[Trends in mortality in Serbia, excluding the provinces, 1973-1994].

The war and break up of former Yugoslavia began in 1991. In May 1992 the United Nations imposed economic sanctions on Serbia and Montenegro which were suspended only in November 1995. The purpose of this study was to assess the effects of the war and UN sanctions on health of the population of Serbia without the provinces of Vojvodina and Kosovo. The period 1973-1994 was studied. Mortality data were derived from unpublished and published materials of the Federal Institute of Statistics [1]. Refugees, who, because of civil war, came to Serbia and Montenegro from other parts of former Yugoslavia, were not counted as a part of the population when mortality rates were calculated. Mortality rates were standardized directly using the "European population" as the standard [2]. The least square method was used to fit mortality rates to different trend curves. Linear trend was used whenever it significantly (p < 0.05) demonstrated the existing mortality rates. To measure the possible effect of the war and sanctions (WAS) on mortality between 1991 and 1994, dummy variable (variable WAS) consisting of 0's and 1's was made to signify the passage from the period before and the period after the beginning of the war and sanctions [3]. Over the period 1991-1994, characterized by the war and UN sanctions, in women aged 25-34, 35-44 and 75-84, total mortality was significantly higher than expected on the basis of the trend for the preceding period (p = 0.006, p = 0.000 and p = 0.015 respectively). The opposite effect was found in the age group 85+ (p = 0.012)/Table 2. Of major causes of death, in age group 25-34, mortality from endocrine diseases increased more rapidly in both sexes (p = 0.000) and mortality from urogenital diseases in women decreased more slowly than expected (p = 0.006). On the other hand, in age group 85+ mortality was significantly lower for cardiovascular diseases in both sexes (p = 0.035 and p = 0.006), for respiratory diseases in men (p = 0.011) and for neoplasms in women (p = 0.006)/Table 4. In addition, in the years 1991 and 1992 the increase in mortality from injuries and poisoning was evident in men aged 15-24, 25-34 and 85+ years (Graph 5). Our results show that over the period 1991-1994 changes in mortality were present in some age groups and were caused by certain groups of diseases. In men, besides mortality of infectious disease which decreased more slowly during 1991-1993 than expected, [4], the main departures were found in the mortality from injuries and poisoning and in mortality from endocrine diseases. The excess of death due to injuries and poisoning in the age group 15-34 can be explained as a direct consequence of the war. There were no military operations on the territory of Serbia, but young men from Serbia were nevertheless engaged in the war in other republics of former Yugoslavia. The outstanding increase in mortality caused by injuries and poisoning in men aged 85+ has two explanations. The first is the fact that suicide rate which was on an average of 86 per 100,000 over the period 1984-1990 rose to 140 per 100,000 during the period 1991-1993. In the year 1994 it fell to 92 per 100,000. Since there were no great differences in percent distribution of suicides among all deaths caused by injuries and poisoning in the two periods (27% in 1984-1990 and 20% in 1991-1993), it is clear that the rise of suicidal rate cannot be the only explanation for increased mortality from injuries and poisoning. In a situation when medical services were badly overextended (lack of medical equipment and proper maintenance of the existing equipment, lack of drugs and other medical inputs, a large number of wounded coming from Bosnia as well as numerous refugees) [5, 6], priority had to be given to younger age groups. Higher mortality due to endocrine diseases in men and women aged 25-34 years and higher mortality due to urogenital diseases in women of the same ages can be most probably attributed to poor medical supplies. Although formally excluded from the international economic blockade medical supplies were in practice badly affected by the fact that the dinar was rendered almost worthless and the Ministry of Health could no longer pay the medical inputs. In addition, bureaucratic hurdles of getting clearance from the UN added months of delay and made foreign companies unwilling to trade [5, 7]. The supply and distribution of drugs within the country was also irregular because communication lines were cut and local companies were not prepared to risk distributing drugs that nobody could pay for [7]. Higher than expected mortality in women aged 25-44 over the period 1991-1994 could be probably explained by their higher vulnerability (period of fertility) and the fact that the main burden of family survival was on them, so they had no time to think and to take care of their health. (ABSTRACT TRUNCATED)