Indicator of general and primary morbidity of the adult population. The concept of primary morbidity, pain, pathological damage

LECTURE . morbidity of the population. Types and methods of study.

Incidence- one of the indicators of public health.

The main indicators of public health:

1. Medico-demographic.

2. Morbidity.

3. Disability.

4. Physical development.

Information about the health of the population allows you to determine:

1.risk factors

2. justify recreational activities

3. evaluate the effectiveness of the implemented measures

4. for the operational management of the activities of healthcare institutions

5.for current and long-term personnel planning

6. to improve the structure of the health service as a whole and individual institutions

The study of morbidity is carried out according to the generally accepted scheme of statistical studies and a strict sequence of stages.

Stages:

1. collection of information

2. grouping and summary of materials, their encryption

3.counting processing

4. analysis of materials and their design (conclusions of the recommendation).

When studying morbidity due to the condition environment a directed study of environmental factors and an in-depth analysis of morbidity are needed.

Sources of information on incidence:

1. medical information about the application for medical care

2.data honey. inspections

3.Materials according to cause of death

Appeal for honey. help is absolute number patients for the first time in a calendar year who applied to medical institutions for the disease. All primary and repeated appeals are characterized by attendance.

INCIDENCE RATES

Distinguish:

1. Primary or actual incidence

2. Prevalence or soreness

3. The frequency of diseases detected during medical examinations or pathological affection.

Primary incidence- this is the number of diagnosed diseases for the first time in life within 1 year. All acute diseases and chronic diseases established for the first time in life are taken into account at the first visit to a medical institution (relapses chronic pathology occurring during the year are not taken into account).

Soreness or disease prevalence is the totality of all acute and all chronic diseases registered in this calendar year. Morbidity is always higher than the level of actual morbidity. The indicator of morbidity, in contrast to morbidity, indicates the dynamic processes taking place in the health of the population and is more preferable for identifying causal relationships.

The indicator of morbidity gives an idea of ​​both new cases of the disease and cases diagnosed earlier but with an exacerbation of which the population applied in a given calendar year.

Pathological affection - the totality of all diseases and pathological conditions identified during complex medical examinations. This indicator gives an idea of ​​the contingent of patients registered for certain date. Basically, chronic pathology is distinguished and in most cases of this disease with which the population did not apply to medical institutions.

TYPES OF INCIDENCE.

1. Morbidity according to the data of primary appeal, which includes general morbidity, infectious morbidity, hospital morbidity with temporary disability, the most important non-epidemic diseases (tuberculosis, syphilis).

2. Morbidity according to medical examinations and dispensary observation.

3. Morbidity according to the causes of death (data are taken from the registry office documents - death certificates).

If it is necessary to study the incidence of hospitalized employees of the Academy, the data are taken from the archive (document - a card of a person who left the hospital).

If it is necessary to study the incidence with temporary disability, you need to take a certificate of incapacity for work, which is stored in the accounting department).

To study the general morbidity, a medical card and stat are taken. ticket.

To study the incidence of tuberculosis, syphilis, gonorrhea, a document is taken on the most important non-epidemic disease.

Each type of morbidity has an accounting and reporting form. Infectious hospital the most important non-epidemic morbidity, morbidity with temporary disability are components general morbidity. The study of only one of the listed species is only part of the general morbidity data.

The requirements for separate study of these types of morbidity are explained by certain reasons.

THE REASONS:

1.infectious morbidity - requires rapid anti-epidemic measures

2. hospital morbidity - information about it is used to plan the bed fund

3. morbidity with temporary disability - determines the economic costs

4. the most important non-epidemic morbidity - provides information on the prevalence of socially conditioned diseases.

To assess the incidence of the population, coefficients are used that are calculated as the ratio of the number of diseases to the number of population groups and recalculated to the standard (per 100 1000 10000 people). These coefficients make it possible to estimate the probability of the risk of occurrence of any diseases in the population.

To obtain indicative ideas about the incidence of the population, the calculation of general coefficients (extensive intensive) is provided.

To identify causal relationships, special coefficients are needed, that is, taking into account the gender, age of the profession, etc.

METHODS OF STUDYING INCIDENCE.

1. solid

2. selective

Solid - acceptable for operational purposes. Selective- used to identify the relationship between morbidity and environmental factors. The sampling method was used during the census years. An example of it is the study of morbidity in a separate area. The choice of method for studying the incidence of the population in a particular territory or its individual groups is determined by the purpose and objectives of the study. indicative information about the levels, structure and dynamics of morbidity can be obtained from the reports of medical institutions and reports from the central administration using the continuous method.

Identification of patterns, morbidity, relationships is possible only with a selective method by copying passport and medical data from primary accounting documents onto a statistical card.

When assessing the level, structure and dynamics of the incidence of the population and its individual groups, it is recommended to compare with indicators for Russian Federation, city, district, region.

Unit of observation in the study of general morbidity is the primary appeal of the patient in the current calendar year about the disease.

Basic accounting documents to study the general morbidity, these are: a medical card and a statistic card for an updated diagnosis.

Analysis of the structure of general morbidity according to age categories(among children, adolescents, adults) in St. Petersburg:

0 - 14 years old 64.7%

15 - 18 years old 51.3%

adults - more than 38.5%.

Among children (0-14) years in the structure of general morbidity, infectious diseases occupy the second place, the share of which is 9.7%. In adolescents and adults in St. Petersburg, injury and poisoning are in second place (17% and 25%). The level of general morbidity among the entire population of St. Petersburg averages about 50% per 1000 (0 - 14 - 1430%, 15-18 years old - 896.9%, adults - 455.7%). Most high level observed in the Kuibyshevsky, Vasileostrovsky, Kalininsky districts, and the lowest in the Zelenogorsk and Petrodvortsovy districts.

The incidence of infectious diseases is studied by taking into account each case of an infectious disease or suspicion of an infectious disease, for which a record document is issued - an emergency notification of an infectious disease. An emergency notification is sent within 12 hours to the center of the State Sanitary and Epidemiological Supervision and is registered in the journal infectious diseases. Based on the entries in this journal, a report is compiled on the movement of infectious diseases for each month, quarter, half year, year.

Unit of observation in the study of infectious morbidity is the case infectious disease. It is calculated for 10,000, 100,000 people. The study of infectious morbidity includes identifying the source of infection, analyzing seasonality, and analyzing the effectiveness of anti-epidemic measures. In the Russian Federation, the highest incidence falls on the group of acute respiratory viral infections, which in the structure of the total infectious incidence is 87%. The incidence of influenza per 100,000 population is 3721, acute infection of the upper respiratory tract 20. In last years vaccination recommended by WHO for mass prevention is used. High level of OKI. In recent years, more than 1 million 100 thousand have been ill with dysentery, typhoid fever, salmonella. About 60% are children under 14. Unfavorable areas for dysentery: Korelia, Komi, Arkhangelsk, Kostroma, Penza regions. Calculation of the incidence of hepatitis, including hepatitis B and C. There is a normalization of the situation with cholera, including imported. The incidence of measles increased by 4 times, whooping cough by 63%. Diphtheria is epidemic in a number of regions. In general, the incidence of diphtheria increased by 4 times. The highest incidence rate is in St. Petersburg (more than 5 times higher than in Russia).

The most important non-epidemic diseases: tuberculosis, venereal diseases, mental illness, mycoses, malignant neoplasms, cardiovascular diseases.

accounting document- notification of the most important non-epidemic diseases.

Unit of observation- with these diseases is a sick person. Morbidity records are kept in dispensaries.

The incidence of tuberculosis in Russia increased by 25%, among children by 18%. The highest incidence rate is observed in Komi, Dagestan, Volgograd region, Moscow. This situation is associated with a large emigration of the population, with a decrease in the quality of nutrition, with a decrease in the number of patients open form tuberculosis.

The incidence of syphilis in Russia increased by 2.6 times, gonorrhea by 37.4%. The incidence of venereal diseases in children and adolescents has increased. This is due to negative social phenomena in society, the lack of work on the moral education of children and adolescents.

Morbidity with temporary disability.

Unit of observation is every case of temporary disability.

accounting document- a certificate of incapacity for work (has not only medical and statistical, but also legal financial significance).

Recalculation per 100 employees.

Main characteristics:

1. The structure of the incidence in the case.

2. Morbidity structure in calendar days.

3. Number of cases per 100 workers.

4.Number calendar days per 100 employees.

5. Average duration one case of illness.

Average level in Russia:

80-120 cases per 100 employees

800-1200 calendar days per 100 employees.

Decrease in incidence now. reporting document- Form 16 VN.

AT recent times for an in-depth methodology, an in-depth analysis methodology is applied (not all, but those who have worked in the institution for at least 1 year). They study all 5 indicators, but taking into account the length of service, gender, professional experience and determine the risk groups.

Surgeon 8 or more years of work experience, surgical nurse 1-3 years of work experience.

With an in-depth study of risk groups:

1. Often ill: 4 times or more etiologically related diseases and 6 times or more etiologically unrelated diseases.

2. Long-term ill patients: in a calendar year 40 days or more with etiologically related diseases and 60 days or more with etiologically unrelated diseases.

3. Often long-term ill: 4 times or more in a calendar year and 40 days or more with etiologically related diseases, 6 times or more and 60 days or more with etiologically unrelated diseases.

In deep learning, it calculates health index - this is the percentage of people who have never been ill this year (normally 50-60%). At all productions - a police record card. Health Assessment Centers. Encryption of morbidity according to the etiological form 16 VN.

10 International revision of the classification of diseases - 21 classes of diseases. In code:

1. First acute diseases.

2. Preference for infectious over non-infectious diseases.

3. Preference for more severe diseases (diphtheria, measles).

4. Preference for cases of violent death over non-violent ones.

Ministry of Health of the Russian Federation

State budgetary educational institution higher professional education

"North-Western State medical University named after I.I. Mechnikov"

Ministry of Health of the Russian Federation

Department of Public Health and Health

ANALYSIS OF POPULATION MORBIDITY

ed. z.d.s. RF, prof. V.S. Luchkevich

Teaching aid

St. Petersburg

UDC 312.6001.8 BBK 51.18

Population morbidity analysis: teaching aid / ed. V.S. Luchkevich. - St. Petersburg: SZGMU im. I.I. Mechnikova, 2015. - 47 p.

Team of authors: V.S. Luchkevich, P.N. Morozko, G.M. Pivovarova, N.I. Pustotin, V.P. Panov, I.L. Samodova, A.Yu. Lomtev, E.V. Mironchenko, E.A. Abumuslimova, G.N. Marinicheva, T.V. Samsonova, A.Sh. Kalichava.

Reviewer: head. Department of Social Hygiene, Management and Health Economics, SBEI VPO North-Western State Medical University named after A.I. I.I. Mechnikova, Doctor of Medical Sciences, Professor Filatov Vladimir Nikolaevich

The teaching aid is devoted to the methodological aspects of the study, calculation and analysis of indicators various kinds morbidity, necessary for a comprehensive assessment of health individual groups and contingents of the population of the administrative territory, to determine the effectiveness of therapeutic, preventive, hygienic and anti-epidemic measures.

The teaching aid contains the basics of the incidence of the population as the most important indicator of public health, a criterion for assessing the quality and effectiveness of health-improving work, an objective and sensitive indicator of medical and social well-being. AT teaching aid the causes and risk factors of morbidity are reflected, the consequences of the influence of the disease on the state of health are determined.

The educational and methodical manual is intended for students in the direction of training (specialty) 060101 "Medicine" and 060105 "Medical and preventive business".

Approved as a teaching aid

TOPIC: Analysis of the incidence of the population.

STUDENT STUDENTS- students in the direction of training (specialty) 060101 "General Medicine" and 060105 "Medical Preventive Business".

DURATION OF PRACTICAL LESSON - 4 hours (in

academic hours)

PURPOSE OF THE LESSON: to study the basics of medical, social and clinical statistical analysis of morbidity various groups of the population and learn how to use health data to assess the effectiveness of medical and recreational activities, as well as to justify organizational forms preventive measures acceptance.

As a result of studying the topic, the student should know:

1. The concept of public health. health criteria. Comprehensive assessment of public health.

2. Definition of the concept of morbidity, pain, pathological affection.

3. Types of morbidity. Methods and sources for studying morbidity.

4. Morbidity according to referral data.

5. Incidence according to data medical examinations.

6. Morbidity, studied on the basis of registration data of causes of death.

7. Status, trends and forecast of changes in health indicators of various population groups, taking into account the impact socio-economic conditions.

8. Morbidity according to the study of the causes of disability.

9. Basic concepts of the International Statistical Classification of Diseases (ICD).

As a result of studying the topic, the student should be able to:

1. Know how to register correctly certain types morbidity with the definition of units of observation for each type of morbidity.

2. Be able to analyze the data of summary statistical forms (reports), assess the level and structure of registered morbidity.

3. To be able to assess the incidence according to the hospitalization of inpatients.

4. Be able to analyze data on newly diagnosed pathology and accumulated chronic forms diseases according to the results of complex medical examinations.

5. To be able to calculate and analyze morbidity indicators (structure, level, dynamics), with the construction of graphic images, identifying the relationship between morbidity and risk factors.

HEALTH

According to the definition of the World Health Organization (WHO): “Healthy

Vie is a state of complete physical, mental and social well-being and not merely the absence of disease or infirmity.

AT in accordance with Federal Law No. 21.11.2011 323-FZ) Zdo-

health is a state of physical, mental and social well-being of a person, in which there are no diseases, as well as disorders of the functions of organs and systems of the body.

AT medical and social studies in the assessment of health is advisable

identify four levels:

1. Individual health is individual health.

2. The health of social and ethnic groups is group health.

3. Health of the population of administrative territories - regional health

4. Population health is public health.

1. Deduction of the gross national product for health care.

2. Availability of primary medical and social assistance.

3. Coverage of the population with medical care.

4. Level of immunization of the population.

5. The degree of examination of pregnant women by qualified specialists.

6. Nutritional status of children.

7. Child mortality rate.

8. Average life expectancy.

9. Hygienic literacy of the population.

Based on WHO materials, the Ministry of Health of the Russian Federation proposes the following definitions of health.

Public Health - medical and social resource and the potential of society, contributing to national security.

Public health - medical-demographic and social category, reflecting the physical, mental, social well-being of people who carry out their livelihoods within certain social communities.

More complete is the definition of public health, developed at the seminar of heads of organizational profile departments:

Public Health - this is the most important economic and social potential of the country, due to the impact various factors environment and lifestyle of the population, allowing to provide optimal level quality and safety of human life.

Health is a state that ensures the optimal relationship of the body with the environment and contributes to the activation of all types of human activity (labor, economic, household, recreational, family planning, medical and social, etc.).

health criteria.

The main criteria characterizing public health are:

1. Medical and demographic(fertility, mortality, natural increase, infant mortality, premature birth rate, expected average duration future life.

2. Morbidity (general, infectious, with temporary disability, major non-epidemic diseases, hospitalized, according to medical examinations).

3. primary disability.

4. Indicators of physical development.

5. Mental health indicators.

All criteria are evaluated in dynamics.

Comprehensive assessment of public health.

At integrated assessment health status of adults, the distribution into health groups is as follows.

The first group is healthy individuals (who have not been ill for a year or rarely go to the doctor without losing their ability to work).

The second group is practically healthy individuals, with functional and some morphological changes or rarely sick during the year (isolated cases of acute diseases).

The third group - patients with long-term chronic diseases (more than four cases and 40 days of disability per year).

The fourth group - patients with long-term chronic diseases (compensated condition).

The fifth group - patients with frequent exacerbations of long-term diseases.

However, the division of both adults and children into health groups is rather arbitrary.

For rate individual health a number of very conditional indicators are used: health resources, health potential and health balance.

BASIC CONCEPTS OF INCIDENCE

Definition of the concept of morbidity, primary morbidity, pain, pathological affection.

The incidence of the population is the most important indicator of public health, a criterion for assessing the quality and effectiveness of health work, the most objective and sensitive indicator of medical and social well-being. Reducing the incidence of the population is of great social and economic importance, is one of the key social and hygienic problems and requires the active participation of legislative and executive power in the preparation and implementation of special programs for the promotion of health and social protection population. Studying the causes and risk factors of morbidity, determining the consequences of the impact of diseases on health status and developing ways to prevent diseases are priority professional tasks for employees of medical institutions. Thus, incidence data is a tool for the operational management and management of health care. Moreover, morbidity rates reflect the real picture of the life of the population and make it possible to identify problem situations to develop specific measures to protect public health and improve it on a nationwide scale.

According to the WHO disease is any subjective or objective deviation from the normal physiological state organism.

Thus, the concept of "disease" is broader than the concept of "disease".

An important direction in the study of morbidity is the assessment of the influence of risk factors of conditions and lifestyle, the analysis of the relationship of medical and social, hygienic, genetic, organizational, clinical and other factors that contribute to the formation of the most common forms of diseases. The use of modern statistical techniques has made it possible to establish that a higher level of morbidity in the population depends not only on adverse impact environmental factors, but also from a number of biological, socio-economic, social and living conditions and lifestyle.

One of the principles of modern health care is the preservation of the health of the healthy, which makes it possible to give priority to state and public activities in the field of disease prevention. The disease is generally available for registration when the patient seeks medical help. Morbidity is one of the criteria for assessing the state of health of the population and shows the level, frequency of spread of all diseases.

taken together and each separately among the population as a whole and its individual age, sex, social, professional and other groups.

Morbidity is an indicator that characterizes the level, prevalence, structure and dynamics of registered diseases among the population as a whole or in its individual groups and serves as one of the criteria for evaluating the work of a doctor, medical institution, health authority in the territory.

In the incidence statistics, there are the following indicators:

1. Actually morbidity (primary morbidity).

2. Prevalence (morbidity).

3. pathological lesion.

4. true morbidity.

Primary morbidity (actual morbidity) is a combination of

ness of newly emerged, nowhere in previous years diseases not taken into account and for the first time in this calendar year detected among the population of diseases (relapses of chronic pathology that occur during the year are not taken into account). It is calculated as the ratio of the number of newly emerging diseases to the average population, multiplied by 1000, expressed in ppm.

It is registered according to statistical coupons (account form 025-2 / y) of specified diagnoses with a sign (+).

Cases of acute diseases are registered at each occurrence, cases of chronic diseases - only once a year.

Morbidity (prevalence of diseases) - this is a set of all diseases among the population, both first detected in this calendar year and registered in previous years, but about which the patient again turned to this year(registered according to all statistical coupons for updated diagnoses, accounting f. 025-2/y), expressed in ppm. Statistically expressed as the ratio of the number of all diseases of the population per year to the average population, multiplied by 1000.

There is a significant difference between the concepts of actual morbidity and morbidity. Soreness is always higher than the level primary disease

bridges.

Incidence rate itself in contrast to the pain of

indicates the dynamic processes occurring in the health of the population and is more preferable for identifying causal relationships.

Soreness index gives an idea of ​​both new cases of diseases and previously diagnosed cases, but with an exacerbation of which the population applied in a given calendar year. The pain index is more stable in relation to various influences environment, and its increase does not always mean the presence of negative shifts in the health status of the population. This increase may take place as a result of the achievements medical science and practice in the diagnosis, treatment of patients and prolongation of their lives, which leads to the "accumulation" of contingents registered in the dispensary.

Primary incidence- this is an indicator that is more sensitive to changes in environmental conditions in the year under study; when analyzing this indicator for a number of years, you can get the most correct idea of ​​the incidence and dynamics of morbidity, as well as the effectiveness of a complex of socio-hygienic and medical measures aimed at reducing it.

In the specialized literature, the term “ accumulated morbidity" - it is the totality of all cases of primary diseases registered during a number of years when seeking medical help.

The cumulative incidence rate per 1000 population of the corresponding age is calculated. This incidence rate most reliably reflects the health of the population studied by the method of seeking medical attention.

Pathological affection - a set of diseases and pathological conditions identified by doctors through active medical examinations of the population. Statistically expressed as the ratio of the number of cases of diseases present in the this moment, to the average population, multiplied by 1000, expressed in ppm.

These are mainly chronic diseases, but acute diseases that are present at the moment can also be taken into account.

Periodic and mass medical examinations make it possible to identify previously unknown chronic diseases, for which the population does not actively seek medical attention. medical institutions. Cases of initial (hidden) manifestations of certain diseases are subject to registration. The advantage of the method of active medical examinations is also the clarification of the diagnosis of certain chronic diseases and pathological abnormalities.

Reliable information about the size and nature of morbidity for various groups of the population (age and sex, social, professional, etc.) is necessary to assess trends in the state of public health, the effectiveness of medical and social measures, and planning various types of specialized care, rational use material and human resources of health care.

The true morbidity it is negotiability plus morbidity on medical examinations and minus unconfirmed diagnoses on medical examinations.

In the analysis of morbidity, a number of indicators of the frequency of cases of diseases are calculated for certain age and sex groups.

Depending on the purpose of the study, various statistical materials and accounting documents are used (medical records, emergency notices, sick leave certificates, hospital leave cards, medical death certificates, other special forms and questionnaires). When choosing the main diagnosis, one should be guided by the "International Classification of Diseases and Related Health Problems" (10th revision, 1993, WHO). When diagnosing and coding morbidity, preference should be given to: 1) the underlying disease, rather than a complication; 2) more severe and deadly disease; 3) infectious, not noncommunicable diseases; 4) acute form disease, not chronic; 5) specific disease associated with certain conditions work and life.

TYPES OF INCIDENCE.

METHODS AND SOURCES FOR STUDYING INCIDENCE

Classification of types of morbidity.

1. According to the referral data:

a) general morbidity; b) infectious disease;

c) hospital morbidity; d) morbidity with temporary disability;

e) the most important non-epidemic diseases (tuberculosis, syphilis, sexually transmitted diseases, etc.).

2. According to the data of medical examinations and dispensary observation: children,

conscripts, working teenagers and other decreed categories of the population.

3. According to cause of death.

4. According to the study of the causes of disability.

Of these, two types are subject to general continuous current registration, including data on the causes of death and data from preventive medical examinations, and three types are subject to additional special registration and statistical accounting, due to their special medical and social significance and signal-operational significance for the organization of preventive measures.

can be studied separately detection rate - the number of cases

left per 1000 examined according to preventive examinations and dispensary observation, as well as data on the causes of death. Sources of information and types of morbidity are presented in Scheme 1.

Each type of morbidity has an accounting and reporting form. The study of only one of the listed species is only part of the general morbidity data. When studying morbidity, especially during short term, for example, years, it is not always possible to take into account all cases of the disease according to the attendance data. This is especially true for the initial forms of diseases.

WHO points out that whatever indicator of incidence is calculated, it must meet a number of requirements: be reliable, objective, sensitive and accurate.

Each of the methods for studying morbidity has its own characteristics regarding the quality and value of the data collected on their basis.

The reasons for the separate study of each type of morbidity:

1. Infectious morbidity - requires rapid anti-epidemic measures.

2. Hospital morbidity - information about it is used to plan the bed fund.

3. Morbidity with temporary disability - determines the economic costs.

4. Major non-epidemic morbidity - provides information on the prevalence socially determined diseases.

Data on the incidence of the population are collected, processed and analyzed using the methods of medical statistics. The incidence of the population is studied by three methods:

A) according to the population's accessibility for medical care - the foundation was laid by zemstvo doctors who offered cards; allows you to identify clinically expressed diseases and for medical care. awn

B) according to medical examinations, the initial forms of the disease are revealed, as well as latent, latent forms.

C) according to the data on the causes of death - latent diseases are detected that are not diagnosed during life, masked diseases (in case of discrepancy between clinical and post-mortem diagnoses).

The completeness of the detection of diseases is affected by:

1) the completeness of the population's appeal to medical institutions - determined by remoteness, the presence of transport links, the need for sick leave, the presence of self-treatment, the fashion for diagnoses

2) completeness of accounting for the detection of diseases

3) equipment medical institution diagnostic equipment and qualified personnel

4) the possibility of patients applying to non-state institutions

5) qualification and conscientiousness of the doctor

6) organization of professional examinations

AT foreign countries to study the incidence, data from disease registries, the results of special selective studies, sociological methods (surveys, questionnaires, interviews) are used.

Statistical study of incidence population can be carried out:

BUT) continuous method- allows you to get exhaustive materials about the incidence of the population; is based on a summary of reported data on the incidence of the population for all medical institutions.

B) Selective method- allows you to obtain data on the incidence of various population groups Taking into account the influence of various factors, conditions and lifestyles of people; research is carried out according to special programs in certain periods of time in specific territories.

Each method has its own source of information, statistical accounting document, analysis algorithm. For statistical analysis can be used as a) officially established documents medical records, and b) specially designed forms.

An important methodological point in the characterization, description and analysis of morbidity is correct application terms and their common understanding.

The study of the incidence of the population By negotiability for medical care in health care facilities - the leading method that usually detects acute diseases and chronic diseases in the acute stage.

It consists of the study of general and primary morbidity, as well as 4 types of special morbidity records:

1) acute infectious diseases

2) important non-epidemic diseases

3) hospitalized diseases

4) diseases with temporary disability - they are distinguished, because they have medical, social and economic significance.

Methodology for studying general and primary morbidity

The general morbidity of the population is being studied Based on a complete accounting of all primary applications for medical care in medical institutions. Unit of account- the first visit to the doctor for this disease in the current year. Main accounting document in outpatient clinics - "Statistical coupon for registration of final (refined) diagnoses" (f. 025-2 / y), which is filled in for all cases of acute diseases and the first visits in this calendar year for chronic diseases. For each acute illness a statistical coupon is filled in and a plus sign (+) is put in the column “diagnosis established for the first time in life”. For chronic diseases, the statistical coupon is filled out only once a year at the first application. The sign "+" is put in the event that a chronic disease is detected in a patient for the first time in his life. At the first visit of a patient in a given year regarding an exacerbation of a chronic disease identified in previous years, a minus sign (-) is put. With repeated appeals in a given year for exacerbations of chronic diseases, the diagnosis is not recorded. All specified diagnoses are recorded by the doctor in "Sheet for recording the final (clarified) diagnoses" in " Medical card outpatient” (f. 025 / y), which allows you to see the dynamics of diseases.

All coupons with registered diagnoses of diseases at the end of the reception are transferred to the medical statistics office, encrypted and used for statistical summaries, reporting and calculation of morbidity rates. Information about cases of diseases among the population is contained in “Report on the number of diseases registered in patients living in the service area of ​​a medical institution for ... a year” (f. 12).

Some outpatient clinics use new system accounting for diseases for a completed service case with automated processing of primary medical documentation. To do this, use the "Coupon of the outpatient". This record is completed for each completed case of outpatient care (POS) for a patient at an outpatient facility (i.e. a case of recovery, remission, hospitalization, or death of the patient). All visits made due to the disease are entered into it, this document is kept in the doctor's office until the SPO is completed, after which it is signed by the doctor and transferred to the medical statistics office. Information about return visits is used to characterize the volume of medical care.

Indicators of general and primary morbidity.

1) the frequency of primary morbidity

Average annual population = (number of inhabitants on January 1 + number of inhabitants on December 31) / 2

2) the frequency of general morbidity

3) special intensive indicators - calculated by age, gender groups, by nosological forms of diseases, by professional, social, territorial and other characteristics:

4) incidence structure

Modern levels of general and primary morbidity and their structure in the Republic of Belarus.

Primary morbidity: 74,000 per 100,000 population, increased by 40% since 1990, there is an increase in all classes, except for infectious and endocrine diseases

1st place: respiratory diseases (49%)

2nd place: injuries and poisoning (10%)

3rd place: diseases musculoskeletal system (5%)

4th place: diseases of the skin and subcutaneous fat (5%)

5th place: infectious diseases

6th place: diseases of the genitourinary system

General morbidity: 130,000 per 100,000 population, increased by 18% in 10 years

– the accumulation index is calculated (general morbidity / primary morbidity)

- in children, the incidence is 3 times, in adolescents 2 times more than in adults

– in women, the incidence is higher, because more often they turn to

- Citizens have a higher incidence of morbidity than rural population, because the accessibility of medical institutions is higher

1st place: respiratory diseases

2nd place: diseases of the circulatory system

3rd place: diseases of the digestive system

4th place: diseases of the musculoskeletal system

The world's most frequent illnesses are:

2nd place: anemia (2 billion cases annually)

3rd place: external diseases– injuries, poisoning, occupational diseases

4th place: mental disorders.

The concepts of illness and disease are very close in meaning, but the latter term has a broader interpretation. A disease is any deviation from physiological norm. On the other hand, morbidity is whole complex indicators of the quality and structure of diseases, reflecting the level and frequency of the spread of pathologies. These indicators reflect the situation in the country as a whole, in a particular region, in a particular age or social group.

Morbidity rates reflect the economic and social processes taking place within any country. If they increase, then we can conclude that there is a shortage of medical facilities in the state, or qualified specialists. As a result, the mortality rate is of great importance, reflecting not only social problems but also medical, biological and demographic.

At the same time, morbidity data allow us to analyze the effectiveness of medical institutions, both in general and separately in a particular region. It becomes possible to plan the volume of necessary preventive measures and determine the circle of persons who are subject to mandatory dispensary examination.

Classification of diseases

All over the world, a unified diagnostics and registration of known ones has been adopted, which is conditionally divided into 21 classes and 5 groups. ICD ( international classification diseases) reflects modern stage development of all medicine. Following the example of structuring the ICD, classifiers of diseases have been created in individual industries medicine. The classifier is reviewed every 10 years in order to bring it into line with the data and achievements in medical science obtained during this period.

Types of morbidity on contact with medical institutions

Morbidity analysis is carried out according to the following indicators:

1. Actually, morbidity, cases of detection of a certain pathology first registered in the current year. Calculations are carried out by comparing newly emerged diseases to the average number of the population.
2. prevalence or soreness. Primary cases of detection of the disease in the current year and repeated cases are taken into account. Calculated by the ratio between all cases of detection of a certain class of disease, to the population for 1 calendar year.
3. Pathological affection, that is, disorders and diseases that were identified during medical examinations.
4. true morbidity. An indicator that includes information on the number of visits to a doctor, diseases detected during medical examinations, and data on causes of death.

Types of morbidity by contingents of the population

Information on contingents is classified according to occupational, morbidity with temporary disability, pregnant women and women in childbirth, and other categories.

Occupational morbidity

This is the number of people who received Occupational Illness or poisoning, in relation to the number of healthy workers. The main causes of occupational diseases include:

• impact harmful factors per person;
• accidents;
• violation of the technological and production process;
• equipment malfunction;
• lack of sanitary facilities;
• non-use or lack of personal protective equipment at work.

Today, in our country, this figure is negligible. However, even isolated cases are, as they reflect the presence adverse conditions labor that require urgent preventive measures at work. For example, in relation to the 70s of the last century, occupational morbidity has decreased by 50%. Today, of all identified cases, 2/3 belong to chronic pathologies.

Morbidity with temporary disability

In this case, morbidity is the actual record of cases of the appearance of diseases in the working contingent. It doesn't matter if the disability is due to injury or other problems.

For this analysis of incidence, the following indicators are taken into account:

• cases of disability per a certain number of people per year;
• the number of days of temporary disability for 12 months;
• average duration of 1 case;
• the structure of morbidity, that is, the number of cases of treatment for one type of disease.

Morbidity of pregnant women and childbirth

It is regrettable to admit that the statistics of the incidence of pregnant women is only getting worse every year, being the most topical issue for all countries of the world. This indicator reflects not only the health of women, but also the offspring that will remain after her.

Some statistics (indicators in%, in relation to the number of women who have already given birth, data throughout the Russian Federation):

• the threat of termination of pregnancy decreased slightly in 2016 - an indicator of 18.2, in 2015 this figure was 19.0;
• venous complications in 2016 amounted to 5.5%, and in 2005 the figure was 3.9%;
• women with diabetes in 2016 - 3.14%, and in 2005 - 0.16%.

For individual diseases, it is already possible to clearly understand in which direction it is necessary to direct preventive actions in every medical institution in the country.

Morbidity in children of preschool and school age

As in the case of pregnant women and women in childbirth, the health situation of children and adolescents in the country is only getting worse. So, as of the beginning of this year, 32.8 cases of the disease were detected. viral hepatitis per 100,000 children aged 0 to 14, and intestinal infections in 1625 children. Neoplasms were diagnosed in 986 children in 2016, and in 2015 only in 953.

Also, data can be analyzed on the incidence in military personnel, specialists in various professions, and on other indicators.

Types of morbidity by age

The incidence of the population is analyzed by age:

• newborns;
• children of school and preschool age;
• morbidity in adolescents;
• in the adult population;
• population older than working age.

Statistics of children's morbidity aged 0 to 14 years (diagnosis is made for the first time)

Incidence statistics throughout the Russian Federation: children from 15 to 17 years old

Data for the entire Russian Federation, on the incidence of the population aged 55 years and over - women, men over 60 years old:

It should be noted that the incidence of cancer is steadily growing in almost the entire population. Only in relation to 2015, last year this indicator slightly decreased in newborns and children under 14 years old.

Do not forget that there is still a category of people who never go to the doctors. According to Profi Online Research, which conducted independent research, it was found that about 9% of respondents never go to medical institutions for help at all, but cope with all illnesses on their own.

Nevertheless, in the context of the overall incidence in the country, the numbers are not so scary. For some diseases, there is a slight, but still decrease in the number of patients.

Classification by groups and nosological forms

Accounting for general morbidity is carried out according to two standard documents:

1. according to the form No. 025-10 / y, which is issued to each patient who applied to the clinic.
2. Statistical card of the departed from the hospital. The card has a standardized form - No. 066 / y. The unit of observation is each case of hospitalization in any medical institution.

The first document allows you to register the patient and the reason for contacting the outpatient clinic, and the second in the hospital.

It is according to these documents that the classification into groups or nosological forms is carried out. There are also the following classes.

Infectious incidence. Indicators of the incidence of an infectious direction allow you to respond as quickly as possible to outbreaks of morbidity in a particular region. Registration of infectious patients is carried out regardless of the place of infection, the citizenship of the person who applied.

Incidence in Russia infectious diseases, for the period from January to August 2016 and 2017, with indicators of increase or decrease:

Morbidity for socially significant and dangerous diseases:

• venereal diseases;
• malignant neoplasms;
• trachoma;
• tuberculosis;
• mycoses and a number of other ailments.

AT this case The unit of study for non-epidemic morbidity is each person presenting to the hospital where they were first diagnosed.

Statistical data on the incidence of the population by gender: the first diagnosis of "tuberculosis in active form for 2016 compared to 2015:

According to the nosological form, they are distinguished into a separate category oncological diseases, whose number is only increasing.

Incidence rate by stages of development of the tumor process and regions (as a percentage of the number of detected cases):

Statistics are also kept on the level of injuries, the number mental illness and gender.

Methodology for studying and analyzing the incidence of the population

There are two main methods for studying morbidity:

1. Solid. The technique is used to obtain operational data.
2. Selective. The main goal is to reveal the relationship between morbidity and environmental factors.

A striking example is the study of morbidity in a particular region of the country or in a separate social group.

In terms of the increase in the incidence of HIV infection, the Russian Federation is in 3rd place after Nigeria and the Republic of South Africa in 2016. At the same time, it cannot be said that all countries of the world can provide up-to-date data, for example, in Moldova and Ukraine, Tajikistan or Uzbekistan, there are not enough funds allocated for screening the entire population.

If we compare the world data of 2016 compared to 2010, then there is a downward trend in the incidence in a number of countries:

If we talk about the Russian Federation, then the incidence structure is as follows:

In general, morbidity is the most important indicator for determining general condition health of the entire population of a particular region and the whole country. Statistical data make it possible to timely direct preventive measures in the “right direction” and do everything to avoid an epidemic. It not only helps to establish the percentage of a particular type of disease among the population, but also to organize measures to combat it.

The incidence rate is used along with birth and death rates to predict life expectancy and the likely percentage of the population that will retire on disability. For in-depth study and the ability to analyze the level and structure of morbidity at the state level, a mandatory record of the incidence of patients has been introduced, which is carried out in hospitals and outpatient clinics.

public health- this is the health of the population, due to the complex impact of biological and social factors of the environment, with the decisive importance of the socio-political and economic system and the living conditions of society that depend on it. Conditions affecting health:

Lifestyle (50%);

Heredity (20%);

External environment (20%);

Healthcare (10%).

The health of the population is due to the complex influence of factors that determine the way of life of a person, his environment, heredity and the state of the health care system.

The following classification of factors determining the state of health of the population is generally accepted:

Socio-economic (lifestyle, working conditions, housing conditions, material well-being, etc.);

Socio-biological (age, gender, heredity, etc.);

Ecological and climatic (state of air, water, soil, level of solar radiation, etc.);

Medical and organizational (quality, efficiency, availability of medical and social assistance, etc.)

Basic principles of protecting the health of citizens of the Russian Federation ( the federal law dated November 21, 2011 No. 323 "On the basics of protecting the health of citizens in the Russian Federation").

The basic principles of protecting the health of citizens of the Russian Federation are a set of political, legal and medical measures aimed at preserving and strengthening the physical and mental health of citizens of the Russian Federation and providing assistance in case of loss of health.

State (research part of hospitals);

Municipal (polyclinics);

Private (about 15%).

The main principles of protecting the health of citizens are:

1) observance of the rights of a person and a citizen in the field of health protection and provision of state guarantees related to these rights;

2) the priority of preventive measures in the field of protecting the health of citizens;

3) availability of medical and social assistance;

4) social protection of citizens in case of loss of health;

5) the responsibility of public authorities and administration, enterprises, institutions and organizations, regardless of the form of ownership, officials for ensuring the rights of citizens in the field of health protection;

6) inadmissibility of refusal to provide medical care;

7) observance of medical secrecy;

8) priority of the patient's interests.

Human health and primary risk factors.

Human health- this is a state of complete socio-biological and mental well-being, when the functions of all organs and systems of the human body are balanced with the natural and social environment, there are no diseases, painful conditions and physical defects.

There are primary risk factors that depend on socio-economic, political, natural conditions, and secondary risk factors that contribute to the emergence of pathological conditions and the development of diseases.

The most adequate criterion of public health is the category of lifestyle, and the indicator is the medical and social potential of working capacity. Public health research, especially the health of the healthy, is of strategic importance in preventing disease and improving the health of the population.

Health levels:

1) Individual;

2) Group;

3) Regional;

4) Public;

Indicators of individual health:

1) Anthropometric;

2) Somatoscopic (constitution, condition skin etc);

3) Functional (muscle strength, VC, heart rate, etc.);

Factors affecting health:

Socio-economic;

Sanitary and hygienic;

Natural and ecological;

hereditary;

Bad habits.

Risk factors.

Primary:

• Alcohol;

  Irrational nutrition;

  Hypodynamia;

  Psycho-emotional stress;

Secondary:

• Lipodemia, cholesterolemia;

  Rheumatism;

  Allergy;

  Immunodeficiencies.

At-risk groups:

age;

Social;

Prof. risk;

Functional, pathological condition;

Low standard of living;

with deviant behavior

Methods for studying the health of the population.

According to the WHO, “health is a state of complete physical, mental and social well-being and not merely the absence of disease or infirmity”.

There is also a so-called third (or intermediate) state, which is close either to health or to a disease, but is neither one nor the other. It includes: neurasthenia, loss of appetite, irritability, headache, fatigue, etc.

Human health is researched and measured at various levels. If a we are talking about individuals, they talk about individual health, if about their communities - about group health, if about the health of the population living in a certain territory - about the health of the population.

The health of the population is also studied at the sociological level, that is, at the level of public health. Public health reflects the health of the individuals that make up society. This is not only a medical concept, but to a large extent a social, socio-political and economic category, since the external social and natural environment is mediated through specific living conditions - work and life.

The health status of the population includes:

demographic phenomena;

morbidity and disability;

Physical development;

Which are characterized by medical-demographic and sanitary-(medical)-statistical indicators.

Demographic phenomena:

Population - the original baseline, the number of people in the population that defines them (region, etc.)

n - birth rate;

N x - total number born alive in a year;

P x is the average annual population.

Mortality is the process of natural reduction in the number of people due to deaths.

M is the overall mortality rate;

M x is the number of deaths in a given year;

P x is the average annual population.

Infant mortality rate.

m 0 - the number of deaths at the age of 0 to 1 year;

M -1 - the number of children who died under the age of one year out of those born in the previous year;

N 0 - the number of births in the reporting year;

N -1 - the number of births in the previous year;

Total population growth

P1 - P0 = Ppr

P0 - population at the beginning of the period (usually a year)

Р1 - at the end of the period

Natural population growth

N is the total number of births

M - total number of deaths

The value of the indicator can be negative if there is a natural population decline (in Russia since 1992)

Medical and statistical indicators:

Incidence is an indicator that determines the totality of diseases first registered for the current calendar year among the population living in a particular territory.

Primary morbidity - the ratio of the number of newly emerging diseases to the average population and X 1000

The number of diseases first detected in life / the average number of the population X1000 Characterizes the frequency of occurrence and dynamics of newly emerging diseases.

Morbidity is the ratio of the number of initial visits to the average population. Number of all diseases per year / average population.

Pathological susceptibility characterizes the totality of diseases and pathological conditions identified through active medical examinations per 1000 population. The number of diseases detected in honey. examinations / average number of examined population X1000

Indicators of individual physical development

Anthropometric indicators (height, weight, etc.)

Somatoscopic (constitution, condition of the skin, etc.)

Functional (muscle strength, VC, heart rate)

Methods for studying the incidence of the population

For the study of morbidity, the following sources are used:

Negotiability

Medical examinations

For reasons of death

According to socio-hygienic and clinical-statistical studies

A visit is every visit to the doctor.

Treatment is the first visit regarding this disease.

General morbidity –

Unit of observation is the initial visit of the patient to the doctor about a specific disease in a given calendar year. The main accounting document is the “Statistical coupon for registration of final (refined) diagnoses” (f. 025-2 / y).

The "statistical coupon" is filled out for each case of an acute disease (with a "+" sign), for each case of a chronic disease diagnosed for the first time in life (with a "+" sign), as well as for the first visit in the current calendar year for a previously diagnosed chronic disease (with the sign "-").

Chronic diseases are counted only once a year, exacerbations of chronic diseases in

this year again as diseases are not taken into account. Based on the development of data on "Statistical coupons", a "Report on the incidence" is filled out (form 12).

When studying the primary morbidity of the population, according to the data on appeal, “Statistical coupons” filled out only for newly diagnosed diseases (with a “+” sign) are taken into account.

When studying the prevalence of diseases, according to the data on appealability, all statistical coupons filled out during the year are taken into account, both in cases of newly established diagnoses with a “+” sign, and in cases that have been transferred from previous years with a “-” sign.

When analyzing the overall incidence, it is customary to calculate the following indicators.

Primary morbidity:

number of diseases newly diagnosed in a year x 1000 (10,000, 100,000) / average annual population.

Prevalence:

number of diseases first detected in a year and re-registered from previous years x 1000 (10,000, 100,000) / average annual population.

General incidence rates give only a general idea of ​​the incidence rate. More accurately characterize the general incidence of special indicators (age and sex, according to diagnoses, professions, etc.).

Age-sex incidence rates:

number of diseases detected per year in persons of this sex and age x 1000 (10,000, 100,000) / average annual population of this sex and age.

Overall morbidity rate by diagnosis:

number of diseases diagnosed per year x 1000 (10,000, 100,000) / average annual population.

Similarly, special prevalence rates are calculated by sex, age, diagnosis, etc.

The following indicators allow assessing the severity of the course of the disease.

Structure of general morbidity (share of certain diseases in the total morbidity):

the number of diseases with this diagnosis detected per year x 1000 / total number of diseases.

Mortality rate:

the number of deaths from this disease per year x 1000(10,000, 100,000)/average annual population.

Lethality rate:

the number of deaths from this disease per year x 1000 / the number of patients with this disease.

Mortality and mortality rates can also be calculated by sex, age, profession, etc.

When analyzing the morbidity rate according to the data on seeking medical care, it should be remembered that it depends on the population's seeking medical care. The accessibility, in turn, is influenced by the availability of medical care, the medical activity of the population, material well-being, the qualifications of doctors and other factors.

Morbidity Study Scheme. Morbidity study methods:

1) Negotiability:

a) General morbidity (outpatient medical card, record sheet, outpatient coupon);

b) C VUT (ticket for a completed case with VUT);

c) Hospitalization or hospital rehabilitation (card of the person who left the hospital);

d) Illness with acute infectious diseases (EMERGENCY notification of a newly diagnosed infectious disease);

e) Incidence of the most important non-epidemic diseases (notification of a patient with a diagnosis of newly registered tuberculosis in active form).

2) Method of medical examinations:

a) preliminary;

b) Periodic;

c) target. (Medical card of an outpatient; card of a person subject to periodic medical examination; List of persons subject to periodic medical examination).

3) Method by cause of death (Medical certificate of death; Medical certificate of perinatal death)

4) Selective study or socio-hygienic study (freeform document).

6. Types of morbidity of the population

5 types of information about the incidence of the population:

The general incidence of the population is the level of diseases among population groups for a certain period.

The incidence of infectious diseases. Accounting is carried out by counting each disease if it is suspected

Incidence of the most important non-epidemic diseases. These are tuberculosis, venereal diseases, tumors, fungal and others, first registered this year. Diseases are registered in the dispensary.

Diseases with temporary disability.

hospital morbidity

7. General and primary morbidity, pathological affection.

Primary incidence This is the first time the disease has been reported this year. It is calculated as the ratio of the number of newly emerging diseases (diseases with a first diagnosis) to the average population, multiplied by 1000.

Soreness- characterizes the prevalence of registered diseases, both newly emerged and pre-existing, about which there were primary appeals in the calendar year. The calculation is made per 1000 inhabitants. Number of all diseases per year / average population x 1000.

General morbidity – it is a set of diseases (acute and chronic) among certain groups of the population for a certain calendar year. The study of general morbidity is carried out according to the data of outpatient clinics. General morbidity data are needed to fully characterize the health of the population.

Pathological affection - all diseases, all anatomical defects, all functional abnormalities identified during medical examinations. (all detected diseases during medical examinations / average number of examined population X 1000).

8. Morbidity with temporary disability.

The study of morbidity with temporary disability has been conducted in the Russian Federation since 1925. Morbidity with temporary disability - the frequency of all cases and days of disability due to the disease. The unit of observation is each completed case of temporary disability during the year. Documentation - certificate of incapacity for work (workers), certificate (students) and coupon. Dates of issuance sick leave for the care of a child under 15 years old for 3 days. Up to 2x - for the entire period. Up to 7 for the entire duration. From 7 to 15 years - 15 days. Inpatient care for a child for the entire duration of the child's stay.

The indicators are calculated:

Number of cases of temporary disability per 100 employees:

N / Rrab X100,

where N is the total number of cases with temporary disability,

Rrab - average annual number of workers

Number of days of incapacity for work per 100 employees:

Dnetrud/RrabX100

The average duration of one case of the disease with VUT:

Dnetrud/N

The structure of morbidity with VUT in cases of:

Nx-number of cases of diseases with VUT due to a specific disease

Morbidity structure with VUT in days:

Dx/Dnetrud X100

dx - the number of days of disability due to a specific disease

Percentage of conditionally unemployed for the reporting period (percentage of disabled people)

Dnetrud / (Rrab x 365) x 100

Day of work - days of disability

Rrab - average annual number of employees