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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.


Geographical distributions of super-district average annual cause-specific standardized mortality ratio, 2001-2014
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Fig6: Geographical distributions of super-district average annual cause-specific standardized mortality ratio, 2001-2014

Mentions: The geographical distributions of cause-specific mortality for the 12 selected causes of death are shown in Fig. 6. The northern region had higher rate of death from HIV/AIDS, COPD, lung cancer, and asthma compared to the other regions. The upper northeast region had relatively high rates of death from liver cancer and diabetes. Compared with the upper northeast, the lower northeast had lower mortalities from liver cancer, diabetes, and others except tuberculosis. The southern part had relatively low mortality from most diseases except asthma and traffic injuries. Deaths from stroke, IHD, tuberculosis and pneumonia were geographically homogeneous though the rates were relatively higher in the central region. For traffic injuries, super-districts having high SMR seem to be spread throughout most region, except the northeast. Similar to all-cause mortality, the distribution patterns for each of 12 selected conditions were clustered.Fig. 6


Post universal health coverage trend and geographical inequalities of mortality in Thailand
Geographical distributions of super-district average annual cause-specific standardized mortality ratio, 2001-2014
© Copyright Policy - OpenAccess
Related In: Results  -  Collection

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

Fig6: Geographical distributions of super-district average annual cause-specific standardized mortality ratio, 2001-2014
Mentions: The geographical distributions of cause-specific mortality for the 12 selected causes of death are shown in Fig. 6. The northern region had higher rate of death from HIV/AIDS, COPD, lung cancer, and asthma compared to the other regions. The upper northeast region had relatively high rates of death from liver cancer and diabetes. Compared with the upper northeast, the lower northeast had lower mortalities from liver cancer, diabetes, and others except tuberculosis. The southern part had relatively low mortality from most diseases except asthma and traffic injuries. Deaths from stroke, IHD, tuberculosis and pneumonia were geographically homogeneous though the rates were relatively higher in the central region. For traffic injuries, super-districts having high SMR seem to be spread throughout most region, except the northeast. Similar to all-cause mortality, the distribution patterns for each of 12 selected conditions were clustered.Fig. 6

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.