Analysis of the influence of living conditions, as a collection of social factors within the environment, on mortality rates among the rural and urban populations of the Nenets autonomous okrug from 2000 to 2019

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Abstract

BACKGROUND: Currently, in the Arctic zone of the Russian Federation (AZRF), there are evident indications of a deterioration in the medical and demographic situation amidst a lack of adequate social infrastructure development. For the first time, we attempted to analyze the impact of living conditions, which encompass various social factors within the habitat, shaped by the social infrastructure, on the mortality rates of the population of one of the regions within AZRF.

AIM: To assess the impact of living conditions, as a set of social factors within the environment, on the mortality rates among the rural and urban populations of the Nenets autonomous okrug (NAO) in the period from 2000 to 2019.

MATERIALS AND METHODS: The databases “Housing and communal services and social infrastructure in NAO in 2000-2019” and “Death cases in NAO in 2000–2019” including information on the population number and age and gender structure of the NAO population across individual settlements have been collected. Using the scoring system for assessing living conditions, a ranking with subsequent division into tertiles of all rural NAO settlements was carried out according to the value of the integral index of living conditions (IILC). A comparative analysis (tertiles with the city, and tertiles with each other) of average annual age-standardized rates of overall mortality, mortality from the main causes and structural components of external causes (EC) of mortality was performed. Relative risks were calculated as the ratio of mortality rates in each tertile to the corresponding indicator for the urban population.

RESULTS: Average annual standardized rates and relative risks of mortality (total, EC, drowning, freezing, alcohol poisoning and transport accidents) of the NAO population demonstrated a “step by step” increase in the sequence “city — highest tertile — middle tertile — lowest tertile”, i.e. as living conditions worsen and as the IILC decreases. Statistically significant differences were identified between the city and tertiles, as well as between the highest (“favorable” living conditions) and lowest (“unfavorable” living conditions) tertiles in terms of total mortality, mortality from EC, drowning and freezing. Mortality rates from alcohol poisoning and transport accidents also increased as living conditions worsened, although the associations did reach the level of statistical significance. With the exception of suicides, the relative risks of mortality for individual EC reached maximum values in the lowest tertile of living conditions.

CONCLUSION: Statistically significant inverse associations between total mortality, mortality from external causes and its main structural components, and the values of the integral index of living conditions have been identified among the rural population of NAO. A decrease in living conditions was significantly associated with an increase in mortality rates and relative risks.

About the authors

Alexey A. Dudarev

Northwest Public Health Research Center

Email: alexey.d@inbox.ru
ORCID iD: 0000-0003-0079-8772
SPIN-code: 1683-1401

MD, Dr. Sci. (Medicine)

Russian Federation, Saint Petersburg, 191036

Alexey V. Dozhdikov

Northwest Public Health Research Center

Author for correspondence.
Email: aleksejdozhdikov@yandex.ru
ORCID iD: 0000-0001-7286-7648
SPIN-code: 9959-9339
Russian Federation, Saint Petersburg, 191036

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2. Fig. 1. Average annual (2000–2019) age-standardized rates of total mortality, mortality from circulatory system diseases (CSD), external causes (EC) and cancer, per 10 thousand of the urban and rural Nenets Autonomous Okrug population with the designation of 95% CI and p-value.

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3. Fig. 2. Average annual (2000–2019) age-standardized rates of total mortality, mortality from circulatory system diseases (CSD), external causes (EC) and cancer, per 10 thousand of the urban population compared to rural Nenets Autonomous Okrug population divided into tertiles (highest, middle and lowest), with the designation of 95% CI and p-values for the compared mortality rates in the populations; * differences between the compared populations are statistically insignificant, since the Kruskal–Wallis test level exceeds 0.05.

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4. Fig. 3. Average annual (2000–2019) age-standardized rates of mortality from selected external causes, per 10 thousand of the urban and rural Nenets Autonomous Okrug populations with the designation of 95% CI and p-values.

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5. Fig. 4. Average annual (2000–2019) age-standardized rates of mortality from external causes, per 10 thousand of the urban population compared to the rural Nenets Autonomous Okrug population divided into tertiles (highest, middle and lowest), with the designation of 95% CI and p-values for the compared mortality rates in the populations; * differences between the compared populations are statistically insignificant, since the Kruskal–Wallis test level exceeds 0.05.

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