1. Social diseases (HIV and tuberculosis) and population health in Russia Vladimir Kozlov NRU-Higher school of economics, BSPS Annual Conference, 08/09/11 York, UK

2. Definition Social Disease - a human disease, which generally occurs and distributes as a result of unfavorable socioeconomic conditions. In our case “Social diseases” include tuberculosis (TB) and human immunodeficiency virus (HIV).

3. Deaths due to infectious diseases, %

4. Research question Do social diseases have a serious influence on the population health in the Russian Federation?

5. Main propositions 1.Epidemical situation with social diseases is beyond effective control 2.There are significant inequalities in risk of morbidity & mortality due to social diseases between different social groups 3.The burden of social diseases is high and growing (or stable)

6. TB Mortality & Morbidity (incidence) Male, per 100 000Female, per 100 000

7. HIV Mortality & Morbidity (incidence) HIV, morbidity, cases HIV diseases mortality, per 100 000

8. Gender and age differences Gender: For TB risk of morbidity for men is 2,7 times higher, of mortality – more than 8,2 times. For HIV, nowadays the proportion of new incidences: 41 (f): 59 (m) Age groups: HIV morbidity is concentrated at the age of 20- 29. Age of onset is increasing TB morbidity – in older working age 45-54 (male) and in active reproductive age 30-39 (female). Age of onset had been decreasing for a long time until the mid of 2000-s.

9. Morbidity (prevalence) HIV, per 100 000 TB, per 100 000

10. TB morbidity (p 100 000), cross- country comparison

11. TB mortality in comparison with MI (working age) Male, per 100 000Female, per 100 000 3,6 % of all deaths in working age were due to TB (2008)

12. Inequality: vulnerable social groups For TB: Inmates Unemployed (? Causality effect) For HIV: IV (intravenous) Drug-users

13. Vulnerable groups TB morbidity within inmates groupHIV within IV drug-users

14. Burden of the social diseases (main approach) Measurement: disability-adjusted life years (DALY) (Murray, 1994) Years of Life Lost (YLL). Years Lived with Disability (YLD).

15. Problems Disadvantages of the method (see f.e. Anand, Sudhir, Jonson, 1995; Anand, Hudson, 1997) Underestimation of TB and HIV incidences by Russian national statistics Complexity in definition of AIDS (HIV) as a cause of death WHO’s DALY estimation can be debatable

16. Method and model As a standard life expectancy we use West Level (e(0)=80 – male and 82,5 – female) DALY parameters standard from GBD Studies: Discount rate (r) – 0,03; Beta (b) = 0; Constant = 0,1658; no age weights) Disability weight: TB (0,271), HIV (0,123-0,14) Age groups: TB (0-14, 15-19, 20-29, 30-39, 40-59, 60+) HIV (0, 1-4, 5-9, 10-14, 15-19,20-29, 30-39, 40-49, 50-59, 60-69, 70+) Duration: TB (2,5), HIV (1-17 varies with age)

17. TB, burden Male, per 1 000Female, per 1 000

18. HIV, burden Male, per 1 000Female, per 1 000

19. Cross-country analysis (WHO, 2004) Share of TB in total burdenShare of HIV in total burden

20. Conclusions The social diseases are playing not the main but the important role in Russian health ill-being : 1.The epidemiological situation with HIV is unstable, TB is controlled, but with the high level of incidences and death rates 2.There are specific vulnerable groups 3.The burden of social diseases is high in case of TB and growing in case of HIV