7. Huong DL, et al. (2006). Burden of 9. Murray CL, Lopez AD (1996). Global health premature mortality in rural Vietnam from 1999 - Statistics: A Compendium of Incidence, 2003: analyses from a Demographic Surveillance Prevalence and Mortality Estimates for Over 200 Site. Population Health Metrics. 4 (9): 54 - 6 1 . Conditions. Cambridge: Harvard University Press.
8. Murray CL, Lopez AD (1996). The Global 10. UNICEF Vietnam - Ministry of Labour Burden of Disease ed. C.J.L. Murray; and A.D. Invalids - Social Affair (2010). A review of Child Lopez;. Vol. 1: World Health Organization: 1 8 - 2 5 . Injury prevention In Vietnam.
Summary
BURDEN OF PREMATURE MORTALITY IN VIETNAM IN 2006
The burden of premature mortality contributes to assessing diseases pattern and giving evidence - based allocation health resources. Objective: to estimate burden of premature mortality in Vietnam in 2006. Method: burden due to premature mortality (YLL) were estimated based on number of death and life expectancy at birth by age groups and cause of death. Verbal autopsy (VA) was used to identify cause of every death in representative sample of 64 provinces/cities in Vietnam. Results: burden of premature mortality in Vietnam in 2006 was estimated about 9.5 million YLLs. Burden of premature mortality among women was higher than among men in terms of non - communicable diseases. However, burden of premature mortality among women was lower than among men in terms of injury. Conclusions: In 2006 Vietnam lost about 9.6 million YLLs. Leading causes were stroke, injury and cancer.
Keywords: burden of premature mortality (YLL), Verbal Autopsy (VA)
NGHIEN CL/U TY LE TL/VONG DO UNG THU TAI MOT SO TINH 6 VIET NAM
• • •
Pham Thj Ngoc Bich, Nguyin PhOdng Hoa Trifdng Dai hoc Y Ha Noi Ung thd la mdt trong cac bdnh giy td vong hang dau tai Viet Nam. Muc tieu: xic djnh ty le td vong do ung thd tai mot sd tinh d Vidt Nam. Doi tugng va phuang phap nghien ciifu: nghien cdu md ta cit ngang, sil dung phdang phap phdng van ngddi trdc tiep chim sdc ngddi mat trong dat dm cudi cung trddc khi chet tai 76 tlnh/thinh phd td 1/1 - 31/12/2008. Ket qua: ty le td vong do ung thd tha'p nha't la 4,3%o gap d nhom tre nhd (0 - 14 tuoi) va cao nhat la 24,1 % gap d nhdm tuoi lao ddng (15 - 59 tuoi). Sd khac nhau ve ty Id til vong do ung thd d hai nhdm tuoi cd y nghTa thdng ke vdi p < 0,001. O nam gidi, td vong do ung thd gan chie'm ty le cao nhi't (6,4%o), tiep theo la ung thd phoi (4,6%o), da day (2,4%o), dai tring (0,,8%o) vi vdm hong (0,5%).
Ket luan: ty Id td vong do ung thd nam 2008 la 18,3%o. Ty le td vong do ung thd d nam gidi (19,8%o) cao han d nO gidi (16,1%o).
TO khoa: Tfl vong, xac dinh nguyen nhan tO vong bang phOOng phap phong van, ung thfl
I. D A T V A N D E khde va y te cua d e qudc gia. Tam quan trpng Sd lieu v l td vong la mpt trong nhdng ehi sd y cua cac chi sd do Ifldng tfl vong cdn the h i | n te quan trpng nha't nham do lifdng tinh trang sflc trong hai mpc tieu cua ke hoach phat trien Thien
Nien Ky va la mot trong ba y l u t d ca'u thanh nen chi sdphat trien eon ngudi eua Lien hdp qudc [1].
Viec tim hieu md hinh td vong dUdc coi la mot dieu kien thiet ye'u trong djnh hodng cac hoat dpng y te va hd trd viec xay dflng chinh sach dfla tren bang chdng. Hien nay, mpt trong d c benh gay tfl vong hang dau la ung thfl. Tren the gidi hiln cd hdn 22 trieu ngifdi chung sdng vdi ung thU va gan 7 trieu ngUdi da bi ung thU cUdp di tinh mang. DU k i l n d i n nam 2030 ty le mac ung thU tren t h i gidi la 27 trieu ngUdi va se ed 1 7 trieu ngUdi tfl vong do ung thu [2]. 0 Viet Nam, ty le mac va tfl vong do ung thU ngay cang tang nhanh.
Dif bao nam 2010, Viet Nam ed khoang 200.000 trudng hpp mac mdi va 100.000 trUdng hdp tfl vong do ung thfl [3]. Nghien cflu nay dfldc t i l n hanh vdi muc tieu: Xac dinh ty le td vong do ung thu theo tudi va gidi nam 2008 tai mgt sd tinh d Viet Nam.
II. DOI TUONG VA PHUONG
PHAPNGHIEN CL/U
1. Dja diem nghien cOu: nghien eflu thflc hien tai 16 tinh, thanh phd sau: Sdn La, Hda Binh, Thai Nguyen, Quang Ninh, Ha Npi, Hai Dfldng, Thanh Hda, KhInh Hda, Hue, Binh Djnh, Dac Lac, Lam Ddng, Binh Dfldng, thanh phd Ho Chf M i n h , Kien Giang va Can Thd.
2. PhOdng phap nghien cOu: nghien cdu md ta cat ngang.
3. Dd^l tOdng nghien cOu
Toan bp trfldng hpp tfl vong trong nam 2008 tai 192 xa thudc 16 tlnh/thanh p h d dfldc mdi tham gia nghien cdu
Ngfldi trflc tiep cham sdc ngfldi benh trdng ddt dm eudi eung (trflde khi chet) tai 16 tinh/thanh phd tren.
4. C9 mau va chon mau
- Chon miu: ' ' ' rf-;
VN gdm 63 tinh/thanh; chia thanh 8 vung hanh chfnh: Tay Bae, Ddng Bae, DB sdng Hdng, Bac Trung bp. Nam Trung bp, Tay Nguyen, Ddng Nam bp va DB sdng Cdu Long.
Chpn ngau nhien 2 tinh/vung •> tdng cdng cd 16 tinh.
Lap danh sach d c xa trong tinh. Chpn ngau nhien 1 2 xa/tlnh
Udc tinh ty le chet thd ~ 4%o.
- Cd mau: dupe tfnh qua viee lap danh sach ngUdi tfl vcng trong xa td d c ngudn: TYT xa, tfl phap UBND xa, sd lieu eua cpng tac vien dan so', d e ngudn khac (trifdng thdn, hpi ngUdi cao tudi, CLfu chien binh, chfl thap do...) sau dd tdng hdp lap danh sach ngUdi tfl vong tO 1/1 - 31/12/2008.
III. KET QUA
1. Mo ta tinh hinh tO vong tai 16 tinh tham gia nghien cOu
Tdng sd ed 9291 trfldng hdp tfl vong tai 1 6 tinh tham gia nghien eflu. Trong dd cd 1697 trfldng hdp td vong do ung thU c h i l m ty le 18,3%.
Nhin vao bang 1 ta thay ty le tfl vong thd do ung thu tai 16 tinh tUdng ddi eao. Tinh cd ty le tfl vong do ung thfl eao nhat la K h I n h Hda (24,9%) va tinh cd ty le td vong do ung thU thap nhat la Sdn La (14,8%). Ty le nay la 14,9% tai thanh phd Ho Chf M i n h va 20,7% tai thd dd Ha Npi.
2. So sanh ty le tO vong do ung thO theo nhdm tuoi va theo gldl
Trong nghien cflu nay chung tdi ehia thanh 3 nhdm tudi: nhdm tre nhd (< 15 tudi), nhdm d dp tudi lao dpng (tfl 1 5 - 59 tudi) va nhdm ngfldi eao tudi (> 60 tudi).
Bang 1. Ty le td vong tho do ung thUtai 16 tinh
STT Ten tfnh So tO vong So ung tho
Ha Noi 899 186
Tong 9293 1697 18,3
Ty le (%) 20,7 2
3 4 5 6 7 8 9 10 11 12 13 14 15 16
Sdn La Hoa Binh Thai Nguyen Quang Ninh H I i Dfldng Thanh Hoa H u l Binh Dinh Khanh Hoa Dac Lac Lam Ddng Binh Difdng Tp H C M Kien Giang C i n Thd
Tdng
Bang 2. Ty Nhdm tudi So tu' vong
391 369 410 543 452 357 5D3 637 481 504 454 747 1026
568 950 9291
58 66 79 124
89 62 103 107 120 96 81 119 153 101 153 1697 le td vong do ung thu theo nhdm tudi
So ung tho Ty le (%)
14,8 17,9 19,3 22,8 19,7 17,4 20,5 16,8 24,9 19,0 17,8 15,9 14,9 17,8 16,1 18,3
P 0 - 14
15 - 59
> 60
345 3218 5730
15 774 908
4,3 . 24,1
15,8 < 0 , 0 5
Bang 2 cho ta thI'y ty le tfl vong do ung thfl tha'p nha't la nhdm tre nhd (ehiem 4,3%) va cao nhat la nhdm tudi lao dpng (tfl 15 - 59 tudi). Sfl khae biet gifla d c nhdm cd y nghia thdng ke vdi p < 0,001.
Bang 3. Ty le td vong do ung thU theo nhom tudi va gidi
Nhdm tudi
So tu' vong d
TO vong do ung t h o d nam
n % So to vong d
nO
TO vong do ung thodi nO
%
0 - 14 1 5 - 5 9
> 6 0 Tdng
198 2439 2822 5459
6 530 543 1079
3,0 21,7 19,2 19,8
147 779 2908 3834
9 244 365 618
6,1 31,3 12,6 . 16,1
< 0 , 0 1
< 0,001
< 0 , 0 5
< 0 , 0 1
Bang 3 chi ra rang ty le tfl vong do ung thfl ehung d nam gidi cao hdn d nO gidi. Tuy nhien ty le td vong do ung tho d trd em nam va nam gidi d dd tudi lao dpng lai it hdn d tre nfl va nfl gidi d dp tudi lao dpng. Sfl khac biet nay ed y nghTa thd'ng ke vdi p < 0,001.
Kit q u i cua nghien cdu cung ehi ra rang eae nguyen nhan tfl vong do ung thU hay gap d nam gidi la ung thu gan, x I p sau dd la ung thU phdi, da day, dai trang, vdm hpng. Chpn 5 loai ung thU eao nha't d nam va ghep sd lieu cua nO vao de so s i n h sfl k h I c biet ta cd bang sau.
Bang 4. Ty le cac loai ung thU theo gidi
STT 1 2 3 4 5 6
Loai ung t h o
Gan Phdi Da day Dai trang Vdm hpng
Khac Tdng
N n 349 253 133 46 29 287 1097
i m
%
6,4 4,6 2,4 0,8 0,5 5,3 2 0 , 1 %
NO n 120 106 74 36 13 269 618
%
3,1 2,8 1,9 0,9 0,3 7,0 1 6 , 1 %
P
< 0,001
< 0,001
> 0 , 0 5
> 0 , 0 5
> 0 , 0 5
< 0,001
< 0,001 Ty le td vong do ung thu gan, ung thd phdi d nam cao han cd y nghTa so vdi nd (p < 0,05). Tuy nhien, khdng cd sd khac nhau ve gidi gida ty le td vong do ung thd da day, dai trang va vdm hong (bang 4).
IV. BAN LUAN
T'/ le tfl vong do ung thfl trong nghien cdu cua chung tdi la 18,3%. Sdn La la tinh cd Xy le td vong do ung thfl thap nha't (14,8%). K h I n h Hda la tinh co Xy le tfl vong do ung thfl cao nhat 24,9%.. Tuy nhien tai Thanh p h d Hd Chi M i n h , ndi cd ty le dan eU ddng nhat d nflde, lai cd Xy le tfl vong do ung thfl thap thd hai trong 1 6 tinh tham gia nghien ci'fu (14,9%). Nhin chung ty le tfl vong do ung thfl tai Viet Nam tfldng ddi cao, cao hdn Xy le td vong do ung thfl cua mpt so' nflde khac tren t h i gidi [5].
Ty le tfl vong d nO gidi thap hdn d nam gidi d ca 3 nhdm tudi, k i t q u i nay eung gidng k i t qua nghien cdu cua cae tac gia MerIi [8], Byass [4] va Nguyin Thj Kim Chdc [8]. Nhdm tudi cd ty le tfl vong do ung thfl cao nhat la nhdm tudi lao dpng (tfl 1 5 - 5 9 tudi). Dieu nay ed the giai thieh la do cd rat n h i l u cac y l u t d nguy cd ed t h i anh hudng
trflc t i l p tdi d hai gidi d.dd tudi nay. Nam gidi thi do anh hfldng cua Id'i sd'ng nhfl lam dung thud'c la, rflpu, bia...Nfl gidi thi dang trdng dp tudi thay ddi dae diem sinh hpe, thay ddi npi t i l t nhfl sinh de, tien man kinh...
K i t qua cua nghien eflu cung ehi ra rang, Xy le tfl vong do ung thU gan d nam gidi la cao n h i t , sau dd la ung thU phdi, da day, dai trang, vdm hpng.
Tren the gidi ung thU hay gap nha't d nam gidi la ung thu phdi, t i l p den la ung thU tuyen t i l n Net, dai trang, thflc q u I n , tuy [6]. Ly do tai sao ung thfl gan la nguyen nhan gay tfl vong hang dau d Viet Nam eung d l dflde g i i i thich bdi vi ngfldi dan tai mpt so' vung ndng thdn van cd thdi quen ud'ng rflpu n h i l u va udng rflpu "sudng"_tflc udng rifdu ma khdng an, them vao dd phfldng phap nau rifdu theo phfldng phap truyen thd'ng van cdn nhieu, ty le cdn trong rifpu eao, do dd ty le xo gan va ung
thfl gan d Viet Nam ngay cang tang. Hpn nfla khi ngfldi dan phat hien ra bi ung thfl va thfldng d giai doan muon, ngfldi dan - n h i t la d e l c vung ndng thdn, hp khdng ed d i l u kien chOa trj theo Tay y, ma toan chfla thudc nam vi vay ty le td vong do ung thfl d Viet Nam v i n edn eao. Ty le tfl vong do ung thfl gan d nam gidi trong nghien cflu cua ehdng tdi (6,4%) eao hPn n h i l u so vdi Xy le nay tren t h i gidi (1,4%) [7].
V. KET LUAN
Ty le td vong do ung thU chung d Viet Nam nam 2008 la 18,3%. Tinh ed Xy le tfl vong do ung thfl eao nhat la Khanh Hda (24,9%) va thap nhat la Sdn La (14,8%).
Ty le td vong do ung thfl d nam gidi (19,8%) cao hdn d nd gidi (16,1%). Nhdm tudi lao dpng ( 1 5 - 5 9 tudi) ed ty le tfl vong do ung thfl nhieu nhat (24,1%).
Ty le tfl vong do ung thU gan hay gap nhat d nam gidi (6,4%), tiep sau dd la ung thU phdi, da day, dai trang va vdm hpng.
T A I
LIEU
T H A M K H A O1 . Nguyin Thj Kim Chuc, Nguyin PhOdng Hoa (2009). Md hinh tfl vong tai huyen Ba Vi, Ha Npi qua hdn 9 nam theo ddi, 1999 - 2008; Tap chf Nghien edu Y hpe, tap 6 1 , sd 2: 100 - 105.
2. World Health Organization (2009). World Cancer Report. Geneva
3. World Health Organization (2005). Global action against cancer 1 - 24. Geneva.
4. Byass P. (2003) Pattern of mortality in Bavi, Vietnam 1999 - 2001. Seand J Public Heath; 3 1 : 8 - 1 1 .
5. W H O , http://www.who.int/mediacentre/
factsheets/fs297/en/index.html
6. C a n c e r R e s e a r c h UK, h t t p : / / info.cancerresearchuk.org/eancerstats/reports.
7. World Health Organization (2004). "Annex Table 2: Deaths by cause, sex and mortality atratum in W H O regions, estimates for 2002". The world health report 2004 - changing history.
Retrieved 2008 - 11 - 0 1 .
8. Merll M G , 1998. Mortality in Vietnam 1979 - 1989. Demography; 35: 345 - 360.
Summary
MORTALITY RATE OF CANCER IN SOME PROVINCES IN VIETNAM
Cancer is one of the leading causes of death in Vietnam. Objective: to describe mortality rate of cancer in some provinces in Vietnam. Methods: a cross - sectional study was conducted by using verbal autopsy method to interview the person who was directly care of the patient (before die) in last illness in 16 provinces from January 1 to December 3 1 , 2008. Results: mortality rate of cancer was minimum in children ( 0 - 1 4 years old) at 4.3% and maximum in working age group ( 1 5 - 5 9 years old) at 2 4 . 1 % . The diferrence between two groups was statistical significant with p^value < 0 . 0 0 1 . Liver cancer was the most common cancer in men (6.4%), after that is lung cancer (4.6%), stomach cancer (2.4%), colorectal cancer (0.8%), and upper jam cancer (0.5%). Conclusions: mortality rate of cancer in 2008 was 18.3%; this rate among men (19.8%) was significantly higher than that among women (1 6.1 % ) .
Keywords: mortality. Verbal Autopsy (VA), cancer
