M. Diachuk 1, T.Gruzieva 2
1 State Scientific Institution "Scientific-Practical Center for Preventive and Clinical Medicine" DUS, Kyiv, Ukraine
2 Bogomolets National Medical University, Kyiv, Ukraine
ABSTRACT. Introduction. Measures for the prevention of diseases, their timely diagnosis and effective treatment are based on data on the features and trends of morbidity in different groups of the population, which requires constant quality monitoring.
The Aim of the Study. to identify the features and trends in the incidence of the genitourinary system diseases among the population of Ukraine.
Material and Methods. When performing research bibliographic, epidemiological and medical-statistical methods were used.
Results. The structure of incidence and prevalence of the genitourinary system diseases in population of Ukraine is estimated. High levels of incidence and prevalence of the genitourinary system diseases among the population are established, as evidenced by the third ranked place of urugenital diseases in the structure of incidence and the fifth place — in the structure of the prevalence of all diseases.
The negative tendencies in the indicators dynamics during 1991–2017 were revealed, in particular, the increase in the incidence of the genitourinary system diseases of Ukrainian population by 58.8 %, prevalence – by 87.2 %, including among children – by 2 times and by 83.2 % respectively.
The structure of morbidity in different age and sex groups is characterized.
It was found that the incidence of diseases of the genitourinary system of the female population was higher than that of males (by 4.5 times); of the working age population – by 2.0 times compared to the population older than the able-bodied age; of urban population – by 49.8 % higher compared with rural.
The differences in the incidence of certain nosological forms depending on the age of the population and the sex are revealed. The estimation of incidence and prevalence of diseases of the genitourinary system in certain administrative territories of Ukraine is given.
Conclusions. The analysis of statistical information revealed significant rates and negative tendencies in the increase of the morbidity of the population for diseases of the genitourinary system, features of the prevalence of pathology in the regional, sexual, and age aspects. The established features and trends require further indepth study and taking into account in the development of medical-preventive measures.
Key Words: diseases of the genitourinary system, monitoring, morbidity, prevalence of diseases, features and trends, regional, gender-age aspects.
Relevance. It is known that monitoring as a system of long-term observation, assessment, control and prediction of changes in certain objects or events is the base for the development and adoption of managerial decisions. Population health monitoring is an important means of tracking the features and tendencies of population health, the patterns of its formation. Analysis of monitoring study data allows determining the incidence of certain types of pathology, its prevalence in the population, differences in the patterns of the course and establishing the real needs for preventive or treatment and diagnostic interventions.
Monitoring results are an important means for detecting shortcomings in the work of healthcare facilities as well as the formation of healthcare policy. Due to the monitoring of morbidity, comparative features of the study of the events in different groups of the population, in the territorial context, etc., it is possible to establish causal relationships between medical-organizational interventions and changes in the state of population health. Development and implementation of monitoring technologies are obligatory for effective healthcare policy.
The necessity of creating a national healthcare information system, which contains well-defined parameters and makes it possible to monitor the tendencies in the population health, its certain groups, is highlighted in WHO/Europe document Health 2020. A European policy framework and strategy for the 21st century. At the same time, epidemiological surveillance should be carried out both in medical-demographic processes and in infectious and non-infectious diseases [1-2].
Special emphasis on the feasibility of conducting regular comprehensive monitoring of the state of population health has been made in a number of other WHO and WHO/Europe documents [3-5]. They should cover both monitorings of parameters of health disorders, including morbidity, disability, mortality, and risk factors for their occurrence, including behavioural, metabolic, etc. [6].
The results of surveillance studies of population health at the global and regional levels are presented in numerous scientific publications [7-11]. They allowed tracking the tendencies and outline the priorities of healthcare systems in the future.
At the national level, countries monitor health and factors that are determined according to their needs, established priorities and considering international recommendations.
However, national health monitoring needs to be improved in line with new requirements, current challenges, and threats. Thus, according to the European Action Plan for Strengthening and Public Health Services and Capacity (EAP) in each country of the WHO European Region, an epidemiological system should be set up and monitored to monitor the incidence and prevalence of diseases by an appropriate range of parameters. This system should also include data on integral health parameters for identifying the needs of the health care sector and planning actions based on objective data. In the context of studying population health, data on the health of local communities, on existing inequalities in the health status of specific groups of the population and on their protection are important [12].
Specific steps for the implementation of the goals of Ukrainian national health care policy in the context of the European policy Health-2020 include the establishment of public health systems in the country. Among other important tasks of the national public health system are the improvement of the analytical and informational components of public health activities, the creation of information databases and real-time systems for the exchange of information. This will be a solid base for identifying healthcare priorities to ensure their priority funding [13-14].
Population health analysis is conducted in Ukraine by numerous scientific institutions and healthcare facilities, and its results concern various aspects of morbidity, disability and mortality, but they are often discriminatory. At the same time, a modern monitoring and assessment system, which would be carried out on common methodological positions and is comparable to European monitoring systems, needs to be implemented.
Certainly, specialized studies are an important means for the thorough research of certain aspects of health. The studies conducted in Ukraine on the prevalence of genitourinary conditions are non-comprehensive, they cover different time periods, are characterized by a certain fragmentary nature and relate to certain diseases or individual populations [15-19].
Therefore, monitoring and assessment of population health from the point of view of genitourinary morbidity among different groups of the population, including territorial, gender- and age-related, with the definition of tendencies for the substantiation of managerial decisions, is an important task of the present, which determines the relevance of the study.
The objective of the study is to identify the current features and tendencies of the health of various groups of the population of Ukraine in the context of the genitourinary conditions.
Methods. The study used bibliographic, epidemiological, medical and statistical, analytical methods. The analysis of the health status of the population of Ukraine according to the reporting forms No. 12 for 2000–2017, data from the Centre for Health Statistics of the Ministry of Health of Ukraine has been carried out. The features and tendencies of genitourinary system morbidity of separate population groups, including adolescents, adults, working age and older working age, depending on gender, inhabitants of rural and urban areas were studied. The leading diseases that form the morbidity structure, the rate of growth of the morbidity of the population on individual nosological forms during the 15-year period, differences in the incidence and prevalence of genitourinary diseases in the regions of the country have been determined.
Discussion. The analysis of statistical sources showed that genitourinary conditions took the third place in 2017 in the structure of the morbidity of the population of Ukraine with a relative share of 6.5 % and the fifth place in the structure of the prevalence of diseases.
According to monitoring data, during 1991–2017, genitourinary morbidity in the population of Ukraine had a negative tendency to increase from 2,559.9 cases per 100 thousand population to 4,064.0 cases per 100 thousand population, i. e .58.8 %. The analysis of changes in the prevalence of genitourinary condition over time among the Ukrainian population for the indicated period revealed even faster rates of its growth compared to morbidity, namely from 4,948.6 cases per 100 thousand population to 9,265.7 cases per 100 thousand population, an increment was 87.2 %.
Increase in the genitourinary morbidity of the paediatric population during 1991–2017 by 2 times, its prevalence among children — by 83.2 % is of particular concern.
Research of age-related features of genitourinary morbidity showed that the highest level of morbidity was characteristic of the adolescent population, and it was 5,478.8 cases per 100 thousand population in 2017. For comparison, this figure in adults was 4,415.6 cases per 100 thousand population of the corresponding age, in children 1,958.1 cases per 100 thousand respectively.
The basis of this morbidity structure of adolescents in 2017 were menstrual disorders (56.9 %), salpingitis, oophoritis (12.3 %), renal infections (6.9 %), and other diseases. In the structure of prevalence of diseases of this class in adolescents, menstrual disorders (57.0 %), renal infections (13.6 %), salpingitis, oophoritis (11.4 %) also prevailed. In the adult population, erosion and ecotropion of the cervix, cystitis, and renal infections prevailed in the structure of the morbidity and prevalence of the genitourinary conditions. The structure of the morbidity of the paediatric population was formed by menstrual disorders, renal infections, and cystitis.
Taking into account the important role of the age factor, parameters of genitourinary morbidity of the population of working age and the population older than the working age were analysed. During the study, it was found that the incidence rate of the working-age population (5,330.3 cases per 100 thousand) in 2017 was twice as high as in the population older than the working age (2,695.1 cases per 100 thousand). The above excess was formed due to a higher incidence of breast diseases (3.2 times), salpingitis and oophoritis (54.9 times), inflammatory (13.2 times) and non-inflammatory diseases of the cervix (8.4 times), other disorders of female genital organs (3.3 times) in the working age population.
At the same time, the population older than the working age had a higher incidence and visits to healthcare facilities due to diseases of the prostate (4.3 times), including hyperplasia of the thyroid gland (9.3 times), chronic cystitis (2 times), chronic pyelonephritis (by 27.1 %).
The analysis of gender-related features of genitourinary morbidity has shown that the female population traditionally had its highest levels. In 2017, the incidence rate of the female population in this class of diseases was 6,811.6 cases per 100 thousand and 4.5 times exceeded the similar incidence rate of the male population (1,508.9 cases per 100 thousand).
At the same time, according to some nosological forms, the male population has higher rates of morbidity than females. For example, the incidence of chronic glomerulonephritis in males was 17.4 % higher, the incidence of the renal and ureteral stones — by 9.6 %. However, the incidence rates of the female population for renal infections and cystitis were higher than in the male population by 69.6 % and 3.4 times.
In the structure of the genitourinary morbidity of the female population, menstrual disorders (15.5 %), non-inflammatory diseases of the cervix (14.5 %), cystitis (8.6 %), inflammatory diseases of the cervix (8.0 %), salpingitis, oophoritis (7.5 %) prevailed. The structure of the morbidity of the male population was predominantly formed by diseases of the prostate (33.6 %), cystitis (11.5 %), renal and ureteral stones (10.5 %), renal infections (9.8 %).
As for regional differences in the genitourinary morbidity of population, they did not have certain geographic patterns. The highest levels of this morbidity in 2017 were detected in the region of Dnipropetrovsk (8.2 thousand cases per 100 thousand), Kyiv (7.0 thousand cases per 100 thousand), Region of Mykolaiv (5.5 thousand cases per 100 thousand), Region of Ivano-Frankivsk (4.9 thousand cases per 100 thousand), Region of Kharkiv (4.5 thousand cases per 100 thousand), where the parameters were 2 times, 1.7 times, 1.3 times 1.2 and 1.1 times higher than the average in the country (4.1 thousand cases per 100 thousand). As can be seen from the above data, these regions represent different regions of Ukraine.
At the same time, in the Region of Zakarpattia, the incidence rate was 1.6 times lower than the all-Ukrainian one. Genitourinary morbidity in the Region of Vinnytsia, Sumy, Kyiv and Khmelnytskiy was significantly lower than the all-Ukrainian parameter.
Considering the potential impact of urbanization factors, the incidence of detection of genitourinary conditions depending on the place of residence has been analysed. It was established that genitourinary morbidity of the urban population exceeded the similar parameter in rural population by 49.8 %, and the prevalence of diseases of this class — by 39.9 %. The greatest differences in the incidence rates of diseases genitourinary system diseases in urban and rural areas were found regarding male infertility, visits to healthcare facilities about which in urban areas occurred 2.8 times higher than in rural areas. Among the urban population, inflammatory diseases of the cervix were registered 2.3 times higher, chronic cystitis — 2.2 times, menopause and after menopause disorders — 1.9 times, and female infertility — 1.8 times.
At the same time, some acute genitourinary diseases were more common among the rural population than the urban population. In particular, rural inhabitants 25.0 % more likely to have acute glomerulonephritis than the urban population, while acute cystitis was more frequent by 18.6 %.
It is known that the data on the morbidity of the population, including genitourinary diseases, are important for determining the reasons, justification of predictions, the establishment of the needs for medical treatment of various services and the development of preventive measures. Furthermore, analysis of the prevalence of pathology, which characterizes its scale, gives an indication of the contingent of patients, is essential for calculating the need for preventive, treatment and diagnostic measures.
The analysis of the prevalence of genitourinary diseases has shown that its highest levels are typical for adolescents and adults, and they were 10,433.5 cases per 100 thousand and 10,291.5 cases per 100 thousand population of the corresponding age in 2017. Since prevalence level is predominantly determined by chronic diseases, this parameter was somewhat lower among the paediatric population, although it is significant — 3,609.8 cases per 100,000 children throughout the age of 14 years.
During the study, it was found that the incidence rate of genitourinary diseases in the working-age population (10,883.9 cases per 100 thousand) in 2017 was by 16.3 % higher than in the population older than the working age (9,356.7 cases per 100 thousand). The above excess was formed due to higher levels of prevalence of salpingitis and oophoritis (47.0 times), inflammatory (12.1 times) and non-inflammatory diseases of the cervix (6.8 times), breast (2.4 times), other disorders of female genital organs (2.4 times) among the working-age population.
At the same time, the population older than the working age had a higher incidence of the diseases of the prostate (6.0 times), including hyperplasia of the thyroid gland (16.7 times), chronic cystitis (2.8 times), chronic pyelonephritis (2.0 times), renal stones (2.0 times) according to data on the visits to healthcare facilities.
Differences in the prevalence of genitourinary diseases among the male and female population are similar to the differences in the incidence rates of this condition. The prevalence of genitourinary diseases among the female population was 2.9 times higher than among the male population. At the same time, the prevalence of renal infections in females exceeded a similar figure in males by 1.8 times, the prevalence of cystitis — 3.2 times.
Among the separate regions of Ukraine, the highest parameters of prevalence genitourinary diseases among the population in 2017 were allocated to Kyiv (16.3 thousand cases per 100 thousand), Region of Dnipropetrovsk (15.9 thousand cases per 100 thousand), Region of Mykolaiv (12.9 thousand cases per 100 thousand), Region of Kharkiv (12.6 thousand cases per 100 thousand), where the parameters were 1.8 times to 1.4 times higher than the average in the country (9.3 thousand cases per 100 thousand). The above regions represent different regions of Ukraine.
In the Region of Zakarpattia, the prevalence of genitourinary diseases, as well as the incidence rates of this condition, were among the lowest and amounted to 5.7 thousand per 100 thousand population, which is 38.7 % less than the all-Ukrainian parameter. Parameters of the prevalence of genitourinary diseases in the Region of Volyn, Kyiv and Kropyvnytskyi were significantly lower than the average in Ukraine.
Differences in the prevalence of the condition may be due to the population composition by the territory of residence — urban or rural, by the gender- and age-related features of the inhabitants, by socio-economic, ecological and other characteristics, by the organization of medical care, including availability and quality of medical care. Therefore, analysis of genitourinary morbidity requires a thorough special study taking into account all significant exposure factors.
Conclusion. The obtained results of the monitoring of the morbidity of the Ukrainian population for genitourinary diseases and the prevalence of this condition indicate their high levels and a significant contribution to the formation of illness burden, which confirms the third rank place in the structure of the disease and the fifth — in the structure of the prevalence of diseases.
The negative tendencies of parameters during 1991–2017 were established, in particular, increase in the incidence of genitourinary system conditions in the population of Ukraine by 58.8 %, prevalence — by 87.2 %, including children — 2 times and by 83.2 %, respectively. The reasonable alert is caused by high levels of genitourinary morbidity of the adolescent population, which is an adverse phenomenon in the vies of prediction.
Significantly higher rates of genitourinary morbidity of the female population (4.5 times) were found to be higher than in males, in the working-age population (2.0 times) compared to the population older than the working age, urban population (by 49.8 %) compared to rural. Differences in the incidence of certain nosological forms depending on the age of the population and gender, a region of residence, etc. have been established.
The revealed differences in the levels of genitourinary morbidity of certain age- and gender-related, regional, and territorial populations need to be taken into account when planning preventive, treatment and diagnostic measures and further in-depth analysis of the exposure factors for determining the needs for medical care and the priorities of the organization of medical provision.
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