Recent Mortality Trend Reversal in Russia: Are Regions Following the Same Tempo?

After several decades of negative trends and short-term fluctuations, life expectancy has been increasing in Russia since 2004. Between 2003 and 2014, the length of life rose by 6.6 years among males and by 4.6 years among females. While positive trends in life expectancy are observed in all regions of Russia, these trends are unfolding differently in different regions. First, regions entered the phase of life expectancy growth at different points in time. Second, the age- and cause-specific components of the gains in life expectancy and the number of years added vary noticeably. In this paper, we apply decomposition techniques—specifically, the stepwise replacement algorithm—to examine the age- and cause-specific components of the changes in inter-regional disparities during the current period of health improvement. The absolute inter-regional disparities in length of life, measured by the population-weighted standard deviation, decreased slightly between 2003 and 2014, from 3.3 to 3.2 years for males, and from 2.0 to 1.8 years for females. The decomposition of these small changes by ages and causes of death shows that these shifts were the result of diverse effects of mortality convergence at young and middle ages, and of mortality divergence at older ages. With respect to causes of death, the convergence is mainly attributable to external causes, while the inter-regional divergence of trends is largely determined by cardiovascular diseases. The two major cities, Moscow and Saint Petersburg, are currently pioneering mortality improvements in Russia and are making the largest contributions to the inter-regional divergence.     

Recent Life Expectancy Divergence in Baltic Countries

Until the end of the 1990s, mortality patterns and trends in Estonia, Latvia and Lithuania were remarkably similar. However, from the year 2000 onwards, life expectancy trends in the three countries started to diverge. In particular, sustainable progress in Estonia over the period 2000–2007 contrasts with stagnation in Latvia, and even worsening trends in Lithuania. These contradictory changes seem to be mainly explained by contrasting dynamics in mortality from cardiovascular diseases, external causes of death and digestive system diseases. Whereas cardiovascular and external-cause mortality declined in Estonia and Latvia, worsening or stagnation of mortality from these causes of death was observed in Lithuania. The negative mortality changes in Lithuania were also reinforced by a striking increase in mortality from alcohol-related digestive system diseases. The findings suggest that the divergence in health trends between the three countries may be attributable to their varying degrees of success in implementing structural health care reforms and specific health policy measures. By contrast, the very recent improvement (since 2008) is parallel in the three countries and is largely because of the introduction of rather similar anti-alcohol measures.     

Mortality by cause in the USSR in 1970–1987: the reconstruction of time series

This paper is the first step in an exploration of Soviet cause-of-death statistics which became accessible after 1986. Its main aim is the reconstruction of consistent annual series for the period 1970–1987 in spite of changes in cause-of-death classification caused by the 1980 revision of the Soviet nosological system. In a second part, the series thus reconstructed are analysed to describe the main features of the evolution of mortality during these two decades, using first standardized mortality rates for several very important specific causes and, second, using a method of decomposition of life expectancy changes. For the first time, trends in causes of death are thus shown for the crucial period where life expectancy has grown again after two decades of regression.Cet article constitue la première étape d'une exploration des statistiques soviétiques de décès par cause, devenues disponibles à partir de 1986. Il a pour principal objectif la reconstruction de séries annuelles cohérentes pour la période 1970–1987, en traitant les ruptures introduites par la révision de la Classification soviétique de 1980. La méthode utilisée pour ce faire est exposée dans la première partie. Dans une deuxième partie, les résultats ainsi obtenus permettent de décrire les grands traits de l'évolution de la mortalité au cours de ces deux décennies, d'abord sur la base de taux comparatifs de mortalité pour des causes spécifiques, puis grâce à une décomposition des variations de l'espérance de vie. Pour la première fois on peut ainsi suivre l'évolution des causes de décès dans une période déterminante au cours de laquelle, après deux décennies de recul, les progrès de l'espérance de vie ont repris.     

The Recent Mortality Decline in Russia: Beginning of the Cardiovascular Revolution?

The health situation in Russia has often been characterized as a long‐running crisis. From the 1960s until the beginning of the 2000s, the declining life expectancy trend was substantially interrupted only twice: once in the mid‐1980s as a result of Gorbachev's anti‐alcohol campaign, and again at the end of the 1990s as a result of the “rebound” effect following the dramatic rise in mortality associated with the acute socioeconomic crisis. In both cases, the progress made proved to be short‐lived. A third mortality decline in Russia began in 2003 and is still ongoing. We investigate the components and driving forces of this new development, in particular the role played by cardiovascular diseases. Using cause‐specific mortality data, we identify the main features of the recent improvements and compare these features with those observed in selected European countries, specifically France, Poland, and Estonia. Our aim is to gauge whether the features of the improvements in these countries are similar to those of the recent advancements made in Russia. Although the recent improvements in Russia have features in common with initial stages of prior mortality declines in other countries and may support optimism about the future, a return to mortality stagnation cannot be ruled out.     

Losses of Expected Lifetime in the United States and Other Developed Countries: Methods and Empirical Analyses

Patterns of diversity in age at death are examined using e ^†, a dispersion measure that equals the average expected lifetime lost at death. We apply two methods for decomposing differences in e ^†. The first method estimates the contributions of average levels of mortality and mortality age structures. The second (and newly developed) method returns components produced by differences between age- and cause-specific mortality rates. The United States is close to England and Wales in mean life expectancy but has higher life expectancy losses and lacks mortality compression. The difference is determined by mortality age structures, whereas the role of mortality levels is minor. This is related to excess mortality at ages under 65 from various causes in the United States. Regression on 17 country-series suggests that e ^† correlates with income inequality across countries but not across time. This result can be attributed to dissimilarity between the age- and cause-of-death structures of temporal mortality reduction and intercountry mortality variation. It also suggests that factors affecting overall mortality decrease differ from those responsible for excess lifetime losses in the United States compared with other countries. The latter can be related to weaknesses of health system and other factors resulting in premature death from heart diseases, amenable causes, accidents and violence.     

Induced Abortion in Russia: Recent Trends and Underreporting in Surveys

The abortion level in Russia has been exceptionally high for several decades, yet during the last ten years it experienced a considerable decline. There is a concern that this favourable change could be largely due to a deterioration of statistical registration in the 1990s. In this paper, we use three reproductive and health surveys for a crosscheck with provider statistics, and analyse patterns and determinants of abortions. Each survey includes questions about the history of abortions. Our data indicate that survey estimates of the crude, total, and age-specific abortion rates emerge to be very close to respective figures from provider statistics for about two years preceding each survey. Survey estimates progressively deviate downwards from provider statistics when moving further back in time due to growing under reporting. This finding suggests that provider statistics on abortion in Russia are a true reflection of the situation they monitor, that the observed declining trend in abortion is a real one, and that analyses of survey data on abortions are justified for up to two years preceding the survey. Logistic regression using the data from the survey carried out in 2000 for the period of 1998-2000 reveals that the odds for an induced abortion are lower in case of a higher educational degree, that the odds increase with the number of children and decrease with the use of more reliable contraceptive methods, and that married women are more likely to have an abortion than never-married ones but less likely when compared to cohabiting women.     

Mortality in Belarus, Lithuania, and Russia: Divergence in Recent Trends and Possible Explanations

Before the collapse of the Soviet Union, Belarus, Lithuania, and Russia were quite comparable in terms of their socioeconomic development. Despite some differences in overall mortality levels, the three former Soviet republics were also very close to each other in terms of directions of mortality trends and age- and cause-specific mortality patterns. After 1991, all the three countries experienced substantial political and social transformations, and the challenges associated with the transition from a socialist to a market economy system. The sudden changes brought numerous problems, such as rapid growth in unemployment, falling standards of living, and growing social and income inequalities. These factors contributed to the significant deterioration of the health situation in all the countries, but the size and the nature of the mortality crisis was different in Belarus than it was in Lithuania and Russia. The marked similarities in socioeconomic and mortality trends in the countries up to 1991 contrast with their notable divergence during the subsequent years. The nature and success of market reforms seems to be the most plausible explanation for these differences. Russia and Lithuania have chosen more radical forms of economic and political transformations, which have led to massive privatization campaigns. The reforms were more sustainable and systematic in Lithuania than in Russia. By contrast, Belarus has chosen a gradual and slow transition path. Recent mortality trends in Belarus are explored in detail here, and are contrasted with those observed in Lithuania and Russia. Including a cause-of-death analysis sheds more light on the plausible determinants of the variations in mortality levels between the countries.