Demografska analiza uticaja zdravstvene zaštite i javnog zdravlja na trendove smrtnosti stanovništva Srbije
Abstract: Osnovni cilj monografije je razmatranje uticaja zdravstvene zaštite i javnog zdravlja na stope smrtnosti stanovništva Srbije. To se čini putem traženja odgovora na sledeća specifična pitanja: Da li se može, pomoću analize mortalitetne statistike, ocenjivati da li sistem zdravstvene zaštite i javnog zdravlja Srbije zaostaje u odnosu na razvijene zemlje? Da li se unapređenje sistema zdravstvene zaštite i javnog zdravlja može iskoristiti za produženje životnog veka muškaraca i žena u Srbiji? Da li postoje margina… Show more
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Cited by 4 publications
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Avoidable mortality is defined as death that could have been avoided by adequate and timely healthcare and public health and prevention measures. The method measures the efficiency of the health system by quantifying premature deaths (0-74) from certain causes. The analysis of avoidable mortality in Serbia, including both amenable and preventable mortality, covers the period from 2010 to 2019. The results for Serbia have shown that the contribution of specific mortality rates by age is mostly positive and that in the second decade of the 21st century, we can see a trend of increasing life expectancy (LE). The decomposition of life expectancy by age groups, sex, and cause of death showed that most positive contributions relate to the reduction of avoidable mortality (about 70%). Observed by gender, the reduction in avoidable mortality rates is higher in men, especially in middle-aged people, where gains in LE are over 80%. In women, the share of avoidable mortality by age in changes in LE is usually around 70%. Avoidable mortality rates in Serbia remain relatively high compared to the rest of Europe, but there is a positive shift. The fact that the probability of avoidable mortality in the male population at birth in Serbia is about 30% (18% for women) shows that there is much room for improvement. With the hypothetical elimination of avoidable mortality, the increase in LE in men could be 6.3 years, and in women 3.9. Amenable and preventable mortality rates are always higher in the male population, but the reduction in standardised values is more intense in men in Serbia. Standardised preventable mortality rates have been declining faster than standardised amenable mortality rates in Serbia. Since the male population is significantly more burdened with preventable causes of death, the possibility of reduction is higher. Diseases and conditions that can be amenable by adequate healthcare showed a steady decrease in mortality rates by sex in the observed period, while the main difference observed in avoidable mortality is the result of a greater shift in preventable mortality in men. The most significant positive trend in the reduction of avoidable mortality is in cardiovascular diseases and violent deaths. At the beginning of the observed period, cardiovascular diseases had a higher share than cancer, but 10 years later the situation changed, and cancer became the most significant cause of avoidable mortality in Serbia, with an increasing trend. Malignant neoplasm of the trachea, bronchi, and lungs is the most common disease that can be avoided, while ischemic heart disease is in second place. Data from the 10-year period (2010 to 2019) show that respiratory diseases, infectious and contagious diseases, and addiction have a clear growth trend, as does cancer. The most significant positive trend in the reduction of avoidable mortality is in cardiovascular diseases and violent death. Diseases that can be treated and prevented by lifestyle changes and regular check-ups can significantly extend life expectancy in Serbia. Investing in the healthcare system pays off many times over because the costs of treating an individual are reduced in the long run, and that person can potentially contribute more to the community in good health over the years.
Avoidable mortality is defined as death that could have been avoided by adequate and timely healthcare and public health and prevention measures. The method measures the efficiency of the health system by quantifying premature deaths (0-74) from certain causes. The analysis of avoidable mortality in Serbia, including both amenable and preventable mortality, covers the period from 2010 to 2019. The results for Serbia have shown that the contribution of specific mortality rates by age is mostly positive and that in the second decade of the 21st century, we can see a trend of increasing life expectancy (LE). The decomposition of life expectancy by age groups, sex, and cause of death showed that most positive contributions relate to the reduction of avoidable mortality (about 70%). Observed by gender, the reduction in avoidable mortality rates is higher in men, especially in middle-aged people, where gains in LE are over 80%. In women, the share of avoidable mortality by age in changes in LE is usually around 70%. Avoidable mortality rates in Serbia remain relatively high compared to the rest of Europe, but there is a positive shift. The fact that the probability of avoidable mortality in the male population at birth in Serbia is about 30% (18% for women) shows that there is much room for improvement. With the hypothetical elimination of avoidable mortality, the increase in LE in men could be 6.3 years, and in women 3.9. Amenable and preventable mortality rates are always higher in the male population, but the reduction in standardised values is more intense in men in Serbia. Standardised preventable mortality rates have been declining faster than standardised amenable mortality rates in Serbia. Since the male population is significantly more burdened with preventable causes of death, the possibility of reduction is higher. Diseases and conditions that can be amenable by adequate healthcare showed a steady decrease in mortality rates by sex in the observed period, while the main difference observed in avoidable mortality is the result of a greater shift in preventable mortality in men. The most significant positive trend in the reduction of avoidable mortality is in cardiovascular diseases and violent deaths. At the beginning of the observed period, cardiovascular diseases had a higher share than cancer, but 10 years later the situation changed, and cancer became the most significant cause of avoidable mortality in Serbia, with an increasing trend. Malignant neoplasm of the trachea, bronchi, and lungs is the most common disease that can be avoided, while ischemic heart disease is in second place. Data from the 10-year period (2010 to 2019) show that respiratory diseases, infectious and contagious diseases, and addiction have a clear growth trend, as does cancer. The most significant positive trend in the reduction of avoidable mortality is in cardiovascular diseases and violent death. Diseases that can be treated and prevented by lifestyle changes and regular check-ups can significantly extend life expectancy in Serbia. Investing in the healthcare system pays off many times over because the costs of treating an individual are reduced in the long run, and that person can potentially contribute more to the community in good health over the years.
The pandemic generated by the SARS-CoV-2 virus should be viewed as a severe public health threat because, in the first ten months of its existence, over 3 million people perished worldwide. According to available data, mortality due to the COVID-19 pandemic is markedly different across countries but also within them. In the analysis of the consequences of the mortality pandemic in Serbia in 2020, the final data of vital statistics published by the Statistical Office of the Republic of Serbia were used. The results of the research are presented at all territorial statistical-administrative levels (except the settlement level). The research showed that the highest intensity of deaths due to the new disease is in the south of the country and larger city centers (Belgrade, Nis, Kragujevac). Vojvodina and the districts and municipalities that belong to it have the most favorable values in Serbia. The quality of mortality data by cause of death varies considerably at different statistical-administrative levels, primarily with the underreporting of COVID-19 as the primary cause of death. As a more reliable indicator of the impact of the pandemic on the total mortality of the population, excess mortality indicates a record-high increase in mortality in 2020 in Presevo, Sjenica, and Novi Pazar. The difference between the northern part of Serbia and the southern part in mortality due to COVID-19 is potentially based on more intergenerational contacts and more pronounced population migrations, so it can be stated that the rate of transmission is a more important determinant of mortality in the population of different parts of Serbia, than the level of available health care or age structure. different statistical-administrative levels, primarily with the underreporting of COVID-19 as the leading cause of death (a striking example is the Kolubara district). As a more reliable indicator of the impact of the pandemic on the total mortality of the population, excess mortality indicates a record-high increase in mortality in 2020 in Presevo, Sjenica, and Novi Pazar. Once virus transmission takes root in the community, parts of the country with high intergenerational contacts can see the faster infection rate. The difference between the northern part of Serbia and the southern part in mortality due to COVID-19 is potentially based on higher intergenerational contacts and more pronounced population migrations. It can be stated that the degree of transmission of the infection is a more important determinant of mortality in the population of different parts of Serbia than the level of available health care or age structure.
The research of thirty-year changes in the mortality of the population of Serbia (1990-2021) is given through two basic indicators of mortality. Using the decompose method to calculated the effect of population aging on the difference between crude mortality rates, as well as the contributions of specific mortality rates and leading causes of death in the changes in life expectancy. The crude death rate shows that the intensity of dying in Serbia is very high. The pandemic contributed to record values in the last two years. Overall, in the period 1990-2019, the negative contribution of the age structure is twice as intense as the positive effect of age-specific mortality rates. Aging is more intense in the female population, which explains the greater increase in the crude death rate in women. The data show that the importance of demographic aging has always been more pronounced. The main characteristic in the observed time interval is that mortality decreases at all ages and that all age groups had a positive effect on life expectancy, as well as that men and women in Serbia have a different pattern of decreasing mortality by age. The most significant effect on life expectancy was the reduction of infant mortality (a fifth of the total contribution), a common feature of the male and female populations. In other age groups, men have more pronounced contributions up to the age of 50, and women in older cohorts. Due to higher mortality rates, the space for improving mortality is greater in young and middle-aged men than in women, so the positive effects are more pronounced at these ages. The largest number of leading causes of death burdens the population of Serbia less now than three decades earlier. Cardiovascular diseases, as the leading cause of death, contributed the most to positive changes in mortality. The biggest effect of life expectancy is the reduction of mortality rates due to diseases of the circulatory system in the 65-79 year old population. Observed by gender, the effect is greater in the female population, where cardiovascular diseases contribute to the extension of life expectancy by as much as 67% or by 2.4 years, while in the male population the importance of cardiovascular diseases in the extension of life expectancy is lower and amounts to 42% or by 1.9 years. Tumors, as the second most common cause of death in Serbia, contribute negatively to those aged 50 and over and positively to younger age groups. The overall effect on life expectancy is positive, and mortality rates in men decline until the age of 60. In women, rates increase from age 50 or older, and of all causes of death, only tumors have an overall negative effect on life expectancy growth. Among the other causes, the importance of violent deaths and their positive effect should be singled out, due to the reduction of mortality rates at all ages, especially among the younger population. Positive changes in the age of 15-49 years in the male population contribute to an increase in life expectancy of even 1 year. In the female population, a positive contribution is also present at all ages, but the effect is significantly lower. The COVID-19 pandemic brought the highest increase in mortality in Serbia in the last 70 years. Mortality increased by 14% in the first year of the pandemic, and by 34% in the second, compared to the 2017-2019 average. The crude death rate has increased tremendously and for men in 2020 it is 18.0‰, and in 2021 it will show a maximum value of 21 deaths per 1,000 persons. For women, this mortality rate is 15.9‰ and 19.0‰ (in 2020 and 2021, respectively). Changes compared to the values from 2019, for both sexes, are solely the result of the increase in mortality by age, while changes in the distribution of the population by age had a negligible effect in this period. The last analyzed year (2021) brings a drop in life expectancy for men of as much as 3.4 years compared to the period before the pandemic. Women in Serbia have a slightly smaller decline in life expectancy in this period of 2.9 years.
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