Trends in avoidable mortality in Lithuania during 2001-2008 and their impact on life expectancy.

UNLABELLED: The process of the restructuring of health care system in Lithuania demonstrates the need to continue the monitoring of changes in avoidable mortality. OBJECTIVE: To assess the level of avoidable mortality as well as its changes over time in Lithuania during 2001-2008 and to define the impact of avoidable mortality on life expectancy. MATERIAL AND METHODS: The mortality data were taken from the Lithuanian Department of Statistics. Twelve avoidable causes of deaths (treatable and preventable) were analyzed. Mortality trends were assessed by computing the average annual percent change (AAPC). The shortening of average life expectancy was computed from survival tables. RESULTS: During the period 2001-2008, the avoidable mortality was increasing more significantly (AAPC 3.0%, P<0.05) than the overall mortality (AAPC 1.7%, P<0.05) in the population aged 5-64 years. The increasing trend was mainly determined by mortality from preventable diseases (AAPC 4.6%, P<0.05). The avoidable causes of death reduced the life expectancy by 1.77 years (preventable by 1.12 and treatable by 0.63 years). Diversity in trends in mortality of different avoidable causes was disclosed. A declining trend in mortality caused by chronic rheumatic heart disease and lung cancer was observed for males (AAPC -22.6% and -2.1%, respectively; P<0.05). However, the mortality caused by liver cirrhosis was increasing for both genders (AAPC 16.1% for males and 17.6% for females, P<0.01) and that caused by tuberculosis - only for females (AAPC 7.8%, P<0.05). CONCLUSIONS: An increasing trend in avoidable mortality was observed. Deaths caused by the diseases that could have been prevented had the greatest impact on the increasing mortality and decreasing life expectancy.

Perinatal health monitoring in Europe: results from the EURO-PERISTAT project.

Data about deliveries, births, mothers and newborn babies are collected extensively to monitor the health and care of mothers and babies during pregnancy, delivery and the post-partum period, but there is no common approach in Europe. We analysed the problems related to using the European data for international comparisons of perinatal health. We made an inventory of relevant data sources in 25 European Union (EU) member states and Norway, and collected perinatal data using a previously defined indicator list. The main sources were civil registration based on birth and death certificates, medical birth registers, hospital discharge systems, congenital anomaly registers, confidential enquiries and audits. A few countries provided data from routine perinatal surveys or from aggregated data collection systems. The main methodological problems were related to differences in registration criteria and definitions, coverage of data collection, problems in combining information from different sources, missing data and random variation for rare events. Collection of European perinatal health information is feasible, but the national health information systems need improvements to fill gaps. To improve international comparisons, stillbirth definitions should be standardised and a short list of causes of fetal and infant deaths should be developed.

[Primary health care development in 2002-2006 in Lithuania: will we achieve the objective set?]. / Pirmines sveikatos prieziuros pletra Lietuvoje 2002-2006 m. Ar pasieksime uzsibrezta tiksla?

The aim of this study was to identify the changes in the development of primary health care in 2002-2006 and to predict its potential results in 2008, based on various criteria (indicators). Data from the compulsory health insurance system "Sveidra" have been used for the analysis. A share of the private primary health care institutions, the persons enrolled with them, and visits in such institutions from all primary health care institutions during the study period have significantly statistically increased (average annual changes were 6.9%, 22.2%, and 27.2%, respectively). In 2008, this part would make up 61.0%, 30.6%, and 27.2%, respectively. The proportion of persons registered with family doctors and the number of visits to family doctors were significantly increasing (average annual changes were 22.5% and 27.2%, respectively). It is predicted that this part would make up 27.8% and 35.2% in 2008. More detailed analysis has shown that relatively more young and working-age persons (aged 18-44 years) were enrolled in private primary health care institutions. It is in particular evident in Vilnius and Kaunas where the choice of such institutions is high. The number of persons registered with family doctors was increasing in both private and public institutions (average annual changes were 22.5% and 8.3%, respectively; P<0.05). In private institutions, the proportion of persons registered with local district pediatricians was also significantly increasing. The study results have shown significant differences in the developments of primary health care in 2002-2006 by various indicators. The objective defined in the strategy of restructuring will be achieved in 2008 only in respect of the number of institutions. Assessing by the aspect of services, the results achieved will be approximately two times lower. The practice of the institution of the family doctor is becoming more intensive in both private and public institutions.

Prediction of perinatal mortality at an early stage of pregnancy.

AIM: To define the probability of foetal and neonatal death (PFND) in Lithuania by means of the Medical Birth registry. METHODS: The Medical Birth registry for the year 2002 (29,619 pregnancies resulting in delivery) was used, covering social, environmental, health behaviour factors, obstetric history, health status of pregnant women, and delivery. RESULTS: A statistically significant model has been obtained in which 12 out of 45 analysed factors were significant for the risk of perinatal mortality (PM). In the case of previous neonatal pathology, e.g. damage to CNS, the risk of PM (OR 5.2; 95% CI = 2.1-13.3) was similar to the reported manual work or harmful working conditions during pregnancy (OR 4.8; 95% CI = 1.9-12.1 and OR 4.5; 95% CI = 1.3-15.2, respectively). The influence of father's alcohol abuse (OR 2.6; 95% CI = 1.4-4.7) was comparable to that of the stillborns or premature deliveries. The combination of several factors increased PFND significantly: maternal smoking during pregnancy and paternal smoking and alcohol abuse raised PFND to 0.03 (OR 6.8), mother's hard manual work in combination with harmful conditions during pregnancy increased OR more than 10 times (PFND 0.32) as compared with the situation when only one of those factors was present. CONCLUSIONS: The influence of social, environmental, and behavioural factors on the risk of PM was comparable to that of some of the complications during a previous pregnancy. The combination of risk factors significantly increased PFND. Using modelling, the individual prognosis may be presented to every pregnant woman at an early stage of pregnancy to potentially decrease the impact of unfavourable risk factors on PM.

Monthly number of newborns and environmental physical activity.

UNLABELLED: In the last decades many studies have demonstrated the cosmophysical influences on human homeostasis. The aim of the study was to explore links between environmental physical activity--solar, geomagnetic, cosmic ray--and monthly number of newborns in general and, separately, for each gender. MATERIAL AND METHODS: The distribution of newborns' number (n=286,963) over 96 months in the Republic of Lithuania from 1995 to 2002 was compared with the monthly cosmophysical indices nine months before the month of delivery. For the comparison of gender ratio, other 52,289 newborns at the same time were studied in a big Israeli hospital. Pearson's correlation coefficients and their probabilities between the newborns' number and cosmophysical indices were established. RESULTS: A strong and significant inverse correlation of monthly newborns' number with monthly solar activity indices (r=-0.72, p<0.0001) and similar, but positive, with cosmic ray activity was shown (r=0.67, p<0.0001). CONCLUSIONS: The monthly number of newborns of both genders is strongly and significantly related to the level of monthly cosmic ray and, inverse, to solar activity indices nine months before the month of delivery. Geomagnetic activity was not significantly related to the monthly number of newborns. The subject and mechanism of these relationships needs further investigation.

Maternal socio-economic factors and the risk of low birth weight in Lithuania.

AIM: To evaluate the importance of maternal socio-economic factors on the risk of low birth weight in Lithuania. MATERIAL AND METHODS: The case-control study involved 851 newborns with low birth weight (<2500 g) (cases) and 851 newborns with normal weight (controls). Study was accomplished from 1st February, 2001 until 31st October, 2002 in six main maternity hospitals in Lithuania. Mothers of infants were interviewed on the first day after delivery using the structured questionnaire. The database was processed by the application of statistical package "SPSS for Windows v.10.0". RESULTS: Young (<20 years) and older (35 years and older) maternal age, primary or basic education, being single, divorced or widowed, low income, living in rural area and unemployment before pregnancy and during pregnancy increased the risk to deliver low birth weight baby in univariate analysis. In logistic multivariable regression analysis, low education, low income and unemployment during pregnancy significantly increased risk of low birth weight--OR - 2.0, 1.7 and 1.6 respectively. Interaction between several unfavorable risk factors increased risk of low birth weight by 3.4-7.8 times, being the highest among mothers with low education, unstable marital status and low income. CONCLUSION: Maternal unfavorable socio-economic factors increased the risk to deliver low birth weight baby.

Avoidable mortality in Lithuania: 1991-199 compared with 1970-1990.

This paper assesses the changes in avoidable mortality in Lithuania in 1991-1999 compared with 1970-1990. Causes of death were disaggregated into causes most amenable to treatment and those amenable to prevention. Trends in age-standardised death rates were calculated. In 1970-1990, avoidable causes of death accounted for 26.3% of all deaths. By 1991-1999 this figure had decreased slightly to 24.6%. At the same time, age-standardised death rates from avoidable causes increased by 8%, from 118.1 per 100000 in 1970-1990 to 127.9 in 1991-1999. Avoidable mortality among men was considerably higher than for women in both periods. There was considerable fluctuation in both treatable and preventable mortality during the 1990s, reflecting diversity in trends in different causes of death. Increases occurred in death rates from tuberculosis, cervical cancer and liver cirrhosis and, immediately after independence, also in hypertensive and cerebrovascular diseases and, among men, lung cancer, followed by subsequent declines. Deaths from chronic rheumatic heart disease, asthma and other respiratory diseases, appendicitis, abdominal hernia, cholelithiasis and maternal mortality consistently declined. In conclusion, avoidable mortality declined as a proportion of total mortality in Lithuania during 1991-1999 compared with 1970-1990. This reflected the combined impact of an initial rise in death rates from treatable and, to a lesser extent, preventable causes, followed by subsequent declines. While this indicates some success in the development of medical care, it emphasises the need for more effective public health policies directed at the major determinants of health.

Risk factors of perinatal mortality in Lithuania, 1997-1998.

AIM: The aim of this paper is to determine the risk factors of perinatal mortality in Lithuania during 1997-1998. METHODS: The focus of the study is the 1997-1998 Medical Birth Register Database (N = 75,178) covering social-demographic factors, the obstetric anamnesis of previous pregnancies, as well as mothers health behaviour and pathology of the current pregnancy, delivery and obstetric aid. The multivariate analysis assessing odds ratios of risk factors for perinatal mortality using logistic regression has been carried out and related population attributable risk fractions were calculated. RESULTS: A statistically significant (p < 0.01) model predicting perinatal mortality has been obtained in which 19 out of 76 analysed factors have been distinguished to be statistically significant. The septic state of the mother during the delivery (OR = 13.3; CI = 8.9-19.9) and haemorrhage due to a premature placental separation (OR = 11.6; CI = 7.9-16.9) were associated with substantial increased risks of the foetus. Factors from other groups (perinatal pathology during previous pregnancies and social, behavioural or environmental factors) had somewhat lower, though significant, risk on perinatal mortality. The highest population attributable risk fraction (PARF) was found for the breech birth and foetal growth retardation (PARF = 13 percent and PARF = 9.7 percent, respectively). It should be pointed out that the impact of marital status on perinatal mortality was very high (PARF = 6.4 percent), even higher than that of some clinical factors, though its odds ratio was among the lowest (OR = 1.5; CI = 1.2-1.7). CONCLUSION: During 1997-1998, the highest risk for perinatal mortality in Lithuania was associated with obstetric aid during delivery and pathology of current pregnancy. These groups of risk factors had also the highest population attributable risk fraction.

[Do maternal social factors, health behavior and work conditions during pregnancy increase the risk of low birth weight in Lithuania?]. / Ar motinos socialiniai veiksniai, gyvensena ir darbo salygos nestumo laikotarpiu didina naujagimiu mazo gimimo svorio rizika Lietuvoje?

UNLABELLED: The objective of the paper was to evaluate the importance of maternal social factors, health behavior (smoking, alcohol drinking and drug abuse) and working conditions on incidence of low birth weight (LBW). MATERIAL AND METHODS: Statistical analysis was performed utilizing database of Medical Birth Registry for the years 1995-1998 using the indicators of maternal social factors, health behavior and working conditions. Statistical analysis was carried out using statistical package SPSS 10.0. RESULTS: During 1995-1998 the incidence of LBW (< 2500 g) was 3.6 per cent. Young (< 20 years) and older (> or = 35 years) maternal age, low (primary or basic) education and "lone mother" status (single, divorced or widowed) increased the risk of delivering LBW baby. The odds ratio of smoking mothers to deliver LBW baby was 3.3. Odds ratios of LBW newborns associated with alcohol drinking and drug abuse were 10.3 and 6.1 respectively. The odds ratio of mothers physically abused during pregnancy to deliver LBW baby was 2.7. However, the harmful working conditions were not associated with the higher odds of LBW. Young and older age was attributable for 22.2 and 49.3 per cent LBW cases in the exposed group respectively. While attributable fraction in exposed due to the low educational level and unfavourable marital status accounted to 38.9 and 52.9 per cent LBW cases respectively. Smoking was attributable for 68 per cent LBW cases, alcohol drinking--87.2 per cent, drug abuse--80.5 per cent LBW cases among exposed mothers. Preventable population attributable risk for unfavourable marital status was 11.7 per cent, low education--9 per cent, smoking--8 per cent, older age--6.9 per cent. Drug abuse and hard manual work had minimal association while harmful working conditions were not associated with higher risk to deliver the LBW baby in the total population. CONCLUSIONS: Maternal health behavior peculiarities and hard manual work are related to newborns' birth weight, and medical professionals should encourage quitting the hazardous habits and regulation of workload for expectant mothers. Adverse social factors contribute to the higher incidence of LBW. The solution of social problems should become the priority of State health policy.

[Ecological monitoring of population mortality in Kaunas micro-districts, 1992-1997]. / Gyventoju mirtingumo stebesena 1992-1997 metais Kauno miesto mikrorajonuose.

In Lithuania, the mortality rate is constantly increasing. However, regional differences of mortality rates in a large industrial town were unexplored. The study was carried out in Kaunas, second biggest town of Lithuania with a well-developed industry, as well as high atmospheric air pollution. Harmful effects of the regional environmental complex (dustiness, carbon monoxide, sulfur and nitrogen dioxides) were evaluated by summarized pollution index. Causes of death were taken from certificates of death for 1992-1997. In the study, the 9th revision of International Classification of Diseases and the European age standard were used. Mortality was studied in three microdistricts with threefold differences in levels of air pollution. The age-adjusted death rate (SMR) from all causes in a relatively clean microdistrict--D3 (SMR = 1720.5 +/- 60.4) is higher than the same indicator of microdistricts with developed industry--D1 (SMR = 1446.5 +/- 102.1) or heavy traffic--D2 (SMR = 1402.7 +/- 86.2). In terms of cause-specific mortalities, there is a prevalence of cardiovascular diseases and neoplasms. The SMR from circulatory system disorders (ICD-9 390-459) in D3 is equal 562 +/- 56.1, compared to D2--509.7 +/- 63.9 and D1--479.7 +/- 79.2. Neoplasms (ICD-9 140-239) are ranked second in the list of causes of deaths. They account for 244.8 +/- 32.0 per 100,000 population in D3, 184.4 +/- 40.8 in D2 and 221.1 +/- 47.6 in D1, respectively. The overall mortality of the population did not relate to the levels of outdoor pollution. Circulatory disorders and neoplasms are the main cause of death. In a polluted micro district risk of death for a young person is higher, irrespective of accidents, injuries and poisonings.

[Trends in health care expenditures in Lithuania]. / Islaidu sveikatos prieziurai kitimo tendencijos Lietuvoje 1994-1999 m.

The aim of the study was to analyze the tendencies of public and private health care expenditure in Lithuania during 1994-1999. Crude examination of statistical data show, that the growth rate of health care spending per capital is largely determined by growth of national gross domestic product (GDP). We have estimated that health care spending in Lithuania have risen twice faster than GDP during 1994-1999. (Percentage of rise in health care spending, divided by percentage rise of GDP, is +2.26). The introduction of compulsory health insurance in 1997, and the development of private health care sector in Lithuania, led to increase health care expenditure in total, and has influenced changes in public-private spending proportions. A source of private spending in national health account has increased from 15 per cent in 1994-1995 to 24 percent in 1996-1999. The tendency of increasing private spending shows, the evidence, that households are facing more financial risk of purchasing health care. This should be an implication for health care policy makers. Further decisions to increase private payments have to be based on evidence after detailed analysis of impact of consequences on health care access for various social economic groups of population.