Department of Health Policy and Management, Bloomberg School of Public Health, Johns Hopkins University, 624 N. Broadway, Baltimore, MD 21205, USA.
Health Policy Plan. 2012 Sep;27(6):487-98. doi: 10.1093/heapol/czr073. Epub 2011 Oct 20.
BACKGROUND In many middle-income countries, there is limited data available to evaluate the effectiveness of non-communicable disease (NCD) programmes. Since 1970, three neighbouring middle-income countries-Argentina, Chile and Uruguay-have undergone health sector reforms and reorganized their NCD programmes. In this paper, we explore whether data on premature adult mortality can be used to gauge the effectiveness of these programmes. METHODS We describe NCD programmes and examine mortality trends for the years 1970-2005 among adults aged 15-59 years. We contrast mortality trends from all-NCD to mortality trends from NCD that are avoidable through timely and effective medical care. The assumption is that if NCD programmes exert no effect, then all-NCD mortality and avoidable-NCD mortality will follow the same trend and avoidable-NCD mortality will not change at a faster pace. We used joinpoint regression analysis to describe the pace of change, measured as the geometric weighted average of the annual percentage change (AAPC). RESULTS Since the 1980s, all three countries have implemented NCD programmes delivered through health care, but only after the year 2000 did these countries begin to scale-up population-based NCD prevention programmes. In Argentina, all-NCD mortality is declining at a faster pace than avoidable-NCD mortality, while the contrary is occurring in Chile. In Uruguay, all-NCD mortality is declining at a faster pace than avoidable-NCD mortality among males, whereas among females, all-NCD mortality has stagnated while avoidable-NCD mortality continues to decline. CONCLUSION NCD interventions through health care have likely contributed to the reduction of premature NCD mortality in Chile and among women in Uruguay. In Argentina and among men in Uruguay, factors outside the health sector seem to have had a greater impact. This approach could be used in other countries to assess the effect of NCD interventions and raise key questions on programme effectiveness.
在许多中等收入国家，用于评估非传染性疾病（NCD）规划有效性的数据十分有限。自 1970 年以来，三个中邻国家——阿根廷、智利和乌拉圭——经历了卫生部门改革，并对其 NCD 规划进行了重组。本文旨在探讨能否利用成年人早逝数据来评估这些规划的效果。
我们对 NCD 规划进行了描述，并考察了 1970 年至 2005 年期间 15-59 岁成年人的死亡率趋势。我们对比了全因 NCD 死亡率和通过及时、有效的医疗保健可以避免的 NCD 死亡率的趋势。假设如果 NCD 规划没有效果，那么全因 NCD 死亡率和可避免 NCD 死亡率将遵循相同的趋势，可避免 NCD 死亡率不会以更快的速度变化。我们使用 joinpoint 回归分析来描述变化的速度，其衡量指标为年变化百分比（AAPC）的几何加权平均值。
自 20 世纪 80 年代以来，三国均实施了通过医疗保健提供的 NCD 规划，但仅在 2000 年以后，这些国家才开始扩大基于人群的 NCD 预防规划。在阿根廷，全因 NCD 死亡率的下降速度快于可避免 NCD 死亡率，而在智利，情况则相反。在乌拉圭，男性的全因 NCD 死亡率的下降速度快于可避免 NCD 死亡率，而女性的全因 NCD 死亡率则停滞不前，可避免 NCD 死亡率仍在下降。
通过医疗保健进行的 NCD 干预措施可能有助于降低智利的 NCD 过早死亡率和乌拉圭女性的 NCD 过早死亡率。在阿根廷和乌拉圭男性中，卫生部门以外的因素似乎产生了更大的影响。这种方法可用于其他国家，以评估 NCD 干预措施的效果，并提出关于规划效果的关键问题。
