Adult mortality in Russia

Ecohost coordinators:  David Leon, Martin McKee, Laurent Chenet

• Russia's transition from a socialist to market-led economy has been accompanied by a severe decline in the health status of the population. Between 1991 and 1994 life expectancy for males has fallen by over 6 years and for females by over 3 years. This dramatic decline is quite unprecedented both in Russia and in other industrialised countries.
• In 1995 and 1996 there is evidence of a reversal in these negative trends, with life expectancy among males and females increasing.
• Between June 1996 and October 1997 ECOHOST, in collaboration with the Centre of Demography and Human Ecology (of the Russian Academy of Sciences, Moscow), undertook a project to investigate the reasons for the decline in life expectancy and to communicate the results to policy makers within Russia and the international community. The work was funded by the DFID through a grant from UK Government's Know-How Fund.
• Our major findings relate to these areas:

profile of mortality crisis
role of alcohol consumption
health care
diet
smoking

• Huge variation in Russian mortality rates 1984-1994: artefact, alcohol, or what?
  Leon D, Chenet L, Shkolnikov VM, Zakharov S, Shapiro J, Rakhmanova G, Vassin S, McKee M.
  Lancet 1997; 350: 383-8.
• Death from alcohol and violence in Moscow: socio-economic determinants.
  Chenet L, Leon D, McKee M, Vassin S.
  Eur J Population 1998; 14: 19-37.
• Alcohol and cardiovascular mortality in Moscow, new evidence of a causal association.
  Chenet L, McKee M, Leon D, Shkolnikov V, Vassin S.
  J Epidemiol Comm Health 1998; 52: 772-74.
• Patterns of smoking in Russia.
  McKee M, Bobak R, Rose R, Shkolnikov V, Chenet L, Leon D.
  Tobacco Control 1998; 7: 22-26.
• Social stress and the Russian mortality crisis.
  Leon DA, Shkoilnikov VM.
  JAMA 1998; 279: 790-791.
• Seasonal variation in mortality in Moscow.
  McKee M, Sanderson C, Chenet L, Vassin S, Shkolnikov V.
  J Publ Health Med 1998; 20: 268-274.
• Educational level and adult mortality in Russia : an analysis of routine data 1979 to 1994.
  Shkolnikov V, Leon DA, Adamets S, Andreev E, Deev A.
  Soc Sci Med 1998; 47: 357-369.
• Economic change, crime, and mortality crisis in Russia: a regional analysis.
  Walberg P, McKee M, Shkolnikov V, Chenet L, Leon DA.
  BMJ 1998; 317: 312-8.

• The recent increase in mortality is real and not due to problems in data collection.
• Life expectancy at birth has fallen between 1990 and 1995 by 6.3 years for men (63.8 to 57.5) and by 3.4 years for women (74.4 to 71.0).
• The increase in mortality began in the late 1980's and rose sharply in 1992. Mortality rates have increased most steeply among men and women of working age. The biggest increase has been among those in their early 40s.
• Mortality has increased in all categories but the most marked increases are in dealths from fatal events (eg. accidents, injuries, suicides, posonings) and in deaths from cardiovascular disease.
• Alcohol consumption played a much larger role in the mortality crisis than had been previously suspected.
• The deterioration of the health care system could not account for the sharp decrease in life expectancy.
• Diet and smoking play a crucial part in long-term mortality trends but could not account for recent changes.

• Alcohol consumption plays a far greater role in the mortality crisis than had previously been thought.
• The decline in mortality in the mid-1980s (which co-incides with Gorbachev's anti-alcohol campaign) and the subsequent rise after 1988 parallels what is known about alcohol consumption in Russia. This has soared due to the upsurge of home brewing, the relatively cheap price of alcohol and the absence of any concerted attempt to counteract alcohol abuse.
• The direct effect of alcohol consumption on mortality is shown in the four-fold increase of deaths from alcohol-related conditions between 1988 and 1994.
• The indirect effects of alcohol are shown in the alarming increase in accidents and violence (a significant proportion of which may be alcohol-related).
• An important finding is that much of the increase in mortality from cardiovascular and respiratory disease among people of working age can be attributed to the effects of alcohol. (Acute episodes of very high levels of alcohol consumption can result in death from cardiac arrythmia and haemorrhagic stroke.)

• There is insufficient evidence to assess accurately the effect of changes in the health care service on mortality rates.
• Mortality rates amongst children and pensioners (the most vulnerable groups) has remained fairly stable. This suggests that the health service has certainly not 'collapsed' since 1991.
• It seems unlikely, therefore, that a deterioration in health services could account for more than a small proportion of increased mortality.
• Long-standing weaknesses in the health service are probably an important factor in explaining the generally poor levels of health in Russia by comparison with other European countries.

• Changes in diet are very unlikely to have played a large part in the recent mortality crisis.
• However, many sections of the population continue to eat a diet that is low in fresh fruit and vegetables, and this may contribute in the longer term to a rise in the incidence of cancer and heart disease.

Smoking in Russia

• High levels of smoking, especially among Russian men, is a significant factor in explaining the generally high mortality levels in Russia compared to most European countries.
• For Russian men, lung cancer deaths are about one third higher than in Western Europe.
• There is a new and worrying trend which shows that increasing numbers of Russian women now smoke, especially the young and those living in large cities.