Seasonal Mortality Variations of Cardiovascular, Respiratory and Malignant Diseases in the City of Belgrade
Article Sidebar
Main Article Content
Abstract
The main purpose of this paper is to examine seasonal variations in mortality resulting from cardiovascular diseases, respiratory diseases and cancer, as well as to provide a review of environmental factors underlying such phenomenon. The herein presented study was conducted on the territory of Belgrade based on the data on daily mortality rates obtained from the Institute of Public Health in Belgrade for the period 2009-2014, as well as the data on annual mortality rates provided by the Statistical Office of the Republic of Serbia for the period 2000-2014. The analysis of mortality variations was performed by the use of Theil-Sen method, smooth trend method and cubic spline interpolation, whereas desriptive tools, such as winter/summer ratio and dissimilarity index, were used to examine the seasonal pattern.
According to the Institute of Public Health, over 113430 deaths were registered in Belgrade area for the period 2009-2014, out of which 53.25% is attributed to cardiovascular diseases, 4.01% to respiratory diseases and 27.50% to cancer. The annual mortality rates caused by cardiovascular diseases and cancer on the territory of Belgrade are among the highest ranking in Europe. The leading causes of death in the observed period included: cardiomyopathy, heart attack and stroke with accompanying complications, breast cancer in women, prostate and colorectal cancer in men, lung and bronchus cancer for both genders, and chronic obstructive pulmonary disease. Cardiovascular and respiratory mortality rates are significantly higher among people aged 65 and over, whereas more than one third of deaths caused by cancer is observed among younger people aged between 45 and 64 years.
Research results show that seasonal variations were most pronounced in mortality resulting from cardiovascular and respiratory diseases, with highest mortality rates recorded in February and March and lowest during the summer season. Also, the number of deaths due to cardiovascular diseases increased twice, namely at the end of June and October, which is assumed to be the result of sudden temperature changes. Nonetheless, no such seasonal variations were observed in mortality caused by cancer. Seasonal variations in mortality resulting from cardiovascular diseases also indicate gender differences, which is why sudden temperature changes in interim periods affect more women than men.
As regards deseasonalized trend, mortality caused by cardiovascular diseases stagnates, while mortality caused by cancer and mortality caused by respiratory diseases records moderate to severe increase. This is a uniform trend in almost all municipalities in Belgrade, with average mortality rates being higher in central zones than in suburbs over the last 15 years, particularly mortality caused by cancer. A slight increase in the overall mortality can also be attributed to aging of the population, which cannot be verified due to lack of available accurate data on the average age structure of Belgrade population for the observed period.
A better understanding of seasonal variations in mortality caused by chronic non-communicable diseases can contribute to improving the population health care and rising awareness of the population concerning greater health care in changeable weather conditions due to global warming and climate change. These findings can also enhance preventive action on environmental risk factors that are not limited exclusively to weather conditions, such as air pollution.
Downloads
Article Details
Published by the Institute of Social Sciences - Center for Demographic Research
References
AHMED, A. PHAM, D., VIRANI, S., HAMZEH, I. R., JNEID, H., LAKKIS, N. & ALAM, M. (2014). Does Gender Still Influence Mortality Post Percutaneous Coronary Intervention (PCI)? A Meta-Analysis of the Impact of Gender on PCI Outcomes. Circulation 130 (Suppl 2): A15682-A15682.
ARSENOVIĆ, D. (2014). Uticaj temperature vazduha na sezonalnost mortaliteta u Novom Sadu (doktorska disertacija). Prirodno-matematički fakultet Univerziteta u Novom Sadu.
BARRETT, J. R. (2015). Exported Deaths and Short-Term PM10 Exposure: Factoring the Impact of Commuting into Mortality Estimates. Environmental Health Perspectives 123(1): A22.
BELL, M. L., MORGENSTERN, R. D. & HARRINGTON W. (2011). Quantifying the human health benefits of air pollution policies: Review of recent studies and new directions in accountability research. Environmental Science & Policy 14(4): 357-368.
BOULAY, F., BERTHIER, F., SISTERON, O., GENDREIKE, Y. & GIBELIN, P. (1999). Seasonal variation in chronic heart failure hospitalizations and mortality in France. Circulation 100(3): 280-286.
BREITNER, S., WOLF, K., DEVLIN, R. B., DIAZ-SANCHEZ, D., PETERS, A. & SCHNEIDER, A. (2014). Short-term effects of air temperature on mortality and effect modification by air pollution in three cities of Bavaria, Germany: a time-series analysis. Science of the Total Environment 485-486: 49-61.
CANCER RESEARCH UK (2015) Cancer Mortality by Age (elektronski izvor). http://www.cancerresearchuk.org/health-professional/cancer-statistics/mortality/age#heading-Zero
CARSLAW, D. C. & ROPKINS, K. (2012). Openair - An R package for air quality data analysis. Environmental Modelling & Software 27: 52-61.
CARSLAW, D. C., BEEVERS, S. D., & TATE, J. E. (2007). Modelling and assessing trends in traffic-related emissions using a generalised additive modelling approach. Atmospheric Environment 41(26): 5289-5299.
DEVEDŽIĆ, M. (2013). Raskršća demografije. Stanovništvo 51(2): 23-38.
DIAZ, A., GERSCHCOVICH, E. R., DÍAZ, A. A., ANTÍA, F. & GONORAZKY, S. (2013). Seasonal variation and trends in stroke hospitalizations and mortality in a South American Community Hospital. Journal of Stroke and Cerebrovascular Diseases 22(7): e66-e69.
ĐURĐEV, B. S., ARSENOVIĆ, D. & SAVIĆ, S. (2012). Temperature-related Mortality: Results from Belgrade in the Period 1888-2008. Acta Geographica Slovenica 52(2): 385-40.
EGONDI, T., KYOBUTUNGI, C., KOVATS, S., MUINDI, K., ETTARH, R. & ROCKLÖV, J. (2012). Time-series analysis of weather and mortality patterns in Nairobi's informal settlements. Global Health Action 5.
EUROSTAT (2013). Mortality and life expectancy statistics. Statistics Explained. Eurostat (elektronski izvor). http://ec.europa.eu/eurostat/statistics-explained/index.php/Mortality_and_life_expectancy_statistics
GAJIĆ, V., MILOJEVIĆ, D., SMAILAGIĆ, J., ĐONOVIĆ, N. & GAJIĆ, S. (2011). Biometeorološki uticaj na kardiovaskularni mortalitet. Pons 8(1): 3-9.
GASPARRINI, A., GUO, Y., HASHIZUME, M., LAVIGNE, E., ZANOBETTI, A., SCHWARTZ, J. & LEONE, M. (2015). Mortality risk attributable to high and low ambient temperature: a multicountry observational study. The Lancet 386(9991): 369–375.
GEHR, P. & J. HEYDER (Eds.). (2000). Particle-lung interactions. New York: CRC Press.
GOLDSTEIN, E., VIBOUD, C., CHARU, V. & LIPSITCH, M. (2012). Improving the estimation of influenza-related mortality over a seasonal baseline. Epidemiology 23(6): 829-839.
HECKING, M., BIEBER, B. A., ETHIER, J., KAUTZKY-WILLER, A., SUNDER-PLASSMANN, G., SÄEMANN, M. D. & PORT, F. K. (2014). Sex-Specific Differences in Hemodialysis Prevalence and Practices and the Male-to-Female Mortality Rate: The Dialysis Outcomes and Practice Patterns Study (DOPPS). PLOS Medicine 11(10): e1001750.
HOPSTOCK, L. A., BARNETT, A. G., BØNAA, K. H., MANNSVERK, J., NJØLSTAD, I. & WILSGAARD, T. (2013). Seasonal variation in cardiovascular disease risk factors in a subarctic population: The Tromsø Study 1979–2008. Journal of Epidemiology and Community Health 67(2): 113-118.
KEATINGE, W. R. (2002). Winter mortality and its causes. International Journal of Circumpolar Health 61(4): 292-305.
KINDIG, D. A. & CHENG E. R. (2013). Even as mortality fell in most US counties, female mortality nonetheless rose in 42.8 percent of counties from 1992 to 2006. Health Affairs 32(3): 451-458.
KRALL, J. R., ANDERSON, G. B., DOMINICI, F., BELL, M. L. & PENG, R. D. (2013). Short-term exposure to particulate matter constituents and mortality in a national study of US urban communities. Environmental Health Perspectives 121(10): 1148-1161.
LI, T., HORTON, R. M. & KINNEY, P. L. (2013). Projections of seasonal patterns in temperature-related deaths for Manhattan, New York. Nature Climate Change 3(8): 717-721.
MARINKOVIĆ, I. (2012). Uzroci smrti u Srbiji od sredine 20. veka. Stanovništvo 50(1): 89-106.
MARINKOVIĆ, I. (2014). Visoka smrtnost kao uzrok depopulacije u Republici Srbiji. Demografski pregled 51: 1-4.
MAZICK, A., GERGONNE, B., NIELSEN, J., WUILLAUME, F., VIRTANEN, M. J., FOUILLET, A. & NUNES, B. (2012). Excess mortality among the elderly in 12 European countries, February and March 2012. Euro Surveillance 17(14): pii=20138.
McCARTNEY, G., MAHMOOD, L., LEYLAND, A. H., BATTY, G. D. & HUNT, K. (2011). Contribution of smoking-related and alcohol-related deaths to the gender gap in mortality: evidence from 30 European countries. Tobacco Control 20(2): 166-168.
McKEE C. M. (1989). Deaths in Winter: Can Britain learn from Europe? European Journal of Epidemiology 5(2): 178–82.
McKINLEY, S. & LEVINE, M. (1998). Cubic spline interpolation. College of the Redwoods (elektronski izvor). http://pages.intnet.mu/cueboy/education/notes/numerical/cubicsplineinterpol.pdf
MÜLLER-NORDHORN, J., BINTING, S., ROLL, S. & WILLICH, S. N. (2008). An update on regional variation in cardiovascular mortality within Europe. European heart journal 29: 1316-1326.
NIELSEN, J., MAZICK, A., GLISMANN, S. & MØLBAK, K. (2011). Excess mortality related to seasonal influenza and extreme temperatures in Denmark, 1994-2010. BMC Infectious Diseases 11(1): 350-359.
PENEV, G. & PREDOJEVIĆ-DESPIĆ, J. (2012). Prostorni aspekti emigracije iz Srbije. Tri "vruće" emigracione zone. Stanovništvo 50(2): 35-64.
PENEV, G. (2014). Sezonalost suicida u Srbiji, 1990-2012. Stanovništvo 52(2): 67-89.
PERIŠIĆ, M., STOJIĆ, A., STANIŠIĆ STOJIĆ. S., ŠOŠTARIĆ, A., MIJIĆ, Z. & RAJŠIĆ, S. (2014). Estimation of required PM10 emission source reduction on the basis of a 10-year period data. Air Quality, Atmosphere and Health 1-11.
POLLOCK, D. (1993). Smoothing with cubic splines (elektronski izvor). http://www.researchgate.net/profile/D_Pollock/publication/241171192_SMOOTHING_WITH_CUBIC_SPLINES/links/0046352cfad5c46ccb000000.pdf
POPE, C. A., BURNETT, R. T., THURSTON, G. D., THUN, M. J., CALLE, E. E., KREWSKI, D. & GODLESKI, J. J. (2004). Cardiovascular mortality and long-term exposure to particulate air pollution epidemiological evidence of general pathophysiological pathways of disease. Circulation 109(1), 71-77.
RAU, R. (2007). Seasonality in human mortality: a demographic approach. Berlin: Springer
R CORE TEAM. (2015). R: A Language and Environment for Statistical Computing. Vienna, Austria: R Foundation for Statistical Computing. (elektronski izvor). http://www.r-project.org
ROSS, C. E., MASTERS, R. K. & HUMMER, R. A. (2012). Education and the gender gaps in health and mortality. Demography 49(4): 1157-1183.
SALAM, A., ALBINALI, H., SINGH, R., ASAAD, N., ALQAHTANI, A. & AL SUWAIDI, J. (2013). Female gender is an independent predictor of in-hospital mortality in patients hospitalized with dizziness. Journal of the American College of Cardiology 61(10): E81.
STANIŠIĆ STOJIĆ. S., STANIŠIĆ, N., STOJIĆ, A. & ŠOŠTARIĆ, A. (2016). Single and combined effects of air pollutants on circulatory and respiratory system-related mortality in Belgrade, Serbia. Journal of Toxicology and Environmental Health, part A: Current Issues, 79(1): 17-27.
STOJIĆ, A., STANIŠIĆ STOJIĆ, S., ŠOSTARIĆ, A., ILIĆ, L., MIJIĆ, Z. & RAJŠIĆ, S. (2015a). Characterization of VOC sources in urban area based on PTR-MS measurements and receptor modelling. Environmental Science and Pollution Research 17: 13137-13152.
STOJIĆ, A., STANIŠIĆ STOJIĆ, S., MIJIĆ, Z., ŠOŠTARIĆ, A. & RAJŠIĆ, S. (2015b). Spatio-temporal distribution of VOC emissions in urban area based on receptor modelling. Atmospheric Environment 106: 71-79.
ŠUKOVIĆ, D. (2013). Reforma penzionog sistema i problem starenja populacije. Stanovništvo 51(1): 91-102.
WHO EUROPE (2015). European Detailed Mortality Database. World Health Organization, Regional Office for Europe (elektronski izvor). http://data.euro.who.int/dmdb/
WOOD, S. (2006). Generalized additive models: an introduction with R. New York: CRC press.
YE, X., WOLFF, R., YU, W., VANECKOVA, P., PAN, X. & TONG, S. (2012). Ambient temperature and morbidity: a review of epidemiological evidence. Environmental Health Perspectives 120(1): 19-28.
ZHANG, Z., FANG, J., GILLESPIE, C., WANG, G., HONG, Y. & YOON, P. W. (2012). Age-specific gender differences in in-hospital mortality by type of acute myocardial infarction. The American Journal of Cardiology 109(8): 1097-1103.