Suchergebnisse

This study analyzes the effects of age, period, and birth cohorts on long-term mortality in Ukraine. For the first time, the APC model was used to analyze mortality in Ukraine for the 1850-2011 period and the cohorts born from 1850 to 1923. These estimations allow us to discriminate the impact of the historical and contemporary factors (at specific times) that could change the mortality rates. The following statistical methods are used: calculation of period and cohort death rates; age-period-birth cohort (APC) model that provides a method to assess the significance of the three interrelated factors (age, calendar period of death, and birth cohort) on mortality. As indicated by the results of APC analysis, the contribution of the period effect to the long-term mortality in Ukraine is likely to be larger than that of the cohort effect, and both effects are found to be more influential for men than for women. The analysis revealed intergenerational variations in death rates and inversion in cohort mortality when survival rates for the younger generations are worse than for the older generations. In particular, almost all generations born during the first half of the XX century had higher mortality rates than the reference cohort born in 1900, while lower mortality rates are found only for those born after 1945. At the same time, the overall decline in mortality among cohorts born after 1945 varied across different age groups: while death rates at the age 0 to 15 declined with each new generation, mortality in the 45 to 60 age group for younger generations tended to be higher than for older generations. The cohorts born in 1915—1925 and especially in 1917—1921 appeared to be the most disadvantaged and the hardest affected in terms of survival. A comparative analysis of the probability of dying in large age intervals for different generations showed that, first, among the cohorts of adult men who participated in World War II, those born in 1915—1925 were the most affected; second, during the First World War, the Ukrainian Revolution of 1917—1921 and the famine of 1921—1923 young and middle-aged men born in 1880—1890 suffered the greatest losses whereas the highest mortality due to Holodomor of 1932—1933 was observed among children and adolescents, as well as older persons born in the 1870s.

The aim of this paper is to identify the age-specifi c characteristics of the mortality in the large cities of Ukraine and their contributions to the changes in life expectancy in these cities. The article presents the results of a comparative analysis of the dynamics of life expectancy from 2002 through 2019 in six cities: Kyiv, Kharkiv, Odesa, Dnipro, and Donetsk. It is shown that most of the large cities have generally experienced higher life expectancy than other urban settlements in Ukraine, but there is a signifi cant variation in the levels and changes in life expectancy across cities. Overall, the study established the vanguard position of Lviv and Kyiv in terms of life expectancy, although these cities, as well as Kharkiv, showed a slower increase in life expectancy in 2002-2019. In contrast, Dnipro and Odesa, as well as Donetsk (up to 2014) having lower life expectancy and wider diff erences by sex demonstrated the pronounced improvement in life expectancy during that period. In recent years, there has been a trend towards narrowing the gap between cities, and this convergence is occurring more rapidly among men than among women. In 2002, the gap between cities with the highest and lowest life expectancy was 5.4 years for males and 2.6 years for females while in 2019 it was reduced to 2 years for men and 1.6 years for women. We made a decomposition of diff erences in life expectancy at birth between the cities in 2002 and 2019 to assess the age-specifi c mortality contributions into disparities between urban areas. The results have revealed that across almost all cities these diff erences are mainly driven by excess mortality in working ages. Also, we found that excess mortality in the middle working ages and under 1 year of age appeared to be the important factors of lower life expectancy in Donetsk compared to Lviv and Kyiv. Odesa and Dnipro are lagging behind by survival rate not only in the older but also in young working age groups, and Kharkiv has slightly higher mortality among older people (in comparison to Lviv and Kyiv). Th e conclusion is made that the main gradient of diff erences in life expectancy between the large cities has been determined mainly by deaths in working ages, i.e. mostly driven by health-related behavior and lifestyle. Nevertheless, a gradual shift in urban life expectancy diff erences is now taking place towards mortality in older age groups, i.e. more determined by the eff ectiveness of treatment of chronic diseases. Th e issue of data quality is also considered. In particular, the confi dence interval of the probability of dying in the fi rst year of life in the six selected cities is estimated to determine the accuracy of these indicators.

Large cities are often at the forefront of social change, not only in their region, but throughout the country. Therefore, the analysis of their demographic trends, in particular mortality by causes of death, is important not only by itself, but also in the context of general demographic prospects of the country. The aim of this study is to make a comparative analysis of the gains in life expectancy in Dnipro, Kyiv, Lviv, Odesa and Kharkiv over the period 2005— 2019, and an estimation of the cause-specific mortality contributions to the life expectancy changes. For the first time, decompositions analyses are conducted to evaluate contributions to fluctuations in life expectancy not only by age and sex, but also by causes of death for each of the five largest cities of Ukraine. The following statistical measures and methods are used: calculation and analysis of demographic rates, life tables, graphic method and decomposition method. Our results show that, during the observed period, life expectancy at birth has increased in all cities, mostly due to changes in mortality from circulatory diseases, which have resulted in a one-year increase in life expectancy among men in Odesa to almost 2.5 years among women of Kharkiv. However, it might be possible that such a large contribution in Kharkiv is a result of a part of the deaths falling into the category of ill-defined causes, for which mortality has increased rapidly in that city. The second major contribution to the improvement in life expectancy is attributable to external causes of death: from 0.3 years of increase in females of Lviv to almost 1.9 years in females of Odesa. Males in Odesa benefited the most from the reduction in mortality due to infectious diseases (+2 years). In some cases, there was a significant positive contribution of the reduction in mortality from diseases of the digestive system (+0.5 years in men of Dnipro). The decline in cancer mortality also had a positive impact on life expectancy in all cities, except for Kharkiv. Overall, the increase in life expectancy for men was due to a reduction in mortality at younger ages than for women. In particular, the common age interval for all five cities, with men having the greatest gain in life expectancy, is 45-59 years, while for women it is 65 to 79 years. In men, the gain in life expectancy was accounted for by the decline in mortality at the age 45 to 59 years, with 24.4 per cent in Odesa and almost 46 per cent in Lviv and Kharkiv, mainly due to a reduction in mortality from circulatory diseases and external causes. In women, the decline in mortality at the age 65 to 79 years contributed 30.3-34.8 per cent of the increase in life expectancy in Dnipro, Kyiv and Lviv; however, in Odesa it was only 19.4 per cent, in Kharkiv it was almost 54.3 per cent, which seems unlikely due to an increase in the proportion of ill-defined causes of death. In all five cities, the main trend over 2005-2013 years was the decline in mortality from the major causes of death, while the period 2013-2019 was turbulent, with mortality by causes of death changing in different directions even in the same city. Some contradictory results may be explained by the deterioration in the quality of the registration of demographic events as well as changes in the age and sex structure of the population of cities, which have not been reflected in the current estimates of the State Statistical Committee of Ukraine due to the long absence of a population census.

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.