TY - JOUR
T1 - Premature adult mortality from non-communicable diseases (NCD) in three middle-income countries
T2 - Do NCD programmes matter?
AU - Robles, Sylvia
AU - Adrion, Emily
AU - Anderson, Gerard F.
PY - 2012/9
Y1 - 2012/9
N2 - Background In many middle-income countries, there is limited data available to evaluate the effectiveness of non-communicable disease (NCD) programmes. Since 1970, three neighbouring middle-income countries - Argentina, Chile and Uruguay - have undergone health sector reforms and reorganized their NCD programmes. In this paper, we explore whether data on premature adult mortality can be used to gauge the effectiveness of these programmes.Methods We describe NCD programmes and examine mortality trends for the years 1970-2005 among adults aged 15-59 years. We contrast mortality trends from all-NCD to mortality trends from NCD that are avoidable through timely and effective medical care. The assumption is that if NCD programmes exert no effect, then all-NCD mortality and avoidable-NCD mortality will follow the same trend and avoidable-NCD mortality will not change at a faster pace. We used joinpoint regression analysis to describe the pace of change, measured as the geometric weighted average of the annual percentage change (AAPC).Results Since the 1980s, all three countries have implemented NCD programmes delivered through health care, but only after the year 2000 did these countries begin to scale-up population-based NCD prevention programmes. In Argentina, all-NCD mortality is declining at a faster pace than avoidable-NCD mortality, while the contrary is occurring in Chile. In Uruguay, all-NCD mortality is declining at a faster pace than avoidable-NCD mortality among males, whereas among females, all-NCD mortality has stagnated while avoidable-NCD mortality continues to decline.Conclusion NCD interventions through health care have likely contributed to the reduction of premature NCD mortality in Chile and among women in Uruguay. In Argentina and among men in Uruguay, factors outside the health sector seem to have had a greater impact. This approach could be used in other countries to assess the effect of NCD interventions and raise key questions on programme effectiveness.
AB - Background In many middle-income countries, there is limited data available to evaluate the effectiveness of non-communicable disease (NCD) programmes. Since 1970, three neighbouring middle-income countries - Argentina, Chile and Uruguay - have undergone health sector reforms and reorganized their NCD programmes. In this paper, we explore whether data on premature adult mortality can be used to gauge the effectiveness of these programmes.Methods We describe NCD programmes and examine mortality trends for the years 1970-2005 among adults aged 15-59 years. We contrast mortality trends from all-NCD to mortality trends from NCD that are avoidable through timely and effective medical care. The assumption is that if NCD programmes exert no effect, then all-NCD mortality and avoidable-NCD mortality will follow the same trend and avoidable-NCD mortality will not change at a faster pace. We used joinpoint regression analysis to describe the pace of change, measured as the geometric weighted average of the annual percentage change (AAPC).Results Since the 1980s, all three countries have implemented NCD programmes delivered through health care, but only after the year 2000 did these countries begin to scale-up population-based NCD prevention programmes. In Argentina, all-NCD mortality is declining at a faster pace than avoidable-NCD mortality, while the contrary is occurring in Chile. In Uruguay, all-NCD mortality is declining at a faster pace than avoidable-NCD mortality among males, whereas among females, all-NCD mortality has stagnated while avoidable-NCD mortality continues to decline.Conclusion NCD interventions through health care have likely contributed to the reduction of premature NCD mortality in Chile and among women in Uruguay. In Argentina and among men in Uruguay, factors outside the health sector seem to have had a greater impact. This approach could be used in other countries to assess the effect of NCD interventions and raise key questions on programme effectiveness.
KW - NCD programmes
KW - Non-communicable diseases
KW - avoidable mortality
KW - chronic diseases
KW - middle-income countries
KW - premature mortality
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U2 - 10.1093/heapol/czr073
DO - 10.1093/heapol/czr073
M3 - Article
C2 - 22016367
AN - SCOPUS:84865734998
SN - 0268-1080
VL - 27
SP - 487
EP - 498
JO - Health policy and planning
JF - Health policy and planning
IS - 6
ER -