Multiple faces of the health transition

Hospitals and other health care establishments are collecting huge amounts of data about patients. With development of information technologies in 1960’s there was also progress in systems for efficient processing of these data. DRGs (Diagnosis Related Groups) was formed in USA among the first classification systems that categorizes hospitalization cases into groups, so that groups are homogeneous from the clinical and cost-related viewpoints. Categorized data serves for calculating fees charged for acute medical care. DRG system spread rapidly from USA to other countries (e.g. Australia, Austria and Germany) and since 1995 there were efforts to adopt the system also in the Czech Republic. In 2011 the new way of DRGs implementation into Czech health care system was developed by IBM Company to automate and streamline the algorithm of processing the data file with all cases of inpatients from the reference year. Since 2012 almost 75 % of the inpatient health care costs have been calculated using DRGs. This paper shows the possible use of statistical methods for the health care cost determination on the example of the Czech Republic. The outputs contain graphical representation and the selected characteristics of the data set with complete information about the inpatient care provided in 2010 in the Czech Republic.

In India, the under-five mortality rates (U5MR) including neonatal, infant and child mortality rates started declining since the late 1970s and socio-economic behavioural determinants have had a significant role in reducing child mortality. Factors such as place of residence and sex have bearing on child mortality. The basic objective of this study is to describe and understand how deaths of children under-five years vary with and depend upon these socio-economic characteristics. The study uses data from the three National Family Health Surveys conducted between 1992 and 2006 to study changes that have taken place across regions over time. U5MRs are computed for the three surveys for four subgroups viz., Urban Males, Rural Males, Urban Females and Rural Females. The box percentile plot is used to compare the distribution for its extent of variation and the trend in variations graphically. Distribution dynamics is used to examine explicit patterns of cross regional interactions and states with low and high U5MRs are identified. The results of this study show that a higher share of public services on health, education and amenities has had a significant impact in bringing down mortality levels. The essentiality of public services is thus emphasised.

At adult ages x, the force of mortality increases more or less exponentially with age, and the parameter associated with age, Beta, can be used to gauge the rate of senescence (ageing) of a generation. The hypothesis has recently been advanced that, with rare exceptions, the rate of senescence at the individual level is constant through space and time, and not far from 0.1.
We contribute to this discussion in two ways: first, we propose a new and simpler method to estimate the rate of senescence Beta when frailty and period effects operate, and, secondly, we offer a few empirical estimates for Beta, for various cohorts, in different countries (all data taken from the Human Mortality Database). The transformation that we suggest leads to a linear estimation, which is considerably simpler than all the others we are aware of, characterized by non-linear equations, numerical recursive likelihood maximization, etc.
Our estimates of the rate of senescence Beta are all very close to 0.1, but most of the differences that we detect (e.g. by country) are statistically significant, and there appears to be a decreasing trend of Beta over time.

Hypertension is a major public health problem in many sub-Saharan African countries including Ghana. The prevalence of hypertension in Ghana is on the increase and evidence suggests that awareness, management and control in urban poor communities are very low. The objective was to assess the prevalence, awareness and control of hypertension in Accra. The study was a cross-sectional study of adults in their reproductive ages (15-49 for women and 15-59 for men). The overall prevalence of hypertension was 28.3%. The prevalence increased with age in both men and women. Among respondents who had hypertension, 7.4% were aware of their condition, 3.9% were on antihypertensive medication while 3.5% of hypertensive respondents on treatment had their blood pressure controlled below 140/90 mmHg. The level of awareness and treatment was lower in men than in women. Among individuals on treatment, the level of control was higher among women compared with men. The low levels of awareness, treatment and control despite the high prevalence of hypertension should be a matter of concern to stakeholders in the health sector. Urgent medical assistance, which should be comprehensive, is advocated for implementation in such communities. The human resource needed to implement such plans should have adequate training.

To date, no study has satisfactorily addressed the relationship between social mobility and mortality in China’s context. The present paper examines how grandparents’ status, parents' status and individuals' status together influence the physical well-being of individuals, using the China Multi-Generational Panel Dataset-Liaoning (CMGPD-LN). A mobility-Path model is proposed to estimate effects of specific components in individual mobility course for three generations. Results show that mobility itself has effects on mortality risks. The relative effects of grandfather position, father position and individual position vary by individuals' childhood, early adulthood and late adulthood. Cumulative effects of socioeconomic circumstances over a lifetime are not obvious in the current analysis.

Over the years there has always been an interest in the relationship between the two important variables for people: marital status and health. With the development of economic and the society, the nature of marriage and family has changed a lot nowadays. In the case that the value of marriage is coming under increased scrutiny and many aspects of marital roles are changing, it is necessary to find whether or not marriage is still associated with enhanced well-being.
Data for this analysis come from the EASS (East Asian Social Survey) Health Module conducted in 2010. Our study found that, there are almost no significant impact of marital status on people’s subjective health condition and physical health, but there are significant impacts on people’s mental health and health related habits. The married people always feel calm and energetic more frequently than the unmarried people significantly, and the married couples always feel less depressed and downhearted. The health related living habits are also different between the married and the unmarried. Married people smoke significantly more frequently than unmarried people in China, but significantly less frequently than unmarried people in Japan and South Korea. Married people drink alcohol significantly more frequently than unmarried people in Japan.

Previous studies have shown that bereavement is associated with increased mortality. However, the amount and nature of post bereavement mortality can be assumed to differ by various circumstances surrounding widowhood. One such factor is the cause of death of the predecedent partner. We used data from a population registration database at Statistics Finland with detailed sociodemographic information to examine the excess mortality among those bereaved by two specific groups of causes of death of a predecedent spouse (altogeter 43 100 bereavement persons of whom 7 858 died during the follow-up). The method includes Cox regression model and the results are presented as hazard ratios (HRs). Among the widowed men and women, mortality from external causes of death was 4.69 -fold when the predecedent spouse had died from alcohol related death and as high as 10.09 -fold when the cause of death of the predecedent spouse was accidental and violent. Mortality risks were especially large soon after the death of a spouse. Immediate stress and the grief of bereavement are thus some of the causal mechanism leading from the loss of spouse to mortality. Support to those widowed should be a priority. Especially vulnerable are those bereaved by alcohol related causes of death or accidents and violence and soon after the bereavement.

A study was undertaken to assess the underlying determinants of stunting among under-5 children in Ugandan cattle corridor; A case study of Nakaseke and Nakasongola districts with specific objectives; assessing the effect of demographic and socio-economic factors on stunting of children below five years. Secondary data of household socio-economic and demographic characteristics as well as anthropometry for children below five years was used. The findings indicated a statistically significant relationship between stunting and maternal occupation specifically those who did pastoralism (pr=0.013) and business (pr=0.015).
In the multivariate logistic regression model, maternal occupation remained a significant determinant on child stunting status especially on women who did pastoralism (pr=0.051*). Women who did pastoralism as their occupation were less likely to have stunted children than women who did peasantry as reference category (OR=0.12).
In conclusion, there is need to obtain primary data at an appropriate time, taking into consideration, the use of an appropriate indicator of child nutrition status that is, by obtaining data on child weights to enable use of wasting as an alternate regressor/indicator.

In a span of 40 years, the life expectancy of the Philippines increased by ten years for males and 11.5 years for females. It is unknown however, which ages contribute most to these gains in life expectancy. Using discrete decomposition approach, this paper estimates the relative contributions of each age group in the improvement of life expectancy over the years, separately for males and females. The resulting life expectancy given possible gains in mortality rates in the next few years in the context of the millennium development goals will also be estimated.

It has been a long accepted demographic maxim that females outlive males. Using data for England and Wales, we show that life expectancy at age 30 is converging and continuation of this long-term trend suggests it could reach parity in 2030. Key among the reasons identified for the narrowing of the gap are differences in smoking prevalence between males and females which have narrowed considerably. Using data from 30 comparator countries gender differences in smoking prevalence are found to explain over 75% of the variance in the life expectancy gap, but other factors such as female emancipation and better health care are also considered. The paper presents a model which considers differences in male and female longevity in greater detail using novel methods for analysing life tables. It considers the ages from which death is being postponed to the ages at which people now die; the relative speed at which these changes are taking place between genders; how the changes observed are affecting survival prospects at different ages up to 2030. It finds that as life expectancy continues to rise there is evidence for convergence in the oldest ages to which either gender will live.