Social diseases (HIV and tuberculosis) and population health in Russia

1. Social diseases (HIV and tuberculosis) and population health in Russia Vladimir Kozlov NRU-Higher school of economics, BSPS Annual Conference, 08/09/11 York, UK

2. Definition Social Disease  - a human disease, which generally occurs and distributes as a result of unfavorable socioeconomic conditions. In our case “Social diseases” include tuberculosis (TB) and human immunodeficiency virus (HIV).

3. Deaths due to infectious diseases, %

4. Research question • Do social diseases have a serious influence on the population health in the Russian Federation?

5. Main propositions • Epidemical situation with social diseases is beyond effective control • There are significant inequalities in risk of morbidity & mortality due to social diseases between different social groups • The burden of social diseases is high and growing (or stable)

6. TB Mortality & Morbidity (incidence) Male, per 100 000 Female, per 100 000

7. HIV Mortality & Morbidity (incidence) HIV, morbidity, cases HIV diseases mortality, per 100 000

8. Gender and age differences Gender: • For TB risk of morbidity for men is 2,7 times higher, of mortality – more than 8,2 times. • For HIV, nowadays the proportion of new incidences: 41 (f): 59 (m) Age groups: • HIV morbidity is concentrated at the age of 20-29. Age of onset is increasing • TB morbidity – in older working age 45-54 (male) and in active reproductive age 30-39 (female). Age of onset had been decreasing for a long time until the mid of 2000-s.

9. Morbidity (prevalence) HIV, per 100 000 TB, per 100 000

10. TB morbidity (p 100 000), cross-country comparison

11. TB mortality in comparison with MI (working age) Male, per 100 000 Female, per 100 000 3,6 % of all deaths in working age were due to TB (2008)

12. Inequality: vulnerable social groups For TB: • Inmates • Unemployed (? Causality effect) For HIV: • IV (intravenous) Drug-users

13. Vulnerable groups TB morbidity within inmates group HIV within IV drug-users

14. Burden of the social diseases (main approach) Measurement: disability-adjusted life years (DALY) (Murray, 1994) Years of Life Lost (YLL). Years Lived with Disability (YLD).

15. Problems • Disadvantages of the method (see f.e. Anand, Sudhir, Jonson, 1995; Anand, Hudson, 1997) • Underestimation of TB and HIV incidences by Russian national statistics • Complexity in definition of AIDS (HIV) as a cause of death • WHO’s DALY estimation can be debatable

16. Method and model • As a standard life expectancy we use West Level (e(0)=80 – male and 82,5 – female) • DALY parameters standard from GBD Studies: Discount rate (r) – 0,03; Beta (b) = 0; Constant = 0,1658; no age weights) • Disability weight: TB (0,271), HIV (0,123-0,14) • Age groups: TB (0-14, 15-19, 20-29, 30-39, 40-59, 60+) HIV (0, 1-4, 5-9, 10-14, 15-19,20-29, 30-39, 40-49, 50-59, 60-69, 70+) • Duration: TB (2,5), HIV (1-17 varies with age)

17. TB, burden Male, per 1 000 Female, per 1 000

18. HIV, burden Male, per 1 000 Female, per 1 000

19. Cross-country analysis (WHO, 2004) Share of TB in total burden Share of HIV in total burden

20. Conclusions • The social diseases are playing not the main but the important role in Russian health ill-being : • The epidemiological situation with HIV is unstable, TB is controlled, but with the high level of incidences and death rates • There are specific vulnerable groups • The burden of social diseases is high in case of TB and growing in case of HIV