system also figure prominently in the increase. The causes directly related to alcoholism make minor contributions to the overall rise in loss of life, although it might be argued that relative to their (slight) 1989 levels, the role of these categories has increased substantially. In contrast, mortality from neoplasms has declined in most instances (rural women being the exception), presumably as a result of premature mortality from other causes. Curiously enough, the cause category receiving the most attention in U.S. media accounts of recent Russian demographic trends—infectious disease—turns out to have played a negligible role in the mortality increase according to actual statistics.

As to rural-urban variations, several patterns appear in our data. As expected, the predominance of infectious diseases in the Southern Tier mortality profile appears to be primarily a rural phenomenon. Loss of life due to degenerative diseases and external causes is greater among the urban populations of these republics. In contrast, in the European republics, loss of life due to these causes is not much lower, and is frequently higher, among rural than among urban populations; the rural disadvantage is often more pronounced among women than among men. Loss of life due to external causes tends to be higher in rural than in urban areas in the European republics, while the opposite is typical of the Southern Tier republics. A similar pattern obtains with respect to homicide and suicide in particular.

With regard to sex differentials, our results indicate that these are nearly always in favor of women.8 The cause categories associated with the greatest excess of male over female years of life lost are accidents, diseases of the circulatory system, and homicides/suicides in the Russian and other European republics.

1979-1989 Trends

We have at our disposal some data on the distribution of deaths by broad cause categories that can be analyzed relative to the 1989 data to shed some light on regional mortality trends in the former Soviet Union around the end of its existence. Tables 5-6a, b, and c present our estimates of years of life lost for these categories for the total, urban, and rural populations of our set of nine republics. Reductions in mortality from diseases of the respiratory system appear to be largely responsible for the overall declines in mortality in most of the republics during the period. While perhaps surprising at first in light of the attention given to the anti-alcoholism campaign in Soviet and Western media, this result appears entirely plausible in terms of the age pattern of respiratory system disease mortality. Because many deaths from respiratory illnesses occur in infancy and childhood, they are associated with higher levels of years of life lost than the majority of deaths due to external causes, which tend to occur at much older ages. In any case, the results in Table 5-6 indicate that reductions in mortality from injuries do in fact make a greater contribution to the mortality



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