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

An impact of economic slowdown on health. New evidence from 21 European countries

Background

The economic slowdown affects the population's health. Based on a social gradient concept, we usually assume that this detrimental impact results from a lower social status, joblessness, or other related factors. Although many researchers dealt with the relationship between economy and health, the findings are still inconsistent, primarily related to unemployment. This study reinvestigates a relationship between the economy's condition and health by decomposing it into macroeconomic indicators.

Methods

We use data for 21 European countries to estimate the panel models, covering the years 1995–2019. Dependent variables describe population health (objective measures – life expectancy for a newborn and 65 years old, healthy life expectancy, separately for male and female). The explanatory variables primarily represent GDP and other variables describing the public finance and health sectors.

Results

(1) the level of economic activity affects the population’s health – GDP stimulates the life expectancies positively; this finding is strongly statistically significant; (2) the unemployment rate also positively affects health; hence, increasing the unemployment rate is linked to better health – this effect is relatively short-term.

Conclusions

Social benefits or budgetary imbalance may play a protective role during an economic downturn.

Supplementary Information

The online version contains supplementary material available at 10.1186/s12889-022-13740-6.

A two-layer nested heterogeneous ensemble learning predictive method for COVID-19 mortality

The COVID-19 epidemic has had a great adverse impact on the world, having taken a heavy toll, killing hundreds of thousands of people. In order to help the world better combat COVID-19 and reduce its death toll, this study focuses on the COVID-19 mortality. First, using the multiple stepwise regression analysis method, the factors from eight aspects (economy, society, climate etc.) that may affect the mortality rates of COVID-19 in various countries is examined. In addition, a two-layer nested heterogeneous ensemble learning-based prediction method that combines linear regression (LR), support vector machine (SVM), and extreme learning machine (ELM) is developed to predict the development trends of COVID-19 mortality in various countries. Based on data from 79 countries, the experiment proves that age structure (proportion of the population over 70 years old) and medical resources (number of beds) are the main factors affecting the mortality of COVID-19 in each country. In addition, it is found that the number of nucleic acid tests and climatic factors are correlated with COVID-19 mortality. At the same time, when predicting COVID-19 mortality, the proposed heterogeneous ensemble learning-based prediction method shows better prediction ability than state-of-the-art machine learning methods such as LR, SVM, ELM, random forest (RF), long short-term memory (LSTM) etc.

Socioeconomic factors and the onset of peripheral artery disease in older adults

Background: As evidence concerning the impact of socioeconomic factors on the risk of peripheral artery disease (PAD) is sparse, we assessed the association of education and area-level factors (population density, type of municipality and local unemployment rate) on the onset of PAD in older adults. Patients and methods: The analysis used data of the getABI study, a prospective cohort study with seven years of follow-up. Onset of PAD was determined by ankle brachial index (<0.9) or PAD symptoms. Cox regression analysis was employed. Results: Out of 5,444 primary care attendees without PAD at baseline, there were 1,381 participants with PAD onset (cumulative observation time 31,739 years), yielding an event rate of 43.5 (0.95 confidence interval [0.95 CI] 41.2-45.8) per 1,000 person-years. Multivariable Cox regression analysis showed an association of PAD onset with low education (hazard ratio 1.29; 0.95 CI 1.14-1.46; P<0.001), high population density (0.93; 0.89-0.98; P=0.002), small cities (compared to large cities) (0.71; 0.53-0.96; P=0.027) and high local unemployment rate (1.04; 1.00-1.07; P=0.032). The impact of low education on PAD onset was higher for men (2.11; 1.64-2.72) than for women (1.22; 1.07-1.40) (interaction term P=0.013). Conclusions: Socioeconomic factors, education as well as area-level socioeconomic indicators, make independent contributions to PAD onset in older adults.

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.

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.

Influence of Demographic Determinants on the Number of Deaths Caused by Circulatory System Diseases in Comparison to the Number of Deaths Caused by Neoplasms in Slovak Regions from 1996-2014

OBJECTIVES

The objective of our study was to evaluate the influence of available demographic determinants on the number of deaths caused by circulatory system diseases as compared to deaths caused by neoplasms in Slovakia in 1996-2014.

METHODS

Mortality data were kindly provided by the National Health Information Centre in Slovakia. The first method was trend curve fitting of death ratios caused by circulatory system diseases (Chapter IX) and of deaths caused by neoplasms (Chapter II) as a function of age for both sexes. The second method comprised a decision tree for classification between deaths caused by Chapter IX and Chapter II diseases. Input variables were available demographic indicators: age, sex, marital status, region, and calendar year of death. Statistical data analyses were performed by IBM SPSS version 19 statistical software.

RESULTS

We found that the odds ratios of deaths caused by circulatory system diseases (Chapter IX) in comparison with deaths caused by neoplasms (Chapter II) were non-decreasing. At first, the values of odds ratios are constant until they reach a critical sex-dependent value with a subsequent steady increase. In the case of men the odds ratio was greater than in the 60 years age-group where the odds ratio value increased slowly (from 1.14 at age 60 to 7.25 at age 90 years). The relative increase was 6.36 (7.25/1.14). The odds ratio in the women group was smaller but increased more rapidly (from 0.81 at age 60 to 12.27 at age 90 years). The relative increase was 15.15 in women (12.27/0.81). Hence, the odds ratio of death caused by Chapter IX diseases vs. Chapter II was greater in the older women group (i.e. higher age values). Utilizing the decision tree model, we have found that the most significant demographic determinant of death counts in both ICD Chapters was the age of the deceased, followed by marital status and finally gender. The last two predictors (year and region) were relatively negligible though formally significant.

CONCLUSIONS

The proposed method could be useful for prognostic classification of patients and primarily beneficial for hospitals in human or financial resources planning.

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.

Impact of Selected Socio-demographic Factors on the Development of Mortality due to Circulatory System Diseases in the Slovak Republic

AIM

We mapped the situation within a group of diseases of the circulatory system (I00-I99) in the Slovak Republic during 1996-2014. We focused mainly on spatiotemporal differences in mortality while controlling for age and sex.

METHODS

We performed binary logistic regression aiming to reveal socio-demographic factors that influence the odds of dying due to diseases of the circulatory system (I00-I99). In our analysis, the dependent variable was death diagnosis and the independent variables were age, region, gender, and marital status.

RESULTS

Our findings suggest that odds of dying due to diseases of the circulatory system (I00-I99) increased for every year of age by 5.4%. Within the period from 1996 to 2014, the risk of dying from diseases of the circulatory system decreased by 2% every year. We also documented the fact that being female raised the odds of dying due to diseases of the circulatory system (I00-I99) by 12.9% compared to males. Furthermore, it could be argued that serious differences in terms of regional distribution of deaths caused by diseases of the circulatory system (I00-I99) exist in the Slovak Republic.

CONCLUSIONS

We present the development of diseases of the circulatory system (I00-I99) in the Slovak Republic. Differences in spatial distribution of deaths are documented as well as related gender differences. Our study can serve as a tool for policy makers and benchmark for professionals.

Income Inequality in Non-communicable Diseases Mortality among the Regions of the Slovak Republic

AIM

A great amount of non-communicable disease deaths poses a threat for all people and therefore represents the challenge for health policy makers, health providers and other health or social policy actors. The aim of this study is to analyse regional differences in non-communicable disease mortality in the Slovak Republic, and to quantify the relationship between mortality and economic indicators of the Slovak regions.

METHODS

Standardised mortality rates adjusted for age, sex, region, and period were calculated applying direct standardisation methods with the European standard population covering the time span from 2005 to 2013. The impact of income indicators on standardised mortality rates was calculated using the panel regression models.

RESULTS

The Bratislava region reaches the lowest values of standardised mortality rate for non-communicable diseases for both sexes. On the other side, the Nitra region has the highest standardised mortality rate for non-communicable diseases. Income quintile ratio has the highest effect on mortality, however, the expected positive impact is not confirmed. Gini coefficient at the 0.001 significance level and social benefits at the 0.01 significance level look like the most influencing variables on the standardised mortality rate. By addition of one percentage point of Gini coefficient, mortality rate increases by 148.19 units. When a share of population receiving social benefits increases by one percentage point, the standardised mortality rate will increase by 22.36 units.

CONCLUSIONS

Non-communicable disease mortality together with income inequalities among the regions of the Slovak Republic highlight the importance of economic impact on population health.

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 Košice, Nitra and Trenčín 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 Žilina and Prešov 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.

Similarity of Slovak Regions in Neoplastic Mortality in the Context of Risk Factors and Access to Health Care

AIM

Access to primary health care is highly connected to the prevention of cancer mortality, since the risk factors threatening health can be early identified. The aim of this paper is, firstly, to explore similarity within and between the regions of the Slovak Republic and cancer mortality patterns, and secondly, to reveal if similar regions are characterised by the similar access to health care or risk factors occurrence.

METHODS

Data on deaths by sex, type of cancer death and region from 1996 to 2014 is provided by the National Health Information Centre of Slovakia. The relationships between 8 regions and 16 cancer types are described by correspondence analysis for both sexes.

RESULTS

The most similar cancer mortality patterns among Slovak regions are between the Nitra and Trnava regions for both sexes, and the Košice region for males. The Prešov region is showed as an outlier from other regions for females, likely due to the highest concentration of Roma marginalised communities. As for access to health care, the Trnava region as well as Nitra region report the lowest densities of physicians, 2.4 and 2.6 per 1,000 inhabitants, respectively. The most serious cancer types mortality is attributed to the digestive organs (C15-C26) in each Slovak region for both sexes with the average proportion of 35.56%. Observed high association between the Nitra region and respiratory cancer (C30-C39) in males may be confirmed by the increased incidence of radon in this region. Similarly, a tight relationship between the Bratislava region and cancer of male genital organs (C60-C63) can relate to the highest proportion of drug users in the Bratislava region.

CONCLUSIONS

Based on the findings of similar regions in cancer mortality patterns, we recommend to set the same prevention programs in the Trnava and Nitra regions, on the other hand, different preventive interventions should be introduced in the Prešov region.

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.

On the Structure of Mortality among the Regions in the Slovak Republic

AIM

The Slovak Republic consists of eight regions which may dispose a different structure of cause-specific mortality. The aim of this study is to reveal the regions with higher risk of dying from the main categories of diseases selected according to the chapters of the International Classification of Diseases (ICD-10).

METHODS

Data were obtained from mortality reports throughout 1996-2014. We applied multinomial logistic regression analysis, where the dependent variable is death categories and the explanatory variables are regions, age, year and gender. The Bratislava region and Diseases of the circulatory system are set as the reference level.

RESULTS

We propose a spatiotemporal analysis of the relative risk ratio of dying in the Slovak Republic for every significant group of diseases from the International Statistical Classification of Diseases and Related Health Problems maintained by the World Health Organization. Moreover, we propose gender and age analysis.

CONCLUSIONS

These results could be useful for setting active prevention programs, as well as a hospital network specialising in high risk diagnoses in Slovakian regions.

Influence of Demographic Factors on Standardised Rate Ratio of Age-adjusted Mortality Rates of Men in Comparison with Women Caused by Neoplasms and Circulatory System Diseases in Slovak Regions during 1996-2013

AIM

The aim of our study was to find statistical associations including trends of standardised rate ratio of age-adjusted mortality rates for the male population as compared to the female population, in relation to available demographic factors (Chapter II - Neoplasms vs. Chapter IX - Diseases of the circulatory system, Slovak region and calendar year of death).

METHODS

Dataset of individual cases of death in Slovakia with some demographic factors during 1996-2013 were provided by Slovak National Health Information Center. We used regression and correlation analyses, as well as analyses of variance and covariance along with descriptive statistics.

RESULTS

The standardised rate ratio of age adjusted mortality rates of men versus age-adjusted mortality rates of women differs between Chapter II and Chapter IX (mean 2.08 vs. 1.35, p<0.001). There are also significant differences of standardised rate ratio among regions (p<0.05). Trends show that the standardised rate ratio has significant regional decline for Chapter II: Košice (p<0.01), Trenčín (p<0.001) and Žilina (p<0.05) whereas in Chapter IX Žilina region (p<0.01) is implicated. In other Slovak regions standardised rate ratio stagnates.

CONCLUSIONS

Standardised rate ratios of age-adjusted mortality rates for the male population compared to the female population are significantly dependent on chapter, sex and region. Standardised rate ratios either decline or stagnate.

Regional disparities in medical equipment distribution in the Slovak Republic - a platform for a health policy regulatory mechanism

BACKGROUND

This study aims to examine the localisation of selected parameters in the deployment and use of medical equipment in the Slovak Republic and to verify potential regional disparities. The study evaluates the benefits of an analytical platform for regulatory mechanisms in the healthcare system.

METHODS

The correspondence analysis is applied to the entire data set containing information regarding medical equipment distribution and mortality.

RESULTS

The results highlight regional differences in the use of medical equipment throughout the analysed period from 2008 to 2014. The total amount of medical equipment increased slightly to 9192 devices during the time span. In 2014, there was a significant decrease of 16.44%. Disparities are found in the frequencies and structure of medical equipment. In some regions, medical equipment is not present or is present in low numbers.

CONCLUSIONS

The results regarding regional disparities demonstrate the regional development of the amount of medical equipment. The deployment of medical equipment is not proportional, and not all of the analysed devices are available in each region. The tests also indicate the appropriateness of the amount of medical equipment and create a platform for further investigation. The results of the analysis suggest the unsuitable distribution of medical equipment throughout the Slovak regions, where there are significant regional disparities. These findings can serve as a monitoring platform to evaluate the accessibility and efficiency of medical equipment usage.

TRIAL REGISTRATION

No human participants were involved in the research.