Post universal health coverage trend and geographical inequalities of mortality in Thailand

Abstract

Background: Thailand has achieved remarkable improvement in health status since the achievement of universal health coverage in 2002. Health equity has improved significantly. However, challenges on health inequity still remain.This study aimed to determine the trends of geographical inequalities in disease specific mortality in Thailand after the country achieved universal health coverage.

Methods: National vital registration data from 2001 to 2014 were used to calculate age-adjusted mortality rate and standardized mortality ratio (SMR). To minimize large variations in mortality across administrative districts, the adjacent districts were systematically grouped into "super-districts" by taking into account the population size and proximity. Geographical mortality inequality among super-districts was measured by the coefficient of variation. Mixed effects modeling was used to test the difference in trends between super-districts.

Results: The overall SMR steadily declined from 1.2 in 2001 to 0.9 in 2014. The upper north and upper northeast regions had higher SMR whereas Greater Bangkok achieved the lowest SMR. Decreases in SMR were mostly seen in Greater Bangkok and the upper northern region. Coefficient of variation of SMR rapidly decreased from 20.0 in 2001 to 12.5 in 2007 and remained close to this value until 2014. The mixed effects modelling revealed significant differences in trends of SMR across super-districts. Inequality in mortality declined among adults (≥15 years old) but increased in children (0-14 years old). A declining trend in inequality of mortality was seen in almost all regions except Greater Bangkok where the inequality in SMR remained high throughout the study period.

Conclusions: A decline in the adult mortality inequality across almost all regions of Thailand followed universal health coverage. Inequalities in child mortality rates and among residents of Greater Bangkok need further exploration.

Keywords: Geographical inequalities; Mortality; Thailand.

Fig. 1

Geographical distributions of average annual standardized mortality ratio by super-district, 2001-2014

Fig. 2

Geographical distributions of average annual age-specific mortality rate, 2001-2014

Fig. 3

Trend of standardized mortality ratio over time, 2001-2014

Fig. 4

Trend in super-district death rate and CV by age group, 2001-2014. (a) Age specific death rate per 100,000 (b) Coefficient of variation for super-district age specific death rate

Fig. 5

Trend in super-district level standardized mortality ratio and coefficient of variation by region, 2001-2014. (a) Age specific death rate per 100,000 (b) Coefficient of variation for super-district age specific death rate

Fig. 6

Geographical distributions of super-district average annual cause-specific standardized mortality ratio, 2001-2014

Fig. 7

Trend in super-district cause-specific mortality rates, six selected conditions, by region, 2001-2014

Fig. 8

Trend in super-district coefficient of variation of cause-specific mortality rates, six selected conditions, by region, 2001-2014