Два роки пандемії COVID-19 в Україні: зміни смертності внаслідок новоутворень

Abstract

In Ukraine, neoplasms have been in the second most significant place in the structure of population mortality in recent years (with the exception of 2021, when they were overtaken by COVID-19, moving to the third position). Neoplasms also largely shape a country’s levels of disease and disability, and contribute significantly to the Global Burden of Disease. The COVID-19 pandemic has affected the epidemiological situation of all noncommunicable diseases, including neoplasms. The purpose of the work: to identify changes in the levels and structure of mortality due to neoplasms during the years of the COVID-19 pandemic in Ukraine (2019-2021) and to determine the factors that determine them / may determine them in the future. Methods of statistical, comparative analysis, generalization were used. The novelty lies in the definition and grouping of objective and subjective factors causing changes in mortality from neoplasms in Ukraine. The analysis showed that in 2021 there was a slight decrease in the structural share of neoplasms and a decrease in mortality rate. According to the 2021 results, the share of neoplasms decreased to 10.4 % of all deaths in the population of both sexes Compared to 13.5 % in 2019. Analysis of changes in the structure of mortality due to neoplasms (Class II according to ICD-10) for both sexes in Ukraine in 2021 compared to the “pre-COVID” year 2019 did not reveal any significant changes. An increase in the share of death because of malignant neoplasms of the colon, rectum and anus (from 13.7 to 14.1 %) is noted. Over the 2019-2021 period, the crude death rate decreased by 9.1 % for women and by 10.2 % for men. The study of factors directly or indirectly related to the COVID-19 pandemic, which cause or may cause changes in the mortality rate from neoplasms in Ukraine in the near future, showed different mechanisms of action. Some factors really affect the probability of death, and accordingly, the decrease / increase in the number of deaths from this cause, others relate to the registration and classification of death. The analysis made it possible to distinguish two groups with different directions. Some lead / may lead after a certain time to increase in mortality due to neoplasms. For example, delay in seeking help due to fear of infection; deterioration of population mobility and access to medical care, including specialized and screening programs and diagnostics; postponing of necessary treatment; concentration of the main forces of the health care system on fighting the pandemic, work overload of medical personnel; lack of funds for high-cost specific examination and treatment, etc. A Significant factor “beyond the COVID-19 pandemic” that determines the probable increase in the mortality rate and the share in the structure of neoplasms is the progressive aging of the population of Ukraine. Factors that lead to decrease in the level of neoplasm-caused mortality and its share in mortality structure may include the death from COVID-19, which “precedes” the existing oncological disease; a deterioration in the quality of determining the cause of death, especially for the elderly and the rural population; as well as the practice of assigning all those who died from COVID-19 to Class XXII according to ICD-10. The result depends on the number, duration and intensity of the influence of individual factors. The urgent need to monitor and evaluate the epidemiological situation regarding neoplasms and to track the effects of factors that affect today and / or will affect mortality from these diseases in the future for timely intervention and effective response in order to eliminate or minimize the negative impact is substantiated.