Special indicators of morbidity. Indicators of general morbidity and methods of their calculation

Incidence- a phenomenon that characterizes the state of health of the population; a set of diseases detected and registered among the population as a whole or its individual groups for a certain period of time.

Significance of morbidity data for ZO:

1) levels and structure of morbidity - the most important components in a comprehensive assessment of health, the criterion of public health

2) determines the level of disability and mortality

3) planning is carried out on the basis of morbidity data preventive measures hostility and programs at the state and regional levels

4) on its basis, the need for staffing and various types of assistance is determined

5) are used as criteria for evaluating the work of institutions and doctors

Conditions required for conducting morbidity studies:

1) the use of unified terminology

2) use of standard nomenclatures and classifications

3) unified methods of collecting information

4) calculation of morbidity rates using uniform formulas.

Terminology of morbidity.

Primary incidence- the totality of new, nowhere previously recorded and for the first time in a given calendar year, diseases detected and registered among the population, calculated per 100 thousand population.

General morbidity- the totality of all diseases among the population, both first detected in a given calendar year and registered in previous years, about which patients again applied to this year.

Accumulated incidence - the totality of all primary diseases registered over a number of years (minimum 3 years).

Pathological affection- the totality of all pathological conditions (acute and chronic, premorbid conditions) identified during one-time examinations and preventive examinations.

Contingent of patients- the number of persons registered at a certain point in time for each disease.

Modern trends and features of morbidity in the Republic of Belarus.

1) the level of general morbidity in the Republic of Belarus in 2005 - 130,000 per 100 thousand of the population, the primary incidence in the Republic of Belarus in 2005 was 74,000 per 100 thousand.

2) the presence of differences in the morbidity of the urban and rural population - the rural population has reduced access to a doctor, it is located far away, not a complete account of the incidence, the level of doctors is lower in the village, the incidence in the village is lower.

3) the incidence depends on age, after 16 years - an increase in the incidence rate, by the age of 60 - high level and further increases.

4) the incidence depends on gender (in women - more often endocrine, in men - gastric ulcer, myocardial infarction)

5) different structure of primary and general morbidity

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 appeal for medical care - the foundation was laid by zemstvo doctors who offered cards; allows you to identify clinically expressed diseases and seek medical help.

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 of the medical institution with 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 medical examinations

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

Statistical study of incidence population can be carried out:

a) 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) sampling 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 areas.

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

An important methodological point in the characterization, description and analysis of morbidity is the correct use of 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) sharp infectious diseases

2) important non-epidemic diseases

3) hospitalized diseases

4) diseases with temporary disability - they are isolated, because. they are of medical, social and economic importance.

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 disease, a statistical coupon is filled out 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 the "Medical card of an 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 are using a new case-based case management system with automated processing of primary medical records. 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 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, sex groups, by nosological forms of diseases, by professional, social, territorial and other characteristics:

4) the structure of morbidity

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 of the musculoskeletal system (5%)

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

5th place: infectious diseases

6th place: diseases 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

In urban areas, the incidence is higher than in the rural population, tk. higher availability of medical facilities

1st place: respiratory diseases

2nd place: diseases of the circulatory system

3rd place: diseases of the digestive system

4th place: diseases musculoskeletal system

The most common diseases in the world are:

2nd place: anemia (2 billion cases annually)

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

4th place: mental disorders.

Morbidity rates are calculated by medical statisticians for individual medical districts, departments and for the institution as a whole (in dynamics). Doctors, heads of departments and heads of healthcare institutions analyze the established features and trends based on the established dependencies and patterns of influence of factors, events are planned and necessary management decisions are made.

Under the conditions of the system operation health insurance, the development of automation of work of medical statisticians, various information statistical programs and computer

technology. Perfect Information Technology provide for mandatory control over the implementation of the rules for coding information about the patient and his diseases.

Peculiarities of parallel analysis of primary morbidity and prevalence rates

Parallel analysis of indicators and in dynamics (prospectively or retrospectively) makes it possible to identify factors influencing the magnitude of indicators. So, for example, if prevalence rates are trending upward, it is important to look at the trend in the primary incidence rate. If the latter indicator also tends to increase, then it should be concluded that the increase in prevalence reflects the deterioration in the health of the population, since. the accumulation of "contingents" is due to the growth of "primary morbidity".

The growth of primary morbidity means that there are "culprits" of such growth. This circumstance of an in-depth analysis of factors requires the development and implementation of a complex of therapeutic and preventive measures, and, ultimately, the improvement of conditions and lifestyle, the economic improvement of the external environment, etc. ( targeted programs, prevention programs).

If the primary incidence has a favorable trend - to decrease, then the increase in prevalence reflects the longer life expectancy of patients and due to this there is an "accumulation" of diseases. This prevalence trend reflects the presence of "favorable" factors - improving the quality of life of patients, including by improving the quality of medical care.

Significance for doctors and healthcare facilities simultaneous analysis of indicators

According to the trends of growth, stabilization or decrease in primary incidence and prevalence in dynamics (trends), reflecting the influence of factors and the subsequent use of statistical methods of evidence and justification, it is possible to determine the priorities for the implementation of those

arterial hypertension, etc.) in the service area of ​​the polyclinic may be associated with:

- with impact etiological factors the risk of these diseases;

- with the improvement of the level and quality of diagnostics;

The growth of predominantly acute diseases is due to the increased influence of risk factors for these diseases, since their diagnosis is not as difficult as chronic diseases.

When analyzing trends in primary morbidity and the prevalence of chronic diseases, the doctor and healthcare facility will need an in-depth study of the circumstances that led to the increase:

- whether the conditions and lifestyle of the population have deteriorated;

- whether the influence of environmental risk factors has increased;

- whether the availability or availability of diagnostic equipment has deteriorated;

- whether accessibility and qualifications have declined medical specialists. The simultaneous increase in the prevalence of chronic diseases in

the trend of increasing incidence may be due, firstly, to an increase in newly diagnosed diseases, and secondly, to an increase in the number of exacerbations (recurrences) of previously registered chronic diseases with a low level of organization of preventive work.

AT last years the preventive activities of polyclinic doctors have intensified. With the introduction of targeted programs for the prevention of chronic

diseases, as well as active visits to patients during dispensary observation, can also influence the increase in prevalence rates.

The doctor will need an in-depth study of the circumstances that led to the increase in incidence: whether the conditions and lifestyle of patients worsened, ecological environment etc., as well as whether the availability of diagnostic equipment, the availability and qualification of specialists who diagnose diseases have deteriorated.

A simultaneous increase in the prevalence of chronic diseases with an increase in incidence may be due, firstly, to an increase in new diseases and early detected diseases (their exacerbations or the active dispensary work of doctors).

A decrease in primary morbidity with stabilization or an increase in prevalence may be due, first of all, to an improvement in the conditions and lifestyle of the population, a decrease in the influence of risk factors due to preventive measures. At the same time, an increase in the prevalence rate indicates an exacerbation of chronic diseases, or a better organization and implementation of preventive measures to prevent relapses.

Hospitalized morbidity - this is the frequency of all cases of diseases registered in patients who left the hospital for a given year.

Unit of observation - the main case of the disease of a patient who left the hospital (discharged or deceased). As a rule, the main diagnosis is the diagnosis at discharge.

Accounting document: - "Statistical card of the person who left the hospital" (form No. 066 / y-04 and f. No. 066 / y-02), which is filled out or controlled by the attending physician on the basis of the "Medical card of the hospital patient" (case history - f. No. 003/y). Disease data from Statistical maps left the hospital" are summarized in the "Report on the activities of the hospital" (form No. 14), which provides information on the composition of patients in the hospital according to

nosological groups, age groups(adults and adolescents, children).

Based on the development of the data of the consolidated record of hospitalizations for diseases and annual data, the following indicators can be calculated (Table 3.4):

Table 3.4

Indicators of hospitalized morbidity and their methodology

Incidence rates can be calculated both for individual nosological forms and for classes of diseases. The analysis can be carried out in dynamics, as well as depending on gender, age and other characteristics.

Infectious incidence is the frequency of all cases of infectious diseases registered in the population during a certain period of time.

Special accounting of all infectious diseases, despite the fact that they are reflected in the overall incidence, is caused by the need to develop urgent anti-epidemic measures carried out by both medical institutions and institutions of the Rospotrebnadzor service.

Unit of observation- each case of a registered infectious disease for certain period time.

accounting document- in addition to accounting forms (Outpatient Coupon, or "Single Coupon"), a " emergency notice about

infectious disease, food poisoning, acute occupational poisoning, unusual reaction to vaccination” (form No. 058/y). It is filled in by the doctor within the first 12 hours from the moment of diagnosis, sent to the Center for Hygiene and Epidemiology, and the summary data is transmitted to the territorial department of Rospotrebnadzor.

Each "Emergency Notice" is registered in a special journal (f. No. 060 / y) in a medical institution and an institution of the Rospotrebnadzor service.

In the future, data on registered infectious diseases are used to compile monthly and annual reports. For efficiency in some cities, information about infectious diseases is transmitted by multi-channel telephone to health authorities and institutions of the Rospotrebnadzor service.

For evaluation and analysis infectious disease the following main indicators are calculated (Table 3.5):

Table 3.5

Indicators of infectious morbidity and methods for their calculation

Incidence rates can be calculated both in general, for individual classes of diseases, and for nosological forms. The analysis is carried out in dynamics, as well as among children, adolescents and adults.

Incidence- one of the indicators of public health. 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 is taken medical card and stat. 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 of the 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

The incidence has essential in the study of the state of health of the population. Morbidity is studied on the basis of an analysis of medical documentation of outpatient and inpatient medical institutions: cards of patients who have left the hospital; statistical coupons for registration of updated diagnoses; emergency notifications of infectious diseases; death certificates, etc.

The study of morbidity includes quantitative ( incidence rate), qualitative ( incidence structure) and individual ( frequency rate of diseases transferred per year) evaluation.

Distinguish:

morbidity itself- newly registered diseases in the reporting year;

prevalence of the disease (morbidity)- diseases that reappeared in a given year and transferred from the previous year to this moment.

Pathological affection- a set of diseases and pathological conditions identified by doctors through active medical examinations of the population; expressed statistically as the ratio of the number of diseases present at the moment, the average population, multiplied by 1000.

By health groups, workers are distributed as follows:

healthy (who did not have a single case of disability in a year);

practically healthy (who had 1-2 cases of disability in a year due to acute forms of diseases);

who had 3 or more cases of disability per year due to acute forms diseases;

having chronic diseases, but not having cases of disability;

those who have chronic diseases and who had cases of disability due to these diseases.

The incidence of the population shows the level, frequency, prevalence of all diseases, taken together and each separately, among the population as a whole and in separate groups by age, sex, profession.

Morbidity rates are determined by the corresponding figure: per 1000, 10 000 or 100,000 people.

Epidemiological evidence strongly suggests that the incidence is higher in men than in women.

Men die from myocardial infarction 7.5 times more often between the ages of 40 and 49; 5.5 times - at the age of 50 to 55 years and 2.5 times - at the age of over 60 years. The unequal life expectancy of men and women is also explained by genetic differences in the chromosomal apparatus of the cell nucleus, the presence of a double set of X chromosomes in women, which determines the higher reliability of important mechanisms of biological regulation of the cell.

Disability rates

Disability- a health disorder with a persistent disorder of body functions due to diseases, congenital defects, the consequences of injuries leading to a restriction of activity.

Disability and disability of the population are the most important indicators of public health and have not only medical, but also socio-economic significance.

According to WHO, every fifth person in the world

(19.3%) become disabled due to malnutrition,

about 15% became disabled due to bad habits(alcoholism, drug addiction, drug abuse),

15.1% received disability due to injuries at home, in production and on the road.

On average, people with disabilities make up about 10% of the world's population.

In Russia, the average level of disability ranges from 40 to 49 per 10,000 inhabitants.

The causes of primary disability are mainly 4 groups of diseases:

Diseases of the circulatory organs - 27 - 35% of cases;

Malignant neoplasms - 23 - 29%,

Injuries - about 10%,

Diseases nervous system and sense organs - 5-7%.

Most people (80 - 90%) become disabled at working age. At the same time, the level of rehabilitation and restoration of working capacity is insignificant (10-12%).

Incidence is one of the criteria for determining the state of health of the population. Materials on the incidence of the population in the practice of a doctor are necessary for:

assessment of public health and identification of risk factors contributing to the reduction of morbidity;

Evaluation of the effectiveness of ongoing medical and recreational activities, including medical examinations;

volume planning preventive examinations;

determination of the contingent for dispensary observation, hospitalization, sanatorium treatment, employment of a certain contingent of patients, etc.;

current and advanced planning personnel, a network of various services and divisions of health care;

operational management of health care institutions;

morbidity forecast.

Analysis of the state of health of the population or its individual groups is mandatory in the activities of a doctor. Main elements complex analysis are:

1) collection of information about the state of health;

2) processing and analysis of health information;

3) putting forward a hypothesis about the relationship of environmental factors with the state of health;

5) health characteristics;

6) identification of quantitative relationships between environmental factors and health characteristics;

7) making a decision on recovery environment for primary prevention diseases;

8) implementation decisions taken;

9) verification of the effectiveness of the decisions made.

Depending on the purpose of the study, various statistical materials and accounting documents are used (medical records, emergency notices of infectious diseases, sick leave certificates, cards of patients who have left the hospital, statistical coupons for registering updated diagnoses, medical death certificates, other special forms and questionnaires) .

The study of morbidity includes a quantitative (morbidity rate), qualitative (morbidity structure) and individual (frequency rate of diseases transferred per year) assessment.

Distinguish: actual incidence - newly registered diseases in the reporting year; morbidity - the prevalence of diseases (diseases that reappeared in a given year and passed from previous years at the moment) and pathological affection.

Primary incidence- This is the number of first-ever diagnosed diseases within 1 year. Everything counts acute diseases and for the first time in my life established chronic diseases on the first visit to medical institution(relapses chronic pathology occurring during the year are not taken into account).

Incidence rate \u003d (Number of newly diagnosed patients per year / Average annual population) x 1000

Seeking medical care- this 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.

General morbidity of the population is studied according to the data of all primary requests for medical care in medical institutions. The main accounting document in outpatient clinics is a medical card. The unit of observation in the study of general morbidity is the primary appeal of the patient in the current calendar year about this disease. When studying general morbidity, general and special indicators are calculated.

The indicator of general morbidity is determined by the number of primary applications for medical care to medical institutions in a given year per 1,000 or 10,000 inhabitants.

General indicator is the ratio of the number of cases per year to the total population. The number of requests for medical care for diseases, for example, in St. Petersburg has now significantly decreased and is: the total incidence of the adult population is about 900 requests per 1000, and the primary incidence is about 500 requests per 1000 inhabitants. Morbidity of the child population: general - 1800, primary - 1500 appeals per 1000 children.

Special indicators incidence: morbidity by sex, age, nosological forms, administrative territories. In the structure of the general incidence of the adult population of St. Petersburg, the first places are occupied by:

respiratory diseases (about 25%),

diseases of the circulatory system (about 16%),

diseases of the nervous system and sensory organs (about 12%),

injury and poisoning (about 12%).

The study of various types of morbidity is explained by certain reasons, for example:

Infectious morbidity - requires rapid anti-epidemic measures;

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

morbidity with temporary disability - determines the economic costs;

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 taking into account gender, age, profession, etc.

Exist following methods study of morbidity:

· solid,

selective.

The continuous method is acceptable for operational purposes.

Sampling method - used to identify the relationship between incidence and environmental factors. The sampling method was used during the years of the population census, for example, the study of morbidity in certain territories. 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 map.

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.

The unit of observation in the study of general morbidity is the initial appeal of the patient in the current calendar year about the disease. The main accounting documents for the study of general morbidity are: a medical card and a statistical coupon for an updated diagnosis.

The overall incidence is calculated per 1000, 10000 population. In the structure of general morbidity in Russia, respiratory diseases occupy the first place, diseases of the nervous system and sensory organs are in second place, circulatory organs are in third place, and skin and skin diseases are in fourth place. subcutaneous tissue, on the fifth - diseases of the nervous system and sensory organs.

Incidence infectious diseases studied by taking into account each infectious disease or suspicion of it. The record document is an emergency notification of an infectious disease. An emergency notification is drawn up for each infectious disease or suspicion of a disease and is sent within 12 hours to the center of Rospotrebnadzor (sanitary and epidemiological supervision). An emergency notice prior to departure is recorded in the journal of infectious diseases (form No. 060). Based on the entries in this journal, a report is compiled on the dynamics of infectious diseases for each month, quarter, half year and year. The analysis of infectious morbidity is carried out using general and special indicators. The total infectious disease rate is the number of infectious diseases registered per year per 10,000 inhabitants divided by the population. Special indicators - age and sex, depending on the profession, work experience, etc.

The structure of infectious diseases (in%) is the proportion of infectious diseases among total number registered diseases. The mortality rate is calculated and estimated (the number of deaths per 10,000 registered patients with infectious diseases). With a deeper study of infectious morbidity, seasonality, sources of infection, effectiveness are analyzed. preventive vaccinations etc., which enables doctors to develop measures to combat infectious diseases.

The number of registered infectious diseases (diphtheria, whooping cough, tick-borne encephalitis, salmonellosis). Incidence rate has risen sexually transmitted diseases, tuberculosis.

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 top respiratory tract 20.

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 incidence of acute intestinal infections. 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.

Soreness or the prevalence of diseases is the totality of all acute and all chronic diseases registered in a given 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 diseases, previously diagnosed cases, and exacerbations of chronic diseases, about which the population applied in a given calendar year.

Pain score = ( The number of patients with this disease registered per year - the number of patients deregistered + the number of patients newly registered) / Average annual population x 1000

Pathological affection - a set of diseases pathological conditions identified by doctors through active medical examinations of the population; expressed statistically as the ratio of the number of diseases currently present to the average population, multiplied by 1000. These are mainly chronic diseases, but acute diseases present at the moment can also be taken into account. In practical public health, this term can be used to define the results of medical examinations of the population. Calculated as the ratio of the number of diseases detected during medical examination, to the number of persons examined, multiplied by 1000.

Incidence with temporary disability (TD) takes special place in morbidity statistics due to high economic importance. Morbidity with TD is one of the types of morbidity in terms of negotiability, it is a priority characteristic of the state of health of workers. Morbidity with VUT characterizes the prevalence of those cases of morbidity among workers that resulted in absence from work.

The unit of observation in the study of morbidity is each case of temporary disability due to illness or injury in a given year. The accounting document is a certificate of incapacity for work, which is not only a medical statistical, but also a legal document certifying temporary release from work, and financial, on the basis of which benefits are paid from social insurance funds. In addition to passport data (last name, first name, patronymic, gender, age), the disability certificate contains information about the place of work of the sick person, the duration of treatment.

According to the generally accepted methodology, a number of indicators can be calculated based on the data of form 16-VN: 1) the number of cases of temporary disability per 100 employees (on average 80-100 cases per 100 employees); 2) the number of days of MST per 100 employees (average 800-1200 per 100 employees); 3) average duration one case of MTD (the ratio of the total number of days of disability to the number of cases of disability) - about 10 days.

In the analysis of MTD, the structure of temporary disability in cases and days is also determined (first place - diseases of acute respiratory infections, further - diseases of the nervous system and sensory organs, hypertonic disease, diseases of the musculoskeletal system, etc.). MTD can be analyzed according to nosological forms.

By health groups, workers can be divided into 5 main groups:

1) healthy (who did not have a single case of disability in a year);

2) practically healthy (who had 1-2 cases of disability per year due to acute forms of diseases);

3) who had 3 or more cases of disability in a year due to acute forms of diseases;

4) having chronic diseases, but not having cases of loss of ability to work;

5) those who have chronic diseases and who had cases of loss of ability to work due to these diseases.

Hospital morbidity rates. The incidence of hospitalized patients is a record of persons treated in a hospital during the year. Information about hospitalized morbidity makes it possible to judge the timeliness of hospitalization, the duration and outcome of treatment, the coincidence or discrepancy between diagnoses, the amount of medical care provided, etc. Data on hospitalized morbidity are taken into account when planning the bed fund, determining the need for various types inpatient care. The unit of observation in the study of hospitalized morbidity is each case of hospitalization. The accounting statistical form is the card of the person who left the hospital. General level hospitalization is about 150 cases per 1000 people. In the structure of hospitalized patients, the main share is made up of patients with diseases of the circulatory system, digestion, chronic diseases respiratory organs, patients with injuries.

When studying the morbidity and mortality of the population, the International Statistical Classification of Diseases and Related Health Problems14 (10th revision, 1995, WHO) is used, which includes 21 classes of diseases, which are divided into a block of headings, terms and diagnostic formulations.

Morbidity structure - the proportion of diseases of a particular body system in the total incidence, taken as 100% (an example of the incidence structure on the example of the Krasnoyarsk Territory is shown in Fig. 4.3.). In the first place - diseases of the respiratory system (36%), in the second - injuries and poisoning (13%), in the third - diseases of the genitourinary system (7%), in the fourth - diseases of the eye and its adnexa (6%), in the fifth - diseases of the musculoskeletal system and connective tissue (5%).

Rice. 4.4. Morbidity structure

Currently, there is a change in the structure of morbidity and mortality. So, if until the middle of the twentieth century, infectious diseases were the most common, which became the main cause of death of the population, now noncommunicable diseases(chronically occurring cardiovascular, oncological, neuropsychic, endocrine diseases and injury). This fact is explained by certain achievements in the field of medical science and the development of a preventive direction in public health: vaccination, labor protection measures, the elimination of natural foci of malaria, plague, health education.

Some researchers speak of a public health crisis. The manifestations of the crisis include the growth of non-communicable epidemics, an increase in the number of deaths due to cardiovascular, respiratory, and oncological diseases. World average cardiovascular diseases are responsible for 25% of deaths. In developed countries - 40-50%, in developing - 16%. Mortality from cancer over the past 20 years has increased in the 28 most developed countries by 19% (including from lung cancer - by 76% in men and 135% in women). The crisis is generated, according to experts, sharp drop the level of the mental component of health (mental disorders - in 2% of the population, taking into account mild forms, alcoholism and drug addiction - in 5-10%, suicide - 40-200 per 100 thousand of the population) and especially spiritual: the growth of crime, selfishness, the cult of violence , drug addiction, loss of a sense of happiness, self-satisfaction, etc. The threat of a crisis is in the deterioration of the gene pool: everything survives and gives offspring more people with a poor gene pool.

Epidemiological evidence strongly suggests that men have a higher incidence than women. Men die from myocardial infarction 7.5 times more often between the ages of 40 and 49; 5.5 times - at the age of 50 to 55 years and 2.5 times - at the age of over 60 years. The unequal life expectancy of men and women is also explained by genetic differences in the chromosomal apparatus of the cell nucleus, the presence of a double set of X chromosomes in women, which determines the higher reliability of important mechanisms of biological regulation of the cell.

One of the main features of the current medical and demographic situation in the country is the high incidence of all categories of the population, including women and children - contingents that determine the reproductive potential of the country for the future. Thus, according to the results of the All-Russian clinical examination of children in 2002, only 32.1% of children can be recognized as healthy. Violations physical health women, their high gynecological morbidity and frequency obstetric complications during pregnancy and childbirth are the leading factors in reducing the quality of health of the offspring.