Premature Death in the New Independent States (1997) / Chapter Skim
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Epidemiological Transitions in the Former Socialist Economies: Divergent Patterns of Mortality and Causes of Death
Epidemiological Transitions in the Former Socialist Economies: Divergent Patterns of Mortality and Causes of Death
Pages 184-219
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From page 184... ...
, known collectively as the Formerly Socialist Economies, are a unique demographic and epidemiological region.) Mortality trends in the region over the last three decades appear to define a new pattern of the epidemiological transition, one that deviates from the collective experience of other developed countries and the middle-income countries of Latin America and Asia (Murray et al., 1992; Kingkade and Arriaga, in this volume)
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From page 185... ...
The major demographic and epidemiological puzzle of the Formerly Socialist Economies is the sustained increase in adult male mortality, which has affected those aged 30-44, 45-59, and 60-69, and remarkably began in almost exactly the same year 1964 in all countries of the region. Partial data for the former Soviet Union indicate that similar developments occurred throughout the region at the same time (Anderson and Silver, 1990; Ryan, 1982; Cooper, 1981; Eberstadt, 1993~.
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From page 186... ...
This is followed by discussion of the unique mortality trends and cause-of-death patterns in the region of the Formerly Socialist Economies that includes the northern European former Soviet republics. The final section presents conclusions.
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From page 187... ...
. Table 6-1 shows the NMRc and IMRc for all the former Soviet republics and the estimated proportion of underregistered neonatal and infant deaths; for NMR, this percentage varies from 26.6 percent in Turkmenistan to about 53.5 percent in Latvia.
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From page 188... ...
188 ~ Y o ~ · - 7 So ~ SO O O ~ 4= ._4 ~ ca O ~ SO C)
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From page 189... ...
, however, have analyzed regional mortality patterns in the former Soviet Union and concluded that there is substantial underregistration of adult deaths in the former Central Asian republics. To date, judgments that there has been substantial underreporting of deaths in certain republics have been based solely on the fact that observed mortality rates appear to be too low.
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From page 190... ...
190 lo Cq a' VO a' a' a' _.
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From page 191... ...
Given that vital registration for the Soviet Union as a whole is very close to complete, we suspect that internal migration in the former Soviet republics may play an important role in explaining the low coverage. Nevertheless, it is reasonable to suspect that vital registration coverage in Central Asia and Azerbaijan is lower than in other parts of the former Soviet Union.
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From page 192... ...
Registration coverage of adult female deaths in Central Asia, Georgia, and Azerbaijan may be lower than that of adult male deaths. For our analysis, we have chosen not to adjust the reported levels of adult mortality based on the Bennett-Horiuchi technique.
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From page 193... ...
Excess years of life lost thus defined can be negative for a cause if the mortality rates by age and sex for a given disease are lower in a region than in the Established Market Economies.6 RESULTS This section presents results for geographic patterns of mortality (1990) , years of life lost due to premature mortality, and excess years of life lost for the Formerly Socialist Economies.
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From page 194... ...
, and North FSE. Notably, Kazakstan, which is sometimes included with the four Central Asian republics, is on the demographic boundary with North FSE in terms of the child-adult mortality map.
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From page 195... ...
. And North FSE has low child mortality rates and very high levels of adult mortality (twice or more the model life table value)
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From page 196... ...
FIGURE 6-2 Adult male mortality vs. child mortality in the Formerly Socialist Economies of Europe and Central Asia.
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From page 198... ...
SOURCE: Vital registration data and adjusted mortality rates. Years of Life Lost Due to Premature Mortality by Cause, Age, and Sex Combining the registered deaths for each of the countries in each region, we have created regional figures for North FSE, South FSE, and Central Asia.
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From page 200... ...
In South FSE, because of a younger population and slightly higher child mortality than in North FSE, Group I (communicable, maternal, and perinatal causes) is still an important cause of years of life lost.
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From page 201... ...
.~. MURRAY AND JOSE LUIS BOBADILM 201 TABLE 6-7 Percent Distribution of Years of Life Lost by Major Causes of Death, by Region, 1990 Cause NorthSouthCentral Asia Group I: Communicable, maternal, and perinatal diseases 9.914.853.9 Infectious and Parasitic 2.73.115.2 Tuberculosis 1.00.80.9 Diarrheal disease 0.50.98.6 Meningitis 0.40.40.8 Hepatitis 0.10.22.6 Respiratory infection 2.97.129.7 Maternal 0.10.40.2 Perinatal 4.32.89.5 Group II: Noncommunicable diseases 68.071.734.7 Malignant neoplasm 18.716.46.0 Esophagus 0.50.20.6 Stomach 2.71.70.9 Colon/rectum 1.61.30.4 Lung 4.13.40.8 Breast 1.31.40.3 Cervix 0.50.60.2 Lymphoma/leukemia 1.62.00.8 Diabetes 0.71.10.5 Nutritional endocrine 0.40.41.0 anemia 0.00.10.0 Neuropsychiatric 1.82.41.8 Cardiovascular 35.037.515.6 Ischemic heart disease 17.212.68.6 Stroke 10.311.04.1 Other 7.614.0 Respiratory 3.23.02.2 Digestive 3.35.33.2 Cirrhosis 1.43.01.5 Genito-urinary 1.31.51.3 Congenital 2.82.92.9 Group III: Injuries 22.113.511.4 Unintentional 15.511.89.5 Motor vehicle accident 6.22.33.3 Poisoning 2.70.20.5 Fall 1.00.40.5 Fire 0.40.20.6 Drowning 1.80.31.7 Intentional 6.61.71.9 Suicide 4.41.31.1 Homicide 2.10.40.8 Total 100.0100.0100.0 Number in millions 31.05.45.0
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From page 202... ...
Total years of life lost in Central Asia is 80 percent higher than expected based on rates of the Established Market Economies, and in North FSE and South FSE is 67 and 50 percent higher, respectively. The excess can be apportioned among different age and sex groups.
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From page 203... ...
. The prominent role of hepatitis in this age group is highly unusual; further efforts are needed to confirm the coding and validity of this burden.
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From page 204... ...
204 EPIDEMIOLOGICAL TRANSITIONS IN THE FORMERLY SOCIALIST ECONOMIES South FSE Region Males 15-59 25.3% Males 60+ 14.3% Females 0-4 12.8% _-___ Females 5-14 1.5% Females 15-59 1 1.2% FIGURE 6-3a Excess years of life lost by age, South FSE region. North FSE Region Males 15-59 44.8% Males 60+ 13.1%~ Females 0-4 6.2% /~ _ Females 5-14 0.9% Females 15-59 10.6% FIGURE 6-3b Excess years of life lost by age, North FSE region.
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From page 205... ...
Respiratory Infections 56.6% 205 Females 60+ 3.6% Females 15-59 4.2% Females 5-14 1.6% Diarrheal Diseases 17.0% Perinatal Conditions 10 8% Other 6~4% ~ Digestive 1.4% Em, Congenital 1.6% Drowning 1 9% Hepatitis 4.2% FIGURE 6-4 Excess years of life lost by cause for ages 0-4, Central Asia region.
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From page 206... ...
The literature on the rising mortality among adult males, particularly in North FSE, has stressed that most of the increase is due to cardiovascular disease. Here, we are examining not only the cause of the increase, but also the difference in the level of mortality.
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From page 207... ...
UNDERSTANDING NORTH FSE The mortality trends and cause-of-death patterns in North FSE are unique. Many hypotheses advanced to explain the rising adult mortality in the former Soviet Union really apply primarily to this region.
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From page 208... ...
It is difficult to blame rising adult male mortality on pollution in the face of declining child and adult female mortality, yet pollution could offer a partial explanation for the high levels of mortality among adult males in the region. Causes of death associated with air pollution, such as chronic respiratory disease and some cancers, do contribute to excess years of life lost.
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From page 209... ...
Given that the systems in South FSE and Central Asia are probably similar to if not worse than those in North FSE, the health system is unlikely to be the primary contributor to the problem. However, it is quite possible that adult mortality would be much lower with a better health system.
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From page 210... ...
Second, in North FSE, adult male mortality is markedly higher than expected based on income per capita or achievements in child mortality. This excess is probably caused by many factors, but the major contributors are cardiovascular disease, unintentional and intentional injuries, and lung cancer.
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From page 211... ...
Demeny 1966 Regional Model Life Tables and Stable Populations. Princeton, NJ: Princeton University Press.
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From page 212... ...
1981 Causes of Soviet adult mortality increases. Soviet Studies 33(4)
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From page 213... ...
Yang, and C Qiao 1992 Adult mortality: Levels, patterns and causes.
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From page 214... ...
The number of years of life lost due to a death at each age is based on the expectation of life at each age from model life table West, Level 26 (Coale and Demeny, 1966)
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From page 216... ...
Neuropsychiatric18,9402,87525,2704,5829,7868,879 Cardiovascular348,71962,343408,485109,363122,562122,115 Ischemic heart disease209,24538,071198,75262,72583,57668,277 Cerebrosvascular95,59917,997131,57834,97927,16338,736 Respiratory43,8273,04660,2235,65910,80914,271 Digestive21,9433,87449,5286,3298,15942,896 Cirrhosis7,21694422,1601,5143,30831,705 Genito-urinary13,4391,92422,8894,5795,2385,120 Congenital29,6564,84965,32110,66312,85018,734 III. Injuries208,65735,127358,35168,67088,348102,341 Unintentional148,96624,383260,21650,88163,54378,277 Motor vehicle accidents58,1549,77095,76224,69828,87635,964 Poisoning30,8303,57935,2854,5027,4808,255 Fall8,4972,16012,7184,5366,4804,570 Fire4,2611,35510,4463,1431,5942,239 Drowning20,5712,66633,4287,62710,4929,879 Intentional59,69110,74498,13517,79024,80524,064 Suicide43,6397,89461,80712,40319,95015,509 Homicide16,0522,85136,3285,3864,8568,555 Total944,723159,6701,729,953286,611347,919459,208 na.
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From page 217... ...
CHRISTOPHER J.L. MURRAY AND JOSE LUIS BOBADILLA Causes 217 Czecho ,ithuaniaMoldovaRussiaUkraineslovakiaHungaryPoland 19,98470,6731,598,546391,56889,91767,032268,350 6,313441,57216,724132,5957,70912,74658,598 3,2874,023189,18665,4752,3796,80216,875 5773,67572,91911,1164712041,736 1,1143,57072,08024,1722,0582,64611,947 2581,73914,0214,2424522552,917 2,65328,123430,21492,99538,08014,35055,440 46380329,7246,4144197351,946 11,05625,126714,294163,05144,33439,658153,439 39,587286,19510,175,6523,743,7601,145,294983,4762,642,410 64,62366,1312,803,1271,007,144345,048282,013716,789 9631,18277,67718,6765,6216,86511,934 8,4186,995498,669146,70024,02721,43660,610 5,3516,184239,30288,67840,56731,99254,252 12,73612,625612,074214,22775,34568,836170,001 5,6655,603182,42476,29024,12320,86147,882 2,0921,76361,89424,6857,5937,33025,166 5,8487,082218,59083,72940,00729,11880,889 1,8593,15680,84428,02419,74414,75347,162 1,5772,50850,68623,2204,6715,42315,138 n.a.n.a.n.a.n.a.9269683,201 9,7868,879253,83398,40228,48431,09778,273 22,562122,1155,363,0311,935,622590,377485,9981,312,738 83,57668,2772,734,9701,040,814307,213202,391401,671 27,16338,7361,788,185584,283155,493130,658185,295 10,80914,271496,772222,54529,39736,91767,271 8,15942,896422,347165,18885,632111,416113,857 3,30831,705135,63168,19251,04079,56142,661 5,2385,120188,44266,83826,99810,76441,914 12,85018,734419,457162,18326,20721,24198,009 88,348102,3413,947,9351,063,296195,324194,538578,825 63,54378,2772,705,250772,342138,082118,758442,427 28,87635,9641,035,106318,94850,20856,716197,840 7,4808,255513,406152,0059,6284,91757,200 6,4804,570128,08841,74929,20525,84644,266 1,5942,23984,07016,9982,5323,2817,938 10,4929,879338,46493,30210,1007,93637,084 24,80524,0641,242,685290,95457,25675,699136,406 19,95015,509779,248203,17150,30868,985111,526 4,8568,555463,43687,7836,9456,71024,925 47,919459,20815,722,1325,198,6241,430,4651,245,0383,489,650
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From page 218... ...
Noncommunicable147,412309,0711,706,6811,007,686677,313 Malignant Neoplasm37,46460,458366,894265,926151,471 Esophagus5908313,1284,1082,850 Stomach4,5196,97536,99024,64618,603 Colon/rectum2,5783,81625,52721,64816,218 Lung7,72510,78275,30258,02331,869 Breast3,9577,79028,46521,55112,174 Cervix9812,18222,2405,6023,587 Lymphoma/leukemia4,2246,58450,42431,68816,853 Diabetes3,7425,67116,97419,51313,993 Nutritional endocrine1,4821,1009,4135,9551,851 anemian.a.1,5871,133579n.a. Neuropsychiatric3,4904,72374,18733,87112,979 Cardiovascular69,500194,385866,168482,130400,596 Ischemic heart disease43,951117,140263,727118,260135,703 Cerebrosvascular18,16767,699239,944129,940133,364 Respiratory6,9649,90598,05928,99218,223 Digestive8,62619,517162,30362,43633,828 Cirrhosis2,68112,35990,78838,93017,686 Genito-urinary3,9076,51637,43118,39114,570 Congenital10,4814,99894,91327,45816,804 III.
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From page 219... ...
CHRISTOPHER J.L. MURRAY AND JOSE LUIS BOBADILLA 219 Central Asia DslaviaBulgariaAzerbaijanKyrgyzTajikistanTurkmenistanUzbekistan ]
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