Use of health information systems in the Russian federation in the assessment of environmental health effects.

Abstract

The Russian Federation has made an intensive effort to compile and use information on the environment and human health. In 1996-1997, we evaluated the information that was collected and analyzed on the local (raion), regional (oblast), and federal levels with reference to its usefulness in the assessment of environmental health effects. The Russian Federation maintains standardized nationwide institutions that routinely collect health data in polyclinics and hospitals and then report to the national offices. The allocations of the workforce and the broad range of surveyed health outcomes are extensive, but a lack of systematic control of information quality limits the ability to take full advantage of these efforts. On the other hand, the hierarchical system of data collection has advantages over more decentralized or commercial health systems. A major weakness in the current reporting is the aggregation and transformation of data. Although this may not disturb the generation of health statistics, it seriously limits the use of regional and federal level data in the assessment of health effects of environmental exposures. In spite of limitations, some revised approaches to the analysis of existing data may be both feasible and fruitful. Combining information from routine data and newly collected data is likely to be the most effective way to assess the relationship between environmental exposures and diseases. Although there is a strong and justifiable desire to rapidly translate information of environmental health effects into policy alternatives, at present, it seems more useful to emphasize data quality, completeness, and plans for the use of data.

Russia-specific relative risks and their effects on the estimated alcohol-attributable burden of disease

“…First, mortality and morbidity data contain inaccuracies, even when obtained from the most reliable sources [ 27 – 29 ], with the measurement of the burden of morbidity being commonly subject to more error than the burden of mortality [ 54 ]. For Russia and similar countries, the estimates of YLD are very provisional and uncertain in nature, making estimates of the alcohol-attributable DALYs lost for Russia presented in this study less accurate than the estimates presented for alcohol-attributable mortality [ 55 , 56 ]. Specifically, the databases which result from the collection of morbidity data from polyclinics and hospitals (the sources of most morbidity data) are problematic in terms of their diagnostic accuracy [ 55 ].…”

“…For Russia and similar countries, the estimates of YLD are very provisional and uncertain in nature, making estimates of the alcohol-attributable DALYs lost for Russia presented in this study less accurate than the estimates presented for alcohol-attributable mortality [ 55 , 56 ]. Specifically, the databases which result from the collection of morbidity data from polyclinics and hospitals (the sources of most morbidity data) are problematic in terms of their diagnostic accuracy [ 55 ]. Additionally, even data collected in Russia in a systematic manner and on a large scale (such as cancer registries) have problems with accuracy and detail [ 55 ].…”

“…Specifically, the databases which result from the collection of morbidity data from polyclinics and hospitals (the sources of most morbidity data) are problematic in terms of their diagnostic accuracy [ 55 ]. Additionally, even data collected in Russia in a systematic manner and on a large scale (such as cancer registries) have problems with accuracy and detail [ 55 ]. Second, the estimates presented are based on RR functions that were adjusted for age and smoking status, and in some cases for a variety of other risk factors, which may introduce bias [ 33 , 57 , 58 ].…”