Scientific Online Resource System

Conference Proceedings

Неравенства "център-периферия" при стандартизираната смъртност в България

Виржиния Aтанасова


Introduction: The inequalities "center-periphery" in standardized mortality have not been studied in Bulgaria. The presented research investigates for the first time inequalities related to standardized mortality at a regional level.

Material and Methods: Data for reason for death and demographic data for all 28 regions are obtained from the National Statistical Institute for the period 2000 - 2012.

Aged-standardized mortality rates are estimated with direct standardization using revised European standard population.

An absolute risk and Rate ratios RR (95% CI) are calculated for men and women comparing the region with highest and lowest mortality rate.

The impact of socioeconomic factors on inequalities has been studied by variables such as GDP per capita, unemployment rate, % of population living below the poverty line, % of urban population, % of school dropouts,

% of higher education, number of people per general practitioner.

Results: Lower standardized mortality rates are established for Sofia-capital (center) for most of the causes of death: all causes, circulatory system diseases, cerebrovascular disease, and еxternal causes of death.

Higher risk and unfavorable position of the capital in comparison with the other regions (periphery) was found for lung cancer (only for women) and for some localizations of neoplasms such as the colon, the prostate, breast cancer and the corpus uteri.

The income, urbanization, and education and belonging to higher social strata with a specific way of life are closely related to the standardized mortality rates.

Conclution: Regional mortality patterns are related to different area-level socioeconomic characteristics. Understanding the regional mortality inequalities is important for adequate future public health planning in order to achieve effective investments in health.


center-periphery; inequality; age-standardized mortality rate; regions; Bulgaria

Full Text


World Health Organization. Health 21: Health For All in the 21st Century. Geneva: WHO, 1998

55/2 United Nations Millennium Declaration, Resolution adopted by the General Assembly, 8 September 2000, Available from:

2030 Agenda for Sustainable Development, 17 Sustainable Development Global Goals, 25 September 2015

OECD/EU, 2016, Health at a Glance: Europe 2016 – State of Health in the EU Cycle, OECD Publishing, Paris., Available from:

OECD, 2015, Cardiovascular Disease and Diabetes: Policies for Better Health and Quality of Care, OECD Publishing, Paris, Available from:

Townsend P., Phillimore P. and Beattie A., 1987, Health and deprivation. Inequality and the North, Croom Helm, London.

Britton M., Fox A., Goldblatt P. et al., 1990, The influence of socio- economic and environmental factors on geographic variations in mortality, in Britton M (ed), Mortality & Geography: а review in the mid-1980s, Series DS, No. 9. HMSO, Office of Population, Censuses and Surveys: London

Townsend P., Davidson N. and Whitehead, M., 1992, Inequalities in Health. The Black Report and the Health Divide. Penguin Books, London

Strachan D. P., Leon D. A., Dodgeon B., 1995. Mortality from cardiovascular disease among interregional migrants in England and Wales. British Medical Journal 310, 423± 427.

World Health Organization, 2017, Global Health Observatory (GHO) data - Top 10 causes of death, Available from:

Eurostat regional yearbook 2016 edition, Theme: General and regional statistics, Collection: Statistical books, Luxembourg: Publications office of the European Union, 2016, doi: 10.2785/29084

Ferlay J. et al., 2013, Cancer Incidence and Mortality Patterns in Europe: Estimates for 40 Countries in 2012, European Journal of Cancer, Vol. 49, pp. 1374-1403


Font Size