Undiagnosed hypertension in Croatia.

AIM: To determine the prevalence of undiagnosed hypertension in Croatia, and to assess its association with various demographic, socioeconomic, lifestyle, and health care usage factors. METHODS: We used the data from European Health Interview Survey wave 3, conducted in Croatia in 2019. The representative sample consisted of 5461 individuals aged 15 years and older. The association of undiagnosed hypertension with various factors was assessed with simple and multiple logistic regression models. The factors that contribute to undiagnosed hypertension were identified by comparing undiagnosed hypertension with normotension in the first model and with diagnosed hypertension in the second model. RESULTS: In the multiple logistic regression model, women and older age groups had lower adjusted odds ratio (OR) for undiagnosed hypertension than men and the youngest age group. Respondents living in the Adriatic region had a higher adjusted OR for undiagnosed hypertension than those living in the Continental region. Respondents who did not consult their family doctor in the previous 12 months and those who did not have their blood pressure measured by a health professional in the previous 12 months had a higher adjusted OR for undiagnosed hypertension. CONCLUSION: Undiagnosed hypertension was significantly associated with male sex, age from 35 to 74, overweight, lack of consultation with a family doctor, and living in the Adriatic region. The results of this study should be used to inform preventive public health measures and activities.

The economic burden of disease-related undernutrition in selected chronic diseases.

BACKGROUND & AIMS: Undernutrition is a common and aggravating problem in people suffering from various chronic diseases as well as a source of material costs. The aim of this study was to investigate the prevalence of disease-related undernutrition among adults in Croatia in the year 2012, as well as the cost of undernutrition associated with tumour cachexia, chronic pancreatitis, inflammatory bowel disease, hepatic encephalopathy, chronic obstructive pulmonary disease, chronic renal insufficiency requiring dialysis, cerebrovascular insult, pressure ulcers, and femoral fractures in the elderly. METHODS: A cost-of-illness analysis was conducted, including direct costs only. The study employed the dominant cost-of-illness method, which restricts the summation of medical expenditure to the disease of interest. The bottom-up, prevalence-based approach was used. The budget holder perspective was employed, and data sources include the list of reimbursed drugs, clinical opinions, and literature. RESULTS: The prevalence of disease-related undernutrition in people over the age of 20 in Croatia in the year 2012 was estimated to be 33.7/1000. The total cost of adult malnutrition for selected diagnoses was 97.35 million EUR, accounting for 3.38% of the total Croatian national health care budget. The largest share was used for medications (43%), followed by 34% for hospitalizations, 13% for community health nursing, while parenteral and enteral nutrition contributed with 6% and 1% respectively. The average cost per patient was estimated at 1640.48 EUR. CONCLUSIONS: The cost of malnutrition for the selected diagnoses in Croatia was substantial. These health costs will increase due to population ageing, which calls for undernutrition screening in people at risk as well as for effective approaches in nutrition supplementation.

Five-year cumulative incidence of hypertension in adult Croatian population: the CroHort study.

The aim of this study was to establish a five-year cumulative incidence of arterial hypertension (hereinafter 5-CIAH) and its dependence on initial prehypertension, body weight, age and gender "Croatian Adult Health Cohort Study (CroHort)" data collected during 2003 and 2008 for the 1383 subjects aged 18 + with initially normal blood pressure (systolic < 140 mmHg and diastolic < 90 mmHg, and not taking medication) was analised. Methods of descriptive statistics, Student's t-test, chi2-test and logistic regression were used. The recorded 5-CIAH in male cohort was 36.9% [32.1 to 41.6] and 33.0% [30.1 to 36.0] in women and was higher in subjects with initial prehypertension (men 43.3% [37.5 to 49.0] versus 9.6% [12.1 to 27.2]; women (42 3% [38.1 to 46.6] versus 22.3% [18.5 to 26.1]). The development of arterial hypertension was affected by age (OR = 2.2168), initial prehypertension (OR = 2.1987) and overweight (OR = 1.9399).

Is there any association between blood pressure and education level? The CroHort study.

The aim of this study was to explore how the association of 5-year cumulative incidence of arterial hypertension (further 5-CIAH) and education varies according to body weight, age and sex. The study was conducted on cohort of 1383 subjects aged 18+ with initially normal blood pressure (systolic < 140 mmHg and diastolic < 90 mmHg, and not taking medication). Data were collected in 2003 and repeated in 2008. Methods of descriptive statistics, chi2 test and logistic regression were used. No association between education level and hypertension development was recorded in the group of men and in the group of woman aged 65+. In the group of women with normal body weight, younger than 65 years, significantly higher 5-CIAH values were recorded in those with less than 12 years of education (32.5% [22.0 to 42.9]) compared to those with 12 or more years of education (9.6% [6.1 to 13.1]).

Regional differences in the prevalence of arterial hypertension in Croatia.

This paper analyzes the Croatian Adult Health Survey data, collected in 2003 with a total of 9,070 respondents aged 18+. Based on an average of two measurements, respondents with the mean systolic arterial pressure > or = 140 mmHg or mean diastolic pressure > or = 90 mmHg were classified as hypertensive. The data for men and women were analyzed separately, according to regions. Prevalence of hypertension in men was 40.5% (95% confidence interval CI 37.9-43.01; coefficient of variability CV = 3.2), women 34.9% (95% CI 33.2-36.7; CV 2.5). There were no significant differences in regional prevalence in men, except in the Northern and Eastern region. In women we did not detect any significant regional difference. Non-controlled arterial hypertension is an important public health problem in all monitored regions of Croatia. Raising awareness about the problem, early detection and encouraging the population to adhere to the therapy for elevated arterial pressure, in addition to a healthy life style, are important for successful control and harm reduction.

[Incidence and prevalence of asbestos-related diseases in Croatia]. / Pojavnost bolesti uzrokovanih azbestom u Republici Hrvatskoj u razdoblju od 2002. do 2007.

The aim of this study was to identify the incidence and prevalence of asbestos-related diseases in Croatia, based on the Hospital Morbidity Database and General Mortality Database of the Croatian National Institute of Public Health. Both databases cover a period from 2002 to 2007), and include information from the Register of Occupational Diseases. Diagnoses in focus were mesothelioma (C45), asbestosis, and pleural plaque (J61 and J92). Yearly rates of inpatients treated for mesothelioma, asbestosis, or pleural plaque that were higher than the Croatian average (2.1) were recorded in the Counties of Split-Dalmatia (5.0), Dubrovnik-Neretva (3.9), Istria (3.7), and Primorje-Gorski kotar (3.1 per 100,000 people). From 2002 to 2007, 649 occupational diseases were reported, out of which 11.7% were asbestos-related. The most frequent were pleural plaque with asbestosis (38 cases, 50.0%), pleural plaque (23 cases, 30.3%), and mesothelioma (6 cases, 7.9%). Mortality attributable to asbestos was assessed using official Croatian National Statistics Bureau reports for 2002 to 2007 at the county and national level. During that period, Croatia recorded 312 deaths with the average yearly rate of 1.2 per 100.000 people. Four counties had higher rates than the national average: Primorje-Gorski kotar (3.4), Split-Dalmatia (2.8), Istria (2.8), and S1. Brod-Posavina (1.5). The number of inpatients treated for asbestos-related diseases was higher than the national average in the counties of Split-Dalmatia, Dubrovnik-Neretva, and Primorje-Gorski Kotar. Mesothelioma incidence was above the national average in the counties of Split-Dalmatia, Primorje-Gorski Kotar, and Istria. The rates of occupational, asbestos-related diseases were higher than the national average in the counties of Split-Dalmatia and Primorje-Gorski Kotar. We were aware that the interpretation of data is somewhat limited by the relatively small absolute number of treated persons and deaths for the observed period, by the fact that crude rates have not been adjusted for total numbers and for regional differences in population distribution by age and gender. The real extent of asbestos-related burden in Croatian general population remains unknown, because only occupational exposure has been monitored. Therefore, the National Public Health Institute and county public health institutes should implement a specific monitoring programme in collaboration with government environmental bodies to assess asbestos exposure of the population living in the vicinity of asbestos plants. It is also necessary to establish the number of exposed persons who have developed an asbestos-related disease. Their health should be monitored and their environment inspected on a regular basis.

[Regional characteristics of arterial hypertension in adult population of Croatia]. / Regionalne znacajkev arterijske hipertenzije u odraslog stanovnistva republike Hrvatske.

Data collected in the Croatian Health Survey launched in 2003 by the Ministry of Health and Social Welfare were analyzed. The survey included a regionally stratified random sample. Using the method of structured questionnaire and anthropometric measurements (blood pressure, height and weight), data were collected on 9,070 subjects aged >18. The mean systolic and diastolic blood pressure was calculated from two measurements. Inclusion criteria in the group of subjects with elevated blood pressure were the subject's reporting taking antihypertensive medication and/or mean systolic blood pressure > or =140 mm Hg, and/or mean diastolic blood pressure > or =90 mm Hg. Descriptive analysis was done on figures yielded by use of the SPSS software. Subjects with elevated blood pressure accounted for 44.2% (95%CI=42.61-45.85) of study population, with a h gher rate in male (45.6%; 95%= 43.14-48.06) and lower in female subjects (43.0%; 95%CI=41.46-44.55). Croatia was estimated to have 1,538,982 inhabitants with high blood pressure (748,072 males and 790,910 females). The proportion of individuals with elevated blood pressure was highest (78.9%; 95%CI=76.9-81.0; CV=1.32) in the 65 age group, followed by 35-64 age group 46.9% (95% CI=44.8-41.0; CV=2.3), and lowest rate (13.8%; 95%CI=11.1-16.6; CV=10.2) in the 18-34 age group. Regional distribution of high blood pressure was as follows: central Croatia 46.4% (95%CI=42.9-49.9; CV= 3.8), south 45.3% (95%CI= 40.9-49.7; CV=. 5.0), City of Zagreb 44.7% (95%CI= 40.9-48.5; CV= 4.3), east 44.2% (95%CI=40.5-47.8; CV=4.2), north 43.0% (95%CI=40.9-49.7; CV= 5.0), and west 40.5% (95%CI= 36.0-45.0; CV= 5.7). In the female group aged 35-64, regional distribution was as follows: east 52.3% (95%CI=46.0-58.7; CV=6.2), central Croatia 45.4% (95%CI=40.3-50.5; CV=5.7), City of Zagreb 43.5 (95%CI=38.1-48.9; CV=6.4), south 40.7% (95%CI=37.4-44, 0; CV=4.1), north 39.3% (95% CI=33.7-44.8; CV=7.2), and west 35.1% (95%CI=26.1-44.2; CV= 13.1). Differences between the east and south, west and City of Zagreb should be investigated. In the high blood pressure group, 76.5% of subjects had a body mass index greater than 25 and 48% ofthose with inadequate physical activity, both exceeding the rates recorded in persons with normal blood pressure. Whereas 58.6% of the subjects knew they had elevated blood pressure, 48.4% of them were taking their therapy, and only 14.8% kept their blood pressure under control (systolic <140 mm Hg and diastolic <90 mm Hg). Arterial hypertension is a major public health problem in all regions of Croatia. The available literature data suggest that the Croatia's share of individuals with high blood pressure is comparable to that in industrialized countries of continental Europe. The prevention of excessive body weight, also through increased physical activity of the population and changes in poor dietary habits, remains the essential element in planning primary prevention programs for high blood pressure. Raising the population's awareness of the problem, early detection of high blood pressure and encouraging the population to take regular therapy for high blood pressure, along with the adoption of healthy lifestyle are important factors in achieving effective control and alleviating the consequences of hypertension.

Life expectancy and mortality differences between populations on Croatian islands and the mainland.

AIM: To examine the differences in life expectancy and mortality between the populations on Croatian islands and the mainland, and among the islands themselves. METHOD: Data on population size and mortality collected in Croatia in 2001 were analyzed by life table and standardized mortality rates. RESULTS: Life expectancy at birth (95% confidence interval) of the population on Croatian islands was 76.4 yr (75.7-77.1) which was significantly higher than life expectancy at birth of general Croatian population which was 73.8 yr (73.5-73.9) or mainland Croatian population which was 73.7 yr (73.6-73.8). Island population had higher life expectancy until the age of 80 and again in the oldest age group, 95+. More than 10% of inhabited islands in Croatia had life expectancy at birth over 80 years. Two inhabited islands, Ilovik (Kvarner islands) and Lopud (South Dalmatian islands), had one of the highest life expectancy at birth recorded in the literature, with 95.0 and 90.6 years respectively. Mortality rates on islands were significantly lower for age groups 50-64 and 65-79 years, and this difference persisted for all island groups compared with general Croatian population. CONCLUSION: Residents of Croatian islands had a higher life expectancy than general or mainland Croatian population. Life expectancy at birth on Croatian islands was lower than in other European Mediterranean countries, but it resembles that in the neighboring Slovenia, and it is considerably higher than in central and eastern Europe and Balkan countries.

Development and deployment of a health information system in transitional countries (croatian experience).

Croatian Primary Health Care Information System pilot project, conducted between 2001 and 2003, aimed to develop and deploy a health information system based on the latest technologies which would improve the quality of primary health care and rationalise the consumption. 60 primary health care teams (physician and nurse) were equipped with PCs and connected via central server to the main national health insurer, state treasury and public health institute. Developed information system enabled rapid retrieval of documents, replacement of manual data input and a real-time insight into needed information as well as prompt interventions within the system. The project also introduced electronic smart cards for physicians and nurses, so that at each medical check-up the information system verified both the ensuree's and the physician's or nurse's status and rights.Based on the experiences from the pilot project, plan has been made for comprehensive health information system at national level which would connect primary health care teams, hospitals, laboratories, dentistries, health insurance companies, state treasury, public health institutes and electronic health records database. Its major goals are more rapid diagnostics, accuracy in prescribing therapy, standardisation of the good practice as well as better utilisation of capacities, shorter waiting times and shorter stays in hospitals, which would lead to improvement in overall health care quality and better control over the health care consumption. Estimated 5-year investment for installing such system would be 125 million EUR. However, information system could save substantially more and yield a return of investment in only two years.As information system for primary health care should be a strategic component of every health care reform and development plan, we can recommend our model, based on the results of the pilot project, to other transitional countries.