Krzysztof Kanecki

Incidence and prevalence of Systemic Sclerosis (SSc) in Poland – differences between rural and urban regions

[b] Abstract Introduction.[/b] Systemic sclerosis (SSc) is a rare and potentially severe connective tissue disease, characterized by skin fibrosis and involvement of internal organs. Because of its rarity and heterogeneous clinical presentation, reliable epidemiological studies on SSc have been particularly difficult to carry out. [b]Objectives[/b]. The purpose of this study was to present SSc epidemiology among hospitalized patients in Poland. MATERIALS AND METHOD The analysis was based on population-based administrative data, taken from a Polish hospital morbidity study carried out by the National Institute of Public Health between January 2008 - December 2012. [b]Results[/b]. Analyzed data covered 9,049 hospitalization records. The final sample comprised 3,653 patients with first-time hospitalizations for SSc. The average age of the sample was 53 years (SD 16.2; range 0-91 years); 84% of patients were female and 16% male. Based on hospitalization registers, the average SSc incidence was estimated to be 1.9/100,000 per year and peak age of incidence was 55 years. The point prevalence was estimated to be 9.4/100,000 at the end of 2012. SSc was more common in females, with F:M ratio ranging from 6.2:1-4.6:1 depending on the year. Analysis of hospitalization trends revealed that overall numbers of SSc hospitalizations increased, while first-time hospitalizations decreased between 2008-2012. Clusters of higher incidence were observed in more rural regions vs. urban regions. [b]Conclusion[/b]. Estimated incidence of SSc in Poland was comparable to reported incidence in other European countries. Analysis of demographic factors and reports of clusters of higher incidence may suggest the existence of environmental risk factors for the development of SSc. These observations may require further research.

Transformation of the ownership structure in Polish healthcare and its effects

Poland, like other countries with previously dominant state healthcare systems, has introduced ownership transformation in the healthcare structure. These changes, however, are being accomplished without a clearly defined state policy in this area. The aim of the present study was to assess the course and effects of ownership transformation in outpatient healthcare and hospitals. Data were collected from publications of the Central Statistical Office, which provided information on the numbers of outpatient healthcare institutions, medical practices, general hospitals, and services they provided. The healthcare ownership transformation has divided the medical services market into public and nonpublic providers. In addition, privatization of outpatient healthcare facilities precedes privatization of hospitals, outpatient institutions providing primary healthcare were privatized first; the subsequent stage included those providing specialized services, at first privatization of ambulatory medical infrastructure preceded privatization of services in urban areas, whereas in rural areas, privatization of services preceded structural privatization, privatization provides favorable conditions to improve territorial availability of outpatient healthcare in urban areas, medical practices, although numerous, are of little importance in providing services, the hospital ownership transformation is at its initial stage, and structural ownership transformation in the Polish healthcare system is subject to market rules.

Use of statistical data concerning hospital morbidity in epidemiological studies on rare rheumatic diseases

Introduction. Data validity constitutes a fundamental problem in epidemiology. An accurate estimate of the occurrence of a rare disease may require a large population study. In the case of rare diseases, all available data resources are used to estimate the occurrence rate, including statistical data concerning hospital morbidity. For life-threatening systemic vasculitides an analysis of its epidemiology is of particular importance. Objective. The main aim of the study was to present the possibilities for the use of data from hospital databases in an analysis of the epidemiology of rare diseases, using the example of particular systemic vasculitides. Results. The study shows the results of analyses performed on a population-based administrative data set concerning systemic vasculitides taken from the national hospital morbidity database prepared by the Polish National Institute of Public Health in 2004–2013. The study also discusses the main advantages and limitations of the adapted methodology. Furthermore, it proves that data from hospital databases can be used for analyzing disease incidence and prevalence, gender and territorial distribution, analysis of hospital mortality (fatality) rates, and trends in long-term observations. Conclusion. An analysis of the epidemiology of rare rheumatic diseases can contribute to a better understanding of their specificity, which can be useful in everyday clinical practice.

Takayasu’s arteritis: a rare disease in Poland

INTRODUCTION Takayasus arteritis (TA) is a rare and potentially life-threatening granulomatous large-vessel vasculitis that involves mostly in the aorta and its proximal branches, and occurs most commonly in young females. This study measures the incidence and prevalence of TA, and assesses the gender distribution and territorial differences in the occurrences of this disease in Poland over a five-year period. To the best of our knowledge, this is the first evaluation of this rare disease in Poland based on a hospital morbidity database. MATERIAL AND METHODS Analyses were performed with population-based administrative data obtained from a national hospital morbidity study carried out between January 2011 - December 2015 by the Polish National Institute of Public Health. Yearly incidence rates and prevalence of TA were calculated using the number of TA patients and corresponding census data for the overall Polish population. RESULTS Data included 660 hospitalization records. The final study sample comprised 177 patients: 154 female (87%) and 23 male (13%) with first-time hospitalization for TA. The mean age was 45.4years (95% CI: 42.9-47.8; SD 16.8; range 4-81 years), median 47. The incidence rate of TA was estimated at 0.92 per million per year (95% CI: 0.68-1.16). Five-year TA prevalence was estimated to be 4,6 per million. Incidence rates of TA did not vary significantly between more urban and more rural regions. CONCLUSIONS The incidence of TA in Poland was similar or lower to data reported by other European countries. The study provides epidemiological data on TA in Poland that may be useful while comparing it with other geographical regions.

Assessment of the incidence rate of end-stage renal disease in patients with and without diabetes in Poland

INTRODUCTION Several studies have suggested, that diabetes is very important factor of the risk of the chronic a renal disease. The paper aims to present a retrospective analysis of incidence of end-stage renal disease in subgroups of patients with and without diabetes in Poland. MATERIAL AND METHODS For assessing this problem an electronic search was performed using Polish National Health Fund data base from 01.01.2011 until 31.12.2013 in general population and from 01.01.2012 until 31.12.2012 in 2 populations: with diabetes and without diabetes mellitus. RESULTS The 43.70 % patients with end-stage renal disease was diabetic. The incidence rate in 2012 was: 292.48 ± 90.97 diabetic men / 100,000 diabetic population; 203.10 ± 90.97 diabetic women / 100,000 diabetic population; 23.44 ± 6.34 non-diabetic men / 100,000 non-diabetic population; 17.88 ± 6.33 non-diabetic women / 100,000 non-diabetic population. CONCLUSIONS The incidence rate of end-stage renal failure in diabetics was multiple times higher than the incidence rate in non-diabetics. The incidence rate of new ESRD cases in Poland estimated to be 36.17 per 100,000 of general populations in 2011, 35.28% in 2012 and 30.46 per 100,000 of general populations in 2013. In 2012, the incidence rate of new ESRD cases in male diabetics was 292.48 ± 90.97 per 100,000 of diabetes men population, and in women diabetics 203.10 ± 66.06 per 100,000 of diabetes women population. In the same 2012 year, the incidence of new ESRD cases in men non-diabetics was 3.44 ± 6.34 per 100,000 of non-diabetes, and in women non-diabetes 17.58 ± 6.33 per 100,000 of non-diabetes women population.

Polyarteritis nodosa: decreasing incidence in Poland

Introduction There are many studies on the epidemiology of the orphan disease polyarteritis nodosa (PAN) in European countries. The use of a hospital morbidity database is an important element of epidemiological analysis. The study is the first such analysis in Poland and may provide an opportunity to compare the data in a European context. Material and methods We conducted a retrospective, population-based study using hospital discharge records with a PAN diagnosis. PAN incidence was estimated based on data from a Polish hospital morbidity study carried out by the National Institute of Public Health. Data on all inpatients discharged from non-psychiatric hospitals in Poland were collected between 2008 and 2013. We identified 557 patients with first-time hospitalizations for PAN. Results The sample consisted of 202 (36.3%) males and 355 (63.7%) females. The median and mean age was 53 and 50 years, respectively. The average annual incidence of PAN in Poland was estimated to be 2.4 per million. PAN incidence decreased significantly over time in Poland between 2008 and 2013 (3.3 per million vs 1.9 per million, p < 0.001) and it may be associated with a decrease in hepatitis B incidence observed in Poland. Conclusions Incidence of PAN in Poland was estimated to be 2.4 per million and was comparable to the incidence found in other European countries. PAN incidence decreased during 2008–2013. The decrease in PAN incidence may be related to environmental, infectious (hepatitis B) or other unknown factors. Future research is needed to identify the cause of the decrease and potential triggers of the disease.

Clinical and health care aspects of respiratory tract disorders in Poland

INTRODUCTION Respiratory diseases constitute a public health priority worldwide. This is related to the increasing exposure to microorganisms, toxic factors, allergens, drugs and smoking, as the most important factors. Increasing costs of health promotion, prevention, diagnosis and treatment of respiratory tract diseases forces the search for effective strategies in the reduction of costs without making a significant impact of these activities on health results. Chronic obstructive pulmonary disease (COPD) is an example of these diseases with increasing incidence, which has few known modifiable factors and absorbs large medical and social costs. OBJECTIVES The aim of this study is to present the conception of cost driver analysis that could be useful in constructing a good combination of the EBM-based treatment with cost reduction decisions. MATERIAL AND METHODS Analysis of cost drivers was based on the Global Initiative for Chronic Obstructive Lung Disease (GOLD) guidelines and Polish recommendations of COPD diagnosis and treatment. The proposition of cost reduction strategy in COPD treatment was based on identification of cost drivers in value chain conception. RESULTS AND CONCLUSIONS An increasing incidence and treatment costs of COPD force the search for methods of costs reduction in health care. Identifying, evaluating and modifying the cost drivers with use of the value chain conception could be an effective method in achieving these objectives.