iTtNeauMisKemEHCitui
Ganh nang benh tat do tvl vong sdm tai CHILILAB Chi Linh Hai Dtfcfng
Nguyin Thi Trang Nhung (*), Bui Thi Tu QuySn (*), Le Thi VuiC), Pham Viet Cifofng (*), L€ Tri Hoang (*)
Gdnh ndng bfnh tdt do td vong sdm duac sd dung di giiip cdc nhd hogch dinh chinh sdch cd thim nhang bdng chiing cho viic phdn bd nguon luc y ti'. Muc tiiu: Vdc lut?ng gdnh ndng benh tdt do ri?
vong sdm tai thuc dia Chi Unh Hdi Duang tai cdc chii't khdu vd trong sdtudi khdc nhau. Ddi tu<?ng vd phuongphdp nghiin cdu: chi sd ndm sdng hi mdt {Years of Life Loss-YLL) dU(rc dUng di ddnh gid gdnh nang binh tdt do n? vong sdm. Chi sdnay duac Udc luang dita vdo sdluang tH vong va kp vong sdng chudn cua tieng nhom tudi va nguyin nhdn. Nguyin nhdn tii vong duac xdc dfnh bdng phuang phdp phong vdn (VA) tgi casdthuc dia Chi Linh ndm 2008. Kit qua: ndm 2008, tdng sdgdnh ngng binh tdt do tvc vong sdm d Chi Linh udc luang vdo khodng 1763 ni'u khdng dp dung miic chii't khdu va trgng sdtudi; 4451 ni'u khong chiit khdu vd co trgng sdtudi; 5778 niu co chiit khdu vd khong cd trgng sd tudi va 4} 39 niu chiit khdu va co trgng sd tudi. Khong co sU thay doi ddng ki thik tusdp xip cdc benh cu the trong danh Sdch 10 nguyin nhdn hdng ddu gdy ra gdnh ngng bfnh tdt khi dp dung cdc phuang phdp tinh gdnh ngng benh tgt khdc nhau. Nhin chung thi gdnh n^ng binh tgt do tU vong d chu yi'u la cdc binh khdng lay nhiim nhu ung thU, tim mgch vd chd'n thuang khong chd dinh. Kit ludn: Khong cd sukhdc biit nhiiu vi thii tu sdp xe'p cdc benh trong bdng nhiing binh ddng gdp chinh cho gdnh ngng binh tgt Viet Nam khi sH dung cdc phuang phdp tinh todn khdc nhau.
THkhda: gdnh ngng benh tgt do tii vong sdm (YLL), xdc dinh nguyen nhdn tdvong bdng phUOng phdp phdng vdn (VA), trgng sdtudi, chiit khdu, CHILILAB.
Disease burden due to premature death in CHILILAB Chi Linh, Hai Duong
Nguyen Thi Trang Nhung (*), Bui Thi Tu Quyen (*), Le Thi Vui (*), Pham Viet Cuong (»), Le Tu Hoang (*)
Burden of disease due to premature death is often used as an indicator for distribution process of health resource. Objective: To estimate burden of disease due to premature death based on CHILILAB database with or withoul discount rate and age weights. Method: YLL (Years of Life Loss) is used to assess the burden of disease due to premature death. This indicator was calculated based on number of deaths and standard of life expectancy by causes and age groups. Causes of death were identified by using verbal autopsy (VA) in CHILILAB demographic site. Results: in 2008, total burden of disease due to premature death was about 1763 years without discount rate and age weights; 4451
Tap chi Y te Cfing cong, 4.2012, Sfi' 24 (24)
ITfiNBQUAN&HGHrEltCliUI
years without discount rate but with age weights: 5778 with discount rate and without age weights and 4139 with discount rate and age weights. There is no significant difference on the rank list ofthe important causes which contributed lo the total burden of disease due to premature death. In general, non-communicable diseases such as cancer, cardiovascular disease and unintentional injuries are the leading causes for the burden of disease due premature death. Conclusion: there is no significant difference among the rank in the list of important causes for total burden of diseases due to premature death with or without discount rate atid age weights when using different measurements.
T i c gii:
(•) - Ths. Nguyin Thi Trang Nhung - Giang vien mon moa Dich t l - Thfi'ng ke trffdng D?i hoc Y tfi* CSng c^t Email: [email protected]
- Ths. B6i Thi Td Qnyfin -Ph6 trffSng bfi mfin Dich le - Thong kfi tnJflng Dai hpc Y tfi" Cong cgng.
Email: btq@hsph,edu.vn
- Ths. Lg thi Vui - B6 mfin Din so, TnlSng d?i hoc Y tfi* Cfing cgog. Email ltv@ hsph.edu,vn - Ths. Ph^m Vigt Cffdng • Phfi tnrdng bo mfin Tin hoc - TrffSng dgi hijc Y tfi' Cong c$ng.
Email: pvc2@hsph,edu.vn.
- CN Lfi Tff Hoing - Tri? giing bfi mfin Dich le- Thong kfi trffftng Dai hpc Y tS" Cong cfing.
Email. [email protected]
1. D a t v S n d e
D o liJSng g i n h n a n g b$nh t?t do tuf vong sdm b a n g so n a m sfi'tig t i e m tSng bi ma't (Year of Potential Life Loss - YPLL) la mpt c i c h tUdng d^i d6 d i l n giai va tinh t o i n . Tuy nhi^n phiJdng pbap nay h a n c h ^ b S i a n h hirdng ciia tudi vdi cac va'n d e siJc k h o e du'dc so sanh. Do'i vdi xa hgi, c i c tracing hdp tu" vong d n h d m ngiJdi t r e , d a c biet la tre em thi CO tinh chS't n g h i e m trpng hdn c i c trifdng hdp tu"
vong d n h d m tudi ldn hdn[10]. Chi s ^ g i n h nang bSnh tSt do tu" vong sdm (Years of Life Lost- YLL) da giai quyfi't du'dc va'n de n a y b^ng c^ch x e m xel tuT vong difa vao ky vpng sd'ng. Chi so Y L L vdi chi so' do l^dng g i n h n a n g b e n h t$t khong gay ra tu"
vong ( Y e a r s Lived with Disability- YLD) cau thanh n e n chi s6'- So n i m song t i n t^t hieu chinh (DALYs -Disability Adjusted Life Y e a r s ) . C a c chi so va phtfdng p h i p nay do Muray va Aland L o p e z dtfa ra lan d a u tien v a o n a m 1993 trong dtf i n do Itfdng g i n h n a n g b e n h l§t t o i n c l u do To chifc Y te'thfe'
gidi va Trtfdng dai hpc Havard thtfc hien [11].
D i n h g i i g a n h nang b$nh l^t do tu" vong sdm da dtfdc tinh t o i n tai Viet N a m mOt each ri^ng le tren quy md nhd va suT dung c i c sd' li#u k h i c nhau va phtfdng p h i p khac nhau. Trong khi mot sS" nghifin cihi nhtfng n a m 90s da su* dung phtfdng p h a p tinh Y P L L di d i n h g i i [ l , 3 . 4 ] thi mgt sd" nghifin ctfu nhtfng nam g a n day da siJ dung Y L L d e d i n h g i i [ 2 , 8 , 9 ] . Nhffng ket qua ban dau cua c i c nghien ctfu nay da cho tha'y mgt phan btfc tranh g i n h n a n g b e n h tat do tiJ" vong cua Viet Nam.
D A L Y do Itfdng s S ' n i m sd'ng k h d e m a n h m a t di trong ttfdng lai cua mdi trtfdng hdp tii' vong hay m o i trtfdng hdp mdi m^c bfinh/chan thtfdng. Nhtf vSy, D A L Y dtfdc coi la phtfdng p h ^ p do ltfdng dtfa trfin sd'lifiu mdl m a c hdn la sd'lieu hien mac, M g t trong nhihig tranh cai trong svt dung Y L L de d a n h gia g i n h n a n g bfinh tat la cd hay khdng sit dung chiet khau va trpng so tudi khi tinh loan. Va cac y kien nay l i t r i i chieu nhau ve ung ho ho^c b a c bd vi$c
Tap chi Y ti C o n g cgng, 4.2012, So' 24 (24) 5
ITdNBQUAN&NGHIEHNiUI
dtfa chiet khafu vao trong so'tuoi khi tinh ginh nang bfinh tat[8]. Trpng so'tudi la vific xem nhtfng ddng gdp cua tre em va ngtfdi gia khac nhdm tuoi cdn lai.
Chinh dieu nay cung lam tranh cai vi mat dao dtfc khi su'dung. Va mdi ]$p luan thi cd tinh hdp ly rieng nfin trong cic bio cio danh gia ganh nang toan can cic nha nghifin ctfu trtfdng trinh bay kfi't qua cua cac kha nang: i p dung va khdng ap dung chie't khau va trpng sd'tudi[l].
Trong cic nghien ctfu danh gia ganh nang trtfdc day d Viet Nam cac nha nghien ctfu chi trinh bay ket qua tinh toin cho mtfc chiet khau 3% va khong ip dung trpng s6'tudi[4,9]. Muc tieu chinh cua bai bio niy li tinh loan ganh nang bfinh tit do ttf vong sdm (YLL) sd" dung cac phtfdng phap cd hoac khong tinh chi^t khau va cd va khdng cd trgng sdtudi cho sd lifiu dieu tra nguyen nhan ttf vong nam 2008 tai thirc dia CHILILAB Chi Linh, Hai Dtfdng (CHILILAB la thanh vifin cua Mang Itfdi cic cd sd thtfc dia qudc tfi'INDEPTH). De ttf dd, chdng toi se dinh gii stf khic bifit cua cic kfi't qua ganh nang bfinh tSt khi stf dung cic phtfdng phap tinh khac nhau dtfa tren sd'lifiu Vifit Nam.
Khii nifim tit vong sdm trong dtfdc hifi'u la ttf vong trtfdc tudi thg "ly ttfdng" chu^n mi con ngtfdi cd thd sdng. Tudi thg ly ttfdng chu^n dtfdc GBD tinh toin chung cho the'gidi dtfa vao bang sd'ng.
2. PhiToTng phap nghiin ci^u
Sd' nam sd'ng bi mi't do td" vong sdm dtfdc tinh dtfa vao htfdng dan cua Danh gia Ganh nang bfinh tat loan cau (GBD)[11]. Trong dd, YLL dtfdc linh cho ttfng gidi vi ttfng nhdm tudi. YLL cua mdt nhdm tuoi dtfdc tinh bang sd trtfdng hdp Itf vong cua nhdm tudi (N) nhan vdi ky vpng
Cdng thtfc tinh YLL cd ban nhtf sau:
YLL = N xL 2.1. Chiii khdu
Chie't kha'u nhtfng ldi ich stfc khoe trong ttfdng lai thtfdng dtfdc diJng trong phan tich ldnh te. Trong phan tich stfc khde chie't khau the hien cpng ddng thich cd stfc khde Id't hien nay hdn la trong ttfdng Iai.
Trong ket qua cua nghifin ctfu nay chdng tdi se trinh bay ca ket qua cd chiet kha'u va khdng cd chie't kha'u
2.2. TrQng sdtuoi
Cdng thtfc tinh YLL dtfdc gan trpng sd' cho
nhdm tre em va ngtfdi gii cd trgng sd thap hdn nhSag nhdm tudi khic. Ket qua chtfng tdi trinh bay phfa sau cho hai trtfdng hdp cd trpng sd tudi bang 1 va khdng cd trpng sdtudi.
2.3. TS vong theo nguyin nhdn.
Ta't ca cac tnrdng hdp ttf vong theo nguyen nhan va gidi tinh cua nam 2008 dtfdc thtfc dia CHILILAB cdng bd' dtfdc dtfa vao linh toin troug nghien ctfu nay. Sd'cictrtfdnghdpttf vong dtfdc thu thap ttf nen sd lieu dan sd', sd khai td* vi mlu thu th^p thdng tin ttf sd khim benh cua Tram Y te. Sau dd, cic trtfdng hdp td" vong nay da dtfdc didu tra xac dinh nguyfin nhin ttf vong bang phtfdng phip phdng v^n {Verbal Autopsy- VA) ngtfdi dai difin. Nguyen nhan ttf vong sau Idii dtfdc ch^n doin bang bic sy dtfdc chia theo nhdm bfinh (phan loai ICD-10), theo gidi tinh ddi vdi tii'ng nhdm tudi. Cd 302 trtfdng hdp tu' vong trong nam 2008 dtfdc nghi nhan va dtfdc dtfa vao sd' dung de tinh loan YLL. Chi tifi't phtfdng phip xic dinh nguyen nhan bang phtfdng phap phdng van dtfdc xui't ban trong bii bio cua Quyfin vi cdng stf [6],
3. K^'t qua nghidn ci^u
Ganh nang bfinh tit do tiJ vong sdm tai CHILILAB dtfdc tinh theo 4 lu'a chpn: khfing cd chie't khS'u vi trpng sd tudi YLL(0,0); khdng cd chie't kha'u va cd trpng sd'tudi YLL (0,1); cd chiet khau 3% vi khong cd trpng sd tudi YLL (3,0) vi c6 ca chie't kha'u va trpng sd tudi YLL (3,1). Nam 2008, ganh nang bfinh tat do ttf vong sdm tai CHILILAB lin Itfdc cd cic mtfc la 6798; 2983; 4139 vi 3536 ttfdng tfng vdi cic ltfa chpn d trfin. Nhin chung thi cac benh khdng truydn nhiem (nhdm 2) ddng gdp phin ldn vao ginh nang bfinh t$t do ttf vong sdm tai Chi Linh, sau dd li chan thtfdng (nhdm 3) va cudi cung la nhdm cac bfinh truyen nhiem, cic v^n de ve bi me va bfinh ]y thdi ky chu sinh (nhdm 2) (xem bang 1). Vi thtf ttf cic xe'p hang nay khfing thay ddi khi ap dung cac phtfdng phip tinh toin khic nhau.
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chu dinh, tim mach va ung thtf cho cic mtfc YLL (0,0); YLL{0,1), YLL(3,1) thi trong YLL (3,0) thi thtf ttf cd stf thay ddi la benh tim mach, ung thrf va ch^n thrfdng khdng chu dinh. Vi tri cila cac bfinh khic nhrf benh 1^ thdi ky chu sinh, HIV/AIDS vi bfinh dtfdng tifiu hda trong bang xep hang nay cung cd stf thay ddi. Die bi?t mdt sd bfinh nhtf cic bfinh lay truyen qua dtfdng tinh due (STD) ngoai trff HIV, tieu drfdng cd the xui't hifin trong trrfdng hdp nay hay khdng xu^t hien trong trtfdng hdp khac. Trong nhdm nam, YLL (0,0) va YLL (0,1) cd stf thay vd stf hoin ddi cic vi tri xfi'p hang 1,2 vi 3. Vi du bfinh tim mach dtfng dau ve YLL (0,0) nhtfng lai xep vi tri thtf hai tai YLL(0,1); benh ung thtf dtfng thtf 3 trong YLL(0,I) nhtfng lai drfng thtf 2 trong YLL(0,0). Tuy nhifin stf thay ddi niy khdng xay ra d YLL(3,0) vi YLL (3,1). Van de niy cung ttfdng ttf nhtf trong nhdm nff, chan thtfdng khdng chu dinh dtfng dau trong YLL(0,0) nhtfng lai dtf^g thtf 3 trong YLL(0,1). Vi tri hai b#nh benh tira mach vi ung thtf hoin ddi nhau trong YLL(3,0) vi YLL(3,1) (xem bang 2).
Bang 3 trinh biy 10 nguyfin nhan hang dau gay ra ginh ning benh tat tai CHILILAB, Hai Dtfdng. Chung cho ca hai gidi, d nhdm nam va ca d nhdm nff thi dpt quy va tai nan giao thdng la hai nguyen nhan hang dau cho ginh nang b$nh tit vdi tat ca cic phrfdng phip tinh khic nhau. Nhe can sd sinh drfdc xem la nguyfin nhin quan trpng hdn HIV va suy thin khi khdng ap dung chiet kha'u khi dtfng d vi tri thtf 3 (xem bang 3) nhrfbg khi ap dung chie't khau thi ngtfdc lai.
4. B^n luan
Vi$c do Itfdng ginh nang tu" vong ludn dtfdc quan tim do ti le til' vong li nhtfng chi sd' cd ban va quan trpng de dinh gia stfc khde cdng ddng. Dd'i vdi y te' cdng cdng, phdng trinh ttf vong sdm la mpt muc tieu quan trpng, vl chi sd cd the do Itfdng dtfdc hiu qua dd'i vdi nen kinh te - xa hdi gay ra do ttf vong sdm.
Nghifin ctfu nay cOng chi ra cac nhdm benh khdng truydn nhilm nhtf tim mach.
Tap chi Y te Cdng cdng, 4.2012, Sd 24 (24)
ITftNGOUAN&KGHI'ENDliUI
Bdng 3. Danh sdch 10 bfnh hdng ddu cho gdnh ngng do ft? vong tgi CHILILAB Chi Linh tgi cdc mtic chiit khdu vd trgng sdtuoi khdc nhau
Ket qua nay trfdng ddng vdi cac ket qua bio cao md hinh ganh nang b$nh tat trtfdc tren nghien ctfu qud'c gia[5]. Mpt difi'm ltfu J li trong nghien ctfli niy til" vong so nhe can sd sinh vi b?nb 1^ thdi kJ chu sinh vin cdn xu^t hifin trong danh sich nhffng benh hang dSu gay ra ginh ning bfinh t§t.
Vific siJ dung ginh ning bfinh tat do tiJ vong sdm nhtf la mdt chi sd' tham khao cho viec hoach dinh chinh sich vln da vi dang dtfdc dilng. Dac biet vdi Vift Nam thi chi sd nay drfdc tinh trong mdt thdi gian ngan gin k day, Tuy nhien viec phien giai cic kfi't qui vl do Itfdng ginh nang bfnh bfnh tit do ti^ vong ludn cln dtfdc can nhac khi i p dung vao phSn bd ngan sich y te. Mdi mpt phtfdng phip tinh toin cd nhffng han cheva ttu diem khac nhau.
4.1. Ap dtfng trong sd'tudi
Cic nghien ctfu ginh ning benh tat hifn nay chtfa thdng nha't trong viec gin sd nim sdng cila tre con vi ngrfdi gia thi'p hdn so vdi cac nhdm tpdi khac [8], [7]. Dd la bdi vl
4.1.1. Xet vi mat dao ddc xd hgi thi mSi tudi cd quyen sdng vd khd ndng sdng nhunhait
4.1.2. Cdc ki't qud vi dp dung trgng so tudi chua duac kiim chiing trin qudn thi ldn, nhdt Id trong sUphdt triin cua cdc thdnh tuu y hgc vd xd hdi phdt trien
4.1.3. Trgng sdtudi khdng phdn dnh gid tri cua xd hdi.
Trong ket qua nghifin crfu cung cho thay khi so sinh bang xep hang cic nhdm benh c6 ddng gdp chinh cho ginh ning bfnh tat 6 Chi Linh (bang 2) khi ap dung trgng sd tudi vi khdng cd trpng sd'tudi thi danh sach cic bfnh quan trpng khdng ma'y thay ddi. Nhin chung thi bang xfi'p hang YLL(0,0) va YLL(0,1) chung cho ca hai gidi vi nhdm khdng cd srf khic bift nhidu: dtfng dau li chi'n thrfdng khong chu dinh, cac bfnh tim mach vi ung thtf; chi cd thrf trf mpt sd' bfnh c6 srf hoin chuyen lan nhau. Vi du trong nhdm nam thi trong YLL(0,0) cua bfnh tim mach dtfng trtfdc trong khi trong YLL{0,I) nhdm chi'n . thtfdng khdng chu dinh dtfng trrfdc. So sinh ung thtf va Chan thrfdng la nhtfng nguyen nhan hang Y L L ( 3 0) va YLL (3 1) thi srf hoin chuydn nay tap dau gayra ganh nang bfnh tat. Cac bfnh cu thd nhrf trung d'nhdm diu. Viy cd thd chi'cd srf thay ddi mdt um mach. tai nan giao thong vi cic Ioai ung thrf. chiit vd vi tri cic bfnh hay xiy ra nhdm tudi tre nhtf
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(3%1 Ung Ihit vom h9ng 0%) Bao lire 13%)
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Tap chi Y le C6ng cong, 4.2012, So 24 (24)
ITfiNeqUAN&NGHIENCUUI
sinh nhe can. Cdn vdi xu htfdng tre hda va kha nang xay ra benh d hau nhtf cic nhdm tudi khac nhau ctia cic benh khdng truydn nhiem nhtf ung thtf, tim mach nhtf hifn nay thi vifc gin trpng sd khdng lam thay ddi nhieu cd cau ginh nang bfnh tat.
4.2. VifC dp dtfng chiet khdu
DALY ip diing chidt khiu 3% ddi vdi sd nam sdng ttfdng lai de tfdc tinh cho gii tri hifn tai cua nam sdng dd. Dieu niy cd nghTa l i neu i p dung chif't khau 3% thi mgt nim sdng khde manh cua 10 nam sau cd gii tn tha'p hdn 24% mft nam sdng khde manh bay gid. NhCfng ngtfdi ung ho viec ap dung chidt khiu cho DALYs lip luin rang[12]:
4.2.1. Ap dung chii't khdu nhdm bdo ddm sunhdt qudn trong phdn tich chi phi hieu qud (sut dgng cdc phuang phdp trong phdn tich kinh ti').
4.2.2. Chii't khdu bdt sd ndm si ddm bdo rdng trgng sd gdnh ngng binh tgt khong bi gdn qud ldn khi tli vong vdo liia tudi Ire dgc biit la tri em.
Tuy nhifn mgt sdnha nghifn ci?u lip lu§n rang stfc khde, cu the li nam sdng, khdng phai li tidn nfn chidt khi^u li khdng hdp 1^. Va chtfng ta khdng dam bao cho tinh chac chan trong trfdng lai de chon mdt mtfc chidt khiu phu hdp. Do v$y, viec ap dung chif't kh^u bao nhieu ciing cd nhtfng tranh luin khic nhau [10].
Vifc i p dung chif't khau hoac khdng chidt khi'u rat anh htfdng den ket qua tinh toin [11]. Ket qua nghien ctfu cung chi ra rang cic trtfdng hdp tu" vong d tre em nhtf sinh nhe can hoic cac benh nhtf tai nan giao thdng hay HIV/AIDS thtfdng chiem nguyen nhan chinh trong cic trtfdng hdp khdng i p dung chidt khi'u so vdi trtfdng hdp ap diing chiet kha'u.
Tuy nhien ket qua trong nghien ctfu niy the hifn ngoii stf thay ddi ve tJ 16 ddng gdp khi ap dung chiet khau hay khdng chiet kh^u thi stf hoin ddi vi tri trong danh sach chung ca hai gidi, nam va nff deu khdng nhieu. Dieu nay cd the giai thich la do so' Itfdng ttf vong it va cac nguyfn nhan ttf vong tap
trung vao phan bd' deu cho cic nhdm tuoi ttf 30 trd di nen vifc i p dung chidt kha'u hay khdng chiet khau khdng nhin thi'y dtfdc trong nghifn cttu nay.
Tuy nhien, trong cic nghifn ctf^ chi phi hifu qua va stfc khde ngtfdi ta khuydn cio nen su" dung chiet khau 3% [13], [14]. Mrfc nay drfdc xem li phii hdp dd dam bao cin bang cho xa hdi. Nhuiig neu chi so sinh md hinh stfc khde thi ket qua khdng sii" dung chif't kha'u can dtfdc can nh^c bdn.
Han che cua nghien ctfu nay li sd trtfdng hdp tu"
vong it lam cho stf thdm hoac bdt moi trtfdng bijp tu"
vong d mgt nhdm tuoi cd the lim cho kdt qua so sanh khdng dn dinh. Hay ndi mgt each khic Iam cho ket qua nghifn ctfu khdng tim ra srf thay ddi dang ke cua cic kdt qua.
5. Kdt IUSD va khuyg'n nghi
Cic nha nghien ctfu khi sii'dung cac kdt qua tinh toan ganh nang benh tit, cu the la chi sd ganh nang nang bfnh tat do ttf vong sdm - YLL, can cin nh^c Irfa chon chl so' cd chidt khi'u hay khdng cd chie't khau phii hdp vdi muc tieu stf dung.
Cac ke't qua tinh toin ganh nang benh tit it thay ddi khi i p dung hoac khdng ap dyng trgng sd tudi nhutig srf thay ddi ve lrfdng nay se cd khi i p dung chidt khau vi khdng chiet khau. Vay chung tdi khuyen nghi can thrfc hifn so sinh va phan tich cac ket qua tfdc Itfdng ginh nang bfnh tat do t& vong sdm dtfa vao cac phtfdng phip khic nhau trong cic nghifn crfu tren quin the ldn (cho toin qudc) can tidn hinh dd danh gia va phin tich cac md hinh benh tat khic nhau.
Liii cam (fn
Chung tdi xin chin thinh cam dn Chinh quydn vi nhan dan thi xa Chi Linh, Van phdng thtfc dja CHILILAB ciing ddi ngu dieu tra vien, giim sit vien, nhap lieu vifn da tham gia, thu th^p, cung ca'p sd'hf u va hd trd chdng tdi thtfc hifn nghifn ctfu niy.
Tap chi Y te C6ng cdng, 4.2012, Sd 24 (24) 9
ITtfNeQUAN&KGHIENCUUI
Tai lifu Iham kbao
Tirng V i f t
1. Lg v a ADh (2000). Banh gfi ginh odng benb t$t thdng qua chi so S^nam sdng dem rang bi m£'t PYLL.TnIdng Quin 1^ Cin bp Y lg'. Ha Npi.
2. m o Quang Huy (2000). E)o iiTdng ginh nSng binh t^t sit dungphUcmg phip DALY- NghiSn ciiu tbi^ nghifm tai huygn Ba Vi- Vift Nam, Umea.
3. Tmdng Dinh Ki?t and D§ Van DOng (1999),Nghi6n cilu dinh gii ginh ngng bfnh t^t d mpt s6 khu vtfc Vfing T3y Nguyen, Nam Trung Bg, Dong Nam B$, Dfing Bang sdng Cdu Long va Thanh pho Ho Chi Minh. TnTtJng Dai hoc Y Dtfdc Thanh Phtf Ho Chl Minh, Thanh PhSHfi Chi Mmh.
4. Le Ctf Linh (1999). Nghien cffu dinh gi£i ginh nang bfnh t?! thong qua cic sdlifu nl vong tai Chi linh, Hai DtfOng.
Trtfflng Quan IJ Cin bf Y t^. Ha Nfi.
5. Nguyin Thi Trang Nhung, et al.(2011). Ginh nang bfnh t^t va chi'n thtfdng Vift Nam 2008, Trtfflng Dai hgc Y rf CSng cpng Dai hpc Queenlands, Australia , Hi Ngi.
6. Bili Thi Tli Quyfn, et al.( 2012). Nguyfn nhSn tft vong d CHILILAB giai doan 2008- 2010 quan phtfdng ph^p phong vS'n ngtfdi dai difn. Tap chl Y t^Cong cfng.
TiSng Anh
/. Anand S (1997). H.K. Disability-adjusted life years: a cntical review. Joumal of Health Economics. 16:685-702, 8. Barendregt, J., J.,, L, Bonneux, and P.J. Van der Maas(1996), DALYs: the age-weigbts on balance. BuUedn of tbe World Heal± Organization. 74: 439-43.
9. Dao Lan Huong, el al.( 2006), Burden of premature mortality in rural Vietnam from 1999 - 2003: analyses from a Demographic Surveillance Site. Population Health Metrics. 4: 9.
10. Murray, CJ.L. and Lopez; A.D.(1996). The Global Burden of Disease ed. C.J.L. Murray; and A.D. Lopez;. Vol, 1. World Health Organiadon.
11. Murray, C.J.L. and A.D. Lopez (1996). Global health Statistics: A Compendium of Incidence, Prevalence and Mortality Estimates for Over 200 Conditions, Cambrigde:
Havard Unuversity Press.
12. Murray, C.J.L. and A.K, Acbarya (1997). Understanding DALYs. Journal of Health Economics. 19: 703-30.
13. Siegel Gold, M.R. and M.C.J.E. Weinstein(1996). Cost effectiveness in health and medicine, NY: Oxford University Press.
14. Weatherall, D., et al. (ed 2006), "Science and Technology for Disease Control: Past, Present, and Future,"
Disease Control Priorities in Developing Countries (2nd Edition). New York: Oxford University Press.
10 Tap chi Y td Cdng cong, 4.2012, Sd 24 (24)