Morbidity. Modern state of

population health of Ukraine

Morbidity of population

is a collapsible concept that includes values, which are characterizing the level of different diseases and their structure among all population or its separate groups on the given territory.

The main methods for studying the morbidity are those one, which foresee the use of such given:

• - appeals for medical help in medical establishments;

• - medical examinations of separate groups of population;

• - about the reasons of death;

• - questioning of population;

• - special selective researches.

Comparative description of basic methods of studyingthe population morbidity

Name of method

Advantages of method Disadvantages of method

1. Method of registration

• availability for all layers of population;

• aninterrapting and dynamics of supervision the state the health of population;

• effectiveness of diseases account;

• most complete account of acute diseases;

• possibility of selection of the diseases first registered during the year;

• much more economy

• incomplete account of chronically diseases:

• incomplete account of initial symptomless stages and forms of diseases;

• incomplete account of diseases in cases: insufficient availability of medicare, insufficient plenitude of diseases registration and degree of specialization of medicare, bad sanitary culture of population; during service of population in private medical establishments

Comparative description of basic methods of studyingthe population morbidity

Name of method

Advantages of method

Disadvantages of method

2. Studying of the morbidity according the results of medical examinations

almost a complete account of chronical diseases; “exposure of diseases on initial stages”;

the independence of examinations results from availability of medicare, sanitary culture of population etc.

• impossibility of account of acute diseases;

• scope of only separate groups of population: children, young people, workers of some professions;

• high price

Plenitude of information, about the morbidity of population after the

method of appeals can be limited:

• at insufficient availability of medicare (for example, in rural locality);

• bad level of medical culture of population;• insufficient authority among the population

of medical establishment on the whole or separate doctors etc.

At the studying of morbidity from data of medical examinations, plenitude of information about

morbidity depends on:

• their systematic providing;

• participation of doctors of necessary specialties;

• sufficient diagnostic providing;

• the control of timeliness and plenitude of examinations.

International statistical classification of diseases of the last Tenth revision (ICD-10) was ratified by the forty-

third Assembly of WHCO January, 1, 1993. In obedience to the decision of

the Assembly the document has a new name "International statistical

classification of diseases and close problems of health protection", though

the comfortable abbreviation ICD is preserved

International classification of diseases of the Tenth revision (ICD-10)

I Infectious and vermin diseases

II New formation

III Diseases of blood and blood producing organs and separate violations with bringing in of immune mechanism

IV Endocrine diseases, disorders of feed and metabolic disturbances

V Disorders of psyche and behavior

VI Diseases of the nervous system

VII Diseases of eye and its additional vehicle

VIII Diseases of ear and papillary sprout

IX Diseases of the system of blood circulation

X Diseases of breathe organs

XI Diseases of digestion organs

XII Diseases of skin and hypodermic cellulose

XIII Diseases of the bone-muscle system and connecting tissue

XIV Diseases of the urogenital system

XV Pregnancy, births and post-natal period

XVI Separate conditions which arise up in a perinathal period

XVII Born defects of development, deformations and chromosomal anomalies

ХVIII Symptoms, signs and deviations from the norm, that appear at clinical and laboratory researches, not classified in other headings

XIX Traumas, poisonings and some other results from action of external factors

Besides 19 classes of Diseases, two additional headings are included into

ICD-10:

• ХХ External reasons of morbidity and death rate

• ХХІ Factors which influence the state of population health and appeal to establishments of health protection

The basic principles of construction of International classification of diseases, traumas and reasons of death are the community of etiology or pathogenesis of diseases or combination of locally-etiologic and local-pathogenetic principles.

There are such kinds of morbidity at its study from the data of appeals

for medical help:

1. General morbidity - the account of all diseases (sharp and chronic) which are registered at the population of certain territory for certain period of time;

2. Infectious morbidity - the special account of acute diseases, connected with the necessity of the operative conducting of non-epidemical measures;

3. Morbidity on the major non-epidemical diseases falls due the special account as a result of their epidemiology and social value (malignant new formations, tuberculosis, venereal, psychical diseases etc.);

4. Hospital or "hospitalized" morbidity enables to learn composition of patients which were treated in permanent establishment;

5. Morbidity with the temporal disability of workers and employees is selected as a result of its social and economic value.

Basic sources of information and values, which characterize the separate types of morbidity

Methods of study, types of morbidity

Basic information sources Basic values

From data of appeals for medical helpGeneral morbidity

Statistical coupon for registration of final (specified) diagnosesCoupon of ambulatory patient

The general morbidity (prevalence of diseases) Primary morbidity Structure of general and primary morbidity

Infectious Urgent report Level and structure of infectious morbidity

Nonepidemic Report about the important nonepidemic diseases

Level and structure of nonepidemic morbidity

Hospitalized patients Statistical card of patient. that left permanent establishment

Level and structure of morbidity of the hospitalized patients

With the temporal disability Bulletin Number of cases of temporal disability (ТD) on 100 workersNumber of the calendar days ТD on 100 workersMedium duration of one case ТD

From data of medical examinations (aimed, previous)

List of persons which are subject to the medical examinations

From data about the reasons of death Medical certificate about deathMedical certificate about perynathal deathMedical assistant’s certificate about death

Values of level and structure of morbidity, that led to death

The case of disease or trauma concerning which the patient appealed to medical establishment is taken for unit of supervision at study of general morbidity.

Two documents are the source about general morbidity: "Statistical coupon for registration of final (specified) diagnoses" (f.№ 025-2/о) and "Coupon of ambulatory patient" (f. № 025-6/о, f. 025-7/о).

There are such basic values of general

morbidity:

• — primary morbidity (Іпсіdепсе) - the level of t first registered diseases for a calendar year on this territory; all sharp and first set for a year chronic diseases are taken into account also:

• — general morbidity, or prevalence of diseases (Рrеvаlепce) – the level of all registered diseases for a calendar year: sharp and chronic (registered at the first appeal in a current year, and exposed both in current and in previous years);

• — structure primary and general morbidity of population

The method of calculation of the values.

Name of values Method of calculation

Primary morbidity

Amount of diseases which are registered first at current year (all acute + first exposed chronic diseases) х 1000

Average annual quantity of population

General morbidity (prevalence of all registereddiseases)

Amount of all registered during this year diseases (acute + chronic, exposed both in current and in previous years) x 1000

Average annual quantity of population

Structure of primary, general morbidity (prevalence)

Amount of all diseases of this class, group, nosology form registered for a year

(first registered) х 100

Amount of all (first) diseases registered for a year

Every case of disease or suspicion on it is a unit of supervision at the study of infectious morbidity. "Urgent report about the infectious disease, food, acute professional poisoning" (f. № 058/r) is filled at the exposure of them, and it is a basic document for the study of epidemic morbidity.

The following values are used for the analysis of infectious morbidity:

• frequency of the exposed diseases (correlation of their number to the quantity of population of this territory; values are calculated per 100 thousands of population);

• seasonality (data about the number of diseases on months are taken as a basis. The indices of seasonal vibrations are correlation of data during month to average annuals);

• frequency of hospitalization and plenitude of it embrace (in the first case it is correlation of number of hospitalized persons to the quantity of population, in the second — the correlation of the number of hospitalized persons to the number of exposed diseases in percents);

• frequency of diseases after age, sex, profession (correlation of diseases number in the each group to the quantity of population of this group):

• number of exposed bacillus carriers on 1000 inspected persons.

Morbidity on the major nonepidemic diseases

Some nonepidemic diseases are the subject of the special account:

• malignant new formations;

• psychical diseases;

• venereal diseases;

• active tuberculosis;

• difficult mycosis.

The necessity of the special account of the indicated diseases is conditioned by:

• the high level of distribution;

• considerable frequency of death rate at some of them;

• epidemiology meaningfulness;

• a social conditionality.

There are two basic documents for registration of nonepidemic diseases:

• 1. The report about a patient, to which the diagnosis of active tuberculosis, venereal disease, tryhofitis, microsporias, favus, scab, trachoma, and psychical disease is set for the first time in life (f. № 089/r).

• 2.The report about a patient, with diagnosis of cancer or other malignant new formation set for the first time in life (f. № 089/r).

The unit of supervision during it’s study is every case of hospitalization of patient concerning the disease, and information source is the "Statistical card of patient, that left permanent establishment".

Morbidity of the hospitalized patients is studied on such values:

• frequency of hospitalization (the relation of number of hospitalized concerning the certain disease or all hospitalized in a calculation on the quantity of population, that lives on this territory);

• level of hospitalization after age, sex, the place of residence (relation of number of the hospitalized patients of this group in a calculation on the quantity of population of this group);

• structure of hospitalization (specific case of every disease among the common amount of the hospitalized patients; it is possible to calculate the structure of hospitalized after age, sex, the place of residence);

• medium duration of treatment (relation of number of the bed-days conveyed by patients in permanent establishment, to the number of the patients that left): this value is expedient to connect with the age of patients, diagnoses, the results of treatment and to analyze separately for written out from permanent establishment and deceased patients.

Morbidity with the temporal disability

• The case of disability is unit of account.

• The registration document for registration of each case of temporal disability of a worker during the year is a bulletin.

Morbidity of working persons with the temporal disability is analyzed on such basic values:

Value of cases of temporal disability on 100 working persons

=

Absolute number of cases at temporal disability

• 100 Medium quantity of working persons

Value of calendar daystemporal disability on 100

working persons =

Absolute number of calendar days of temporal disability - 100

Medium quantity of working persons

Medium duration of case of temporal

disability=

Number of calendar days of temporal disability

Number of cases of temporal disability

Value of structure of morbidity with the temporal disability

=

Number of cases (or calendar days) of disability from this disease · 100

Number of cases (days) of disability at all diseases

A dynamics of the primary morbidity in general prevalence

depending on the age

• Children (0-14 years) – 80 %

• Working age – 51 %

• Disabled age – 24 %

Diseases are most widespread at the men and women

MansMans WomenWomen

Chronic bronchitis

Traumas and poisonings

Ulcerous illness of stomach

Psychical disorders

Illnesses of the peripheral nervous system

Тhyrоtoxicosis

Diabetes

Hypertensive illness

Cholecystitis

Illnesses of the urinary system

Cerebrovascular illness

Thank you!