Annual Symposium: Recent Trends in Mortality and Morbidity in Ireland: Changing Morbidity Patterns in Ireland 1996-2006

What the paper says

1. INTRODUCTION 1.1 Background In Ireland, since the year 1980 standardised mortality rates have reduced significantly. It is estimated that the Standardised Mortality Rate in 2005 was approximately 60% of what it was in 1980 [1]. This improvement in mortality is consistent with international experience but also exceeds that of comparable countries [2]. The causes of the improvements are uncertain but, perhaps result from advances in medical technology, better access to medical services--including the earlier identification of the need for health services (diagnostic services)--and improvements associated with healthier lifestyles being adopted. Of course, what is also relevant for Ireland is the impact of recent prosperity on mortality and health and well-being. The impact of this is difficult, if not impossible, to measure but it is most likely to have reduced mortality rates. The evidence from the years 1996 to 2005 is that the rate of improvement in mortality increased more than for the previous ten years [2]. This is perhaps an indication of the correlation between improved mortality and economic growth as during the same period the economy grew significantly. The improvement in mortality rates differs significantly by cause of death and these differences have been identified in previous studies [1]. Furthermore, the linkages between the mortality and morbidity are clearly very direct and some studies have commented on the importance of considering both changing mortality and morbidity patterns [3]. However, compared to mortality, relatively little analysis has been undertaken of how morbidity has changed both aggregately and by individual disease category. This paper explores the changing pattern of morbidity, using data from a significant proportion of the population. The population group represent the majority of persons who have private health insurance. The limitations of using data from this group of the population are explored in Section 2.1. It considers the implications of these changing patterns for health policy in Ireland. It comes in the context of considerable debate around the need for additional resources to meet the demands for health care of the population. Of secondary analysis in this study, but nonetheless of tremendous importance, are the different types of hospital settings where treatment is delivered. Some preliminary observations are made that record the change in mix of hospital settings that are used to provide treatments for each morbidity episode. This allows us to consider the change in resources required to treat morbidity within the population. 1.2 Context for Discussion In considering the causes of the utilisation of hospital services it is useful to understand the main categories of diseases treated within the Irish population and their relative importance compared to causes of death. Table 1 shows that a significant proportion of morbidity is caused by either digestive, cancer or circulatory conditions (13.5%, 11.1% and 10.8% respectively). Aside from digestive diseases, which are not a significant cause of mortality, the other two rank as the two most significant causes of mortality. 2. METHODS AND DATA 2.1 Data and Period of Analysis For this study, morbidity and hospital admission data was taken from the records of a large health insurance entity for the years 1996 to 2006. While data for 2007 was available, given that not all of hospital inpatient episodes had been reported to and settled by the insurer as of the date of analysis, it was not considered appropriate to use this data. Thus, we are using the experience of the voluntarily insured population, of this insurer, as a basis for drawing conclusions for the entire population. In considering whether this is reasonable it should be noted that the insurer covers a very significant proportion of the population. …