probability of death in the age range from x to x + 1 years. It is found according to the formula:
where d x is the number of deaths at the age from x to x+1; l x - the number of surviving to the age of x years out of 100,000 simultaneously born.
The sum of the probability of survival and the probability of death should be equal to one, i.e. P x + q x = 1.
6. Number of people living at the age from x to x+1 years - L x. It characterizes (conditionally, since it was obtained by calculation) how many people from the initial population of those born will live to the age of x years and fully live this year of life.
7. The number of person-years of life ahead at the age of x years and older - T X . It characterizes how many person-years will have to live for all those who have survived to the age of x years. It is found according to the formula:
where L x is the number of people living at the age of x years; T x+1 - The number of lived person-years of future life at the age of x+1 years;
8. Average life expectancy - e. Indicates how many years, on average, each person who lives to the age of x years will have to live. It is found according to the formula:
where T x is the number of lived person-years of future life at the age of x years; l x - the number of surviving to the age of x years out of 100,000 simultaneously born.
When analyzing mortality tables, two main aspects are distinguished: demographic and economic. Demographic is associated with the identification of patterns of extinction of individual generations of human society. The economic one is focused on assessing the opportunities for the population to participate in social production, depending on life expectancy. Together, they allow us to draw deeper conclusions about the dynamics of the average life expectancy of the population and the consequences of its change.
MODULE 2.2. METHODOLOGY FOR CALCULATION AND ANALYSIS OF INCIDENCE INDICATORS
MODULE 2.2. METHODOLOGY FOR CALCULATION AND ANALYSIS OF INCIDENCE INDICATORS
The purpose of studying the module: emphasize the importance of morbidity indicators for the analysis of public health, the final results of the health system and the development of medical and social programs aimed at improving the health of citizens.
After studying the topic, the student should know:
The role of morbidity indicators for assessing and analyzing the state of public health, the final results of the health system and the development of medical and social programs aimed at improving the health of citizens;
Sources of obtaining information on the incidence of the population;
The main primary accounting statistical documents used in the study of morbidity;
Rules for registering diseases in medical institutions;
The main trends in the incidence of the population of the Russian Federation and the factors that determine them;
Methods of calculation and analysis of morbidity indicators. The student must be able to:
Calculate, analyze and interpret population morbidity rates;
Use ICD-10 in the practice of a doctor;
Fill in primary accounting statistical documents when registering diseases;
Use the received information on morbidity rates for the analysis of public health, the final results of the health system, the development of medical and social programs, managerial decision-making and training in clinical departments.
2.2.1. Information block
Population morbidity statistics is the most important information for analyzing the health of the population and the activities of health care institutions.
Depending on the sources of information, morbidity is detected:
According to the data of appeals to healthcare organizations;
According to medical examinations;
According to the causes of death;
Exhausted (true).
Morbidity records according to the population's accessibility for medical care, outpatient clinics are led on the basis of an outpatient coupon (f. 025-12 / y), a sample of which is presented in Appendix 11. Coupons are filled out for all diseases and injuries in all outpatient clinics of the system healthcare.
The results of medical examinations are recorded in the Control Card of dispensary observation (f. 030 / y-04).
For each case of hospitalization of a patient in a hospital, an accounting document “Statistical card of a person who left the hospital for a round-the-clock stay, a day hospital at a hospital institution, a day hospital at an outpatient clinic, a hospital at home” (f. 066 / y-02) is filled out, a sample of which is presented in application 12.
The main document for studying epidemic morbidity is the "Emergency notification of an infectious disease, food, acute, occupational poisoning, unusual reaction to vaccination" (f. 058 / y).
When identifying socially significant diseases, fill out:
Notice of a patient with a diagnosis of tuberculosis for the first time in his life, relapse of tuberculosis (f. 089 / y-tube);
Notice of a patient with a diagnosis of a malignant neoplasm for the first time in his life (f. 090 / y);
Notice of a patient with newly diagnosed syphilis, gonorrhea, trichomoniasis, chlamydia, urogenital herpes, anogenital warts, microsporia, favus, trichophytosis, mycosis of the feet, scabies (f. 089 / y-kv);
Notice of a patient with a diagnosis of drug addiction for the first time in his life (f. 091 / y).
These forms are filled out by physicians of all medical organizations, regardless of departmental affiliation and conditions for detecting diseases (during treatment, preventive examination, examination in a hospital, etc.) for all patients who have been diagnosed with this disease for the first time in their lives. Completed notices within 3 days after the diagnosis is established are sent to territorial dispensaries, as well as to territorial authority Rospotrebnadzor.
The main statistical document registering diseases with temporary disability (TWT) is “Information on the causes of temporary disability” (f. 16-VN). In order to unify the formation of the state statistical report medical institution use the Coupon for a completed case of temporary disability (f. 025-9 / y-96).
The methodology for calculating indicators with temporary disability is discussed in detail in module 3.8.
The procedure for registering diseases. When registering diseases, you must follow the following rules: when registering primary morbidity the unit of observation is a case of a disease registered for the first time in a patient's life in a given year. Diagnoses of acute diseases are recorded each time they occur again during the year, chronic diseases are taken into account only once a year, exacerbations of chronic diseases are not taken into account. Thus, to calculate the indicator primary morbidity take all diseases that occurred in the patient for the first time during the year and are marked in the forms of primary medical records (Outpatient Coupon) with a “+” sign.
When studying general morbidity take into account all cases of diseases registered with the signs "+" and "-". With the “+” sign, all diseases classified as primary morbidity are recorded. With the “-” sign, the first appeals in a given year for a chronic disease identified in previous years are registered.
In the presence of a personalized database on the health of the population, formed on the basis of the results of medical and social studies, it is possible to calculate the indicator exhausted (true) morbidity.
The main normative document used in all countries of the world to study morbidity and causes of death is the International Statistical Classification of Diseases and Related Health Problems (ICD). ICD is a system of grouping diseases and pathological conditions, reflecting the current stage in the development of medical science. Currently, the International Classification of the 10th revision (ICD-10) is in force.
Morbidity rates of the population, methods of their calculation, recommended or average values are presented in detail in chapter 3 of the textbook.
2.2.2. Tasks for independent work
1. Study the materials of the corresponding chapter of the textbook, module, recommended literature.
2. Answer security questions.
3. Parse the task-standard.
4. Answer the questions of the test task of the module.
5. Solve problems.
2.2.3. test questions
1. For what purposes is data on the incidence of the population used?
2. List the main sources of information about the incidence of the population.
3. Define the concept of "primary morbidity" and provide a method for calculating the indicator.
4. Define the concept of "general morbidity" and provide a method for calculating the indicator.
5. Give a definition of the concept of "pathological susceptibility" and give a method for calculating the indicator.
6. Give a definition of the concept of "exhausted morbidity". Give the method of calculating the indicator.
7. What are the rules for registering cases of primary and general morbidity of the population?
8. Name the main primary accounting statistical documents used in the study of morbidity.
9. How is the system of registration and control of infectious diseases organized?
10. How are the most important socially significant diseases recorded?
11.What normative document used in all countries of the world to study the incidence?
2.2.4. Reference task
Initial data
The average annual population of a certain subject of the Russian Federation is 713,365 people. During the year, 1,378,078 cases of diseases were registered in medical institutions, of which 440,645 were registered with a diagnosis diagnosed for the first time in their lives.
During selective medical examinations of 35,670 people (5% of the total population), 55,600 cases of diseases were identified.
Among all registered diseases, 330,738 cases were identified related to diseases of the respiratory system, 184,662 - of the circulatory system, 101,978 - of the musculoskeletal system and connective tissue, 88,197 - of the digestive system. During the year, 28,335 cases of infectious diseases were detected.
Exercise
Based on the presented initial data, calculate and analyze the indicators:
1) primary morbidity;
2) general morbidity;
4) structures of general morbidity;
5) infectious morbidity.
Solution
To study the incidence of the population of this subject of the Russian Federation, we calculate the following indicators.
1. Primary incidence =
2. General morbidity =
3. Pathological affection =
4. Structure of general morbidity
4.1. Share of respiratory diseases =
4.2. Share of diseases of the circulatory system =
4.3. The proportion of diseases of the musculoskeletal system and connective tissue =
4.4. The share of diseases of the digestive system =
5. Infectious incidence =
Conclusion
When comparing the obtained indicators with the average, it was found that both the primary morbidity rate of 617.7 0/00 and the overall morbidity rate of 1931.8 0/00 are higher than the average. The structure of the general morbidity of the entire population corresponds to the structure that has developed in the Russian Federation: 1st place is occupied by respiratory diseases - 24.0%, 2nd - diseases of the circulatory system - 13.4%, 3rd - diseases of the musculoskeletal system and connective tissue. fabrics - 7.4%. The indicator of pathological affection is quite high - 1560.0 0 / 00.
The indicator of infectious morbidity - 39.7 0 / 00 - is higher than the average level in the Russian Federation.
2.2.5. Test tasks
Choose only one correct answer.
1. Name the main methods of studying the incidence of the population:
1) according to statistical coupons; according to cause of death; according to medical history;
2) according to the certificates of incapacity for work; outpatient cards; according to medical examinations;
3) according to the data on seeking medical care; according to medical examinations; according to cause of death;
4) according to the population census; on coupons to see a doctor; according to medical history;
5) according to the statistical cards of those who left the hospital; according to the control cards of dispensary observation; according to medical care.
2. Morbidity includes all of the following except:
1) primary morbidity;
2) general morbidity;
3) pathological affection;
4) total mortality;
5) morbidity due to causes of death.
3. What characterizes the indicator of general morbidity?
1) the proportion of a particular disease among the population;
2) the degree of change in the incidence rate over time;
3) exhausted morbidity of the population;
4) the prevalence of diseases among the population;
5) the prevalence of socially significant diseases.
4. Name the data needed to calculate the primary incidence:
1) the number of diseases registered for the first time in life in a given year; average annual population;
2) the number of diseases registered for the first time in life in a given year; the number of diseases registered in the previous year;
3) the number of diseases identified during medical examinations; average annual population;
4) the number of diseases registered for the first time in life in a given year; the total number of diseases registered in a given year;
5) the total number of diseases registered in a given year; average annual population.
5. Name the data needed to calculate the overall morbidity:
1) the number of diseases detected for the first time in a given year; average annual population;
2) the number of diseases identified during medical examinations; the number of people who passed the medical examination;
3) the number of all diseases detected in a given year; average annual population;
4) the number of all diseases detected in a given year; the total number of diseases registered in the previous year;
5) the number of diseases detected in the previous year; average annual population.
6. What document is used to study morbidity by negotiability?
1) work diary of a general practitioner (family doctor)
(f. 039 / y-wop);
2) outpatient coupon (f. 025-12 / y);
3) outpatient medical card (f. 025 / y-04);
4) a coupon for an appointment with a doctor (f. 024-4 / y-88);
5) medical card of an inpatient (f. 003 / y).
7. Name the data necessary for the calculation of pathological damage:
1) the number of all detected diseases; the number of people seeking medical help;
2) the number of diseases detected for the first time in a given year; average annual population;
3) the number of diseases identified during medical examinations; the number of persons who underwent a medical examination;
4) the number of diseases identified during medical examinations; average annual population;
5) the number of registered cases of this disease; the total number of registered diseases.
8. Name the data needed to calculate the incidence structure:
1) the number of cases for each type of disease; average annual population;
2) the number of all diseases detected in a given year; average annual population;
3) the number of cases of a particular disease; the total number of cases of all diseases;
4) the total number of cases of all diseases detected in a given year; the total number of cases detected in previous years;
5) the number of diseases identified during medical examinations in a given year; the number of complaints about diseases in a given year.
9. What document is used in the statistical development of morbidity?
1) a unified statistical classification of diseases and deaths;
2) international nomenclature of diseases;
3) international classification of diseases and injuries;
4) international statistical classification of diseases and health-related problems;
5) statistical classification and nomenclature of diseases and causes of death.
10. What document is used to study infectious diseases?
1) outpatient card;
2) an outpatient card;
3) medical history;
4) emergency notice;
5) a statistical card of the person who left the hospital.
11. What document is used to study the incidence of malignant neoplasms?
1) an outpatient card;
2) statistical coupon;
3) a ticket to see a doctor;
4) notification of a patient with a diagnosis of cancer or other malignant neoplasm established for the first time in his life;
5) a diary of the work of a polyclinic doctor.
2.2.6. Tasks for independent solution
Task 1
Initial data: the average annual population of a certain subject of the Russian Federation is 1,223,735 people. During the year, 1,615,660 cases of diseases were registered in medical institutions, of which 778,525 were diagnosed for the first time in their lives.
During selective medical examinations of 85,662 people (7% of the population), 119,925 cases of diseases were identified.
Among all registered diseases, 354,075 cases were identified associated with diseases of the respiratory system, 252,450 - of the circulatory system, 132,200 - of the musculoskeletal system and connective tissue, 116,195 - of the genitourinary system. During the year, 64,910 cases of infectious diseases were detected.
Task 2
Initial data: the average annual population of a certain subject of the Russian Federation is 521,210 people. During the year, 802,145 cases of diseases were registered in medical institutions, of which 457,172 were diagnosed for the first time in their lives.
During selective medical examinations of 26,060 people (5% of the population), 35,180 cases of diseases were identified.
Among all registered diseases, 188,970 cases were identified related to diseases of the respiratory system, 87,065 - of the circulatory system, 50,190 - of the musculoskeletal system and connective tissue, 124,285 - of the digestive system. During the year, 25,693 cases of infectious diseases were detected.
