MORTALITY TRENDS IN CROATIA IN THE FIRST TWO DECADES OF THE 21st CENTURY

Negative demographic trends in Croatia (natural decrease, negative net migration and population aging) are increasingly influencing socio-economic development of the country. Already in early 21st century, the long term decrease of live births and the increase of deaths were recognized as destabilizing factors of population development in Croatia. After the Croatian accession to the EU, the concerns regarding future demographic development of the country raised even more due to intensive emigration to other EU countries, which coincided with the historically low birth rates and high death rates. The focus of this paper is on mortality trends in Croatia in the first two decades of the 21st century. In this period, mortality in Croatia was influenced by different socio-economic, demographic, and epidemiological factors. Given the lack of recent papers dealing with mortality in Croatia, the main aim of this paper is to provide an overview of the changes in selected mortality indicators and contribute to the discussion on recent mortality trends in Croatia. The results of this research indicate that Croatia experienced some positive changes regarding mortality (increase of life expectancy at birth and decrease of infant mortality rates in the first period, in particular), but, some of the trends are not favourable, particularly the changes in the causes of death. Although improvements were observed regarding the share of deaths caused by the diseases of the circulatory system, there was a notable increase in deaths caused by the endocrine, nutritional and metabolic diseases which can be attributed to the unhealthy lifestyle and various behavioural factors.

Research Note: COVID-19 Is Not an Independent Cause of Death.

The COVID-19 pandemic has had overwhelming global impacts with deleterious social, economic, and health consequences. To assess the COVID-19 death toll, researchers have estimated declines in 2020 life expectancy at birth (e0). When data are available only for COVID-19 deaths, but not for deaths from other causes, the risks of dying from COVID-19 are typically assumed to be independent of those from other causes. In this research note, we explore the soundness of this assumption using data from the United States and Brazil, the countries with the largest number of reported COVID-19 deaths. We use three methods: one estimates the difference between 2019 and 2020 life tables and therefore does not require the assumption of independence, and the other two assume independence to simulate scenarios in which COVID-19 mortality is added to 2019 death rates or is eliminated from 2020 rates. Our results reveal that COVID-19 is not independent of other causes of death. The assumption of independence can lead to either an overestimate (Brazil) or an underestimate (United States) of the decline in e0, depending on how the number of other reported causes of death changed in 2020.

LIFE EXPECTANCY AT BIRTH IN RF REGIONS WITH DIRIMENT SANITARY-EPIDEMIOLOGICAL WELLBEING AND DIFFERENT LIFESTYLES. MANAGEMENT RESERVES

The article focuses on estimating reserves of growth in life expectancy at birth (LEB) for the RF population in regions with different sanitary-epidemiological wellbeing and people's lifestyles. The existing trends in the country development within the regional context corroborate relevance of the present study. The methodical approach includes use of factor and cluster analysis, artificial neuron networks, and scenario forecasting. Activities performed by Rospotrebnadzor within its authority produce positive modifying effects on LEB as an integral health indicator. Differentiated contribution made by these activities to achieving regional target LEB levels by 2024 (COVID-related processes excluded) amounts to 8–62 % as per the group of indicators that describes a sanitary-epidemiological situation on a given territory and 5–45 % as per the group of lifestyle-related indicators. We identified priority factors for each of four types of regions;these factors provide the maximum positive effect on LEB. Working conditions for working population, quality of drinking water, ambient air and nonfoods are priority manageable factors in regions where the sanitary-epidemiological situation is the most unfavorable. Levels of alcohol and food consumption, balanced diets and people's physical activity are the priority manageable factors in regions with the most unfavorable lifestyle-related indicators. The study revealed that additional LEB growth would be secured if the targets set within national projects were achieved. By 2024, this additional LEB growth would equal 6–420 days and 107–659 days accordingly given the existing trends and regional differentiation as regards improved sanitary-epidemiological situation in regions and people's lifestyles. Improved working conditions, better quality of drinking water and ambient air are reserves of LEB growth for all types of the RF regions in short and middle-term. A potential reserve of LEB growth and priority determinants were identified for each type of regions. These identified national and regional determinants should be considered when building an optimization model of LEB management allowing for reserves of its growth. The study results develop the authors' methodical approach to estimating potential LEB growth based on scenario modeling;they are consistent with the results obtained by other relevant studies. We have identified limitations of the present study as well as prospects and trends for future research. © Kleyn S.V., Onishchenko G.G., Zaitseva N.V., Glukhikh М.V., 2022

Assessing potential of the gain in the life expectancy of population using artificial neural networks

Introduction. At present it is especially vital to search for and test new analytical systems that can give a possibility to predict a medical and demographic situational lowing for multifactorial influence exerted by the environment. Our research goal was to establish regional peculiarities and predictive estimates of potential gain in such an important indicator as life expectancy at birth (LEB) depending on changes in socio-hygienic determinants potent of modifying it. To do that, we took data collected in a RF region where the current demographic situation was rather tense against the backdrop of stable economic conditions. Materials and methods. A potential of the gain in LEB was estimated by modelling cause-effects relations between environmental indicators and life-style related ones, or determinants that determined population health. Models were created by using artificial neural networks. Results. Our methodology was proven to be optimal and precise (differences are equal to 0.98%). It can be applied quite successfully to predict a potential gain in LEB at a regional level together with identifying what modifying factors should be considered priority ones. LEB on the analyzed territory (the Perm region) was established to likely grow by 661.6 days by 2024 and reach 73.12 years;by 855.7 days by 2030 and reach 73.65 years if the current trends related to changes in the analyzed determinants persisted and the achievement of target indicators of national projects and regional development programs. In case the relevant targets set within national projects and regional development programs were achieved, this indicator would grow by 661.6 days and reach 73.12 years. The most significant groups of factors that determine LEB on the analyzed territory against the backdrop of stable economic situation include sanitary-epidemiological welfare (working conditions et al.), public healthcare indicators (population provided with sufficient number of doctors), sociodemographic indicators (expenses on social policies), lifestyle factors (the proportion of the population involved in physical culture and sports;consumption of vegetables and fruits;retail sales of alcoholic beverages, etc.). Their contribution to the gain in LEB varies from 51.2 to 228.6 days. Limitations. Limitations of the study include the model being "stationary” due to its training relying on data collected in 2010–2019;use of a specific set of indicators;failure to consider the influence exerted by the current epidemiological processes (the COVID-19 pandemics). Conclusion. We analyzed data collected in an RF region with a rather tense demographic situation and established that by 2024 an adjusted target LEB value would be achieved there if the trend in changes in socio-hygienic determinants recovered to its pre-pandemic levels. Achievement of target LEB values by 2030 requires additional project activities that consider specific regional features and focus on managing priority determinants and reducing mortality among working age population. © 2022 Izdatel'stvo Meditsina. All rights reserved.

Exploring the Status of Life Expectancy at Birth in Indian States and the Evolving Health Perspectives for well-being

The present study aims to assess the life expectancy at birth (LEB) of the fifteen major states in India and verify for the regional disparity in LEB over the study period. An analysis of secondary data on LEB is performed. The coefficient of variation (CV) of LEB across states is estimated to examine sigma-convergence and absolute convergence is assessed by means of ordinary least square (OLS) technique. Gini Coefficient is also used to measure the change in regional inequality in LEB over the time period. A technique of estimating divergence reduction is employed to assess the accomplishment of states on the LEB indicator. The sigma and absolute convergence estimation reveals that India is experiencing continuous gains in life expectancy and regional divide in LEB has reduced over the years. But a regional gap still remains. A variation in life expectancy is mostly caused by differences in the social determinants of health viz. potable water, medical care, sanitation, hygiene. The states which are aiming at improving LEB should focus on non-clinical measures as well to enhance the life span of individuals and also to reduce the burden on health infrastructure. The health policy design and implementation should also be designed in creating health rather than purely focused on curing illness. A pandemic like the coronavirus disease (COVID -19) has urged a new way of looking at health;beyond pharmaceutical measures. Social, meditative and technology based intervention can help in improving the life expectancy and other health indicators.

Effects of globalization, energy consumption and ICT on health status in Australia: the role of financial development and education.

BACKGROUND: The outbreak of COVID-19 has alerted governments around the world, including Australia, to think seriously about the health issues. Life expectancy is one of such issues. Therefore, this study tries to reveal the effects of globalization, energy consumption, information and communication technology, financial development, education rate, and economic growth on life expectancy at birth in Australia. METHODS: Using the data period of 1990-2018, a series of econometric techniques: the Dickey-Fuller generalized least square test, Autoregressive Distributive Lag bounds test, fully modified ordinary least square method and the pairwise Granger causality test, are applied. RESULTS: The findings disclose that globalization, renewable energy use, information and communication technology, per capita gross domestic product, education rate, and financial development increased during this period but non-renewable energy use reduced life expectancy at birth. Unidirectional causal associations of the studied variables with life expectancy at birth are also revealed. CONCLUSIONS: All the outcomes are relevant and useful for articulating an innovative policy in the health sector. The prime policy implication of this work is: the effective, efficient, and inclusive policies considering globalization, renewable and non-renewable energy consumption, information and communication technology, financial development, education rate, and economic growth should be formulated and executed for guaranteeing health status.

PREDICTING GROWTH POTENTIAL IN LIFE EXPECTANCY AT BIRTH OF THE POPULATION IN THE RUSSIAN FEDERATION BASED ON SCENARIO CHANGES IN SOCIO-HYGIENIC DETERMINANTS USING AN ARTIFICIAL NEURAL NETWORK

The article presents the result produced by predicting growth potential in life expectancy at birth (LEB) of the RF Population. The predictions are based on scenario changes in social and hygienic determinants (SHD) identified by using an artificial neural network (ANN). This research is vital given the existing social strategies aimed at improving the medical and demographic situation in the Russian Federation. These strategies stipulate achieving targets set within the major national and federal projects. We identified an optimal ANN structure based on a four-layer perceptron with two inner layers containing eight and three neurons accordingly. This structure is able to produce results at the highest determination coefficient (R2= 0.78). Differences between actual LEB levels and predicted ones obtained by using the suggested model did not exceed 1.1 % (or 0.8 years). We established that average LEB in the RF would reach 75.06 years (by 2024) provided that the demographic situation in the country recovers in the nearest future, LEB level reaches its values detected in 2018–2019, and SHD values grow to their preset levels according to the target scenario. Therefore, the detected growth potential amounts to 3.0 years (1095 days) against 2018. “Lifestyle-related determinants” produce the greatest effects on the growth potential in LEB by 2024 (461 days). We also identified effects produced by such SHD groups as “Sanitary-epidemiological welfare on a given territory” (212 days), “Social and demographic indicators” (196 days), “Economic indicators” (131 days), “Indicators related to public healthcare” (70 days). An indicator that shows “A share of population doing physical exercises or sports” is the most significant determinant producing the greatest effects on potential changes in LEB. If it grows up to 55.0 %, a potential growth in LEB amounts to 243.5 days. If we do not consider COVID-related processes and rely only on the trends that are being observed now when predicting changes in the demographic situation by 2030, we can expect a possible additional growth in LEB that equals 286 days. The developed algorithm for determining growth potential in population LEB can be used as an instrument for determining and ranking priority health risk factors. © Zaitseva N.V., Kleyn S.V., Glukhikh М.V., Kiryanov D.А., Kamaltdinov М.R., 2022

[The life-span of population of the Irkutsk Oblast].

The indicator of average life expectancy at birth is widely used as systemic indicator of population quality of life and health. The purpose of the study is to identify, to evaluate quantitative and structural changes of indicator of life expectancy at birth in population of the Irkutsk Oblast during 1990-2019. The data of life expectancy at birth was obtained from the Rosstat websites. The original calculations of survival tables were carried out using the databases of the Center for Demographic Research at the New Economic School. The analysis of trends was carried out using linear regression analysis. The analysis of role of exogenous and endogenous determination of mortality in formation of average life expectancy was carried out. In 1990-2005, in the Irkutsk Oblast, occurred change in ranking of causes of death that determined the greatest irrecoverable losses of population and reduction of indicator of average life expectancy at birth. The essence of this change is in abnormally high proportion of exogenous causes of mortality, especially class of external causes of mortality, in the structure of irreversible demographic losses. In the Irkutsk Oblast, in 2006-2019, occurred favorable changes in the structure of irrecoverable losses, testifying returning to modern type of mortality. During the same period, indicator of average life expectancy at birth increased. It is established that changes occurred since 2006 in the quantitative and structural indices of mortality and average life expectancy at birth are very positive. However, during demographic processes in 2020, the COVID-19 pandemic intervened. This factor is bringing negative impact on economy, and after that on social sphere and public health. The further course of development of social demographic situation in the Irkutsk Oblast, in particular, dynamics of indicator of average life expectancy at birth, will depend on success of activities of authorities of all levels in struggle with pandemic and overcoming crisis events in social economic development.

Does the augmentation of monetary and non-monetary factors prerequisite for the improvement of health outcomes? Evidence from the Indian states.

The present study was conducted in Indian states to examine the effect of monetary and non-monetary factors on Infant Mortality Rate (IMR) and Life Expectancy at Birth (LEB) by using the panel regression model. In addition, an attempt was also made to analysis the unequal pattern of health infrastructure and services across states over time with the help of a composite index on health infrastructure and services. It was found that the index value of the best performing state Chhattisgarh is more than fourth six times that of the worst performing state. The study also showed that, despite the higher level of average per capita public health expenditure and moderately better health infrastructure, the COVID 19 induced death rate was high in Punjab, Sikkim, Delhi and Goa. The panel regression results revealed that, an average increase of 1% in the monetary factor, public health expenditure to Gross State Domestic Product ratio (PHEGSDPR), would decrease the average of IMR by about 10%. Moreover, the elasticity of IMR with respect to non-monetary factor, health infrastructure and services per 0.1 million population (HISPLP), was negative and significant. Likewise, the explanatory variables, HISPLP and PHEGSDPR have a positive and significant effect on the LEB.