COUNTRY REPORT ON HEALTH STATUS LITHUANIA Jurate Klumbiene Institute for Biomedical Research Kaunas University of Medicine Meeting on adult premature mortality in EU October, 2006, Warsaw

Content of the Report Introduction General information about the country Methodology Results Life expectancy and mortality (infant, total, CVD, cancer, liver cirrhosis, injuries) Mortality inequalities by education level Tobacco, alcohol, nutrition Biological risk factors Conclusions

Republic of Lithuania (2004) Territory: km 2 Population: ~3.43 mln. (83.5% Lithuanians, 6.7% Polish, 6.3% Russians, and 3.5% others) Average population density per 1 km 2 : 52.5 Live births per 1000 population: 8.8 Crude death rate per 1000 population: 12.0 Population growth per 1000 population: -3.2 Infant mortality per 1000 live births: 7.9

RESULTS Life expectancy and mortality

Life-expectancy at birth in Lithuania in

Infant mortality in Europe 2001

Structure of the main causes of death in Lithuania and European Union countries (%; 2003) External death causes Diseases of the respiratory system Infectious and parasitic diseases Other causes Malignant neoplasms Cardiovascular diseases EU-15EU-10LithuaniaCauses of death

Trends in premature mortality in Lithuania,

Trends in cardiovascular mortality in Lithuanian population aged in

Trends in lung cancer mortality rates in Lithuanian population aged 20-44,

Trends in lung cancer mortality rates in Lithuanian population aged 45-64,

Trends in mortality from liver cirrhosis in Lithuanian population aged 20-44, ns

Trends in mortality from external causes in Lithuanian population aged 20-44,

RESULTS Mortality inequalities by education

Mortality from major causes of death among Lithuanian males with university education and primary or no education (mortality of the group with a university education = 1) Mortality ratio * p<0.05 vs the group with university education MALES Source: R.Kalediene, J.Petrauskiene, Public Health (2005) 119

Mortality from major causes of death among Lithuanian females with university education and primary or no education (mortality of the group with a university education = 1) Mortality ratio * p<0.05 vs the group with university education FEMALES Source: R.Kalediene, J.Petrauskiene, Public Health (2005) 119

RESULTS Nutrition

The proportion of persons using vegetable oil for cooking in *p for trend <0.001 Source: Lithuanian Health Behaviour Monitoring among population 20-64

The proportion of persons using animal fat for cooking in *p for trend <0.001 Source: Lithuanian Health Behaviour Monitoring among population 20-64

The proportion of persons eating fresh vegetables at least 3 days a week in *p for trend <0.001 Source: Lithuanian Health Behaviour Monitoring among population 20-64

Proportion of persons who have eaten fresh vegetables at least on 3 days during the last week in 1996 and 2004 by level of education MEN WOMEN *p<0.05 compared to 1996 Source: Lithuanian Health Behaviour Monitoring among population 20-64

Prevalence of obesity among Lithuanian males aged by educational level in * p for trend < 0,05 Source: Lithuanian Health Behaviour Monitoring among population 20-64

Prevalence of obesity among Lithuanian women aged by educational level in

RESULTS Tobacco

Proportion of daily smokers among Lithuanian population in Source: Lithuanian Health Behaviour Monitoring among population 20-64

Proportion of daily smokers among Lithuanian population in 1994 and 2004 by level of education MEN WOMEN *p<0.05 compared to 1994 Source: Lithuanian Health Behaviour Monitoring among population 20-64

RESULTS Alcohol

Annual consumption of alcoholic beverages per capita in Lithuania Source: FAOSTAT Liter/capita

Proportion of persons consuming alcohol few times a week or more in Lithuania Source: Lithuanian Health Behaviour Monitoring among population %

RESULTS Biological risk factors

Prevalence of hypertension among Lithuanian urban population aged in 1983, 1987, 1993 and 2002 * p<0,05; **p< 0,01, ***p<0,001 compared with 1983 year % Source: Domarkine S. et al. Medicina 2003,39:

Prevalence of hypertension among Lithuanian rural population aged in 1987, 1993 and 1999 * p<0,05 compared with 1987 year % Source: CINDI - Lithuania

Prevalence of hypercholesterolaemia (>5 mmol/l) among Lithuanian urban population aged in 1983, 1987, 1993 and 2002 % * p<0,05 compared with 1983 year Source: Domarkine S. et al. Medicina 2003,39:

Prevalence of hypercholesterolaemia (>5 mmol/l) among Lithuanian rural population aged in 1987, 1993 and 1999 * p<0,05 compared with 1987 year % Source: CINDI - Lithuania

CONCLUSIONS (I) Life expectancy of Lithuanian population is much lower compared to 15 EU countries. The female-male difference in life expectancy is among the highest in EU. Cardiovascular diseases and external causes of death are the main contributors to the mortality gap between Lithuania and 15 EU countries. The decreasing trends in mortality from major causes were observed in two time periods: from 1981 to 1988 and from 1994 to A significant increase was estimated during first phase of transition in Lithuania ( ).

CONCLUSIONS (II) Significant educational inequalities in mortality from all causes, cardiovascular disease and external causes have been estimated. Gradient in mortality between educational groups have increased. The positive changes in nutrition habits have occurred in Lithuanian population over the last decade: the consumption of fresh vegetables, vegetable oil and low fat margarine has increased, the intake of animal fat has decreased. The decreasing trend in prevalence of obesity and overweight in females and increasing trend in males were observed.

CONCLUSIONS (III) Prevalence of smoking is high among males and rather low among females in Lithuania. Since 1994 the increasing trend has been observed in females. The decreasing trend has been found in males since the year Consumption of alcohol has increased over the last decade. Highly educated persons have healthier lifestyle than people with lower education. Over the last two decades the decreasing trend in the prevalence of hypertension among females has been estimated. Prevalence of hypercholesterolaemia decreased in rural population.