patterns of regional mortality in ukraine from soviet...

PATTERNS OF REGIONAL MORTALITY IN UKRAINE FROM SOVIET TIME TO NOWADAYS

Svitlana PONIAKINA

XXVII IUSSP International Population Conference26‐31 August 2013, Busan, Korea

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

Research questions:

3

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 ?

Data

4

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

Method:

5

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

12

‐ 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

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

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?

I. Life expectancy at birth by regions: males

1988‐1991: LE – 65.5 yearmax‐min = 4.4 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

I. Life expectancy from past till now: females




>76.5

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

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

12

‐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)

13

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)

14

‐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

15

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

16

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

17

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

Conclusions:

18

• 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.

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