While diseases of the respiratory system are a less frequent cause of death than cardiovas-cular diseases or cancer, and their share in total mortality has diminished, they remain an important problem in some parts of the Region. In the USSR, respiratory diseases (mainly pneumonia and other acute respir-atory infections) were diagnosed as the cause of death in about 25 % of children aged
1–14 years (Tables 4.2 and 4.3). In the rest of the Region, this cause of death in children was less important: the mortality rates in the USSR were 3 times those in the CCEE and more than 20 times those in the western countries. In the group aged 65 years and over, deaths due to respiratory diseases con-stituted a greater share of all deaths in the western countries of the Region than in the remainder, although chronic respiratory dis-eases were most common in older people in all groups of countries.
Among children aged 1–14 years, mortal-ity from respiratory diseases decreased in the western countries and the CCEE from 1970, and in the USSR from 1980 (Fig. 4.12). In both the CCEE and the USSR, the rates in children exceeded the mortality in adults (those aged 15–44 years). This pattern is the opposite of that observed for the western countries and of that characteristic of most other causes of death.
Among adults, the mortality rates in fe-males declined over the last two decades in all groups of countries (by 25–55 % of the level in the early 1970s). A remarkable ex-ception was the trend in females in Den-mark, mainly because of an increase in mor-tality from bronchitis, emphysema and asthma (see below). An improvement was also seen among males, but the trend in the CCEE was less stable than that in the west-ern countries, particularly for the groups aged 15–64 years. This was due to an in-crease in respiratory mortality in Hungary and Romania around 1980. Mortality rates for respiratory diseases varied more within groups of countries than those for other fre-quent causes of death. The ratio of the hig-hest to the lowest national rates varied from 1.7 to 3.5 in men and women aged 65 years and over in the western countries, mainly owing to high rates in Ireland; the ratio was 4.5 in males aged 15–44 years in the CCEE, owing to very high mortality in Romania.
Chronic airways diseases, including bron-chitis, emphysema and asthma, are an im-portant group of respiratory diseases. They affect large parts of the population and may severely restrict normal activity for decades
Occurrence of Selected Diseases 111
of life. Owing to improvements in treatment, these diseases have tended to cause fewer deaths in recent years than at the beginning of the 1970s (Fig. 4.13). This improvement is
most visible in people aged 45–64 years, and particularly in western European males, where mortality rates were three times lower at the end of the 1980s than 20 years before.
Fig. 4.12: Age-specific mortality from diseases of the respiratory system in the WHO European Region, by sex, 1970–1990
A markedly different trend was observed among Danish women aged 45–64 years; the rates for this group were average for a west-ern country in 1970, but had tripled by the late 1980s. The rates for Danish men of the same age did not rise, although they were
relatively high. Improvement is less evident in younger people, in whom asthmatic rather than obstructive forms of respiratory disease are more frequent.
In the USSR, the trend was the opposite of that seen in other countries. To some
ex-Fig. 4.13: Age-specific mortality from bronchitis, emphysema and asthma in the WHO European Region, by sex, 1970–1990
Occurrence of Selected Diseases 113
tent, this may be due to differences in diag-nostic practice, since the overall mortality due to respiratory diseases does not follow the trend seen for chronic airways diseases.
The prevalence of chronic bronchitis and chronic nonspecific respiratory disease, as-sessed in studies conducted in selected adult European populations in the past 20 years, varies considerably between populations and depends on smoking status and age (Table 4.4). The accumulated evidence indicates that close to 10 % of the total adult popu-lation may suffer from chronic nonspecific respiratory disease. Data from the Latvian and Lithuanian SSRs and Poland suggest a decrease in prevalence of the disease in adults in the 1980s [30,31]. Comparable data on asthma prevalence are available from only a few countries. Asthma diag-nosed by a physician was recently reported in 5–6 % of adults in Sweden [28], in 5 % of adults in Ireland [32] and in 6–7 % in a Swiss study [29]. Preliminary reports from a re-spiratory health study under way in the Euro-pean Union indicate that the annual inci-dence of asthmatic attacks amounts to 3–4 % in adult populations in several locations in Italy and 2–3 % in several Nordic countries [33–36]. In Italian schoolchildren, the prevalence of asthma was found to be about 6 % [37]. Recent studies from England [38]
and from the Nordic countries [28] suggest that the prevalence of asthma is increasing in some parts of the population. Similar
con-clusions emerge from a study completed in the United States [39].
While tobacco smoking is the main risk factor for chronic obstructive airways dis-ease, outdoor and indoor air pollution (both occupational and residential) has a signifi-cant contributory role. Host factors (bron-chial hypersensitivity and atopy) are import-ant risk factors for asthmatic forms of chronic airways disease, and several chemi-cal and biologichemi-cal pollutants present in out-door and inout-door air, as well as in the work-place, may induce or aggravate asthma [40,41].
Injury and poisoning
Although injury and poisoning are respon-sible for less than 7 % of all deaths in the western countries and the CCEE, and for less than 10 % in the former USSR, they re-main the leading cause of death in males aged 1–44 years and females aged 1–14 throughout the Region.
In the western countries, the mortality rates have declined in all age groups and both sexes for most of the past two decades (Fig. 4.14). A deviation from this pattern was observed in Finland, where mortality in males and females aged 15–64 years de-clined in the 1970s and the beginning of the 1980s but recently rose by 20 %, leading to a return to the level observed in the early 1970s.
Table 4.4: Prevalence of chronic bronchitis (CB) and chronic nonspecific respiratory disease (CNRD) reported by epidemiological studies in the WHO European Region
Fig. 4.14: Age-specific mortality from injury and poisoning in the WHO European Region, by sex, 1970–1990
Occurrence of Selected Diseases 115 In the CCEE, the mortality from injury
and poisoning was higher than that in the western countries by almost 100 % in males and 70 % in females during most of the past two decades, and decreased more slowly. An increasing trend was seen in most age groups in Hungary, and in the oldest group of women in Czechoslovakia. In these groups the rates were higher by 25 % in the late 1980s than 20 years earlier.
In the USSR, mortality due to external causes for people under 65 years exceeded the rates observed in the rest of the Region by at least 100 %, with a further increase at the end of the 1980s in males aged 15–64 years. In older people, the rates in men were similar to those elsewhere in the Region, and the rates in women markedly lower, but the trends were increasing.
The variation within groups of countries was substantial. The highest rates exceeded the lowest by a factor of more than four, in both the western countries and the CCEE.
In the latter, this was mainly due to relatively high rates in Hungary. In western Europe, relatively high rates were observed in Den-mark, Finland, France and Spain.
The main causes of fatal accidents were road traffic accidents, and suicide or self-in-flicted injuries. In males, these two causes were responsible for 83 % of accidents in the western countries, 76 % in the CCEE and 62 % in the USSR. In females they were re-sponsible for 50 %, 53 % and 58 % of acci-dents, respectively. Accidental poisoning was identified most often in the USSR: in 21 % of all fatal accidents to both sexes. This markedly exceeded the proportion of acci-dental deaths attributed to poisoning in the CCEE (8 % in males and 6 % in females) and the western countries (3 % in males and 5 % in females). The mortality rates due to accidental poisoning were extremely high in the USSR (24 per 100 000 in males and 6 per 100 000 in females), more than three times the rates in the CCEE and over ten times those in the western countries. The only country reporting similar mortality rates was Finland (17 per 100 000 in males and 4 per 100 000 in females). Chapter 16
gives a more detailed analysis of traffic acci-dents.