Social diseases (HIV and tuberculosis) and

population health in Russia

Vladimir KozlovNRU-Higher school of economics,

BSPS Annual Conference,08/09/11York, UK

DefinitionSocial Disease   - a human disease, which

generally occurs and distributes as a result of unfavorable socioeconomic conditions.

In our case “Social diseases” include tuberculosis (TB) and human immunodeficiency virus (HIV).

Deaths due to infectious diseases, %

Research question

•Do social diseases have a serious influence on the population health in the Russian Federation?

Main propositions1. Epidemical situation with social

diseases is beyond effective control

2. There are significant inequalities in risk of morbidity & mortality due to social diseases between different social groups

3. The burden of social diseases is high and growing (or stable)

TB Mortality & Morbidity (incidence)

Male, per 100 000 Female, per 100 000

HIV Mortality & Morbidity (incidence)

HIV, morbidity, cases HIV diseases mortality, per 100 000

Gender and age differencesGender:•For TB risk of morbidity for men is 2,7 times

higher, of mortality – more than 8,2 times.•For HIV, nowadays the proportion of new

incidences: 41 (f): 59 (m)Age groups:•HIV morbidity is concentrated at the age of

20-29. Age of onset is increasing•TB morbidity – in older working age 45-54

(male) and in active reproductive age 30-39 (female). Age of onset had been decreasing for a long time until the mid of 2000-s.

Morbidity (prevalence)HIV, per 100 000 TB, per 100 000

TB morbidity (p 100 000), cross-country comparison

TB mortality in comparison with MI (working age)

Male, per 100 000 Female, per 100 000

3,6 % of all deaths in working age were due to TB (2008)

Inequality: vulnerable social groups

For TB:•Inmates•Unemployed (? Causality effect)

For HIV:•IV (intravenous) Drug-users

Vulnerable groups

TB morbidity within inmates group HIV within IV drug-users

Burden of the social diseases (main approach)

Measurement:

disability-adjusted life years (DALY) (Murray, 1994)

Years of Life Lost (YLL). Years Lived with Disability (YLD).

Problems•Disadvantages of the method (see f.e.

Anand, Sudhir, Jonson, 1995; Anand, Hudson, 1997)

•Underestimation of TB and HIV incidences by Russian national statistics

•Complexity in definition of AIDS (HIV) as a cause of death

•WHO’s DALY estimation can be debatable

Method and model•As a standard life expectancy we use West

Level (e(0)=80 – male and 82,5 – female)•DALY parameters standard from GBD Studies:Discount rate (r) – 0,03; Beta (b) = 0; Constant

= 0,1658; no age weights)•Disability weight: TB (0,271), HIV (0,123-0,14)•Age groups: TB (0-14, 15-19, 20-29, 30-39, 40-59, 60+)HIV (0, 1-4, 5-9, 10-14, 15-19,20-29, 30-39, 40-

49, 50-59, 60-69, 70+)•Duration: TB (2,5), HIV (1-17 varies with age)

TB, burdenMale, per 1 000 Female, per 1 000

HIV, burdenMale, per 1 000 Female, per 1 000

Cross-country analysis (WHO, 2004)

Share of TB in total burden Share of HIV in total burden

Conclusions•The social diseases are playing not the main

but the important role in Russian health ill-being :

1.The epidemiological situation with HIV is unstable, TB is controlled, but with the high level of incidences and death rates

2.There are specific vulnerable groups3.The burden of social diseases is high in case

of TB and growing in case of HIV