PATTERNS OF REGIONAL MORTALITY IN UKRAINE FROM SOVIET...
Transcript of PATTERNS OF REGIONAL MORTALITY IN UKRAINE FROM SOVIET...
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PATTERNS OF REGIONAL MORTALITY IN UKRAINE FROM SOVIET TIME TO NOWADAYS
Svitlana PONIAKINA
XXVII IUSSP International Population Conference26‐31 August 2013, Busan, Korea
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2
The special interest in Ukraine
Difference in Life Expectancy among regions is large (≈5 years)
max
81.079.9
68.676.2
min
82.1
max
69.368.6
66.967.1
min
71.7Crisis following the collapseof Soviet Union made causedchanges in mortality patterns
Life expectancy at birth in Europe and Ukraine, 2005‐2010
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Research questions:
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1. How large are geographical variations in mortality in Ukraine?
2. How have they changed over time?
3. What are causes of death behind variations ?
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Data
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Data of State Statistics Office of Ukraine:26 administrative units:
• 24 regions (oblasts)• Autonomous Republic of Crimea • Capital Kyiv
1988
1989
1990
1991
1992
1993
1994
1995
1996
1997
1998
1999
2000
2001
2002
2003
2004
2005
2006
2007
2008
2009
2010
Population by age (rn2) Death by age and by cause (C8)
census census
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Method:
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stx
xjxj pmSDR ,
ynynyn
cyncyncyn MM
MM
21
2,
1,
,
Standardized Death Rates:Decomposition of change in life expectancy
by causes of death
‐ death rate at age x for a region j
stxp ‐ proportion of the population at
age x in standard population
jxm ,
cynM ,
yn M
cyc
nyn , ‐ contribution produced by the difference in mortality in the age group y, y+n
y
W
xynxx ee
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‐ difference in life expectancy in 2 periods
‐ central death rate for age group y, y+n and cause of death c
‐ central death rate for age group y,y+n and all causes
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Three time periods at a focus:1) around census of 1989 – last census in Soviet Union2) around census of 2001 – first all‐Ukraine’s census3) latest years – nowadays
Census 1989, begin of the year
Census 2001, end of the year Nowadays
Soviet Union
1988 19901989
economic crisis
2000 2001 2002 2003 2007 2008 2009 2010
I n d e p e n d e n c e
1991
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females
I.degradation II.
crisis
III.recovery
males
60
62
64
66
68
70
72
74
76
1988
1989
1990
1991
1992
1993
1994
1995
1996
1997
1998
1999
2000
2001
2002
2003
2004
2005
2006
2007
2008
2009
2010
Life expectany
at b
irth in years
years
62.063.4
74.673.5
74.4
65.5
Life expectancy at birth, 1988‐2010
After two decades LE returned to its initial values observed at the end of Soviet epoch.
What happened during this period with mortality patterns?
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I. Life expectancy at birth by regions: males
1988‐1991: LE – 65.5 yearmax‐min = 4.4 year
2007‐2010: LE – 64.3 yearmax‐min = 6.5 year
2000‐2003: LE‐ 62 yearsmax‐min = 6.3 year
South and North (around Chernobyl) have lost the most in LE.South and West have contributed the most to its recovery.
>66.9
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I. Life expectancy from past till now: females
1988‐1992: LE – 74.6 yearmax‐min = 2.9 year
2008‐2012: LE – 74.4 yearmax‐min = 4.6 year
2000‐2003: LE – 73.5 yearmax‐min = 4.1 year
>76.5
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Mix type:• High share of chronic conditions and of
“man‐made” diseases• Communicable diseases are still
important
II. Nosological structure of mortality*: males1988‐1991 2000‐2003 2007‐2010
49.4
19.8
13.7
8.33.21.6
53.6
14.3
15.6
6.34.0 3.0
56.8
13.9
12.3
4.5
5.7 3.5
Circulatory systemCancersExternal causesRespiratory systemDigestive systemInfectious and parasitic diseases With course of time this contradiction only
strengthened
*According to standardized death rates based on all‐Ukraine’s population of 2001 used as a standard
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II. Nosological structure of mortality: females1988‐1991 2000‐2003 2007‐2010
Circulatory systemCancersExternal causesRespiratory systemDigestive systemInfectious and parasitic diseases
Circulatory system diseases are crucially important in surviving of females,
and their role is increasing
71.1
13.3
3.75.1 2.1 0.4
76.1
11.3
4.3 2.82.2 0.6
76.5
11.5
3.31.8 3.2 1.1
*According to standardized death rates based on all‐Ukraine’s population of 2001 used as a standard
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‐1,8
‐1,3
‐0,8
‐0,3
0,2
circulatory system
external cau
ses
cancers
respira
tory system
digestive system
infectious diseases
othe
r cau
ses
contrib
ution in years
males females
Increased mortality from circulatory system diseases, external causes and infectious diseases
have the most contributed to the decline of life expectancy
III. Contribution to difference in LE by causes: 2000‐2003 comparing to 1988‐1991 (degradation)
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Decreased mortality from Circulatory system diseases (for females)
andExternal causes (for males)
have the most contributed to the recovery of LE
Digestive system diseases Infectious diseases
constantly contribute to deterioration in LE‐0,4
‐0,2
0,0
0,2
0,4
0,6
0,8
1,0
1,2circulatory system
external cau
ses
cancers
respira
tory sy
stem
digestive system
infectious diseases
othe
r cau
ses
contrib
ution in years
males
females
III. Contribution to difference in LE by causes: 2007‐2010 comparing to 2000‐2003 (recovery)
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‐45
‐35
‐25
‐15
‐5
5
15
25
circulatory system
external cau
ses
cancers
respira
tory sy
stem
digestive system
infectious diseases
othe
r cau
ses
ZAKARPATSKALVIVSKAVOLYNSKARIVNENSKATERNOPILSKAIVANO‐FRANKIVSKACHERNIVETSKAKHMELNYTSKAZHYTOMYRSKAVINNYTSKAKYIVSKACHERNIHIVSKACHERKASKASUMSKAKIROVOHRADSKAPOLTAVSKAKHARKIVSKAODESKAMYKOLAYIVSKADNIPROPETROVKAKHERSONSKAZAPORIZKADONETSKALUHANSKAARCRIMEAKYIV
III. Contribution to difference in LE by causes: males(two periods together)
2000‐2003 comparing to 1988‐1991
• Only external causes covered back loses in LE (eastern regions concerned)• Circulatory system diseases – only partly• Digestive system diseases continue to generate loses • Cancers and respiratory system disease continue to generate gains (western regions concerned)
West
North‐Center
South‐East
2007‐2010 comparing to 2000‐2003
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III. Contribution to difference in LE by causes: females(two periods together)
2000‐2003 comparing to 1988‐1991
• Circulatory system diseases external causes covered back loses in LE (eastern regions concerned)• Digestive system and infectious diseases continue to generate loses • Cancers and respiratory system disease continue to generate gains (western regions concerned)• Other causes contributed to gains
‐45
‐35
‐25
‐15
‐5
5
15
25
circulatory system
external cau
ses
cancers
respira
tory sy
stem
digestive system
infectious diseases
othe
r cau
ses
ZAKARPATSKALVIVSKAVOLYNSKARIVNENSKATERNOPILSKAIVANO‐FRANKIVSKACHERNIVETSKAKHMELNYTSKAZHYTOMYRSKAVINNYTSKAKYIVSKACHERNIHIVSKACHERKASKASUMSKAKIROVOHRADSKAPOLTAVSKAKHARKIVSKAODESKAMYKOLAYIVSKADNIPROPETROVKAKHERSONSKAZAPORIZKADONETSKALUHANSKAARCRIMEAKYIV
2007‐2010 comparing to 2000‐2003
West
North‐Center
South‐East
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IV. Contribution to difference in LE by causes and regions:Circulatory system diseases: males
1.5min ‐0.5 0 0.5‐1.5 max
• East and North are responsible for major losses though situation on the East have recovered, West and North still contribute to decrease in LE
2000‐2003 comparing to 1988‐1991 2007‐2010 comparing to 2000‐2003
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1.5min ‐0.5 0 0.5‐1.5 max
IV. Contribution to difference in LE by causes and regions:Circulatory system diseases: females
• Degradation was about the same over entire Ukraine• Improvement is particular for the South and West
2000‐2003 comparing to 1988‐1991 2007‐2010 comparing to 2000‐2003
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Conclusions:
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• During two decades life expectancy in Ukraine experienced sharpdecrease, then stagnation followed by a recovery.
• Though average values at the end of Soviet times and now are close,regional and cause‐specific patterns changed.
• The biggest killer, pathologies of circulatory system, contributed a lotto the losses in life expectancy and their role is still cruciallyimportant even after a recovery
• As for geography mortality improved more in the regions wheresituation was already favorable (West), and degraded where it wasalready difficult (East‐South) bringing western regions to the secondstage of a health transition.