Desigualdad en carga de enfermedad por Infección respiratoria aguda (IRA) y enfermedad diarreica aguda (EDA) menores de 5 años, Colombia 2010.
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Calderón Ramirez, Viviana Andrea
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Introducción: La metodología de carga de enfermedad calcula el indicador de años vida ajustados por discapacidad (AVAD) para conocer la brecha entre el estado de salud y el estado de salud ideal de la población. El objetivo de este estudio fue analizar las desigualdades existentes en la carga de infección respiratoria aguda (IRA) y enfermedad diarreica aguda (EDA) por régimen contributivo, subsidiado, sexo y departamentos en menores de 5 años en Colombia durante el 2010. Metodología: Estudio ecológico en el que se estimó el AVAD de IRA y EDA como la suma de años de vida con algún tipo de pérdida de la salud de corto o largo plazo, ajustados por su gravedad\(APD) y años de vida perdidos por mortalidad prematura (AVP). Se calculó el riesgo absoluto por régimen y la fracción atribuible por sexo, régimen y departamento para identificar desigualdades. Se usaron datos agrupados de morbilidad y mortalidad de los 32 departamentos. Resultados: La prevalencia de IRA y EDA fue de 4% (IC3.4-4.7) y 1,11% (IC0.8-1.5) respectivamente. EDA presenta mayores APD, mientras que IRA presenta mayores AVP. Se evidencian desigualdades estadísticamente significativas entre los dos tipos de regímenes p0,001 para IRA y EDA. Con la estimación del riesgo absoluto, el régimen subsidiado aporta mayor carga (21,21 AVAD) para IRA y el contributivo aporta mayor carga para EDA (-1,18AVAD). Discusión: La carga de enfermedad y desigualdad más alta se presenta en IRA comparada con EDA. Existen comportamientos atípicos en algunos departamentos con mayor carga de enfermedad en el régimen contributivo que subsidiado. Esto puede obedecer al alto índice de heterogeneidad al interior de cada régimen, a las prácticas de la vida cotidiana y al alto índice de subregistro de eventos. Conclusiones: Reducir carga de enfermedad en Colombia implica análisis de los determinantes sociales en salud por régimen de afiliación, la mejora de los sistemas de información y el seguimiento de eventos en salud, así como también, el mejoramiento de estrategias de prevención y de atención en salud. Contar con evidencia sobre la carga de la enfermedad es importante para los procesos de toma de decisiones dentro del sector de la salud, a fin de tomar decisiones pertinentes y establecer las prioridades adecuadas.
Abstract: Background: The methodology for measuring burden of disease calculates the DALYs to assess the gap between the health status and the ideal health status of the population. This study aimed to describe the inequalities in acute respiratory infection and acute diarrheal diseases by contributory and subsidized regime, stratified by departments and sex in children younger than 5 years old in 2010. Methods: Ecological study in which DALYs for acute respiratory infection and acute diarrheal diseases were calculated as the sum years of life lived with any health loss of short or long term, adjusted by YLDs and YLLs. In order to evaluate inequalities, attributable Fraction was calculated by sex, regime and department. Morbidity and mortality of pooled data were used in the 32 departments. Results: The prevalence of acute respiratory infection and acute diarrheal diseases in 2010 was 4% (IC3.4-4.7) and 1,11% (IC0.8-1.5) respectively. Acute diarrheal diseases have higher YLDs, whereas acute respiratory infection has higher YLLs. Statistically significant differences were found in both type of regime (p0.001). With the estimation of absolute risk, the subsidized regime has a higher burden for acute respiratory infection (AR 21,21) and the contributory regime has a higher burden for acute diarrheal diseases (AR - 1,18). Discussion: Higher burden of disease and inequalities are found with acute respiratory infection compared to acute diarrheal disease. When analyzing the regimes, the contributory shows a higher burden of disease in some of the studied departments. This could be explained by the heterogeneity within the regimes, lifestyles of people, and the high rate of underreporting of cases. Conclusions: Decreasing the burden of disease in Colombia needs an analysis of the social determinants of health by regime, improvement of information systems and health events follow up, as well as the improvement of prevention and promotion strategies in health.It is important to have evidence about burden disease in order to go through decision-making processes and to prioritize the most relevant issues in the health sector.
Abstract: Background: The methodology for measuring burden of disease calculates the DALYs to assess the gap between the health status and the ideal health status of the population. This study aimed to describe the inequalities in acute respiratory infection and acute diarrheal diseases by contributory and subsidized regime, stratified by departments and sex in children younger than 5 years old in 2010. Methods: Ecological study in which DALYs for acute respiratory infection and acute diarrheal diseases were calculated as the sum years of life lived with any health loss of short or long term, adjusted by YLDs and YLLs. In order to evaluate inequalities, attributable Fraction was calculated by sex, regime and department. Morbidity and mortality of pooled data were used in the 32 departments. Results: The prevalence of acute respiratory infection and acute diarrheal diseases in 2010 was 4% (IC3.4-4.7) and 1,11% (IC0.8-1.5) respectively. Acute diarrheal diseases have higher YLDs, whereas acute respiratory infection has higher YLLs. Statistically significant differences were found in both type of regime (p0.001). With the estimation of absolute risk, the subsidized regime has a higher burden for acute respiratory infection (AR 21,21) and the contributory regime has a higher burden for acute diarrheal diseases (AR - 1,18). Discussion: Higher burden of disease and inequalities are found with acute respiratory infection compared to acute diarrheal disease. When analyzing the regimes, the contributory shows a higher burden of disease in some of the studied departments. This could be explained by the heterogeneity within the regimes, lifestyles of people, and the high rate of underreporting of cases. Conclusions: Decreasing the burden of disease in Colombia needs an analysis of the social determinants of health by regime, improvement of information systems and health events follow up, as well as the improvement of prevention and promotion strategies in health.It is important to have evidence about burden disease in order to go through decision-making processes and to prioritize the most relevant issues in the health sector.