Inequalities in mortality by marital status during socio-economic transition in Lithuania.

OBJECTIVES: To analyse the changes in mortality inequalities by marital status over the period of socio-economic transition in Lithuania and to estimate the contribution of major causes of death to marital-status differences in overall mortality. METHODS: A survey based on routine mortality statistics and census data for 1989 and 2001 for the entire country. RESULTS: The proportion of married population has declined over the past decade. Widowed men and never married women were found to be at highest risk of mortality throughout the period under investigation. Although inequalities have not grown considerably, mortality rates have increased significantly for divorced populations and for never married men, widening the mortality gap. Cardiovascular diseases contributed most to excess mortality of never married and divorced men, as well as all unmarried groups of women. The excess mortality of widowed men from external causes was greatest in 2001. CONCLUSIONS: Marriage can be considered as a health protecting factor, particularly in relation to mortality from cardiovascular diseases and external causes. Local and national policies aimed at health promotion must focus primarily on improving the position of unmarried groups and providing psychological support.

Epidemic of suicide by hanging in Lithuania: does socio-demographic status matter?

OBJECTIVE: To analyse suicide by hanging, compared with other methods, by demographic and selected social factors in Lithuania, and to evaluate changes during 1993-1997, and 1998-2002. METHODS: Data on committed suicides were compiled from the Lithuanian Department of Statistics. Suicides were identified by the International Classification of Diseases (ICD): codes in ICD-9 E950-E959 and codes in ICD-10 X60-X84. These were categorized into seven groups by method of suicide. Particular attention was paid to suicide and self-inflicted injury by hanging, strangulation and suffocation (ICD-9: E953; ICD-10: X70). These data were analysed by gender, age, place of residence, education, and marital status. RESULTS: A total of 8324 suicides (6864 men and 1460 women) were committed during 1993-1997, and 7823 suicides (6455 men and 1368 women) during 1998-2002. Of all registered suicides in Lithuania during 1993-2002, hanging was the most common method. Over the period under investigation, hanging, in proportion to all other methods used to commit suicide, increased statistically significantly from 89.4% among men and 77.3% among women between 1993 and 1997 to 91.7% among men and 82.6% among women between 1998 and 2002. The most noticeable rise occurred among girls aged 10-19 years. The next most common methods among men were firearms and poisoning; among women, poisoning and jumping from high places were common methods. Hanging predominated in men, older people, rural residents and people with low levels of education. A logistic regression analysis showed that gender (odds ratio [OR]=2.4; 95% confidence interval [CI] 2.2-2.7), place of residence (OR=2.0; 95% CI 1.8-2.2) and education (OR=1.2; 95% CI 1.1-1.3), independently of other factors, had the strongest influence on the choice of hanging as the method of suicide between 1993 and 2002. Age had only a minor effect, and marital status had no significant effect on choosing hanging to commit suicide. CONCLUSIONS: Hanging is the most common method of suicide in Lithuania. The popularity of this highly lethal method may be one of the underlying causes for the high rate of committed suicides. Universal approaches to suicide prevention deserve serious consideration, especially challenging the social acceptability of hanging among men, older people, rural residents, and low educated groups of the population in Lithuania.

Suicide-homicide temporal interrelationship, links with other fatalities, and environmental physical activity.

UNLABELLED: Homicide and suicide are extremes in human behavior. The aim of this study is to investigate the connection by time between suicide and homicide, between them and other fatalities, and their links with the level of cosmophysical activity. METHODS: Using the national database of Lithuania (1990-2002) we found that 547,875 deaths, 4,638 homicides (3,374 male) and 19,527 (16,019 male) suicides were registered in that period. Their temporal distribution over 156 months was compared with solar and cosmic-ray activity. Pearson correlation coefficients and their probabilities were established. RESULTS: There was a correlation between monthly rates of homicide and male groups. Female suicide rates correlated with male and total homicide numbers. Both homicide and suicide rates were inversely correlated with solar and cosmic-ray activity. Suicide numbers, but not homicides, were inversely related to geomagnetic activity. Suicide rates were inversely correlated with total, cardiovascular, traffic accident, and sudden deaths; homicide with total, traffic accident, and sudden deaths. CONCLUSION: Temporal distribution of homicide and suicide is significantly interrelated. Both are linked to parameters of cosmophysical activity. The influence of cosmic rays deserves special attention.

Inequalities in mortality by education and socio-economic transition in Lithuania: equal opportunities?

AIM: The aim of this study was to examine the changes in mortality differentials by level of education during the period of socio-economic transition in Lithuania. METHODS: This analysis was based on routine mortality statistics and census data for 1989 and 2001 for the entire country. RESULTS: Despite a general improvement in the level of education in the Lithuanian population, some negative educational patterns were observed amongst its young members. Increasing inequalities in mortality by education have occurred due to a declining mortality rate in people with higher educational achievements and, conversely, an increasing mortality rate in people with a low level of education. Mortality inequalities by education amongst females exceeded those amongst males in 2001, particularly in middle-aged groups and due to external causes. The results of this survey predict an unfavourable forecast of increasing health inequalities in Lithuania in the near future. CONCLUSIONS: General policies for health promotion and disease prevention should be based on the realities faced by lower educated groups, rather than on experiences that are general for the total population or the class of society that has at least achieved an average education. Inequalities in health by the level of education should plateau as the society-at-large enters into a more stable stage of social and economic development.

Cosmic rays activity and monthly number of deaths: a correlative study.

We studied the relation between the intensity of cosmic rays, the level of solar/geomagnetic activity, and the monthly numbers of deaths in a large hospital in Israel and in all Lithuania. The Israeli data include 30526 hospital deaths, two groups of fatal suicides (2359, 2763), and 15435 suicidal attempts for two periods of 108 and 236 consecutive months. The national data for the entire Republic of Lithuania include 424925 deaths for the period of 120 consecutive months. Cosmic rays intensity was measured by an Apatity neutron monitor. We obtained the data on solar, geomagnetic radiovawe propagation, ionosphere ionization hours, proton flux of two energy levels (>90 and 60 MeV) from the National Geophysical Data Center at Goddard Space Flight Center, National Space Environment Center at Boulder, Colorado, USA, and from the Institute of Terrestrial Magnetism, Ionosphere and Radio Wave Propagation (IZMIRAN), Russia. We calculated Pearson coefficients and their probabilities for correlation between monthly space activity level and monthly number of male and female deaths from different causes. Cosmic rays activity revealed significant negative correlation with solar/geomagnetic activity indices and related physical phenomena levels. This activity strongly correlated with flux of protons with the energies >90 MeV proton flux and did not exhibit significant correlation with 60 MeV proton fluxes. Cosmic rays intensity correlation with monthly numbers of deaths was strong for noncardiovascular deaths, suicides, and traffic accidents. The correlation was much weaker for deaths caused by ishemic heart disease and strokes.

Distribution of monthly deaths, solar (SA) and geomagnetic (GMA) activity: their interrelationship in the last decade of the second millennium: the Lithuanian study 1990-1999.

Thirty percent of cardiovascular deaths cannot be explained by known risk factors. In this study, we sought links between 1) circannual rhythmicity, solar activity (SA) - sunspot number, solar radioflux and geomagnetic activity (GMA) - Ap., Cp., Am. with monthly number of deaths looking for environmental influence on mortality at the end of the second millennium. The Lithuanian national death data from for 120 consecutive months according to the IDC (1990 - 1999, n = 424925 deaths) was studied: 157189 from IHD (72144 male, 85045 female), 50228 from stroke (19062 male, 31166 female), 33722 from accidents (26193 male, 7529 female), 10655 from road accidents (8127 male, 2528 female) and 14810 from suicide (12137 male, 2673 female), 217508 - non cardiovascular (134308 male, 83200 female). Monthly death numbers (total, < 65y, 65-74, > 74y old for IHD and Stroke, and by gender) were compared with time of year, SA and GMA indices obtained from the National Geophysical Data and National Space Services Center, USA. Circannual rhythmicity indices, Pearson correlation coefficients and their probabilities were obtained and analyzed. The interrelationships of deaths from IHD and stroke and some other pathologies were also studied. In addition a multivariate linear regression analysis was done in order to evaluate the influence of time (month), Solar (S.A.) and Geomagnetic (GMA) activity on the temporal distribution of deaths. The total IHD monthly death number was significantly linked with GMA indices (r = 0.2-0.24, p = 0.03-0.075), but not with SA. IHD correlated with SA (r = 0.25-0.27, p = 0.006-0.0026), only in the 74 year age group. p = 0.0001) In the 65-74 age group, there was an inverse relationship with SA (r = -0.46-0.44) and no significant relationship to GMA. The IHD death number was correlated with GMA only in the < 65 and > 74 year age group (r = 0.30-0.36, p = 0.001-0.001). 2) Stroke-related deaths showed an inverse correlation with SA and GMA only for the 65-74y age group (r = -0.5, p = 0.0001 - SA, r = -0.4, p = 0.0001- GMA) and with GMA at age < 65 only for males (r = 0.20-0.25, p = 0.03-0.04). 3) Both IHD and stroke were strongly circannual rhythmic with acrophase at month 1.27 (IHD) and 1.32 (stroke) - first half of February, (p = 0.0001). 4) The IHD / stroke death ratio was correlated both with SA and GMA (r = 0.35, p 0.0001 - SA, r = 0.40-0.44, p = 0.0001 - GMA). 5) There was a strong inverse monthly deaths correlation between IHD and suicide (n = 14,810, r = -0.53, p = 0.0001). Stroke and suicide were also related, but to a much weaker extent (r = -0.217, p = 0.017). Accidents were inverse related to S.A. (r = -0.286, p = 0.0015), but not to GMA. Road Accidents - with both S.A. (r = 0.427, p < 0.0001) and GMA (r = 0.258, p = 0.004); with acrophases in October for road and November for other fatal accidents. Non cardiovascular deaths were annually rhythmic only for female - acrophase in early February, and for both gender inverse related to S.A. (r = -0.57, p < 0.0001) but not with GMA. Suicide victims had their acrophase in July (p < 0.0001) and were inverse related to S.A. (r = -0.6, p < 0.0001) and GMA (r = -0.27, p = 0.002). At the onset of the third millennium, the temporal distribution of deaths is still related to environmental physical activity. Those links differ for each of the pathologies, and by age and gender.

Daily variations in deaths in Lithuania: the possible contribution of binge drinking.

BACKGROUND: During the early 1990s the countries of the Former Soviet Union experienced a dramatic rise in mortality, especially from cardiovascular diseases. Although still poorly understood there is evidence, particularly from Russia, that this mortality crisis is partly linked to alcohol consumption. In this paper we use data from Lithuania to explore the daily variations of deaths and the probable relationship with binge drinking. METHODS: Computerized death certificates for those aged 20-59 years were analysed according to the day of death, place of death, and cause of death for the years 1988-1997. RESULTS: There is a marked increase in deaths from accidents, violence, and alcohol poisoning at the weekend, suggesting a pattern of binge drinking in Lithuania. There is also a significant increase in ischaemic heart disease (IHD) deaths on Saturdays, Sundays and Mondays. If the analysis is performed separately according to place of death, the day of the week effect is strengthened for cardiovascular deaths outside of hospital; consistent with the idea of a sudden cardiac death. CONCLUSION: The increase in mortality from cardiovascular diseases observed at the weekend in Lithuania is similar to that observed in Moscow and other populations. The relationship with alcohol consumption is supported by the available physiological evidence. We propose that bingeing can be solely responsible for, or acts as a 'catalyst' for, pathophysiological events by increasing blood pressure, cardiac rhythm and coagulability. The increased IHD mortality observed throughout the weekend and on Monday in Lithuania may reflect the influence of alcohol consumption patterns in a population already subject to high psychosocial stress.

Correlation of two levels of space proton flux with monthly distribution of deaths from cardiovascular disease and suicide.

In our previous studies /1-3/ we described some significant links between monthly number of deaths due to cardiovascular disease and suicide and space proton flux > 90 MeV. The aims of the present study were to compare the relationship of some solar and geomagnetic parameters with space proton fluxes of > 60 and > 90 MeV; to examine the monthly correlation of these two proton groups with the monthly death distribution in two countries, Israel and Lithuania. Physical data were obtained from the National Geophysical Data Center and the SESC in Boulder, CO; NSSDC in Goddard Space Flight Center, USA, and the Izmiran Institute of the Academy of Sciences in Russia. Pearson correlation coefficients and probabilities were compared for 56-180 consecutive months. Proton flux of > 60 MeV significantly correlated with three of the four studied monthly geomagnetic activity indices (Ap, Am, Dst), but not with such solar activity markers as sunspot number and solar flux (2800 MGH, 10.6 cm). There was no significant relationship between proton flux of > 60 MeV and monthly number of deaths from cardiovascular diseases and suicide, in contrast to the results for > 90 MeV. From the data available during the 36 months (1986-1988), there was no correlation between monthly levels of > 60 to > 90 MeV. In conclusion, a monthly space proton flux of > 60 MeV is not significantly correlated with the monthly death distribution from cardiovascular disease and suicide and some solar activity indices, such as proton flux of > 90 MeV. It is possible that the 60-90 MeV fraction in the > 60 MeV proton flux "blunts" the cosmobiological relationship between proton flux of > 90 MeV and monthly death number.

Inequalities in life expectancy in Lithuania by level of education.

The purpose of this study was to examine educational inequalities in life expectancy of the Lithuanian population. The life-tables by level of education were calculated on the basis of the individual records of the 1989 census, which were linked to the death records of males and females, aged 25-70 years. In comparison with the group with university education, the life expectancy of males with primary or lower education was 11.7 years shorter, and of females 4.3 years shorter. The greatest impact of educational differentials on life expectancy was the inequality found in the mortality of the population, aged 25-44 years. Sex differences in life expectancy were greatest among those with primary or lower education. External causes of death contributed most to educational differences in life expectancy of males, whereas cardiovascular diseases had a major impact to educational differences in females.

Relationship between deaths from stroke and ischemic heart disease--environmental implications.

We analyzed the ratio of deaths from stroke and ischemic heart disease in Lithuania over a 72-month period (1990-1995) in relation to fluctuations in five physical environmental parameters. Results indicated a highly significant adverse correlation of the stroke/ischemic heart disease death ratio with both solar activity (r = -0.64, p = 0.0001), stronger for women than for men, and the planetary geomagnetic activity index (r = -0.33, p = 0.005). Proton flux > 60 MeV correlated significantly with the death ratio only for the 65-74-year age group (r = -0.36, p = 0.03) (36-month study). The last finding may be a result of different environmental influences on the pathogenesis of ischemic heart disease and cerebral vascular accidents at different ages. We conclude that the monthly ratio of deaths from stroke/ischemic heart disease is related to environmental physical activity.

Distribution of deaths from ischemic heart disease and stroke. Environmental and aging influences in men and women.

UNLABELLED: The goal of this study was to check: 1) links between month of the year (1-12), monthly solar activity (SA) and monthly geomagnetic activity (GMA) with the temporal distribution of deaths from ischemic heart disease (IHD) and stroke in Israel and Lithuania (48 months); 2) related age and gender differences; 3) temporal connection between deaths from IHD and suicide and their relationship to SA and GMA, as was suggested in our previous study in Israel. RESULTS: Total deaths from IHD in Lithuania showed a trend towards a link with SA (r = 0.25, p = 0.09) and a highly significant correlation for females (r = 0.37, p = 0.00096) but not for males. Age < 74 showed no correlation with SA or GMA in females, but a negative correlation with SA in males (r = -0.513, p = 0.0002). At age > 74 both females (r = 0.467, p = 0.0006, n = 20763) and males (r = 0.476, p = 0.0006, n = 14682) showed a highly significant correlation with SA and a negative correlation with 1-12 months of the year, with deaths concentrating at the beginning of the year (r = -0.32, p = 0.002). Number of monthly suicide and IHD deaths were negatively related to each other (r = -0.45, p = 0.0014). CONCLUSIONS: 1) Around age 70 an increasingly positive relationship between the temporal distribution of deaths from IDH and SA is seen. 2) Gender differences in links to SA are partially a consequence of the higher number of deaths in females from IHD at age > 74.3) Monthly number of suicides is inversely related to number of deaths from IHD.

Clinical cosmobiology: the Lithuanian study 1990-1992.

The numbers of deaths from ischaemic heart disease (IHD), stroke (CVA), all accidents except vehicular, vehicular accidents and suicide (overall total, totals for men and women) per month for 36 months (1990-1992) in Lithuania were analysed in relation to: (1) month of the year (1-12); (2) geomagnetic activity; and (3) solar activity. A total of 122227 deaths (64490 men and 57737 women) was studied, and the results compared with those obtained in an earlier study in Israel, differing geographically and climatically from Lithuania. It was shown that the time of year, solar activity, and geomagnetic activity were related to the monthly death distribution, especially regarding death from IHD and suicide. Age and gender differences were apparent in the relationship between death distribution and physical environmental factors. At age > 70 years, many of these relationships change. The monthly distribution of deaths from IHD and suicide are adversely correlated with solar activity and with each other. Differences are presumed in serotoninergic effects as caused by environmental influences.