Every year almost 600 thousand people die in Ukraine. It’s nearly the population of Kryvyi Rih and a little bit more than the population of Mykolaiv or Mariupol.
Our death may be the most important part of our life. For many people who suffer from severe, irremediable conditions death is a relief ending their pain. For their relatives, it’s pain and sorrow.
Anyway, we all are going to die and become another number in statistics of death.
The title illustration shows a rough ratio between those who were born, died or are alive in Ukraine in 2018.
According to the State Statistics, the population of Ukraine was 42 386 403 as of the beginning of 2018. At the same time in 2018, there were registered 335 874 births and 587 665 deaths.
For almost 20 years we have not had a national census in Ukraine; the UN recommends conducting it every 10 years. In this situation, when we do not know the main parameters of the society data on birth and death are one of the most reliable. Death is documented better than for example one’s place of residence or migration.
Data on causes of death are crucial for the analysis and development of the state health policy. They are also fundamental for assessment of the need for palliative care. Besides causes of death such details as age, gender and place of residence are being registered. This information gives us an idea about the causes of death related to gender, age, regional or geographic characteristics and so on.
Since 2005 the 10th edition of the international classification of disease ICD-10 is used to code causes of death.
Previously, data on causes of death were available by oblasts of Ukraine. As a result of a collaboration between the Ukrainian Center for Social Data and the State Statistics Service of Ukraine, a tool for interactive visualization of causes of death has been created. It represents data on deaths by:
- Groups of diseases and causes of death;
- Ukrainian oblasts, rayons and cities of the oblast significance;
- Age (5-year age groups as well as additional disaggregation into children and adults).
- Types of the locality (city/town, village)
ІInteractive visualization of causes of death in2018 is available here:
What are the elements of the visualization?
1. The map of Ukraine is what you notice first, but the table with causes of death grouped in classes is the most important. By default, this list shows t number of deaths in each class for the whole country (the values for class 19 and 20 are identical since they are the same causes of death duplicated in different measurements). If you press a name of one of the classes you can open it and see a list of specific causes of death that belong to the class with their values.
2. Chosen classes or causes of death are reflected on the map: rayons or towns/cities of oblast significance are painted according to mortality by classes or causes of death. The map has two modes: indicators by 100 thousand people by default, and absolute values (you can change them using switch above the map). The map is navigation at the same time: when you choose one of the regions you get corresponding values for each of causes of death at that level.
3. Path / filter / breadcrumbs. Both the map and figures in the table change after you chose a new region (oblast, rayon, town/city of oblast significance) or class/cause of death. A combination of filters as well as a number of deaths by chosen parameters is reflected in this block.
4. Under the map there is a table generated according to chosen territories and causes of death; it is disaggregated by gender (male/female), age (children/adults), a type of locality (village/town), administrative units (rayons, towns/cities of oblast significance). For user’s convenience, the table also shows a total number of residents in a chosen territory and a total number of deaths from a chosen cause.
5. Gender and age diagram for each filter (territory, cause of death). It shows how many men and women of a certain age group (5-year intervals) died of a chosen cause in a chosen territory.
6. For those who would like to make their own research on data we prepared tidy datasets in open data format: download dataset.
Now let’s move to observations and preliminary conclusions.
Why the general number of deaths in our visualization (574 571) is different from the number on the website of the State Statistics (587 665)?
The reason is that our visualization does not include those who died in temporally occupied territories of Donetsk and Luhansk oblast. The birth and death certificates issued in occupied territories are the only documents recognized by Ukraine. And the number of deaths from those territories is included in the general statistics. Nevertheless, we could not take them into account since they are incomplete. In this visualization there are 254 causes of death grouped in 20 classes. Keep in mind that figures in classes 19 and 20 are identical; they just describe same deaths from different angles.
The most common registered causes of death
For comparison, let’s take England and Wales (Great Britain) who had a similar number of deaths in 2018, although their population is almost 20 million larger.
You notice at once that in Great Britain dementia and Alzheimer’s disease is a number one cause of death and that their deaths are distributed more evenly in the general structure.
Where do the data on causes of death come from?
The source of information for causes of death is a medical death certificate (or perinatal death certificate) issued by a doctor or a nurse practitioner. Registry offices pass this document together with vital records to bodies of state statistics that belong to the Ministry of Justice.
There are the doctors who fill medical certificate out. It is a very important document; relatives cannot receive a death certificate without it. Age, gender, place of residence, date and place of death are documented quite well; however, there are serious issues with a cause of death.
Thus, a quick analysis shows that 67% of all causes of death belong to class 9: Cardiovascular diseases, while 35% of all deaths allegedly were caused by atherosclerotic heart disease.
For comparison, in 2018 in England and Wales, there were registered 132 233 (24%) deaths caused by Cardiovascular diseases (Great Britain rates world number 1 in quality of care or provision of palliative care).
If you look at the map of deaths of atherosclerotic heart disease you will notice some anomalies:
Atherosclerotic heart disease mortality is considerably higher in Vinnytsia oblast; surprisingly, atherosclerosis mortality borders correspond to the administrative borders; there are somewhat lower indicators in Ivano-Frankivsk, Ternopil and Chernivtsi oblasts
The similar regional anomalies that overlap with administrative borders of oblasts are typical also for other causes of death.
Atherosclerosis looks very different in Zakarpattia and Khmelnytsky oblast (relative indicators per 100 thousand of people).
At the same time results of tuberculosis as a cause of death is very popular in Zakarpattia oblast in comparison to the rest of the country.
Zaporizhya oblast registers pneumonia as a cause of death differently from other regions of Ukraine:
It is worth noting the old age, which is number 10 cause of death in Ukraine (10124 cases); as you can see it is registered very differently from oblast to oblast.
Our interactive visualization tool allows studying causes of death in details and finding weaknesses in its registration. With its help data are stored, processed and systemized.
Statistics of death are based on a single document: the medical death certificate (form N 106/o), which is the main form of original records. However, a cause of death is just one of the fields filled by a doctor. Statistical bodies also collect the other information, such as a place of death (in-patient or out-patient), but it is not analyzed (for instance, place of death could be confronted with causes of death).
The medical death certificate, as it looks now, could provide more data. According to instructions to that form, it should reflect more than one cause of death:
The main or primary cause of death is a disease or injury that led to morbid processes causing death. In part I, paragraph 11, line ‘A’ a disease or medical state that directly led to death should be written; in lines B, C, D should be written pathological states (if present) that determined the abovementioned cause of death; the main cause of death is to be mentioned as the last one.[…]
Part II of the death certificate reflects other significant medical states or diseases that factored into death although not related to a direct disease or medical state causing death. In this part, it is necessary to fill the date of surgery, myocardial infarction, stroke, or pregnancy term if applicable.
However, from our personal experience, we know that medical death certificates may indicate a circulatory collapse or an atherosclerotic heart disease instead of a real cause of relative’s death. From available data one may assume that there is an epidemic of the atherosclerotic heart disease in Ukraine, however, it can be explained by the formalism of many doctors in documenting causes of death. Such nonchalance or negligence, no matter how you call it, results in mass falsification on a national scale.
What can we do about it?
Availability and accessibility of more than one cause of death, other significant diseases or medical states documented in medical death certificates could shed some light on inaccuracies and anomalies and possibly correct them. We could make our data on causes of death more reliable, accurate and detailed by means of:
- Professional development and raising responsibility of doctors and nurses practitioners to make them fill out medical death certificates (or perinatal death certificates) as accurately as possible.
- The practice of regional methods of registering causes of death involving administrative pressure to reduce or increase the number of certain causes should be abandoned; a national approach following existing instructions should be introduced.
- A multidimensional electronic register of deaths with detailed microdata (all possible data from medical death certificates) should be introduced; it would allow aggregating and studying data without being limited by rigid statistical forms. The question is it going to be a separate register or a part of a national electronic system of medical records remains open, but all authorized bodies such as the State Statistics Service of Ukraine, the Pension Fund, the National Health Service, the State Fiscal Service, the Ministry of Justice, the National Cancer Register and so on should have access to it.
Data visualization and this publication were prepared within the project Improvement of data collection system on palliative care with the support from the International Renaissance Foundation.