Cause of Death

Our detailed data on mortality by cause of death for the former Soviet republics in 1989 and Russia in 1993 provide an excellent basis for assessing the impact of cause-specific mortality on the overall loss of life experienced by their populations. Tables 5-3 through 5-5 present our decomposition of years of life lost by cause of death for the total, urban, and rural populations, respectively, of the nine republics. Our ten cause-of-death categories reflect our subdivision of two broad cause classes that figure prominently in the mortality patterns of the former Soviet republics: diseases of the respiratory system and external causes of death. Respiratory system diseases are often treated as a typical ''Third World" category because they include many illnesses, such as pneumonia and bronchitis, that are etiologically similar to infectious diseases; we distinguish such diseases from other respiratory conditions of more degenerative character, such as emphysema. Within the important group of external causes of death, we distinguish homicides and suicides from the remainder of accidental fatalities. In addition, we list separately two categories of alcohol-related death: alcohol poisonings and another ("Alcohol") category that includes alcoholic psychosis and alcoholic cirrhosis.

According to the data shown in Tables 5-3 through 5-5, the former Soviet republics are quite diverse in their patterns of mortality by cause of death. Most notably, a sharp Northern/Southern Tier distinction emerges, reflecting the different stages of the epidemiological transition attained by the respective populations. In most of the European republics, the category accounting for the greatest loss of life is diseases of the circulatory system, while infectious respiratory disease is the leading category in Azerbaijan and the Central Asian republics. Accidents, homicides, and suicides led to substantial loss of life among men in all the republics. In the context of the pronounced infectious disease mortality in the Southern Tier republics, those categories appear less salient than in the European republics, where they are associated with more than 25 percent of overall loss of life among men. In Moldova, accidents excluding homicide/suicide represent the leading cause of mortality among men in 1989.

According to our data, deaths directly related to alcoholism generally make a negligible contribution to overall mortality levels. Only among Russian men in 1993 does the combined effect of alcohol poisonings and other directly alcohol-related diseases approach a year of life lost. Nonetheless, the increase in alcohol-related mortality among Russian men from 1989 to 1993 is certainly troubling.

The results shown in Tables 5-3 through 5-5 offer insight into the cause-specific mortality trends underlying the decline in Russian male life expectancy from 1989 to 1993. The roles of the various causes of death in this increase are quite distinct, as the data in the tables demonstrate. Accidents, homicides, and suicides account for most of the increase in Russian male loss of life and slightly under half of the much smaller female increase. Diseases of the circulatory



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