CAUSES OF DEATH IN TURKEY: HOW THE INCREASE IN THE BURDEN OF COMMUNICABLE DISEASES VARY BY SEX AND AGE?

Yıl 2023, Cilt: 8 Sayı: 1, 1 - 19, 17.01.2023

Zehra Yayla Enfiyeci , Alanur Çavlin

https://doi.org/10.35232/estudamhsd.1165384

Öz

Causes of death statistics are essential tools for public health, but Turkey lags in the number of studies on causes and
trends of death. This study measures causes and trends of death in Turkey for the 2013-2019 period, with special
emphasis on the increase in communicable diseases (CDs). This study has a representative research design based on
the national population and cause of death registration systems. Causes of death with International Classification of
Diseases, Tenth Revision (ICD-10) codes were grouped and garbage codes were determined and redistributed. To
understand how the increase in the burden of CDs vary by sex and age, modal age at death, age-specific death rates,
probability of eventual death, years of life lost (YLL) due to three main causes of death were calculated by using discrete
absorbing Markov chain model. According to results, modal age at death among male population shifted to older ages,
the share of respiratory infectious diseases and other infectious and parasitic diseases increased rapidly between 2013
and 2019, just before the onset of COVID-19 pandemic. Overall, our results suggest that burden of CDs increased for
both sexes, and elderly male population was among the most effected group. Since non-communicable diseases were
still the leading causes of death, increasing rate of CDs may create an extra burden on health system.

Anahtar Kelimeler

Causes of death, communicable diseases, Markov chain, modal age at death, Turkey

Destekleyen Kurum

None

Proje Numarası

None

TÜRKİYE’DE ÖLÜM NEDENLERİ: BULAŞICI HASTALIK YÜKÜNDEKİ ARTIŞ CİNSİYETE VE YAŞA GÖRE NASIL DEĞİŞMEKTEDİR?

Öz

Ölüm nedeni istatistikleri, halk sağlığı için çok önemli araçlardır, ancak Türkiye ölüm nedenleri ve eğilimlerine ilişkin
yapılan çalışmalarda geride kalmaktadır. Bu çalışma, bulaşıcı hastalıklardaki (BH’lerdeki) artışa özel bir vurgu yaparak,
2013-2019 döneminde Türkiye'deki ölüm nedenlerini ve eğilimlerini değerlendirmektedir. Çalışma, ulusal nüfus ve ölüm
nedeni kayıt sistemlerine dayalı temsili araştırma tasarımına sahiptir. Uluslararası Hastalık Sınıflandırması Onuncu
Revizyon (UHS-10) kodlarına sahip tüm ölüm nedenleri gruplandırılmış ve çöp kodlar belirlenerek ölüm nedenleri içinde
yeniden dağıtılmıştır. BH yükündeki artışın cinsiyete ve yaşa göre nasıl değiştiğini anlamak için ayrık Markov zinciri
modellemesi kullanılmış ve en fazla ölümün meydana geldiği yaş, üç ana ölüm nedenine göre yaşa özel ölüm oranları,
ölüm olasılıkları ve kaybedilen yaşam yılları hesaplanmıştır. Çalışmanın sonuçlarına göre, erkek nüfusta en fazla
ölümün meydana geldiği yaş daha ileri yaşlara kaymış; her iki cinsiyette de 2013-2019 yılları arasında- COVID-19
pandemisinin başlamasından hemen önce- solunum yolu enfeksiyon hastalıkları ile diğer bulaşıcı ve parazit
hastalıkların payı hızla artmıştır. Genel olarak, sonuçlarımız her iki cinsiyet için de BH yükünün arttığını ve yaşlı erkek
nüfusunun en çok etkilenen grup arasında olduğunu göstermektedir. Bulaşıcı olmayan hastalıklar hala önde gelen ölüm
nedenleri olduğundan, artan BH oranları sağlık sistemi üzerinde fazladan bir yük oluşturabilir.

Anahtar Kelimeler

Ölüm nedenleri, bulaşıcı hastalıklar, Markov zinciri, ölümdeki mod yaş, Türkiye

Proje Numarası

None

Kaynakça

• 1. Shorter FC, Macura M. Trends in fertility and mortality in Turkey, 1935-1975. Washington, D.C.: National Academies Press; 1982.
• 2. Toros A. Hypotheses on the major demographic developments in the recent past in Turkey. Genus [Internet]. 1985;41(1–2):97–117. Available from: http://www.ncbi.nlm.nih.gov/pubmed/12267541
• 3. Koç İ, Eryurt MA, Adalı T, Seçkiner P. Türkiye’nin Demografik Dönüşümü: Doğurganlık, Aile Planlaması, Anne-Çocuk Sağlığı ve Beş Yaş Altı Ölümlerdeki Değişimler 1968-2008. Ankara: HÜNEE, Sağlık Bakanlığı, DPT, TÜBİTAK; 2010.
• 4. Bakar C, Oymak S, Maral I. Turkey’s epidemiological and demographic transitions: 1931-2013. Balkan Med J [Internet]. 2017 [cited 2021 Sep 2];34(4):323–34. Available from: /pmc/articles/PMC5615965/
• 5. Nayir T, Nazlican E, Şahin M, Kara F, Alp Meşe E. Effects of immunization program on morbidity and mortality rates of vaccine-preventable diseases in Turkey. Turkish J Med Sci. 2020;50(8):1909–15.
• 6. TurkStat. Life Tables, 2013-2019 [Internet]. 2021 [cited 2021 Jun 6]. Available from: https://data.tuik.gov.tr/Kategori/GetKategori?p=nufus-ve-demografi-109&dil=1
• 7. Shorter FC. The population of turkey after the war of independence. Int J Middle East Stud [Internet]. 1985 Nov 29;17(4):417–41. Available from: https://www.cambridge.org/core/product/identifier/S002074380002941X/type/journal_article
• 8. TurkStat. Sustainable development indicators, 2010-2019 [Internet]. 2021 [cited 2021 Jun 6]. Available from: https://data.tuik.gov.tr/Bulten/Index?p=Surdurulebilir-Kalkinma-Gostergeleri-2010-2019-37194
• 9. McMichael AJ. Human culture, ecological change, and infectious disease: Are we experiencing history’s fourth great transition? Ecosyst Heal [Internet]. 2001 Jun;7(2):107–15. Available from: http://doi.wiley.com/10.1046/j.1526-0992.2001.007002107.x
• 10. Weiss RA, McMichael AJ. Social and environmental risk factors in the emergence of infectious diseases. Nat Med [Internet]. 2004 Dec;10(12S):S70–6. Available from: http://www.nature.com/articles/nm1150
• 11. WHO. The world health report 1996 - Fighting disease, fostering development. Vol. 18, World Health Forum. Geneva; 1997.
• 12. Morens DM, Folkers GK, Fauci AS. The challenge of emerging and re-emerging infectious diseases. Nature [Internet]. 2004 Jul 8;430(6996):242–9. Available from: http://www.nature.com/articles/nature02759
• 13. Jones KE, Patel NG, Levy MA, Storeygard A, Balk D, Gittleman JL, et al. Global trends in emerging infectious diseases. Nature [Internet]. 2008 Feb 21;451(7181):990–3. Available from: http://www.nature.com/articles/nature06536
• 14. Semenza JC, Lindgren E, Balkanyi L, Espinosa L, Almqvist MS, Penttinen P, et al. Determinants and Drivers of Infectious Disease Threat Events in Europe. Emerg Infect Dis [Internet]. 2016 Apr;22(4):581–9. Available from: http://wwwnc.cdc.gov/eid/article/22/4/15-1073_article.htm
• 15. Özdemir R. The evaluation of the new death registration system started to be applied in 2009 in Turkey in the case of İzmir city. [İzmir]: PhD, Ege University; 2012.
• 16. Özdemir R, Rao C, Öcek Z, Dinç Horasan G. Reliable mortality statistics for Turkey: Are we there yet? BMC Public Health [Internet]. 2015 Dec 10;15(1):545. Available from: http://bmcpublichealth.biomedcentral.com/articles/10.1186/s12889-015-1904-1
• 17. Yayla Z. Assessment of the completeness and timeliness of death registration in Turkey: 2009-2015. [Ankara]: Master thesis, Hacettepe University; 2016.
• 18. Sozmen K, Unal B. Socioeconomic Inequalities in Non-Communicable Diseases and Self Assessed Health in Turkey. Iran J Public Health [Internet]. 2014 Jun [cited 2022 Jun 13];43(6):736–48. Available from: http://ijph.tums.ac.ir
• 19. Balbay Y, Gagnon-Arpin I, Malhan S, Öksüz ME, Sutherland G, Dobrescu A, et al. Modeling the burden of cardiovascular disease in Turkey. Anatol J Cardiol [Internet]. 2018 [cited 2022 Jun 13];20(4):235–40. Available from: https://www.ncbi.nlm.nih.gov/pmc/articles/PMC6249532/
• 20. Breda J, Allen LN, Tibet B, Erguder T, Karabulut E, Yildirim HH, et al. Estimating the impact of achieving Turkey’s non-communicable disease policy targets: A macro-simulation modelling study. Lancet Reg Heal - Eur [Internet]. 2021 Feb 1 [cited 2022 Jun 13];1:100018. Available from: https://linkinghub.elsevier.com/retrieve/pii/S2666776220300181
• 21. WHO. WHO methods and data sources for global burden of disease estimates 2000-2011 [Internet]. WHO. Geneva; 2013. Available from: http://www.who.int/healthinfo/statistics/GlobalDALYmethods_2000_2011.pdf?ua=1
• 22. Naghavi M, Makela S, Foreman K, O’Brien J, Pourmalek F, Lozano R. Algorithms for enhancing public health utility of national causes-of-death data. Popul Health Metr. 2010 Dec 10;8(1):9.
• 23. Mathers CD, Lopez AD, Murray CJL. The Burden of Disease and Mortality by Condition: Data, Methods, and Results for 2001 [Internet]. Lopez AD, Mathers CD, Ezzati M, Jamison DT, Murray CJL, editors. Global Burden of Disease and Risk Factors. New York: Oxford University Press; 2006. 45–93 p. Available from: http://www.ncbi.nlm.nih.gov/pubmed/21250373
• 24. WHO. WHO methods and data sources for global causes of death 2000-2011. Global Health Estimates Technical Paper WHO/HIS/HSI/GHE/2013.3. Geneva; 2013.
• 25. Kemeny JG, Snell JL. Finite Markov chains: with a new appendix “Generalization of a fundamental matrix.” Springer-Verlag; 1976. 238 p.
• 26. Caswell H. Stage, age and individual stochasticity in demography. Oikos. 2009.
• 27. Engelman M, Caswell H, Agree EM. Why do lifespan variability trends for the young and old diverge? A perturbation analysis. Demogr Res [Internet]. 2014 May 1;30(1):1367–96. Available from: http://www.demographic-research.org/volumes/vol30/48/
• 28. Caswell H. Applications of Markov chains in demography. In: MAM 2006: Markov Anniversary Meeting. 2006.
• 29. Caswell H, Ouellette N. Mortality and causes of death: matrix formulation and sensitivity analysis. In: European Population Conference 2016, Mainz, Germany [Internet]. 2016. Available from: http://epc2016.princeton.edu/papers/160437
• 30. Caswell H, Zarulli V. Matrix methods in health demography: A new approach to the stochastic analysis of healthy longevity and DALYs. Popul Health Metr [Internet]. 2018 Dec 7;16(1):8. Available from: https://pophealthmetrics.biomedcentral.com/articles/10.1186/s12963-018-0165-5
• 31. Currie ID, Durban M, Eilers PH. Smoothing and forecasting mortality rates. Stat Modelling. 2004;4:279–98.
• 32. Camarda CG. Smoothing methods for the analysis of mortality development [Internet]. Vol. Doctor (PH. PhD, Universidad Carlos III de Madrid; 2008 [cited 2022 Jun 13]. Available from: https://e-archivo.uc3m.es/handle/10016/5133
• 33. Buzcu AF, Yetım Şahin A, Karapinar E, Erol Ö, Gökçay EG. Epidemiology of under-five mortality in İstanbul: changes from 1988 to 2011. Turkish J Med Sci [Internet]. 2017 Jan 1 [cited 2022 Jun 23];47(3):817–25. Available from: https://journals.tubitak.gov.tr/medical/vol47/iss3/16
• 34. Mathers CD, Stevens GA, Boerma T, White RA, Tobias MI. Causes of international increases in older age life expectancy. Lancet [Internet]. 2015 Feb 7 [cited 2022 Jun 13];385(9967):540–8. Available from: https://linkinghub.elsevier.com/retrieve/pii/S0140673614605699
• 35. Meslé F, Vallin J. Diverging Trends in Female Old-Age Mortality: The United States and the Netherlands versus France and Japan. Popul Dev Rev [Internet]. 2006;32(1):123–45. Available from: http://www.mortality.org/
• 36. Özdemir R, Dinç Horasan G, Rao C, Sözmen MK, Ünal B. An evaluation of cause-of-death trends from recent decades based on registered deaths in Turkey. Public Health [Internet]. 2017 Oct;151:121–30. Available from: https://linkinghub.elsevier.com/retrieve/pii/S0033350617302354
• 37. Dinç G, Sözmen K, Gerçeklioǧlu G, Arik H, Critchley J, Ünal B. Decreasing trends in cardiovascular mortality in Turkey between 1988 and 2008. BMC Public Health [Internet]. 2013 Dec 30;13(1):896. Available from: http://bmcpublichealth.biomedcentral.com/articles/10.1186/1471-2458-13-896
• 38. Unal B, Sözmen K, Arık H, Gerçeklioğlu G, Altun DU, Şimşek H, et al. Explaining the decline in coronary heart disease mortality in Turkey between 1995 and 2008. BMC Public Health [Internet]. 2013 Dec 5;13(1):1135. Available from: http://bmcpublichealth.biomedcentral.com/articles/10.1186/1471-2458-13-1135
• 39. Institute for Health Metrics and Evaluation. Turkey: 2009-2019 [Internet]. 2020. Available from: https://www.healthdata.org/turkey
• 40. TurkStat. Elderly Statistics, 2021 [Internet]. 2021. Available from: https://data.tuik.gov.tr/Bulten/Index?p=Istatistiklerle-Yaslilar-2021-45636
• 41. Désesquelles A, Demuru E, Pappagallo M, Frova L, Meslé F, Egidi V. After the epidemiologic transition: A reassessment of mortality from infectious diseases among over-65s in france and Italy. Int J Public Health [Internet]. 2015 Dec 4;60(8):961–7. Available from: http://link.springer.com/10.1007/s00038-015-0704-9
• 42. Choe YJ, Choe SA, Cho S Il. Trends in infectious disease mortality, South Korea, 1983-2015. Emerg Infect Dis [Internet]. 2018 Feb;24(2):320–7. Available from: http://wwwnc.cdc.gov/eid/article/24/2/17-0862_article.htm
• 43. Feddema JJ, van der Geest AM, Claassen E, van de Burgwal LHM. Lower Respiratory Tract Infection Trends in East and South-East Asia: In the Light of Economic and Health Care Development. Glob Pediatr Heal [Internet]. 2021 Jan 24;8:1–9. Available from: https://doi.org/10.1177/2333794X21989530
• 44. McDonald SA, van Wijhe M, van Asten L, van der Hoek W, Wallinga J. Years of Life Lost Due to Influenza-Attributable Mortality in Older Adults in the Netherlands: A Competing-Risks Approach. Am J Epidemiol [Internet]. 2018 Aug 1;187(8):1791–8. Available from: https://academic.oup.com/aje/article/187/8/1791/4840734
• 45. Plass D, Chau PYK, Thach TQ, Jahn HJ, Lai PC, Wong CM, et al. Quantifying the burden of disease due to premature mortality in Hong Kong using standard expected years of life lost. BMC Public Health [Internet]. 2013 Dec 18;13(1):863. Available from: http://bmcpublichealth.biomedcentral.com/articles/10.1186/1471-2458-13-863
• 46. Chan AHY, Horne R. Preventing a Post-Pandemic Double Burden of Disease in the COVID-19 Pandemic. Glob Adv Heal Med. 2021.
• 47. Fullman N, Yearwood J, Abay SM, Abbafati C, Abd-Allah F, Abdela J, et al. Measuring performance on the Healthcare Access and Quality Index for 195 countries and territories and selected subnational locations: A systematic analysis from the Global Burden of Disease Study 2016. Lancet. 2018 Jun 2;391(10136):2236–71.