In recent years, the demographic crisis in Bulgaria has become increasingly apparent. Demographic development in Bulgaria is characterized by a reduction of the total population, low birth rate, high mortality rate, and aging of the population. According to the Central Intelligence Agencys World Factbook, in March 2014 Bulgaria ranked sixth in the world in terms of mortality. According to the recent data, the number of deaths per 1,000 people is 14.3 in Bulgaria (Central Intelligence Agency, n.d.). This situation requires research into the causes of such high mortality and development of measures to reduce it. The paper considers possible reasons for the high mortality rate in Bulgaria.

Causes of Death

The World Health Organization distinguishes between internal and external causes of death. According to the World Health Organization, the major causes of death in the European region are as follows: cardiovascular diseases, cancers, injuries, infectious diseases (including respiratory infections), digestive diseases, respiratory diseases, neurological and sense organ conditions, endocrine, blood, immune disorders, diabetes mellitus, genitourinary diseases, mental and behavioral disorders. The percentage distribution is shown in Figure 1.


Figure 1. Main causes of death in Europe (European Commission Eurostat, 2014).

Among the external causes of death in Bulgaria the World Health Organization has identified the following: intentional self-harm, transport accidents, falls, accidental poisoning by and exposure to noxious substances, accidental drowning and submersion, assault, exposure to smoke, fire and flames, and other external causes. Their proportion distribution is shown in Figure 2.


Figure 2. External causes of death in Bulgaria (WHO, 2010/2014).

The leading cause of death among children and adolescents aged 0 to 19 years in Bulgaria are injuries. Most of them are unintentional deaths. On closer inspection, one will notice that after choking and strangulation of children of less than one year of age, there are road accidents that take the greatest toll, especially among men aged from 15 to 19.

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Injuries have different influence on children and adolescents according to the well-being of the individual and the country. Children from families with low income and education level, families living in more cramped conditions and in countries with inadequate funding of a public health are more susceptible to injuries than others.

Studies show that a large proportion of child deaths is caused by the lack of the recommended safety equipment. This occurs in particular because many families can not afford to purchase such safety equipment. Improving availability and affordability should increase the probability that every child born is provided with a safe environment to live, learn, and play. This should help to reduce the mortality rate among children and adolescences.

However, the reasons for more than 60% of deaths in Bulgaria are diseases. The most common of these are shown in Figure 3. The major causes of death in Bulgaria, as in the EU, are cerebrovascular, ischemic heart, and hypertensive diseases. Tuberculosis mortality rate among HIV-negative people in Bulgaria is the highest in the EU.

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