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Nazan YARDIM, MD, Public Health Specialist School of Public Health

Nazan YARDIM, MD, Public Health Specialist School of Public Health. National Burden of Disease and Cost Effectiveness Study. NBD STUDY IN TURKEY.

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Nazan YARDIM, MD, Public Health Specialist School of Public Health

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  1. Nazan YARDIM, MD, Public Health Specialist School of Public Health National Burden of Disease and Cost Effectiveness Study

  2. NBD STUDY IN TURKEY • Trend in mortality decrease in recent years and increase in chronic diseases which cause long-term disability for people require the use of Burden of Disease criteria (for example, DALY) in order for community needs for health to be identified.

  3. TURKISH NBD STUDY • Studies on Burden of Disease provide a country with valuable information and data which would help to find out the causes and level of negative health status in that country and identify policies to be developed and adopted in order for such disadvantages to be eliminated. • Health investments in a country could be made in a rational manner only when that country’s needs for health are well identified and defined. Pointing out to health needs of priority within a country, Studies on National Burden of Disease, in this context, might facilitate to develop and implement necessary policies.

  4. TURKEY UHY ÇALIŞMASI • Methods based on the Global Burden of Disease approach, which was first defined in 1993 and then amended in 1996, were used for the NBD Study also including the amendments made to the evaluations in 2003.

  5. TURKEY NBD STUDY Study was conducted on 1 March 2002 - 25 December 2004 in cooperation with • Başkent University, • INTRAH (USA) (The University of North Caroline at Chapel Hall, School of Medicine, School of Public Health, Sheps Center for Health Services Research), • John Hopkins University, School of Hygiene and Public Health (USA) • Tulane University-School of Public Health and Tropical Medicine (USA).

  6. GOAL - I • To set up clear and objective criteria to guide and steer forward-looking health policies and strategies in Turkey.

  7. GOAL - II In order to make in-depth assessment of burden of disease, injuries and other major risk factors • to lay the foundation for follow-up of changes and trends in the performance of health and health systems; • to provide comprehensive data on the needs for ensuring rational allocation of sources and elimination of imbalance in health services.

  8. GOAL - III • To build technical and institutional capacity capacity in Turkey so as to facilitate and improve the NBD and Cost-Effectiveness studies in the future. • To strengthen and promote Health Information Systems in Turkey so as to ensure sustainability of the NBD.

  9. STUDY COMMITTEES • In this context, • “Monitoring Committee” (consisting of the MoH-affiliated General Directorates’ representatives) • “Steering Committee” (consisting of the Turkish Institute of Statistics (TIS), SSK, Emekli Sandığı (Government Employees’ Retirement Fund), State Planning Organization (SPO), Ministry of Finance, Ministry of Internal Affairs and Treasury Undersecretariat) • “Scientific Committee” (consisting of representatves from departments and faculties of universities) were established and these Committees followed up the study on behalf of the Ministry of Health.

  10. STAGES OF STUDY - I • Household Survey, the sampling plan of which was made by the former State Institute of Statistics, was conducted on 12,000 households (January 2003-April 2003). In this survey, the World Health Survey Questionnaire of the WHO was used by adaptin it to domestic conditions in Turkey. • Verbal Autopsy Survey (covering 60,000 households) was conducted in April-May 2003 in order for causes of death to be identified, age-specific mortality rates to be calculated and life tables in Turkey by regions, age groups and gender (on rural/urban basis) to be designed.

  11. STAGES OF STUDY-II • In addition to these surveys, all scientific studies conducted in Turkey, regardless if they were published or not, were brought together as the “secondary data” together with death and health statistics collected by the former SIS, Ministry of Interior and Ministry of Health. Secondary data was then entered to a computer program called “Referance Manager” and made a catalogue. • Burden of Disease (DALY) was calculated for the whole country and by rural/urban areas, regions, age groups and gender. • Rural/urban areas and regions-based Causes of Deaths, Estimated Mortality Rates, Mortality Rate at the Age of 0, Mortality Rate Under the Age of 5 were calculated by age groups and gender, and life (expectancy) tables were produced.

  12. STAGES OF STUDY-III • Necessary data was collected at 29 health care facilities (including public hospitals, 2 former SSK hospitals, 1 private hospital and 6 health centers - two in provinces, two in districts and the last two in villages-, 1 AÇSAP (Mother-Child Care and Family Planning) Center, 1 Malaria Eradication Dispensary and 1 Tuberculosis Eradication Dispensary) in order to make Cost-Effectiveness Analysis. • Within the framework of Cost-Effectiveness Analysis, the costs which occurred at hospitals and in primary care facilities due to the intervention in diseases specificed in the specification were calculated and cost-effectiveness was analyzed. • Primary (Basic) Services Package was developed.

  13. SOME FINDINGS

  14. NBE-CE STUDY: DEFINITION OF FIVE REGIONS WESTERN REGION PROVINCES: Edirne, Tekirdağ, Kırklareli, İstanbul, Kocaeli, Sakarya, Çanakkale, Yalova, Bursa, Bilecik, Balıkesir, Kütahya, Manisa, Uşak, Afyon, Denizli, İzmir, Aydın, Muğla SOUTHERN REGION PROVINCES: Isparta, Antalya, İçel, Adana, Hatay, Burdur, Osmaniye, Kahramanmaraş, CENTRAL REGION PROVINCES: Eskişehir, Ankara, Kırıkkale, Kırşehir, Çankırı, Yozgat, Sivas, Kayseri, Nevşehir, Aksaray, Konya, Niğde, Karaman NORTHERN REGION PROVINCES: Zonguldak, Karabük, Bartın, Sinop, Kastamonu, Samsun, Ordu, Giresun, Trabzon, Bayburt, Gümüşhane, Amasya, Artvin, Bolu, Rize, Tokat, Düzce, Çorum EASTERN REGION PROVINCES: Kars, Erzurum, Iğdır, Van, Muş, Elazığ, Malatya, Adıyaman, Diyarbakır, Siirt, Şırnak, Mardin, Şanlıurfa, Gaziantep, Ağrı, Bitlis, Erzincan, Batman, Ardahan

  15. Distribution of Life Expectancy at Birth at National, Urban, Rural and Regional Level by Gender in Turkey - e0(YEAR) Men: 67,6 Women: 71,9 Men: 69,0 Women : 73,4 Men: 67,7 Women: 72,1 Men: 65,5 Women: 69,3 Men: 68,7 Women: 72,9 NBD-CE STUDY, TURKEY

  16. COMPARISON OF RAW MORTALITY RATES FOR NATIONAL LEVEL AND FIVE REGIONS IN TURKEY FOR THE YEAR 2000 (DEATH / 1000 PEOPLE) 7,9 6,2 6,6 6,2 5,7 National 6,3 NBD-CE STUDY, TURKEY

  17. Source: Preventing Chronicle Diseases -a vital investment WHO 2005 CHRONICLE DISEASES ARE AMONG THE MAJOR CAUSES OF DEATH ALMOST IN ALL COUNTRIES. IT IS ESTIMATED THAT 35,000,000 PEOPLE ALL OVER THE WORLD DIED OF CHRONICLE DISEASES IN 2005.

  18. NBD-CE STUDY, TURKEY Estimated Total of Deaths 430,459 for 2000 in Turkey

  19. NBD-CE STUDY, TURKEY

  20. NBD-CE STUDY, TURKEY

  21. Distribution of Causes of Death at National Level in Turkey by Gender, % NBD STUDY, TURKEY

  22. GENDER-SPECIFIC % DISTRIBUTION OF FIRST 20 DISEASES WHICH CAUSE MORTALITY AT NATIONAL LEVEL IN TURKEY (CONTINUING) NBD-CE STUDY, TURKEY

  23. Region-Specific % Distribution of Major Diseases Causing DALY Among Men NBD-CE STUDY, TURKEY

  24. Region-Specific % Distribution of Major Diseases Causing DALY Among Women NBD-CE STUDY, TURKEY

  25. DALY (Disability Adjusted Life Years) • A DALY could be considered as the loss of a year (to be) spent in good health • Depending on the perspective of incidence / prevalance, DALY evaluates both YLL (Years of Life Lost), which is caused by premature/early deaths due to certain diseases, and YLD (Years of Life Disabled), which is caused by diseases, accidents and/or injuries not resulting in death, together. • DALY = YLL + YLD

  26. In this formula; r= ratio of discount (r=0.03) a= age of disease onset L= length of disease D= disability ratio C= correction factor for age-weight(ed) function (C=0,16243) = parameter of age-weight(ed) function (=0.04).

  27. Comparison of DALY values at National Level and Five Regions (DALY/1000 Persons DALY/1000 Person: 165,8 DALY Number: 958.088 NATIONAL BURDEN OF DISEASES SURVEY, TURKEY DALY/1000 Person: 160,1 DALY Number: 2.358.340 DALY/1000 Person: 144,2 DALY Number: 3.449.667 DALY/1000 Person: 194,3 DALY Number: 2.600.662 DALY/1000 Person: 143,5 DALY Number: 1.408.727 NATIONAL DALY/1000 Person: 194,3 Total DALY Number: 2.600.662

  28. NBD-CE STUDY, TURKEY

  29. NBD-CE STUDY , TURKEY

  30. Distribution of DALY Causes at Western Turkey by Basic Disease Groups Maternal and Perinatal; 6,8 Cardiovascular; 22,3 Cancers; 7,6 Neuro-psychiatric ; 13,8 Infections other than HIV/AIDS; 8,1 Injuries; 11,4 NBD-CE STUDY, TURKEY

  31. Distribution of DALY Causes at Southern Turkey by Basic Disease Groups Cancers; 7,3 Maternal and Perinatal; 7,9 Cardiovascular; 20,0 Neuro-psychiatric ; 13,5 Infections other than HIV/AIDS; 9,9 Injuries; 10,6 NBD-CE STUDY, TURKEY

  32. Distribution of DALY Causes at Central Turkey by Basic Disease Groups Cancers; 7,3 Maternal and Perinatal; 9,7 Cardiovascular; 20,6 Infections other than HIV/AIDS; 10,1 Neuro-psychiatric ; 13,4 Injuries; 10,4 NBD-CE STUDY, TURKEY

  33. Distribution of DALY Causes at Northern Turkey by Basic Disease Groups Maternal and Perinatal; 8,6 Cardiovascular; 23,1 Cancers; 7,1 Injuries; 9,8 Neuro-psychiatric ; 12,7 Infections other than HIV/AIDS; 9,9 NBD-CE STUDY, TURKEY

  34. Distribution of DALY Causes at Eastern Turkey by Basic Disease Groups Infections other than HIV/AIDS; 17,4 Injuries; 10,8 Respiratory System Diseases; 5,3 Cardiovascular; 12,4 Maternal and Perinatal; 16,4 Neuro-psychiatric ; 12,7 NBD-CE STUDY, TURKEY

  35. Region-Specific % Distribution of Major Diseases Causing DALY Among Women NBD-CE STUDY , TURKEY

  36. Region-Specific % Distribution of Major Diseases Causing DALY Among Women in NBD-CE STUDY, TURKEY

  37. PROJECTIONS: • WHO methodology was used to calculate trends and estimations for the number of deaths to occur among women and men by causes of deaths in 2000, 2010, 2020 and 2030.

  38. Comparison of Deaths Among Men at National Level in 2000 with the Number of Deaths Estimated for the Year 2010, 2020 and 2030 by Age Groups (NBD-CE STUDY, TURKEY) Total Age groups Deaths

  39. Comparison of Deaths Among Women at National Level in 2000 with the Number of Deaths Estimated for the Year 2010, 2020 and 2030 by Age Groups (NBD-CE STUDY, 2000, TURKEY) Total Age groups Deaths

  40. Comparison of Deaths from Respiratory Tract Diseases Among Men at National Level in 2000 with the Number of Deaths Estimated for the Year 2010, 2020 and 2030 Türkiye Ulusal Düzey 2000 Yılında Erkeklerde Solunum Sistemi Hastalıklarına Bağlı Gelişen Ölüm Sayılarının 2010, 2020 ve 2030 Yılında Beklenen Ölüm Sayıları İle Karşılaştırılması Chronic Respiratory Tract Diseases among Men Age groups Deaths

  41. Comparison of Deaths from Respiratory Tract Diseases Among Women at National Level in 2000 with the Number of Deaths Estimated for the Year 2010, 2020 and 2030 Türkiye Ulusal Düzey 2000 Yılında Kadınlarda Solunum Sistemi Hastalıklarına Bağlı Gelişen Ölüm Sayılarının 2010, 2020 ve 2030 Yılında Beklenen Ölüm Sayıları İle Karşılaştırılması Chronic Respiratory Tract Diseases among Women Age groups Deaths

  42. Comparison of Deaths from Respiratory Tract Infections Among Men at National Level in 2000 with the Number of Deaths Estimated for the Year 2010, 2020 and 2030 Türkiye Ulusal Düzey 2000 Yılında Erkeklerde Solunum Enfeksiyonlarına Bağlı Gelişen Ölüm Sayılarının 2010, 2020 ve 2030 Yılında Beklenen Ölüm Sayıları İle Karşılaştırılması Respiratory Tract Diseases among Men Age groups Deaths

  43. Comparison of Deaths from Respiratory Tract Infections Among Women at National Level in 2000 with the Number of Deaths Estimated for the Year 2010, 2020 and 2030 Türkiye Ulusal Düzey 2000 Yılında Kadınlarda Solunum Enfeksiyonları Bağlı Gelişen Ölüm Sayılarının 2010, 2020 ve 2030 Yılında Beklenen Ölüm Sayıları İle Karşılaştırılması Respiratory Tract Diseases among Women Age groups

  44. Number of Deaths and DALYs To Be Prevented By Gender in Turkey Avoiding Selected Risk Factors (NBD-CE STUDY, TURKEY)

  45. Number of Deaths and DALYs To Be Prevented By Gender in Turkey Avoiding Selected Risk Factors (NBD-CE STUDY, TURKEY)

  46. RECOMMENDATIONS • Population in Turkey is getting elder (60+ aged population was 6.4 % in 2003) • Chronicle Diseases, which have a very big share in Burden of Diseases and Causes of Deaths, are likely to increase in number as indicated by projections. • Regular notification forms are not available for chronicle diseases within the current system. • Accurate and regular notification and data system should be established. • As for diseases that cause burden, necessary preventive measures should be regulated considering age groups and regions. • The lack of diagnosis and treatment guidelines for secondary care makes standardization of treatment difficult.

  47. RECOMMENDATIONS • Avoiding major factors such as hypertension, smoking, cholesterol and obesity and facilitating physical exercise could prevent Ischemic Heart Diseases-caused • 772.814 DALY of 860.083 burden of DALY • More than 300,000 deaths

  48. RECOMMENDATIONS • Smoking - discouraging factors in laws and regulations should be reviewed, indoor smoking should absolutely be banned and implementation of preventive measures should be controlled so as to fight with smoking, which is an important risk factor that increases the burden of disease caused by ischemic heart diseases the COPD. • Education and awareness of health personnel should be promoted by in-service trainings and etc.

  49. ASTHMA • diagnosing based on announcementabove 18 years in Turkey is %3.87 percent. • %3.11 among men • %4.44 among women

  50. ASTHMA • Is within the 20 major diseases causing %0,2 death among men in 0-14 age group at national level. • Is at seventeenth rank in urban area 0-14 age group • Not among the 20 major diseases that cause death at rural area.

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