TRANSFORMATION OF MORTALITY BY SEX IN THE FOUR BIGGEST CITIES IN UKRAINE

Abstract

Large cities concentrate a substantial part of the educated, highly qualified, and economically active populations. Such social “selection” with the peculiarities of lifestyle determines the distinctive characteristics of the level and structure of mortality. Even though data on deaths by causes of death for the large cities are available in Ukraine, very few studies have analyzed cause-specific mortality in these cities. The objective of the study is to make a comparative analysis of mortality from the most influential causes of death in large cities. The novelty lies in the comparative analysis done for Dnipro, Kyiv, Lviv, Odesa, and Kharkiv for the first time. The study uses the direct method of standardization to calculate standardized death rates by sex in 2005-2019.

The results indicate lower all-cause mortality rates for the large city residents compared to the corresponding average country-level indicators. Kyiv, Lviv, and Odesa have lower death rates compared to Dnipro and Kharkiv. In Kyiv and Lviv, this is attributed to lower mortality from almost all major causes of death, while in Odesa this mainly resulted from the extremely low ischemic heart disease mortality. Relatively high mortality from circulatory diseases is observed in Kharkiv and Dnipro. However, in Dnipro, this is associated with a high death rate from coronary heart disease and a very low contribution of cerebrovascular disease, whereas in Kharkiv coronary and cerebrovascular disease death rates are quite high. Mortality rates from diseases of the digestive system in the large cities are found to be the closest to the average in Ukraine (except for Lviv). The neoplasms are the only large group of diseases with a mortality rate that exceeds the average level in Ukraine, in particular for women. Overall, the death rates from most of the causes of death in the large cities demonstrated a positive trend in 2005-2019, with some exceptions. External causes and infectious diseases showed the most decrease while mortality from AIDS and ill-defined causes increased. Also, there were uncertain dynamics of deaths due to suicide and injuries with undetermined intent. Given some specific mortality differences between the cities, some concerns have been raised over the accuracy of the coding of diagnoses. In particular, unusually low mortality from ischemic heart disease was found in Odesa and from cerebrovascular disease in Dnipro, very rare deaths from alcoholic liver disease in Odesa, accidental alcohol poisoning in Kyiv, and a group of other liver diseases in Dnipro. We also assume misclassification of suicides as injuries with undetermined intent in Kharkiv. Our findings highlight the importance of the implementation of automated coding and selection of causes of death that can minimize the number of subjective decisions made by coders and lead to significant improvements in the quality of data.

REFERENCES

1. Korchak-Chepurkivsky, Yu. (1930). Mortality in 4 Largest Cities of the USSR in 1923-1929. Kyiv: VUAN [in Ukrainian].
2. Global report on urban health: equitable, healthier cities for sustainable development (2016). World Health Organization & UN-Habitat. https://apps.who.int/iris/handle/ -10665/204715
3. Population оf Ukraine 2019: Demographic Yearbook (2020). State statistics service of Ukraine. http://ukrstat.gov.ua/druk/publicat/kat_u/2020/zb/10/zb_nas_ 2019.pdf [in Ukrainian].
4. Revision of the European Standard Population (2013). Luxembourg: Publications Office of the European Union.
5. Korchak-Chepurkivsky, O. V. (Ed.). (1929). Complete International nomenclature and classification of diseases and causes of death. (2nd ed.). Kharkiv: State Trust “Harpoligraf ”. The third printing house named after Frunze. http://irbis-nbuv.gov.ua/ulib/item/0002073 [in Ukrainian].
6. Ptoukha, М. (1960). An Essays to Population Statistics. Moscow [in Russian].
7. Zarulli, V., Kashnitsky, I., & Vaupel, J. W. (2021). Death rates at specific life stages mold the sex gap in life expectancy. Proceedings of the National Academy of Sciences 118. https://doi: 10.1073/pnas.2010588118
8. Korchak-Chepurkovsky, A. V. (1902). Change in mortality in Kiyv since the introduction of sewage in it. Report to the fi ft h plumbing congress in Kiyv in March 1901 [in Russian].
9. Hladun, O. M. (Ed.). (2020). The population of Ukraine. Demographic trends in Ukraine in 2002-2019. Ptoukha Institute for Demography and Social Studies of the National Academy of Sciences of Ukraine. Kyiv [in Ukrainian].
10. Rodionova, L. A., & Kopnova, E. D. (2020). Gender and Regional Differences in the Life Expectancy in Russia. Questions of statistics, 27(1), 106-120. https://doi.org/10.34023/2313-6383-2020-27-1-106-120 [in Russian].
11. Andreev, E. M. (2001). Mortality of men in Russia. Questions of statistics, 7, 27-33 [in Russian].
12. Shchur, A. (2019). Cities of over a million people on the mortality map of Russia. Demographic survey, 5 (5), 64-84. https://doi.org/10.17323/demreview.v5i5.10179
13. Cullen, M. R., Baiocchi, M., Eggleston, K., Loft us, P., & Fuchs, V. (2015). The weaker sex? Vulnerable men, resilient women, and variations in sex differences in mortality since 1900 (No. w21114). National Bureau of Economic Research. https://doi 10.3386/w21114
14. Ryngach, N. О. (2021). Mortality in Metropolises of Ukraine: Historical Parallels with the Study of Yu. O. Korchak-Chepurkivsky. Statistics of Ukraine, 91 (1), 47-57. https://doi:10.31767/su.1(92)2021.01.05 [in Ukrainian].