Health and mortality in Eastern Europe

This paper aims to explore the association between two chronic health conditions (heart attack and stroke) and disability among older population (50+) in different welfare regimes with the special focus on East European countries. It is of interest to understand the risk of disability due to heart attack and stroke among older population in the countries where the timing of entrance to the phase of cardiovascular revolution has differed remarkable. The analysis includes 16 European countries that carried out the fourth wave of SHARE (Survey on Health, Ageing and Retirement) in 2010-2011. Disability will be measured by using both ADL and IADL instruments combined into three scales (basic, medium, complex) in order to reflect different levels of disability. Odds ratios for two chronic diseases will be calculated in relation to disability levels and logistic regression analysis will be conducted to assess the associations between diseases and disabilities. Model includes demographic (gender, age) and socio-economic variables (the highest level of attained education, partnership status), life-time occurrence of some behavioural aspects such as smoking and alcohol consumption. Cholesterol, blood pressure and diabetes are considered the confounding risk factors to heart attack and stroke.

While studies examining differentials in mortality across Eastern European countries abound, few researchers to date have focused on the diversity in quality of life. Using data from the European Values Study (EVS), the present study investigates variations in quality of life, measured by healthy life expectancy (HLE) between ages 20 and 74 for 23 Eastern European countries in 2008. The analyses from the prevalence-based Sullivan method demonstrate substantial disparities in quality of life between East Central Europe and the former Soviet Union. In 2008, the difference in HLE amounted to 21.79 years for men (ranging from 35.57 years in Macedonia to 13.98 years in Russia) and 21.86 years for women (from 34.37 years in the Czech Republic to 12.51 years in Russia). These findings suggest that men and women in East Central Europe enjoy much healthier lives compared to those in the former Soviet Union. Fully understanding the diversity in population health status within Eastern European countries requires research that focuses not only on quantity of life but also on quality of life.

It is acknowledged that the level of injury mortality reacts quickly to socioeconomic changes. Transition from the Soviet system initially brought a two-fold rise from the average level of the 80’s to an injury SDR of 242 per 100000 in 1994 in Estonia (54 in EU). Thereafter the decline, both in total mortality and injury mortality, has been exemplary. The nature and success of reforms is the best explanation for differences among countries according to Vallin and Shkolnikov. During the Asian crisis of 1997/8 and especially the 2008/9 global recession, which had severe economic consequences, the trend did not change – injury SDR fell from 110 in 2007 to 77 in 2011.

Interestingly today, when the injury mortality is much lower, inherent characteristic features still remain in Estonia. The male/female ratio, globally around 2, has firmly stayed at 4-5 during past 20 years. Unlike in most countries where injury mortality is peaking in the oldest age group, a second peak at the age of 45-59 is evident.

There is a notable difference between cohorts during the transition – those born around 1955 were hit the hardest. Employed population has enjoyed a significant decline of injury deaths, unemployed have seen their situation stabilise.

Numerous population- and individual-level studies have confirmed a strong relationship between excessive alcohol consumption and striking excess male mortality in the countries of the former USSR. Yet the complex interplay between macro- and micro-level factors underlying this relationship has remained underexplored. Our analysis refers to the most recent period, and focuses on the male population aged 20-64. Using the detailed cause-specific mortality at the district level we first explore a spatial distribution of alcohol-related mortality in the two neighboring countries, Belarus and Lithuania. Then, using the simultaneous autoregressive models we assess the strength of association between mortality and its potential determinants. As independent explanatory macro-level variables we consider a set of indicators available from the adjacent population censuses such as unemployment, education, marital status, and ethnicity. The preliminary results show that the districts located at the Belarus-Lithuania border show similar patterns and form large cross-border areas with elevated alcohol-related mortality. Although mortality variation is likely to be largely explained by differences in the contemporary socioeconomic conditions, the observed spatial patterns suggest the relevance of the common socio-cultural context.

This paper compares regional cause-specific mortality profiles in the course of time from the last census in Soviet Union (1989) to nowadays (2010) taking for the reference point the year of the last and a single so far census in Ukraine, 2001. In the early 2000s, the geography of mortality varies from one cause to the other. Standardized death rates for the biggest killer, circulatory system diseases were higher in eastern and northern parts of the country, which is sometimes associated with Chernobyl disaster. Mortality from external causes was as well high on the east, center and north. South is distinctive by infectious mortality and digestive system problems. The results show that this interregional variation has increased between 1989 and 2001 in respect to most causes of death except cancers and respiratory system diseases. Since 2001, reversely, differences are reducing.
Considering regional cause-of death patterns highlights the fact that some regions of Ukraine are more advanced than others on the path of health transition, which is characterized by the prevailed type of nosological structure as well as spread of lifestyles, self-preserving behaviour and modern attitude toward health in a wide sense.

The probability of death and with it the hope of survival depended in the past to a considerable extent on the level of advancement of the health service, the medical findings acquired and knowledge of the appropriate treatment processes. In the case of persons with Celiac Disease, which is a disease involving gluten intolerance, the hope of survival in the majority of countries was slim until the eighties of last century. These people died at a very young age thanks to ignorance of the diagnosis of their disease. However, as soon as it was possible to determine the diagnosis of Celiac Disease correctly there was a considerable breakthrough and progress rapidly changed the hope of survival for these people. In this way treatment procedures were found for hitherto unknown diseases, or at least there was information on reducing the consequences of these diseases. The submitted study will provide a look at the alternative assessment of the prob. of death of persons with Celiac Disease and the prob. of death in general. The modelling of the prob. of death of persons with Celiac Disease and persons in the general population is possible with the use of the LOGIT & PROBIT. On the basis of supplementary information about the population it’s then possible to construct various prob. scenarios with the utilisation of alternative variables.

The aim of our study is a critical analysis of modern methods of calculation of economic damage and the development (modification) of the optimal methodologies to assess the extent of economic losses due to mortality in the Far East Federal District, taking into account the valuation of the average life. This study is based on the concept of human capital, which considers health as one of the most important conditions for social and economic development of any territory.
Overall the Far East the total damage from the mortality of all ages increased by 2.8 times in 2003-2010, amounting to 42.7 billion of rubles or 2.4% of GRP in 2010. In Russia the growth rate of this indicator amounted to 2.6 times (in 2010 - 798 billion rubles or 2.5% of GDP). These estimates show that the mortality rate in the Far East and Russia as a whole, is associated with very significant economic losses, which couldn’t be ignored in the current circumstances, considering the low level of health, high mortality in the working age and the reduction of population.

Though high male mortality is considered to be a marker of negative demographic processes in Russia, situation with female mortality occurs to be less favourable.
The aim is to manifest the sources of unstable female mortality dynamics, age groups and death causes slowing down life expectancy growth in females during 2002-2010.
Mortality decreased by 15-23% depending upon age. In young and middle ages positive trends developed after 2005, in women over 50 - during the first part of decade.
Mortality decline in all age groups was due to external causes. In young and middle ages general positive dynamics was intensified by reduction of deaths in circulatory and respiratory diseases. But mortality from infections and digestive diseases retards positive processes.
Considering essential share of marginal deaths in external causes (alcohol poisonings, homicides, drawnings, falls etc.) it is possible to assume that their reduction reflects gradual negotiation of population marginalization, growth of living standards, decrease of poverty scale. But growth of mortality from infections and digestive diseases evidences that marginalization factor is not overcome. The form of its manifestation changes: in 1990s marginal population increased mortality risk from external causes, nowadays their mortality switches to somatic causes.

In the Caucasus region, data quality has always been at issue, but since the collapse of the Soviet Union in 1991, the issue becomes more acute. In the 1990s mortality rates published by national statistics of Armenia and Georgia were far from the real levels. In this paper, we are going to focus on the third Caucasian country Azerbaijan and to propose adjusted infant mortality rates.
For the 1990s and the 2000s, it is possible to rely on results issued of recent demographic surveys to estimate the under-registration of infant deaths. After producing new estimates for the last two decades we discuss possible assumptions to correct the levels of infant mortality during the Soviet period, using information on mortality by month of age and by cause of death below age 1.