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¢π‘…∞“ °Ÿâ»√’ °ÿ≈
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*°π‘…∞“ ∫ÿ≠∏√√¡‡®√‘≠
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∫∑§—¥¬àÕ °“√쓬∑’ËÀ≈’°‡≈’ˬ߉¥â‡ªìπμ—«™’È«—¥Àπ÷Ëß∑’Ë ”§—≠„π°“√ª√–‡¡‘π§ÿ≥¿“æ°“√√—°…“欓∫“≈À√◊Õ°“√æ—≤π“π‚¬∫“¬ ÿ¢¿“æ
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æ.». 2552 §‘¥‡ªìπ√âÕ¬≈– 36.7 ¢Õß°“√쓬∑—ÈßÀ¡¥„π∑ÿ°°≈ÿà¡Õ“¬ÿ Õ—μ√“°“√쓬¡“μ√∞“π„π‡æ»™“¬‚¥¬√«¡ Ÿß°«à“‡æ»
À≠‘ߪ√–¡“≥ Õ߇∑à“ ·≈–≈¥≈ß®“° 332.6 ·≈– 178.8 μàÕª√–™“°√· π§π ‡ªìπ 288.1 ·≈– 149.7 „πªï 2547 ·≈–
2552 μ“¡≈”¥—∫ “‡Àμÿ°“√쓬 Ÿß ÿ¥ “¡≈”¥—∫·√°§◊Õ‚√§μ‘¥‡™◊ÈÕ™π‘¥·∫§∑’‡√’¬·≈–‚ª√‚μ´—« °“√¶à“엫쓬·≈–∑”√⓬
μπ‡Õß ·≈–¡–‡√Áßμ—∫ ‚¥¬ √ÿª™à«ßæ.». 2547-2552 °“√쓬∑’ËÀ≈’°‡≈’ˬ߉¥â¢Õߪ√–‡∑»‰∑¬≈¥≈ßÕ¬à“߇ÀÁπ‰¥â™—¥ ·μà
§«“¡∂Ÿ°μâÕߢÕß°“√ª√–‡¡‘π°“√쓬∑’ËÀ≈’°‡≈’ˬ߉¥â¢÷Èπ°—∫§ÿ≥¿“æ¢âÕ¡Ÿ≈®“°¡√≥∫—μ√ °“√æ—≤π“§ÿ≥¿“æ¢âÕ¡Ÿ≈¡√≥∫—μ√
®÷ß¡’§«“¡ ”§—≠
§” ”§—≠: °“√쓬∑’ËÀ≈’°‡≈’ˬ߉¥â, °“√쓬∑’ˉ¡à “¡“√∂√–∫ÿ “‡Àμÿ°“√쓬‰¥âÕ¬à“ß™—¥‡®π, Õ—μ√“쓬¡“μ√∞“π
Abstract Avoidable mortality in Thailand in 2009
Khanitta Kusreesakul*, Kanjanawadee Prasittisa*, Kanitta Bundhamcharoen*
*International Health Policy Program, Ministry of Public Health
Avoidable mortality, defined as deaths which should not have occurred when effective public health and medical interventions were available, is a widely-used indicator for quality and effectiveness of the healthcare system in developed countries. This study aimed to estimate the avoidable mortality from the death registry in Thailand in 2009 and its trend from 2004 to 2009. We applied a list of avoidable causes of mortality and age limits based on the Australian and New Zealand study. Vital registration data were used to calculate age- and sex- specific death rates and standardized with the reference from the World Health Organization World Population. The findings showed that avoidable mortality amounted to 36.7%
of total deaths in 2009. The rate for men was approximately double that for women throughout the period.
Age-standardized mortality rates for men and women decreased from 332.6, and 178.8 per 100,000 to 288.1, and 149.7 per 100,000 in 2004 and 2009, respectively. The top three causes in 2009 were invasive bacterial and protozoan infectious diseases, followed by suicide, self-inflicted injuries and liver cancer.
There was a notable reduction in avoidable mortality in Thailand from 2004-2009. But since the estimation relies on the cause-of-death information, effort to improve data quality is required.
Keywords: avoidable mortality, ill-defined mortality, age-standardized death rate
¿Ÿ¡‘À≈—ß·≈–‡Àμÿº≈
“√쓬∑’ËÀ≈’°‡≈’ˬ߉¥â (avoidable mortality) ‡ªìπμ—«™’È«—¥
Àπ÷Ëß∑’Ë„™âÕ¬à“ß°«â“ߢ«“ß ”À√—∫ª√–‡¡‘π§ÿ≥¿“æ∫√‘°“√
ÿ¢¿“æÀ√◊Õπ‚¬∫“¬ ÿ¢¿“æ¢Õߪ√–™“°√ ‚¥¬ª√–‡¡‘π°“√
쓬®“° “‡Àμÿ∑’ˉ¡à§«√®–‡°‘¥ √«¡∑—Èß°“√쓬°àÕπ«—¬Õ—π§«√
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§«“¡®”‡ªìπ¢Õß°“√æ—≤π“√–∫∫·≈–§ÿ≥¿“æ¢Õß°“√∫√‘°“√
∑“ß ÿ¢¿“æ
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Õ“≥“®—°√ Charton ·≈–§≥–(2) ‰¥âª√—∫ª√ÿß√“¬°“√‚√§‡æ◊ËÕ
„™â„πª√–‡∑»∑’Ëæ—≤π“·≈â« μ√“∫®πªí®®ÿ∫—π¬—ß¡’°“√»÷°…“‡æ‘Ë¡
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‡π◊ËÕß®“°§«“¡´—∫´âÕπ·≈–‰¡à·πàπÕπ„π°“√‡≈◊Õ° “‡Àμÿ∑’Ë·∑â®√‘ß Nolte ·≈– McKee(3) ·≈– Page(4) ®÷ߥ—¥·ª≈ß·π«§‘¥‡¥‘¡
¥â«¬°“√·∫àß “‡Àμÿ°“√쓬‡ªìπ 2 °≈ÿà¡ §◊Õ “‡Àμÿ°“√쓬∑’Ë ªÑÕß°—π‰¥â®“°°“√√—°…“∑“ß°“√·æ∑¬å (amenable mortality)
·≈– “‡Àμÿ°“√쓬∑’˪ÑÕß°—π‰¥â¥â«¬π‚¬∫“¬ “∏“√≥ ÿ¢∑’Ë¡ÿàß ªÑÕß°—πÕ—πμ√“¬®“°§«“¡‡ ’ˬß∑’Ë°àÕ„À⇰‘¥§«“¡ Ÿ≠‡ ’¬™’«‘μ (preventable mortality) ‚¥¬ Page ‰¥âπ”¡“„™â„π√“¬ß“π
°“√쓬∑’ËÀ≈’°‡≈’ˬ߉¥â¢Õߪ√–‡∑»ÕÕ ‡μ√‡≈’¬·≈–π‘«´’·≈π¥å μ—Èß·μà §.». 1997 ∂÷ß 2001
ªí®®ÿ∫—π‰¥â¡’°“√π”°“√쓬∑’ËÀ≈’°‡≈’ˬ߉¥â‰ª„™â«‘‡§√“–Àå
§ « “ ¡ — ¡ æ— π ∏å √ – À «à “ ß “ ‡ À μÿ ° “ √ μ “ ¬ °— ∫ ∂ “ π ¿ “ æ ∑ “ ß
‡»√…∞°‘®·≈– —ߧ¡ ‡æ◊ËÕª√–‡¡‘π§ÿ≥¿“æ·≈–ª√– ‘∑∏‘¿“æ
¢Õß°“√∫√‘°“√ ÿ¢¿“æ πÕ°®“°π’Ȭ—ß„™â„π°“√‡ª√’¬∫‡∑’¬∫
ª√– ‘∑∏‘¿“æ¢Õß°“√¥Ÿ·≈√—°…“√–À«à“ߪ√–‡∑»À√◊Õ√–À«à“ß æ◊Èπ∑’Ë∑’Ë¡’§«“¡·μ°μà“ß∑“ß —ߧ¡¥â«¬(3,5)
„πª√–‡∑»‰∑¬¬—߉¡à‡§¬¡’°“√ª√–‡¡‘π°“√쓬∑’ËÀ≈’°‡≈’ˬß
‰¥âμ“¡·π«§‘¥¢â“ßμâπ °“√»÷°…“π’È®÷ß¡’«—μ∂ÿª√– ߧå‡æ◊ËÕ ª√–‡¡‘π°“√쓬∑’ËÀ≈’°‡≈’ˬ߉¥â„πª√–‡∑»‰∑¬ æ.». 2552
‚¥¬‡ª√’¬∫‡∑’¬∫§«“¡·μ°μà“ß√–À«à“ß‡æ» °≈ÿà¡Õ“¬ÿ ·≈–
“‡Àμÿμà“ßÊ ·≈–»÷°…“·π«‚πâ¡„πª√–‡∑»‰∑¬μ—Èß·μàæ.». 2547
∂÷ßæ.». 2552
√–‡∫’¬∫«‘∏’»÷°…“
°“√»÷°…“π’ȇªìπ°“√»÷°…“‡™‘ßæ√√≥π“ ‚¥¬„™â¢âÕ¡Ÿ≈
∑ÿ쑬¿Ÿ¡‘ª√–¡“≥°“√쓬∑’ËÀ≈’°‡≈’ˬ߉¥â ‚¥¬„™âÀ≈—°‡°≥±å¢Õß Page ·≈–§≥– „π§.». 2006 ”À√—∫°“√‡≈◊Õ°√“¬°“√‚√§ 2
‡√◊ËÕß §◊Õ 1) amenable mortality 2) preventable mortality
¢âÕ¡Ÿ≈∑’Ë„™â„π°“√»÷°…“
°“√»÷°…“Õ“»—¬¢âÕ¡Ÿ≈°“√쓬®“° ”π—°∫√‘À“√°“√∑–‡∫’¬π
°√¡°“√ª°§√Õß °√–∑√«ß¡À“¥‰∑¬ æ.». 2547-2552 ®”·π°
°“√μ“¬μ“¡Õ“¬ÿ·≈–‡æ» ´÷Ëß∫—π∑÷° “‡Àμÿμ“¡√“¬°“√‚√§¢Õß
∫—≠™’®”·π°‚√§√–À«à“ߪ√–‡∑»©∫—∫∑’Ë 10 (International Classification of Diseases: ICD-10) ·≈–¢âÕ¡Ÿ≈ª√–™“°√
°≈“ߪﮓ° Ì“π—°π‚¬∫“¬·≈–¬ÿ∑∏»“ μ√å Ì“π—°ß“πª≈—¥
°√–∑√«ß “∏“√≥ ÿ¢ æ.». 2547-2552
‡°≥±å°“√®”·π°°“√쓬∑’ËÀ≈’°‡≈’ˬ߉¥â
°“√®”·π° “‡Àμÿ „™âÀ≈—°‡°≥±å‡¥’¬«°—∫°“√»÷°…“¢Õß Page ·≈–§≥–(4) ‚¥¬°”Àπ¥√“¬°“√‚√§∑’ˇ°’ˬ«¢âÕß°—∫°“√
쓬∑’˧«√À≈’°‡≈’ˬ߉¥â∑’Ë ”§—≠„πªí®®ÿ∫—π ´÷Ëߪ√–°Õ∫¥â«¬ pre- ventable mortality ·≈– amenable mortality ¥—ß· ¥ß
„πμ“√“ß∑’Ë 1 ·≈–·ºπ¿Ÿ¡‘∑’Ë 1 ·≈–·¬° “‡Àμÿ∑’ˉ¡à∑√“∫·®âß
™—¥ (ill-defined causes) ÕÕ°‡ªìπÕ’°°≈ÿà¡ ‡π◊ËÕß®“°¢âÕ¡Ÿ≈
°“√쓬¢Õ߉∑¬¡’ —¥ à«π¢Õß°≈ÿà¡π’È Ÿß(6)
°“√«‘‡§√“–Àå¢âÕ¡Ÿ≈
«‘‡§√“–ÀåÕ—μ√“쓬 (crude death rate; m) ·≈–Õ—μ√“
ª√—∫¡“μ√∞“πÕ“¬ÿ (age-standardized rate; ASR) ‡∑’¬∫
°—∫ª√–™“°√¡“μ√∞“π¢Õß‚≈°„π·μà≈–°≈ÿà¡Õ“¬ÿ¢ÕßÕߧ尓√
Õπ“¡—¬‚≈° (WHO)(8)
ASR §◊ÕÕ—μ√“√«¡¢Õß°“√‡°‘¥‡Àμÿ°“√≥凡◊ËÕª√–™“°√¡’
‚§√ß √â“ߢÕߪ√–™“°√¡“μ√∞“π ª√–¡“≥‚¥¬·ª≈ß
°
μ“√“ß∑’Ë 1 “‡Àμÿ°“√쓬·≈–√À— ICD-10 ¢Õß amenable ·≈– preventable mortality
Amenable mortality Preventable mortality
“‡Àμÿ°“√쓬 √À— ICD-10 “‡Àμÿ°“√쓬 √À— ICD-10
«—≥‚√§ A15-A19, B90 °“√μ‘¥‡™◊ÈÕ‡Õ™‰Õ«’/‡Õ¥ å B20-B24
‚√§μ‘¥‡™◊ÈÕ®“°·∫§∑’‡√’¬·≈–‚ª√‚μ´—« A38-A41, A46, A48.1, ‚√§‰«√— μ—∫Õ—°‡ ∫ B15-B19 B50-B54, G00, G03,
J02.0, L03
¡–‡√Áß≈”‰ â„À≠à·≈–∑«“√Àπ—° C18-C21 ¡–‡√Áߪ“°·≈–≈”§Õ C00-C14
¡–‡√Áߺ‘«Àπ—ß∑’ˇ°’ˬ«°—∫‡´≈≈åº≈‘μ‡¡Á¥ ’„πº‘«Àπ—ß C43 ¡–‡√ÁßÀ≈Õ¥Õ“À“√ C15
¡–‡√Áߺ‘«Àπ—ß∑’ˉ¡à‡°’ˬ«°—∫‡´≈≈åº≈‘μ‡¡Á¥ ’„πº‘«Àπ—ß C44 ¡–‡√Áß°√–‡æ“–Õ“À“√ C16
¡–‡√Á߇μâ“π¡ C50 ¡–‡√Áßμ—∫ C22
¡–‡√Áß¡¥≈Ÿ°·≈– à«πμà“ßÊ¢Õß¡¥≈Ÿ° C54-C55 ¡–‡√Áߪե C33-C34
¡–‡√Áߪ“°¡¥≈Ÿ°·≈–¡¥≈Ÿ° C53 §«“¡º‘¥ª°μ‘∑’ˇ°’ˬ«¢âÕß°—∫°“√¥◊Ë¡ ÿ√“ F10, G31.2, G62.1, I42.6, K29.2, K70, K73-K74 (exclud- ing. K74.3-K74.5), K86.0
¡–‡√Áß°√–‡æ“–ªí “«– C67 §«“¡º‘¥ª°μ‘®“°°“√‰¥â√—∫ “√‡ æμ‘¥ F11-F16, F18-F19
À√◊Õ¬“μâÕßÀâ“¡
¡–‡√ÁßμàÕ¡‰∑√Õ¬¥å C73 ¿“«–À≈Õ¥‡≈◊Õ¥·¥ß‡ÕÕÕ√åμ“‚ªÉßæÕß I71
¡–‡√ÁßμàÕ¡πÈ”‡À≈◊Õß™π‘¥ŒÕ¥®å°‘π C81 ¿“«–À≈Õ¥‡≈◊Õ¥¢“·≈–ªÕ¥Õÿ¥μ—π I26, I80.1-I80.3, I80.9, I82.9
¡–‡√Á߇¡Á¥‡≈◊Õ¥¢“« C91.0-C91.1 ‰¢âÀ«—¥„À≠à J10-J11
‡π◊ÈÕßÕ°∑’ˉ¡à√⓬·√ß D10-D36 ‚√§ªÕ¥∫«¡ J12-J18
‚√§¢ÕßμàÕ¡‰∑√Õ¬¥å E00-E07 ‚√§ªÕ¥Õÿ¥°—Èπ‡√◊ÈÕ√—ß J40-J44
‚√§‡∫“À«“π E10-E14 Õÿ∫—쑇Àμÿ∑“ß∂ππ V01-V89
‚√§≈¡™—° G40-G41 Õÿ∫—쑇Àμÿ®“°°“√ —¡º— “√æ‘… X40-X49
‚√§À—«„®√Ÿ¡“μ‘° I01-I09 °“√æ≈—¥μ°À√◊Õ≈â¡ W00-W19
‚√§À—«„®®“°§«“¡¥—π‚≈À‘μ Ÿß I10-I15 Õÿ∫—쑇Àμÿ®“°‡æ≈‘߉À¡â X00-X09
‚√§À—«„®¢“¥‡≈◊Õ¥ I20-I25 °“√®¡πÈ” W65-W74
‚√§À≈Õ¥‡≈◊Õ¥ ¡Õß I60-I69 °“√¶à“엫쓬·≈–∑”√â“¬μ—«‡Õß X60-X84, Y10-Y34
(excluding Y33.9)
‰μÕ—°‡ ∫·≈–‰μæ‘°“√ N00-N07, N17-N19, °“√∂Ÿ°∑”√⓬ X85-Y09, Y33.9
N25-N27
¿“«–∑“߇¥‘πªí “«–Õÿ¥μ—π N13, N20-N21, N35, N40, N99.1
‚√§ÀÕ∫À◊¥ J45-J46
·º≈„π°√–‡æ“–Õ“À“√ K25-K28
‰ â‡≈◊ËÕπ∫√‘‡«≥ºπ—ßÀπâ“∑âÕß, ‰ âμ‘ËßÕ—°‡ ∫ K35-K38, K40-K46,
·≈–‚√§π‘Ë«„π∂ÿßπÈ”¥’À√◊Õ∂ÿßπÈ”¥’Õ—°‡ ∫ K80-K83, K85, K86.1-K86.9, K91.5
§«“¡æ‘°“√À√◊Õº‘¥ª°μ‘μ—Èß·μà°”‡π‘¥ Q00-Q99
°“√쓬ª√‘°”‡π‘¥¬°‡«âπ°“√쓬®“°°“√§≈Õ¥ P00-P96
*¥—¥·ª≈ß®“°°“√»÷°…“¢Õß Wells C.(7)
**‚√§∑’ËÕ¬Ÿà„π°≈ÿà¡ avoidable mortality ·μà‰¡à‰¥â®—¥Õ¬Ÿà„π∑—Èß 2 °≈ÿà¡ ¡’‚√§ª“°·À«à߇楓π‚À«à ‚√§μ—∫‡√◊ÈÕ√—ß ·≈–‚√§¢Õß√–∫∫ªí “«–
‚§√ß √â“ßÕ“¬ÿª√–™“°√„Àâ¡’‚§√ß √â“ßÕ“¬ÿ‡À¡◊Õπª√–™“°√
¡“μ√∞“π ·μà‡π◊ËÕß®“°ª√–™“°√„π·μà≈–æ◊Èπ∑’Ë¡’§«“¡·μ°μà“ß
∑—Èß¢π“¥·≈–°“√°√–®“¬¢Õߪ√–™“°√„π·μà≈–™à«ßÕ“¬ÿ „π
°“√‡ª√’¬∫‡∑’¬∫Õ—μ√“쓬√–À«à“ߪ√–™“°√∑’Ë·μ°μà“ß°—πÀ√◊Õ
„πª√–™“°√‡¥’¬«°—π·μàμà“߇«≈“ ®÷ߧ«√ª√—∫§«“¡·μ°μà“ß
¢Õß‚§√ß √â“ߪ√–™“°√°àÕππ”¡“‡ª√’¬∫‡∑’¬∫
... (1) m = Õ—μ√“°“√쓬μàÕª√–™“°√· π§π
n = ®”π«π°“√쓬
P = ®”π«πª√–™“°√∑—ÈßÀ¡¥
... (2) Pk = ª√–™“°√¡“μ√∞“π¢Õß‚≈°μ“¡ WHO „π°≈ÿà¡Õ“¬ÿ μà“ßÊ
mk= Õ—μ√“°“√쓬μàÕª√–™“°√· π§π∑’Ë°≈ÿà¡Õ“¬ÿμà“ßÊ k = °≈ÿà¡Õ“¬ÿμà“ßÊ (0-4, 5-9,..., 85+)
°“√§”π«≥§à“§«“¡‡™◊ËÕ¡—Ëπ∑’Ë√–¥—∫√âÕ¬≈– 95 (95 % con- fidence interval; 95% CI) §”π«≥μ“¡ ¡°“√∑’Ë 3
... (3) r = Õ—μ√“쓬¡“μ√∞“π (age-standardized mortal-
ity rate)
nk = ®”π«π°“√쓬∑’ˇ°‘¥¢÷Èπ„π°≈ÿà¡Õ“¬ÿμà“ßÊ k = °≈ÿà¡Õ“¬ÿμà“ßÊ (0-4, 5-9,..., 85+)
º≈°“√»÷°…“
μ“√“ß∑’Ë 2 · ¥ß®”π«π°“√쓬·≈– ASR μàÕª√–™“°√
· π§π¢Õߪ√–™“°√‰∑¬™à«ßÕ“¬ÿ 0-74 ªï ®“° “‡Àμÿμà“ßÊ
„πæ.». 2552 æ∫ —¥ à«π°“√쓬®“° avoidable mortality Ÿß∂÷ß√âÕ¬≈– 56.3 ®“°°“√∑—Èß쓬À¡¥¢Õߪ√–™“°√Õ“¬ÿ 0-74 ªï ‚¥¬‡æ»™“¬·≈–À≠‘ߧ‘¥‡ªìπ√âÕ¬≈– 36.2 ·≈– 20.1 μ“¡
≈”¥—∫ ∑—Èßπ’È§à“ ASR „π°≈ÿà¡ avoidable mortality ¢Õ߇æ»
™“¬¡’§à“ 288.1 ·≈–‡æ»À≠‘ß 149.7 Õ—μ√“ à«π¢Õß ASR
™“¬μàÕÀ≠‘߇ªìπ 1.92 °≈ÿà¡ amenable mortality ¡’Õ—μ√“ à«π ASR ™“¬μàÕÀ≠‘ßμË” ÿ¥ §◊Õ 1.30 (ASR ‡æ»™“¬=131.2
·≈–À≠‘ß=100.6) ¢≥–∑’Ë preventable mortality ¡’Õ—μ√“ à«π ASR ™“¬μàÕÀ≠‘ß Ÿß ÿ¥ §◊Õ 3.2 ‡∑à“ (ASR ‡æ»™“¬=147.1
·≈–À≠‘ß=45.9)
μ“√“ß∑’Ë 3 · ¥ß®”π«π·≈–Õ—μ√“쓬μàÕª√–™“°√· π
§π¢Õß°≈ÿà¡ avoidable mortality μ“¡‡æ»·≈–™à«ßÕ“¬ÿμà“ßÊ
„πæ.». 2552 Õ—μ√“ à«π°“√쓬¢Õß™“¬μàÕÀ≠‘ß¡’§à“μË” ÿ¥„π
™à«ßÕ“¬ÿπâÕ¬°«à“ 1 ªï (1.17) ¢≥–∑’Ë™à«ßÕ“¬ÿ 15-24 ‡ªìπ™à«ß∑’Ë Õ—μ√“ à«π°“√쓬™“¬μàÕÀ≠‘ß Ÿß ÿ¥ §◊Õ 3.80 √Õß≈ß¡“§◊Õ
™à«ßÕ“¬ÿ 25-44 ªï (2.67 ‡∑à“) ”À√—∫«—¬ºŸâ„À≠à §◊Õ ™à«ßÕ“¬ÿ 45-64 ªï ·≈– 65-74 ªï Õ—μ√“°“√쓬™“¬μàÕÀ≠‘ß¡’§à“‡ªìπ 1.90
·≈– 1.50 ‡∑à“μ“¡≈”¥—∫
·ºπ¿Ÿ¡‘∑’Ë 2 · ¥ß§à“ ASR μàÕª√–™“°√· π§π∑’Ë¡’Õ“¬ÿ 0-74 ªï √«¡ 2 ‡æ» ™à«ßæ.». 2547-2552 ·¬°μ“¡°≈ÿà¡ ame- nable, preventable ·≈– avoidable mortality ∑—Èß 3 °≈ÿà¡
¡’·π«‚πâ¡≈¥≈߇≈Á°πâÕ¬ ‚¥¬∑ÿ°ªï°≈ÿà¡ amenable mortal-
n ××××× 100,000
m =
p
·ºπ¿Ÿ¡‘∑’Ë 1 ·ºπº—ß°“√·∫àß “‡Àμÿ°“√쓬ª√–‡¿∑μà“ßÊ
ΣΣΣΣΣPkmk ASR =
ΣΣΣΣΣPk
1.96r 95%CI = r ±±±±±
¶
¶¶
¶
¶Σ Σ Σ Σ Σ nk
·ºπ¿Ÿ¡‘∑’Ë 2 ASR √«¡ 2 ‡æ» ·¬°°≈ÿà¡ amenable, preventable ·≈– avoidable mortality ™à«ß æ.». 2547-2552 μ“√“ß∑’Ë 2 Avoidable, unavoidable ·≈– ill-defined mortality ¢Õߪ√–‡∑»‰∑¬ æ.». 2552 (0-74 ªï)
Number of death ASR per 100,000 persons
Type of mortality Males Females Total Males Females Total Ratio
(% of total (% of total (% of total (95% CI) (95% CI) (95% CI) M:F
death) death) death)
Avoidable 91740 51078 142818 288.1 149.7 216.5 1.92
(36.2) (20.1) (56.3) (286.4 -289.8) (148.6-150.8) (215.5-217.5)
- Amenable 40640 34167 74807 131.2 100.6 115.2 1.30
(16.0) (13.5) (29.5) (130.1-132.3) (99.8-101.5) (114.5-115.9)
- Preventable 47725 15762 63487 147.1 45.9 94.9 3.20
(18.8) (6.2) (25.0) (145.8-148.3) (45.2-46.6) (94.2-95.6)
Unavoidable 29362 18792 48154 92.8 54.3 72.6 1.71
(11.6) (7.4) (19.0) (91.9-93.8) (53.6-55.0) (72.0-73.2)
Ill-defined 38573 24071 62644 125.6 70.6 96.7 1.78
(15.2) (9.5) (24.7) (124.7-126.5) (70.1-71.1) (96.2-97.2)
Total death 159675 93941 253616 506.6 274.6 385.7 1.84
(0-74 years) (63.0) (37.0) (100.0) (504.4-508.7) (273.3-275.9) (384.5-387.0)
μ“√“ß∑’Ë 3 Avoidable mortality æ.». 2552 μ“¡°≈ÿà¡Õ“¬ÿ 0-74 ªï
Number Both sex Rate per 100,000 persons
Age (years) Males Female Number % of total Males Female Total Rate M:F
Infants (< 1) 2216 1771 3987 2.8 570 487 530 1.17
1 - 14 2366 1439 3805 2.7 38 24 31 1.58
15 - 24 6532 1650 8182 5.7 133 35 85 3.80
25 - 44 23844 9099 32943 23.1 222 83 152 2.67
45 - 64 37989 21919 59908 41.9 556 293 418 1.90
65 - 74 18793 15200 33993 23.8 1345 894 1097 1.50
Total 91740 51078 142818 100.0 301 164 232 1.84
ity ¡’§à“ ASR Ÿß°«à“°≈ÿà¡ preventable mortality ·≈–
‡¡◊ËÕæ‘®“√≥“‡©æ“–‡æ»™“¬μ“¡·ºπ¿Ÿ¡‘∑’Ë 2-1 æ∫«à“∑—Èß 3 °≈ÿà¡
¡’·π«‚πâ¡≈¥≈߇™àπ°—π ·μàμà“ß°—π∑’Ë°≈ÿà¡ preventable mor- tality ¡’§à“ ASR Ÿß°«à“°≈ÿà¡ amenable mortality ‡≈Á°
πâÕ¬„π∑ÿ°ªï ·μà ”À√—∫‡æ»À≠‘ß (·ºπ¿Ÿ¡‘∑’Ë 2-2) °≈ÿà¡ ame- nable mortality ¡’§à“ ASR Ÿß°«à“°≈ÿà¡ preventable mor- tality Õ¬à“ß™—¥‡®π
·ºπ¿Ÿ¡‘∑’Ë 3 · ¥ß°“√‡ª≈’ˬπ·ª≈ߢÕß‚√§ 10 Õ—π¥—∫
Ÿß ÿ¥¢Õß avoidable mortality „π‡æ»™“¬√–À«à“ß æ.». 2547- 2552 ®–‡ÀÁπ‰¥â«à“„π æ.». 2547 ‚√§μ‘¥‡™◊ÈÕ®“°·∫§∑’‡√’¬
·≈–‚ª√‚μ´—«¡’§à“ ASR Ÿß ÿ¥ √Õß≈ß¡“ 3 Õ—π¥—∫ §◊Õ °“√
¶à“엫쓬·≈–∑”√â“¬μ—«‡Õß ‚√§À≈Õ¥‡≈◊Õ¥ ¡Õß ·≈–
Õÿ∫—쑇Àμÿ∑“ß∂ππ ∑’Ëπà“ —߇°μ §◊Õ ‚√§μ‘¥‡™◊ÈÕ®“°·∫§∑’‡√’¬
·≈–‚ª√‚μ´—« ·≈–°“√¶à“엫쓬·≈–∑”√â“¬μ—«‡ÕߢÕ߇æ»
™“¬¡’§à“ ASR §àÕπ¢â“ß Ÿß°«à“ “‡ÀμÿÕ◊Ëπ ∑—Èßπ’È„π æ.». 2547
∑—Èß 2 “‡Àμÿ¡’§à“ ASR μà“ß°—π¡“° ·μàÀ≈—ß®“° æ.». 2549
‡ªìπμâπ¡“ §à“§àÕπ¢â“ß„°≈⇧’¬ß°—π ‚¥¬·π«‚πâ¡¢Õß‚√§μ‘¥
‡™◊ÈÕ®“°·∫§∑’‡√’¬·≈–‚ª√‚μ´—«≈¥≈ß à«π°“√¶à“엫쓬·≈–
∑”√â“¬μ—«‡Õß°≈—∫‡æ‘Ë¡ Ÿß Õ’°Àπ÷Ëßμ—«Õ¬à“ß∑’Ëπà“ π„® §◊Õ ‚√§
À≈Õ¥‡≈◊Õ¥ ¡Õß æ.». 2547 ∑’Ë¡’§à“ ASR ª√–¡“≥ 30 ·μà
≈¥≈ßÕ¬à“ß¡“°„π æ.». 2549 ‡À≈◊Շ撬ߪ√–¡“≥ 20 ·≈–¡’
·π«‚π⡧ß∑’Ë®π∂÷ßªí®®ÿ∫—π
·ºπ¿Ÿ¡‘∑’Ë 4 ”À√—∫ 10 Õ—π¥—∫ Ÿß ÿ¥¢Õß‚√§∑’Ë®—¥Õ¬Ÿà„π
°≈ÿà¡ avoidable mortality ¢Õ߇æ»À≠‘ß ‚√§μ‘¥‡™◊ÈÕ®“°
·∫§∑’‡√’¬·≈–‚ª√‚μ´—«¡’§à“ ASR Ÿß ÿ¥‡™àπ‡¥’¬«°—∫‡æ»™“¬
·≈–§à“§àÕπ¢â“ß Ÿß°«à“®“° “‡ÀμÿÕ◊Ëπ¡“° à«π 3 Õ—π¥—∫√Õß≈ß
¡“ „πæ.». 2547 §◊Õ ‚√§À≈Õ¥‡≈◊Õ¥ ¡Õß ‰μÕ—°‡ ∫·≈–‰μ æ‘°“√ ·≈–‚√§‡∫“À«“π ∑—Èßπ’È·π«‚πâ¡¢Õß‚√§μ‘¥‡™◊ÈÕ®“°
·ºπ¿Ÿ¡‘∑’Ë 2-1 ASR ‡æ»™“¬ ·¬°°≈ÿà¡ amenable, preventable ·≈– avoidable mortality ™à«ß æ.». 2547-2552
·ºπ¿Ÿ¡‘∑’Ë 2-2 ASR ‡æ»À≠‘ß ·¬°°≈ÿà¡ amenable, preventable ·≈– avoidable mortality ™à«ß æ.». 2547-2552
·∫§∑’‡√’¬·≈–‚ª√‚μ´—«·≈–‚√§À≈Õ¥‡≈◊Õ¥ ¡Õß ®“° æ.».
2547 ∂÷ß 2552 ¡’·π«‚πâ¡≈¥≈ß à«π‚√§Õ◊ËπÊ ¡’·π«‚π⡧ß∑’Ë
‡¡◊ËÕæ‘®“√≥“ 10 Õ—π¥—∫ Ÿß ÿ¥¢Õß∑—Èß 2 ‡æ»¥—ß·ºπ¿Ÿ¡‘∑’Ë 5 æ∫«à“ æ.». 2547 “‡Àμÿ°“√쓬 3 Õ—∫¥—∫·√° §◊Õ ‚√§μ‘¥
‡™◊ÈÕ®“°·∫§∑’‡√’¬·≈–‚ª√‚μ´—« √Õß≈ß¡“§◊Õ °“√¶à“엫쓬
·≈–∑”√â“¬μ—«‡Õß ·≈–‚√§À≈Õ¥‡≈◊Õ¥ ¡Õß ‚√§À≈Õ¥‡≈◊Õ¥
¡Õß¡’Õ—μ√“°“√쓬≈¥≈ßÕ¬à“ß¡“°„π™à«ßæ.». 2547-2549
‚¥¬ æ.». 2547 Õ¬ŸàÕ—π¥—∫ 3 ·μà æ.». 2552 μ°‰ªÕ¬ŸàÕ—π¥—∫ 4
¢≥–∑’Ë‚√§¡–‡√Áßμ—∫¢÷Èπ¡“Õ¬ŸàÕ—π¥—∫ 3
«‘®“√≥å
°“√쓬∑’ËÀ≈’°‡≈’ˬ߉¥â∂◊Õ‡ªìπμ—«™’È«—¥Àπ÷Ëß„π°“√ª√–‡¡‘π
§ÿ≥¿“æ∫√‘°“√À√◊Õπ‚¬∫“¬ ÿ¢¿“æ¢Õߪ√–™“°√ °“√»÷°…“
§√—Èßπ’ȉ¥â‡ª√’¬∫‡∑’¬∫§«“¡·μ°μà“ߢÕß avoidable mortality
√–À«à“ß‡æ» °≈ÿà¡Õ“¬ÿ ·≈– “‡Àμÿ°“√쓬μà“ßÊ √«¡∂÷ß»÷°…“
·π«‚πâ¡¢Õß°“√쓬μ—Èß·μà æ.». 2547-2552 „π™à«ßÕ“¬ÿ 0-74 ªï ‚¥¬æ∫«à“ avoidable mortality ¢Õߪ√–™“°√‰∑¬ æ.».
2552 ¡’ ASR μàÕª√–™“°√· π§π‡ªìπ 216.5 ¢≥–∑’˪√–‡∑»
Õ—ß°ƒ… avoidable mortality ¡’§à“ ASR μàÕª√–™“°√· π
·ºπ¿Ÿ¡‘∑’Ë 3 10 Õ—π¥—∫ Ÿß ÿ¥¢Õß‚√§„π°≈ÿà¡ avoidable mortality ¢Õ߇滙“¬ æ.». 2547-2552
·ºπ¿Ÿ¡‘∑’Ë 4 10 Õ—π¥—∫ Ÿß ÿ¥¢Õß‚√§„π°≈ÿà¡ avoidable mortality ¢Õ߇æ»À≠‘ß æ.». 2547-2552
§π‡ªìπ 189.0(7) ®–‡ÀÁπ‰¥â«à“ª√–‡∑»‰∑¬¡’§à“ ASR Ÿß°«à“
ª√–‡∑»Õ—ß°ƒ…∂÷ß 1.1 ‡∑à“ ·≈–‡¡◊ËÕæ‘®“√≥“‡©æ“–°≈ÿà¡ ame- nable mortality ª√–‡∑»‰∑¬¡’ ASR μàÕª√–™“°√· π§π
‡∑à“°—∫ 115.2 ¢≥–∑’˪√–‡∑»Õ—ß°ƒ…¡’ ASR μàÕª√–™“°√
· π§π‡ªìπ 94.3(7) π—Ëπ§◊Õ ª√–‡∑»‰∑¬¡’Õ—μ√“°“√쓬¥â«¬
amenable mortality Ÿß°«à“ª√–‡∑»Õ—ß°ƒ…∂÷ß 1.2 ‡∑à“ º≈
¢Õß avoidable mortality ∑’Ë·μ°μà“ß°—π‡™àππ’È –∑âÕπ∂÷ß
§«“¡·μ°μà“ߢÕߪ√–‡∑»∑’Ë°”≈—ßæ—≤π“Õ¬à“ߪ√–‡∑»‰∑¬
·≈–ª√–‡∑»∑’Ëæ—≤π“·≈â«Õ¬à“ߪ√–‡∑»Õ—ß°ƒ…
À“°æ‘®“√≥“ avoidable mortality ¢Õߪ√–‡∑»‰∑¬
·¬°‡æ» ‡æ»™“¬¡’ ASR μàÕ· πª√–™“°√‡ªìπ 288.1 ·≈–
‡æ»À≠‘ß¡’ ASR 149.7 ®–‡ÀÁπ‰¥â«à“‡æ»™“¬·≈–À≠‘ß§à“ ASR μà“ß°—π¡“° π—Ëπ§◊Õ ‡æ»™“¬¡’Õ—μ√“ avoidable mortality Ÿß
°«à“‡æ»À≠‘ß 1.92 ‡∑à“ ·π«‚πâ¡π’È„°≈⇧’¬ß°—∫√“¬ß“π®“°
ª√–‡∑»Õ◊Ë𠇙àπ ª√–‡∑»ÕÕ ‡μ√‡≈’¬ °“√»÷°…“¢Õß Page
·≈–§≥–√“¬ß“π ASR ¢Õß avoidable mortality √–À«à“ß
‡æ»™“¬μàÕ‡æ»À≠‘߇ªìπ 1.92(4) ¢≥–∑’Ë°“√»÷°…“¢Õߪ√–‡∑»
Õ—ß°ƒ… ASR „π‡æ»™“¬ Ÿß°«à“‡æ»À≠‘ß 1.72 ‡∑à“(7) À“°æ‘®“√≥“ ASR „π°≈ÿà¡ amenable mortality ¢Õß
‡æ»™“¬·≈–À≠‘ß æ∫«à“¡’§à“ 131.2 ·≈– 100.6 μàÕª√–™“°√
· π§π μ“¡≈”¥—∫ à«π preventable mortality ¡’§à“ ASR
¢Õ߇滙“¬‡∑à“°—∫ 147.1 ·≈–‡æ»À≠‘߇∑à“°—∫ 45.9 prevent-
able mortality ®÷߇ªìπ°≈ÿà¡°“√쓬∑’Ë¡’§«“¡·μ°μà“ß√–À«à“ß
‡æ»™“¬°—∫À≠‘ß¡“°∑’Ë ÿ¥ °≈à“«§◊Õ ‡æ»™“¬μ“¬¡“°°«à“À≠‘ß
∂÷ß 3.20 ‡∑à“ ©–π—ÈπÀ“°μâÕß°“√≈¥°“√쓬„π°≈ÿà¡ prevent- able mortality §«√ÕÕ°π‚¬∫“¬ ÿ¢¿“æ∑’˪ÑÕß°—πÕ—πμ√“¬
®“°§«“¡‡ ’ˬßμà“ßÊ ∑’Ë∑”„À⇰‘¥§«“¡ Ÿ≠‡ ’¬™’«‘μ ‚¥¬‡©æ“–
„π‡æ»™“¬´÷Ëß¡’Õ—μ√“°“√쓬∑’ËÀ≈’°‡≈’ˬ߉¥â„πª√–‡¿∑π’È Ÿß
°«à“‡æ»À≠‘ß
°“√쓬„π°≈ÿà¡ unavoidable mortality ¢Õß ª√–™“°√‰∑¬§‘¥‡ªìπ√âÕ¬≈– 19.2 ¢Õß°“√쓬∑—ÈßÀ¡¥„π™à«ß Õ“¬ÿ 0-74 ªï (ASR ‡∑à“°—∫ 72.6 μàÕª√–™“°√· π§π) ¢≥–
∑’˪√–‡∑»ÕÕ ‡μ√‡≈’¬¡’ —¥ à«π‡ªìπ√âÕ¬≈– 28.5 (ASR ‡∑à“°—∫
70.2 μàÕª√–™“°√· π§π)(4) ®–‡ÀÁπ‰¥â«à“ unavoidable mor- tality ¢Õߪ√–‡∑»‰∑¬¡’§à“πâÕ¬°«à“„π°≈ÿࡪ√–‡∑»∑’Ë æ—≤π“·≈â«Õ¬à“ßÕÕ ‡μ√‡≈’¬ “‡ÀμÿÀπ÷ËßÕ“®‡π◊ËÕß¡“®“°
¢âÕ¡Ÿ≈∑’ˉ¡à ¡∫Ÿ√≥å¢Õߪ√–‡∑»‰∑¬ ‡æ√“–º≈°“√»÷°…“æ∫«à“
°≈ÿà¡∑’ˉ¡à “¡“√∂√–∫ÿ “‡Àμÿ°“√쓬‰¥âÕ¬à“ß™—¥‡®π (ill-defined mortality) ¢Õߪ√–‡∑»‰∑¬¡’®”π«π Ÿß∂÷ß√âÕ¬≈– 24.7
¢Õß°“√쓬∑—ÈßÀ¡¥„π™à«ßÕ“¬ÿ 0-74 ªï (ASR ‡∑à“°—∫ 96.7 μàÕª√–™“°√· π§π) ®÷ßÕ“®‡ªì𠓇ÀμÿÀπ÷Ëß∑’Ë∑”„ÀâÕ—μ√“°“√
쓬®“° “‡Àμÿμà“ßÊ πâÕ¬°«à“§«“¡‡ªìπ®√‘ß
ªí≠À“¢Õß ill-defined mortality Õ“®‡°‘¥®“°°“√≈ß “‡Àμÿ°“√쓬‰¡à∂Ÿ°μâÕß À√◊Õ‰¡à “¡“√∂√–∫ÿ “‡Àμÿ°“√쓬
·ºπ¿Ÿ¡‘∑’Ë 5 10 Õ—π¥—∫ Ÿß ÿ¥¢Õß‚√§„π°≈ÿà¡ avoidable mortality ¢Õ߇滙“¬·≈–À≠‘ß æ.». 2547-2552
‰¥â·∑â®√‘ß ‡π◊ËÕß®“°ºŸâ«‘π‘®©—¬‰¡à„™à∫ÿ§≈“°√∑“ß°“√·æ∑¬å(10) À√◊Õ‡°‘¥®“°°“√μ°®¥®“°°“√·®âß쓬 ¥—ßπ—Èπ ill-defined mor- tality ®÷ß∂◊Õ‡ªìπ¢âÕ®”°—¥∑’Ë ”§—≠¡“°μ—«Àπ÷Ëß„π°“√π”
¢âÕ¡Ÿ≈¡“„™â √–∫∫¢âÕ¡Ÿ≈∑’ˉ¡à ¡∫Ÿ√≥å¢Õߪ√–‡∑»‰∑¬®÷߬—ß μâÕß°“√°“√·°â‰¢·≈–æ—≤π“μàÕ‰ª ªí®®ÿ∫—π‰¥â¡’°“√»÷°…“
“‡Àμÿ°“√쓬„π ∂“π欓∫“≈ ‚¥¬®—π∑√å‡æÁ≠ ™Ÿª√–¿“«√√≥
·≈–§≥–(10) ‡ª√’¬∫‡∑’¬∫√–À«à“ß “‡Àμÿ°“√쓬„π‚√ß欓∫“≈
®“°∞“π¢âÕ¡Ÿ≈∑’ˉ¥â®“°√–∫∫®¥∑–‡∫’¬π°“√쓬 (¡√≥∫—μ√)
°—∫Àπ—ß ◊Õ√—∫√Õß°“√쓬 (∑√.4/1) ‡æ◊ËÕæ—≤π“·≈–·°âªí≠À“
„π à«π¢Õß ill-defined mortality
Nolte ·≈– McKee(3) ‰¥â√“¬ß“π«à“ avoidable ·≈–
amenable mortality Õ“®¡’§ÿ≥ ¡∫—쑉¡à‡æ’¬ßæÕ∑’Ë®–„™â
‡ªìπ¥—™π’™’È«—¥°“√∫√‘°“√∑“ß ÿ¢¿“æÀ√◊Õ√–∫∫ ÿ¢¿“æ∑—ÈßÀ¡¥
‰¥âÕ¬à“ß·∑â®√‘ß °≈à“«Õ’°π—¬Àπ÷Ëߧ◊Õμ—«∫àß™’Èπ’ÈÕ“® –∑âÕπ„Àâ
‡ÀÁπ‡æ’¬ß·§à·π«∑“ß·°âªí≠À“«à“§«√ π„®ªí≠À“„¥‡ªìπ摇»…
·μà‰¡à “¡“√∂μ√«® Õ∫ “‡Àμÿ∑’Ë·∑â®√‘ߢÕߪí≠À“À√◊Õ√–∫ÿ«‘∏’
·°â‰¢ªí≠À“∑—ÈßÀ¡¥‰¥â πÕ°®“°π’È √“¬°“√ “‡Àμÿ°“√쓬∑’Ë ªÑÕß°—π‰¥âÕ“®‡ª≈’ˬπ·ª≈߇¡◊ËÕ‡«≈“‡ª≈’Ë¬π‰ª Õ—π‡π◊ËÕß¡“®“°
°“√√—°…“À√◊Õ‡∑§‚π‚≈¬’∑’Ë¥’¢÷Èπ Õ¬à“߉√°Á¥’ À“°¡Õߢⓡ¢âÕ
®”°—¥¥—ß°≈à“« «‘∏’°“√π’Ȭ—߇ªìπ∑“߇≈◊Õ°∑’Ë¥’ ‡æ√“–‡ªìπ«‘∏’∑’Ëßà“¬
·≈–§à“„™â®à“¬μË” ”À√—∫°“√ª√–‡¡‘π·≈–μ√«® Õ∫√–∫∫°“√
∫√‘°“√ ÿ¢¿“æ
À“°®”·π° avoidable mortality ¢Õߪ√–™“°√‰∑¬
μ“¡°≈ÿà¡Õ“¬ÿ ‡ª√’¬∫‡∑’¬∫°—∫ª√–‡∑»ÕÕ ‡μ√‡≈’¬·≈–
π‘«´’·≈π¥å ¥—ßμ“√“ß∑’Ë 4 æ∫«à“ª√–™“°√‰∑¬°≈ÿà¡Õ“¬ÿ 65-74 ªï ¡’Õ—μ√“°“√쓬 Ÿß ÿ¥‡¡◊ËÕ‡∑’¬∫°—∫°≈ÿà¡Õ“¬ÿÕ◊ËπÊ ‡™àπ‡¥’¬«
°—∫ª√–‡∑»ÕÕ ‡μ√‡≈’¬·≈–π‘«´’·≈π¥å(4) ·μà∂Ⓡ∑’¬∫Õ—μ√“°“√
쓬¢Õߪ√–‡∑»‰∑¬°—∫ÕÕ ‡μ√‡≈’¬·≈–π‘«´’·≈π¥å æ∫«à“§à“‡ªìπ 0.82 ·≈– 0.67 ‡∑à“ μ“¡≈”¥—∫ (Õ—μ√“°“√쓬¢Õߪ√–‡∑»‰∑¬
ÕÕ ‡μ√‡≈’¬ ·≈–π‘«´’·≈π¥å‡ªìπ 1,097 1,339 ·≈– 1,640 μàÕ ª√–™“°√· π§π μ“¡≈”¥—∫) ®÷ßπà“ —߇°μ«à“°≈ÿà¡Õ“¬ÿ 65-74 ªï
‡ªìπ°≈ÿà¡Õ“¬ÿ∑’ËÕ—μ√“°“√쓬¢Õߪ√–‡∑»‰∑¬μË”°«à“∑—Èß 2 ª√–‡∑» „π¢≥–∑’Ë°≈ÿà¡Õ“¬ÿÕ◊ËπÊ ¢Õߪ√–‡∑»‰∑¬¡’Õ—μ√“°“√
쓬 Ÿß°«à“∑ÿ°°≈ÿà¡Õ“¬ÿ ®÷߇ªìπ‰ª‰¥â«à“°≈ÿà¡ ill-defined mor- tality Õ“®¡’¢âÕ¡Ÿ≈ à«πÀπ÷Ë߇ªìπ«—¬ºŸâ ŸßÕ“¬ÿ àߺ≈„Àâ¢âÕ¡Ÿ≈
”À√—∫™à«ß«—¬π’È¢Õߪ√–‡∑»‰∑¬¡’§à“μË”°«à“§«“¡‡ªìπ®√‘ß
°≈ÿà¡Õ“¬ÿ∑’Ë¡’§«“¡·μ°μà“ߢÕßÕ—μ√“°“√쓬¡“°∑’Ë ÿ¥
®“°μ“√“ß∑’Ë 4 §◊Õ °≈ÿà¡Õ“¬ÿ 1-14 ªï ‚¥¬Õ—μ√“쓬„πª√–‡∑»
‰∑¬¡“°°«à“ª√–‡∑»ÕÕ ‡μ√‡≈’¬·≈–π‘«´’·≈π¥å∂÷ß 3.10 ·≈–
1.82 ‡∑à“ μ“¡≈”¥—∫ (Õ—μ√“°“√쓬„π°≈ÿà¡Õ“¬ÿ 1-14 ªï¢Õß ª√–‡∑»‰∑¬ ÕÕ ‡μ√‡≈’¬·≈–π‘«´’·≈π¥å‡ªìπ 31 10 ·≈– 17 μàÕª√–™“°√· π§π μ“¡≈”¥—∫)(4) °≈ÿà¡Õ“¬ÿÕ◊ËπÊ ¡’Õ—μ√“
°“√쓬∑’ˉ¡àμà“ß°—π¡“° §◊Õ ª√–‡∑»‰∑¬¡’Õ—μ√“°“√쓬¡“°
°«à“∑—Èß 2 ª√–‡∑» Àπ÷Ë߇∑à“μ—«„π∑ÿ°°≈ÿà¡Õ“¬ÿ Õ“®‡ªìπ‰ª‰¥â«à“
«‘ «— ≤ π “ ° “ √ ∑ “ ß ° “ √ · æ ∑ ¬å À √◊ Õ π ‚ ¬ ∫ “ ¬ ∑ “ ß ÿ ¢ ¿ “ æ ¢ Õ ß ª√–‡∑»‰∑¬ ¬—߉¡à‡æ’¬ßæÕ„π°“√√—°…“À√◊Õ≈¥ “‡Àμÿ¢Õß
μ“√“ß∑’Ë 4 ‡ª√’¬∫‡∑’¬∫Õ—μ√“°“√쓬¢Õߪ√–‡∑»‰∑¬ ÕÕ ‡μ√‡≈’¬·≈–π‘«´’·≈π¥å(4)
Number Rate per 100,000 persons
Age (years) Rate Th:Aust
Thailand Aust NZ Thailand Aust NZ
Infants (< 1) 3987 3791 1109 530 315 406 1.68
1 - 14 3805 1878 644 31 10 17 3.10
15 - 24 8182 7045 1712 85 52 66 1.63
25 - 44 32943 24356 4900 152 83 88 1.83
45 - 64 59908 64282 15511 418 310 402 1.35
65 - 74 33993 88493 20396 1097 1339 1640 0.82
Total 142818 189845 44272 232 177 219 1.31
avoidable mortality ‰¥âÕ¬à“ß¡’ª√– ‘∑∏‘¿“æ ‡¡◊ËÕ‡∑’¬∫°—∫
ª√–‡∑»ÕÕ ‡μ√‡≈’¬·≈–π‘«´’·≈π¥å
‡¡◊ËÕæ‘®“√≥“ “‡Àμÿ¢Õß avoidable mortality μ“¡
√“¬°“√‚√§ ‚√§μ‘¥‡™◊ÈÕ®“°·∫§∑’‡√’¬·≈–‚ª√‚μ´—«∂◊Õ‡ªì𠓇Àμÿ ”§—≠∑’Ë ÿ¥„π æ.». 2552 Õ’°∑—È߇ªì𠓇ÀμÿÕ—π¥—∫Àπ÷Ëß
¢Õß avoidable mortality Õ¬à“ßμàÕ‡π◊ËÕßμ—Èß·μàæ.». 2547 ®π∂÷ß æ.». 2552 ´÷Ëß·μ°μà“ß®“°√“¬ß“π°“√»÷°…“„πª√–‡∑»
ÕÕ ‡μ√‡≈’¬·≈–π‘«´’·≈π¥å∑’Ë¡’ “‡Àμÿ°“√쓬®“°‚√§À—«„®
¢“¥‡≈◊Õ¥‡ªì𠓇Àμÿ°“√μ“¬Õ—π¥—∫Àπ÷Ëß(4) ¢≥–∑’Ë‚√§À—«„®¢“¥
‡≈◊Õ¥¢Õߪ√–‡∑»‰∑¬ æ.». 2552 Õ¬Ÿà∑’ËÕ—π¥—∫ 7 à«πª√–‡∑»
ŒàÕß°ß·≈–≠’˪ÿÉπ avoidable mortality ¡’ “‡Àμÿ à«π„À≠à
®“°‚√§À≈Õ¥‡≈◊Õ¥ ¡Õß(11,12) ¢≥–∑’Ë„π æ.». 2552 ‚√§
À≈Õ¥‡≈◊Õ¥ ¡ÕߢÕߪ√–‡∑»‰∑¬‡ªì𠓇ÀμÿÕ—π¥—∫ 4 º≈°“√
»÷°…“¬—ßæ∫«à“°“√¶à“엫쓬·≈–∑”√â“¬μ—«‡ÕߢÕߪ√–‡∑»
‰∑¬‡ªì𠓇ÀμÿÕ—π¥—∫ ÕßÕ¬à“ßμàÕ‡π◊ËÕßμ—Èß·μàæ.». 2547 ∂÷ß 2552
·π«‚πâ¡¢Õß avoidable mortality μ—Èß·μàæ.». 2547 ∂÷ß 2552 ¡’Õ—μ√“≈¥≈ß∑—Èß„π‡æ»™“¬·≈–À≠‘ßÕ¬à“ß¡’π—¬ ”§—≠
(p-value<0.05) ‚¥¬≈¥≈ßμ—Èß·μà æ.». 2547 ®π°√–∑—Ëß∂÷ß æ.».
2552 §‘¥‡ªìπ√âÕ¬≈– 14.6 (æ.». 2547 ·≈– 2552 §à“ ASR
‡ªìπ 253.6 ·≈– 216.5 μàÕª√–™“°√· π§πμ“¡≈”¥—∫) À√◊Õ
‡ªìπÕ—μ√“≈¥‡©≈’ˬ√“¬ªï (annual average % change) √âÕ¬
≈– 3.12 °≈ÿà¡ amenable ·≈– preventable mortality ∑—Èß
‡æ»™“¬·≈–À≠‘ß¡’Õ—μ√“≈¥≈߇™àπ°—π ‚¥¬ amenable mor- tality ¡’Õ—μ√“≈¥≈ß„π™à«ß‡«≈“¥—ß°≈à“«√âÕ¬≈– 16.4 (æ.». 2547
·≈– 2552 §à“ ASR ‡ªìπ 137.8 ·≈– 115.2 μàÕª√–™“°√
· π§πμ“¡≈”¥—∫) Õ—μ√“≈¥‡©≈’ˬ√“¬ªï√âÕ¬≈– 3.51 ¢≥–∑’Ë preventable mortality ≈¥≈ß√âÕ¬≈– 13.0 (æ.». 2547 ·≈–
2552 §à“ ASR ‡ªìπ 109.1 ·≈– 94.9 μàÕª√–™“°√· π§π μ“¡≈”¥—∫) Õ—μ√“≈¥‡©≈’ˬ√“¬ªï√âÕ¬≈–2.75 „π¢≥–∑’˪√–‡∑»
∑’Ëæ—≤π“·≈â« ‡™àπ ª√–‡∑»Õ—ß°ƒ… avoidable mortality ≈¥
≈ß√âÕ¬≈– 14.2(7) (ASR „π æ.». 2547 ·≈– 2552 ‡ªìπ 219.2
·≈– 189.0 μàÕª√–™“°√· π§π μ“¡≈”¥—∫) ‡ÀÁπ‰¥â«à“Õ—μ√“
°“√≈¥≈ߢÕß avoidable mortality ¢Õߪ√–‡∑»‰∑¬¡’§à“
„°≈⇧’¬ß°—∫ª√–‡∑»Õ—ß°ƒ… · ¥ß«à“√–∫∫°“√√—°…“ ÿ¢¿“æ
·≈–«‘«—≤π“°“√∑“ß°“√·æ∑¬å„πª√–‡∑»‰∑¬¥’¢÷Èπ ·μà§à“ ASR μàÕª√–™“°√· π§π¢Õß avoidable mortality „πª√–‡∑»
‰∑¬¬—ß Ÿß°«à“ª√–‡∑»Õ—ß°ƒ…„π∑ÿ°Ê ªï À“°„πÕπ“§μª√–‡∑»
‰∑¬æ—≤π“√–∫∫°“√√—°…“ ÿ¢¿“æ·≈–°“√·æ∑¬å„Àâ¡’ª√– ‘∑∏‘-
¿“楒¬‘Ëߢ÷Èπ °ÁÕ“®≈¥ avoidable mortality ‰¥â¡“°¢÷Èπ
¢âÕ¬ÿμ‘
°“√»÷°…“§√—Èßπ’È √ÿª‰¥â«à“ avoidable mortality ¢Õß ª√–‡∑»‰∑¬ æ.». 2552 ¡’ —¥ à«π Ÿß∂÷ß√âÕ¬≈– 56.3 ¢Õß°“√
쓬∑—ÈßÀ¡¥„π™à«ßÕ“¬ÿ 0-74 ªï (ASR ‡∑à“°—∫ 216.5 μàÕ ª√–™“°√· π§π) ª√–°Õ∫¥â«¬ amenable mortality
√âÕ¬≈– 29.5 (ASR ‡ªìπ 115.1 μàÕª√–™“°√· π§π) ·≈– pre- ventable mortality ‡∑à“°—∫ 25.0 (ASR ‡ªìπ 94.9 μàÕ ª√–™“°√· π§π) ‡æ»™“¬¡’ —¥ à«π°“√쓬¡“°°«à“‡æ»
À≠‘ß∂÷ß Õ߇∑à“ ·≈– Ÿß ÿ¥„π°≈ÿà¡ preventable mortality “‡Àμÿ ”§—≠‡°‘¥®“°‚√§μ‘¥‡™◊ÈÕ™π‘¥·∫§∑’‡√’¬·≈–‚ª√‚μ´—«
°≈ÿà¡Õ“¬ÿ 1-14 ªï ‡ªìπ°≈ÿà¡Õ“¬ÿ∑’˧«√„À⧫“¡ ”§—≠®“° avoid- able mortality ¡“°∑’Ë ÿ¥ ‡π◊ËÕß®“°¡’Õ—μ√“°“√쓬 Ÿß·≈–
·μ°μà“ß®“°ª√–‡∑»Õ◊ËπÊ Õ¬à“ß™—¥‡®π
Õ¬à“߉√°Áμ“¡ °“√»÷°…“§√—Èßπ’È„™â¢âÕ¡Ÿ≈®“°√–∫∫°“√®¥
∑–‡∫’¬π°“√쓬¢Õߪ√–‡∑»‰∑¬ ´÷Ëß¡’°“√쓬®”π«π¡“°∑’Ë
‰¡à “¡“√∂√–∫ÿ “‡Àμÿ‰¥â™—¥‡®π º≈°“√»÷°…“®÷߇ªìπ°“√
ª√–¡“≥§à“∑’ËπâÕ¬°«à“§«“¡‡ªìπ®√‘ß À“°„πÕπ“§μ¡’°“√
æ—≤π“√–∫∫¢âÕ¡Ÿ≈∑’Ë¥’¢÷Èπ º≈°“√»÷°…“πà“®–¡’§«“¡πà“‡™◊ËÕ∂◊Õ
¡“°¢÷Èπ ·≈– –∑âÕπª√– ‘∑∏‘¿“æ¢Õßπ‚¬∫“¬∑“ß ÿ¢¿“æ¢Õß ª√–‡∑»‰∑¬‰¥â∂Ÿ°μâÕß
°‘μμ‘°√√¡ª√–°“»
¢Õ¢Õ∫§ÿ≥ §ÿ≥Õ√æ‘π ∑√—æ¬å≈âπ ”π—°π‚¬∫“¬·≈–
¬ÿ∑∏»“ μ√å ∑’Ë„À⧫“¡Õπÿ‡§√“–Àå¢âÕ¡Ÿ≈°“√쓬∑’Ë„™â„πß“π»÷°…“
·≈–¢Õ¢Õ∫§ÿ≥ ”π—°ß“π°Õß∑ÿπ π—∫ πÿπ √â“߇ √‘¡ ÿ¢¿“æ ( .) ·≈– ”π—°ß“πÀ≈—°ª√–°—π ÿ¢¿“æ·Ààß™“μ‘ ( ª ™.) ∑’Ë
„Àâ∑ÿπ π—∫ πÿπ°“√¥”‡π‘πß“π
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