乌克兰各大城市按死因分列的死亡率

N. Levchuk, P. Shevchuk
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引用次数: 1

摘要

大城市集中了大部分受过良好教育、高素质和经济活跃的人口。这种带有生活方式特殊性的社会“选择”决定了死亡率水平和结构的鲜明特征。尽管有乌克兰大城市按死因分列的死亡数据,但很少有研究分析了这些城市中特定原因的死亡率。这项研究的目的是对大城市中影响最大的死亡原因造成的死亡率进行比较分析。新颖之处在于首次对第聂伯罗、基辅、利沃夫、敖德萨和哈尔科夫进行了比较分析。该研究使用直接标准化方法计算2005-2019年按性别划分的标准化死亡率。结果表明,与相应的国家平均指标相比,大城市居民的全因死亡率较低。基辅、利沃夫和敖德萨的死亡率比第聂伯罗和哈尔科夫低。在基辅和利沃夫,这是由于几乎所有主要死因的死亡率都较低,而在敖德萨,这主要是由于缺血性心脏病死亡率极低。哈尔科夫和第聂伯罗的循环系统疾病死亡率相对较高。然而,在第聂伯罗,这与冠心病的高死亡率和脑血管疾病的低死亡率有关,而在哈尔科夫,冠心病和脑血管疾病的死亡率相当高。大城市的消化系统疾病死亡率与乌克兰的平均水平最接近(利沃夫除外)。在乌克兰,肿瘤是死亡率超过平均水平的唯一一大类疾病,特别是对妇女而言。总体而言,2005-2019年,除了一些例外,大城市大多数死因的死亡率呈现出积极趋势。外因和传染病的死亡率下降幅度最大,而艾滋病和原因不明的死亡率上升。此外,由于自杀和意图不明的伤害而导致的死亡也存在不确定的动态。考虑到城市之间的死亡率差异,人们对诊断编码的准确性提出了一些担忧。特别是,敖德萨的缺血性心脏病死亡率和第聂伯罗的脑血管疾病死亡率异常低,敖德萨的酒精性肝病死亡率非常罕见,基辅的意外酒精中毒死亡率和第聂伯罗的其他肝脏疾病死亡率非常低。我们还假设在哈尔科夫,自杀被错误地归类为意图不明的伤害。我们的研究结果强调了实施自动编码和死亡原因选择的重要性,这可以最大限度地减少编码人员做出的主观决定的数量,并显著提高数据质量。
本文章由计算机程序翻译,如有差异,请以英文原文为准。
Mortality by Causes of Death in Metropolices of Ukraine
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.
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