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Seminar "What is unusual about the Russian mortality? Population-level evidence"

The 12th scientific seminar "Modern demography" was held on the 11th of December. Vladimir M. Shkolnikov, PhD, academic supervisor of the International laboratory for population and health of NRU HSE, research scientist at Laboratory of demographic data at Max Planck Institute for demographic research presented a paper "What is unusual about the Russian mortality? Population-level evidence".

In his report, Vladimir. M. Shkolnikov refers to epidemiological studies ever conducted in Russia, such as MONICA, SAHR, Izhevsk Family Survey, Know Your Heart, and others in order to examine the phenomenon of Russian mortality (high mortality level and other distinct features).

Among the features of the Russian mortality, V. M. Shkolnikov highlights the long-lasting sustainability of high mortality level and the plurality of negative phenomena.  

V. M. Shkolnikov highlights that the working-age population had an important role to play in the determining of the life expectancy dynamics in 1965-2008, while in 2008-2009 the role of the older population was gaining importance. Other distinct features of Russian mortality making it different as compared to other European countries are the much higher level of excess mortality among men, a high concentration of mortality among the least educated population and a combination of very high mortality at the young age with high mortality in middle and older age.

V. M. Shkolnikov, stresses that the possibilities for an accurate examination of this phenomenon are being hampered due to the lack of population-level data and that it is necessary to remember that the interindividual variability of the same characteristics is greater than the average group variability and in many aspects is much different from it.

The LRC and Monica cohort studies were the first significant epidemiological study conducted in Russia. It had seven waves (had more than 10,000 objects of observation in Moscow only) and examined the “classical” risk factors for cardiovascular diseases (blood pressure level, heart rate at rest, blood lipids) and mortality from them.

To “unravel the enigma” of the high mortality from cardiovascular disease in Russia (standardized death rate from CVD`s, including that of the ischemic heart disease, in Arkhangelsk and Novosibirsk, where the study was conducted, was 8-10 times higher than in Norwegian city of Tromso) another major study called “Know Your Heart” was conducted. Preliminary results showed that this difference in mortality can hardly be explained by various practices of coding of causes of death, while the difference in systolic and diastolic blood pressure between the two populations can explain no more than 20% and 60% differences in mortality, respectively (out of 800-1000% total).

Another major risk factor, that is more common in Russia, primarily among males, is smoking. An analysis of a large number of surveys studying the prevalence of smoking in the Russian population revealed that it decreases in males starting with 2008, which is especially evident in the youngest age groups (a phenomenon that most likely results from implementation of the provisions of the WHO Convention on Tobacco Control), while remaining significantly higher than that in the Anglo-Saxon countries for all ages combined. For females, an increase in the proportion of smokers in all age groups, except for 20-25 years, may be observed, but this increase starts from a much lower level, thus, in the age groups 50+, smoking among Russian females is still less common than among that of British and American females.

The phenomenon of extremely high mortality among Russian working-age males (25-54 years) observed in the 1990s and lasting in many aspects to the present time was studied in now-classic Izhevsk survey of families. It was this study that revealed the strong relationship between hazardous alcohol consumption and premature mortality at working ages, including mortality from cardiovascular diseases.

Hazardous alcohol consumption in the early 2000s was responsible for 42% of all deaths of Izhevsk males aged 25 to 54 years (for country level, it was about 170,000 “extra” deaths). A significant degree of marginalization of excess mortality (evident signs of dangerous alcohol consumption were identified in no more than 12-13% of working age males) and a significant educational gradient was also observed.

Presentation by V. M. Shkolnikov