cufu KHOA HOC
THirC TRANG TlT VONG VA SO NAM SONG TIEM TANG MAT Dl DO UNG THU TAI MOT SO PHUdNG TRUNG TAM THANH PHO THAI N G U Y I N GIAI DOAN 2014-2016
T 6 M T A T
Muc tllu: Phdn tich sd nam sdng tiim tang mdt di do ung thu tai radt sd phudng trung tam thdnh phd Thai Nguyln ttong giai doan 2014-2016. Phuttng phdp nghien cdu: Md la cat ngang dugc tiin hanh bang each hdi cuu sd lilu quan ly td vong tgi trara y le va uy ban nhdn dan cac phudng. Kit q u i : So ca tii vong do ung thu trong giai dogn 2014-2016 Id 193 ca. Tdng sd YLL do ung thu Id 3007,8 nam, AYLL la 15,6 nam. Nu gidi cd sd nara mdt di trung binh cao han nam gidi. Nhdm tuii td 51-60 cd YLL cao nhat (chiim 43,2%). Chi sd YLL theo Ioai ung thu: ung thu phii chiem ty IS cao nhdt (20,0%), tiip theo Id ung thu gan, vdm bong, da day, vu. Tinh theo ehi si AYLL thi ung thu vd cd AYLL cao nhdt (29,8 nam), sau dd la ung thu mau, ed tu cung, vdm hgng va gan. Kit lu^n vd khuyen nghi: Cdn tang cudng cdng tac sdng Ipc
• ung thu; viec qudn ly, theo ddi td vong phai dugc thgc hien ddng bd va chinh xdc.
Td khda: Unglhu, td vong, YLL, AYLL, Thai Nguyln.
SUMMARY
THE SITUATION OF DEATH AND YLL DUE TO CANCER IN SOME CENTRAL WARD OF THAI NGUYEN CITY FOR THE PERIOD 2014-2016
Objectives: To analyze the years of potential life lost due to cancer in some central wards of Thai Nguyen city for the period 2014-2016. Methods:
Cross-sectional description was performed by rettospective management of mortality data at health stations and the People's Committees at the study sites. Results: The number of cancer deaths for the period 2014-2016 was 193. The total number of YLLs due to cancer is 3007.8 years, AYLL is 15.6 years.
Females loose on average more life years to cancer than men (22,2 vs 12,0). Lung cancer causes the most
Trjnh Van Hiing^ Nguyen Mqnh TUa'n' YLL (20.0%), followed by liver cancer, nasopharynx cancer, stomach cancer and breast cancer. Breast cancer loses the average number of years of life (29.8 years), followed by blood cancer, cervix cancer, throat cancer and liver cancer. Conclusions and Recommendations: The need for increased screening for cancer; the raanagement and monitoring of death must be carried out in a uniform and accurate raanner.
Keywords: Cancer, death, YLL, AYLL, Thai Nguyen I. D^T VAN DE
Ung thu dang ttd thdnh rapt ttong nhung nguySn nhdn hang dau gay td vong ttln loan thi gidi ciing nhu tgi Viet Nam. Theo thdng kS cua Td ehdc Danh gia ganh ndng bpnh lat toan cdu (The Global Burden Disease - GBD) mdi nam ttln todn cdu cd khoang 14,9 trieu ca mdi radc ung thu vd 8,2 trieu ca td vong, ttong dd cd tdi 2/3 Id d cdc nude cd thu nhdp thdp vd ttung binh [0],
Tai Vilt Nara radi nam cd khodng tten 125.000 ca mac ung thu mdi va ti IS td vong chiira gdn 75%>, trung binh mdi ngdy tai Viet Nara cd khoang 250 ngudi chit vi can bpnh ung thu. Du bdo vdo nam 2020 se cd it nhdt 189 344 ca ung thu radi mac Trong sd ca ung thu, nu chiSra 43%i va nam gidi 57%. Bdn loai ung thu phd biin nhat d nam gidi la ung thu gan, phdi, dg ddy vd dai trgc ttang, chiera 66% tdng sd ca ung thu mdi mac d nara gidl. a nu gidi, bdn logi phi biin nhdt la ung thu vu, phdi, gan, cd td cung, chiem gan 50% tdng sd ca ung thu radi radc d nu. Theo sd lieu udc tinh sd nam sdng tiem tang mat di do binh (YLL) trong nam 2010 tdng sd YLL do eac benh khdng Idy nhilm Id 6.760.146 nara, chiem 56,1% tdng sd ganh ngng bpnh tgt, trong dd ung thu chiSra 19,2%, ddng ddu trong cdc nguySn nhan gay tu vong [0].
Hien tgt cd nhiSu phuang phdp dl danh gid gdnh ndng benh tal ddi vdi con ngudi. Trong dd sd nam sdng mdt di I. TVwdug Dai hgc Y Duge Thii Nguyen
Ngaynhanbai: 15/01/2018 | » Ngdy phan bien: 20/02/2018 | » Ngay duyet dang: 28/02/2018 s o 3 (44) - Thang 05-06/2018 I •• ^ 1 I
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do Id vong sdm (YLL) la phuang phdp dem gian, phan anh md hinh benh tat vd td vong. Vile ap dung chi sd YLL da dugc tiin hdnh tgi nude ta td kha lau, tuy nhiSn cac nghien cdu tai Thai NguySn cdn it cac nghien cdu ap dung chi sd nay ttong viec ddnh gia gdnh nang bpnh tgt. Vi nhimg ly do trln chdng tdi tiln hanh nghien cuu nay vdi rage lieu:
Phdn tich so ndm song tiim tdng mat di do ung thu tgi mot si phudng irung tdm thanh pho Thdi Nguyin trong giai doan 2014-2016.
II. DOI TlTgiNG VA PHU'ONG PHAP NGHIEN CUtJ
Doi tvgag nghien cdu
- Cde trudng hgp td vong do ung thu tgi 4 phudng tnmg tam thanh phd Thai NguySn giai doan 2014-2016.
- HI thing sd sach, bdo cdo thing kl vi td vong do ung thu dugc quan ly lai tram y te vd UBND phudng.
Tiiu chuin chpn dii tirgng nghiin ctru - Cac trudng hgp tu vong do ung thu tu 01/01/2014 den 31/12/2016.
Dia diem nghien cuu
- Tgi 4 phudng trung tam thdnh phd Thdi NguySn bao gdm: Quang Trung, Hodng Van Thy, Phan Dinh Phung, Trung Vuang-
Phinmg phdp nghien cihi - Nghiin cuu md ta, thiit ki cdt ngang Phirong phdp thu thap so lieu
- Sd lipu thu cdp dugc thu thgp dga trln he thdng so sach cd san lai ttgm y ti vd UBND cac phudng. Cdc thdng tin thu thgp bao gdm chin doan benh khi tu vong, tudi khi td vong, gidi, ddn tdc, nghe nghipp, ngay td vong va noi td vong.
Phuvng phdp phdn tich si lipu
Vipc danh gid gdnh ngng bpnh tal ttong nghiin cdu ndy dua tten hai chi sd Id sd nam sing mat di do td vong sdm va sd nam sdng trung binh mdt di do Id vong sdm:
- Sd nam song rait di do td vong sdm (YLL) cua moi ngudi dugc tinh bang hieu sd gifta tudi thp trung bmh va tudi tu vong thgc. NSu radt ngudi cd tudi td vong Idn hon tudi thp trung binh, thi YLL cda ngudi dd duge thiSl lap vS khdng (tuc la khdng cd YLL "tiiu cgc"). Trong thgc tl, chi tinh nhiing ngudi td vong trudc tudi thp trung binh bao gdm ttong tinh loan. Nghiin cdu ndy su dung ky vpng sdng cda ngudi Viet Nara Id 71,3 d nam gidi va 80,7 tuoi is m gidi theo sd lipu cda WHO nam 2015 [8].
- Sd nam sdng tnmg bmh mdt di do tu vong sdm (AYLL) duge tinh bdng each chia tdng si YLL cho si ngudi tu vong ttong khoang thdi gian xac dinh, chi so nay cung cdp mdt thudc do vl gdnh ndng cua benh ung thu eho tiing benh nhdn, chu khdng phai loan bd dan so, no cho th4y trung binh bao nhilu nara eudc sdng ciia bpnh nhan cd thi bi rut ngan do ung thu.
III. KET QUA NGHlfeN CtTU
Bdng 1. Chisd YLL vdAYLL do ung thu theo dia du
Phinmg Quang Tnmg HoElngVanThy Phan Dinh Phiing Trung Vuong
Tong
So trinmg hop tu vong
42 46 67 38 193
YLL S6 nam
617,2 809,8 1003,4 577,4 3007,8
Ty le % 20,5 26,9 33,4 19,2 100,0
AYLL (nam) 14,7 17,6 15,0 15,2 15,6
Nhgn xet; Trong 4 phudng nghien cdu, phudng Phan Trung Vuong, YLL chilm 19,2%,. Tinh theo chi sd AYLL Dinh Phung cd sd ca tu vong nhiiu nhdt vd chiim 33,4% phudng Hodng Van Thu cd AYLL cao nhdt (17,6 nam) vi YLL ttong tdng sd. Sd ca td vong it nhdt la d phudng phudng Quang Tnmg cd AYLL thdp nhat (14,7 nam).
I s o 3 (441 - Thane 05-06/2018
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Bdng 2. Chi si YLL vdAYLL do ung thu theo gi&i
Gi*i
Nam N i TSng
S6 t r u ^ g hgrp tu vong
125 68 193
YLL So nam 1497,6 1510,2 3007,8
T y l $ % 49,8 50,2 100,0
AYLL (nam)
12,0 22,2 15,6 Nhdn xet: Chi sd YLL vd AYLL d nam gidi Idn lugt la 1497,6 va 12,0 nam, diu Ihdp ban so vdi nu gidi (1510,2 va 22,2 nam)
Bdng 3. Chi si YLL vd AYLL do ung thu theo nhdm tuii
Nhom tuoi
<40tu6i 41-50 «i6i 51-60 tudi 61-70 tu6i 71-80
>80 Tong
S6 truomg hop tir vong
13 22 73 50 26 9 193
YLL S 6 n a m
526,3 624,8 1300,5 510 46,2 0,0 3007,8
Ty le % 17,5 20,8 43,2 17,0 1,5 0,0 100,0
AYLL (nam)
40,5 28,4 17,8 10,2 1,8
15,6
NhdnxSt: Nhdm tudi td 51-60 tudi cd chi sd YLL cao nhat la 1300,5 nara, chiem 43,2%, Nhdra tudi cd YLL thap nhat la 71-80 ttiii, chiim 1,5%,
Bdng 4. Chi si YLL vd AYLL do ung thu theo ddn tgc
DSn tdc Kinh Khac Tong
S6 trucmg hgfp tir vong
180 13 193
YLL So nam 2794,6
213,2 3007,8
Tj- le % 92,9
7,1 100,0
AYLL (nam) 15,5 16,4 15,6 Nhdn xet: Chi sd YLL d ngudi dan tdc Kinh cao hon sdng mdt di trung binh d cac ddn tdc khac cao hon so vdi 0 vdi dan tdc khac, tuy nhiSn tinh theo AYLL thi sd nam ngudi ddn tpc Kinh
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Bang 5. Chisd YLL vd AYLL do ung thu theo vi tri
Vi tri ung thu
Ph6i Gan Vom hong Da day Dai trang Thuc quan Vi Tijrcung Mau Triic trang Khdc TSng s6
Tir vong So luijug
44 30 23 22 12 11 8 8 5 4 26 193
T y l ? % 22,8 15,5 11,9 11,4 6,2 5,7 4,1 4,1 2,6 2,1 13,6 100,0
YLL So nam
602,2 463,9 364,0 256,2 169,1 123,1 238,2 198,8 138,8 47,2 406,3 3007,8
TJIS%
20,0 15,4 12,1 8,5 5,6 4,1 7,9 6,6 4,6 1,6 13,5 100,0
AYLL (niim)
13,7 15,5 15,8 11,6 14,1 11,2 29,8 24,9 27,8 11,8 15,6 15,6
Nh|n xet: Cac vj tri ung thu cd si lugng td vong nhiiu theo la ung thu gan, vdm hpng, da day, vd. Tinh theo chi Id ung thu phdi (22,8%), gan (15,5%), vdm hpng (11,9%), sd AYLL thi ung thu vd cd AYLL cao nhat (29,8 nam), sau dg day (11,4%), dgi ttdng (6,2%). Tinh theo chi sd YLL dd Id ung thu radu (27,8 nam), cotu cung (24,9 ndm), vom thi ung thu phdi ciing chiem ty 11 cao nhat (20,0%), tiip hpng (15,8 nam) va gan (15,5 nam).
Bdng 6. Chisd YLL vdAYLL do ung thu theo ndm
Nam
2014 2015 2016 Tong
SS tnrjrag h^p tir vong
42 96 55 193
YLL S6 nam Tj If %
814,8 27,1 1331,6
861,4 3007,8
44,3 28,6 100,0
AYLL (nam)
19,4 13,9 15,7 15,6
Nhan xet: Trong 3 nam tit 2014-2016, s6 oa hi vong YLL cao nhit d nam 2015 (chilm 44,3%), tinh theo AYLL nhiSu nhat tip ttung trong nam 2015 (96/193 ca). Chi s6 thi nam 2014 co chi so AYLL cao nhat (19,4 nam).
^VyVUBHliN CtfU KHOA HOC
IV. BAN LU4N
Vile danh gid ganh nang benh tdt ludn Id vdn dl quan ttpng ttong y ti cdng cdng, dac bilt la do ludng ganh ndng td vong. Tai Vipt Nara hiln nay vipe theo ddi, ghi chep va quan ly tu vong vdn cdn nhieu thieu sdt, dac biet Id d tuyin ca sd Nghiin cuu nay su dgng thdng tin tir viec so sdnh, doi chieu gifta sd quan ly td vong (A6), si theo doi benh ung thu (A 12) tai trgm y ti vd sd khai tu tai UBND phudng dl thu thap dugc thdng lin tdi da va chinh xac nhat.
Kit qud nghiin cdu cho thay ttong khodng thdi gian lu 2014-2016 da cd tdng cpng 193 ttudng hgp td vong do ung thu tgi 4 phudng khu vgc trung tam thanh phd Thai NguySn. Tdng sd YLL ttong 3 nam la 3007,8 nam va trung buih mdi ngudi m4t di 15,6 nam eudc sdng do unglhu.
YLL theo gidi linh: Sd ca td vong do ung thu d nam la 125 ca, cao ban so vdi nu (68 ca), tuy nhiin chi sd YLL 0 nam lgi thap han so vdi d nft. Tuang tu chi sd AYLL d nam cung thdp han nu (12,0 nara va 22,2 ndm). Nghien cull tgi Iran cho thay ty IS YLL d nam la 50,6%, cao hon 0 nu gidi [8]. NghiSn cuu tgi Nauy cho thdy ty IS YLL d nu gidi cao hon nam gidi va nd gidi ciing mdt trung binh nhieu nara sdng hom d nara gidi (14,9 so vdi 12,7 nam) [8]. Bao cdo ciia Co quan Ung thu qudc gia Hoa Ky da chi ra tnmg binh m§i ngudi chSl vi ung thu lai qudc gia nay mat khodng 15,4 nam cupe sdng [8]. Theo bao cao gdnh nang benh tdt tai \^St Nam nam 2008, gdnh nang benh tat 6 nam gidi cao han d nir gidi d hau het cac logi ung thu [8]. Su khac nhau giua cdc nghiin cdu cd thi la do dgc linh cua mdu, hoac do sd dung ky vgng sdng khdc nhau giua cdc qudn thS va giai dogn. NghiSn cuu cua chdng tdi sii dgng ky vpng sdng riing cho hai gidi tgi Vipt Nara nara 2015, vi v^y YLL, AYLL d nd cao ban nam cd thi radt phan ia do ky vpng sdng d nu gidi (80,7 tudi) chSnh ISch Idid nhilu so vdi nam gidi (71,3 tudi).
YLL theo nhdra tudi: Nhdra tuoi cd chi sd YLL cao nhit la td 51-60 tudi, chiira 43,2%, nhdra cd YLL thdp nhdt Id 71-80 tudi (chiim l,5%i), diiu ndy hodn toan phu hpp vi sd ca chit do ung thu chd yeu d nhdm 51-60 tudi (73/193 ca). Cac nghiSn cdu khac cung cho thdy ddy Id lip tudi cd ty lp td vong cao nhdt do ung thu. Chi sd YLL thip nhdt d nhdm 71-80 tudi la do d nhdra tuii nay si ca td vong do ung thu thdp (26 ca) va da gdn dat tdi ki vpng sdng.
' YLL theo vi tri ung thu: Tinh chung cho cd hai gidi, 5 vi tri ung thu cd YLL cao nhdt Id phdi (chiira 20,0%), gan
(15,4%), vdra hpng (12,1%), dg ddy (8,5%), vu (7,9%).
Tuy nhiin cd sg khac biet khi tinh loan theo AYLL, theo chi sd ndy 5 vi tri ung thu lam mdt di sd nam sdng trung binh cao nhdt lln lugt la vd (29,8 nara), mdu (27,8 nam), td cung (24,9 nam), vdm hpng (15,8 nara), gan (15,5 ndm). Theo ket qud nghiin cdu cua Td ehdc Ganh ngng bSnh lat loan cdu nam 2013 cd tdng cdng hon 8 ttilu ca td vong do ung thu cac loai, ttong dd td vong do ung thu phdi la nhiSu nhat (khoang 1,6 trieu ea), mdt sd logi ung thu khdc cd sd tu vong cao Id da day, gan, dai trgc trang, vd [8]. Bdo cdo tgi Vilt Nam nam 2012 cung cho thdy cac logi ung thu cd ty 11 id vong cao lan lugt Id gan, phdi, da day, vd, dai true ttang. Cdc nghien cuu trudc ddy chi ra rang chi sd YLL phan anh gdnh nang tu vong tuang ddng vdi sd ca td vong do binh, ddc biet Id d nhung logi ung thu thudng gap, tdc la dua ra ra ldc ddng cua bpnh vdi xa hdi.
Trong khi dd chi sd AYLL lgi dac tnmg cho ganh ngng bpnh tdt cua mdi ea nhan, hay ndi cdch khac nhftng logi ung thu cd AYLL cao se lam cho benh nhdn radt di nhiiu tudi thp hon, bdi vdy nd cd thi la nhung logi ung thu cd thdi gian sdng thSm ngan (raau, phdi) hogc la nhiing loai ung ihu gap d lua tudi tte hon (vu, lu cung...).
V. KET L U . ^
- YLL do ung thu tgi 4 phudng trung ldm thanh phd Thai Nguyln giai dogn 2014-2016 la 3007,8 nam, AYLL Id 15,6 nam
- Chi sd YLL va AYLL d nii gidi deu cao ban so vdi d nam gidi
- Nhdm tudi tu 51-60 tudi cd chi sd YLL cao nhdt, chiim 43,2%. Nhdm tudi cd YLL thdp nhdt Id 71 -80 hidi, chilm 1,5%.
- Chi sd YLL d ngudi ddn tpc Kinh cao hon so vdi eac dan tdc khdc, tuy nhien AYLL d ngudi ddn tdc khdc cao ban so vdi dan tdc Kmh
- Chi sd YLL theo logi ung thu: Ung thu phdi ehiem ty Ip cao nhdt (20,0%), tiSp theo Id ung thu gan, vdm hong, da ddy, vu. Tinh theo ehi sd AYLL thi ung thu vu cd AYLL cao nhdt (29,8 nam), sau dd la ung thu radu, cd td cung, vdm hpng va gan.
VI. KHUYEN NGHI
1. Cdn tang cudng cdng ldc sdng Ipc, phdt hiln sdm ung thu, dac bipt la d tuyln y tl ca sd
2. Viec gidm sal, qudn Iy, theo ddi cdc trudng hgp Id vong tai cac ttgm y tl, UBND phudng can phdi dugc thuc hipn ddng bd, chinh xdc.
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JOURNAL OF COMMUNITY MEDICINE O O N 6 w O N 6 fcU I O
HAM KHAO
1. Bd Y tl (2011), Gdnh nang benh tal vd chan thuang d Viet Nam nam 2008, Nha xuat bdn Y hpc. Ha Npi.
2 Bp Y IS, (2015) "Bdo cdo chung nganh Y ti ", Nhd xuat bdn Y hpc. Ha Ndi.
3. Altefcruse SF, et al (2010), SEER Cancer Statistics Review, 1975-2007, National Cancer Instttute.
4. Khorasani Sl, Rezaei S, Rashidian H, Daroudi R (2015), Years of potential Ufe lost and productivity costs due to premature cancer-related mortality in Iran, Asian Pac J Cancer Prev, 16(5), 1845-50.
5. Mohsen Naghavi (2015), The Global Burden of Cancer 2013, JAMA Oncology
6. N G Buraet, S J Jefferies, R J Benson, D P Hunt, F P Treasure (2005), Years of life lost (YLL) ftom cancer is an iraportanl raeasure of population burden — and should be considered when allocating research funds, British Joumal ofCancer 92, 241-24
7. O T Brustugim, B M0ller and Helland (2014), Years of life lost as a measure of cancer burden on a national level, Br J Cancer, 111(5), 1014-1020.
8. WHO (2015), "Global Health Observatory Data Repository: Life expectancy -- Data by countty" (CSV).
Geneva, Switzerland: World Health Statistics 2015, World Health Organization.
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