Mortality of Roma population in Serbia, 2002-2005

Aim

To describe and compare mortality and population changes in the Roma and non-Roma population in Serbia in 2002 and 2005.

Methods

The number of cases of death were obtained from the 2002 and 2005 Mortality Database and population data from the Population Census 2002. Standardized sex specific rates of non-traumatic and traumatic mortality in 2002 and 2005 were calculated in relation to the European standard population. We presented population pyramid and aging index for both populations in 2002 and compared sex specific standardized traumatic and non-traumatic mortality rates and the average age of death for 2002 and 2005. The causes of death were coded according to the 10th revision of the International Classification of Diseases (ICD-10) groups, and the proportional mortalities in the year 2002 and 2005 were compared between the Roma and non-Roma population using χ² test.

Results

Standardized mortality rates were higher in the Roma than in the general population. Non-traumatic mortality rate in Roma men in 2002 was 18.2 per 1000 and in slightly decreased to 18.0 per 1000 in 2005; it was significantly higher than in non-Roma men in both years (11.9 per 1000 in 2002 and 12.5 per 1000 in 2005; P<0.001). Standardized non-traumatic mortality rate in Roma women decreased significantly from 16.78 per 1000 in 2002 to 14.89 per 1000 in 2005 (P=0.014), but it was still significantly higher than in non-Roma women (8.46 per 1000 in 2002 and 8.84 per 1000 in 2005; P<0.001). Morbidity structure indicated that the most common causes of death in the Roma population were cardiovascular diseases, neoplasms, and respiratory system diseases. In relation to the general population respiratory system diseases were denoted as main causes of deaths in significantly higher percent (6% vs 3% in 2002 and 7% vs 4% in 2005; P<0.001) and cardiovascular diseases in significantly lower percent (44%:55% in 2002 and 46%:57%; P<0.001).

Conclusions

Our data show that mortality rates in the Roma population are significantly higher than in the general population, and morbidity structure of the most common causes of death significantly different from that of general population.According to the most recent population census in the Serbia from 2002, 108 193 or 1.44% residents declared themselves as Romani. The Roma population is among the most imperiled and potentially most vulnerable groups. Living Standards Measurement Survey (LSMS) conducted in Serbia in 2002-2003 indicated significant differences in living conditions between the Roma and non-Roma population (1). The prevalence of poverty, defined as an average total consumption below the poverty line of 57 euros per month/consumption unit, in the Roma population was as high as 64.4%, which is 6.1 times more frequent than in the general population (10.5%) (1). Extremely low level of education and very high level of unemployment characterize the social status of the Romani people. Almost two thirds (62%) of the Roma older than 15 years did not finish primary school, as opposed to 19% of the general population (1). The unemployment rate is also high, reaching 45%, while in the rest of the Serbian population it amounts to 9% (1). Such findings are not unexpected since these characteristics are highly associated with poverty (1).Although the range of vaccination coverage in Serbian general population is 98%-100%, many Roma children are not included in vaccination programs (2). Twenty nine percent of Roma children aged 18-29 months do not even have vaccination cards. Data regarding the education of Roma children are also discouraging: 62% of them attended pre-school programs one year prior to the first grade, as opposed to 89% children in the general population. Also, the vast majority (98%) of children of primary school age in general population attends school, while the attendance rate among Roma children is significantly lower (74%). The difference between the proportions of Roma children and children in general population who attend secondary schools is even more drastic (only 10% vs 85%).During the last decade, several studies dealing with diverse problems of the Roma population have been conducted in South-Eastern Europe (3-10). Compared with the general populations in Eastern and Central Europe, life expectancy of the Roma population is 10-year shorter because of poor living conditions and poverty (11). A study conducted in the Czechoslovakia in 1989 compared census data and pointed out that life expectancy of the Roma men and women were 12.1 and 14.4 years, respectively, shorter than in the general population (12).The aim of this study was to describe and compare mortality and population changes in the Roma and non-Roma population in Serbia in 2002 and 2005. We present population pyramid and aging index for both populations for the year 2002 and compared sex specific standardized traumatic and non-traumatic mortality rates and the average age of death for 2002 and 2005.