Potential gains in life expectancy by eliminating deaths from cardiovascular diseases and diabetes mellitus in the working life ages among Slovak population.

BACKGROUND: In recent years, high mortality from cardiovascular diseases (chronic ischemic heart disease, acute coronary syndrome, cerebrovascular diseases, atherosclerosis, hypertensive diseases) and diabetes mellitus have burdened economic and health system of the Slovak Republic considerably. By eliminating these deaths, the life expectancy could be prolonged. Since the mortality of population during working period has higher importance in terms of economic consequences of diseases, this article aims to assess the potential gains in life expectancy (PGLEs) of the Slovak population comparing the entire life span and working life-time. METHODS: Data are obtained from the National Health Information Center mortality reports by sex during 1996-2014, and the method of constructing abridged life tables is used to compute the corresponding PGLEs. The added years, which would be gained by eliminating causes of deaths, are decomposed by the two sets of working age groups population (25-44 and 45-64 years). RESULTS: The highest impact on life expectancy was recorded in chronic ischemic heart disease for both sexes aged 45-64 years (0.078 for males, 0.019 added years for females) over 1996-2014. However, they showed a small declining trend (- 16%) for males and even an increasing trend (2%) for females. At present, the labour force potential of working group (25-44 years) is most threatened by deaths from cerebrovascular diseases, while population of working age (45-64 years) by deaths from chronic ischemic heart disease. Relative importance of acute coronary syndrome for males (45-64 years) increased, when comparing the entire with working time life. CONCLUSIONS: The findings pose new and immediate challenges to policy makers and provoke discussion about prevention program strategies leading to increasing the life expectancy.

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.

Mortality Amenable to Health Care in European Union Countries and Its Limitations.

AIM: The concept of amenable mortality is intended to assess health care system performance. It is defined as "premature deaths that should not occur in the presence of timely and effective health care". The purpose of paper is to analyse differences in amenable mortality across European Union countries and to determine the associations between amenable mortality and life expectancy at birth. METHODS: This is a cross-country and time trend analysis. Data on deaths by cause, and five-year age groups were obtained from the World Health Organization database for the 20 European Union countries, throughout the period from 2002 to 2013. The rates of amenable mortality were expressed by the age-standardised death rates per 100,000 inhabitants. We applied the method of direct standardisation using the European Standard Population. RESULTS: Throughout the explored period, the statistically significant variations of the age-standardised death rates in a relation to the European Union average fluctuated from 78.7 per 100,000 inhabitants (95% CI 72.4-84.9) in France to 374.3 per 100,000 inhabitants (95% CI 350.8-397.7) in Latvia. The leading causes of amenable mortality were ischaemic heart disease, cerebrovascular diseases, and colorectal cancer that accounted for, respectively, 42.2%, 19.5%, and 11.3% of overall amenable mortality. As expected, statistically significant strong negative relationship (R2=0.95; ρ=-0.98) between amenable mortality and life expectancy at birth was proved by linear regression. The concept has several limitations relating to the selection of causes of death and setting age threshold over time, not consideration actually available health care resources in each country, as well as differences in the prevalence of diseases among countries. CONCLUSIONS: We found an explicit divide in amenable mortality rates between more developed countries of Western, Northern and Southern Europe, and less developed countries of Central and Eastern Europe. Increasing of amenable mortality may suggest deterioration in health care system performance.

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.

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.

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.

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.

Time Trend, Age and Sex Distribution of Deceased 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 Kosice, Nitra and Trencín 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 Zilina and Presov 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.

Regional differences of standardised mortality rates for ischemic heart diseases in the Slovak Republic for the period 1996-2013 in the context of income inequality.

BACKGROUND: The aim of paper is to analyse the development of standardised mortality rates for ischemic heart diseases in relation to the income inequality in the regions of Slovakia. This paper assesses different types of income indicators, such as mean equivalised net income per household, Gini coefficient, unemployment rate, at risk of poverty threshold (60 % of national median), S80/S20 and their effect on mortality. METHODS: Using data from the Slovak mortality database 1996-2013, the method of direct standardisation was applied to eliminate variances resulted from differences in age structures of the population across regions and over time. To examine the relationships between income indicators and standardised mortality rates, we used the tools of descriptive statistics and methods of correlation and regression analysis. RESULTS: At first, we show that Slovakia has the worst values of standardised mortality rates for ischemic heart diseases in EU countries. Secondly, mortality rates are significantly higher for males compared with females. Thirdly, mortality rates are improving from Eastern Slovakia to Western Slovakia; additionally, high differences in the results of variability are seen among Slovak regions. Finally, the unemployment rate, the poverty rate and equivalent disposable income were statistically significant income indicators. CONCLUSIONS: Main contribution of paper is to demonstrate regional differences between mortality and income inequality, and to point out the long-term unsatisfactory health outcomes.