William & Mary, USA.
National Statistical Institute, Bulgaria; University of National and World Economy, Bulgaria.
Public Health. 2024 Nov;236:144-152. doi: 10.1016/j.puhe.2024.05.031. Epub 2024 Aug 26.
Despite extensive public health initiatives, Bulgaria still has the lowest life expectancy at birth (LE) in the European Union. Sex and ethnic differences in LE and mortality are also exceptionally large. We aimed to identify what causes of death drive these wide disparities and thus provide clear targets for future public health interventions.
We conducted a retrospective analysis of mortality rates from 2010 to 2022 to assess sex disparities in LE by age and cause of death. Combining mortality data with the 2021 Bulgarian census also allowed us to study LE disparities among the three main ethnic groups (Bulgarians, Turks, and Roma). We implemented standard demographic decomposition methods to quantify the role of seven major causes of death on LE disparities.
We found that the difference between male and female LE has persisted for around seven years. Circulatory diseases contribute 3.66 years, or around 50% of the male-female gap. Ethnic LE disparities are larger for women than for men. Circulatory diseases account for more than 60% of these ethnic LE gaps. COVID-19 mortality explained between 0.5 and 1.1 years of the male-female gap. We found minimal differences in COVID-19 mortality across ethnic groups in Bulgaria.
In Bulgaria, circulatory diseases contributed more to both the sex and ethnic LE gaps than in any other previously studied country. Our findings suggest that future public health policy initiatives should focus on circulatory diseases to narrow the Bulgarian LE disparities. One possible target for such a policy would be to reduce excessive smoking and alcohol consumption.
尽管开展了广泛的公共卫生举措，保加利亚仍是欧盟中出生预期寿命（LE）最低的国家。LE 和死亡率方面的性别和族裔差异也非常大。我们旨在确定哪些死因导致了这些巨大差异，从而为未来的公共卫生干预措施提供明确的目标。
我们对 2010 年至 2022 年的死亡率进行了回顾性分析，以评估按年龄和死因划分的 LE 性别差异。将死亡率数据与 2021 年保加利亚人口普查相结合，还使我们能够研究三大主要族裔（保加利亚人、土耳其人和罗姆人）之间的 LE 差异。我们采用了标准的人口统计分解方法来量化七个主要死因对 LE 差异的作用。
我们发现，男性和女性 LE 之间的差距持续了大约七年。循环系统疾病导致了 3.66 年的差距，约占男女差距的 50%。女性的族裔 LE 差异大于男性。循环系统疾病占这些族裔 LE 差距的 60%以上。COVID-19 死亡率占男女 LE 差距的 0.5 至 1.1 年。我们发现，保加利亚不同族裔群体之间的 COVID-19 死亡率差异极小。
在保加利亚，循环系统疾病对男女 LE 差距以及族裔 LE 差距的贡献均大于其他任何先前研究的国家。我们的研究结果表明，未来的公共卫生政策举措应侧重于循环系统疾病，以缩小保加利亚的 LE 差距。这种政策的一个可能目标是减少过度吸烟和饮酒。
