5RF]3DQVWZ=DNO+LJ * Corresponding author:6WDQLVáDZ*yĨGĨĝZLĊWRNU]\VNLH&HQWUXP2QNRORJLL6DPRG]LHOQ\3XEOLF]Q\=DNáDG2SLHNL=GURZRWQHM XO$UWZLĔVNLHJR.LHOFH3RODQGWHO HPDLO VWDQLVODZJR]G]#RQNRONLHOFHSO &RS\ULJKWE\WKH1DWLRQDO,QVWLWXWHRI3XEOLF+HDOWK1DWLRQDO,QVWLWXWHRI+\JLHQH
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6WDQLVáDZ*yĨGĨ 0LFKDOLQD.U]\ĪDN'RPLQLN0DĞODFK0RQLND:UyEHO4 0DJGDOHQD%LHOVND/DVRWD4 1 +RO\FURVV&DQFHU&HQWUHLQ.LHOFH3RODQG -DQ.RFKDQRZVNL8QLYHUVLW\LQ.LHOFH3RODQG 3 'HSDUWPHQWRI3XEOLF+HDOWK)DFXOW\RI+HDOWK6FLHQFHV0HGLFDO8QLYHUVLW\RI%LDO\VWRN3RODQG 'HSDUWPHQWRI+HDOWK3URPRWLRQDQG3RVWJUDGXDWH(GXFDWLRQ1DWLRQDO,QVWLWXWHRI3XEOLF+HDOWK1DWLRQDO,QVWLWXWHRI +\JLHQH:DUVDZ3RODQG $%675$&7
Background. Premature mortality in younger age groups influences the society as far as social and economic aspects are FRQFHUQHG7KHUHIRUHLWLVLPSRUWDQWWRFRPHXSZLWKDWRROZKLFKZLOODOORZWRDVVHVVWKHPDQGZLOOHQDEOHWRLPSOHPHQW only these health care measures that bring tangible benefits. That is the reason for introducing PYLL rate (PYLL - potential \HDUVRIOLIHORVW ZKLFKLVDQDGGLWLRQWRWKHDQDO\VLVRISUHPDWXUHPRUWDOLW\DVLWLQFOXGHVWKHQXPEHURIGHDWKVGXHWRD particular cause and the age at death.
Objective. The purpose of this study was to analyse the level and trends of PYLL rate according to death causes in years ±LQĝZLĊWRNU]\VNLH3URYLQFH
Material and methods. The material for the analysis was the information from the Central Statistical Office on the number RIGHDWKVGXHWRDOOFDXVHVUHJLVWHUHGDPRQJWKHLQKDELWDQWVRIĝZLĊWRNU]\VNLH3URYLQFHLQ\HDUV&DXVHVRIGHDWK ZHUHFRGHGDFFRUGLQJWRWKHth revision of the International Classification of Diseases. The analysis of premature
mortal-ity was carried out with the use of PYLL rate. PYLL rate was calculated according to the method proposed by 5RPHGHU according to which theSUHPDWXUHPRUWDOLW\ZDVGHILQHGDVGHDWKEHIRUHWKHDJHRI7KHDQDO\VLVRIWLPHWUHQGVRI3<// UDWHDQGWKH$3& DQQXDOSHUFHQWFKDQJH RIWKH3<//UDWHZHUHFDOFXODWHGXVLQJMRLQWSRLQWPRGHODVZHOODVWKH-RLQWSRLQW 5HJUHVVLRQ3URJUDP 9HUVLRQ±-DQXDU\
Results. ,QPHQLQ\HDUV±3<//UDWHLQFUHDVHGE\SHU\HDU S )URP\HDUWKHWUHQGZHQW GRZQZDUGDQG3<//UDWHGHFUHDVHGRQDYHUDJHE\SHU\HDUWLOO\HDU([WHUQDOFDXVHVRIGHDWKFDUGLRYDVFXODU GLVHDVHVDQGFDQFHUVLQ\HDUV±ZHUHWKHUHDVRQIRUDOPRVW3<//LQPHQ,Q\HDU3<//UDWHGXHWR DOOGHDWKFDXVHVDPRXQWHGWR 5DQGZDVWKUHHWLPHVKLJKHUWKDQLQZRPHQ 5 ,QZRPHQKRZHYHUGXULQJ
WKHDQDO\VHGSHULRG3<//UDWHGLGQRWFKDQJHVLJQLILFDQWO\DQGZDVGRPLQDWHGE\FDQFHUVFDUGLRYDVFXODUGLVHDVHVDQG H[WHUQDOGHDWKFDXVHV6LPLODUO\WRPHQWKRVHWKUHHJURXSVRIGHDWKFDXVHVZHUHUHVSRQVLEOHIRUDQDYHUDJH3<// Conclusions. 7KHDQDO\VLVRIWKHFDXVHVRISUHPDWXUHPRUWDOLW\LQĝZLĊWRNU]\VNLH3URYLQFHVKRZVWKDWLQWKHPDMRULW\RI FDVHVLWLVGXHWRSUHYHQWDEOHGHDWKVZKLFKFDOOVIRUWKHQHFHVVLW\RIPRUHLQWHQVLYHPHDVXUHVLQSULPDU\DQGVHFRQGDU\SUH-YHQWLRQDVZHOODVWKHLPSURYHPHQWLQWUHDWPHQWVWDQGDUGVPDLQO\RIFDUGLRYDVFXODUGLVHDVHVFDQFHUVLQMXULHVDQGDFFLGHQWV Key words SUHPDWXUHPRUWDOLW\SRWHQWLDO\HDUVRIOLIHORVW3<//ĝZLĊWRNU]\VNLH3URYLQFH 675(6=&=(1,(
:SURZDG]HQLH 3U]HGZF]HVQD XPLHUDOQRĞü Z PáRGV]\FK JUXSDFK ZLHNX ZSá\ZD QD IXQNFMRQRZDQLH VSRáHF]HĔVWZD ]DUyZQRSRGZ]JOĊGHPVSRáHF]Q\PMDNLHNRQRPLF]Q\P'ODWHJRZDĪQHVWDáRVLĊRSUDFRZDQLHQDU]ĊG]LDNWyUHSR]ZROL QDLFKRFHQĊLSRGHMPRZDQLHW\ONRW\FKG]LDáDĔ]]DNUHVXRFKURQ\]GURZLDNWyUHSU]\QRV]ąZ\PLHUQHHIHNW\'ODWHJR ZSURZDG]RQRZVNDĨQLN3<// 3RWHQWLDO<HDUVRI/LIH/RVW NWyU\MHVWX]XSHáQLHQLHPDQDOL]\XPLHUDOQRĞFLSU]HGZF]HVQHM JG\ĪXZ]JOĊGQLDOLF]EĊ]JRQyZ]SRZRGXRNUHĞORQHMSU]\F]\Q\RUD]ZLHNZNWyU\PQDVWąSLá]JRQ Cel. &HOHPEDGDĔE\áDDQDOL]DSR]LRPXRUD]WUHQGyZZVSyáF]\QQLNDSRWHQFMDOQ\FKXWUDFRQ\FKODWĪ\FLD 3<// ZHGáXJ SU]\F]\QZZRMHZyG]WZLHĞZLĊWRNU]\VNLPZODWDFK 0DWHULDáLPHWRG\0DWHULDáVWDQRZLá\SXEOLNRZDQHLQIRUPDFMH*áyZQHJR8U]ĊGX6WDW\VW\F]QHJRROLF]ELH]JRQyZ]SR-
ZRGXRJyáXSU]\F]\Q]DUHMHVWURZDQ\FKZĞUyGPLHV]NDĔFyZZRMHZyG]WZDĞZLĊWRNU]\VNLHJRZODWDFK3U]\-6*yĨGĨ0.U]\ĪDN'0DĞODFKHWDO
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F]\Q\]JRQyZE\á\NRGRZDQH]JRGQLH];5HZL]Mą0LĊG]\QDURGRZHM.ODV\ILNDFML&KRUyEL3UREOHPyZ=GURZRWQ\FK $QDOL]ĊXPLHUDOQRĞFLSU]HGZF]HVQHMSU]HSURZDG]RQR]Z\NRU]\VWDQLHPZVNDĨQLNDSRWHQFMDOQ\FKXWUDFRQ\FKODWDĪ\FLD (3<//3RWHQWLDO<HDUVRI/LIH/RVW /LF]EĊSRWHQFMDOQ\FKXWUDFRQ\FKODWĪ\FLDREOLF]RQR]]DVWRVRZDQLHPPHWRGRORJLL zaproponowanej przez 5RPHGHUD=DXPLHUDOQRĞüSU]HGZF]HVQąSU]\MĊWR]JRQSU]HGURNLHPĪ\FLD$QDOL]\WUHQGyZ F]DVRZ\FKZVSyáF]\QQLND3<//RUD]ZDUWRĞFLĞUHGQLHMURF]QHM]PLDQ\ $3&DQQXDOSHUFHQWFKDQJH ZVSyáF]\QQLND 3<//REOLF]RQR]DSRPRFąPRGHOLMRLQSRLQW i programu -RLQSRLQW5HJUHVVLRQ3URJUDP 9HUVLRQ±-DQXDU\ . :\QLNL8PĊĪF]\]QZODWDFKZVSyáF]\QQLN3<//Z]UDVWDáRURF]QLH Sޒ 2GURNXWUHQG ]PLHQLáNLHUXQHNQDPDOHMąF\DZDUWRĞüZVSyáF]\QQLNDGRURNXREQLĪDáDVLĊĞUHGQLRRURF]QLH=HZQĊWU]QH SU]\F]\Q\]JRQXFKRURE\XNáDGXNUąĪHQLDRUD]QRZRWZRU\]áRĞOLZHZODWDFKE\á\SU]\F]\QąXWUDW\ĞUHGQLR 3<//XPĊĪF]\]Q:URNXZDUWRĞüZVNDĨQLND3<//]SRZRGXZV]\VWNLFKSU]\F]\QXPĊĪF]\]QZ\QRVLáD 5LE\áDNURWQLHZ\ĪV]DQLĪXNRELHW 5 8NRELHWSU]\F]\QąXWUDW\3<//E\á\QRZRWZRU\]áRĞOLZH FKRURE\XNáDGXNUąĪHQLDRUD]]HZQĊWU]QHSU]\F]\Q\]JRQyZ3RGREQLHMDNXPĊĪF]\]QWHWU]\JUXS\SU]\F]\Q]JRQXE\á\ RGSRZLHG]LDOQH]DXWUDWĊĞUHGQLR3<// :QLRVNL$QDOL]DSU]\F]\QXPLHUDOQRĞFLSU]HGZF]HVQHMZZRMHZyG]WZLHĞZLĊWRNU]\VNLPZVND]XMHĪHZ]GHF\GRZDQHM ZLĊNV]RĞFLMHVWRQDVSRZRGRZDQDÄ]JRQDPLPRĪOLZ\PLGRXQLNQLĊFLD´FRZVND]XMHQDNRQLHF]QRĞüLQWHQV\ILNDFMLG]LD-áDĔSURILODNW\NLSLHUZRWQHMLZWyUQHMRUD]SRSUDZĊVWDQGDUGyZOHF]HQLDJáyZQLHFKRUyEXNáDGXNUąĪHQLDLQRZRWZRUyZ ]áRĞOLZ\FKRUD]Z\SDGNyZLXUD]yZ 6áRZDNOXF]RZH XPLHUDOQRĞüSU]HGZF]HVQDSRWHQFMDOQHXWUDFRQHODWDĪ\FLDZRMHZyG]WZRĞZLĊWRNU]\VNLH ,1752'8&7,21
Premature mortality in younger age groups influ-HQFHVWKHVRFLHW\LQWKHLUVRFLDODQGHFRQRPLFDVSHFWV WKHUHIRUHPHDVXUHVXQGHUWDNHQZLWKLQWKHKHDOWKFDUH policy aim at longer human life expectancy. In order to render such measures effective it is important to establish a tool which will allow to assess social and economic consequences of premature mortality. It will enable to implement only these health care measures WKDWDUHUHDOO\HIIHFWLYHDQGWRHOLPLQDWHRUPRGLI\WKH ineffective ones.
A traditional premature mortality indicator shows the intensity of deaths in a population and allows for the analysis of time trends and the comparison of SUHPDWXUH PRUWDOLW\ LQ YDULRXV SRSXODWLRQV7KRXJK it does not include social and economic burdens of SUHPDWXUHGHDWKVIRUDVRFLHW\7KXVSRWHQWLDO\HDUVRI life lost (3<// SRWHQWLDO\HDUVOLIHORVW) indicator has EHHQLQWURGXFHGZKLFKLVDQDGGLWLRQWRWKHSUHPDWXUH mortality analysis as it includes the amount of deaths resulted from a particular cause as well as the age at GHDWK>@
Potential years of life lost is an indicator which DUELWUDU\ DVVXPHV WKH OLIH H[SHFWDQF\ HJ LQ 2(&' FRXQWULHV LW LV VHW IRU WKH DJH RI 8QGHU VXFK DQ DVVXPSWLRQGHDWKDWWKHDJHRILVDFFRXQWDEOHIRU SRWHQWLDO\HDUVRIOLIHORVWZKLFKUHVXOWVIURPWKH DERYHGLIIHUHQFH7KXVGHDWKVLQWKH\RXQJHUDJHJUR-ups cause a greater loss burden as they are the reason IRUPRUHSRWHQWLDO\HDUVRIOLIHORVW>@,Q3RODQGWKH use in epidemiological studies of synthetic PYLL rate is not widespread.
The purpose of the work was the analysis of the levels and trends of the rate of potential years of life ORVWGXHWRSDUWLFXODUFDXVHVLQĝZLĊWRNU]\VNLH3URYLQFH 3RODQG LQ\HDUV±
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The material based on the data from the Central Statistical Office on the number of registered deaths LQĝZLĊWRNU]\VNLH3URYLQFHLQ\HDUV±>@ &DXVHVRIGHDWKZHUHFRGHGDFFRUGLQJWRWKHth
revi-VLRQRIWKH,QWHUQDWLRQDO&ODVVLILFDWLRQRI'LVHDVHV>@ Potential years of life lost were calculated according to the method proposed by 5RPHGHUaccording to which thepremature mortality was defined as death before the DJHRI>@
The number of deaths in 5-year age groups was used WRFDOFXODWH3<//LQĝZLĊWRNU]\VNLH3URYLQFHLQ\HDUV 7KHFDOFXODWLRQVZHUHPDGHDFFRUGLQJWR the formula:
ZKHUH
±LVWKHFXWRIIDJHEHIRUHGHDWKRFFXUUHQFH
L– is the average number of potential years of life lost due to death
FDXVHVUHJLVWHUHGDWDJLYHQDJHJURXS HJ\HDUVIRUWKHDJH JURXS±
dL – is the number of deaths inL age group.
PYLL rate was calculated as a quotient of PYLL QXPEHUDQGWKHQXPEHURILQKDELWDQWVLQĝZLĊWRNU]\-skie Province at the age group 1-69. PYLL rate was
7UHQGVRISUHPDWXUHPRUWDOLW\LQĝZLĊWRNU]\VNLH3URYLQFH 3RODQG Nr 3
FDOFXODWHGSHUSHUVRQV7KHFDOFXODWLRQVZHUH performed separately for both sexes.
PYLL number and PYLL rate were calculated for all deaths overall as well as for the selected groups of death causes (Table 1).
Table 1. Selected causes of deaths used in the analysis of rate of potential years of life lost
&ODVVL¿FDWLRQRIGLVHDVHV DFFRUGLQJWR,&' Category $< All causes && Cancers ,, Cardiovascular disease 9< External causes 6WDWLVWLFDODQDO\VLV 7LPHWUHQGVIRU3<//UDWHLQ\HDUVLQ ĝZLĊWRNU]\VNLH3URYLQFHZHUHDQDO\VHGIRUDOOGHDWK FDXVHVRYHUDOOVHSDUDWHO\IRUFDUGLRYDVFXODUGLVHDVHV FDQFHUV H[WHUQDO GHDWK FDXVHV DQG IRU RWKHU FDXVHV overall.
The changes in PYLL rates were evaluated using the joinpoint model. This method is an extension of linear UHJUHVVLRQPRGHOLQZKLFKWKHWLPHWUHQGLVH[SUHVVHG with the joined log-linear segments (joinpoints) at which changes in time trends occur in a statistically significant ZD\ S >@
2QWKHEDVLVRIWKHOLQHDUUHJUHVVLRQPRGHOLQZKLFK the natural logarithm of PYLL rate was a dependent YDULDEOH DQG WKH FDOHQGDU \HDU ZDV DQ LQGHSHQGHQW variable
\ DE[ZKHUH\ Q 3<//UDWH [ FDOHQGDU\HDU APC (annual percent change) of PYLL rates for each trend was evaluated according to the following formula: $3& H[Sb-1)
$FRQILGHQFHLQWHUYDORI ZDVVHWLQRUGHUWR estimate the statistical significance of APC level in the analysed period. The cut-off significance level was IL[HGDWS
The analysis of trends and APC were calculated XVLQJWKH-RLQSRLQW5HJUHVVLRQ3URJUDP 9HUVLRQ ±-DQXDU\ >@ 5(68/76 7DEOHVDQGSUHVHQWWKHQXPEHURISUHPDWXUHGH-DWKV3<//UDWHDQGSURSRUWLRQRI3<//GXHWRVHOHFWHG FDXVHVLQ\HDUV±7DEOHSUHVHQWVWKH3<// rate trends in the analysed period.
,QPHQLQ\HDU3<//UDWHGXHWRDOOGHDWK FDXVHVDPRXQWHGWR 5DQGLWZDVWKUHHKLJKHU WKDQLQZRPHQ 5 ,Q\HDUV±3<// UDWHLQPHQLQFUHDVHGE\SHU\HDU S )URP 7D EOH 1XPEHURIGHDWKVLQ DJHJURXSDQG3<// aLQPHQLQĝZLĊWRNU]\VNLH3URYLQFHLQ Y ear Causes of deaths Cardiovascular disease C ancers E xternal causes Other causes All causes Number of deaths Rate of PYLL b Number of deaths Rate of PYLL b Number of deaths Rate of PYLL b Number of deaths Rate of PYLL b Number of deaths Rate of PYLL 919 1757.6 3399 18.7 31.7 3369 871 1697.1 18.5 588 786 3391 786 1 158 19.1 588 913 3566 1 136 19.3 9597.8 18.6 938 1 197 1676.8 18.8 876 18.3 8913.8 c 1 135 896 18.9 577
D±UDWHRISRWHQWLDO\HDUVRIOLIHORVWSHUSRSXODWLRQ b – proportion of PYLL
by causes in all PYLL
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\HDUWKHWUHQGFKDQJHGDQGZHQWGRZQZDUGDQG 3<//UDWHGHFUHDVHGE\RQDYHUDJHDQQXDOO\WLOO \HDUZKHUHDVLQZRPHQGXULQJWKHDQDO\VHGSH-riod PYLL rate did not change significantly.
([WHUQDOGHDWKFDXVHVFDUGLRYDVFXODUGLVHDVHVDQG FDQFHUV ZHUH WKH FDXVHV IRU DOPRVW RI 3<// UDWHLQPHQLQ\HDUV±7KHH[WHUQDOGHDWK FDXVHVRQDYHUDJHDPRXQWHGWRRIFDXVHVRI PYLL. In the analysed period PYLL rate decreased E\ SHU \HDU GXH WR WKDW UHDVRQ &DUGLRYDVFXODU GLVHDVHVRQDYHUDJHFRQWULEXWHGWRRI3<// ,Q\HDUV±3<//UDWHGXHWRFDUGLRYDVFXODU GLVHDVHVLQFUHDVHGE\SHU\HDU&DQFHUVZHUHWKH third cause of PYLL in men and in the structure of the GHDWKFDXVHVDPRXQWHGWR ,Q\HDUV± 3<//WUHQGGXHWRFDQFHUVLQFUHDVHGE\SHU\HDU LQLWEHJDQWRGHFUHDVHE\SHU\HDU
,QWKHDQDO\VHGSHULRGFDQFHUVFDUGLRYDVFXODUGL-seases and external causes dominated in the structure RIFDXVHVRI3<//LQZRPHQ6LPLODUO\WRPHQWKRVH three groups of death causes were responsible for an DYHUDJHRI3<//
In the period mentioned above the highest PYLL UDWH LQ ZRPHQ ZDV FDXVHG E\ FDQFHUV ZKLFK LQ WKH VWUXFWXUH RI FDXVHV RI 3<// DPRXQWHG WR RQ DYHUDJH3<//UDWHGXHWRWKDWFDXVHLQFUHDVHGE\ per year. An increase of PYLL was also for cardiova-VFXODUGLVHDVHVSHU\HDU&DUGLRYDVFXODUGLVHDVHV LQZRPHQFRQWULEXWHGWRDQDYHUDJHRI3<// 7KHWKLUGFDXVHRI3<//ZHUHH[WHUQDOFDXVHVRIGHDWK ZKLFKFRQWULEXWHGWRRI3<//LQZRPHQ7KH PYLL trend due to external causes was a favourable RQHDVLWGHFUHDVHGE\SHU\HDU
',6&866,21
,Q3RODQGIURPWKHPLG VWRWKHHQGRI V premature mortality in men increased systematically whereas it remained on the same level in women. $IWHU\HDU DVORZGRZQLQWKHWUHQGLQERWKPHQ DQGZRPHQZDVVHHQDQGWKHQDUHYHUVHFKDQJHDQG a decrease in premature mortality were observed. The reason for such changes was most of all a decrease in PRUWDOLW\GXHWRFDUGLRYDVFXODUGLVHDVHV>@
'HVSLWHWKRVHFKDQJHV3RODQGLQ\HDUV ± was still characteristic for having one of the highest OHYHOVRISUHPDWXUHPRUWDOLW\LQWKH(XURSHDQ8QLRQ and the tempo of PYLL rate changes was among the VORZHVWRQHVLQWKH(8>@
,Q\HDUV±LQĝZLĊWRNU]\VNLH3URYLQFH PYLL rate due to all death causes in men was three times higher than in women. The biggest surplus of PYLL rate in men to women was for external causes (6 times KLJKHU WKHVPDOOHVWRQH±FDQFHUV WLPHVKLJKHU Table 3.
Number of deaths in 1-69 age group and PYLL
aLQZRPHQLQĝZLĊWRNU]\VNLH3URYLQFHLQ Ye ar Causes of deaths Cardiovascular disease C ancers External causes O ther causes All causes Number of deaths Rate of PYLL b Number of deaths Rate of PYLL b Number of deaths Rate of PYLL b Number of deaths Rate of PYLL b Number of deaths Rate of PYLL 687.1 36.9 17.5 688.1 365 578.5 89 638.6 515 86 378 91 13.9 719.1 535 95 15.1 736.5 573 517.9 3197.8 373 339.7 1 1.6 633.7 98 373.5 719.5 c 376 39.9 71 1.8
D±UDWHRISRWHQWLDO\HDUVRIOLIHORVWSHUSRSXODWLRQ b –proportion of PYLL
by causes in all PYLL
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0HQLQDOO(8FRXQWULHVGLHHDUOLHUWKDQZRPHQDQG LQ\HDUDQDYHUDJHVXUSOXVLQPRUWDOLW\DPRQJPHQ in comparison to women amounted to approximately LQ3RODQGLWZDVKLJKHUDQGDPRXQWHGWR Higher mortality in men in Poland occurred at all age JURXSVEXWZDVWKHKLJKHVWLQSHUVRQVDERYHWKHDJH RI>@ ,Q3RODQGLQ\HDUWKHSULPHFDXVHRISUHPD- WXUHPRUWDOLW\LQPHQZHUHH[WHUQDOFDXVHV FDU-GLRYDVFXODUGLVHDVHV DQGFDQFHUV >@ 7LOO\HDUWKHVLWXDWLRQGLGQRWFKDQJHVLJQLILFDQWO\ The results of the analysis show that the structure of FDXVHVRISUHPDWXUHPRUWDOLW\LQĝZLĊWRNU]\VNLH3UR-vince was similar to the situation in the whole country.
,Q\HDULQ3RODQGWKHSULPHFDXVHVRISUHPD- WXUHPRUWDOLW\LQZRPHQZHUHFDQFHUV FDUGLR-YDVFXODUGLVHDVHV DQGH[WHUQDOFDXVHV DQGVLPLODUO\WRPHQWKHUHZHUHQRVLJQLILFDQWFKDQJHV XSWR\HDU7KHVWUXFWXUHRIFDXVHVRISUHPDWXUH PRUWDOLW\ LQ ZRPHQ LQ ĝZLĊWRNU]\VNLH 3URYLQFH ZDV also similar to the situation in the whole country.
%RWK LQ 3RODQG DQG ĝZLĊWRNU]\VNLH 3URYLQFH WKH structure of causes of premature mortality in men and women was different in comparison to the one in the European Union. According to the OECD data LQ(XURSHLQ\HDUWKHSULPHFDWHJRU\RIFDXVHV IRUSRWHQWLDO\HDUVRIOLIHORVWEHIRUHWKHDJHRILQ PHQZHUHH[WHUQDOFDXVHV FDQFHUV DQG FDUGLRYDVFXODU GLVHDVHV $V IRU ZRPHQ WKRVH ZHUHFDQFHUV H[WHUQDOFDXVHV DQGFDUGLR-YDVFXODUGLVHDVHV >@ ,QĝZLĊWRNU]\VNLH3URYLQFHLQ\HDUV± the level of premature mortality in men due to all death UHDVRQV LQFUHDVHG DQG WKH LQFUHDVH ZDV VWDWLVWLFDOO\ VLJQLILFDQW$IWHU\HDUWKHWUHQGIDYRXUDEO\FKDQ-ged and PYLL rate decreased. A similar trend was for FDQFHUV DQG DIWHU \HDU LW ZDV DOVR IRU ³RWKHU´ death causes. In women PYLL rate due to all death FDXVHV FDUGLRYDVFXODU GLVHDVHV DQG ³RWKHU´ FDXVHV
slightly increased. The decrease of PYLL rate for was external causes.
In the majority of highly developed countries deaths GXH WR FDUGLRYDVFXODU GLVHDVHV FDQFHUV DQG H[WHUQDO UHDVRQVFRQVWLWXWHRYHURISRWHQWLDO\HDUVRIOLIH ORVWEHIRUHWKHDJHRIERWKLQPHQDQGZRPHQ> @ In most cases there these are preventable deaths thanks WRPHDVXUHVXQGHUWDNHQLQWKHILHOGRIKHDOWKSURPRWLRQ VRFLDOHGXFDWLRQHDUO\GHWHFWLRQRIGLVHDVHVHIIHFWLYH WUHDWPHQWDQGUHKDELOLWDWLRQ>@7KHUHIRUHNQRZ-ledge about the causes and an increase in premature deaths in a population is essential to determine priorities in health care planning and to measure their effective-QHVV>@6XFKPHDVXUHVHVSHFLDOO\WKHVHFRQFHUQLQJ SUHYHQWLYHPHGLFLQHDWSULPDU\DQGVHFRQGDU\OHYHOV improvement in availability to optimal treatment as well as better social – economic conditions of a population may contribute to a decrease of potential years of life ORVW> @
&21&/86,216
,QĝZLĊWRNU]\VNLH3URYLQFHDIWHUDSHULRGRIIDVW increase of premature mortality due to all death FDXVHVLQPHQWKHWUHQGFKDQJHGDIWHU\HDUDQG 3<//UDWHEHJDQWRGHFUHDVH,QZRPHQWKHUDWHGLG not change significantly.
3ULPHFDXVHVRISRWHQWLDO\HDUVRIOLIHORVWLQPHQ ZHUH DV IROORZV H[WHUQDO FDXVHV FDUGLRYDVFXODU GLVHDVHVDQGFDQFHUV,QZRPHQWKHVHZHUH FDQFHUV cardiovascular diseases and external causes. 3. PYLL rate in all groups of death causes were higher
in men than in women. The biggest differences rela-WHGWRH[WHUQDOFDXVHVWKHVPDOOHVWRQHWRFDQFHUV (SLGHPLRORJLFDOVLWXDWLRQIRUSUHPDWXUHPRUWDOLW\LQ
ĝZLĊWRNU]\VNLH3URYLQFHVKRZVWKDWLQWKHPDMRULW\ RIFDVHVLWLVFDXVHGE\SUHYHQWDEOHGHDWKVZKLFK leads to a need to intensify measures in primary and
7DEOH 7UHQGVRI3<//aLQĝZLĊWRNU]\VNLH3URYLQFHLQ
Men Women
Time APCb 38c Time APCb &,c
All causes d -3.1 Cancers Cardiovascular disease External causes Other causes d d D±UDWHRISRWHQWLDO\HDUVRIOLIHORVWSHUSRSXODWLRQ b – annual percent change
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