Trends in Avoidable Mortality in Kazakhstan From 2015 to 2021

Document Type : Original Article

Authors

1 Asfendiyarov Kazakh National Medical University, Almaty, Kazakhstan

2 Al-Farabi Kazakh National University, Almaty, Kazakhstan

3 AyEconomics Research Center, Santiago, Spain

Abstract

Background 
The health system performance assessment is a challenging process for decision-makers. In case of Kazakhstan’s healthcare system, the calculation of avoidable mortality, which has been underutilized to date, could serve as an additional tool to prioritize areas for improvement. Therefore, the aim of the study is to analyse avoidable mortality in Kazakhstan.
 
Methods 
The data was retrieved from the Bureau of National Statistics, Kazakhstan. It covers population data by age, mortality rates from disease groups based on the Joint OECD (Organisation for Economic Co-operation and Development)/Eurostat classification of preventable and treatable causes of mortality. The data spans from 2015 to 2021, categorized by gender and 5-year age groups (0, 1-4, 5-9, ..., 70-74). Standardization was performed using the 2015 OECD standard population. We used joinpoint regression analysis to calculate the average annual percentage change (AAPC).
 
Results 
From 2015 to 2019, the annual percentage change (APC) in avoidable mortality per 100 000 population was -3.8 (-5.7 to -1.8), and from 2019 to 2021 it increased by 17.6 (11.3 to 24.3). Males exhibited higher avoidable mortality rates compared to females. The preventable mortality rate was consistently higher than the treatable mortality. Both preventable and treatable mortality decreased from 2015 to 2019, with preventable mortality reaching 272.17 before rising to 379.23 per 100 000 population in 2021. Between 2015 and 2021, treatable mortality rates increased from 179.3 (176.93-181.67) to 205.45 (203.08-207.81) per 100 000 population.
 
Conclusion 
In Kazakhstan, the leading causes of avoidable mortality were circulatory diseases, respiratory diseases, and cancer. To achieve the goals of universal health coverage (UHC) and improve the overall population health, there is an urgent need to amend the healthcare system and reduce avoidable mortality. While it is important to acknowledge the influence of COVID-19 on these trends, our study’s focus on avoidable mortality provides valuable insights that complement the understanding of pandemic-related effects.

Keywords


  1. WHO Methods and Data Sources for Life Tables 1990-2019 (Global Health Estimates Technical Paper WHO/DDI/DNA/GHE/2020.1). https://cdn.who.int/media/docs/default-source/gho-documents/global-health-estimates/ghe2019_daly-methods.pdf.
  2. Mazzuco S, Suhrcke M, Zanotto L. How to measure premature mortality? A proposal combining "relative" and "absolute" approaches. Popul Health Metr. 2021;19(1):41. doi:1186/s12963-021-00267-y
  3. Avoidable Mortality: OECD/Eurostat Lists of Preventable and Treatable Causes of Death (January 2022 Version). 2022. https://www.oecd.org/health/health-systems/Avoidable-mortality-2019-Joint-OECD-Eurostat-List-preventable-treatable-causes-of-death.pdf.
  4. Office for National Statistics (ONS). Avoidable Mortality in the UK. 2022. https://www.ons.gov.uk/peoplepopulationandcommunity/healthandsocialcare/causesofdeath/methodologies/avoidablemortalityinenglandandwalesqmi#:~:text=Avoidable%20mortality%20is%20used%20as.of%20timely%20and%20effective%20healthcare.
  5. Makarova N, Klein-Ellinghaus F, Frisina Doetter L. Applications and limitations of the concept of 'avoidable mortality' among immigrant groups in Europe: a scoping review. Public Health. 2015;129(4):342-350. doi:1016/j.puhe.2015.01.006
  6. Rutstein DD, Berenberg W, Chalmers TC, Child CG 3rd, Fishman AP, Perrin EB. Measuring the quality of medical care. A clinical method. N Engl J Med. 1976;294(11):582-588. doi:1056/nejm197603112941104
  7. Nolte E, McKee M. Does Health Care Save Lives? Avoidable Mortality Revisited. London: Nuffield Trust; 2004. https://researchonline.lshtm.ac.uk/id/eprint/15535.
  8. Nolte E, McKee M. Variations in amenable mortality--trends in 16 high-income nations. Health Policy. 2011;103(1):47-52. doi:1016/j.healthpol.2011.08.002
  9. Canadian Institute for Health Information (CIHI). Health Indicators 2012. Ottawa, Ontario: CIHI; 2012. Available at: https://secure.cihi.ca/free_products/health_indicators_2012_en.pdf.
  10. Australian Institute of Health and Welfare. https://www.aihw.gov.au/reports/life-expectancy-death/deaths-in-australia/contents/age-at-death.
  11. Avoidable mortality (preventable and treatable). In: Health at a Glance 2019: OECD Indicators. Paris: OECD Publishing; 2019.
  12. Papanicolas I, Rajan D, Karanikolos M, Soucat A, Figueras J. Health System Performance Assessment: A Framework for Policy Analysis (Health Policy Series. No. 57). Geneva: World Health Organization; 2022.
  13. Devi S. Reforming health care in Kazakhstan. Lancet. 2014;383(9936):2197-2198. doi:1016/s0140-6736(14)61069-2
  14. State Healthcare Development Program "Densaulyk" for 2016 – 2019. Government of the Republic of Kazakhstan. Approved Government Decree No. 634, October 15, 2018
  15. World Bank. Implementation Completion and Results Report. Report No: ICR00003816. December 28, 2017. http://documents.worldbank.org/curated/en/823341515169244215/pdf/Implementation-Completion-and-Results-Report-ICR-Document-P101928-2017-12-28-16-26-01022018.pdf.
  16. Chan BT, Rauscher C, Issina AM, et al. A programme to improve quality of care for patients with chronic diseases, Kazakhstan. Bull World Health Organ. 2020;98(3):161-169. doi:2471/blt.18.227447
  17. Oortwijn W, Surgey G, Novakovic T, Baltussen R, Kosherbayeva L. The use of evidence-informed deliberative processes for health benefit package design in Kazakhstan. Int J Environ Res Public Health. 2022;19(18):11412. doi:3390/ijerph191811412
  18. https://data.worldbank.org/indicator/SP.DYN.CDRT.IN?locations=KZ.
  19. World Health Organization (WHO). WHO Primary Health Care Demonstration Platform. Copenhagen: WHO Regional Office for Europe; 2022. https://www.who.int/europe/teams/centre-for-primary-health-care-(kaz)/who-phc-demonstration-platform.
  20. Kazakh and Russian Languages. https://rcez.kz/ensz. Accessed November 7, 2023.
  21. https://data.who.int/countries/398. Accessed November 7, 2023.
  22. https://cdn.who.int/media/docs/default-source/gho-documents/global-health-estimates/ghe2019_cod_methods.pdf?sfvrsn=37bcfacc_5. Accessed November 7, 2023.
  23. Olatunde O, Windsor-Shellard B, Campbell A. Revised Definition of Avoidable Mortality. United Kingdom: Office for National Statistics; 2016. Available at: https://www.ons.gov.uk/file?uri=/aboutus/whatwedo/statistics/consultationsandsurveys/allconsultationsandsurveys/reviewofavoidablemortalitydefinition/reviseddefinitionofavoidablemortalityandnewdefinitionforchildrenandyoungpeople.doc.
  24. OECD Health Statistics 2022 Definitions, Sources and Methods. https://stats.oecd.org/index.aspx?queryid=96018.
  25. Wilson L, Bhatnagar P, Townsend N. Comparing trends in mortality from cardiovascular disease and cancer in the United Kingdom, 1983-2013: joinpoint regression analysis. Popul Health Metr. 2017;15(1):23. doi:1186/s12963-017-0141-5
  26. Kiadaliri A. Avoidable deaths in Sweden, 1997-2018: temporal trend and the contribution to the gender gap in life expectancy. BMC Public Health. 2021;21(1):519. doi:1186/s12889-021-10567-5
  27. Bastos TF, Canesqui AM, de Azevedo Barros MB. "Healthy men" and high mortality: contributions from a population-based study for the gender paradox discussion. PLoS One. 2015;10(12):e0144520. doi:1371/journal.pone.0144520
  28. Walli-Attaei M, Joseph P, Rosengren A, et al. Variations between women and men in risk factors, treatments, cardiovascular disease incidence, and death in 27 high-income, middle-income, and low-income countries (PURE): a prospective cohort study. Lancet. 2020;396(10244):97-109. doi:1016/s0140-6736(20)30543-2
  29. Order of Target Groups of Persons Subject to Screening Studies. As Well As the Rules. Scope and Frequency of These Studies Acting Order Minister of Health of the Republic of Kazakhstan Dated October 30. 2020 No. ҚР ДСМ-174/2020. Registered with the Ministry of Justice of the Republic of Kazakhstan on November 2. 2020 No. 21572. (Kazakh or Russian). https://adilet.zan.kz/rus/docs/V2000021572.
  30. Bekbergenova ZH, Derbissalina G, Umbetzhanova A, Koikov V, Bedelbayeva G. Evaluating the effectiveness of a screening program for cardiovascular diseases in Kazakhstan. Eur J Public Health. 2019;29(Suppl 4):ckz186-229. doi:1093/eurpub/ckz186.229
  31. Midlenko A, Mussina K, Zhakhina G, et al. Prevalence, incidence, and mortality rates of breast cancer in Kazakhstan: data from the Unified National Electronic Health System, 2014-2019. Front Public Health. 2023;11:1132742. doi:3389/fpubh.2023.1132742
  32. Igissinov N, Taszhanov R, Telmanova Z, et al. Trend in gastric cancer mortality in Kazakhstan. Asian Pac J Cancer Prev. 2022;23(11):3779-3789. doi:31557/apjcp.2022.23.11.3779
  33. Mauyenova D, Zhadykova Y, Khozhayev A, et al. Trends of colorectal cancer incidence in Kazakhstan. Asian Pac J Cancer Prev. 2021;22(10):3405. doi:31557/apjcp.2021.22.10.3405
  34. Mukasheva G, Abenova M, Shaltynov A, et al. Incidence and mortality of cardiovascular disease in the Republic of Kazakhstan: 2004-2017. Iran J Public Health. 2022;51(4):821-830. doi:18502/ijph.v51i4.9243
  35. Begisbayev T, Kosherbayeva L, Akhmetov V, Khvan D, Brimzhanova M. Implantation of implantable cardioverter defibrillators in Kazakhstan. Glob Heart. 2022;17(1):30. doi:5334/gh.1119
  36. Kossarova L, Holland W, Mossialos E. 'Avoidable' mortality: a measure of health system performance in the Czech Republic and Slovakia between 1971 and 2008. Health Policy Plan. 2013;28(5):508-525. doi:1093/heapol/czs093
  37. Choi MH, Moon MH, Yoon TH. Avoidable mortality between metropolitan and non-metropolitan areas in Korea from 1995 to 2019: a descriptive study of implications for the national healthcare policy. Int J Environ Res Public Health. 2022;19(6):3475. doi:3390/ijerph19063475
  38. Centers for Disease Control and Prevention (CDC). Vital signs: avoidable deaths from heart disease, stroke, and hypertensive disease - United States, 2001-2010. MMWR Morb Mortal Wkly Rep. 2013;62(35):721-727.
  39. Omranikhoo H, Pourreza A, Eftekhar Ardebili H, Heydari H, Rahimi Forushani A. Avoidable mortality differences between rural and urban residents during 2004-2011: a case study in Iran. Int J Health Policy Manag. 2013;1(4):287-293. doi:15171/ijhpm.2013.58
  40. COVID-19 Excess Mortality Collaborators. Estimating excess mortality due to the COVID-19 pandemic: a systematic analysis of COVID-19-related mortality, 2020-21. Lancet. 2022;399(10334):1513-1536. doi:1016/s0140-6736(21)02796-3
  41. Trias-Llimós S, Bilal U. Impact of the COVID-19 pandemic on life expectancy in Madrid (Spain). J Public Health (Oxf). 2020;42(3):635-636. doi:1093/pubmed/fdaa087
  42. Razeghi Nasrabad HB, Sasanipour M. Effect of COVID-19 epidemic on life expectancy and years of life lost in Iran: a secondary data analysis. Iran J Med Sci. 2022;47(3):210-218. doi:30476/ijms.2021.90269.2111
  43. Castro MC, Gurzenda S, Turra CM, Kim S, Andrasfay T, Goldman N. Reduction in the 2020 life expectancy in Brazil after COVID-19. medRxiv [Preprint]. April 9, 2021. Available from: https://www.medrxiv.org/content/10.1101/2021.04.06.21255013v1.
  44. Kulkayeva G, Harun-Or-Rashid M, Yoshida Y, Tulebayev K, Sakamoto J. Cardiovascular disease risk factors among rural Kazakh population. Nagoya J Med Sci. 2012;74(1-2):51-61.
  45. Office for National Statistics. Avoidable Mortality in Great Britain: 2020. https://www.ons.gov.uk/peoplepopulationandcommunity/healthandsocialcare/causesofdeath/bulletins/avoidablemortalityinenglandandwales/2020.
  46. Nguyen NT, Chinn J, De Ferrante M, Kirby KA, Hohmann SF, Amin A. Male gender is a predictor of higher mortality in hospitalized adults with COVID-19. PLoS One. 2021;16(7):e0254066. doi:1371/journal.pone.0254066
  47. Dessie ZG, Zewotir T. Mortality-related risk factors of COVID-19: a systematic review and meta-analysis of 42 studies and 423,117 patients. BMC Infect Dis. 2021;21(1):855. doi:1186/s12879-021-06536-3
  48. Vahid Shahidi F, Parnia A, Siddiqi A. Trends in socioeconomic inequalities in premature and avoidable mortality in Canada, 1991-2016. CMAJ. 2020;192(39):E1114-E1128. doi:1503/cmaj.191723
  49. Rydland HT, Fjær EL, Eikemo TA, et al. Educational inequalities in mortality amenable to healthcare. A comparison of European healthcare systems. PLoS One. 2020;15(7):e0234135. doi:1371/journal.pone.0234135
  • Receive Date: 05 January 2023
  • Revise Date: 27 January 2024
  • Accept Date: 13 February 2024
  • First Publish Date: 17 February 2024