Türkiye ve Avrupa Birliği Ülkelerinde Doğumda Beklenen Yaşam Süresi ve Ölüme Bağlı Kaybedilen Yıllar Üzerine Etkili Sağlık Göstergelerinin Belirlenmesi: Bir Panel Veri Analizi

Yıl 2023, Cilt: 45 Sayı: 6, 978 - 994, 24.10.2023

Emrah Atay , Selma Metintas , Fatih Çemrek , Elgiz Askeroğlu

Öz

Çalışmanın amacı, 2000-2017 dönemi verileri ile Türkiye ve Avrupa Birliği (AB) ülkelerinde seçilmiş sağlık göstergelerinin doğuşta beklenen yaşam süresi (DBYS) ve ölüme bağlı kaybedilen potansiyel yıllar (YPLL) üzerindeki etkisini değerlendirmektir. Çalışma, Temmuz 2019-Haziran 2020 tarihleri arasında yürütülen ekolojik nitelikte bir panel veri analizi (PVA) araştırmasıdır. Sağlık hizmeti kullanımı, sağlık ekipmanları, sağlık kaynakları ve sağlık riskleri olmak üzere dört panel modellenmiştir. Sağlık durumu kategorisinde yer alan DBYS ve YPLL bağımlı değişkenler olarak kabul edilmiştir. Sağlık hizmeti kullanımı kategorisinde, çocuk aşılama oranlarındaki artışın DBYS üzerinde artırıcı bir etkiye sahip olduğu; çocuk aşılama oranı, hastanede kalış süresi ve hastaneden taburcu olma oranlarındaki artışın ise YPLL üzerinde azaltıcı bir etkiye sahip olduğu bulunmuştur. Sağlık ekipmanları panelinde, Manyetik Rezonans Görüntüleme (MRI) cihazı sayısındaki artışın DBYS üzerinde artırıcı bir etkiye sahip olduğu, Bilgisayarlı Tomografi (BT) cihazı ve MRI sayısındaki artışın ise YPLL üzerinde azaltıcı bir etkiye sahip olduğu bulunmuştur. Sağlık kaynakları panelinde, sağlık harcamaları, doktor sayısı ve hemşire sayısındaki artışın DBYS üzerinde artırıcı bir etkiye sahip olduğu; sağlık harcamaları ve doktor sayısındaki artışın ise YPLL üzerinde azaltıcı bir etkiye sahip olduğu tespit edilmiştir. Sağlık riskleri panelinde ise sigara içme prevelans hızı, alkol tüketim miktarı ve obezite prevelans hızındaki artışın DBYS üzerinde azaltıcı etkisi olduğu; sigara içme prevelans hızı ve obezite prevelans hızındaki artışın ise YPLL üzerinde artırıcı etkiye sahip olduğu tespit edilmiştir. Sağlık göstergelerine ait verilerin Panel Veri Analizi (PVA) gibi modern istatistiksel yaklaşımlarla analiz edilmesi, sağlık hizmetlerine yönelik müdahalelerin, projeksiyonların ve stratejilerin belirlenmesinde yol gösterici olabilir.

Anahtar Kelimeler

Sağlık göstergeleri, Panel Veri Analizi, Sağlık Düzeyi

Evaluation of the Effect of Health Indicators on Life Expectancy at Birth and Years of Life Lost in European Union Countries and Türkiye: A Panel Data Analysis

Öz

The aim of the study is to evaluate the effect of selected health indicators on life expectancy at birth (LEAB) and years of potential life lost (YPLL) in Turkey and European Union (EU) countries with data of 2000-2017 period. The study is an ecological research with panel data analysis (PDA) conducted between July 2019 and June 2020. Four panels are modeled as health care use, health equipment, health resources and health risks. LEAB and YPLL which are in health status category were accepted as dependent variables. In health care use category, it was found that an increase in the child vaccination rates had an increasing effect on LEAB, while an increase in the child vaccination rate, length of hospital stay and hospital discharge rates had a decreasing effect on YPLL. In the health equipment panel, it was found that the increase in the number of Magnetic Resonance Imaging devices (MRI) had an increasing effect on LEAB, while the increase in the number of Computed Tomography (CT) devices and the number of MRIs had a decreasing effect on YPLL. In the health recources panel, it was found that the increase in health spending, number of doctors and number of nurses had an increasing effect on LEAB, while the increase in health spending and number of doctors had a decreasing effect on YPLL. In the panel on health risks, it was found that an increase in smoking prevalence rate, alcohol consumption amount and obesity prevalence rate had a decreasing effect on LEAB, while an increase in smoking prevalence rate and obesity prevalence rate had an increasing effect on YPLL. Analyzing the data of health indicators with modern statistical approaches such as Panel Data Analysis (PDA) can help to guide for determining interventions, projections and strategies in health services.

Anahtar Kelimeler

Health Indicators, Panel Data Analysis, Health Status

Kaynakça

• 1. Kelley E, Hurst J. Health Care Quality Indicators Project: Conceptual Framework Paper. 2006.
• 2. Etches V, Frank J, Di Ruggiero E, Manuel D. Measuring Population Health: A Review of Indicators. Annu Rev Public Health. 2006;27:29-55.
• 3. Larson C, Mercer A. Global Health Indicators: An Overview: CMAJ. Canadian Medical Association Journal. 2004;171(10):1199-200.
• 4. Global Health Observatory, Life Expectancy at Birth: World Health Organization; https://www.who.int/gho/mortality_burden_disease/life_tables/situation_trends_life_expectancy/en/
• 5. Roser M, Ortiz-Ospina E, Ritchie H. Life Expectancy Our World in Data: Oxford University, Oxford Martin School, Global Change Data Lab; 2019 Available from: https://ourworldindata.org/life-expectancy
• 6. Aragon TJ, Lichtensztajn DY, Katcher BS, Reiter R, Katz MH. Calculating Expected Years of Life Lost for Assessing Local Ethnic Disparities in Causes of Premature Death. BMC Public Health. 2008;8(1):116.
• 7. Martinez R, Soliz P, Caixeta R, Ordunez P. Reflection on Modern Methods: Years of Life Lost due to Premature Mortality-A Versatile and Comprehensive Measure for Monitoring Non-Communicable Disease Mortality. International Journal of Epidemiology. 2019;48(4):1367-76.
• 8. Gardner JW, Sanborn JS. Years of Potential Life Lost (YPLL)-What Does It Measure? Epidemiology. 1990:322-9.
• 9. Burnet NG, Jefferies SJ, Benson RJ, Hunt DP, Treasure FP. Years of life lost (YLL) from cancer is an important measure of population burden — and should be considered when allocating research funds. British Journal of Cancer. 2005;92(2):241-5.
• 10. OECD Health Data: Organisation for Economic Co-operation and Development; 2019 Available from: https://data.oecd.org/health.htm
• 11. Our World in Data [Internet]. Oxford University, Oxford Martin School, Global Change Data Lab. 2019. Available from: https://ourworldindata.org/life-expectancy
• 12. Institute for Health Metrics and Evalution Global Health Data Exchange (IHME-GHDx]: Washington University; Available from: http://ghdx.healthdata.org/gbd-results-tool
• 13. Health Status: Organisation for Economic Co-operation and Development; Available from: https://data.oecd.org/health.htm#profile-Health%20status
• 14. Health Indicators, Life Expectancy Organisation for Economic Co-operation and Development Available from: https://www.oecd.org/berlin/47570143.pdf
• 15. What is a YLL? Washington University: The Institute for Health Metrics and Evaluation; http://www.healthdata.org/gbd/faq#What%20is%20a%20YLL
• 16. Child Vaccination Rates: Organisation for Economic Co-operation and Development; 2019 Available from: https://data.oecd.org/healthcare/child-vaccination-rates.htm
• 17. Length of Hospital Stay: Organisation for Economic Co-operation and Development; 2019 Available from: https://data.oecd.org/healthcare/length-of-hospital-stay.htm#indicator-chart
• 18. Hospital Discharge Rates: Organisation for Economic Co-operation and Development; 2019 Available from: https://data.oecd.org/healthcare/hospital-discharge-rates.htm
• 19. Hospital Beds: Organisation for Economic Co-operation and Development; 2019 Available from: https://data.oecd.org/healtheqt/hospital-beds.htm#indicator-chart
• 20. Computed Tomography (CT) Scanners: Organisation for Economic Cooperation and Development; 2019 Available from: https://data.oecd.org/healtheqt/computed-tomography-ct-scanners.htm#indicator-chart
• 21. Magnetic Resonance Imaging (MRI) Units: Organisation for Economic Cooperation and Development; 2019 Available from: https://data.oecd.org/healtheqt/magnetic-resonance-imaging-mri-units.htm
• 22. Health Spending: Organisation for Economic Co-operation and Development; 2019 Available from: https://data.oecd.org/healthres/health-spending.htm#indicator-chart
• 23. Doctors: Organisation for Economic Co-operation and Development; 2019 Available from: https://data.oecd.org/healthres/doctors.htm#indicator-chart
• 24. Nurses: Organisation for Economic Co-operation and Development; 2019 Available from: https://data.oecd.org/healthres/nurses.htm#indicator-chart
• 25. Smoking, Our World in Data. Oxford University, Oxford Martin School, Global Change Data Lab. 2019. Available from: https://ourworldindata.org/smoking
• 26. Alcohol Consumption: Organisation for Economic Co-operation and Development; 2019 Available from: https://data.oecd.org/healthrisk/alcohol-consumption.htm#indicator-chart
• 27. Obesity Our World in Data. Oxford University, Oxford Martin School, Global Change Data Lab. 2019. Available from: https://ourworldindata.org/obesity
• 28. Dong Y, Peng CY. Principled Missing Data Methods for Researchers. Springerplus. 2013;2(1):222.
• 29. Cheema JR. Some General Guidelines For Choosing Missing Data Handling Methods in Educational Research. Journal of Modern Applied Statistical Methods. 2014;13(2):3.
• 30. Tatoğlu FY. Temel Kavramlar. Panel Veri Ekonometrisi Stata Uygulamalı. Genişletilmiş 5. Baskı. İstanbul: Beta Basım Yayım Dağıtım 2020. p. 1-36.
• 31. Hsiao C. Panel data analysis—advantages and challenges. Test. 2007;16(1):1-22.
• 32. Yaffee R. A primer for panel data analysis. Connect: Information Technology at NYU. 2003:1-11.
• 33. Çekiç Aİ, Gültekin H. Giriş. R Uygulamalı Panel Veri Analizi ve Ampirik Bir Uygulama. Ankara: Ekin Basım Yayım Dağıtım; 2019. p. 1.
• 34. Tatoğlu FY. Temel Kavramlar. Panel Zaman Serileri Analizi Stata Uygulamalı. İkinci Baskı. İstanbul: Beta Basım Yayım Dağıtım 2018. p. 1-6.
• 35. R Core Team (2014). R: A Language and Environment for Statistical Computing. R Foundation for Statistical Computing, Vienna, Austria. 2020 (3.6.6 for Windows) Available from: https://www.r-project.org/
• 36. Mohan R, Mirmirani S. An assessment of OECD health care system using panel data analysis. 2007.
• 37. Clarke A. Length of in-hospital stay and its relationship to quality of care. BMJ Quality & Safety. 2002;11(3):209-10.
• 38. Cram P. Hospital Length of Stay … A Measure of What, Exactly? Medical Care. 2019;57(10):751-2.
• 39. Schoenman JA, Sutton JP, Kintala S, Love D, Maw R. The value of hospital discharge databases. NORC at the University of Chicago. 2005.
• 40. Hassan FA, Minato N, Ishida S, Nor NM. Social Environment Determinants of Life Expectancy In Developing Countries: A Panel Data Analysis. Global Journal of Health Science. 2017;9(5):105-17.
• 41. Makuta I, O'Hare B. Quality of Governance, Public Spending on Health and Health Status in Sub Saharan Africa: A Panel Data Regression Analysis. BMC Public Health. 2015;15(1):932.
• 42. Rahman MM, Khanam R, Rahman M. Health Care Expenditure and Health Outcome Nexus: New Evidence from the SAARC-ASEAN Region. Global Health. 2018;14(1):113.
• 43. Novignon J, Olakojo SA, Nonvignon J. The Effects of Public and Private Health Care Expenditure on Health Status in Sub-Saharan Africa: New Evidence from Panel Data Analysis. Health Econ Rev. 2012;2(1):22.
• 44. Homaie Rad E, Vahedi S, Teimourizad A, Esmaeilzadeh F, Hadian M, Torabi Pour A. Comparison of the Effects of Public and Private Health Expenditures on The Health Status: A Panel Data Analysis in Eastern Mediterranean Countries. Int J Health Policy Manag. 2013;1(2):163-7.
• 45. Health Workforce: World Health Organization; Available from: https://www.who.int/health-topics/health-workforce#tab=tab_1
• 46. Global Strategy on Human Resources for Health: Workforce 2030. World Health Organization. 2016.
• 47. Bloor K, Hendry V, Maynard A. Do We Need More Doctors? Journal of the Royal Society of Medicine. 2006;99(6):281-7.
• 48. Hewitt C, Lankshear A, Maynard A, Sheldon T, Smith K. Health Service Workforce and Health Outcomes: A Scoping Study. York: University of York, Department of Health Sciences. 2003.
• 49. Gulliford MC. Availability of Primary Care Doctors and Population Health in England: Is There an Association? Journal of Public Health. 2002;24(4):252-4.
• 50. Kennelly B, O'Shea E, Garvey E. Social Capital, Life Expectancy and Mortality: A Cross-National Examination. Soc Sci Med. 2003;56(12):2367-77.
• 51. Poças A, Soukiazis E. Health Status Determinants in the OECD Countries. A Panel Data Approach with Endogenous Regressors. Estudos do GEMF. 2010(4).
• 52. Poças A, Soukiazis E, Antunes M. Factors Explaining Life Expectancy at Age 65: A Panel Data Approach Applied to European Union Countries. Social Indicators Research. 2020:1-24.