—from the Epidemiological Bulletin, Vol. 21 No.1, March 2000—
Argentina: Health Situation Analysis and Trends, 1986-1995
The following study attempts to discover patterns of geographical and socioeconomic distribution, by age, sex, and Years of Potential Life Lost (YPLL), considering total, child, and maternal mortality as well as health trends, mainly for the period 1986 to 1995.
Death certificates (1) corresponding to the period of the study were reviewed, in which the causes of deaths were coded according to the International Classification of Diseases (ICD-9), and population projections from the National Institute of Statistics and Census (INDEC) (2) were used as well. The causes of death were classified in 15 groups, as in previous studies.3 The mortality rates were adjusted by age and sex, and YPLL were calculated for every group of causes. The resulting indicators were stratified according to 5 geographical regions, in which the mortality gaps were analyzed.
Argentina has an area of 2,780,400 km2, with a population of 36.1 million inhabitants (1998) and an average density of population of 12.8 inhabitants by km2. The country is highly urbanized with 88% of the population living in urban areas and more than 50% residing in the five larger cities.
Argentina is a federal country that comprises 23 independent provinces and a Federal Capital (figure 1). Each province has its own constitution, with its own executive, legislative and judicial branches. The president is elected by direct popular vote every four years and can be reelected only once.
The gross domestic product (GDP) of Argentina in 1997 was of 323.4 billion dollars, corresponding to a per capita GDP of US$9,066. The parity of the Peso to the US dollar has been kept since 1991. The principal productive and econo-mic activities include agriculture, livestock, trade, and service industries. It is estimated that 42% of the population is economically active (1997) and the official unemployment rate was of 12.4% in 1998.
The health sector is divided into three sub-sectors: a public health sector, a social works sector and a private sector that includes pre-payment and personal fee-for-service mechanisms. The per capita health expenditures were US$795 in 1995, of which 45% corresponded to the public sector and 55% to the other sectors. Of the total population, 46% (15,900,000 inhabitants) had access to the public sector only, while 51.2% (18,700,000 inhabitants) were covered by social works and private mechanisms.
While the total mortality rate declined from 8.2 per 1,000 in the 1986-1988 period to 7.8 per 1,000 in 1995, the total age-adjusted mortality rate showed significant differences between the regions, with higher figures in the northern regions than the rest of the country. The distribution of the leading causes of death was heterogeneous as well. Deaths from infectious diseases occurred in greater proportion in the northern regions with lower-income population. Between 1986 and 1994 for example, mortality rates due to infectious diseases in the northern provinces went from 69.2 to 83.7 per 100,000, while rates in Patagonia ranged from 22.5 to 43.6 (Figure 2). Meanwhile, deaths due to cancer had a higher proportional weight in the Center and South. In Patagonia and in the center for example, mortality rates due to cancer fluctuated between 163 and 194, while rates in the northwest went from 86 to 124 per 100,000 population (figure 3). Higher mortality rates due to cardiovascular diseases were registered in the Center and Cuyo, showing a correlation with the most developed areas (figure 4). Within the regions except in the northeastern, the differences in mortality from those cardiovascular diseases were greater among women.
Even though cardiovascular diseases constituted the leading cause of death, accidents were responsible for the greatest number of years of potential life lost (YPLL), with 16% compared to about 14% for perinatal causes and cardiovascular diseases (figure 5). Similarly, perinatal diseases, birth defects, infectious diseases and violences took greater weight when the YPLL were considered.
Infant mortality declined from 26.9 per 1,000 live births in 1986 to 18.8 in 1997 but this reduction differed in the different regions. Patagonia showed the more significant decrease, with 38.7%, compared to a reduction of only 28.4% in the Northeastern region (Figure 6). This difference is even more remarkable when considering that Patagonia had one of the lowest, and the northeast one of the highest infant mortality rates (IMR) at the beginning of the period. Consequently, inequity is currently greater than at the beginning of the period. Significant infant mortality gaps were also found within each region.
Maternal Mortality showed a pattern similar to infant and total mortality. The regions of the Northeast and of the Northwest presented rates twice and three times higher than the regions of the Center and Patagonia (figure 7). The leading causes of these deaths were related to abortions (28.1%), prenatal care (23.2%) and delivery care (23.3%) (figure 8).
Different mortality patterns were discovered between regions and provinces. Although climatic and lifestyle factors could partly explain these differences, socioeconomic and demographic factors are more closely related to the ine-quities and gaps that were found. The northern regions, where the proportion of people living in poverty is higher, show worse health indicators. Some of these differences were larger at the end of the period of analysis.
Source: Verdejo G. Bortman M. Study presented during the XV International Meeting of the IEA, Italy, 1999.Data from the Argentinian Health Statistics Direction of the Ministry of Health and Social Action and from the National Institute for Statistics and Census (INDEC)
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Epidemiological Bulletin, Vol. 21 No.1, March 2000