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Morbidity with temporary incapacity for work in the Southern Federal District of Russia. Selected indicators

https://doi.org/10.21886/2219-8075-2021-12-4-91-100

Abstract

Objective: To analyze the patterns of morbidity with temporary incapacity for work in the Southern Federal District of the Russian Federation.

Materials and Methods: The object of the study is a unified interagency analytics platform. The subject of the research is the indicators of morbidity with temporary incapacity for work of the working population of the constituent entities of the Russian Federation of the Southern Federal District over 2005–2019: “The number of cases of temporary incapacity for work per 100 employees”, “The number of days of temporary incapacity for work per 100 employees”. The descriptive statistics methods were applied.

Results: The studied statistical indicators of temporary incapacity for work reveal a steady positive trend in the morbidity rate of the working population in all the constituent entities of the Southern Federal District. From 2014 to 2015, there was a significant reduction in the indicators of temporary incapacity for work in all the constituent entities of the district. The indicators in all the studied constituent entities simultaneously declined, this decline being more prominent than in the previous 10 years. The data of the federal statistical monitoring does not represent an overall set of cases and days of temporary incapacity for work.

Summary: It is deemed essential to amend Order of The Russian Federal Service for Statistics No. 723. All individuals and legal entities involved in medical activities for the examination of temporary incapacity for work in the relevant region must provide reports in accordance with Form 16-VN to the competent authorities of the constituent entities of the Russian Federation.

For citation:


Shastin A.S., Tsepilova T.M., Gazimova V.G., Malykh O.L., Gagarina M.S. Morbidity with temporary incapacity for work in the Southern Federal District of Russia. Selected indicators. Medical Herald of the South of Russia. 2021;12(4):91-100. (In Russ.) https://doi.org/10.21886/2219-8075-2021-12-4-91-100

Introduction

Morbidity with a temporary disability (hereinafter MTD) for many decades has been the subject of study of domestic experts1 2[1–3]. The economic losses of society caused by temporary disability are very significant and are comparable with the entire volume of state financing of national health care in the Russian Federation [4-7]. The nationwide trend of depopulation affected the Southern Federal District to a lesser extent3. Already the majority of constituent entities of the Southern Federal District are included in the group of regions with population aging higher than the national level4. In the long term, the Russian economy will face new risks: an increase in the average age of the working-age population, an increase in the burden of chronic non-infectious diseases, and, consequently, an increase in the risks of social and economic losses from temporary disability [8][9]. Under these conditions, the availability of objective and complete information about morbidity with a temporary disability is especially relevant to public health authorities, occupational medicine and public health specialists.

The study aims to examine the dynamics of morbidity with temporary disability in the Southern Federal District.

Material and methods

The study object is a unified interagency information and analytical system. The study subject is the characteristics of morbidity with temporary disability of the working population of the RF constituent entities included in the Southern Federal District (hereinafter SFD) for 2005-2019. The characteristics "Number of cases of temporary disability per 100 workers", "Number of days of temporary disability per 100 workers" were used as the initial data. The characteristics of the RF constituent entities included in the SFD as of January 01, 2020, were to be studied. The ranking of the RF subjects by the characteristics was carried out. Data on Sevastopol and the Republic of Crimea were not considered in the comparative assessment of characteristics for 2005-2014 and 2015-2019. Statistical analysis of the data was performed using the STATISTICA 10 software product. Methods of descriptive statistics were used. Since some variables have a non-normal distribution (the distribution normality was checked using the Shapiro-Wilk W test), nonparametric tests were used. The Mann-Whitney test is the nonparametric analog of the Student's t-test when comparing two independent groups. This criterion was calculated using the Nonparametric Methods (Mann-Whitney test) options. The critical significance value for the null statistical hypothesis was taken to be 0.05 (differences at p <0.05 were considered statistically significant).

Results

The studied characteristics of temporary disability for the Russian Federation and all constituent entities of the Southern Federal District are presented in Table 1.

Республика Крым/ Republic of Crimea

 

 

 

 

 

485,7

363,2

372,2

411,5

 

Краснодарский край/ Krasnodar Krai

775,5

801,6

779,5

745,7

664,1

573,8

570,4

570,2

685,9

-26,5

Астраханская область/ Astrakhan Oblast

816,7

831,5

849,5

828,7

629,4

457,2

526

487,4

651,1

-40,3

Волгоградская область/ Volgograd Oblast

916,7

890,2

906,9

926,7

773,1

668

700,9

681,6

804,7

-25,6

Ростовская область/ Rostov Oblast

669,9

718

684,4

673,5

586,6

533,9

520,8

496,6

611,4

-25,9

г. Севастополь/ Sevastopol

 

 

 

 

 

600,3

459,7

283,7

467,1

 

* — среднемноголетний уровень за 2005–2019 гг. / Average annual level from 2005 to 2019
** — снижение показателя 2019 г. по отношению к 2005 году (в %) / 2019 Reduction vs. 2005 reduction (%)

The highest average annual MTD level in terms of TD cases per 100 workers over 2005 – 2019 was detected in the Republic of Adygea (73.0 cases). The lowest one was in the Rostov Oblast (48.3 cases).

From 2007 to 2018, according to this characteristic, the Republic of Adygea was among the top ten RF constituent entities with the highest MTD level (except for 2016). In 2010 the republic had the highest rate in the country (88.5 cases). In 2010 and 2012, the Astrakhan Oblast was among the ten constituent entities with the lowest MTD level in terms of TD cases per 100 workers. It should be noted that this characteristic fluctuated abnormally in Astrakhan Oblast from 2009 to 2012. (2009 — 71.2 cases, 2010 — 41.6 cases, 2011 — 60.7 cases, 2012 — 45.2 cases). Since 2017, the Republic of Crimea and Sevastopol are also consistently among the top ten constituent entities with the lowest level of this characteristic.

The highest average annual MTD level in terms of TD days per 100 workers over 2005 – 2019 was also detected in the Republic of Adygea (940,0 days). The lowest one was in the Rostov Oblast (611.4 days).

In 2008-2013, 2015, and 2017, the Republic of Adygea was among the ten RF constituent entities with the highest MTD level in terms of TD days per 100 workers. The ten constituent entities with the lowest level were Rostov Oblast (2005, 2006, 2009, 2013), Astrakhan Oblast (2010, 2012, 2015), Sevastopol (2017-2019), and the Republic of Crimea (2015-2019). And for this indicator from 2009 to 2012 in the Astrakhan Oblast, there were significant fluctuations (2009 — 849.5 days, 2010 — 513.1 days, 2011 — 828.7 days, 2012 — 547.9 days).

In the Republic of Crimea and Sevastopol, which were included in the SFD during the later period, the MTD rate by cases and days of temporary disability per 100 workers is much lower than in other district constituent entities.

The average yearly MTD level by TD cases according to the Notkin scale corresponds to "below average" in the Republic of Adygea and Volgograd Oblast, "low" in the Republic of Kalmykia, Krasnodar Krai, Astrakhan Oblast, "very low" in the Republic of Crimea, Sevastopol, and Rostov Oblast.

The average yearly MTD level by TD days according to the Notkin scale corresponds to "average" in the Republic of Adygea and Volgograd Oblast, "below average" in the Republic of Kalmykia, Krasnodar Krai, Astrakhan Oblast, "very low" in the Republic of Crimea, and Sevastopol.

Practically in all constituent entities of the SFD during the study period, there are positive dynamics of morbidity, according to Notkin (Table 2). The MTD estimate by TD days per 100 workers remained unchanged in the Republic of Kalmykia, while the characteristic decreased by 18.0%.

Таблица / Table 2

Оценка уровня заболеваемости по шкале Ноткина в 2005 и 2019 гг.

Morbidity rate evaluation on the Notkin scale in 2005 and 2019

Субъект / Entity

2005 г. / 2005

2019 г. / 2019

Число случаев временной нетрудоспособности на 100 работающих / Number of cases of temporary incapacity for work per 100 employees

Российская Федерация / Russian Federation

Ниже среднего / Below average

Очень низкий / Ultra low

Республика Адыгея / Republic of Adygeya

Средний / Average

Низкий / Low

Республика Калмыкия / Republic of Kalmykia

Низкий / Low

Очень низкий / Ultra low

Республика Крым / Republic of Crimea

 

Очень низкий / Ultra low

Краснодарский край / Krasnodar Krai

Ниже среднего / Below average

Очень низкий / Ultra low

Астраханская область / Astrakhan Oblast

Ниже среднего / Below average

Очень низкий / Ultra low

Волгоградская область / Volgograd Oblast

Ниже среднего / Below average

Очень низкий / Ultra low

Ростовская область / Rostov Oblast

Низкий / Low

Очень низкий / Ultra low

Севастополь / Sevastopol

 

Очень низкий / Ultra low

Число дней временной нетрудоспособности на 100 работающих / Number of days of temporary incapacity for work per 100 employees

Российская Федерация / Russian Federation

Средний / Average

Низкий / Low

Республика Адыгея / Republic of Adygeya

Выше среднего / Above average

Ниже среднего / Below average

Республика Калмыкия / Republic of Kalmykia

Ниже среднего / Below average

Ниже среднего / Below average

Республика Крым / Republic of Crimea

 

Очень низкий / Ultra low

Краснодарский край / Krasnodar Krai

Ниже среднего / Below average

Низкий / Low

Астраханская область / Astrakhan Oblast

Средний / Average

Очень низкий / Ultra low

Волгоградская область / Volgograd Oblast

Средний / average

Очень низкий / Ultra low

Ростовская область / Rostov Oblast

Ниже среднего / Below average

Очень низкий / Ultra low

Севастополь / Sevastopol

 

Очень низкий / Ultra low

In all constituent entities of the Southern Federal District in 2019, the cases and days of DT per 100 workers significantly decreased compared to 2005. The most significant decrease in characteristics was observed in the Astrakhan Oblast (by 40.5% in the cases and 40.3% in the days). The Republic of Kalmykia showed a minor decrease (23.8% in the cases and 18.0% in the days).

The MTD dynamics in the SFD constituent entities from 2005 to 2019 are shown in Figures 1 and 2 (excluding the Republic of Crimea and Sevastopol).

Russian

English

Показатель на 100 работающих

Indicator per 100 employees

год

year

Российская Федерация

Russian Federation

Республика Калмыкия

Republic of Kalmykia

Астраханская область

Astrakhan Oblast

Ростовская область

Rostov Oblast

Республика Адыгея (Адыгея)

Republic of Adygeya

Краснодарский край

Krasnodar Krai

Волгоградская область

Volgograd Oblast

Рисунок 1. Число случаев временной нетрудоспособности на 100 работающих в Российской Федерации и субъектах Южного федерального округа

Figure 1. The number of cases of temporary incapacity for work per 100 employees in the Russian Federation and the constituent entities of the Southern Federal District

Russian

English

Показатель на 100 работающих

Indicator per 100 employees

год

year

Российская Федерация

Russian Federation

Республика Калмыкия

Republic of Kalmykia

Астраханская область

Astrakhan Oblast

Ростовская область

Rostov Oblast

Республика Адыгея (Адыгея)

Republic of Adygeya

Краснодарский край

Krasnodar Krai

Волгоградская область

Volgograd Oblast

Рисунок 2. Число дней временной нетрудоспособности на 100 работающих в Российской Федерации и субъектах Южного федерального округа

Figure 2. The number of days of temporary incapacity for work per 100 employees in the Russian Federation and the constituent entities of the Southern Federal District

The authors additionally investigated the MTD characteristic dynamics in three separate periods (2005–2014, 2014–2015, 2015–2019).

The choice of the presented periods is conditioned by the new order of the Federal State Statistics Service dated December 25, 2014, No. 723 On Approval of Statistical Tools for the Organization of Federal Statistical Observations in the Healthcare by the Ministry of Health of the Russian Federation," which entered into force in 2015.

The MTD dynamics for the periods mentioned above are presented in Table 3.

Таблица / Table 3

Динамика показателей ЗВУТ (%)

Dynamics of morbidity rates with temporary incapacity for work (%)

Субъект

2005–2014 гг. / 2005–2014

2014–2015 гг. / 2014–2015

2015–2019 гг. / 2015–2019

Динамика по числу случаев временной нетрудоспособности на 100 работающих / Changes over time in the number of cases of temporary incapacity for work per 100 employees

Российская Федерация / Russian Federation

-11,0

-20,4

-1,4

Республика Адыгея / Republic of Adygeya

-9,2

-15,0

-13,1

Республика Калмыкия / Republic of Kalmykia

1,2

-14,5

-12,0

Республика Крым / Republic of Crimea

-9,0

-17,6

-0,6

Краснодарский край / Krasnodar Krai

-15,1

-32,7

4,1

Астраханская область / Astrakhan Oblast

-10,4

-15,8

-0,6

Волгоградская область / Volgograd Oblast

-11,4

-11,5

-6,5

Ростовская область / Rostov Oblast

 

 

-19,0

Севастополь / Sevastopol

 

 

-50,6

Динамика по числу дней временной нетрудоспособности на 100 работающих / Changes overtime in the number of days of temporary incapacity for work per 100 employees

Российская Федерация / Russian Federation

-14,0

-14,9

-2,3

Республика Адыгея / Republic of Adygeya

-12,5

-10,5

-12,7

Республика Калмыкия / Republic of Kalmykia

-5,7

-4,4

-9,0

Республика Крым / Republic of Crimea

-11,7

-16,2

-0,6

Краснодарский край / Krasnodar Krai

-21,6

-28,6

6,6

Астраханская область / Astrakhan Oblast

-18,3

-10,8

2,0

Волгоградская область / Volgograd Oblast

-12,5

-9,0

-7,0

Ростовская область / Rostov Oblast

 

 

-23,4

Севастополь / Sevastopol

 

 

-52,7

In 2014-2015, there was the most significant decrease in MTD indicators in the cases and the days of temporary disability per 100 workers for the Russian Federation as a whole and all the constituent entities of the Southern Federal District separately. The decline in this period far exceeded the average annual decline rate of the previous decade. In all district constituent entities, the number of DT cases decreased more than in 2005-2014. Regarding the number of VN days, the decrease in 2014-2015 exceeded the decline in 2005-2014 in Krasnodar Krai and Astrakhan Oblast.

In subsequent years, there were multidirectional trends in the rates of morbidity with temporary disability in the district. In 2015-2019, there was an increase in MTD per 100 workers in Astrakhan Oblast, in the number of TD days in Volgograd and Astrakhan Oblasts. The indicators in Krasnodar Krai (both in the number of cases and the number of DT days) and Volgograd Oblast (in the number of DT cases) remained practically unchanged. Characteristics in the Republic of Crimea and Sevastopol decreased significantly. The remaining constituent entities of the district showed a moderate downward trend compared to the 2014-2015 period.

A comparative assessment was made of the mean and median MTD characteristics for 2005-2014 and 2005-2019. The comparison was performed using a nonparametric Mann-Whitney test (Table 4).

Таблица / Table 4

Среднемноголетние показатели ЗВУТ субъектов ЮФО

Average long-term morbidity rates with temporary incapacity for work of the constituent entities of the Southern Federal District

 

2005–2014 гг. / 2005–2014

2015–2019 гг. / 2015–2019

 

Субъект / Constituent entity

СМУ* / AAL*

М±σ **

СМУ* / AAL*

М±σ **

p-значение / P

Число случаев ВН на 100 работающих / Number of cases of temporary incapacity for work per 100 employees

 

Российская Федерация / Russian Federation

60,0

60,95±3,12

43,6

43,6±0,51

0,0022

Республика Адыгея / Republic of Adygeya

81,1

81,0±6,27

56,8

56,3±4,46

0,0022

Республика Калмыкия / Republic of Kalmykia

58,2

58,0±2,78

47,3

47,3±2,28

0,0022

Республика Крым / Republic of Crime

 

 

33,8

30,3±5,78

 

Краснодарский край / Krasnodar Krai

63,7

64,2±3,98

46,9

47,3±1,11

0,0021

Астраханская область / Astrakhan Oblast

58,5

62,2±10,01

39,1

39,9±1,94

0,0022

Волгоградская область / Volgograd Oblast

66,8

66,9±3,95

50,7

50,2±1,35

0,0022

Ростовская область / Rostov Oblast

52,2

52,95±3,58

40,5

40,9±1,13

0,0022

Севастополь / Sevastopol

 

 

31,6

31,7±7,60

 

Число дней ВН на 100 работающих / Number of days of temporary incapacity for work per 100 employees

 

Российская Федерация / Russian Federation

782,0

802,3±46,45

587,0

584,4±6,53

0,0022

Республика Адыгея / Republic of Adygeya

1034,4

1038,75±88,25

751,4

752,8±59,36

0,0022

Республика Калмыкия / Republic of Kalmykia

730,2

730,35±22,87

637,9

629,5±25,48

0,0022

Республика Крым / Republic of Crime

 

 

411,5

372,2±66,41

 

Краснодарский край / Krasnodar Krai

746,1

768,9±50,19

565,6

570,4±13,23

0,0022

Астраханская область / Astrakhan Oblast

730,5

815,5±132,52

492,4

494,2±24,58

0,0033

Волгоградская область / Volgograd Oblast

867,5

893,4±64,35

679,1

681,6±21,79

0,0022

Ростовская область / Rostov Oblast

657,5

671,7±47,04

519,2

520,8±14,78

0,0022

Севастополь / Sevastopol

 

 

467,1

459,7±125,36

 

* — СМУ (среднемноголетний показатель) / * — AAL (average annual level)
** — М±σ (Медиана ± стандартное отклонение) / ** — М±σ (Median ± standard deviation)

In all constituent entities of the Southern Federal District, the MTD average yearly and median rates in the TD cases and days in 2005-2014 are higher than those in 2015-2019. The differences are statistically significant (p <0.05). The high σ values in the Republic of Crimea and Sevastopol are due to the high rate of decline in the characteristics (Table 1).

Discussion

The studied statistical indicators of temporary disability show a confident, positive dynamics of morbidity in the working population in all constituent entities of the Southern Federal District. In 2014-2015, there was the most significant decrease in TD indicates in all district subjects. In all of the studied subjects of the district, the characteristics synchronously decreased more than in the previous 10 years. In Astrakhan Oblast, the number of cases of TD per 100 workers dropped by almost a third (32.7%).

In most of the district subjects, the 2019 incidence rate of temporary disability is rated "low" and "very low" on Notkin's scale. The exceptions are the Republic of Adygea and the Republic of Kalmykia, where the level of MTD by the number of days of TD per 100 workers is assessed as "below average.” There are lowest MTD rates in the Republic of Crimea and Sevastopol.

However, the significant improvement of DT characteristics in the district often does not correlate with the assessments of public health by individual authors, especially to the Republic of Crimea and Sevastopol5 6 7 [7][10].

In 2015, a new procedure for federal statistical observation of morbidity with temporary disability came into effect, approved by Order No. 723 of the Federal State Statistics Service (hereinafter Rosstat) dated December 25, 2014, On Approval of Statistical Tools for the Organization of Federal Statistical Observation in the Health Sector by the Ministry of Health of the Russian Federation (hereinafter Rosstat Order No. 723).

Rosstat Order No. 723 prescribes the necessity of reporting on the federal statistical observation form 16-TD Information on the Causes of Temporary Disability (hereinafter the form 16-TD) to medical organizations included in the nomenclature of medical organizations following the Order of the Russian Ministry of Health of August 6, 2013, No. 529n An Approval of the Nomenclature of Medical Organizations. Thus, the consolidated form 16-TD for the constituent entities of the Russian Federation is formed mainly or only at the expense of the information provided by medical organizations subordinated to the authorities in the field of regional health care8.

In fact, we should consider the DT official statistics as indicators of morbidity with a temporary disability according to the data of municipal and state medical organizations subordinated to the authorities in public health protection in the RF constituent entities. It is in that context that it is appropriate to carry out comparative assessments of the level and MTD dynamics by RF constituent entities.

As of April 27, 2021, the territorial funds of obligatory medical insurance of the Southern Federal District included 973 legal entities and physical persons participating in the territorial programs of state guarantees of free medical care to citizens in the registers of medical organizations (hereinafter — MOs) operating in the sphere of obligatory medical insurance. Of these, 390 MOs (or 40.1%) are not subordinate to regional health care authorities, such as federal health care institutions, federal institutions of higher professional education and science, departmental MOs (the RF Ministry of Defense, the RF Interior Ministry, the Federal Customs Service, FMBA, OAO RZhD (Russian Railways), medical units and polyclinics of industrial enterprises, MOs with private ownership and individual entrepreneurs).

A random check on the Federal Service for Surveillance in Healthcare website showed that a significant number of these MOs are licensed to examine temporary incapacity to work.

Thus, the data of federal statistical observation is not the general population of cases and days of temporary disability.

Conclusion

The health of the working population is strategically essential to the state's economic security.

The presence of complete and reliable information about the morbidity with a temporary disability is necessary for health care authorities and compulsory medical funds for long-term planning of measures to provide working citizens with adequate medical care and resources that correspond to the real needs of this population category.

It is necessary to make changes in Rosstat's Order No. 723: reporting under Form 16-TD to the RF constituent entities subjects must be provided by all physical and legal entities engaged in a medical activity related to the expertise of temporary disability in the corresponding region.

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About the Authors

A. S. Shastin
Yekaterinburg Medical Research Center for Prophylaxis and Health Protection in Industrial Workers
Russian Federation

Aleksandr S. Shastin, Cand. Sci. (Med.), researcher at the Laboratory for Social and Hygienic Monitoring and Risk Management

Yekaterinburg


Competing Interests:

Авторы заявляют об отсутствии конфликта интересов



T. M. Tsepilova
Yekaterinburg Medical Research Center for Prophylaxis and Health Protection in Industrial Workers
Russian Federation

Tatyana M. Tsepilova, researcher at the Laboratory for Social and Hygienic Monitoring and Risk Management

Yekaterinburg


Competing Interests:

Авторы заявляют об отсутствии конфликта интересов



V. G. Gazimova
Yekaterinburg Medical Research Center for Prophylaxis and Health Protection in Industrial Workers
Russian Federation

Venera G. Gazimova, Cand. Sci. (Med.), Head of the Department of Occupational Medicine Management

Yekaterinburg


Competing Interests:

Авторы заявляют об отсутствии конфликта интересов



O. L. Malykh
Russian Federal Service for Surveillance on Consumer Rights Protection and Human Wellbeing
Russian Federation

Olga L. Malykh, Cand. Sci., Head of the Department of Social and Hygienic Monitoring and Planning of Activities of the Department of Organization of Control and Supervisory Activities and Provision of Public Services

Moscow


Competing Interests:

Авторы заявляют об отсутствии конфликта интересов



M. S. Gagarina
Yekaterinburg Medical Research Center for Prophylaxis and Health Protection in Industrial Workers
Russian Federation

Marina S. Gagarina, Yekaterinburg Medical Research Center for Prophylaxis and Health Protection in Industrial Workers

Yekaterinburg


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Авторы заявляют об отсутствии конфликта интересов



Review

For citation:


Shastin A.S., Tsepilova T.M., Gazimova V.G., Malykh O.L., Gagarina M.S. Morbidity with temporary incapacity for work in the Southern Federal District of Russia. Selected indicators. Medical Herald of the South of Russia. 2021;12(4):91-100. (In Russ.) https://doi.org/10.21886/2219-8075-2021-12-4-91-100

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ISSN 2219-8075 (Print)
ISSN 2618-7876 (Online)