Accessing free quality health care services and premature death.

BACKGROUND: The type of health insurance may affect the likelihood of mortality of insured people. We conducted this study to determine if accessing free quality health care services could decrease the premature mortality of people in a developing country. METHODS: In a multicenter cross sectional study, "years-life-lost" (YLL) due to premature death was evaluated in 202 671 insured people residing in six large regions in Iran. The participants had access to free quality health care services. The number of insured people that died in the six regions during March 20, 2014, to March 20, 2015, as well as their sex, age, and cause of the death, were collected, and the YLL was calculated based on assumptions made in Global Burden of Disease Study 2010 (GBD2010). RESULTS: The crude mortality rate was 2.3 per 1000, significantly lower than the overall rate of 4.6 per 1000 people in general population of Iran. The average YLL was 47 years per 1000 persons, significantly lower than that in general population of Iran and many industrialized countries. The most common causes of death (and YLL) were cardiovascular diseases and malignancies. CONCLUSION: Having access to free quality health care services is associated with a significant decrease in premature death.

A Validation Study for POSSUM and EuroSCORE as a Predictor of Mortality After Selective Cardiac Surgery.

AIM: to assess physiological and operative severity score for the enumeration of mortality (POSSUM) scoring system and compare it with European system for cardiac operative risk evaluation (EuroSCORE) scores in patients who underwent cardiac surgery from two hospitals in the southwestern region of Iran. METHODS: in this retrospective study, total of all 1420 patients who were admitted for elective cardiac surgery at our centers, from 2007 to 2012, were scored using the POSSUM and EuroSCORE systems. RESULTS: the overall mortality rate was 0.87%. Among the risk factors, history of diabetes, smoking, respiratory disease, and myocardial infarction, were significantly affect the mortality rate. Therefore, of these risk factors, only the hemoglobin was significantly correlated with the morbidity rate. The predictive accuracy of mortality equations was 74.5%. The lower predictive accuracy of mortality equations was 67.8% was observed using EuroSCORE. CONCLUSION: although results are statistically significant, but the analysis have never intended to affect the decision to operate, and this decision must be based on clinical expertise, because of the need to standardize data collection and stratify the risks involved in operations, scoring systems such as POSSUM should be used prospectively. However, if analyzed correctly, POSSUM is a good predictor of mortality in patients undergoing cardiac surgery.