Ups and downs in disease trends for eastern Europe and Central Asia

Guest post by Katie Leach-Kemon, a policy translation specialist from the University of Washington’s Institute for Health Metrics and Evaluation.

This week, the World Bank and the Institute for Health Metrics and Evaluation (IHME) teamed up to release six reports that provide an in-depth view of health progress and challenges in different World Bank regions using findings from the Global Burden of Disease (GBD) Study 2010.

One of the six reports,  Global Burden of Disease: Generating Evidence, Guiding Policy – Europe and Central Asia Regional Edition  is focused on countries in Eastern Europe, where progress has been made but for some parts of the region TB and HIV rates have skyrocketed. This portion of the report includes countries such as Russia, Ukraine, Romania, Belarus, Uzbekistan, Serbia, and Turkey.

Among 1- to 4-year-olds in the region, mortality dropped by around 80% between 1970 and 1990.  Using the online tool GBD Arrow Diagram provides insight into the different diseases that are showing progress in this age group. The dotted red lines show how deaths from communicable diseases, including lower respiratory infections, diarrhea, and meningitis, as well as different types of injuries such as drowning, road injuries, and fire-related injuries decreased between 1990 and 2010:


But while the region has excelled at saving children’s lives, this progress has not extended to all members of society. Adult men in certain age groups are faring poorly. The figure below (taken from the newly published report)  shows that mortality rates in men ages 25 to 29 barely budged between 1970 and 2010, and mortality rates actually increased by roughly 10%in men ages 45 to 59. At a time when people are living longer than ever before in most regions of the world, why aren’t we seeing similar improvements among men in Europe and Central Asia?


The event at the World Bank his week releasing the report featured Christopher Murray, Director of IHME, and Tim Evans, Director for Health, Nutrition and Population at the World Bank. This is a continuation of a longstanding partnership between the bank and burden of disease researchers that began two decades ago when the World Bank funded the first such study and featured its findings in the influential World Development Report 1993: Investing in Health. A video of this week’s event can be found online here.

Now, let’s look at the leading causes of death in 25- to 29-year-old men in Europe and Central Asia using the GBD Arrow Diagram tool. The image below shows that self-harm (suicide) is the leading contributor to deaths in this age group, followed by road injury and HIV/AIDS. Deaths from suicide in this age group rose by 19% between 1990 and 2010, but encouragingly, deaths from road injuries dropped by 23%, most likely due to improved road safety measures in the region. Mortality from HIV/AIDS increased by more than 8,000%. While this is a striking increase, it’s important to note that most regions saw a big increase in deaths from HIV/AIDS between 1990 and 2010.





Now that we have learned about the major injuries and diseases that are killing men ages 25 to 29 in Europe and Central Asia, it’s also important to identify the potentially preventable risk factors that are contributing to these deaths. The next screen grab shows that alcohol use is the leading risk factor for death among 25- to 29-year-old men in the region. GBD estimates that a whopping 70% of suicide deaths and 74% of road injury deaths in Europe and Central Asia were attributable to alcohol use in this age group. According to GBD, reducing alcohol use in countries in this region could potentially save an estimated 22,000 lives in 2010. The high ranking of HIV/AIDS as a cause of death in this age group also suggests that expanded access to antiretroviral therapy (ART) and efforts to reduce HIV transmission through intravenous drug use could greatly improve the health of men in Europe and Central Asia.

GBD Europe Cent Asia 3

Next, let’s look at disease patterns in older men in Europe and Central Asia. We saw earlier how men 45 to 59 were seeing an increase in mortality. Zeroing in on men ages 45 to 49, you see a 12% increase in mortality between 1970 and 2010. Heart disease and stroke were the first- and second-leading causes of death in this age group, respectively, followed by HIV/AIDS:


Examining the possibly avoidable risk factors for men ages 45 to 49 (find the live tool here) reveals that poor diet is the leading driver of death, followed by alcohol use and smoking. Poor diet includes not eating enough fruit, nuts and seeds, and whole grains, and eating too much salt. In this region, alcohol use is a major risk factor for heart disease, while poor diet and smoking contribute to deaths from heart disease and stroke.


In addition to interventions designed to prevent and treat HIV/AIDS and improve eating habits, GBD data show that reducing alcohol use among men in Europe and Central Asia has the potential to address the disturbing increases in mortality the region is experiencing. A study published last week found that Eastern European countries had the highest rates of premature death and disability from alcohol use disorders. The Guardian documented how entire villages in Russia are populated exclusively by women as men have died off from alcoholism since the demise of the Soviet Union.

“Following the collapse of the USSR, economic crises and unemployment in former Soviet Union countries are driving more men to seek solace in alcohol,” said IHME Associate Professor Mohsen Naghavi, a co-author of the GBD study.

As with so many global health challenges, the alcohol use driving the mortality crisis among men in Europe and Central Asia stems from problems that extend far beyond what health systems alone can address.  What kinds of interventions and programs do you think could improve health in countries in Europe and Central Asia? Share your thoughts with us via Twitter and Facebook.


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