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      Impacto de la diabetes sobre la duración y calidad de vida de la población cubana: años 1990, 1995, 2000 y 2003 Translated title: Impact of diabetes on the duration and quality of life of the Cuban population: years 1990, 1995, 2000 and 2003

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          Abstract

          La esperanza de vida saludable (EVS) es un tipo de medida resumen del estado de salud de una población. Estos indicadores combinan mortalidad y morbilidad para cuantificar la carga de las enfermedades. El presente trabajo tiene como objetivos identificar diferencias en la carga integral (combinando mortalidad y morbilidad) de la diabetes entre sexos y grupos de edades, y describir variaciones de su comportamiento en el tiempo (años 1990, 1995, 2000 y 2003). Se utilizó el indicador conocido como esperanza de vida saludable, y para su cálculo se obtuvo la esperanza de vida usual a partir de la tabla de vida, considerando solo la mortalidad por diabetes. La esperanza de vida así obtenida se ajustó teniendo en cuenta la morbilidad por esta condición. Este ajuste se realizó a partir de la prevalencia y la severidad. Bajo el supuesto de que la esperanza de vida tiene un valor máximo de 100, la esperanza de vida saludable del cubano al nacer (mortalidad y morbilidad solo por diabetes) disminuyó en el período comprendido entre los años 1990 y 2003 de 99,6 a 99,3 y de 99,3 a 99,0 en hombres y mujeres respectivamente, lo que evidencia un incremento de la carga integral por esta condición. Los hombres mostraron una esperanza de vida saludable superior a la de las mujeres para los 4 años de estudio (99,6 vs 99,3; 99,7 vs 99,2; 99,5 vs 99,2 y 99,3 vs 99,0). El impacto de la morbilidad sobre la esperanza de vida aumentó del año 1990 al 2003 de 0,19 a 0,46 % en los hombres, y de 0,33 a 0,76 % en las mujeres. Con estos resultados se puede concluir que el impacto de la diabetes sobre la esperanza de vida saludable se incrementó en el período de estudio a expensas (fundamentalmente) de la morbilidad.

          Translated abstract

          Healthy life expectancy is a type of summary measure of the health status of a population. These indicators combine mortality and morbidity to quantify the burden of illnesses. The objective of this paper is to identify differences in the integral burden (combining mortality and morbidity) of diabetes between sexes and age groups, as well as to describe variations of its behavior in time (years 1990, 1995, 2000 and 2003). The indicator known as healthy life expectancy was used. To calculate it, the usual life expectancy was obtained starting from the life table, and considering only mortality from diabetes. Once life expectancy was attained, it was adjusted taking into account the morbidity from this condition. This adjustment was made based on prevalence and severity. Assumming that life expectancy has a maximum value of 100, the healthy life expectancy at birth of the Cubans (mortality and morbidity only from diabetes) decreased between 1990 and 2003 from 99.6 to 99.3 and from 99.3 to 99.0 among men and women, respectively, evidencing an increase of the integral burden by this condition in this period. Men showed a healthy life expectancy higher than women during the 4 years under study (99.6 vs 99.3; 99.7 vs 99.2; 99.5 vs 99.2 and 99.3 vs 99.0). The impact of morbidity on life expectancy raised between 1990 and 2003 from 0.l9 to 0.46 % in men, and from 0.33 to 0.76 % in women. According to these results, we can conclude that the effect of diabetes on healthy life expectancy grew mainly at the expense of morbidity during this period.

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          Mortality in adults with and without diabetes in a national cohort of the U.S. population, 1971-1993.

          To examine 22-year mortality (1971-1993), causes of death, life expectancy, and survival in a national sample of diabetic and nondiabetic adults according to age, sex, and race. A representative national cohort of 14,374 adults aged 25-74 years was identified in 1971-1975 in the First National Health and Nutrition Examination Survey (NHANES I). Diabetes was ascertained by medical history interview. The cohort was followed for mortality through 1992-1993, with verification of vital status for 96.2% (n = 13,830). Causes of death were determined from death certificates. Diabetic subjects comprised 5.1% of the cohort and accounted for 10.6% of the deaths. Mortality for diabetic subjects increased from 12.4 per 1,000 person-years for those aged 25-44 years at baseline to 89.7 per 1,000 person-years for those aged 65-74 years. The age-adjusted mortality rate was 57% higher for diabetic men than for diabetic women; the rate was 27% higher for diabetic non-Hispanic blacks than for diabetic non-Hispanic whites. Mortality rates were highest for insulin-treated subjects and for those with > or = 15 years' duration of diabetes. Diabetes was listed on the death certificate as the underlying cause of death for only 7.7% of diabetic men and 13.4% of diabetic women. Considering multiple causes of death, heart disease was listed the most frequently and was present on 69.5% of death certificates of people with diabetes. Death rates were higher for diabetic than for nondiabetic subjects in all age, sex, and race groups. The relative risk of death (diabetic versus nondiabetic subjects) declined with age from a value of 3.6 for those aged 25-44 years at baseline to 1.5 for those aged 65-74 years. The relative risk was elevated in diabetic subjects for all major causes of death except malignant neoplasms. Survival of diabetic subjects was lower than that of nondiabetic subjects in all age, sex, and race groups. Median life expectancy was 8 years lower for diabetic adults aged 55-64 years and 4 years lower for those aged 65-74 years. In this representative national sample of adults, mortality rates were higher for diabetic men than for diabetic women and for diabetic blacks than for diabetic whites. The study confirms the substantially higher risk of death, lower survival, and lower life expectancy of diabetic adults compared with nondiabetic adults.
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            Global Estimates for Prevalence of Diabetes Mellitus and Impaired Glucose Tolerance in Adults

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              A critical examination of summary measures of population health

              In the past decade, interest has been rising in the development, calculation and use of summary measures of population health, which combine information on mortality and non-fatal health outcomes. This paper reviews the issues and challenges in the design and application of summary measures and presents a framework for evaluating different alternatives. Summary measures have a variety of uses, including comparisons of health in different populations and assessments of the relative contributions of different diseases, injuries and risk factors to the total disease burden in a population. Summary measures may be divided into two broad families: health expectancies and health gaps. Within each family, there are many different possible measures, but they share a number of inputs, including information on mortality, non-fatal health outcomes, and health state valuations. Other critical points include calculation methods and a range of conceptual and methodological issues regarding the definition, measurement and valuation of health states. This paper considers a set of basic criteria and desirable properties that may lead to rejection of certain summary measures and the development of new ones. Despite the extensive developmental agenda that remains, applications of summary measures cannot await the final resolution of all methodological issues, so they should focus on those measures that satisfy as many basic criteria and desirable properties as possible.
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                Author and article information

                Journal
                end
                Revista Cubana de Endocrinología
                Rev Cubana Endocrinol
                Editorial Ciencias Médicas (Ciudad de la Habana, , Cuba )
                1561-2953
                August 2006
                : 17
                : 2
                Affiliations
                [01] Ciudad de La Habana orgnameInstituto Nacional de Endocrinología. Cuba
                Article
                S1561-29532006000200003 S1561-2953(06)01700203
                972f4a7c-c98d-4317-a47b-2c8b01f6d3fc

                This work is licensed under a Creative Commons Attribution-NonCommercial 4.0 International License.

                History
                : 20 October 2005
                : 08 December 2005
                Page count
                Figures: 0, Tables: 0, Equations: 0, References: 26, Pages: 0
                Product

                SciELO Cuba

                Self URI: Texto completo solamente en formato PDF (ES)
                Categories
                TRABAJOS ORIGINALES

                mortality,morbilidad,esperanza de vida,life expectancy,Summary measures of the population health status,mortalidad,Medidas resúmenes del estado de salud de la población,morbidity

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