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T.M.Maximova, E.P.Kakorina, T.A.Korolkova

N.A.Semashko Institute for Research on Social Hygiene, Public Health, Economics and Management of the Russian Academy of Medical Sciences

Morbidity of Russia's population and its regional peculiarities

Morbidity is the objective mass phenomenon of the emergence and prevalence of pathological conditions among population, that is the result of the interaction of present and precedent generations with the environment in its broad sense and that reveals itself in different forms in specific circumstance of society existence.

There are evident general regularities in formation of the pattern of disease in the different regions of Russia, which are connected with age and biological processes and life conditions. The average number of registered children diseases reduced gradually with age reflecting processes of children adaptation to life circumstances as the basic organs and systems develop. The structure correlation is preserved: in childhood the main part fall to respiratory diseases (70 - 75%), infectious and parasitic diseases, diseases of the nervous system and organs of senses (5 - 7%); in adolescence injuries and intoxications are in the principal place parallel with respiratory diseases, diseases of the nervous system and organs of senses; in adult population respiratory diseases constitute up to 27%, cardiovascular diseases - up to 15%, they are followed by osteomuscular and connective tissue diseases (10 - 12%). These regularities are sustainable and stable at different territories.

Special studies reveal that with health care accessibility morbidity in children varies from 1600 to 2600 ‰ and in adult population it varies from 1000 to 1500‰ according to the data on the application for medical services. Medical examinations reveal on the average 800-1000 cases of chronic diseases per 1000 children population and 1200-1500 cases per 1000 adult population. These cases require medical supervision.

The foundation for health of every generation is laid in childhood. The specific structure of pathology, which is forming in the elder ages, depends on the health condition of child at the age of one year. Thus the children that have been frequently ill at the age of one year (4 times a year and more) in future have respiratory diseases and diseases of digestive tract more often, and the children that have been healthy subsequently more often have infectious and parasitic diseases more often in future. Every group in elder ages is divided into those who form the chronic pathology and those who go out of childhood healthy or have episodic acute pathological processes but remain practically healthy. From children who often fell ill at the age of one-year (4 times a year and more) half and more have the chronic diseases at the elder ages.

On the average morbidity of children registered during one year includes 75-80% of acute diseases, 3.5% of newly revealed and about 8% of earlier detected chronic diseases. The quota of newly revealed chronic diseases doesn't really change with age (2.5%-3.8%). The cases of earlier detected chronic diseases constitute 200-300 ‰ according to application for medical services and up to 1000 ‰ according to the data of medical examination among the children of the elder age groups. About 20% of children fall ill 4 times and more a year.

According to the data of the interview survey 30-40% of the mothers point out that their children have the long history of chronic diseases. About 15% of mothers indicates that the disease had begun from birth, in 10-15% of cases the parents and the near relations also had the analogous forms of pathology, 10-20% (6% in the rural area) connect the beginning of diseases with the nutrition, the housing conditions and the environment.

According to the data on applications for medical services in adult population the average number of diseases increases with age: from 1.3 to 1.6 of diseases per person at the age of 40-49, 1.7-2.0 of diseases per person at the age of 50-59, 2.2-2.8 of diseases per person at the age of 60 and over. According to the data of medical examinations there is also the rise on chronic diseases frequency with age from 0.4-1.0 cases at the age of 20-29 to 3.6-3.9 cases at the age of 60 and over. With age the share of people having one disease is reducing and the increase of pathologic condition combinations is observed. The share of persons having 6 diseases and more registered during a year makes 1.5-4% at the age of20-24, 3-9% at the age of 25-29, 5-10% at the age of 30-39 and 9-18% at the age of 60 and over. There are also local peculiarities. The largest proportion of persons having the complex of pathological conditions is observed in Kemerovo (25.2% at the age of 50-59, 33.6% at the age of 60 and over).

The newly revealed cases of chronic diseases make up to 10 % a year. These levels are similar for different forms of pathology (cardiovascular and respiratory diseases, diseases of digestive organs, urinogenital system, skin and hypodermic cellulose). The higher frequency of the chronic pathology occurrence can be observed only at several territories: in Kemerovo these are cardiovascular diseases (23.8‰), respiratory diseases (13.6‰), diseases of skin and hypodermic cellulose (17.4 ‰); in Maykop these are disease of digestive organs (37.9‰) and urinogenital system (22.3 ‰).

About 40% of patients have the chronic diseases during 7 years. The proportion of concomitant diseases rises with age from 10-15% at the age of 40-49 to 20-30% at the age of 60 and over. The largest proportion of all acute diseases fall on respiratory diseases (140-200‰), acute cardiovascular diseases make 2-3‰, diseases of digestive organs constitute 3-6 ‰, diseases of urinogenital system, skin and hypodermic cellulose - 4-9‰.

Chronic diseases detected earlier make more than 50% of all registered diseases in adult population and its acute conditions make 5-10%. For all this 75-80% of diseases are regarded as basic diseases, 10-20% as the concomitant conditions and 2-4% as complications. The rise in the number of chronic diseases and also frequency of its acute conditions are observed with age, the acute conditions on the average constitute 100-150‰ (to 200‰ at the age of 49 and over). The highest frequency of acute conditions is registered in Maykop (195.1‰) where general morbidity is lower.

The study of morbidity that was conducted with single methodical approach in different regions revealed the stable levels of several diseases and that allows judging about the frequency of this phenomenon with greater confidence. The tentative frequency of the most prevalent diseases of children and adult population is given in the Table 1. The deviations from the structure correlations and the fluctuations of the morbidity level in several forms of pathology indicate the effect of the concrete factors.

Table 1

Ranges of the average morbidity levels for revealing the local peculiarities ()

Classes of diseases and several nosologic forms

Children

Adults

Infectious and parasitic diseases

100-135

20- 35

including intestinal infections

15- 30

1,5-2,0

Mental disorders

20- 37

50- 70

including neuroses

10- 18

6- 12

Diseases of ear and mastoid process

30- 50

25- 35

Diseases of the cardiovascular system

3- 7

250-380

including hypertension

-

70-110

Ishemic heart disease

-

40- 90

Diseases of the respiratory system

1400 -1600

240-260

Including pneumonia

8 - 13

3- 4

Chronic bronchitis

4 -6

25- 35

Bronchial asthma

3 -6

2,5-3,0

Diseases of the digestive system (without dental and oral diseases)

43 -56

60-140

Including gastritis, duodenitis

10 -20

25- 50

Cholecystitis

10 -13

15- 25

Diseases of the urinogenital system including acute cystitis

1,3-1,5

2- 3

Acute and chronic pyelonephritis

5 -12

0,3-0,5

Diseases of the skin and hypodermic cellulose

45 -95

30- 40

Including dermatitides

28- 39

8- 12

Diseases of the osteomuscular system and connective tissues

12- 19

130-150

Congenital anomalies

11- 21

1,5-3,0

Among these factors the informational ones are significant: these are the peculiarities of medical provision, the number of physicians with the different specialties, their training and the belonging to one or another clinical school, the specifics of the registration and the coding of diagnoses.

The morbidity of several pathology forms exceeds considerably the highest level of the average in a number of territories. These diseases must be considered as those problem situations that are subjects to be detected during the search of pathogenic factors.

Every form of pathology can be considered both from the point of view the need for medical care and of its social importance. There are diseases that are regarded as the main causes of death, those leading to the different life restrictions including disability and those that arose only brief health disorder but cause the great economic damage due to its mass character.

At present time health status cause different kinds of the life restrictions observed in 3-5% of children, 9-12% of adolescents and 18-20% of adult population of the total population observed.

These levels are approaching the corresponding indexes given by several foreign studies (L.M.Verbrugge, 1990).

According to the data of A.G.Tchuchalin and D.S.Soldatova children have respiratory viral infections on the average 6 times a year. The materials of World conference on respiratory health indicate that children at age 5 years and over have from 5 to 8 episodes of respiratory diseases a year. According to the data of WHO an adult have respiratory viral infection twice a year.

But in some territories (in Moscow region for example) in 1992 the decrease of respiratory diseases distribution was recorded in both children and adults owing to the applications for medical services on the occasion of influenza and acute respiratory infections.

During the profound medical examination it was revealed that 4-7% of children had pneumonia and 0,5-0,7% had bronchial asthma and chronic bronchitis in medical history. In addition harsh breathing was revealed in 2% of children and chronic nasal breathing disorder in 5-7%. Up to 70% children has from 1 to 3 acute respiratory diseases a year and from 8% to 20% of children have chronic diseases of tonsilla and adenoids.

Chronic bronchitis morbidity rise with age up to 6-7% in adults at the age of 60 and over, the bronchial asthma is diagnosed in 1-1,3% of population at the same age.

Outlined trend to the fall in case number of temporary incapacity for work connected with care of an ill child represents a specific danger. The cases number of temporary incapacity for work connected with care of an ill child is smaller than half of all disease cases in children (Table 2), at the same time proportion of mother temporary incapacity for work in connection with chronic disease of her child is infinitesimal. The data of the interview survey indicate that mothers always take sick-leave certificates for care of their ill child up to full recovery in 60% of illness cases in children under school age and in 50% of illness cases in children of school age. And so even in cases of extreme necessity maternal care of an ill child is not ensured in full and that can lead to forming chronic pathology in future.

Table 2

Ratio of the children diseases cases numbers with mother temporary incapacity for work in connection with care of children to the numbers of the registered diseases cases (%).

Class of diseases

Jochkar-Ola

Kemerovo

Majkop

Salavat

Infectious and parasitic diseases

35.9

31.9

35.7

58.1

Diseases of nervous system and organs of sense

13.3

17.3

14.1

21.3

Diseases of respiratory organs

39.5

51.1

36.8

59.4

Diseases of digestive organs

3.4

8.9

7.4

10.4

Diseases of the skin and hypodermic cellulose

11.7

13.9

19.4

16.7

Injuries and intoxications

4.5

2.5

8.8

15.1

Total

32.8

31.6

31.6

49.9

Types of population contacts with medical services net at the ambulatory-polyclinic level are of specific interest for evaluation of medical activity efficiency to correct of arising pathology.

According to the results of the special study full recovery is in 20-30% of all illness cases, the proportion of health improvement is the same. Health worsening including death is registered in 1,0-1,3% of illness cases (0,1-0,4% die during the period of observation), in most cases (30-40%) health state is not change.

During the medical examination physicians made conclusions on prognosis of diagnosed chronic pathology in conformity with their specialties. Recovery is supposed only in the small share of patients (17%), compensation of functions is possible in 30% of illness cases. According to data of applications for medical services health state was without changes in 48% of patients and in 5% of cases it became worse.

Thus in conformity with the modern medical conceptions in considerable share of patients chronic diseases proceed over a long period of time without possibility of radical clinical recovery in future. This objective reality calls for not only medico-social rehabilitation but also for help to patients in adaptation to their conditions. And for that it is necessary to know frequency of ill condition and disorders provoked by disease and accordingly to know ways for its correction. It is necessary to give much attention to practically healthy people strengthening their capacity for self-promotion of health in spite of diseases no matter how serious they are.

Pathology forms discomfort connected with symptoms of diseases and limits life-activity of people to a certain extent. Certain kinds of pathologic symptoms can appear at the prenosologic level. The considerable share of population suffers from certain forms of discomfort (different kinds of headache, pains in heart, in joints, memory weakening, movement difficulty, disorders in functions of gastroenteric tract).

Frequency of these deviations must be known equally with frequency of pathologic processes and it is necessary to study not only genesis of these conditions but correction means including pharmaceutical and to develop recommendations on the change of adequate life style. Pathologic symptomatology forms in childhood: 3-6% of children has epigastric and subcostal pains, 2-4% has headache after eating and 2-3% has it constantly. The medical examination revealed hard nasal breathing in 5-7% of cases (these cases was connected with chronic pathology of otorhinolaryngologic organs) and certain drop of visual acuity (0-0,1) and hearing disorders.

Quantity of different pathologic conditions increases with age. Most deviations is registered in 10-15% of examinated people at the age of 60 and over (more often heart pains and dyspnea, more seldom neurologic conditions), most share of people has vertigo, 25% of them have drop of visual acuity (0-0,1) and 10% have hearing disorders obviously making difficulties in the normal intercourse. Every third person reports on fall of working capacity and every fifth person reports on sleep disorders (Table 3).

Table 3

The prevalence of the main pathologic symptoms in adult population (medical examinations in Kineshma) ().

Symptoms

Age, years

24-29

30-39

40-49

50-59

60 and more

Total

Heart pains

27.6

36.0

127.7

251.3

464.1

221.5

Dispnea in the time of an ascent to the second floor

12.0

46.0

149.5

477.7

696.9

344.6

Legs endema

-

-

24.9

46.3

99.1

44.2

Headache

           

diffusive

32.3

56.0

118.4

221.0

261.8

150.6

Paroxyntic

32.3

42.0

93.4

99.8

149.5

84.9

Giddiness

           

Systematic

4.6

10.0

31.1

49.9

71.8

37.5

episodic

41.4

46.0

96.5

183.6

258.5

138.6

Head noises

           

permanent

4.6

-

6.2

42.7

71.8

32.7

often

4.6

-

21.8

51.6

156.9

65.7

episodic

4.6

24.0

65.4

117.6

132.1

75.2

Visual acuity*:

           

0,8-1,0

852.5

832.0

729.0

499.1

202.3

557.0

0 - 0,1

78.3

76.0

96.6

121.2

256.8

147.2

Lenticular opacity*

-

2.00

-

44.6

45.3

92.9

Pathologic changes of retina vessels

32.2

34.0

46.7

46.1

284.1

135.4

Speaking in a whisper:

           

4-5 m

-

2.0

24.9

48.1

128.8

55.3

2-3 m

-

2.0

-

8.9

24.7

10.6

1 m

-

4.0

-

23.3

80.9

32.4

Decreasing of work

           

capacity:

           

moderate

13.8

16.0

49.8

128.3

285.7

128.6

Pronounced

4.6

2.0

-

21.3

23.9

12.3

Sleep disorders

-

-

71.6

130.1

195.7

99.2

Numbness in one hand or leg

9.2

10.0

62.3

85.5

93.3

53.9

in two hands or legs

-

6.0

18.7

23.1

23.1

14.3

Force decline

           

in the extremities

-

6.0

32.1

58.8

80.0

41.0

Limitation of active movements capacity

-

4.6

6.0

24.9

32.9

20.0

* right eye

Heart pains of different kinds are noted in 22% of urban population and in about 8% of country population (about half of urban population connect them with excessive psychoemotional tension and one third with the physical load, on the contrary rural inhabitants more often note its connections with the physical load). Over one third of urban residents (34,5%) reports on hard breathing of different kind. During medical examination legs endema was revealed by physician in 4,4% of all population (in 9,9% of population at the age of 60 and over).

About 30% of population make complaints to the physician about visual acuity dropping (the same numbers of city and country dwellers, but - more often). Complaints become more often with age and morphologic deviations in organ of vision increase. Frequency of lenticular opacity sharply rises from 5-8% in the age of 40-49 to 16-25% at the age of 60 age and over. Analogous changes due to age are noted in the state of vitreous body and particularly vascular coat of the eye.

Physicians in more than 50% of population revealed deviations of visual acuity. At the same time low visual acuity (0-0,1) is noted in 14,5-14,7% of the persons been under medical examination and in 25,7% of examinated persons at the age of 60 and over.

Permanent head noises is noted in 3% of patients. The proportion of person with that symptom rise with age from single cases (0,5%) in the young people to 7% of cases at the age 60 and over. About 65% of examinated people (more 15% of them at the age 60 and over) can perceive speaking in a whisper only at a distance of 5-3 meters (and 2% of persons at the age 50-59 and 8% of persons at the age 60 and over can perceive it at a distance not more one meter).

Headache and vertigo are enough prevalent: on the average about 20% of examinated people note headache ( 2-3% of them are children) and about 18% note vertigo. This symptomatology rises with age and is noted permanently in 2,5-3,8 of examinated persons. 9% of patients (to 30% of examinated persons at the age over 60) note disorders of memory, and 7-10% (to 20% at the age of 60 and over) note sleep disorders.

As regards the neurologic symptomatology, force decline in a hand are revealed in 4%, disorders of craniocerebral innervation - in 8%, disorders of coordination tests - in 3% of all population (10% of population at the age of 60 and over). 1,5-5,0% of people has heaviness and pains in legs (pulsation in back of the foods is weakened in 1,5%).

Rectal examination revealed straight intestine lesion more often (10%) in urban population and women. Stool disorders (in the main constipation) are observed in 8% of urban population and in 1,5% of country population. Proctorrhagia make 6,1-11,2 cases per 1000 examinated adults.

Different dyspeptic disorders also more often was noted in urban population (18%), particularly heartburn and eructation. 3-6% of children have epigastric pains, disturbing them 4,5-13% have appetite changes, 4-5% - hernia sticked out, to 5% suffer from constipations.

Gynecologic examination revealed different disorders of menstrual function (painful menstruation in 22-24%, premenstrual syndrome in 12-18% of women, climacteric syndrome - in 32,9% of women at the corresponding age). The operations on the organs of sexual sphere was been made in 8-10% of women in cities as in country, primary sterility was revealed in 6-10% of women.

So significant prevalence of pathologic symptoms call for providing with corresponding correction measures needed for normal human life activities in particular for providing population with the different kinds of correction and substitution means including pharmaceutical, it call for adaptation to the lifestyle conducive to health.

According to the data of the interview survey the need for correction means don't ensuring to a considerable extend (Table 4).

Table 4

Population need for correction means according to the data of questioning (%)

Correction mean

Persons used it

Persons needed for it

Glasses

50,0

30,9

Hearing-aid

1,3

3,3

Dental prothesis

21,4

27,7

Crutches, canes

4,7

1,8

Invalid carriages

0,7

9,8

Last years the trend to increase in some kinds of pathology with stable data of general morbidity is noted. First of all these are psychic disorders (owing to neurotic disorders and vegetovascular dystonia), diseases of the digestive organs, the osteomuscular system and connective tissues. Morbidity of these kinds of pathology increased practically in all age and sexual groups of population as compared with 1970 year and during last years.

Modern age-sexual rates of population morbidity in some territories make it possible to speak about possibility of "rejuvenation" of such diseases as hypertension and diabetes.

Prevalence of some earlier extremely rare diseases (ulcerative colitis, chronic intestine ischemia, medicamental intestine and renal lesions, commissure disease, disease of operated organ, hospital infections, allergosis, HIV-infection and others) and also earlier practically eradicated diseases (scabies, pediculosis) increases.

At the same time frequency of some nosologic forms, inflammatory skin diseases, some infectious and parasitogenic diseases decline. Clinical manifestations of many diseases change.

Modern pathology is marked by complex and combinations of pathologic manifestations. So digestive organs diseases are accompanied by common system lesions (isolated forms are found practically seldom), there is an obvious connection of pathology with neurotic disorders.

In modern conditions the crisis taking place in the state and involving considerable mass of population influence on population health. First of all it is a social tension (about 40% population indicate on stresses), including a fear of unemployment. It occurred the weakening of orientation system where a work and a social recognition side by side with a family was the highest value for about half of population. Increasing of the migration stream, including migration for politic and ethnic reasons, leads to the problems with work and to badly organized life of considerable population share. It is known that even in more tranquil time migrants are characterized by more neurotisation, heightened traumatism, worse health condition of children migrated with their parents.

In the condition of social instability the changes reflected the population reaction to the crisis situation and those earlier theoretically assumed developed in reality. These are decrease of birth rate, increase of mortality, fall of natural increase in population. It is possible to expect the corresponding changes in morbidity - it is in order the future rise of frequency of psychical disorders, cardiovascular system diseases and digestive system disease (particularly in men) against a general pathomorphose background, and in connection with migration processes the increase of the injuries and intoxication's frequency is possible.

So the modern health population state and trends revealed a lot of the serious troubles manifestations that can lead to the worsening of population "quality" and its labor and intellectual potential, and to considerable limitations of biological and social functions in several groups of population, including its participation in the improvement of the social and economic situation in the country.

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