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Post universal health coverage trend and geographical inequalities of mortality in Thailand

View Article: PubMed Central - PubMed

ABSTRACT

Background: Thailand has achieved remarkable improvement in health status since the achievement of universal health coverage in 2002. Health equity has improved significantly. However, challenges on health inequity still remain.This study aimed to determine the trends of geographical inequalities in disease specific mortality in Thailand after the country achieved universal health coverage.

Methods: National vital registration data from 2001 to 2014 were used to calculate age-adjusted mortality rate and standardized mortality ratio (SMR). To minimize large variations in mortality across administrative districts, the adjacent districts were systematically grouped into “super-districts” by taking into account the population size and proximity. Geographical mortality inequality among super-districts was measured by the coefficient of variation. Mixed effects modeling was used to test the difference in trends between super-districts.

Results: The overall SMR steadily declined from 1.2 in 2001 to 0.9 in 2014. The upper north and upper northeast regions had higher SMR whereas Greater Bangkok achieved the lowest SMR. Decreases in SMR were mostly seen in Greater Bangkok and the upper northern region. Coefficient of variation of SMR rapidly decreased from 20.0 in 2001 to 12.5 in 2007 and remained close to this value until 2014. The mixed effects modelling revealed significant differences in trends of SMR across super-districts. Inequality in mortality declined among adults (≥15 years old) but increased in children (0–14 years old). A declining trend in inequality of mortality was seen in almost all regions except Greater Bangkok where the inequality in SMR remained high throughout the study period.

Conclusions: A decline in the adult mortality inequality across almost all regions of Thailand followed universal health coverage. Inequalities in child mortality rates and among residents of Greater Bangkok need further exploration.

No MeSH data available.


Trend in super-district level standardized mortality ratio and coefficient of variation by region, 2001-2014. (a) Age specific death rate per 100,000 (b) Coefficient of variation for super-district age specific death rate
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Fig5: Trend in super-district level standardized mortality ratio and coefficient of variation by region, 2001-2014. (a) Age specific death rate per 100,000 (b) Coefficient of variation for super-district age specific death rate

Mentions: Figure 4, Panel A shows that the mortality rates decreased in all age groups except 65+, where it went up and then down in a curvy way. In Panel B, the CV declined in age groups 15–44 and 65+ years while increased in age group 0–4 years. Figure 5 shows that mortality rates declined steadily and most sharply in Greater Bangkok and the upper northern region. The initial high SMR in 2001 in the upper northern region had steadily declined to the average national level among other regions, where their SMRs were relatively stable since the beginning of the study period. In Fig. 5b, there was a declining trend of mortality inequality in all regions except Greater Bangkok. The upper southern part had the highest reduction of mortality variation (65.93% reduction in CV for SMR), followed by west (60.54%), lower northeast (57.11%), lower north (50.20%), and upper north (47.71%).Fig. 4


Post universal health coverage trend and geographical inequalities of mortality in Thailand
Trend in super-district level standardized mortality ratio and coefficient of variation by region, 2001-2014. (a) Age specific death rate per 100,000 (b) Coefficient of variation for super-district age specific death rate
© Copyright Policy - OpenAccess
Related In: Results  -  Collection

License 1 - License 2
Show All Figures
getmorefigures.php?uid=PMC5120448&req=5

Fig5: Trend in super-district level standardized mortality ratio and coefficient of variation by region, 2001-2014. (a) Age specific death rate per 100,000 (b) Coefficient of variation for super-district age specific death rate
Mentions: Figure 4, Panel A shows that the mortality rates decreased in all age groups except 65+, where it went up and then down in a curvy way. In Panel B, the CV declined in age groups 15–44 and 65+ years while increased in age group 0–4 years. Figure 5 shows that mortality rates declined steadily and most sharply in Greater Bangkok and the upper northern region. The initial high SMR in 2001 in the upper northern region had steadily declined to the average national level among other regions, where their SMRs were relatively stable since the beginning of the study period. In Fig. 5b, there was a declining trend of mortality inequality in all regions except Greater Bangkok. The upper southern part had the highest reduction of mortality variation (65.93% reduction in CV for SMR), followed by west (60.54%), lower northeast (57.11%), lower north (50.20%), and upper north (47.71%).Fig. 4

View Article: PubMed Central - PubMed

ABSTRACT

Background: Thailand has achieved remarkable improvement in health status since the achievement of universal health coverage in 2002. Health equity has improved significantly. However, challenges on health inequity still remain.This study aimed to determine the trends of geographical inequalities in disease specific mortality in Thailand after the country achieved universal health coverage.

Methods: National vital registration data from 2001 to 2014 were used to calculate age-adjusted mortality rate and standardized mortality ratio (SMR). To minimize large variations in mortality across administrative districts, the adjacent districts were systematically grouped into “super-districts” by taking into account the population size and proximity. Geographical mortality inequality among super-districts was measured by the coefficient of variation. Mixed effects modeling was used to test the difference in trends between super-districts.

Results: The overall SMR steadily declined from 1.2 in 2001 to 0.9 in 2014. The upper north and upper northeast regions had higher SMR whereas Greater Bangkok achieved the lowest SMR. Decreases in SMR were mostly seen in Greater Bangkok and the upper northern region. Coefficient of variation of SMR rapidly decreased from 20.0 in 2001 to 12.5 in 2007 and remained close to this value until 2014. The mixed effects modelling revealed significant differences in trends of SMR across super-districts. Inequality in mortality declined among adults (≥15 years old) but increased in children (0–14 years old). A declining trend in inequality of mortality was seen in almost all regions except Greater Bangkok where the inequality in SMR remained high throughout the study period.

Conclusions: A decline in the adult mortality inequality across almost all regions of Thailand followed universal health coverage. Inequalities in child mortality rates and among residents of Greater Bangkok need further exploration.

No MeSH data available.