DOI: https://doi.org/10.25305/unj.72611

Correlation between access to health care and stroke mortality

Nikolay Sapon, Anna Nikiforova

Abstract


Objective. To determine the correlation between access to health care and stroke mortality, to define the prospects of stroke mortality in Ukraine based on study results.

Materials and methods. Correlation and regression analysis of indicators from 55 countries ranked with Bloomberg as Most Efficient Countries for Health Care was used. Indicators was derived from publicly available databases.

Results. High significant moderate correlations (r=0.36, p=0.003) were obtained between stroke mortality and country area, stroke mortality and Urban population (r=-0,48, p=0,000).

We found weak but non significant correlation (r=0.16, p=0.116) between stroke mortality and hospital beds density, and the lack of correlation (r=-0.05, p=0.359) between stroke mortality and physicians density. However it should be noted that we have analyzed total number of beds and doctors, not only stroke specializing.

An analysis of the health expenditure (as % of GDP and US$ per capita) and stroke mortality revealed an appreciable (on the Chaddock scale) inverse correlation (r=-0.50, p=0.000 and r=-0.56, p=0.000 respectively) between these parameters.

The value for Health expenditure per capita (current US$) in Ukraine was US$313 as of 2013, that is 5-15 times lower than in developed countries (US$1462-4978). As a result, the mortality rate per 100,000 is 133.05 in Ukraine vs 72.1-29.8 in developed countries.

Conclusions. 1. The stroke mortality rate is largely determined by health care financing. 2. The country area and urban population percentage is important factor influencing the stroke mortality rate. 3. Population numbers and population density does not influence on stroke mortality. 4. Ukraine’s Health expenditure amounts are not sufficient in order to ensure the timely specialized care for population across the country, including stroke care. 5. Ukrainian Health Care System reforms, healthy lifestyle promotion as a preventive measure against cerebrovascular diseases may not reduce stroke mortality to acceptable values under insufficient funding conditions and low level population welfare. 6. In order to reduce the stroke death rate to the range of 60–80 persons per 100,000 of population increase of health spending to US$(1462±316) is needed, to the range of 40–60 persons — US$(1508±351), to the range of 20–40 persons — US$(4978±1793) accordingly. 7. Сombating сerebrovascular diseases and the result expectations should be based on the real economy possibilities. 


Keywords


stroke mortality; availability of medical care; health expenditure

References


1. The top 10 causes of death [Internet]. Geneva (Switzerland): World Health Organization. 2015 [cited 15 December 2015]. Available at: http://www.who.int/mediacentre/factsheets/fs310/en/

2. Mishchenko TS. Analiz sostoyaniya rasprostranennosti, zabolevayemosti i smertnosti ot tserebrovaskulyarnykh zabolevaniy v Ukraine [Analysis of prevalence status, morbidity and mortality from cerebrovascular diseases in Ukraine]. Sudynni zakhvoryuvannya golovnogo mozku. 2007;3:2–4. Russian.

3. Kornatsky VM. Problema bolezney sistemy krovoobrashcheniya i puti yeye minimizatsii v Ukraine. [The problem of cardiovascular diseases and ways to minimize them in Ukraine]. Kardiologiya: ot nauki k praktike. [Internet]. 2013 [cited 15 December 2015]; 5. Russian. Available at: http://kardiolog.in.ua/5-07-2013/172-2014-02-28-10-43-21

4. Natsionalna strategiya reformuvannya systemy okhorony zdorovya v Ukrayini na period 2015–2020 rokiv [National Strategy for health reform in Ukraine in 2015–2020] [Internet]. Kyiv (Ukraine): Strategic Advisory Group on healthcare reform in Ukraine. 2014–2015 [cited 15 December 2015]. Ukrainian. Available at: http://healthsag.org.ua/wp-content/uploads/2014/11/Strategiya_UKR.pdf

5. Gulyaev DV. “Insultomor”: mysli vslukh o politike zdravookhraneniya v borbe protiv insulta v Ukraine [“Insultomor”: thinking out loud about health policy in the fight against stroke in Ukraine]. Therapia [Internet]. 2007 [cited 21 March 2016];(3):78-81. Russian. Available at: http://therapia.ua/therapia/2007/03/insultomor-mysli-vslukh-o-politike-zdravookhraneniya-v-borbe-protiv-insulta-v-ukraine

6. Stroke Europe cause of death [Internet]. World Life Expectancy. 2015 [cited 15 December 2015]. Available at: http://www.worldlifeexpectancy.com/europe/stroke-cause-of-death.

7. Troian MY, Kostyuchenko NM. [Organizational and economic measures to reform the health care system in Ukraine on the way to overcome the demographic crisis]. Mechanism of Economic Regulation [Internet]. 2015 [cited 21 March 2016];(1):116-126. Russian. Available from: http://essuir.sumdu.edu.ua/bitstream/123456789/41856/1/troian_demographic_crisis.pdf

8. 2015 Most Efficient Health Care [Internet]. New York (US): Bloomberg L.P. 2015 [cited 15 December 2015]. Available at: http://www.bloombergbriefs.com/content/uploads/sites/2/2015/11/health-care.pdf

9. The World Factbook [Internet]. Washington (US): Central Intelligence Agency (CIA). 2015 [cited 15 December 2015]. Available at: https://www.cia.gov/library/publications/resources/the-world-factbook/

10. GDP per capita (current US$) [Internet]. Washington (U.S.): World Bank. 2015 [cited 15 December 2015]. Available at: http://data.worldbank.org/indicator/NY.GDP.PCAP.CD

11. Stroke death rate by country [Internet]. World Life Expectancy. 2015 [cited 15 December 2015]. Available at: http://www.worldlifeexpectancy.com/cause-of-death/stroke/by-country/

12. Makarova NV, Trofimets VY. Statistika v Excel [Statistics in Excel]. Moscow: Finansy i statistika; 2002. 368 p. Russian.

13. Konovalov YV. Statisticheskoye modelirovaniye s ispolzovaniyem regressionnogo analiza: Elektronnoye uchebnoye izdaniye [Statistical modeling using regression analysis: Electronic textbook] [Internet]. Moscow: Bauman Moscow State Technical University. 2013 [cited 15 December 2015]. 72 p. Available at: http://www.bmstu.ru/~fn11/docs/Konovalov.pdf

14. List of countries and territories by population density [Internet]. Wikipedia. 2015 [cited 15 December 2015]. Available at: https://en.wikipedia.org/wiki/List_of_countries_and_territories_by_population_density.

15. Yu, R, Chau, PH, McGhee, SM, et al. Trends of Disease Burden Consequent to Stroke in Older Persons in Hong Kong: Implications of Population Ageing. Hong Kong: The Hong Kong Jockey Club. 2012 [cited 15 December 2015]. Available from: http://hdl.handle.net/10722/161124

16. Hsieh FI, Chiou HY. Stroke: morbidity, risk factors, and care in Taiwan. J Stroke. 2014 May;16(2):59-64. [CrossRef] [PubMed]

17. Gulyaev DV. Politika zdravookhraneniya v borbe s insultom: iz opyta razvitykh stran [Health policy in the fight against stroke: from the experience of developed countries]. Therapia [Internet]. 2007 [cited 27 March 2016];(1):34-7. Russian. Available at: http://therapia.ua/therapia/2007/01/politika-zdravookhraneniya-v-borbe-s-insultom-iz-opyta-razvitykh-stran

18. Sapon MA, Huk AP, Nikiforova AM. Orhanizatsiya nevidkladnoyi neyrokhirurhichnoyi dopomohy pry insulti v Ukrayini [Organization of emergency neurosurgical care in stroke Ukraine]. IV Scientific and Educational Forum “Academy stroke”; 2013 November 7-8; Kyiv, Ukraine. [CrossRef]

19. Pro zatverdzhennya ta vprovadzhennya medyko-tekhnolohichnykh dokumentiv zi standartyzatsiyi medychnoyi dopomohy pry ishemichnomu insulti [On approval and introduction of medical and technological documents for standardization of care in ischemic stroke] [Internet]. Kyiv (Ukraine): Ministry of Health of Ukraine. 2012 [cited 29 March 2016]. Ukrainian. Available at: http://www.moz.gov.ua/ua/portal/dn_20120803_602.html

20. Pro zatverdzhennya ta vprovadzhennya medyko-tekhnolohichnykh dokumentiv zi standartyzatsiyi medychnoyi dopomohy pry hemorahichnomu insulti [On approval and introduction of medical and technological documents for standardization of medical care in hemorrhagic stroke] [Internet]. Kyiv (Ukraine): Ministry of Health of Ukraine. 2012 [cited 29 March 2016]. Ukrainian. Available at: http://www.moz.gov.ua/ua/portal/dn_20140417_0275.html

21. Suslin SA. Kharakteristika osnovnykh pokazateley otsenki meditsinskoy deyatelnosti statsionarnykh uchrezhdeniy [Characteristics of the main indicators for assessing the medical activity inpatient facilities]. Zamestitel glavnogo vracha [Internet]. 2009 [cited 21 March 2016];(11):7. Russian. Available from: http://www.zdrav.ru/articles/practice/detail.php?ID=76091

22. Borovik S. Borba s insultom i sosudisto-mozgovymi zabolevaniyami: problemy, resheniya, perspektivy [Fight against stroke and cerebrovascular disease: problems, solutions, perspectives]. Ukrayinskyy medychnyy chasopys [Internet]. 2014 [cited 21 March 2016];(6):24-7. Russian. Available at: http://www.umj.com.ua/?p=81833

23. Lisitsyn YP. Obraz zhizni i zdorovye naseleniya [Lifestyle and health]. Moscow: Znaniye; 1982. Russian.

24. Download entire World Economic Outlook database, October 2015 [Internet]. Washington (U.S.): The International Monetary Fund (IMF). 2016 [cited 03 April 2016]. Available at: http://www.imf.org/external/pubs/ft/weo/2015/02/weodata/download.aspx


GOST Style Citations


1. The top 10 causes of death [Электронный ресурс]. Geneva (Switzerland): World Health Organization. 2015. — Режим доступа: http://www.who.int/mediacentre/factsheets/fs310/en/

2. Мищенко Т.С. Анализ состояния распространенности, заболеваемости и смертности от цереброваскулярных заболеваний в Украине / Т.С. Мищенко // Судинні захворювання головного мозку. — 2007. — №3. — С.2–4.

3. Корнацкий В.М. Проблема болезней системы кровообращения и пути ее минимизации в Украине / В.М. Корнацкий // Кардиология: от науки к практике [Электронный ресурс]. — 2013. — №5. — Режим доступа: http://kardiolog.in.ua/5-07-2013/172-2014-02-28-10-43-21.

4. Національна стратегія реформування системи охорони здоров’я в Україні на період 2015–2020 років [Електронний ресурс]. Київ (Україна): Стратегічна дорадча група з питань реформування системи охорони здоров’я в Україні. 2014–2015. — Режим доступу: http://healthsag.org.ua/wp-content/uploads/2014/11/Strategiya_UKR.pdf.

5. Гуляев Д. В. «Инсультомор»: мысли вслух о политике здравоохранения в борьбе против инсульта в Украине / Д. В. Гуляев // Therapia [Электронный ресурс]. — 2007. — Т.3. — С.78–81. — Режим доступа: http://therapia.ua/therapia/2007/03/insultomor-mysli-vslukh-o-politike-zdravookhraneniya-v-borbe-protiv-insulta-v-ukraine.

6. Stroke Europe cause of death [Электронный ресурс]. World Life Expectancy. 2015. Режим доступа: http://www.worldlifeexpectancy.com/europe/stroke-cause-of-death.

7. Троян М.Ю. Организационно-экономические направления реформирования системы здравоохранения в Украине на пути выхода из демографического кризиса / М.Ю. Троян, Н.Н. Костюченко // Механізм регулювання економіки [Электронный ресурс]. — 2015. — №1. — С.116–126. Режим доступа: http://essuir.sumdu.edu.ua/bitstream/123456789/41856/1/troian_demographic_crisis.pdf.

8. 2015 Most Efficient Health Care [Электронный ресурс]. New York (US): Bloomberg.com. 2015. Режим доступа: http://www.bloombergbriefs.com/content/uploads/sites/2/2015/11/health-care.pdf.

9. The World Factbook [Электронный ресурс]. Washington (US): Central Intelligence Agency (CIA). 2015. Режим доступа: https://www.cia.gov/library/publications/resources/the-world-factbook/.

10. GDP per capita (current US$) [Электронный ресурс]. Washington (U.S.): World Bank. 2015. Режим доступа: http://data.worldbank.org/indicator/NY.GDP.PCAP.CD.

11. Stroke death rate by country [Электронный ресурс]. World Life Expectancy. 2015. — Режим доступа: http://www.worldlifeexpectancy.com/cause-of-death/stroke/by-country/.

12. Макарова Н.В. Статистика в Excel / Н.В. Макарова, В.Я. Трофимец В.Я. — М.: Финансы и статистика, 2002. — 368 с.

13. Коновалов Ю. В. Статистическое моделирование с использованием регрессионного анализа: Электронное учебное издание / Ю.В. Коновалов. — М.: МГТУ им. Н.Э. Баумана [Электронный ресурс]. — 2013. — 72 с. — Режим доступа: http://www.bmstu.ru/~fn11/docs/Konovalov.pdf.

14. List of countries and territories by population density [Электронный ресурс]. Wikipedia. 2015. — Режим доступа: https://en.wikipedia.org/wiki/List_of_countries_and_territories_by_population_density.

15. Yu, R, Chau, PH, McGhee, SM, et al. Trends of Disease Burden Consequent to Stroke in Older Persons in Hong Kong: Implications of Population Ageing. [Электронный ресурс]. Hong Kong: The Hong Kong Jockey Club. 2012. Режим доступа: http://hdl.handle.net/10722/161124

16. Hsieh F.I. Stroke: morbidity, risk factors, and care in Taiwan / F.I. Hsieh, H.Y. Chiou. — J Stroke. — 2014. — V.16, N2. — P.59–64.

17. Гуляев Д.В. Политика здравоохранения в борьбе с инсультом: из опыта развитых стран // Therapia [Электронный ресурс]. — 2007. — №1. — С.34–37/ — Режим доступа: http://therapia.ua/therapia/2007/01/politika-zdravookhraneniya-v-borbe-s-insultom-iz-opyta-razvitykh-stran.

18. Сапон М.А. Організація невідкладної нейрохірургічної допомоги при інсульті в Україні / М.А.Сапон, А.П.Гук, А.М. Никифорова // IV Науково-освітній форум «Академія інсульту» (Київ, Україна, 7–8 листопада 2013 року).

19. Про затвердження та впровадження медико-технологічних документів зі стандартизації медичної допомоги при ішемічному інсульті [Електронний ресурс]. Київ (Україна): МОЗ України. 2012. — Режим доступу: http://www.moz.gov.ua/ua/portal/dn_20120803_602.html.

20. Про затвердження та впровадження медико-технологічних документів зі стандартизації медичної допомоги при геморагічному інсульті [Електронний ресурс]. Київ (Україна): МОЗ України. 2012. — Режим доступу: http://www.moz.gov.ua/ua/portal/dn_20140417_0275.html.

21. Суслин С.А. Характеристика основных показателей оценки медицинской деятельности стационарных учреждений / С.А. Суслин // Заместитель главного врача [Электронный ресурс]. — 2009. — №11. — С.7. — Режим доступа: http://www.zdrav.ru/articles/practice/detail.php?ID=76091.

22. Боровик С. Борьба с инсультом и сосудисто-мозговыми заболеваниями: проблемы, решения, перспективы / С. Боровик // Укр. мед. часопис [Электронный ресурс]. — 2014. — №6(104). — С.24–27. — Режим доступа: http://www.umj.com.ua/?p=81833.

23. Лисицын Ю.П. Образ жизни и здоровье населения / Ю.П. Лисицын. — М.: Знание, 1982. — 40 с.

24. Download entire World Economic Outlook database, October 2015 [Электронный ресурс]. Washington (U.S.): The International Monetary Fund (IMF). 2016 [cited 03 April 2016]. Available at: http://www.imf.org/external/pubs/ft/weo/2015/02/weodata/download.aspx





Copyright (c) 2016 Nikolay Sapon, Anna Nikiforova

Creative Commons License
This work is licensed under a Creative Commons Attribution 4.0 International License.