Date Published: June 6, 2019
Publisher: Public Library of Science
Author(s): Tamás Lantos, Tibor András Nyári, Richard J. Q. McNally, Bernardo Lanza Queiroz.
To analyze trends in external mortality in Hungary between 1995 and 2014 by sex.
Data on the numbers of deaths due to external causes were obtained from the published nationwide population register. Negative binomial regression was applied to investigate the yearly trends in external-cause mortality rates. Cyclic trends were investigated using the Walter-Elwood method.
Suicide and accidents accounted for approximately 84% of the all-external-cause of deaths in Hungary. Annual suicide, unintentional falls and traffic accidents mortality declined significantly (p-value for annual trend: p < 0.001) from 30.5 (95% CI: 29.5–31.5) to 15.8 (15.1–16.5), from 31.2 (30.2–32.2) to 12.2 (11.7–12.8) and from 17.2 (16.4–18) to 5.4 (5–5.8) per 100 000 persons per year, respectively, during the study period. A significant declining trend in annual mortality was also found for assault, cold/heating-related accidents and accidents caused by electric current. However, the declining trend for drowning-related accidents was significant only for males. Significant winter-peak seasonality was found in the mortality rates from accidental falls, cold/heat-related accidents, other accidents caused by submersion/obstruction and other causes. Seasonal trends with a peak from June to July were observed in death rates from suicide/self-harm, accidental drowning/submersion and accidents caused by electric current. A significant seasonal variation with a peak in September was revealed in the mortality due to traffic accidents. This Hungarian study suggests that there was a significant seasonal effect on almost all kinds of deaths from external causes between 1995 and 2014. Environmental effects are involved in the aetiology of suicide and accidents.
During the period of 20 years between 1995 and 2014, Hungary has recorded (on average) the 4th highest standardised death rates from external causes among the 28 members of the European Union (behind the Baltic states) and the highest one of the Visegrad Group (V4; consisting of the Czech Republic, Hungary, Poland and Slovakia) countries . External causes were one of the most prevalent causes of death in Hungary (annually approximately 7700 deaths on average), ranking fourth with 6.3% of the total mortality among the major causes of death behind circulatory diseases (50.6%), neoplasms (24.9%) and digestive diseases (6.6%)–and ahead of respiratory diseases (4.5%) during this period.
Overall, 154 211 deaths from external causes (66.3% males and 33.7% females) were registered in Hungary during the period 1995–2014. Suicide/self-harm, accidental falls and traffic accidents were the most common causes with 53 769 (34.9%), 51 015 (33.1%) and 24 367 (15.8%) deaths, respectively (Table 1).
Our ecological study presented the seasonality pattern of some external-cause mortality which might be related to environmental factors. We found seasonal effects related to–among others–suicide, accidental falls and traffic accidents with peaks in June, December and September, respectively. These death causes account for overwhelming majority of the all-external-cause mortality. Environmental effects are involved in the aetiology of these external causes of death in Hungary.