Phng php o

lng
gnh nng bnh tt
Nguyn vn L
Ging vin chnh
Khi nim
L khi nim dng ch mc tc
ng ca bnh tt n sc khe con
ngi
c lng ha thnh n v o
lng sc khe dn s
Phm vi ng dng

So snh tnh trng sc khe gia hai
dn s hoc cng mt dn s theo thi
gian;
nh lng s mt cn bng v sc
khe;
Bao gm c cc vn sc khe khng
gy t vong m bo cho vic ch
n mt chnh sch y t ph hp;
o lng mc ca cc vn sc khe
khc nhau bng cch s dng mt gi tr
chung;
Phn tch li ch ca cc can thip y t thng
qua cc nghin cu v chi ph hiu qu;
Cung cp thng tin thit lp cc vn sc
khe u tin trong vic lp k hoch y t, cc
chng trnh y t cng cng, nghin cu v
pht trin, cng nh o to chuyn nghip
Hai thnh phn c
bn o lng gnh
nng bnh tt
K vng sng khe mnh
Khong cch sc khe
I .K vng sng
ng ngha
Trin vng sng
Tui th bnh qun
Tui th
K vng sng l s nm trung bnh mt
ngi c kh nng sng c
K vng sng khe mnh l s nm
trung bnh mt ngi sng khng bnh,
khng tt
Lu
K vng sng khng phi tui bnh qun
ca nhng ngi ang sng
th d tnh k vng sng

Gi nhm tr mi sinh l p
0
Sau 1 nm,tr s cht , s cn li l p
1
i vi P
1
, sau mt nm tr cho s cht,
s cn li l p
2
i vi P
2
,sau 1 nm tr s cht, s cn
li l p
3
.
.
n nm n no s cht ht th p
n
= 0

Gin tnh hung trn
p
0
p
1
p
2
p
3
p
4
p
n
Khi nim b sung tnh k
vng sng
Phi nhim
L iu kin hon cnh,hon cnh
hin tng nhn khu hc c th xy ra
n v o s phi nhim:
ngi - nm
1 ngi nm ?
l mt ngi phi nhim 1 nm

Cc bc tin hnh

Bc mt:
Tnh s ngi-nm sng qua tng nm .
T p
0
n p
1
, c :
p
1
ngi sng c 1 nm
(p
0
p
1
) ngi sng c nm
Tng s ngi nm sng t p
0
n p
1
l
p
1
+
1
/
2
(p
0
-p
1
)

T p
1
n p
2
c :
p
2
ngi sng c 1 nm
(p
1
p
2
) ngi sng c nm
Vy tng s ngi nm sng t p
1
n p
2

l
p
2
+
1
/
2
(p
1
-p
2
)

T p
2
n p
3

C p
3
ngi sng c 1 nm
C (p
2
-p
3
)ngi sng c nm
Tng s ngi- nm sng t p
2
n p
3

l
p
3
+
1
/
2
(p
2
-p
3
)


Bc 2:
Tnh tng s ngi-nm sng ca p
0
(s
ngi - nm sng t p
0
n p
n
):
P
1
+
1
/
2
(P
0
-P
1
)+P
2
+
1
/
2
(P
1
-P
2
)+P
3
+
1
/
2
(P
2
-P
3
) +
=

P
1
+
1
/
2
P
0
-
1
/
2
P
1
+P
2
+
1
/
2
P
1

1
/
2
P
2
+ P
3
+
1
/
2
P
2
-
1
/
2
P
3
+
=
1
/
2
P
0
+P
1
+P
2
+P
3
+.
(ngi- nm sng)

Bc 3
Tnh k vng sng ca p
0

Ly tng s ngi- nm sng ca p
0

chia cho p
0
:
P
0
+p
1
+P
2
+P
3
+ P
1
+P
2
+P
3
+.
----------------------- =
1
/
2
+ -------------------------
P
0
P
0

P
1
+P
2
+P
3
+
= 0,5 + --------------------
P
0
1O NC V VNG LNH TH
C TUI TH CAO NHT TH
GII 2008
1. Macau 84.33
2. Andorra 82.67
3. Japan 82.07
4. Singapore 81.89
5. San Marino 81.88
6. Hong Kong 81.77
7. Australia 81.53
8. Canada 81.16
9. France: 80.87
10. Sweden: 80.74
K vng sng mt s nc
trong khu vc 2008
1. Singapore(4) 81,89
2. Brunei (75) 75,52
3. Malaysia(108) 73,03
4. Thailand (111) 72,83
5. Vit nam (126) 71,33
6. Philippine (133) 70,80
7. Indonexia (136) 70,46
8. Cambodia(175) 61,69
9. Laos (186) 56,29
K vng sng chun tnh gnh
nng bnh tt (who.2004)
N 82,5
Nam 80,5
2.Khong cch sc
khe
DALYs (Disability adjusted life years)
YLL (Years of Life Lost due to premature mortality)
ALD (Years Lived with Disability)

n v o khong cch sc
khe
DALYs (Disability adjusted life years s nm
cuc sng c iu chnh theo mc tn
tt)
o khong cch gia sc khe thc t
ca dn c v k vng sng khng bnh
khng tt
Mt DALY l mt nm mt ca cuc
sng khe mnh
DALYs c th c s dng
trong ba lnh vc

Gim st dch t ca tng s gnh nng
bnh tt
o lng chi ph hiu qu ca cc can
thip
Quyt nh chng trnh y t quc gia
trong iu kin mt ngn sch c nh,
ch c nhng can thip hiu qu nht
nn c thc hin.
Cng thc tnh DALYs


DALYs = YLL + YLD
Trong
YLL s nm b mt sm so vi k vng
sng l tng
YLD s nm b bnh hay b tn tt
YLL
Cho c nhn
YLL= e
0
- tui mt
Vi
e
0
= k vng sng chun

Cho cng ng
YLL = N x e
0
Vi:
N = S trng hp t vong
e
0
= k vng sng chun m ci cht xy ra
YLD
C nhn
YLD= (k vng sng l tng- tui b bnh hay
tt) x mc nghim trng ca bnh hay tt
YLD = I x DW x L
Vi:
I = s trng hp mi mc
DW = ch s chun ha mc nghim trng ca
vn sc khe hoc nghim trng ca khuyt
tt
L = thi gian trung bnh ca bnh (nm)
DW = ch s chun ha mc nghim
trng ca vn sc khe hoc trng
lng khuyt tt
Do WHO pht trin dng cho mi quc
gia
C khong gi tr ?
t 0 n 1
Mt ngi bnh thng
DALY= 0
82,5 nm
y
x
-Trc x biu th k
vng sng
- trc y biu thi mc
bnh tt
Mt b gi b thng ct ct chi lc 5
tui.Mt lc sng vi tn tt 77,5
nm.T trng gnh nng ct ct chi l
0.3.S nm b mt l bao nhiu nm?
Minh ha
82,5 nm
y
DALYs =23,3
0.3 x 77.5 = 23.3 (nm)
Mt trng hp(n) t vong do nhi
mu c tim lc 50 tui,trc khng
mc bnh tt g ,s nm b mt?
82,5 nm
y
x
DALYs
DALY= 82.5-50 =32.5
Mt n bnh nhn b ct ct chn lc 5
tui,cht lc 50 tui v tiu chy cp, s
nm mt ca trng hp ny ?
82,5 nm
y
x
DALYs
DALYs = (45 x 0,3) + 32,5 = 46 (nm)
3.Gnh nng bnh tt
hin nay
Ton cu
Vit Nam
Suy dinh dng tr em
Td khng an ton
Ung ru
Nc sch v vsmt
Tng huyt p
Ht thuc l
Con thiu b sa m
ng huyt cao
nhim kk trong nh
Tha cn v bo ph
Thiu vn ng
Tng cholesterol mu
Bnh ngh nghip
Thiu vi ta min A
Thiu st
n t tri cy,rau ti
Thiu km
Thuc gy nghin
Nhu cu trnh thai
khng c p ng
Gnh nng bnh tt nc
thu nhp thp
Yu t nguy c DALYs %
(triu) (/ton b)
Suy dinh dng TE 82 9,9
Nc v vs m.trng 53 6,3
T D khng an ton 52 6,2
B sa m khng 34 4,1
Kh thi trong nh nl rn 33 4,0
Thiu vitamine A 20 2,4
Tng huyt p 18 2,2
Ung ru 18 2,1
Cao ng huyt 16 1,9
Thiu km 14 1,7
Gnh nng bnh tt nc
thu nhp cao
Yu t nguy c DALYs %
(triu) (/ton b)
Ht thuc l 13 10,7
Ung ru 8 6,7
Tha cn v bo ph 8 6,5
Tng huyt p 7 6,1
Cao ng huyt 6 4,9
Thiu vn ng th lc 5 4,1
Cao cholesterol huyt 4 3,4
Thuc gy nghin 3 2,1
Bnh ngh nghip 2 1,5
n t tri cy v rau ti 2 1,3


Gnh nng bnh tt do yu t
mi trng Vit nam
Yu t DALYs
Nc,v sinh MT 2,8
nhim kk trong nh 2,8
nhim kk bn ngoi 0,5

Gnh nng bnh tt
Vit nam
Bnh DALYs
(/1000 ngi /nm)
1. Chn thng khng ch 3,9
2. Tiu chy 2,9
3. Bnh tim mch 2,6
4. COPD 2,2
5. Ri lon thn kinh,tm thn 2,0
6. Nhim trng h hp 1,9
7. Tai nn giao thng 1,6
8. Ung th khc 1,2
9. Chn thng c ch 1,1
10. Bnh suyn 0,8