Amenable mortality inequalities and their changes by place of residence during 1990-2019: the case of Lithuania

OBJECTIVE

The aim of this study was to analyze inequalities of amenable mortality by place of residence and its changes in Lithuania during 1990-2019.

STUDY DESIGN

A record-linked cohort study.

METHODS

Information on deaths was obtained from Statistics Lithuania and the Institute of Hygiene. Mortality rates from amenable causes of death by urban and rural among men and women were calculated per 100,000 population and were standardized by age. Inequalities in mortality were assessed using rate differences. For the assessment of the trends of mortality and its inequalities during 1990-2019, joinpoint regression analysis was applied.

RESULTS

During 1990-2019, amenable mortality of men and women in rural areas was higher compared to urban areas (P < 0.05). Changes in men's and women's mortality and its inequalities between rural and urban areas were characterized by three cut-off points (P < 0.05). However, not all the periods between the cut-off points were characterized by statistically significant changes in mortality. A reduction in amenable mortality was more evident in women, especially those living in rural areas. During 1990-2004 and in 2006, the differences in amenable mortality were greater among rural and urban women than among men. However, during 2013-2019, the differences were smaller (P < 0.05). Inequalities of men's mortality decreased during 1990-2001 and 2005-2012, and inequalities of women's mortality decreased during 1993-2006, 2006-2017, and 2017-2019 (P < 0.05). Inequalities of men's mortality decreased most rapidly during 2005-2012 (on average, by 10.24% per year), while inequalities of women's mortality decreased most rapidly during 2017-2019 (on average by 18.32% per year) (P < 0.05).

CONCLUSION

During 1990-2019, inequalities and a decline of inequalities in amenable mortality among rural and urban men and women were identified in Lithuania. The amenable mortality of the residents of Lithuania remained high, changed unevenly, and no significant sharp decrease was observed. Further reduction of inequalities in amenable mortality between rural and urban inhabitants with a special focus on men remain the health policy challenges in Lithuania.

Inequalities in life expectancy by place of residence and its changes in Lithuania during 1990-2018

Introduction

Health inequalities have emerged as a big issue of public health in Lithuania. Recent studies have demonstrated increasing mortality differentials between different socio-demographic groups of the population. Urban/rural place of residence is related with a set of socio-economic characteristics, different access to material resources, presence or absence of social support, and attitudes to health-related behavior.

The aim of the study

To determine inequalities in life expectancy and its changes by place of residence (urban/rural) in Lithuania during 1990-2018.

Methods

Information on deaths and population numbers for the period of 1990-2018 was obtained from National Mortality Register and Population Register. Life expectancy for males and females of urban and rural populations was calculated using life tables. Changes in the magnitude of life expectancy inequalities by place of residence were assessed using rate differences (urban-rural); while trends in inequalities were estimated by conducting the Joinpoint regression analysis.

Results

Life expectancy among males and females was longer in urban compared to rural areas throughout the entire study period. Life expectancy increased statistically significantly for urban and rural males and females with the most notable increase for males, especially those living in rural areas (on average by 0.4% per year from 64.1 years in 1990 to 70.05 years in 2018). Inequalities in life expectancy by place of residence decreased statistically significantly among Lithuanian males from 3.48 years in 1990 to 1.39 years in 2018, while among females only the tendency of decrease was estimated.

Conclusions

Inequalities in life expectancy of males and females by place of residence decreased significantly in Lithuania throughout the period of 1990-2018, mainly due to positive changes in life expectancy among rural males.

Key messages

Inequalities in life expectancy of males and females by place of residence decreased significantly in Lithuania throughout the period of 1990-2018. Life expectancy increased for Lithuanian urban and rural males and females with the most notable increase for males, especially those living in rural areas.

Changes in mortality inequalities by marital status in Lithuania during 2001-2014

Introduction

Health inequalities have emerged as a big issue of public health in Lithuania. Recent studies have demonstrated increasing mortality differentials between marital status groups, occurring mainly due to a decline in mortality of the married populations.

The aim of the study - to determine changes in inequalities in mortality from major causes of death by marital status in Lithuania during 2001-2014.

Methods

Individual records from population censuses conducted in 2001 and 2011, National Mortality Register (period of 2001-2014), and Population Register (period of 2001-2014) have been linked using personal identification number. Study included those aged 30+. Mortality rates from cardiovascular diseases, cancer, external causes and digestion system diseases by the marital status (married and unmarried - never married, the widowed and the divorced) were calculated per 100 000 person years and standardized by age. Inequalities in mortality were assessed calculating rate ratio, while trends in it - conducting the Joinpoint regression analysis.

Results

Mortality from all analyzed causes of death among males and females in 2001 and 2014 was statistically significantly higher in unmarried compared to married. Inequalities in mortality by marital status increased statistically significantly in Lithuania throughout the period of 2001-2014 from cardiovascular diseases, cancer and external causes. The most significant increase in inequalities by 3.3% (p &lt; 0.05) on average per year was estimated from external causes among males. Inequalities in mortality from digestion system diseases did not change significantly throughout the study period.

Conclusions

Inequalities in mortality by marital status increased significantly in Lithuania throughout the period of 2001-2014 with the most significant increase from external causes.

Key messages

Mortality from all analyzed causes of death among Lithuanian males and females in 2001 and 2014 was statistically significantly higher in unmarried compared to married. Inequalities in mortality by marital status increased significantly in Lithuania throughout the period of 2001-2014 with the most significant increase from external causes.

Socio-economic mortality inequalities in Lithuania during 2001-2009: the record linkage study

OBJECTIVES

To present socio-economic inequalities in mortality and their trends in Lithuania using routinely collected data and record linkage for the years 2001-2009, as related to educational level, occupation, economic activity, marital status and household size.

STUDY DESIGN

Retrospective cohort study.

METHODS

Record linkage was performed using personal identification number between three data sources: 2001 population census, national mortality register for years 2001-2009 and population register, including individuals of age 30 years and older. The linked data set consisted of 2,061,481 records, including 338,652 death cases. Age-standardized mortality rates were calculated for socio-economic groups and compared in terms of rate differences (RD) and rate ratios (RR).

RESULTS

Significant mortality inequalities were found for all socio-economic variables. Both among males and females the highest RR were observed for the occupation (males--3.4, females--2.8) and economic activity status (males--2.7, females--3.1). RR were the highest in mid-ages and declined with ageing. RD increased with the increase in total mortality during 2005-2007, while decline in inequalities was observed in later years.

CONCLUSIONS

Lower education, manual occupations, unemployed, economically inactive and unmarried groups of population appeared in the most unfavourable position in terms of mortality and contributed most to the mortality increase in Lithuania throughout 2005-2007.

Educational inequalities in tuberculosis mortality in sixteen European populations

OBJECTIVE

To describe the magnitude of socioeconomic inequalities in tuberculosis (TB) mortality by level of education in male, female, urban and rural populations in several European countries.

DESIGN

Data were obtained from the Eurothine Project, covering 16 populations between 1990 and 2003. Age- and sex-standardised mortality rates, the relative index of inequality and the slope index of inequality were used to assess educational inequalities.

RESULTS

The number of TB deaths reported was 8530, with a death rate of 3 per 100 000 per year, of which 73% were males. Educational inequalities in TB mortality were present in all European populations. Inequalities in TB mortality were greater than in total mortality. Relative and absolute inequalities were large in Eastern European and Baltic countries but relatively small in Southern European countries and in Norway, Finland and Sweden. Inequalities in mortality were observed among both men and women, and in both rural and urban populations.

CONCLUSIONS

Socio-economic inequalities in TB mortality exist in all European countries. Firm political commitment is required to reduce inequalities in the social determinants of TB incidence. Targeted public health measures are called for to improve access to treatment of vulnerable groups and thereby reduce TB mortality.

Socioeconomic inequalities in diabetes mellitus across Europe at the beginning of the 21st century

AIMS/HYPOTHESIS

The aim of this study was to determine and quantify socioeconomic position (SEP) inequalities in diabetes mellitus in different areas of Europe, at the turn of the century, for men and women.

METHODS

We analysed data from ten representative national health surveys and 13 mortality registers. For national health surveys the dependent variable was the presence of diabetes by self-report and for mortality registers it was death from diabetes. Educational level (SEP), age and sex were independent variables, and age-adjusted prevalence ratios (PRs) and risk ratios (RRs) were calculated.

RESULTS

In the overall study population, low SEP was related to a higher prevalence of diabetes, for example men who attained a level of education equivalent to lower secondary school or less had a PR of 1.6 (95% CI 1.4-1.9) compared with those who attained tertiary level education, whereas the corresponding value in women was 2.2 (95% CI 1.9-2.7). Moreover, in all countries, having a disadvantaged SEP is related to a higher rate of mortality from diabetes and a linear relationship is observed. Eastern European countries have higher relative inequalities in mortality by SEP. According to our data, the RR of dying from diabetes for women with low a SEP is 3.4 (95% CI 2.6-4.6), while in men it is 2.0 (95% CI 1.7-2.4).

CONCLUSIONS/INTERPRETATION

In Europe, educational attainment and diabetes are inversely related, in terms of both morbidity and mortality rates. This underlines the importance of targeting interventions towards low SEP groups. Access and use of healthcare services by people with diabetes also need to be improved.

Socioeconomic inequalities in lung cancer mortality in 16 European populations

OBJECTIVES

This paper aims to describe socioeconomic inequalities in lung cancer mortality in Europe and to get further insight into socioeconomic inequalities in lung cancer mortality in different European populations by relating these to socioeconomic inequalities in overall mortality and smoking within the same or reference populations. Particular attention is paid to inequalities in Eastern European and Baltic countries.

METHODS

Data were obtained from mortality registers, population censuses and health interview surveys in 16 European populations. Educational inequalities in lung cancer and total mortality were assessed by direct standardization and calculation of two indices of inequality: the Relative Index of Inequality (RII) and the Slope Index of Inequality (SII). SIIs were used to calculate the contribution of inequalities in lung cancer mortality to inequalities in total mortality. Indices of inequality in lung cancer mortality in the age group 40-59 years were compared with indices of inequalities in smoking taking into account a time lag of 20 years.

RESULTS

The pattern of inequalities in Eastern European and Baltic countries is more or less similar as the one observed in the Northern countries. Among men educational inequalities are largest in the Eastern European and Baltic countries. Among women they are largest in Northern European countries. Whereas among Southern European women lung cancer mortality rates are still higher among the high educated, we observe a negative association between smoking and education among young female adults. The contribution of lung cancer mortality inequalities to total mortality inequalities is in most male populations more than 10%. Important smoking inequalities are observed among young adults in all populations. In Sweden, Hungary and the Czech Republic smoking inequalities among young adult women are larger than lung cancer mortality inequalities among women aged 20 years older.

CONCLUSIONS

Important socioeconomic inequalities exist in lung cancer mortality in Europe. They are consistent with the geographical spread of the smoking epidemic. In the next decades socioeconomic inequalities in lung cancer mortality are likely to persist and even increase among women. In Southern European countries we may expect a reversal from a positive to a negative association between socioeconomic status and lung cancer mortality. Continuous efforts are necessary to tackle socioeconomic inequalities in lung cancer mortality in all European countries.

Inequalities in mortality by marital status during socio-economic transition in Lithuania

OBJECTIVES

To analyse the changes in mortality inequalities by marital status over the period of socio-economic transition in Lithuania and to estimate the contribution of major causes of death to marital-status differences in overall mortality.

METHODS

A survey based on routine mortality statistics and census data for 1989 and 2001 for the entire country.

RESULTS

The proportion of married population has declined over the past decade. Widowed men and never married women were found to be at highest risk of mortality throughout the period under investigation. Although inequalities have not grown considerably, mortality rates have increased significantly for divorced populations and for never married men, widening the mortality gap. Cardiovascular diseases contributed most to excess mortality of never married and divorced men, as well as all unmarried groups of women. The excess mortality of widowed men from external causes was greatest in 2001.

CONCLUSIONS

Marriage can be considered as a health protecting factor, particularly in relation to mortality from cardiovascular diseases and external causes. Local and national policies aimed at health promotion must focus primarily on improving the position of unmarried groups and providing psychological support.

Inequalities in mortality by education and socio-economic transition in Lithuania: equal opportunities?

AIM

The aim of this study was to examine the changes in mortality differentials by level of education during the period of socio-economic transition in Lithuania.

METHODS

This analysis was based on routine mortality statistics and census data for 1989 and 2001 for the entire country.

RESULTS

Despite a general improvement in the level of education in the Lithuanian population, some negative educational patterns were observed amongst its young members. Increasing inequalities in mortality by education have occurred due to a declining mortality rate in people with higher educational achievements and, conversely, an increasing mortality rate in people with a low level of education. Mortality inequalities by education amongst females exceeded those amongst males in 2001, particularly in middle-aged groups and due to external causes. The results of this survey predict an unfavourable forecast of increasing health inequalities in Lithuania in the near future.

CONCLUSIONS

General policies for health promotion and disease prevention should be based on the realities faced by lower educated groups, rather than on experiences that are general for the total population or the class of society that has at least achieved an average education. Inequalities in health by the level of education should plateau as the society-at-large enters into a more stable stage of social and economic development.

Epidemic of suicide by hanging in Lithuania: Does socio-demographic status matter?

OBJECTIVE

To analyse suicide by hanging, compared with other methods, by demographic and selected social factors in Lithuania, and to evaluate changes during 1993-1997, and 1998-2002.

METHODS

Data on committed suicides were compiled from the Lithuanian Department of Statistics. Suicides were identified by the International Classification of Diseases (ICD): codes in ICD-9 E950-E959 and codes in ICD-10 X60-X84. These were categorized into seven groups by method of suicide. Particular attention was paid to suicide and self-inflicted injury by hanging, strangulation and suffocation (ICD-9: E953; ICD-10: X70). These data were analysed by gender, age, place of residence, education, and marital status.

RESULTS

A total of 8324 suicides (6864 men and 1460 women) were committed during 1993-1997, and 7823 suicides (6455 men and 1368 women) during 1998-2002. Of all registered suicides in Lithuania during 1993-2002, hanging was the most common method. Over the period under investigation, hanging, in proportion to all other methods used to commit suicide, increased statistically significantly from 89.4% among men and 77.3% among women between 1993 and 1997 to 91.7% among men and 82.6% among women between 1998 and 2002. The most noticeable rise occurred among girls aged 10-19 years. The next most common methods among men were firearms and poisoning; among women, poisoning and jumping from high places were common methods. Hanging predominated in men, older people, rural residents and people with low levels of education. A logistic regression analysis showed that gender (odds ratio [OR]=2.4; 95% confidence interval [CI] 2.2-2.7), place of residence (OR=2.0; 95% CI 1.8-2.2) and education (OR=1.2; 95% CI 1.1-1.3), independently of other factors, had the strongest influence on the choice of hanging as the method of suicide between 1993 and 2002. Age had only a minor effect, and marital status had no significant effect on choosing hanging to commit suicide.

CONCLUSIONS

Hanging is the most common method of suicide in Lithuania. The popularity of this highly lethal method may be one of the underlying causes for the high rate of committed suicides. Universal approaches to suicide prevention deserve serious consideration, especially challenging the social acceptability of hanging among men, older people, rural residents, and low educated groups of the population in Lithuania.

Distribution of monthly deaths, solar (SA) and geomagnetic (GMA) activity: their interrelationship in the last decade of the second millennium: the Lithuanian study 1990-1999

Thirty percent of cardiovascular deaths cannot be explained by known risk factors. In this study, we sought links between 1) circannual rhythmicity, solar activity (SA) - sunspot number, solar radioflux and geomagnetic activity (GMA) - Ap., Cp., Am. with monthly number of deaths looking for environmental influence on mortality at the end of the second millennium. The Lithuanian national death data from for 120 consecutive months according to the IDC (1990 - 1999, n = 424925 deaths) was studied: 157189 from IHD (72144 male, 85045 female), 50228 from stroke (19062 male, 31166 female), 33722 from accidents (26193 male, 7529 female), 10655 from road accidents (8127 male, 2528 female) and 14810 from suicide (12137 male, 2673 female), 217508 - non cardiovascular (134308 male, 83200 female). Monthly death numbers (total, < 65y, 65-74, > 74y old for IHD and Stroke, and by gender) were compared with time of year, SA and GMA indices obtained from the National Geophysical Data and National Space Services Center, USA. Circannual rhythmicity indices, Pearson correlation coefficients and their probabilities were obtained and analyzed. The interrelationships of deaths from IHD and stroke and some other pathologies were also studied. In addition a multivariate linear regression analysis was done in order to evaluate the influence of time (month), Solar (S.A.) and Geomagnetic (GMA) activity on the temporal distribution of deaths. The total IHD monthly death number was significantly linked with GMA indices (r = 0.2-0.24, p = 0.03-0.075), but not with SA. IHD correlated with SA (r = 0.25-0.27, p = 0.006-0.0026), only in the 74 year age group. p = 0.0001) In the 65-74 age group, there was an inverse relationship with SA (r = -0.46-0.44) and no significant relationship to GMA. The IHD death number was correlated with GMA only in the < 65 and > 74 year age group (r = 0.30-0.36, p = 0.001-0.001). 2) Stroke-related deaths showed an inverse correlation with SA and GMA only for the 65-74y age group (r = -0.5, p = 0.0001 - SA, r = -0.4, p = 0.0001- GMA) and with GMA at age < 65 only for males (r = 0.20-0.25, p = 0.03-0.04). 3) Both IHD and stroke were strongly circannual rhythmic with acrophase at month 1.27 (IHD) and 1.32 (stroke) - first half of February, (p = 0.0001). 4) The IHD / stroke death ratio was correlated both with SA and GMA (r = 0.35, p 0.0001 - SA, r = 0.40-0.44, p = 0.0001 - GMA). 5) There was a strong inverse monthly deaths correlation between IHD and suicide (n = 14,810, r = -0.53, p = 0.0001). Stroke and suicide were also related, but to a much weaker extent (r = -0.217, p = 0.017). Accidents were inverse related to S.A. (r = -0.286, p = 0.0015), but not to GMA. Road Accidents - with both S.A. (r = 0.427, p < 0.0001) and GMA (r = 0.258, p = 0.004); with acrophases in October for road and November for other fatal accidents. Non cardiovascular deaths were annually rhythmic only for female - acrophase in early February, and for both gender inverse related to S.A. (r = -0.57, p < 0.0001) but not with GMA. Suicide victims had their acrophase in July (p < 0.0001) and were inverse related to S.A. (r = -0.6, p < 0.0001) and GMA (r = -0.27, p = 0.002). At the onset of the third millennium, the temporal distribution of deaths is still related to environmental physical activity. Those links differ for each of the pathologies, and by age and gender.

Cosmic rays activity and monthly number of deaths: a correlative study

We studied the relation between the intensity of cosmic rays, the level of solar/geomagnetic activity, and the monthly numbers of deaths in a large hospital in Israel and in all Lithuania. The Israeli data include 30526 hospital deaths, two groups of fatal suicides (2359, 2763), and 15435 suicidal attempts for two periods of 108 and 236 consecutive months. The national data for the entire Republic of Lithuania include 424925 deaths for the period of 120 consecutive months. Cosmic rays intensity was measured by an Apatity neutron monitor. We obtained the data on solar, geomagnetic radiovawe propagation, ionosphere ionization hours, proton flux of two energy levels (>90 and 60 MeV) from the National Geophysical Data Center at Goddard Space Flight Center, National Space Environment Center at Boulder, Colorado, USA, and from the Institute of Terrestrial Magnetism, Ionosphere and Radio Wave Propagation (IZMIRAN), Russia. We calculated Pearson coefficients and their probabilities for correlation between monthly space activity level and monthly number of male and female deaths from different causes. Cosmic rays activity revealed significant negative correlation with solar/geomagnetic activity indices and related physical phenomena levels. This activity strongly correlated with flux of protons with the energies >90 MeV proton flux and did not exhibit significant correlation with 60 MeV proton fluxes. Cosmic rays intensity correlation with monthly numbers of deaths was strong for noncardiovascular deaths, suicides, and traffic accidents. The correlation was much weaker for deaths caused by ishemic heart disease and strokes.

Daily variations in deaths in Lithuania: the possible contribution of binge drinking

BACKGROUND

During the early 1990s the countries of the Former Soviet Union experienced a dramatic rise in mortality, especially from cardiovascular diseases. Although still poorly understood there is evidence, particularly from Russia, that this mortality crisis is partly linked to alcohol consumption. In this paper we use data from Lithuania to explore the daily variations of deaths and the probable relationship with binge drinking.

METHODS

Computerized death certificates for those aged 20-59 years were analysed according to the day of death, place of death, and cause of death for the years 1988-1997.

RESULTS

There is a marked increase in deaths from accidents, violence, and alcohol poisoning at the weekend, suggesting a pattern of binge drinking in Lithuania. There is also a significant increase in ischaemic heart disease (IHD) deaths on Saturdays, Sundays and Mondays. If the analysis is performed separately according to place of death, the day of the week effect is strengthened for cardiovascular deaths outside of hospital; consistent with the idea of a sudden cardiac death.

CONCLUSION

The increase in mortality from cardiovascular diseases observed at the weekend in Lithuania is similar to that observed in Moscow and other populations. The relationship with alcohol consumption is supported by the available physiological evidence. We propose that bingeing can be solely responsible for, or acts as a 'catalyst' for, pathophysiological events by increasing blood pressure, cardiac rhythm and coagulability. The increased IHD mortality observed throughout the weekend and on Monday in Lithuania may reflect the influence of alcohol consumption patterns in a population already subject to high psychosocial stress.

Inequalities in life expectancy in Lithuania by level of education

The purpose of this study was to examine educational inequalities in life expectancy of the Lithuanian population. The life-tables by level of education were calculated on the basis of the individual records of the 1989 census, which were linked to the death records of males and females, aged 25-70 years. In comparison with the group with university education, the life expectancy of males with primary or lower education was 11.7 years shorter, and of females 4.3 years shorter. The greatest impact of educational differentials on life expectancy was the inequality found in the mortality of the population, aged 25-44 years. Sex differences in life expectancy were greatest among those with primary or lower education. External causes of death contributed most to educational differences in life expectancy of males, whereas cardiovascular diseases had a major impact to educational differences in females.

Relationship between deaths from stroke and ischemic heart disease--environmental implications

We analyzed the ratio of deaths from stroke and ischemic heart disease in Lithuania over a 72-month period (1990-1995) in relation to fluctuations in five physical environmental parameters. Results indicated a highly significant adverse correlation of the stroke/ischemic heart disease death ratio with both solar activity (r = -0.64, p = 0.0001), stronger for women than for men, and the planetary geomagnetic activity index (r = -0.33, p = 0.005). Proton flux > 60 MeV correlated significantly with the death ratio only for the 65-74-year age group (r = -0.36, p = 0.03) (36-month study). The last finding may be a result of different environmental influences on the pathogenesis of ischemic heart disease and cerebral vascular accidents at different ages. We conclude that the monthly ratio of deaths from stroke/ischemic heart disease is related to environmental physical activity.

Time trends in suicide mortality in Lithuania

OBJECTIVE

The aim of this study was to analyse the time trends of suicides during the period 1970-1995 in Lithuania, and to assess the importance of the effects of age, period and birth cohort as risk factors.

METHOD

Trends in suicides and average annual changes were based on logarithmic regression analysis. For assessment of the effects of age, period and birth cohort on suicide mortality, a log-linear regression model with parameters representing age, period and cohort effects was fitted.

RESULTS

Between 1970 and 1995 age-standardized suicide rates almost doubled. There was an increase in suicides in birth cohorts of males from 1910 to 1950, and in cohorts born after 1965. In females, an increase was observed in all successive birth years from 1905 to 1925 and after 1970. The period effect in males and the cohort effect in females were dominant.

CONCLUSION

It is unlikely that suicide rates will decrease in the near future.

Distribution of deaths from ischemic heart disease and stroke. Environmental and aging influences in men and women

The goal of this study was to check: 1) links between month of the year (1-12), monthly solar activity (SA) and monthly geomagnetic activity (GMA) with the temporal distribution of deaths from ischemic heart disease (IHD) and stroke in Israel and Lithuania (48 months); 2) related age and gender differences; 3) temporal connection between deaths from IHD and suicide and their relationship to SA and GMA, as was suggested in our previous study in Israel.

RESULTS

Total deaths from IHD in Lithuania showed a trend towards a link with SA (r = 0.25, p = 0.09) and a highly significant correlation for females (r = 0.37, p = 0.00096) but not for males. Age < 74 showed no correlation with SA or GMA in females, but a negative correlation with SA in males (r = -0.513, p = 0.0002). At age > 74 both females (r = 0.467, p = 0.0006, n = 20763) and males (r = 0.476, p = 0.0006, n = 14682) showed a highly significant correlation with SA and a negative correlation with 1-12 months of the year, with deaths concentrating at the beginning of the year (r = -0.32, p = 0.002). Number of monthly suicide and IHD deaths were negatively related to each other (r = -0.45, p = 0.0014).

CONCLUSIONS

1) Around age 70 an increasingly positive relationship between the temporal distribution of deaths from IDH and SA is seen. 2) Gender differences in links to SA are partially a consequence of the higher number of deaths in females from IHD at age > 74.3) Monthly number of suicides is inversely related to number of deaths from IHD.

Clinical cosmobiology: the Lithuanian study 1990-1992

The numbers of deaths from ischaemic heart disease (IHD), stroke (CVA), all accidents except vehicular, vehicular accidents and suicide (overall total, totals for men and women) per month for 36 months (1990-1992) in Lithuania were analysed in relation to: (1) month of the year (1-12); (2) geomagnetic activity; and (3) solar activity. A total of 122227 deaths (64490 men and 57737 women) was studied, and the results compared with those obtained in an earlier study in Israel, differing geographically and climatically from Lithuania. It was shown that the time of year, solar activity, and geomagnetic activity were related to the monthly death distribution, especially regarding death from IHD and suicide. Age and gender differences were apparent in the relationship between death distribution and physical environmental factors. At age > 70 years, many of these relationships change. The monthly distribution of deaths from IHD and suicide are adversely correlated with solar activity and with each other. Differences are presumed in serotoninergic effects as caused by environmental influences.