How to achieve the UN Sustainable Development Goals in the field of noncommunicable diseases by 2030, according to research in 49 countries

Goal. To analyze chronic noncommunicable diseases (NCD) mortality dynamics and associated efforts to reach UN sustainable development goals (SDG) in the area of NCD “by 2030, reduce by one third premature mortality from NCD through prevention and treatment“.Methods. WHO statistics, based on the unified mortality and cause -of- death reports of Member-States countries along with the latest information from global WHO programmes, were used to evaluate NCD mortality trends in 49 countries in 2000, 2010 and 2016 and make comparisons and assessments of different types of community -based, country-wide interventions. Only countries with multiple years of national death registration data and high completeness and quality of cause-of-death assignments were included in the analysis. Cardiovascular disease (CVD) ischemic heart disease (IHD) and stroke, chronic respiratory disease (CRD) bronchial asthma and chronic obstructive pulmonary disease (COPD) lung cancer and diabetes mortality were analysed in 36 high income countries (HIC) and 13 middle income countries (MIC).Results. The most visible decline was achieved for bronchial asthma 54%, stroke 43% IHD 30% and COPD 29%. Lung cancer and diabetes mortality decline were not statistically significant. Prevalence of tobacco smoking gradually declined in 84% of countries, 55% of countries demonstrated declining prevalence of raised blood pressure. Obesity prevalence was increasing in all countries. CVD and CRD mortality were higher in MIC. HIC better implemented tobacco and diet reduction measures. Same concerns NCD management approach. Air pollution level was higher in MIC.Conclusions. NCD mortality decline is associated with multiple WHO global life style modifications campaigns, global coordinated prevention and control programmes for hypertension, asthma and COPD and WHO developed “best buy” approach. In order to achieve better results in lung cancer mortality together with early detection, more efforts should be concentrated on early diagnosis, strengthening tobacco cessation, clean air and diet actions. Diet and physical activities along with adequate management and patient education remain key elements to improve diabetes prognosis by the year 2030. Air pollution control could also facilitate achievement of the UN SDG 3.4.

Urban Water Disinfection and Mortality Decline in Lower-Income Countries

Historically, improvements in municipal water quality led to substantial mortality decline in today’s wealthy countries. However, water disinfection has not consistently produced large benefits in lower-income countries. We study this issue by analyzing a large-scale municipal water disinfection program in Mexico that increased water chlorination coverage in urban areas from 58 percent to over 90 percent within 18 months. We estimate that the program reduced childhood diarrheal disease mortality rates by 45 to 67 percent. However, inadequate sanitation infrastructure and age (degradation) of water pipes may have attenuated these benefits substantially. (JEL I12, I18, L95, O13, O18, Q25, Q53)

Macroeconomic changes and educational inequalities in traffic fatalities in the Baltic countries and Finland in 2000–2015: a register-based study

This study examined trends and inequalities in road traffic accident (RTA) mortality in the Baltic countries (Estonia, Latvia, Lithuania) and Finland in relation to large-scale macroeconomic changes in the 2000s. Educational inequalities in RTA mortality in 2000–2003, 2004–2007, 2008–2011 and 2012–2015 among 30–74 year olds were examined using census-linked longitudinal mortality data and by estimating the relative and slope index of inequality. Overall RTA mortality decreased substantially between 2000–2003 and 2012–2015. From 2004–2007 to 2008–2011, the RTA mortality decline accelerated but was larger in the Baltic countries. Among men the RTA mortality decline was mostly driven by a larger fall among the high and middle educated. Among women, the changes in RTA mortality by educational level had no clear pattern. From 2000–2003 to 2012–2015 relative educational inequalities in RTA mortality increased among men, although more in the Baltic countries. Among women the pattern was mixed across countries. Absolute inequalities fell in all countries among both sexes. Educational inequalities in male RTA mortality may be growing because of increasingly less access to safer cars and a more hazardous driving culture among the lower educated.

The ratio of expansion to compression: A new measure of lifespan disparity

Numerous studies have shown that high life expectancy is closely related to low life disparity. Unlike life expectancy, which can be increased by mortality decline at any age, life disparity can either increase or decrease in response to mortality decline. Disparity can thus be decomposed into two opposite components, called compression and expansion, depending on the effect of mortality decline on the age distribution of mortality. Without specifying the two components, various conventional measures of disparity may provide misleading information relating to how life chances in society can be equalized. Based on the relevant properties of changes in disparity, we develop a new measure of disparity—the ratio of expansion to compression—that can account for the relative importance of the two components. This simple measure not only provides a clear view of the evolution of disparity, but also permits changes in disparity related to mortality decline to be interpreted in a consistent manner similar to life expectancy. Simulations and an empirical analysis demonstrated the advantages of this new measure over conventional measures of disparity.

Pauses and reversals of infant mortality decline in India in 2017 and 2018

This note examines recent trends in infant mortality in India, based on summary reports from the Sample Registration System (SRS). We find evidence of slowdown, pauses, and reversals in infant mortality decline in large parts of India in 2017 and 2018, the last two years for which SRS data are available. In urban areas, the infant mortality rate stagnated at 23 deaths per 1,000 births between 2016 and 2018. Worse, overall infant mortality increased in the poorer states of Chhattisgarh, Jharkhand, Madhya Pradesh, and Uttar Pradesh in this period. This occurred despite sustained improvements in household access to sanitation and clean fuel. One possible interpretation of these findings is that, in addition to their impact on unemployment and poverty, the demonetization experiment in late 2016 and the subsequent economic slowdown had an adverse effect on child health. In any case, these trends reinforce earlier evidence of faltering human development in India in recent years.

Mortality Compression and Variability in Age at Death in India

The global rise of life expectancy at birth has attracted worldwide interest, especially in understanding the pace of mortality transition in developing countries. In this study, we assess the progress of mortality transition in India during four decades between 1970 and 2013. We estimate measures of mortality compression and variability in age at death to assess the trends and patterns in mortality compression for India as a whole and its twelve biggest states. The results reveal an unequivocal convergence pattern in mortality compression across the states underpinned by the reduction in premature mortality and emerging homogeneity in mortality. Results by gender show that women are more homogenous in their mortality across the country because of an explicit reduction in the Gini coefficients at age 10 by the age group of 15-29 years. Mortality compression has changed in recent decades because of the increased survival of women in their reproductive ages, which marked a distinct phase of mortality transition in India. The pace of mortality transition, however, varies; adult mortality decline was greater than senescent mortality decline. These results show that India has passed the middle stage of mortality transition and has entered an early phase of low mortality.

P119 The impact of minimal alcohol price policy on premature CVD mortality in Kazakhstan

Background In Kazakhstan, premature cardiovascular (CVD) mortality is one of the highest in the world despite the dramatic decline of CVD mortality since 2006. Our previous research found that alcohol consumption was the main determinant of premature CVD mortality in Kazakhstan and the decrease of alcohol use was the main factor influencing the CVD mortality decline. Purpose With the aim of examining the impact of minimal price changes for strong spirits (vodka) and alcohol sales on premature CVD mortality in 2006-2014, we compared age-specific CVD mortality for the age group 19-49 with changes in the minimal price of strong spirit (vodka) and alcohol sales. Methods Age-specific CVD mortality rates in age group 19-49 in Kazakhstan were obtained from the Global Burden of Disease database and explored with regard to changes in minimal prices of vodka and alcohol sales in Kazakhstan over this period. Results Age-standardized CVD mortality rates in age group 19-49 declined by 47% from 2006 to 2014, for both men and women. However, we observed the plateauing effect in CVD mortality trend in 2015-2017. These mortality trends coincided with the sharp increase in minimal vodka prices and decrease or flatten in alcohol sales in 2006-2014 period and consequent minimal price decrease and plateauing in 2015-2017 that was accompanied by increase of alcohol sales in this period. Conclusions Our findings indicate that public health measures such as tax increases for strong spirits can be a very effective CVD prevention strategy in Kazakhstan and other former USSR countries, where similar mortality trends can be observed. Unfortunately, this mortality decline was not sustained over time. We believe it happened due to a weakened policy in regard to the minimal alcohol prices. Therefore, there is much scope for further policy action in this area. Abstract P119 Figure. CVD and Alcohol price