Premature Death in the New Independent States (1997) / Chapter Skim
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Recent Trends in Life Expectancy and Causes of Death in Russia, 1970-1993
Recent Trends in Life Expectancy and Causes of Death in Russia, 1970-1993
Pages 34-65
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From page 34... ...
During the latter 1960s, progress in life expectancy slowed in Russia and France as it had already done in the United States. The fight against infectious diseases had produced its maximum returns, particularly as a result of the spread of antibiotics.
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From page 35... ...
Now, cardiovascular diseases and cancer ranked highest among all causes of death, much above infectious diseases. At the same time, economic and social changes resulted in an increase in such mortality-related factors as alcoholism, smoking, and traffic accidents.
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From page 36... ...
This is clear from a comparison of Russian age-specific mortality rates with the age patterns of each family of the model life tables of Coale and Demeny (1966; Coale et al., 1983) for the same level of life expectancy.
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From page 37... ...
Following the change, infant mortality rates jumped from 13.7 to 17.4 per 1,000 in Latvia and from 10.3 to 16.5 in Lithuania. However, the increase observed for total infant mortality is not due entirely to the rise in mortality within the first week of life, which grew during these years from 6.2 to 9.0 per 1,000 in Latvia, and from 4.8 to 9.4 in Lithuania (Estonian Medical Statistics Bureau, Latvian Medical Statistics Bureau, and Lithuanian Statistics Bureau, 1993~.
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From page 38... ...
It seems to us that such a choice would result in overestimation of mortality at these ages because Russian adult mortality is obviously much higher than could be expected from any model life table at the same level of life expectancy. Despite the underregistration of infant mortality and the very approximate correction coefficients we used, it is probably better to use estimated levels of infant mortality to enter the model life table networks in order to appreciate the quality of the data at old ages.
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From page 39... ...
. In the former Soviet Union, the final aggregation was at the USSR TABLE 2-1 Cumulative Results on Life Expectancy at Birth of Corrections on Infant Mortality and Expectation of Life at Age 70 Males 1958- 1959 1965 Females 1958- 1959 1965 Observed 63.0 64.3 71.3 73.4 After Correction of IMR 62.2 64.0 70.7 73.2 After Correction of IMR and e70 61.9 64.0 69.2 72.1 IMR = infant mortality rate.
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From page 40... ...
Finally, the system for coding of causes of death is decentralized, which means some regional differences in coding practice exist in spite of uniform instructions from the Health Care Ministry and Goskomstat. Goskomstat makes no attempt to verify or revise cause-of-death codification provided by regional statistical offices.
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From page 41... ...
It was necessary to wait until 1988, when the new Gorbachev policies of perestroyka and glasnost began to affect the field of statistics, for the availability of systematic data on causes of deaths. But even in this new statistical era, the published data consisted only of age-specific death rates for very large groups of causes (infectious diseases, neoplasms, cardiovascular diseases, respiratory diseases, external causes of death)
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From page 42... ...
The table shows that there are tendencies toward overregistration of deaths from cerebrovascular disorders, atherosclerotic heart diseases, and respiratory diseases, and of underregistration of deaths from cancer, hypertensive diseases, and myocardial infarction. Yet without knowing the absolute numbers, we cannot evaluate the extent to which these opposite tendencies balance each other.
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From page 43... ...
43 Cq a' VO a' VO a' · ~ VO a' a' ED o be so o C)
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From page 44... ...
, it is possible to use empirically observed transition coefficients to redistribute the deaths previously classified according to the former classification within the new one. Unfortunately, in most cases no such cross-classification is available, and it is necessary to find a method of a posterior)
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From page 45... ...
Trends in Mortality by Large Groups of Causes To begin an overview of the trends in causes of death, we grouped the 185 items of the Soviet classification into the seven following large groups: infectious diseases, neoplasms, cardiovascular diseases, respiratory diseases, digestive diseases, other diseases, and injury and poisoning.) Figure 2-2 shows the change in age-standardized mortality rates for large groups of causes over the period 1970-1993 by sex, on a logarithm scale to keep the slopes of the changes comparable.
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From page 46... ...
In the l990s, it is clearly injury and poisoning for both sexes. For both sexes, the standardized mortality rate for respiratory diseases de
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From page 47... ...
Digestive and infectious diseases have much less influence on total mortality. The standardized mortality rate for digestive diseases is rather constant over the period (around 0.5 per 1,000 for men and 0.2 for women)
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From page 48... ...
is largely balanced by continuing increases in cardiovascular diseases and some other causes. For females, the changes result in stagnation instead of real improve
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From page 49... ...
During 1970-1980, the role of infectious diseases has a negative impact on life expectancy, but this is balanced by the positive impacts of respiratory diseases and other causes. In the following periods, both infectious and respiratory diseases change favorably.
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From page 50... ...
0,5 1 ~ ~1~: 7: 01 ~ 1 T T-1-~ -it I g1 246 95 Hommes, 1980-87 1 1 I L I I_ I I I I I I 0 1 5 15 25 35 45 55 65 75 B5 Contribution (en annees) l l l l l l I r ~l l l l l l I I ICED 250 95 Hommes, 1992-93 1 1 1 1 1 1 1 1 1 0 1 5 15 25 35 45 55 65 75 B5 Age FIGURE 2-3 Cause components of changes in male life expectancy during four periods, by age.
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From page 51... ...
As the leading group of causes shifts from cardiovascular diseases to injury and poisoning, the impact shifts automatically from older to younger ages. For the same reason, the main part of the increase in life expectancy between 1980 and 1987 is among young adults.
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From page 52... ...
TABLE 2-4 Decomposition by Causes of the Differences in Life Expectancy Between Males and Females Cause1970 1975 1980 1984 1987 1992 Infection0.53 0.43 0.39 0.33 0.27 0.29 Cancer1.51 1.47 1.51 1.62 1.83 1.86 Cardiovascular diseases2.76 3.12 3.47 3.50 3.23 3.69 Respiratory diseases1.23 1.19 1.24 1.10 0.84 0.87 Digestive diseases0.31 0.34 0.39 0.38 0.28 0.34 Other0.50 0.48 0.53 0.53 0.56 0.50 Injury and poisoning3.68 3.83 4.09 3.88 2.50 4.26 Total10.53 10.86 11.63 11.33 9.51 11.80
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From page 53... ...
02 Ln ~ Ln Ln L~ ~ Ln Ln Ln ~ C~ C~ ~ L£) ~ ~ W FIGURE 2-5 Cause components of the differences in life expectancy between males and females, by age.
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From page 54... ...
We focus our comparative analysis in this section on continuing improvement in infectious and respiratory diseases, the loss of former advantages in Russian mortality, the leading role of cardiovascular diseases in long-term trends, and the effects of alcohol and violence on short-term fluctuations in mortality. Continuing Improvement in Infectious and Respiratory Diseases In spite of previously rapid progress, mortality from infectious diseases was still much higher in Russia than in France and England in the 1970s.
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From page 55... ...
These two deteriorating factors do not seem to have affected Russia until recently, although registration of AIDS in Russia has perhaps resulted in an underestimation of the true level of this disease. For respiratory diseases, the differences among Russia, England, and France are smaller than for infectious diseases.
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From page 56... ...
. The Leading Role of Cardiovascular Diseases in Long-Term Trends Cardiovascular diseases play an overwhelming role in explaining differences in expectation of life at birth when Russia is compared with France and England.
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From page 57... ...
Improved diagnosis led to dramatic increases in the category "other heart diseases," artificially reducing the role of ischemic heart disease. The main factor in the divergence between Russian and English and French cardiovascular mortality trends is cerebrovascular diseases.
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From page 58... ...
. Overwhelming Effects of Alcohol and Violence on Short-Term Fluctuations While cardiovascular diseases are the main determinants of long-term mortality trends in Russia, injury and poisoning are clearly responsible for the main short-term fluctuations, which are particularly sharp among men.
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From page 59... ...
in France. Therefore, to compare violent deaths in France and Russia more precisely, we should reduce the Russian standardized mortality rate by about 20 points.
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From page 60... ...
and homicide are involved in every violent mortality fluctuation in Russia; suicide is never marked by sharp variation, except during the general decline of 1986; and traffic accidents have a greater influence on the rise of 1988-1989 than on the fall of 1986 and have no impact on the most recent Increase. Thus, the reversal due to the Gorbachev anti-alcohol campaign involved all types of violent deaths, but the subsequent negative changes were induced by different dynamics according to specific causes.
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From page 61... ...
While the 1992 rates for homicide and traffic accidents are much higher than the previous maximum observed in the early 1980s, the rate of suicide remains, after a rather slow increase, below the levels reached before. Thus, the impact of the anti-alcohol campaign is apparent for all types of violent death, even suicide, which has been least sensitive to social change in other time penods.
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From page 62... ...
This paper has presented an analysis of the trends in Russian mortality during 1970-1993 by specific causes and the effects on life expectancy, differentiated by both age and sex. It has also focused on trends in certain specific causes, including cancer, cardiovascular diseases, and alcohol and violence.
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From page 63... ...
Vaughan 1983 Regional Model Life Tables and Stable Populations, second ed. New York: Academic Press.
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From page 64... ...
Paevski 1930 Tablitsi smertnosti naseleniya SSSR v 1926-1927 godu [Life tables for the population of the USSR in 1926-1927]
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From page 65... ...
SHKOLNIKOV, FRANCE MESLE, AND JACQUES VALLIN NOTES 65 1. The correspondence between Soviet items and ICD-9 basic tabulation list items is as follows: Group of Causes Soviet Items ICD-9 Items Infectious diseases 1-44 1-7 Neoplasms 45-67 8- 17 Cardiovascular diseases 84-102 25-30 Respiratory diseases 103-114 31-32 Digestive diseases 115-127 33-34 Other diseases 68-83 and 128-157 18-24 and 35-45 Injury and poisoning 160-185 47-56 2.
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