Exploring Thailand's mortality transition with the aid of life tables

HEALTH RISK TRANSITION AND LOW MORTALITY PATTERNS AMONG A NATIONAL COHORT OF ASPIRATIONAL THAI OPEN UNIVERSITY STUDENTS

In the last 50 years Thailand has achieved advanced demographic and health transitions. Many infectious diseases are controlled and infant and maternal mortality rates are among the lowest in the region. Within such a low mortality setting, however, substantial variations in health persist, with education being a major driver. This paper assesses the ongoing mortality transition in Thailand, examining relationships between risk factors and mortality outcomes among a large nationwide cohort of distance-learning Open University students, as well as examining the differential mortality benefit enjoyed by this educated group when compared with the general Thai population. The cohort comprised 87,151 participants, who in 2005 completed a questionnaire collecting detailed information on socio-demographics, health behaviours and health outcomes. Participants were aged 15-87 at baseline and lived in all regions of the country. Cohort members' citizen identification numbers were matched with official death registration records to identify mortality among participants. A total of 1401 deaths were identified up to November 2016. Results show cohort study participants experiencing mortality at approximately one-third of the rate of the general population in the same age and sex groups. The gap between the mortality rates in the two groups widened with increased age. Differential risk factor prevalence among the two populations, particularly lower overweight and obesity prevalence and lower cigarette smoking rates in the cohort, can explain some of this variation. The largely unmeasurable effect of aspiration for life improvement through distance education while embedded in their communities is shown by this study to have a powerful effect on mortality risk. With overall education levels, including higher education, rising in Thailand this growing group of educated aspirational Thais may represent future trends in Thai mortality. Identifying the drivers and characteristics of this mortality variation can help inform policies to provide health services and to help reduce mortality in the whole population.

Influence of Socioeconomic Factors on Daily Life Activities and Quality of Life of Thai Elderly

Background

The increasing number of older people is a significant issue in Thailand, resulted in growing demands of health and social welfare services. The study aim was to explore the influence of socioeconomic factors on activities of daily living and quality of life of Thai seniors.

Design and methods

Using randomised cluster sampling, one province was sampled from each of the Central, North, Northeast and South regions, then one subdistrict sampled in each province, and a household survey used to identify the sample of 1678 seniors aged 60 years and over. The Mann-Whitney U-test and binary logistic regression were used to compare and determine the association of socioeconomic variables on quality of life and activities of daily living.

Results

The findings showed that sociodemographic and socioeconomic factors were significantly related to functional capacity of daily living. Education levels were strongly associated with daily life activities, with 3.55 adjusted ORs for respondents with secondary school education. Gender was important, with females comprising 61% of dependent respondents but only 47% of independent respondents. Seniors with low incomes were more likely to be anxious in the past, present and future and less likely to accept death in the late stage, with 1.40 Adjusted ORs (95%CI: 1.02-1.92), and 0.72 (95%CI: 0.53-0.98), respectively. However, they were more likely to engage in social activities.

Conclusions

While socioeconomic factors strongly indicated the functional capacity to live independently, a good quality of life also required other factors leading to happiness and life satisfaction.

Risk factors for cardiovascular disease mortality among 86866 members of the Thai Cohort Study, 2005-2010

Thailand is experiencing a development-associated health-risk transition with increasing prominence of chronic diseases. We aim to determine the risk factors for cardiovascular disease (CVD) deaths in Thailand. We conducted longitudinal analyses of deaths in the nationwide Thai Cohort Study from 2005 to 2010 (n=86866) using national vital registration data. Multivariate logistic regression models were used to calculate mutually adjusted estimates of association between dying from CVD and various risk factors measured at baseline in 2005. For three important risks, population attributable fractions were calculated. There were 78 CVD deaths. The probability of dying from CVD for males was 0.15% and for females was 0.04%. Multivariate modelling showed that current smoking (OR=4.01, CI=2.02-7.93), hypertension (OR=1.91, CI=0.95-3.85), and diabetes (OR=2.51, CI=1.01-6.25) are major risk factors of CVD deaths. For males, 54% of CVD deaths can be attributed to smoking. Females are protected by very low rates of smoking. Ischaemic heart disease (OR=6.85, CI=2.47-19.01) is also a strong predictor of CVD deaths. As CVD is a top cause of death, reducing CVD mortality by controlling smoking, hypertension, and hyperglycaemia will substantially improve life expectancy in Thailand today. The low smoking rates among females need to be actively maintained and confer great benefit.

Comparison of mobile apps for the leading causes of death among different income zones: a review of the literature and app stores

Background

The advances achieved in technology, medicine, and communications in the past decades have created an excellent scenario for the improvement and expansion of eHeath and mHealth in particular. Mobile phones, smartphones, and tablets are exceptional means for the application of mobile health, especially for those diseases and health conditions that are the deadliest worldwide.

Objective

The main aim of this paper was to compare the amount of research and the number of mobile apps dedicated to the diseases and conditions that are the leading causes of death according to the World Health Organization grouped by different income regions. These diseases and conditions were ischemic heart disease; stroke and other cerebrovascular diseases; lower respiratory infections; chronic obstructive pulmonary disease; diarrheal diseases; HIV/AIDS; trachea, bronchus, and lung cancers; malaria; and Alzheimer disease and other dementias.

Methods

Two reviews were conducted. In the first, the systems IEEE Xplore, Scopus, Web of Knowledge, and PubMed were used to perform a literature review of applications related to the mentioned diseases. The second was developed in the currently most important mobile phone apps stores: Google play, iTunes, BlackBerry World, and Windows Phone Apps+Games.

Results

Search queries up to June 2013 located 371 papers and 557 apps related to the leading causes of death, and the following findings were obtained. Alzheimer disease and other dementias are included in the diseases with more apps, although it is not among the top 10 causes of death worldwide, whereas lower respiratory infections, the third leading cause of death, is one of the less researched and with fewer apps. Two diseases that are the first and second of low-income countries (lower respiratory infections and diarrheal diseases) have very little research and few commercial applications. HIV/AIDS, in the top 6 of low-income and middle-income zones, is one of the diseases with more research and applications, although it is not in the top 10 in high-income countries. Trachea, bronchus, and lung cancers are the third cause of death in high-income countries but are one of the least researched diseases with regard to apps.

Conclusions

Concerning mobile apps, there is more work done in the commercial field than in the research field, although the distribution among the diseases is similar in both fields. In general, apps for common diseases of low- and middle-income countries are not as abundant as those for typical diseases of developed countries. Nevertheless, there are some exceptions such as HIV/AIDS, due to its important social conscience; and trachea, bronchus and lung cancers, which was totally unexpected.

Comparing the socioeconomic status--health gradient among adults 50 and older across rural and urban areas of Thailand in 1994 and 2007

This paper examines associations between three indicators of socioeconomic status, education, income and bank savings, as well as one composite of these three measures, and self-assessed health for adults aged 50+ across rural and urban Thailand, comparing 1994 and 2007. Between 1994 and 2007 Thailand experienced rapid social changes that could impact on health overall and across groups, including population aging, socioeconomic development and changes in health policy. This led us to test whether overall health has improved as a result and whether the SES health gradient has changed. The data come from comparable survey sources from over seventy-thousand respondents, collected by Thailand's National Statistical Office. Generalized proportional ordered logit models were run that include up to three-way interactions of SES by year by rural versus urban location of residence are run. The three-way interactions allow for testing and of whether changes over time are due to complex intertwined effects. Results indicate that a) there has been improvement in health among the population aged 50 years and older in Thailand; b) there has been a flattening in the SES - health gradient in rural areas, and c) there has been little change in the gradient in urban areas, and if anything, there has been a widening of the relationship between income and health in urban Thailand. Divergence in the way the gradient has changed across rural and urban Thailand may point to the impact of social policy that has been aimed at poorer rural residents.