Trends, patterns, and determinants of regional mortality in Belarus, 1990–2007

Figures & data

Figure 1  Territorial division of Belarus: regions (oblast), districts (rayons), and cities

Source: www.diva-gis.org (base maps).

Table 1  Life expectancy (years) at birth by sex and its changes by region, Belarus 1990–2007

	Life expectancy				Changes in life expectancy
Region	1990	1995	2001	2007	1990–95	1995–2001	2001–07	1990–2007
Males
Brest	67.3	64.4	63.9	65.6	−2.9	−0.5	1.7	−1.7
Vitebsk	65.7	62.1	62.2	64.0	−3.6	0.1	1.8	−1.7
Gomel	66.5	62.8	61.8	63.5	−3.7	−1.0	1.7	−3.0
Grodno	67.0	62.8	62.4	64.1	−4.2	−0.4	1.7	−2.9
Minsk-city	68.6	63.9	65.8	67.4	−4.7	1.9	1.6	−1.2
Minsk	65.2	61.4	61.1	62.8	−3.8	−0.3	1.7	−2.4
Mogilev	66.0	62.8	61.9	63.8	−3.2	−0.9	1.9	−2.2
Belarus	66.3	62.9	62.8	64.5	−3.4	−0.1	1.7	−1.8
Females
Brest	76.3	74.9	75.2	76.5	−1.4	0.3	1.3	0.2
Vitebsk	75.8	74.0	74.1	75.7	−1.8	0.1	1.6	−0.1
Gomel	76.2	74.0	74.2	75.8	−2.2	0.2	1.6	−0.4
Grodno	76.3	74.2	74.5	76.4	−2.1	0.3	1.9	0.1
Minsk-city	76.3	75.1	76.1	77.8	−1.2	1.0	1.7	1.5
Minsk	76.0	73.9	73.5	75.0	−2.1	−0.4	1.5	−1.0
Mogilev	76.0	74.2	73.7	75.5	−1.8	−0.5	1.8	−0.5
Belarus	75.6	74.3	74.5	76.2	−1.3	0.2	1.7	0.6
Source: Belstat 2009a.

Figure 2  Age-standardized death rates (per 100,000 population) from main causes of death, both sexes by region, Belarus 1990–2007

Note: Death rates were standardized using the indirect method of standardization.

Source: Belstat 2009a.

Figure 3  Age-standardized death rates (per 100,000 population) from all causes of death by sex, Belarus 2003–07

Note: Quintile method of classification was used to produce these and the following maps.

Source: Belstat official unpublished data.

Figure 4  Age-standardized death rates (per 100,000 population) from main causes of death, both sexes, Belarus 2003–07

Source: As for Figure 3.

Figure 5  Areas of Belarus contaminated with radionuclides Te-132 and I-132 in April–May 1986

Source: Zuravkov and Mironov 2005, cited in Yablokov et al. 2007.

Figure 6  LISA cluster maps of mortality from selected causes of death, both sexes, Belarus 2003–07

Note: Calculations were performed using GeoDa™; p=0.05, 9,999 permutations.

Source: As for Figure 3.

Table 2  Description and summary statistics of variables predicting mortality at the oblast level, Belarus 1997–2007

Variables	Description	Mean (SD)
Unemployment	Unemployment rate (per cent). The official level of unemployment (only those officially registered as being unemployed are counted)	2.2 (0.9)
Poverty	Poverty rate (per cent). The proportion of people with income below the poverty line. Based on the data from the Income and Expenditure of Households Sample Survey	26.7 (13.9)
Alcohol	SDR from accidental poisonings by alcohol (per 100,000). A proxy measure reflecting hazardous alcohol consumption	27.9 (9.4)
Physicians	Number of physicians per 10,000 residents. A crude indicator of the availability of health care resources	42.1 (11.8)
Source: Belstat 1997–2007, 2009b; Belstat official unpublished data.

Table 3  Multivariate analysis of factors associated with mortality from selected causes of death at ages 15–64 for males and females at the regional level, Belarus 1997–2007. (Panel regression model with fixed effects)

	Dependent variable (SDR per 100,000 population)
		Diseases of the circulatory system			External causes
Independent variables	All causes	All	Heart diseases	Cerebrovascular diseases	All	Suicide	Homicide
Males
Unemployment	25.8** (9.1)	14.2** (4.1)	9.7** (3.4)	4.1*** (0.7)	4.6 (3.0)	2.8** (0.8)	0.9 (0.5)
Poverty	0.4 (0.4)	−0.3 (0.2)	−0.4 (0.2)	0.1* (0.1)	0.7*** (0.2)	0.3*** (0.0)	0.1*** (0.0)
Alcohol	5.0*** (0.7)	1.6** (0.4)	1.3** (0.4)	0.2** (0.1)	2.3*** (0.2)	0.3*** (0.1)	0.1** (0.0)
Physicians	−1.8 (1.8)	−1.0 (1.0)	−0.7 (0.8)	−0.3 (0.2)	X	X	X
Constant	687.8	284.4	216.2	63.1	145.2	28.1	3.7
F	103.73	29.84	38.54	198.53	133.83	24.84	49.04
Prob > F	0.0000	0.0004	0.0002	0.0000	0.0000	0.0009	0.0001
Within R ^2	0.5701	0.4063	0.3661	0.5553	0.5031	0.5664	0.5360
Females
Unemployment	9.4*** (2.0)	6.8*** (1.3)	4.0*** (1.0)	2.6*** (0.6)	1.4** (0.5)	0.4 (0.2)	0.4 (0.3)
Poverty	0.4** (0.1)	0.3** (0.1)	0.1** (0.0)	0.2*** (0.0)	0.1*** (0.0)	0.03** (0.0)	0.1*** (0.0)
Alcohol	1.5*** (0.2)	0.6*** (0.1)	0.5*** (0.1)	0.1 (0.0)	0.7*** (0.1)	0.05* (0.0)	0.1*** (0.0)
Physicians	−0.2 (0.4)	−0.2 (0.3)	−0.1 (0.2)	−0.1 (0.1)	X	X	X
Constant	189.6	70.2	41.2	25.2	22.9	3.8	0.8
F	20.69	27.42	24.19	78.78	38.50	16.99	46.83
Prob > F	0.0012	0.0005	0.0008	0.0000	0.0003	0.0025	0.0001
Within R ^2	0.6212	0.7112	0.5878	0.6096	0.5951	0.1762	0.4638
Note: Figures in the table are regression β coefficients; as an independent variable varies over time by one unit, a dependent variable increases or decreases by β units. Standard errors are presented in parentheses ***p<0.01; **p<0.05; *p<0.1. Number of observations N×T=7 regions×11 years = 77.
Source: As for Table 2.

Appendix A. List of causes of death used in the analysis and their correspondence to the Soviet classification of 1988, abridged list of ICD-10 used in Belarus, and ICD-10

	Abridged version of ICD-10 used in Belarus (2002–)	Soviet classification of 1988 (1988–2001)	ICD-10 (detailed list)
Infectious diseases	1–58	1–44	A00–A99, B00–B99
Tuberculosis	9–17, 57	9–13, 43	A15–A19, B90
Cancers	59–94	45–67	C00–C97, D00–D48
Cancer of lip, oral cavity, and pharynx	59	45	C00–C14
Cancer of oesophagus	60	46	C15
Cancer of stomach	61	47	C16
Cancer of larynx, trachea, bronchial tubes, and lungs	68–69	52, 53	C32–C34
Cancer of the breast	75	57	C50
Cancer of uterus	76–77	58, 59	C53–C55
Cancer of prostate	80	61	C61
Cancer of thyroid gland	86	64	C73
Leukaemia	91,92	65	C91–C95
Diseases of the circulatory system	124–159, 253	84–102, 158	I00–I99, R54
Heart diseases plus senility^1	124–143,253	84–97, 158	I00–I52, R54
Senility	253	158	R54
Cerebrovascular diseases	144–153	98, 99	I60–I69
Diseases of the respiratory system	160–177	103–114	J00–J99
Diseases of the digestive system	178–193	115–127	K00–K93
Cirrhosis and fibrosis of liver	186–187	122–123	K70, K74
Other causes of death	Residual	Residual	Residual
Certain conditions originating in perinatal period	219–235	151–157	P00–P96
External causes	256–277	160–175	V01–Y84
Motor vehicle transport accidents	256–262	160–162	V01–V89, V98–V99
Accidental poisoning by alcohol	269	163	X45
Suicide	271	173	X60–X84
Homicide	272	174	X85–Y09
Unspecified violent death	273	175	Y10–Y34
Other accidents	263–268, 270, 274–277	164–172	W00–W99, X00–X44, X46–X99, Y40–Y84
All causes	1–277	1–175, 206	A00–R99, V01–Y98
^1Item ‘senility’ was combined with ‘atherosclerotic cardiosclerosis’ (and consequently with heart diseases) because there were some reasons to suspect an exchange between these items. First, in Belarus an artificial rise of the share of ‘senility’ in the total number of deaths (from 0.07 to 12 per cent between 1988 and 1991) occurred at the expense of cardiovascular diseases, and the increase was related to a special directive of the Ministry of Health of the USSR regarding the registration of senility and CVD mortality at older ages (see Shkolnikov et al. 1996). Also, in the Soviet system of death registration (which is still largely maintained in Belarus), the leading cause of death of a significant proportion of imprecise diagnoses was ‘atherosclerotic cardiosclerosis’ (Vallin et al. 2005), making this well-defined item somewhat ‘ill-defined’.

Appendix B. Summary statistics for the number of deaths by causes; ‘rayon’ level, 5-year period, Belarus 2003–07

	118 rayons				13 cities
	Min	Max	Mean	SD	Min	Max	Mean	SD
All causes	1,050	13,362	3,975	2,094	2,711	167,266	23,933	43,586
Males	558	7,114	2,060	1,144	1,605	92,386	13,204	24,065
Females	492	6,248	1,915	956	1,106	74,880	10,728	19,522
Infectious diseases	3	339	36	39	26	1,610	257	419
Cancers	319	1,577	446	291	410	31,296	4,289	8,200
Lung cancer	23	336	108	62	81	5,170	751	1,344
Cancer of thyroid gland	0	7	1	1	2	92	13	24
Leukaemia	1	50	15	10	17	1,172	160	310
Diseases of the circulatory system	611	8,558	2,190	1,260	1,335	89,836	12,950	23,400
Diseases of the respiratory system	16	548	165	115	33	3,978	584	1,036
Diseases of the digestive system	10	479	96	78	109	7,650	1,022	2,009
External causes	111	1,518	445	256	468	19,738	2,875	5,130
Certain conditions originating in perinatal period	0	26	6	5	6	482	61	128
Source: Belstat official unpublished data.

Appendix C. Age-standardized death rates (SDRs) from selected causes of death by region and sex, Belarus 2005–07

	Males								Females
	Total	Brest	Vitebsk	Gomel	Grodno	Minsk-city	Minsk	Mogilev	Total	Brest	Vitebsk	Gomel	Grodno	Minsk-city	Minsk	Mogilev
All causes	1,826.1	1,746.4	1,896.2	1,880.0	1,914.6	1,502.4	1,986.3	1,935.3	854.2	827.0	887.7	867.0	876.6	709.9	917.4	918.1
Infectious diseases	23.7	17.1	21.2	39.7	29.3	14.2	21.9	26.4	5.2	4.5	4.9	8.6	6.1	3.7	3.6	5.6
Tuberculosis	16.5	14.6	15.1	20.1	24.4	9.4	16.2	19.9	2.2	2.2	2.1	2.9	2.5	1.3	2.1	2.6
Cancers	261.7	243.4	260.4	271.3	260.8	276.5	257.7	272.3	110.6	103.6	110.1	107.1	104.7	139.0	101.0	112.0
Cancer of lip, oral cavity, and pharynx	14.3	9.3	14.5	18.6	16.2	11.0	16.1	15.7	0.9	0.9	0.7	1.0	0.7	1.20	0.8	1.1
Cancer of oesophagus	7.9	7.1	5.6	7.7	8.9	7.6	9.3	9.4	0.5	0.2	0.2	0.9	0.5	0.6	0.6	0.3
Cancer of larynx, trachea, bronchus, and lung	82.2	82.7	81.9	87.4	83.5	70.1	87.8	86.0	5.5	5.6	6.1	4.4	6.0	7.1	4.4	5.5
Cancer of stomach	36.5	34.4	39.4	37.0	32.7	37.2	37.1	38.8	14.1	13.0	14.7	14.5	11.6	14.9	13.8	16.3
Cancer of prostate	18.6	13.8	20.4	18.5	16.8	24.0	18.8	18.0	–	–	–	–	–	–	–	–
Cancer of the breast	0.2	0.2	0.1	0.2	0.3	0.3	0.0	0.0	19.9	18.6	19.3	17.4	20.7	26.2	18.6	18.5
Cancer of the uterus	–	–	–	–	–	–	–	–	10.9	9.6	10.6	11.0	8.9	12.8	11.0	13.0
Diseases of the circulatory system	1,033.4	1,069.7	1,001.1	1,054.9	1,009.5	850.6	1,141.9	1,112.4	592.2	602.3	591.5	611.4	592.3	450.8	649.2	649.9
Heart diseases plus senility	802.5	887.9	741.8	851.9	793.2	558.2	902.9	878.0	447.1	489.5	425.6	486.8	455.4	268.6	492.5	502.9
Senility	98.0	157.1	113.2	109.5	67.7	37.4	82.3	115.8	120.4	164.0	142.0	141.4	89.0	51.9	102.1	144.0
Cerebrovascular diseases	170.8	125.6	173.3	157.6	169.7	211.4	182.2	187.4	114.2	80.0	122.7	101.4	114.6	143.0	125.1	123.4
Diseases of the respiratory system	93.8	59.1	167.3	66.1	151.9	46.7	94.5	83.9	16.5	8.4	31.6	9.4	32.2	9.1	15.3	11.1
Diseases of the digestive system	60.0	53.1	55.5	58.1	74.0	69.6	56.8	54.9	28.9	23.7	28.9	27.4	35.5	30.9	29.9	28.5
Cirrhosis and fibrosis of liver	35.8	33.8	33.9	30.4	48.7	40.2	32.8	32.0	18.6	15.2	20.4	15.9	25.1	17.3	20.0	18.5
Injury and poisoning	264.4	219.1	317.9	273.7	299.6	183.4	306.8	287.8	58.8	44.1	78.4	55.6	63.4	41.8	71.4	67.5
Motor vehicle transport accidents	31.4	33.1	32.9	28.8	31.5	22.1	45.0	29.1	8.8	8.2	9.4	7.7	8.8	7.3	12.7	9.0
Accidental poisoning by alcohol	47.8	26.1	69.5	50.5	70.3	33.1	38.1	59.8	12.1	5.6	21.0	11.6	16.7	6.8	11.4	16.1
Suicide	50.3	45.1	67.1	53.3	58.3	20.8	61.5	57.9	7.5	5.8	10.7	7.2	7.2	3.9	9.7	9.7
Homicide	10.7	6.5	15.4	13.6	9.2	5.0	13.3	13.8	4.2	2.8	5.5	5.1	4.5	1.8	5.2	5.7
Unspecified violent death	29.4	29.6	23.5	25.0	14.0	43.8	32.8	32.0	6.6	8.1	6.5	5.1	4.0	8.5	7.0	6.6
Other accidents	94.8	78.7	109.5	102.5	116.5	58.6	116.1	95.2	19.6	13.6	25.3	18.9	22.2	13.5	25.4	20.4
Other causes of death (residual)	89.1	84.9	72.8	116.2	89.5	61.4	106.7	97.6	42.0	40.4	42.3	47.5	42.4	34.6	47.0	43.5
Source: Belstat official unpublished data.

Belstat . 2009a . Population of the Republic of Belarus. Statistical Yearbook . Minsk : National Committee of Statistics of Belarus , 436

 Google Scholar

Zuravkov , V. V. and Mironov , V. P. 2005 . Ispol'zovanie GIS-technologii pri ocenke zagryzneniya territorii RB radionuklidami ioda na aktivnoi stadiii [Using GIS technology in the assessment of the contamination of the territory of the Republic of Belarus with radionuclides of iodine] . Izvestiya Belorusskoy Ingenernoy Akademyi , 2 ( 20 ) : 187 – 189 .

 Google Scholar

Yablokov , A. V. , V. B. Nesterenko , and A. B. Nesterenko . 2007 . Chernobyl’: Posledstviya Katastrophy dlya Cheloveka i Prirody [Chernobyl: Consequences of the Catastrophe for People and the Environment] . Sankt-Petersburg : Nauka . Available: http://www.rus-green.ru/publications/fil_yablokov2.pdf (accessed: 23 July 2010) .

 Google Scholar

Belstat . 1997–2007 . Raschody i Dochody Naseliniya Respubliki Belarus [Expenditures and Income of the Population of Belarus]. Annual Statistical Publications . Minsk : National Committee of Statistics of Belarus (Belstat) .

 Google Scholar

Belstat . 2009b . Regiony Respubliki Belarus [The Regions of the Republic of Belarus]. Statistical Yearbook . Minsk : National Committee of Statistics of Belarus , 870

 Google Scholar