Tatiana Vagašová

Standardised mortality rate for cerebrovascular diseases in the Slovak Republic from 1996 to 2013 in the context of income inequalities and its international comparison

Non-communicable diseases represent one of the greatest challenges for health policymakers. The main objective of this study is to analyse the development of standardised mortality rates for cerebrovascular disease, which is one of the most common causes of deaths, in relation to income inequality in individual regions of the Slovak Republic. Direct standardisation was applied using data from the Slovak mortality database, covering the time period from 1996 to 2013. The standardised mortality rate declined by 4.23% in the Slovak Republic. However, since 1996, the rate has been higher by almost 33% in men than in women. Standardised mortality rates were lower in the northern part of the Slovak Republic than in the southern part. The regression models demonstrated an impact of the observed income-related dimensions on these rates. The income quintile ratio and Gini coefficient appeared to be the most influencing variables. The results of the analysis highlight valuable baseline information for creating new support programmes aimed at eliminating health inequalities in relation to health and social policy.

The Significance of Amenable Mortality Quantification for Financing the Health System in Slovakia

Abstract The indicators’ values of health condition of the Slovak citizens significantly lag behind the most developed countries. The issue of healthy inhabitants is more connected with a treatment of bad health condition than with a non-health prevention, which is believed to be caused by social and political development over the last decades. Measuring the influence of health system on inhabitants’ health is very difficult due to the influences of various factors, such as wealth, socio-economic status, citizens lifestyle, quality of environments, etc. Consequently, an amenable mortality indicator is used to evaluate the health system except of the life expectancy indicator. It defines a mortality that should not have occurred in case of effective and early treatment. It only takes into consideration those diagnoses, where effective treatment exists before a certain age limit (75 years) according to experts. The number of these deaths is standardized on 100,000 citizens. The amenable mortality indicator has a great significance for standard comparisons, however, its application also causes methodological issues, such as data quality of mortality, choice of diagnoses, weight of diagnoses, etc. In the international comparing, it is very often deduced from a fact that each country spends different amount of funds on health, while the differences may be connected with a different effectiveness of invested funds in the health systems. The article reflects on the given facts and its aim is to evaluate the development of amenable mortality in Slovakia over the last ten years, as well as to compare the development of this indicator in the EU countries. Similarly, it assesses the significant methodological issues that are related to indicators application and defines the causes of extreme differences that were found out by the results on the basis of the given outputs.

Time trend, age and sex distribution of deaths from diabetes mellitus at the regional level in the Slovak Republic

AIM To describe the time trends, age and sex distribution of death from diabetes mellitus (E10-E14) as a significant part of endocrine, nutritional and metabolic diseases (E00-E90), during 1996-2014 in the Slovak regions, and to estimate the influence of social characteristics on mortality. METHODS Secondary data on deaths during 1996-2014 were gathered from the National Health Information Center in the Slovak Republic. The total crude death rate per 100,000 of the standard Slovak population and age-standardized death rate per 100,000 of the standard European population were calculated by direct standardization. Multilevel logistic regression analysis was performed. RESULTS Deaths from diabetes mellitus account for 91.6% of deaths registered in the endocrine, nutritional and metabolic diseases Chapter. The age-standardized death rate per 100,000 of inhabitants decreased from 19.2 in 1996 to 15.3 in 2014 in the Slovak Republic, although a massive increase of up to 32.5 was reported in 1999. The highest age-standardized death rates per 100,000 inhabitants were typical for the Košice, Nitra and Trenčín regions. On the other hand, the lowest counts were recorded in the Bratislava region. Mortality from diabetes mellitus starts to be evident in the 45-49 year age-group in both sexes. The median age of death for women is lower in the 75-79 year age-group in comparison to men although the total crude death rate for men in lower age groups is higher. After age 80 the situation is reversed. The odds of dying due to endocrine, nutritional and metabolic diseases decreases by 0.4% each year. The odds of dying are lower by 17% and 12.3%, respectively, in the Žilina and Prešov regions compared to Bratislava region. Women have a higher probability of dying by 38% in contrast to men, and married couples by 16.7% than singles. Age is proved to be an insignificant factor. CONCLUSIONS In spite of the declining trend of mortality from diabetes mellitus, it is necessary to reduce the risk of its incidence by healthier food consumption and physical activity.

Disparities of potential gains in life expectancy development between the Slovak Republic and the Czech Republic

AIM The purpose of this paper is to determine how many years a person could be expected to live if a specific cause of death was eliminated, and to compare potential gains in life expectancy (PGLEs) between Slovakia (SVK) and the Czech Republic (CZE). METHODS PGLEs were computed from mortality reports (1996-2013) for deaths from the main groups of chronic diseases, namely ischaemic heart disease (IHD), cerebrovascular diseases (CVD), cancer (CA), diabetes mellitus (DM), and chronic respiratory diseases (CRD) for the Slovak and Czech populations in five-year age groups. Country comparative analysis was conducted by constructing rate ratios of PGLEs. RESULTS In 2013, life expectancy at birth for the Slovak and Czech populations was 76.5 and 78.3 years. Overall trends of standardised mortality rates of chronic diseases roughly paralleled the PGLEs trend. During 1996-2013, SVK reported the highest PGLEs of IHD at an average of 4.54 years, compared to PGLEs of CA reaching a value of 3.61 years in CZE. The PGLEs of IHD showed the largest gap between SVK and CZE, with an average of 1.65 higher values in SVK. With the elimination of CVD as the third most influential disease in both countries, PGLEs decreased from 1.65 to 0.93 years in CZE; a negligible drop from 1.13 to 1.05 was recorded in SVK. The lowest impacts on life expectancy were recorded in DM and CRD. However, since 2005 these trends have deteriorated in CZE. In 2013, IHD had a similar impact on life expectancy in all age groups in SVK and a decreasing impact among 50-54 year olds in CZE. Similarly to SVK, people in CZE aged 45-49 could gain 0.94 years in LE after CVD elimination, which is nearly the same as at birth. CONCLUSIONS The higher the life expectancy after elimination of the cause of death is, the higher the impact of the disease on life expectancy. Health prevention programs should be mainly aimed at CA mortality in CZE, while the highest burden of IHD is seen in SVK.

Inequalities in cancer deaths by age, gender and education

AIM The economy of each state provides a significant amount of money into the health care system with the aim of knowing the health status of its population in the context of socioeconomic characteristics for effective resource allocation. In recent years, there is a growing number of cancer deaths in Slovakia. Therefore, the structure of cancer deaths according to its primary determinants, such as age, sex and education with the aim of effective implementation of prevention programs in Slovakia was examined. METHODS Main source of data on deaths from 1996 to 2014 was provided by National Health Information Centre in Slovakia. However, data were available only from 2011. Standardized mortality rate per 100,000 inhabitants was estimated by the method of direct standardization using European standard population. The R project for statistical computing was used for calculation of statistically significant differences among various groups of mortality. RESULTS The results show that people with primary education die from cancer later than people with higher education. However, major differences related to both sex and age are present in people with university education. A different variety of cancers occur in childhood (neoplasm of brain), adolescents (neoplasm of bone), young adults (neoplasm of brain), or adults (lung cancer and breast cancer). Malignant neoplasm of brain was more prevalent at higher education levels, Malignant neoplasm of bladder and Malignant melanoma of skin were more prevalent at the university level of education. CONCLUSIONS The results can be useful for economists to define the health priorities in each country, make the financial decisions in economics, and thus contribute to better health, economic growth, as well as effective spending of health expenditures.

The impact of selected groups of non-communicable disease deaths on life expectancy in the Slovak republic

AIM The aim of this study was to compute the potential gains in life expectancy (PGLEs) if the five main groups of non-communicable disease deaths were eliminated in the Slovak population during 1996-2014, and to decompose PGLEs by five-year age groups. METHODS PGLEs were computed from mortality reports for deaths from ischaemic heart disease (I20-25), cerebrovascular diseases (I60-I69), cancer (C00-C97), diabetes mellitus (E10-E14), and chronic respiratory diseases (J30-J98) using the life table decomposition technique. RESULTS In 2014, life expectancy at birth was 76.87 years compared to 72.87 in 1996. The highest impact on life expectancy was recorded for ischaemic heart disease and PGLEs have changed from 3.9 years to 4.6 over 1996-2014. However, the trends for other diseases did not fluctuate. The PGLEs of cancer, as the second most influential disease, increased from 3.3 years to 3.6. Conversely, a slight decline was observed in cerebrovascular diseases from 1.13 years to 1.12, and diabetes mellitus from 0.14 years to 0.13. The proportion of diabetes mellitus and chronic respiratory diseases in PGLEs was low, approaching zero. As far as PGLEs among age groups in 2014 are concerened: whereas PGLEs for ischaemic heart disease mortality reduction are very similar among all age groups they are mostly on the decrease from other causes of death. However, PGLEs reached a value of 0.13 years in the 0-54 years age-group for diabetes mellitus; this means that the number of years of life lost are the same for 54 year old people and younger, with the impact of diabetes mellitus declining at age 55 and over. The same scenario is apparent for cerebrovascular diseases. The impact of mortality from other causes of death is decreasing with age. CONCLUSIONS Our findings suggest that optimum benefit would be gained from prevention programs for reduction of ischaemic heart disease mortality in all age groups.

Risk of dying from cancer by socio-demographic indicators in the Slovak Republic

AIM Cancer mortality distribution was investigated by detailed neoplasms groups, age, sex, marital status of deceased, and regions in the Slovak Republic, and examined how these determinants influence the odds of dying due to cancer. METHODS A retrospective analysis of cancer mortality statistics registered in the Slovak Republic during the years 1996-2014. For this time period, data was available only on the underlying subgroups of cancer deaths, place of death, age, year, sex, and marital status. Binary logistic regression was applied for odds of dying calculation influenced by these socio-demographic factors. RESULTS The most common are deaths from malignant neoplasms of digestive organs in males as well as females. The biggest difference among both genders is recognized in malignant neoplasms of lip, oral cavity and pharynx, where deaths among males are on average 7.9 times higher in comparison to females. As for place of death the Bratislava region reports the highest level of cancer mortality stated at 25.22% of all deaths, on the contrary the Banská Bystrica region reports only 21.40% of all deaths. Age has a negative influence on odds of dying due to neoplasms compared to all other causes of death by 1.7%. In all regions compared to the reference Bratislava region, the odds of dying from neoplasms are lower. Being female diminishes the odds of dying due to neoplasms by 25.7% compared to males. Yearly the relative ratio of dying from neoplasms increases with respect to all other causes of death. When single people are set as the reference category, the relation of the probability of death from cancer to the probability of death due to other causes of death is higher for married, divorced and widowed persons. CONCLUSIONS The results should be taken into account when comparing risk of dying due to cancer among people with the mentioned sociodemographic characteristics. Health policy makers should consider place of death and cancer types while planning hospital care units.

HEALTH AND ITS EFFECTS ON THE QUALITY OF LIFE IN THE EU COUNTRIES

Abstract The aim of the paper is to analyse health and its influence on quality of life in the EU countries. One of actually discussed topics in quality of life measurement is health. This paper assesses importance of health in determining the quality of life. First research goal tries to explore relationship between indicators of objective and self-perceived health status to find out means of their usage in the context of quality of life. Next goal is focused on influence of health satisfaction on overall life satisfaction. Final research goal tries to explain relationship between health of population and overall life satisfaction. Main contribution of the paper is to demonstrate differences between objective and self-perceived health and to point out the fact that overall life satisfaction is shaped by various dimensions of life.