Population Health Indicators Research Articles

Using outcome measures in sub-national level performance management: When and under what circumstances?

There is growing interest in using outcome-based measures in sub-national level health system performance management, particularly in high-income countries. Increasingly, population health indicators used for making international comparisons are being applied at a sub-national level. This study aims to understand whether and under what circumstances population health outcome-based measures can be used for performance measurement and management at the sub-national level health systems. We have integrated empirical population-based data with key health system expert perspectives to evaluate the appropriateness of two population health indicators – amenable mortality and ambulatory-sensitive hospitalization of young children. Our assessment focused on two key aspects: (i) the technical validity of these indicators, ensuring they accurately measure these outcomes, and (ii) the functionality and legitimacy of performance information, determining whether it meets stakeholders' program or policy needs and supports strategic decision-making. Overall, we found that the 'intermediate' outcome measure, childhood ambulatory sensitive hospitalization, was more useful for identifying district-level health system performance variation than the 'end' outcome measure, amenable mortality. Performance information based on childhood ambulatory-sensitive hospitalization is more appropriate for improving decision-making, and it is more likely to be accepted by a wide range of stakeholders involved in health system performance improvement.

Exposure to firearm injury and suicide in a rural Pennsylvania county: implications for mental and behavioral health.

To evaluate the association between self-reported gun violence exposures and mental health and behavioral health indicators in a rural population. Using cross-sectional survey responses from 630 residents of a rural county in Pennsylvania, logistic regression models estimate the likelihood of residents indicating moderate or severe levels of health outcomes as a function of gun violence exposure. We control for a series of variables related to gun ownership, behavior, history with firearms and demographic characteristics. Personal firearm victimization was associated with self-reported depressive symptoms and interrupted sleep. Secondary exposure to firearm violence, particularly exposure to friends attempting or completing a suicide, was associated with higher odds of reporting severe levels (14days or more in the past month) of depressive symptoms, anxiety, and poor sleep. For firearm suicide involving a friend or family member, the odds of reporting severe levels of all three outcomes are 3 times greater (OR 2.984, 95% CI 1.457-6.108). For each additional firearm exposure, the odds of experiencing severe levels of mental health and sleep difficulties are 1.4 times greater (OR 1.384, 95% CI 1.115-1.720). Cumulative exposures also increase the odds of reporting binge drinking and drug use. Firearm violence exposure was associated with adverse health indicators in this rural population. Approaches to counter the effects of cumulative firearm exposure and firearm suicide exposure, including reinvigorating community spaces and strengthening social supports, may help to reduce mental health burden in rural communities.

Clustering Portuguese municipalities based on population health indicators

Abstract Background The large number of publicly available health-related indicators poses challenges in health planning to policymakers. Identifying patterns among municipalities may assist these processes, by grouping similar contexts and pointing out relevant differences among neighbouring locations. The aim of this work was to define clusters of municipalities based on health-related indicators. Methods All health-related indicators available at municipality level for the year 2021 were obtained from the Portuguese National Statistics Office website. Missing values were imputed with the closest available year or excluded. Indicators were standardized and K-means clustering was applied. Elbow criterion was used to select the optimal number of clusters. Sensitivity analysis was performed with a priori exclusion of indicators less directly associated with health outcomes. Results The clustering analysis revealed five distinct clusters of municipalities. Clusters were associated with specific socio-demographic patterns, providing insights into common health challenges and strengths within each group. Interestingly, geographic profiles emerged (e.g. coastal vs inland), despite no geographic information being specifically provided. One outlier municipality was identified (Lisbon), highlighting a need for special consideration. Conclusions Clustering techniques provide a data-driven approach to inform public health planning. Our findings show previously unrecognized patterns and relationships between municipalities. Using these clusters, policymakers may implement interventions based on what has been proven to work in similar contexts, enhance collaboration opportunities and promote a tailored policy development, contributing to an overall improvement of public health outcomes. Key messages • Clustering machine learning techniques provide a data-driven approach to inform public health planning. • Identifying comparable municipalities based on health-related indicators allows targeted public health interventions.

Hygienic Aspects of the Quality of Life of Residents of Yaroslavl and the Yaroslavl Region

Introduction. The relevance of the study is due to the need to conduct a scientific analysis of the quality of the country’s population life, improve the standard of citizens living through the implementation of medical measures, including medical and preventive work.The purpose of the work is to conduct a comparative analysis of the quality of life of urban and rural residents of the Yaroslavl Region based on physical and psychological well-being, determine the level of general health indicators of the working-age population, and analyze the role of organizational and preventive measures in improving the quality of life.Materials and methods. The SF‑36 questionnaire was used in the study to assess the quality of life. 600 residents (age (25.1±0.8) years) of Yaroslavl and the Yaroslavl Region took part in the survey. The ratio of men and women was 50 % and 50 %, respectively.Results. It was revealed that the quality of life of rural residents has lower values compared to city residents. This difference is especially noticeable in indicators that are directly dependent on the emotional and physical state of a person.Discussion. The conducted comprehensive analysis shows that as a result, the assessment of the quality of life of the population of the respondents was based on their subjective understanding and perception of their own situation in life, which is also typical for studies in other regions of the country. The indicators of the general health of the rural population of working age indicated insufficient access to medical care and a low level of literacy of the population in matters of maintaining and strengthening their own health, as well as medical activity.Conclusion. Hygienic assessment of the quality of the population life in terms of physical and psychological well-being made it possible to identify a number of differences in the assessment of the quality of urban and rural areas residents life at Yaroslavl and the Yaroslavl Region. Most of the considered characteristics of the quality of rural residents life had reliably significant low values in comparison with city residents.

Hygienic Aspects of the Quality of Life of Residents of Yaroslavl and the Yaroslavl Region

Introduction. The relevance of the study is due to the need to conduct a scientific analysis of the quality of the country’s population life, improve the standard of citizens living through the implementation of medical measures, including medical and preventive work.The purpose of the work is to conduct a comparative analysis of the quality of life of urban and rural residents of the Yaroslavl Region based on physical and psychological well-being, determine the level of general health indicators of the working-age population, and analyze the role of organizational and preventive measures in improving the quality of life.Materials and methods. The SF‑36 questionnaire was used in the study to assess the quality of life. 600 residents (age (25.1±0.8) years) of Yaroslavl and the Yaroslavl Region took part in the survey. The ratio of men and women was 50 % and 50 %, respectively.Results. It was revealed that the quality of life of rural residents has lower values compared to city residents. This difference is especially noticeable in indicators that are directly dependent on the emotional and physical state of a person.Discussion. The conducted comprehensive analysis shows that as a result, the assessment of the quality of life of the population of the respondents was based on their subjective understanding and perception of their own situation in life, which is also typical for studies in other regions of the country. The indicators of the general health of the rural population of working age indicated insufficient access to medical care and a low level of literacy of the population in matters of maintaining and strengthening their own health, as well as medical activity.Conclusion. Hygienic assessment of the quality of the population life in terms of physical and psychological well-being made it possible to identify a number of differences in the assessment of the quality of urban and rural areas residents life at Yaroslavl and the Yaroslavl Region. Most of the considered characteristics of the quality of rural residents life had reliably significant low values in comparison with city residents.

Association of social isolation and depressive symptoms with workplace productivity loss in a multi-ethnic Asian study

The association of health-related productivity loss (HRPL) with social isolation and depressive symptoms is not well studied. We aimed to examine the association of social isolation and depressive symptoms with productivity loss. Data on employed adults aged 21 years and above were derived from the Population Health Index (PHI) study conducted by the National Healthcare Group (NHG) on community-dwelling adults, residing in the Central and Northern residential areas of Singapore. The severity of depressive symptoms and social isolation were assessed using the 9-item Patient Health Questionnaire (PHQ-9) and Lubben Social Network Scale-6 (LSNS-6) respectively. Productivity loss was assessed using the Work Productivity and Activity Impairment Questionnaire (WPAI). We used Generalised Linear Models, with family gamma, log link for the analysis. Models were adjusted for socio-demographic variables (including age, gender, ethnicity, employment status, housing type) and self-reported chronic conditions (including the presence of diabetes, hypertension, and dyslipidemia). There were 2,605 working (2,143 full-time) adults in this study. The median reported percentage of unadjusted productivity loss was 0.0%, 10.0% and 20.0% for participants with social isolation, depressive symptoms, and both, respectively. In the regression analysis, mean productivity loss scores were 2.81 times (95% Confidence Interval: 2.12, 3.72) higher in participants with depressive symptoms than those without. On the other hand, social isolation was not found to be associated with productivity loss scores (1.17, 95% Confidence Interval: 0.96, 1.42). The interaction term of depressive symptoms with social isolation was statistically significant, with an effect size of 1.89 (95% Confidence Interval: 1.04, 3.44). It appeared that productivity loss was amplified when social isolation and depressive symptoms were concomitant. Our results suggested significant associations of social isolation and depressive symptoms with productivity loss. These findings highlighted the potential impact of social isolation and depressive symptoms on work performance and drew attention to the importance of having a holistic work support system that promotes social connectedness, mental wellbeing and work productivity.

The Impact of the COVID-19 Pandemic on the Sex Ratio at Birth in Ireland.

The sex ratio at birth (SRB), calculated as male divided by total live births, is an important indicator of population health. Typically, male live births slightly outnumber female live births. Population events, including pandemics, can alter the SRB, with effects sometimes evident 9 months post-event, potentially due to changes in sexual behavior and/or stress levels. This study investigates the impact of the COVID-19 pandemic on the SRB in the Republic of Ireland. Publicly available monthly live birth data for Ireland were obtained from the Central Statistics Office for the period 2015 to 2021. Time series analysis predicted the SRB for 2020 using data from 2015 to 2019, with comparisons made between observed and predicted values. In December 2020, 9 months after the March 2020 COVID-19 declaration, the observed SRB sharply fell to 49.44% (97.80 males for every 100 females), below the 95% prediction interval of 50.31% to 52.15%, significantly deviating from the expected male predominance. December 2020 also recorded the lowest average daily number of births (n = 145) in the study period. The sharp decline in the SRB in December 2020, alongside the lowest birth count, suggests reduced sexual intercourse at the population level, particularly in March 2020, aligning with recommendations from Ireland's Health Service Executive (HSE). The HSE advocated precautionary measures such as limiting partnered sex in March 2020 to mitigate the spread of COVID-19. These findings highlight the pandemic's potential impact on population dynamics and stress the importance of SRB monitoring as a low-cost and readily available health indicator, especially during national crises.

Mapping fertility rates at national, sub-national, and local levels in Ethiopia between 2000 and 2019.

Fertility rates are key indicators of population health and demographic change, influencing economic development, healthcare planning, and social policies. Understanding subnational variation in fertility rate is important for effective geographical targeting and policy prioritization. This study aimed to identify geographic variation, trends, and determinants of fertility rates in Ethiopia over the past two decades. We estimated total fertility rates (TFRs) and age-specific fertility rates (ASFRs) using five nationally representative cross-sectional Demographic and Health Surveys collected in Ethiopia between 2000 and 2019. ASFRs represent the number of live births per 1,000 women aged 15 to 49 during the 3 years before each survey, while TFRs indicate the average number of children a woman would have by the end of her reproductive years, calculated as the sum of ASFRs over five-year intervals. We developed model-based geostatistics by incorporating demographic and healthcare access data with spatial random fields to produce high-resolution fertility rate maps. These results were then aggregated to produce fertility rate estimates at local, sub-national, and national levels in Ethiopia. The national TFR gradually declined from 4.8 live births in 2000 to 4.2 live births in 2019, but it is still above the replacement level of 2.1 children per woman. There were sub-national and local variations in TFR, ranging from 5.7 live births in Somalia and 5.3 Oromia regions to 2.7 live births in Addis Ababa and 3.6 live births Dire Dawa cities. Geographical areas with high TFR were mostly associated with a high proportion of Muslim women and low access to health facilities. Despite a decline in fertility rates among women of reproductive age over the past two decades, marked spatial variation persists at sub-national and local levels in Ethiopia, with demographic factors determining the spatial distribution and rate of decline, highlighting the need for tailored programs and strategies in high-fertility areas to increase access to family planning.

Identify Affecting Factors on Total Fertility Rate: A Systematic Review

Background: The total fertility rate (TFR) is a key indicator of population dynamics and health. It shows the average number of children a woman would have in her lifetime, based on the current fertility rates for different age groups. Various factors affect the TFR, such as social, economic, political, technological, environmental, and health factors. By analyzing these factors and how they influence the TFR, policymakers and planners can design and implement interventions to achieve optimal population and health outcomes. Methods: We searched PubMed, Scopus, ISI Web of Science, and ProQuest databases, as well as the Google Scholar search engine systematically. We searched for studies from 13 December 2021 - 20 May 2022, without time limits. We included studies that described at least one driver of TFR. We applied the STEEPH framework (social, technology, environmental, economic, political, and health) method to analyze the qualitative data. Results: We included 64 studies from 26 countries. We identified 410 drivers of TFR, and classified 181 drivers into six main categories: Social, technological, environmental, economic, political, and health. The main factors that lower the fertility rate are education, aging, poverty, postponing marriage (social), exposure of women to mass media (technology), type of residence and living in urban areas, road accidents (environmental), income and economic situation (recession and inflation), unemployment, debt, women’s employment (economic), government policies (political), use of anti-fertility drugs (health). The main drivers that raise the fertility rate are having first child girls, women’s proximity to their workplace (social), use of assisted reproductive technology (technology), living in rural areas and natural and unnatural disasters (environmental), improvement in men’s labor market conditions, employment opportunities (economic), increased parental leave (political), high infant mortality (health). Conclusions: We identified a comprehensive list of effective drivers that have increased or decreased TFR in different parts of the world. It is necessary to review these drivers considering the specific conditions and social, cultural, economic, and political coordinates of each country. This review should inform policymakers' actions in this area.

Maternal Health Disparities in Acute Care Rehabilitation.

Patients with a high-risk pregnancy or who immediately give birth are often not provided access to acute care occupational and physical therapy during their hospital admission. The greatest potential for health care crises, including maternal mortality, occurs during the first 6 weeks after birth. Maternal mortality and morbidity, which continue to rise in the United States, are considered indicators of the overall population health of a country. It is estimated that over 80% of pregnancy-related deaths are preventable. The leading causes of death within the first 6 days after birth are hemorrhage, hypertensive disorders, and infection. Implicit biases about childbearing individuals who are perceived to be relatively young, independent, active, and healthy may unintentionally contribute to areas of substandard care that adversely impact maternal health outcomes. It is a professional and ethical imperative that health providers, including occupational and physical therapists, establish themselves as allies to patient groups at high risk for disparate treatment. The Acute Care OB Rehab Implicit Bias Self-Reflection Tool is an instrument designed for health providers to identify stereotypes that may contribute to inequitable access to rehabilitation in the hospital after birth. Including rehabilitation services for the perinatal population in the hospital setting can play a pivotal role in early detection of adverse events with activity that may directly impact the increasing maternal mortality rate in the United States.

The hierarchy of needs for laboratory medicine requires a foundational care delivery model

Under the collective weight of growing test volume, staffing constraints, and Medicare reimbursements cuts, an enhancement-based, alternative payment structure focused on rewarding the laboratory's care delivery efforts via benchmarking is appealing. However, achieving a value-based payment model requires the development of an inclusive laboratory care delivery model (LCDM) framework. Today, a holistic, practical LCDM framework for laboratory medicine does not exist. However, such creation is essential for establishing unifying tenants of practice for value-tracing by which standardized key performance and population health indicators can be derived. LAB-CARES is the first step in formulating an LCDM with the primary objective of defining and streamlining the processes and strategies necessary to deliver and articulate the value of diagnostic excellence across the healthcare system. The goal of LAB-CARES is to maximize efficiencies, enhance quality, disseminate clinical expertise, increase patient safety, and promote integrative practice. LAB-CARES is designed to improve an individual patient's quality of life (longitudinal laboratory results – beyond one test) and their surrounding communities (e.g., through surveillance and prevention – beyond one patient). Further professional conversation and efforts are paramount to integrate LAB-CARES as a formalized structure within the healthcare landscape.

Group Antenatal Care (G-ANC): A way forward to improve Afghanistan's utilisation of maternity care.

In Afghanistan, maternal mortality and infant mortality - two key indicators of population health - are among the highest in the developing world, partly because of nearly a half-century of conflict and persistent socioeconomic instability [1]. The latest data in 2017 show that Afghanistan's maternal mortality ratio (638 per 100,000 live births) and infant mortality rate (36 per 1,000 live births) are much higher than other countries with comparable economic development [1]. Poor health infrastructure, political upheaval, reductions in donor funding and corresponding disruptions in health services, insecurity, climate change, and escalating humanitarian crises further intensify these issues [1].

Analysis of the Ghanaian Health System and Patients Safety within the IHI Triple Aim Framework

Objective: To analyze Ghana’s healthcare system challenges through the Institute for Healthcare Improvement’s Triple Aim framework encompassing population health, patient experience and per capita cost metrics. Method: Dimensional analysis of peer-reviewed papers, government data and case studies assessed population health indicators and equity, literature on patient perspectives regarding quality and responsiveness of care along with evaluation of cost trends and deficiencies driving expenditure growth. Results: Gaps persist in universal health coverage amid rural-urban disparities in access and financial protection. Care experiences vary significantly by socioeconomic status and geography. Rising costs attributed to inefficiencies in areas like procurement and prescriber practices. Scientific Novelty: Unique application of Triple Aim framework for structured health systems analysis in a lower-middle income sub-Saharan country enabling robust diagnosis of coverage, quality, sustainability gaps. Practical Significance: Demonstrates utility of balanced Triple Aim methodology for health policymakers in low-resource settings to systematically evaluate healthcare priorities across access, outcomes, experiences and costs.

Analysis of the Ghanaian Health System and Patients Safety within the IHI Triple Aim Framework

Abstract Objective: To analyze Ghana’s healthcare system challenges through the Institute for Healthcare Improvement’s Triple Aim framework encompassing population health, patient experience and per capita cost metrics. Method: Dimensional analysis of peer-reviewed papers, government data and case studies assessed population health indicators and equity, literature on patient perspectives regarding quality and responsiveness of care along with evaluation of cost trends and deficiencies driving expenditure growth. Results: Gaps persist in universal health coverage amid rural-urban disparities in access and financial protection. Care experiences vary significantly by socioeconomic status and geography. Rising costs attributed to inefficiencies in areas like procurement and prescriber practices. Scientific Novelty: Unique application of Triple Aim framework for structured health systems analysis in a lower-middle income sub-Saharan country enabling robust diagnosis of coverage, quality, sustainability gaps. Practical Significance: Demonstrates utility of balanced Triple Aim methodology for health policymakers in low-resource settings to systematically evaluate healthcare priorities across access, outcomes, experiences and costs.

Методические подходы к измерению общественного и индивидуального здоровья как медико-социального ресурса и потенциала общества.

One of the main indicators in healthcare is public and individual health. However, despite a comprehensive, in-depth and long-term study of the theoretical component of «health», there is still a need to define its universal and effective criteria, methodological approaches to measuring public and individual health as a medical and social resource and the potential of society. The purpose to analyze the published data in the scientific literature on methodological approaches to measuring public and individual health as a medical and social resource and the potential of society. Research methods. The collection, study and analysis of available information sources in the scientometric databases WoS, Scopus included in the list approved by the Higher Attestation Commission under the Ministry of Education and Science of the Russian Federation. The search for scientific articles was carried out in the electronic databases PubMed, Google Scholar, eLibrary.RU by keywords. 47 articles were included in the review for analysis. The results of the study. The analysis of the literature data has shown the need to systematize and adapt existing methods of assessing public and individual health into a single multi-level assessment system. Indicators of public and population health should reflect all aspects of the well-being of the population. This is evidenced by the published data on measuring instruments, which have shown their effectiveness, but have a disadvantage – the lack of complexity, or the complexity claimed in the research is not complete. Conclusion. Currently, there is a whole arsenal of methodological approaches to measuring public and individual health. To assess it as a medical and social resource and the potential of society, the use of individual indicators does not allow a comprehensive assessment of public health, in addition, the lack of monitoring of an integrated assessment of public health makes it difficult to apply operational management decisions in the field of healthcare.

A Summary Prospecting of Possibilities of Providing Public Health Services at the Level of North-East Region of Romania

This paper investigates issues related to the public health system in the North-East Region of Romania, focusing on possibilities for addressing/improving specific deficiencies/difficulties. The concerned region is characterized by the highest and densest population in the country, with a significant proportion of residents in rural areas (55%) and a high level of poverty. Population health indicators are among the weakest nationally, and the healthcare infrastructure is inadequate for the population's needs, with an uneven distribution that generates significant inequalities in access to medical services in the respective counties. Starting from the (statistical) certainty that Romania ranks among EU member states with the highest avoidable mortality, the paper addresses both preventable causes through public health interventions and treatable causes through quality care. After a brief introduction, the overall state of the public health system in Romania is examined, followed by a detailed analysis of the main issue stated in the title, highlighting multiple critical aspects based on data and information from official reports of prestigious institutions. Special attention is given to specific issues in local communities related to healthcare infrastructure and the provision of medical services, as well as possible solutions offered through the implementation of the General Regional Health Services Plan 2021-2027 in the North-East Region. The paper concludes with a section of conclusions, which includes perspectives on the future development of the analyzed sector.

Lost years of life due to the mortality from diseases of the urinary system in the industrial region of Kazakhstan with air pollution

Introduction. The relevance of the epidemiological problems of loss of years due to diseases of the kidney and urinary tract is due to the progressive gain in the number of patients in many regions and countries of the World. 
 Purpose. Estimation of years of life lost due to the mortality from diseases of the urinary system (DUS) in the Pavlodar region, which is one of the industrial regions of Kazakhstan. 
 Materials and methods. Medical-demographic (mortality rates) and medical-statistical (primary morbidity rates) data was obtained from the Department of Statistics of the Republican Center for Electronic Health Care of the Republic of Kazakhstan (RCEHC RK). The study period was eight years (from 2015 to 2022). The Years of Life Lost (YLL) indicator was calculated according to methodological recommendations. An assessment of the relationships between population health indicators for pathologies of the urinary system (US) with social factors (gross domestic product per capita – GDP), and environmental indicators (ecological and meteorological) as possible causes of adverse events in human health was carried out using correlation and time series analysis.
 Results. In the structure of years of life lost due to the mortality from US organs, chronic renal failure (CRF, 55.96–65.85%) led. In the regional center of Pavlodar, there was a peak in years lost in mortality from DUS over 2021 (3.3‰ YLLs), during the COVID-19 pandemic. According to the average annual losses by age groups, in the Pavlodar region, the maximum losses were detected in the elderly (10.5‰ YLLs) and senile (15.8‰ YLLs) age. An excess of the maximum one-time concentrations of pollutants in the atmospheric air above the MPC level with the highest pollution level in 2018 was registered. Correlation analysis showed a high level of correlation between the loss of years of life because of the mortality due to US diseases with atmospheric air pollution in Ekibastuz (r = 0.80), weak – 
 in Pavlodar region (r = 0.28) and low – in Pavlodar (r = 0.13).
 Limitations. Of the environmental pollution factors, only atmospheric air pollution factors were studied, which does not reflect all the possible effects of environmental pollution on population health. In the group of reasons with code R, the conclusion “old age” prevailed, which may have led to an inaccurate analysis of the causes of death.
 Conclusion. Regional connections between the loss of years of life due to mortality due to US diseases with atmospheric air pollution and temperature in the winter season, as well as newly identified morbidity with atmospheric air pollution, have been identified.

Characteristics of Primary Morbidity in the Population of the Far Eastern Federal District (Retrospective Analysis)

Background. The peculiarities of the economic and geographical position of the Far Eastern Federal District determine climatic, socio-biological and medical and organizational characteristics that affect the leading criteria for population health. A relevant and priority direction for the development of the macro-region is the study of the main indicators of population health, reflecting the organizational and economic potential of the region, as well as the preservation and promotion of public health based on the formation of a healthy lifestyle and increasing the availability and quality of medical care. Aims — study and analyse the primary morbidity of the adult population in the Far Eastern Federal District. Methods. A retrospective analytical study was carried out. An analysis of the dynamics of primary morbidity by rate of increase (decrease) and a comparative analysis of average annual primary morbidity, including major classes of diseases diagnosed for the first time in life, in the adult population in the macro-region as a whole and in its 11 constituent entities is given. I–IV, VI–XIV, XVII, XIX classes of diseases were taken into account according to the International Classification of Diseases of the 10th revision. Results. The Far Eastern Federal District ranked 5th in descending order by primary morbidity among other Russian macroregions throughout the study period. There was variability in the primary morbidity ranking among the constituent entities of the district. The dynamics of primary morbidity showed a moderate upward trend in 2017, followed by two years of stable trend, and in 2020 there was a moderate downward trend. The prevalence of disease in patients diagnosed for the first time in the population of the other federal districts of the country was characterised by individual variability. At the same time, in most macro-regions a moderate to pronounced decrease in primary morbidity was found in 2020 (rate of increase (decrease) morbidity: from –2.3 to –7.2%), except for the Central Federal District (rate of increase (decrease) morbidity: –0.1%) and the Urals Federal District (rate of increase (decrease) morbidity: –0.2%), where this indicator remained stable. Conclusions. In the Far Eastern Federal District, characteristic variability in the level, dynamics and structure of primary morbidity among the population has been identified. A general pattern with all-Russian indicators was revealed, consisting in a decrease in incidence in most classes of diseases in 2020, except for X Respiratory disease, in which stability remained. The revealed features of the rank distribution of primary morbidity by classes of diseases in the subjects of the district will make it possible to be based on the principle of targeted distribution of funds when planning the volume of medical care to the population.

Risk of premature mortality due to smoking, alcohol use, obesity and physical activity varies by income: A population-based cohort study

BackgroundPremature deaths are a strong population health indicator. There is a persistent and widening pattern of income inequities for premature mortality. We sought to understand the combined effect of health behaviours and income on premature mortality in a large population-based cohort. MethodsWe analyzed a cohort of 121,197 adults in the 2005–2014 Canadian Community Health Surveys, linked to vital statistics data to ascertain deaths for up to 5 years following baseline. Information on household income quintile and mortality-relevant risk factors (smoking status, alcohol use, body mass index (BMI), and physical activity) was captured from the survey. Hazard ratios (HR) for combined income-risk factor groups were estimated using Cox proportional hazards models. Stratified Cox models were used to identify quintile-specific HR for each risk factor. ResultsFor each risk factor, HR of premature mortality was highest in the lowest-income, highest-risk group. Additionally, an income gradient was seen for premature mortality HR for every exposure level of each risk factor. In the stratified models, risk factor HRs did not vary meaningfully between income groups. All findings were consistent in the unadjusted and adjusted models. ConclusionThese findings highlight the need for targeted strategies to reduce health inequities and more careful attention to how policies and interventions are distributed at the population level. This includes targeting and tailoring resources to those in lower income groups who disproportionately experience premature mortality risk to prevent further widening health inequities.

Health trends in Canada 1990-2019: An analysis for the Global Burden of Disease Study.

Monitoring trends in key population health indicators is important for informing health policies. The aim of this study was to examine population health trends in Canada over the past 30years in relation to other countries. We used data on disability-adjusted life years (DALYs), years of life lost (YLL), years lived with disability, life expectancy (LE), and child mortality for Canada and other countries between 1990 and 2019 provided by the Global Burden of Disease Study. Life expectancy, age-standardized YLL, and age-standardized DALYs all improved in Canada between 1990 and 2019, although the rate of improvement has leveled off since 2011. The top five causes of all-age DALYs in Canada in 2019 were neoplasms, cardiovascular diseases, musculoskeletal disorders, neurological disorders, and mental disorders. The greatest increases in all-age DALYs since 1990 were observed for substance use, diabetes and chronic kidney disease, and sense organ disorders. Age-standardized DALYs declined for most conditions, except for substance use, diabetes and chronic kidney disease, and musculoskeletal disorders, which increased by 94.6%, 14.6%, and 7.3% respectively since 1990. Canada's world ranking for age-standardized DALYs declined from 9th place in 1990 to 24th in 2019. Canadians are healthier today than in 1990, but progress has slowed in Canada in recent years in comparison with other high-income countries. The growing burden of substance abuse, diabetes/chronic kidney disease, and musculoskeletal diseases will require continued action to improve population health.