The Impact of Mortality Changes by the Main Causes of Death on Life Expectancy in the Large Cities of Ukraine

Abstract

Large cities are often at the forefront of social change, not only in their region, but throughout the country. Therefore, the analysis of their demographic trends, in particular mortality by causes of death, is important not only by itself, but also in the context of general demographic prospects of the country. The aim of this study is to make a comparative analysis of the gains in life expectancy in Dnipro, Kyiv, Lviv, Odesa and Kharkiv over the period 2005— 2019, and an estimation of the cause-specific mortality contributions to the life expectancy changes. For the first time, decompositions analyses are conducted to evaluate contributions to fluctuations in life expectancy not only by age and sex, but also by causes of death for each of the five largest cities of Ukraine. The following statistical measures and methods are used: calculation and analysis of demographic rates, life tables, graphic method and decomposition method. Our results show that, during the observed period, life expectancy at birth has increased in all cities, mostly due to changes in mortality from circulatory diseases, which have resulted in a one-year increase in life expectancy among men in Odesa to almost 2.5 years among women of Kharkiv. However, it might be possible that such a large contribution in Kharkiv is a result of a part of the deaths falling into the category of ill-defined causes, for which mortality has increased rapidly in that city. The second major contribution to the improvement in life expectancy is attributable to external causes of death: from 0.3 years of increase in females of Lviv to almost 1.9 years in females of Odesa. Males in Odesa benefited the most from the reduction in mortality due to infectious diseases (+2 years). In some cases, there was a significant positive contribution of the reduction in mortality from diseases of the digestive system (+0.5 years in men of Dnipro). The decline in cancer mortality also had a positive impact on life expectancy in all cities, except for Kharkiv. Overall, the increase in life expectancy for men was due to a reduction in mortality at younger ages than for women. In particular, the common age interval for all five cities, with men having the greatest gain in life expectancy, is 45-59 years, while for women it is 65 to 79 years. In men, the gain in life expectancy was accounted for by the decline in mortality at the age 45 to 59 years, with 24.4 per cent in Odesa and almost 46 per cent in Lviv and Kharkiv, mainly due to a reduction in mortality from circulatory diseases and external causes. In women, the decline in mortality at the age 65 to 79 years contributed 30.3-34.8 per cent of the increase in life expectancy in Dnipro, Kyiv and Lviv; however, in Odesa it was only 19.4 per cent, in Kharkiv it was almost 54.3 per cent, which seems unlikely due to an increase in the proportion of ill-defined causes of death. In all five cities, the main trend over 2005-2013 years was the decline in mortality from the major causes of death, while the period 2013-2019 was turbulent, with mortality by causes of death changing in different directions even in the same city. Some contradictory results may be explained by the deterioration in the quality of the registration of demographic events as well as changes in the age and sex structure of the population of cities, which have not been reflected in the current estimates of the State Statistical Committee of Ukraine due to the long absence of a population census.