Ramunė Kalėdienė

Trends and regional inequalities in mortality from stroke in the context of health care reform in Lithuania

BACKGROUND AND OBJECTIVE The objective of the study was to analyze mortality from stroke in Lithuania the context of health care reform with particular interest in urban/rural and regional inequalities. Based on the analysis of trends in mortality, and to detection of break-points over two decades of socioeconomic transition, it focused on the challenges in stroke care provision. MATERIALS AND METHODS The analysis covered the entire country. Information on deaths from 1991 to 2012 was gathered from death certificates held by the Lithuanian Department of Statistics. The joinpoint analysis was used to identify the best-fitting points, wherever a statistically significant change in mortality occurred. Age-standardized mortality rates were calculated for 60 municipalities of Lithuania. RESULTS The positive break-points in mortality from stroke were registered in 2007 for females and 2008 for males, when the increasing trends reversed to the declining. More positive changes occurred in urban areas, where stroke mortality is lower compare to rural since 1996. Considerable inequalities were disclosed among administrative regions of Lithuania: ratio between the highest and the lowest rates in different municipalities reached 4.88 for males and 3.35 for females. CONCLUSIONS There are good reasons to expect the favorable stroke mortality trends observed will follow the same direction in the future. Stroke centers are growing up in their competence while networking is also under the development. The new strategies in stroke care should result not only in the declining mortality rates and numbers of severely handicapped stroke patients, but also in diminishing regional and urban/rural inequalities.

Stakeholders’ attitudes towards intersectoral collaboration in the area of health inequalities

This article focuses on inter-sectoral collaboration in the area of health inequalities by implementing health in all policies approach. The aim of the study was to assess the attitudes of the specialists of different ministries and institutions subordinated to the Ministry of Health towards inter-sectoral collaboration in health inequalities. A cross sectional questionnaire survey was performed in March–April, 2015. Based on the results, the most of specialists of the health and non-health sectors noted about close collaboration with institutions operating in the same and different areas in order to implement institutional actions, however, specialists of both sectors rarely reported institutional collaboration in the area of health inequalities. Specialists of the health sector emphasized strong institutional collaboration within the health sector in health inequalities, besides, they collaborated with social, education and environmental sectors. Non-health sector institutions were involved in strong collaboration with social sector moreover they collaborated with justice and education sectors. The main forms of intersectoral collaboration in reducing health inequalities were participation in working groups, commissions or committees and development of strategic documents or legislation.

Health profile of the urban community members in Lithuania: Do socio-demographic factors matter?

BACKGROUND AND OBJECTIVE Objective of the study was to explore self-perceived health status, health determinants and its associations with socio-demographic factors among urban community members in Lithuania. MATERIALS AND METHODS Data were obtained from a European survey on urban health, conducted as part of the EURO-URHIS 2 project. The postal questionnaire survey of 3200 adults from Kaunas and Šiauliai (Lithuania) was conducted in 2010. A total of 1407 valid questionnaires were analyzed. Statistical analysis was carried out by using SPSS 17.0 inside Complex Sample module that takes design effects into account. RESULTS Younger respondents (aged 19-64 years) perceived most of the health status indicators better than the older ones (65+ years), while they were less likely to report healthy lifestyle and less often perceived their neighborhood as being socially cohesive than the older ones. Men less frequently experienced psychological problems, indicated regular contacts with friends and/or family and had a greater tendency to be overweighed and obese, daily smokers and drinkers compared to women. Those having secondary or lower educational level perceived most of the health status indicators worse than those with university educational level. Respondents living with a partner less often experienced psychological problems than those living alone. Respondents who indicated having enough money for daily expenses more often perceived their health and health determinants better. CONCLUSIONS The results of this study demonstrate associations between socio-demographic factors and self-perceived health status, lifestyle and factors of living environment among urban community members in Lithuania.

Regional Inequalities of Avoidable Hospitalisation in Lithuania

Background . Avoidable hospitalisation is useful in evaluating access and quality of primary and ambulatory healthcare. For Lithuania it is particularly relevant as hospitalisation remains higher than European level and regional inequalities in available healthcare services within country prevail. Aim. This study aimed to assess regional inequalities of avoidable hospitalisation in Lithuania in the period of healthcare restructuring program. Methodology. Regional age-adjusted rates of hospital admissions for a set of ambulatory care sensitive conditions (per 100 000 pop.) were used in this study. Results. A decline of avoidable hospitalisation level was found in 2005–2011. Rural areas had higher avoidable hospitalisation level compare to urban areas, however in case of emergency avoidable hospitalisation the situation was opposite. Inequalities of avoidable hospitalisation existed between administrative regions. Relatively smaller regions had more ACSC hospital admissions.Conclusion. In Lithuania, avoidable hospitalisation was reduced throughout the period of healthcare restructuring program, which supports national plan to strengthen primary healthcare and expand outpatient services in context of inpatient care reduction. The overview of regional differences indicates potentiality of healthcare improvement and social care integration for policy makers and healthcare managers.

Regional inequalities of hospital morbidity and associations with mortality in Lithuania

BACKGROUND AND OBJECTIVE In Lithuania, hospitalization was planned to be reduced with the approval of the national healthcare restructuring program. The aim of this study was to describe regional inequalities of hospitalization and hospital morbidity in Lithuania and to associate them with mortality in the regions. MATERIALS AND METHODS Routine hospital discharge data of Lithuanian hospitals, reimbursed by the Compulsory Health Insurance Fund and registered in database SVEIDRA, was used. Age-adjusted general hospitalization and hospital morbidity rates (per 1000 population) due to cardiovascular diseases (CVD), malignant neoplasms and external causes were calculated. Contribution of diseases, causing major public health problems, to general hospitalization was evaluated by analysis of components. Association of general hospitalization or hospital morbidity and mortality of respective causes was evaluated using non-parametric Spearman correlation. RESULTS General hospitalization and hospital morbidity of CVD, malignant neoplasms and external causes had increased from 2005 to 2011. Inequalities of hospitalization and hospital morbidity existed between regions of Lithuania. In Šiauliai, Klaipėda, Utena and Panevėžys regions, general hospitalization remained higher than national level. In Marijampolė, Alytus and Kaunas regions, general hospitalization became lower than Lithuanian average. There was no statistically significant correlation between variation in hospitalization and mortality rates in the regions. CONCLUSIONS Despite national efforts to decrease hospital care, our study detected the failure of hospitalization reduction and revealed an increase of hospitalization with the existing regional inequalities in Lithuania.

Lietuvos vyrų ir moterų vidutinės tikėtinos gyvenimo trukmės netolygumai bei juos lemiančios mirties priežastys

Tyrimo tikslas. Įvertinti Lietuvos vyrų ir moterų vidutinės tikėtinos gyvenimo trukmės (VGT) netolygumų pokycius 1990–2006 m. ir nustatyti juos lemiancias mirties priežastis. Tyrimo medžiaga ir metodai. Tyrimui naudoti duomenys apie mirusiuosius ir gyventojus, gauti is Lietuvos statistikos departamento. Įvertinti vyrų ir moterų VGT netolygumai. Pagal isgyvenamumo lenteles apskaiciuotas vyrų ir moterų prarastų dėl svarbiausių mirties priežascių VGT metų skaicius. Pagrindinių mirties priežascių įtaka vyrų ir moterų VGT pokyciams bei skirtumams nustatyta komponentinės analizės metodu. VGT pokycių kritiniai laikotarpiai vertinti jungiamųjų taskų regresinės analizės metodu. Rezultatai. Vyrų ir moterų VGT pokyciams 1990–2006 m. būdingi du lūžio taskai, VGT kreive suskirscius į tris laikotarpius: mažėjancios, didėjancios ir vėl mažėjancios VGT. Vyrų VGT pokyciai visais laikotarpiais buvo intensyvesni nei moterų. Bendras vyrų VGT pokytis 1990–2006 m. buvo statistiskai nereiksmingas, o moterų VGT didėjo vidutiniskai 0,2 proc. per metus. Ir vyrai, ir moterys daugiausia VGT metų prarado dėl mircių nuo sirdies ir kraujagyslių ligų, kurių reiksmė buvo didesnė moterims. Darbingo amžiaus (15–65 metų) vyrų ir moterų VGT labiausiai trumpino nelaimingi atsitikimai, apsinuodijimai ir traumos. Nors vyrų ir moterų VGT skirtumas nuo 1994 m. iki 2006 m. sumažėjo nuo 12,3 iki 11,8 metų, jis yra vienas didžiausių Europoje. Nuo 1991 m. svarbiausia mirties priežastimi, lemiancia vyrų ir moterų VGT skirtumus, tapo nelaimingi atsitikimai, apsinuodijimai ir traumos, kurių reiksmė vyrų ir moterų VGT skirtumams pastaraisiais metais sumažėjo. 2006 m., palyginus su 1994 m., padidėjo sirdies ir kraujagyslių ligų bei piktybinių navikų įtaka vyrų ir moterų VGT skirtumui. Isvados. Demografi nių ir socialinių gyventojų grupių sveikatos netolygumų mažinimas turi tapti valstybės socialinės ir sveikatos politikos prioritetu. Sveikatos, socialinių bei kitų valstybinių arba regioninių programų įgyvendinimo vertinimo kriterijuose turėtų atsispindėti vyrų ir moterų lygių sveikatos galimybių užtikrinimo aspektai.