Area-level socioeconomic deprivation and mortality differentials in Thailand: results from principal component analysis and cluster analysis.

BACKGROUND: Despite achievement of universal health coverage in Thailand, socioeconomic inequality in health has been a major policy concern. This study examined mortality patterns across different socioeconomic strata in Thailand. METHODS: We conducted a cross-sectional analysis of the 2010 Population and Housing Census on area-level socioeconomic deprivation against the 2010 mortality from the vital registration database at the super-district level. We used principal components analysis to construct a socioeconomic deprivation index and K-mean cluster analysis to group socioeconomic status and cause-specific mortality. RESULTS: Excess mortality rates from all diseases, except colorectal cancer, were observed among super-districts with low socioeconomic status. Spatial clustering was evident in the distribution of socioeconomic status and mortality rates. Cluster analysis revealed that super-districts which were predominantly urban tended to have low all-cause standardize mortality ratio but a high colorectal cancer-specific mortality rate. Deaths due to liver cancer, diabetes, and renal diseases were common in the low socioeconomic super-districts which hosted one third of the total Thai population. CONCLUSION: Socially deprived areas have an excess of overall and cause specific deaths. Populations living in more affluent areas, despite low general mortality, still have many preventable deaths such as colorectal cancer. These findings warrant future epidemiological studies investigating various causes of excessive deaths in non-deprived areas and implementation of policies to reduce the mortality gap between rich and poor areas.

Post universal health coverage trend and geographical inequalities of mortality in Thailand.

BACKGROUND: Thailand has achieved remarkable improvement in health status since the achievement of universal health coverage in 2002. Health equity has improved significantly. However, challenges on health inequity still remain.This study aimed to determine the trends of geographical inequalities in disease specific mortality in Thailand after the country achieved universal health coverage. METHODS: National vital registration data from 2001 to 2014 were used to calculate age-adjusted mortality rate and standardized mortality ratio (SMR). To minimize large variations in mortality across administrative districts, the adjacent districts were systematically grouped into "super-districts" by taking into account the population size and proximity. Geographical mortality inequality among super-districts was measured by the coefficient of variation. Mixed effects modeling was used to test the difference in trends between super-districts. RESULTS: The overall SMR steadily declined from 1.2 in 2001 to 0.9 in 2014. The upper north and upper northeast regions had higher SMR whereas Greater Bangkok achieved the lowest SMR. Decreases in SMR were mostly seen in Greater Bangkok and the upper northern region. Coefficient of variation of SMR rapidly decreased from 20.0 in 2001 to 12.5 in 2007 and remained close to this value until 2014. The mixed effects modelling revealed significant differences in trends of SMR across super-districts. Inequality in mortality declined among adults (≥15 years old) but increased in children (0-14 years old). A declining trend in inequality of mortality was seen in almost all regions except Greater Bangkok where the inequality in SMR remained high throughout the study period. CONCLUSIONS: A decline in the adult mortality inequality across almost all regions of Thailand followed universal health coverage. Inequalities in child mortality rates and among residents of Greater Bangkok need further exploration.

Economic burden from smoking-related diseases in Thailand.

OBJECTIVE: To assess economic burden attributable to smoking in Thailand in 2009. METHODS: A prevalence-based, disease-specific cost of illness approach was used to estimate the direct medical costs, indirect medical costs, productivity loss due to premature deaths and absenteeism caused by smoking-related diseases. Direct healthcare costs were obtained from the inpatient and outpatient charge database at the National Health Security Office and the Central Office for Healthcare Information. Indirect healthcare costs were obtained from the Health and Welfare Survey. The household Socioeconomic Survey provided data on income of the population. Costs were estimated for 7 disease groups, namely, lung cancer, chronic obstructive pulmonary disease (COPD), cardiovascular disease (CVD), upper aerodigestive tract cancer, other cancer, other respiratory diseases and other medical conditions. Smoking Attributable Fractions were derived from the 2009 Thai Burden of Disease study. RESULTS: Total economic burden of smoking amounted to 74.88 billion Thai Baht (THB) (95% CI 74.59 to 75.18) (US$2.18, 95% CI US$2.17 to US$2.19 billion). Of this, most of the burden resulted from productivity loss 62.24 billion THB (95% CI 62.05 to 62.44) (US$1.81, 95% CI US$1.81 to US$1.82 billion). Total medical cost was 12.64 billion THB (12.44 to 12.85) (US$0.37, 95% CI US$0.36 to US$0.37 billion). Excluding other medical conditions, the direct healthcare costs were highest for CVD, followed by COPD and other respiratory diseases, respectively. All together, the total cost of smoking accounted for 0.78% (95% CI 0.78% to 0.79%) of the national gross domestic product and about 18.19% (95% CI 18.12% to 18.27%) of total health expenditure. CONCLUSIONS: The total economic loss from smoking-related diseases highlights the significant loss to the society, health sector and the country's economy. Such information is crucial for informing national public health policy, particularly when a conflict arises between the economy and health.