Mortality Trends in Serbia During the 1990s

Troubled historical events from the 1990s considerably influenced the latest demographic trends in Serbia (excluding Kosovo and Metohija). In the domain of mortality, these trends were reflected through the manifestation of many unfavorable changes. Such mortality changes in Serbia were relatively short-lived and considerably less pronounced than in most countries in transition, especially in comparison to some former Soviet republics. Taking into consideration the scale and duration of the general social crisis in Serbia, we could evaluate these aggravations as moderate. On the other hand, improvements of mortality trends that arose during the 1990s were considerably less pronounced than in other European countries, especially in comparison to improvements that were realized in some other countries in the second half of the 1990s. During the 1990s, the annual number of deaths as well as the crude death rates continued increasing. The crude death rate of 13.8 per 1000 in the year 2000 represents the maximum in the last 50 years. Consequently, at the end of the 20th century, Serbia (excluding Kosovo and Metohija) is above the European average according to crude mortality rates, and observed by countries, higher rates were registered only in a few former socialist countries. During the 1990s, significant changes in age-specific mortality rates were not realized. The relatively greatest decrease was in infant mortality rate (from 21.8 in 1991 to 11.7 per 1000 in 2001). Despite the unexpectedly favorable trends, Serbia is considerably behind many other European countries in which the infant mortality rate is reduced to a very low level (under 5 per 1000 live births). As for 1991 and 1992, and partly for 1993, a rapid increase of younger adult population deaths was noted. Such trends, though, did not cause considerable changes either in the total number of deaths or in the life expectancy. The mortality of older adult population (40-59) at the end of the observed decade is almost identical to the one at the beginning of the 1990s. The same trend was present in the old population (60 and over), although the mortality level of the elderly population decreased slowly (75-84) or stagnated (85+). Such a mortality trend of the old has been present in Serbia since the 1970s, which is opposed to the changes in many developed countries in which very significant results in lowering old-age mortality were achieved in the last decades. The mortality of the female population is lower in Serbia as well and the recent changes were mainly directed towards decreasing sex differences. The changes were considerably more favorable with the male population than with the female, especially when it comes to the older adult and old populations. Such trends represent a turnover in relation to the 1980s. In the year 2001 in Serbia, the life expectancy at birth for the male population was 69.7 years, and for the female population 75.1 years. In relation to 1991 the expectation of life at birth has been prolonged for both sexes (1.15 years for the men and 0.38 years for the women). Compared with the European average, the life expectancy in Serbia is 2.6 years lower for males and 5.3 years lower for females. Since the extended life expectancy from the nineties was considerably under the European average, the rank of Serbia on the European LE list was lowered. This primarily refers to the male population, while with as regards to the female population, Serbia is still in the group of 10 European countries with the shortest life expectancy at birth. No significant changes were noted in Serbia with as regards to deaths by cause. At the end of the observed period (1999-2001) the cause of death for over half of the deceased (56.1%) were the diseases of the circulatory system. In the same three-year period, neoplasm represented the cause of death for nearly every sixth person (17.6%). Similar percentages were recorded at the beginning of the period (1990-1992) as well. The next on the list of major causes of death were violent deaths, but their number was considerably lower (4.3%). Despite the armed NATO intervention lasting several months in 1999, the percentage of violent deaths remained at a low level, not only in relation to the beginning of the period (5.8%), but also in relation to the European average, and especially in relation to some former Soviet republics. The percentage of infectious and parasitic diseases was also very low (0.5%). This means that the worsening of conditions that influence the general epidemiological situation did not cause a considerable increase of deaths from this group of diseases, and also that the number of the infected and the number of deaths due to AIDS are low in Serbia. At the end of the twentieth century, the so-called symptoms and ill-defined conditions still represented a relatively large percentage (8.4%) of deaths by cause. It is, in relation to the state at the beginning of the period (6.2%), even increased, and considerably higher than in the most developed countries (about 1%). This points to the unsatisfactory quality of data on mortality, but also to the need to use the results of the analysis of mortality according to deaths by cause with caution.