Abstract | Uvod
Rak gornjih dišnih puteva (RGDP) spada u skupinu visoko preventabilnih uzroka smrti. U Republici Hrvatskoj utvrđena je visoka dobno standardizirana stopa smrtnosti (DSSS) od RGDP među najvećima u europskim zemljama. Zabrinjavajuća je spoznaja trenda povećanja DSSS. Te činjenice, kao i ukupno nepovoljno stanje zdravlja usta i zuba, primoralo je Vladu R. Hrvatske na donošenje Nacionalnog programa za preventivu i zaštitu oralnog zdravlja.
Cilj
Cilj rada je istražiti pojavnost i smrtnost od RGDP stanovnika Splitsko-dalmatinske županije (SDŽ). Usporediti razlike u pojavnosti i smrtnosti od Raka usta i ždrijela (C00-C14, MKB-10) i Raka grkljana (C32, MKB-10) u SDŽ, po područjima SDŽ i usporediti sa smrtnošću u Hrvatskoj i europskim zemljama, te odredi mjesto i ulogu medicinske sestre prvostupnice u ukupnom zdravstvenom zbrinjavanju raka gornjih dišnih puteva.
Materijal i metode
Istraživanje je urađeno iz podataka rutinske zdravstvene statistike dostupne u Službi za javno zdravstvo Nastavnog zavoda za javno zdravstvo SDŽ, te iz dostupnih podataka Hrvatskog zavoda za javno zdravstvo i Europskog ureda svjetske zdravstvene organizacije.
Urađeni su pokazatelji incidencije i smrtnosti od RGDP, ukupno, po spolu i dobi za SDŽ, po područjima SDŽ: priobalje, otoci i zagora. U ovoj retrospektivnoj studiji korišten je komparativni epidemiološki metod. Statistička obrada urađena je software programom Statistica 6.0 (StatSoft, Tulsa, USA).
Rezultati
U razdoblju 2001.-2015. godine prema pokazateljima umrlih od raka usta i ždrijela stanovnika SDŽ bilježi trend povećanja DSSS, a u R. Hrvatskoj bilježi se trend smanjenja. Povećanje je naročito naglašeno kod ženskog spola. Unatoč razlikama u trendovima prosječne godišnje DSSS za sve dobi i dobne skupine u SDŽ su statistički značajno niže godine nego u R. Hrvatskoj 6,08/100.000 (95% CI 5,31-6,86) vs. 8,68/100.000 (95% CI 8,33-9,04).
Između područja SDŽ statistički značajno veće DSSS imaju stanovnici područja zagore 9,48/100.000 (95% CI 8,01-10,96). Između stanovnika priobalja i otoka razlike nisu statistički značajne 4,89100.000 (95% CI 4,16-5,62) vs. 6,34100.000 (95% CI 4,41-8,27).
Incidencija i DSSS od raka grkljana imaju stalni trend samnjivanja kako u SDŽ tako i R. Hrvatskoj. Između SDŽ i R. Hrvatske nema statističke značajnosti DSSS od raka grkljana 5,44/100.000 (95% CI 4,70-6,18) vs. 5,17/100.000 (95% CI 4,83-6,18). Na svim područjima SDŽ zamjetan je trend smanjivanja DSSS. Stanovnici zagore SDŽ imaju značajno veće prosječne godišnje stope smrtnosti 4,54/100.000 (95% CI 3,88-5,20) nego stanovnici priobalja 2,62/100.000 (95% CI 1,35-3,89) i stanovnici otoka 4,01/100.000 (95% CI 1,73-6,29).
Pored toga što je RGDP visoko sprječiva bolest posebno zabrinjavaju visoki udjeli umrlih mlađe dobi do 64 godine. Te prijevremene smrti u razdoblju 2001.-2015. godine kod raka usta i ždrijela za oba spola čine gotovo polovicu broja umrlih (184 : 380 – 48,4%). Kod raka grkljana udjel je nešto povoljniji, ali još uvijek visok 142 : 333 – 42,6%.
Zaključak
Visoka smrtnost RGDP, poglavito smrtnost zbog raka usta i ždrijela, na području SDŽ u razdoblju 2001.-2015. godine u stalnom je povećanju u odnosu na rak grkljana kod kojeg trend smanjenja DSSS.
Nepovoljni zdravstveni pokazatelji kod visoko preventabilnog RGDP posljedica su nedovoljnog rada na primarnoj prevenciji RGDP za što su najviše odgovorni sami građani.
Zdravstveni djelatnici iz primarne zdravstvene zaštite, liječnici i medicinske sestre, trebaju primjeniti aktivni pristup pozivanjem građana svojih osiguranika korisnika u skrbi na potrebu redovitosti pregleda i stalnom sustavnom edukacijom podučiti ih i odgojiti na prakticiranje zdravog načina života po pitanju zdravlja gornjih dišnih puteva. |
Abstract (english) | Introduction
Upper respiratory tract cancer is a group of highly preventable causes of death. In the Republic of Croatia, a high standardized death rate of upper respiratory tract cancer was established among the largest in European countries. It is worrying that the age standardized death rate increases. These facts, as well as the total unfavorable state of health of mouth and teeth, forced the Government of the Republic of Croatia to adopt the National Program for Prevention and Protection of Oral Health.
The aim
The aim of the study was to investigate the occurrence and mortality of cancer of the upper respiratory tract of the inhabitants of the SDŽ. The aim is to compare the incidence and mortality rates of mouth, throat (C00-C14, MKB-10) and throat cancer (C32, MKB-10) in SDŽ areas and compare them with mortality in Croatia and European countries, and determine place and role of the first-degree nursing nurse in the overall health care of upper respiratory cancers.
Material and Methods
The survey was made from routine health statistics available from the Public Health Institute of the Education Institute of Public Health SDŽ, and from the available data from the Croatian Public Health Institute and the European Office of the World Health Organization.
Incidence and mortality rates of the upper respiratory tract, total, sex and age for SDž were calculated, according to SDI areas: coastal, island and inundation. In this retrospective study a comparative epidemiological method was used. Statistical processing was done with the software Statistica 6.0 (StatSoft, Tulsa, USA).
Results
Between 2001 and 2015 according to the indicators of the death of the mouth and throat of the SDŽ population, the trend of the increase of the standardized mortality rate was registered, while in Croatia there was a decrease trend. The increase is particularly pronounced in women's sex. Despite the differences in the trends of the average yearly standardized mortality rate for all ages and age groups in SDŽ, they are statistically significantly lower than in the Republic of Croatia 6.08 / 100.000 (95% CI 5.31-6.86). 8.68 / 100.000 (95% CI 8.33-9.04).
Between the SDŽ area, statistically significantly higher average standardized stops of mortality SMARTITY have residents of zagora 9,48 / 100,000 (95% CI 8,01-10,96). Between the inhabitants of the coast and the island of differences were not statistically significant 4,89100,000 (95% CI 4,16-5,62) vs. 6.34100.000 (95% CI 4.41-8.27).
The incidence and age standardized mortality rate of canine cancer has a constant trend of conflagration both in SDŽ and in R. Croatia. Between SDŽ and R. Croatia there is no statistically significant age standardized mortality rate for canine cancer 5.44 / 100.000 (95% CI 4.70-6.18) vs. 5.17 / 100.000 (95% CI 4.83-6.18). In all areas of SDŽ, there is a noticeable trend of lowering the standardized mortality rate. Residents of SDŽ have significantly higher average annual mortality rates of 4.54 / 100.000 (95% CI 3.88-5.20) than coastal residents 2.62 / 100.000 (95% CI 1.35-3.89) and island residents 4.01 / 100.000 (95% CI 1.73-6.29).
In addition to the cancer of the upper respiratory tract, a highly obstructive disease is particularly troubling for the high rates of deaths of younger ages up to 64 years. This premature death in the period 2001-2015. year in the mouth and throat of both sexes account for almost half of the number of deaths (184: 380 - 48.4%). In cancer of the throat the share is somewhat more favorable, but still high 142: 333 - 42.6%.
Conclusion
High mortality of upper respiratory tract cancer, especially mortality of mouth and throat mortality, in the area of SDŽ in the period 2001-2015. year is a steady increase compared to the larynx cancer, where the trend decreases the standardized mortality rate.
Inadequate health indicators in highly preventable upper respiratory tract cancer are the consequence of insufficient work on primary prevention of upper respiratory tract cancer for the most responsible citizens themselves.
Healthcare workers from primary health care, doctors and nurses should apply an active approach by inviting citizens of their caregivers to care for the need for regular inspection and regular systematic education to teach them and educate them on the practice of healthy lifestyle choices for upper respiratory health. |