The COVID-19 pandemic stimulated the interest of scientists, decision makers and the general public in short-term mortality fluctuations caused by epidemics and other natural or man-made disasters. To address this interest and provide a basis for further research, in May 2020, the Short-term Mortality Fluctuations data series was launched as a new section of the Human Mortality Database. At present, this unique data resource provides weekly mortality death counts and rates by age and sex for 38 countries and regions. The main objective of this paper is to detail the web-based application for visualizing and analyzing the excess mortality based on the Short-term Mortality Fluctuation data series. The application yields a visual representation of the database that enhances the understanding of the underlying data. Besides, it enables the users to explore data on weekly mortality and excess mortality across years and countries. The contribution of this paper is twofold. First, to describe a visualization tool that aims to facilitate research on short-term mortality fluctuations. Second, to provide a comprehensive open-source software solution for demographic data to encourage data holders to promote their datasets in a visual framework.
This chapter provides an overview of global trends in longevity and survival at older ages, with a special focus on global and regional disparities. In particular, existing evidence regarding potential data and estimation challenges will be critically assessed. The chapter also aims at summarizing the mixed evidence on the determinants of longevity at older ages. Our insights into global longevity trends suggest that longevity improvements have been highly uneven between and within the global regions. The reported results highlight the growing divergence in survival at age 65 and at age 80 among the most advanced high-income countries. Meanwhile, model-based estimates indicate that the majority of developing countries have probably not reached the phase in which systematic improvements in survival at older ages are occurring. The evidence is even more complex and problematic for global changes in the prevalence of diseases, risk factors, and disability. Epidemiological studies indicate that the burden of cardiovascular and other noncommunicable diseases is increasing in developing countries. It also appears that in many developed countries, smoking rates are decreasing and the obesity epidemic is stabilizing. Yet even the elderly in some high-income countries have unfavorable longevity profiles, as a substantial proportion of their remaining life expectancy is spent with chronic conditions or disability. More efforts are needed to obtain reliable and internationally comparable data on health and survival at old age in all global regions.
The Human Mortality Database (HMD, www.mortality.org) is the world’s leading data resource on mortality in developed countries. The HMD is a collaborative project of the Department of Demography at the University of California, Berkeley (UCB) and the Max Planck Institute for Demographic Research (MPIDR) in Rostock, Germany. The main purposes of the HMD are to document the longevity revolution of the modern era and to facilitate research into its causes and consequences by providing high-quality data to researchers, students, journalists, policy analysts, and others interested in the history of human longevity. As of 2019, this unique open-access collection provides detailed, high-quality mortality and population data for 40 countries. The database is still growing.
In Russia, cardiovascular disease (CVD) mortality is high and the mortality gap between men and women is large. Conventional risk factors cannot explain these phenomena. Ventricular arrhythmia (VA) is an important contributor to the death toll in community-based populations. The study examines the prevalence and the mortality impacts of VA in men and women and the role of VA in the male mortality excess at older ages.
This is a secondary analysis of data from the Stress, Aging, and Health in Russia (SAHR) study that was fielded in 2007–9 in Moscow (1800 individuals, mean age 68.8 years), with mean mortality follow-up of 7.4 years (416 deaths, 248 CVD deaths). Indicators reflecting the frequency and the complexity of VA were derived from 24-h ambulatory ECG recordings. Other covariates were: socio-demographic characteristics, conventional risk factors, markers of inflammation, reported myocardial infarction, and stroke. The impacts of VA and other variables on CVD and all-cause mortality among men and women were estimated with the proportional hazard models. We assessed the contributions of VAs to the male–female mortality gap using hazard models that do and do not include groups of the predictors. Logistic models were used to assess the associations between VA and other biomarkers.
VAs were about twice as prevalent among men as among women. In both sexes, they were significantly associated with CVD and all-cause mortality independently of conventional risk factors. The highest hazard ratios (HRs) for CVD death were found for the runs of ventricular premature complexes (VPCs) HR = 2.45, 95% CI 1.63–3.68 for men and 2.75, 95% CI 1.18–6.40 for women. The mortality impacts of the polymorphic VPCs were significant among men only (HR = 1.50, 95% CI 1.08–2.07). VA indicators can potentially explain 12.3% and 9.1% of the male–female gaps in mortality from CVD and all causes, respectively. VAs were associated with ECG-registered ischemic problems and reported MI, particularly among men.
VA indicators predicted mortality in older Muscovites independently of other risk factors, and have the potential to explain a non-trivial share of the excess male mortality. The latter may be related to more severe coronary problems in men compared to women.
Russia has a high burden of suicide and alcohol-attributable mortality. However there have been few studies of the epidemiology of depression.
The study population was 5077 men and women aged 35-69 years from a cross-sectional population based survey in the cities of Arkhangelsk and Novosibirsk (2015-17). Moderate depression was defined as Patient Health Questionnaire-9 (PHQ-9) score≥10. Risk factors considered were socio-demographic factors (age, sex, marital status, living alone, education, employment status, financial constraints); health behaviours (smoking, alcohol use) and psycho-social factors (life events and social support).
After mutual adjustment for all other factors, there was evidence that PHQ-9≥10 was associated with sex (higher in women), financial constraints, employment status, being a non-drinker, problem drinking, smoking, not having enough people to confide in and the number of life events in the past 6 months. Employment status was more strongly associated in men (OR 1.84 (95%CI 1.17, 2.88)) than women (OR 1.15 95% CI 0.86, 1.55). The effect size was particularly striking for financial constraints (odd ratio over 3 times higher in those with not enough money for food and clothes compared to no financial constraints), problem drinking (OR 1.72 (1.12, 2.65) among drinkers with CAGE score of 2 and 2.25 (95% CI 1.42, 3.57) in those with score ≥3 compared to zero) and life events (85% higher odds in those experiencing one life event and over 4 times higher odds in those experiencing 3 or more life events) all of which demonstrated a dose-response with PHQ-9>=10
The study was cross-sectional in nature therefore temporal relationships could not be assessed.
We have identified here a range of risk factors for depression among the Russian general population consistent with findings from other populations. The strikingly strong association with financial constraints indicates the importance of social inequality for the burden of depression.
Even in countries with very good statistical systems, routine population statistics that cover individuals of very high ages are often problematic, as the proportion of erroneous cases increases sharply with age. The desire to measure human mortality at extreme ages was the main motivation for the establishment of the International Database on Longevity (IDL). The IDL is a uniquely valuable source of information on extreme human longevity. It provides high-quality age-validated individual-level data on the ages of semi-supercentenarians and supercentenarians. Moreover, the IDL is the only database that provides such data without age-ascertainment bias. It obtains its candidates from records of government agencies to ensure that there is no dependency between the probability of being included and age. Candidates who meet strict criteria for the validity of their age (date of their birth) are then included in the IDL. Nevertheless, the IDL does not include exhaustive sets of validated supercentenarians and semi-supercentenarians for any country, because it is nearly impossible to find documents that would allow for the validation of the ages of all of the individuals on the list. As of August 2017, the IDL has records on 1,304 validated supercentenarians and 18,590 semi-supercentenarians from 15 countries. The first person in the IDL collection who attained age 110 was born in 1852 and died in 1962 in Quebec, while the last person was born in 1906 and attained age 110 in 2016. This chapter introduces the database and explains its purpose and principles. We also describe the data structure and provide an overview of the information available.
To investigate whether the introduction of Minimum Unit Pricing (MUP) in Scotland on 1 May 2018 was reflected in changes in the likelihood of alcohol‐related queries submitted to an internet search engine and in particular whether there was any evidence of increased interest in purchasing of alcohol from outside Scotland.
Observational study in which individual queries to the internet Bing search engine for 2018 in Scotland and England were captured and analysed. Fluctuations over time in the likelihood of specific topic searches were examined. The patterns seen in Scotland were contrasted with those in England.
Scotland and England.
People who used the Bing search engine during 2018.
Numbers of daily queries submitted to Bing in 2018 on eight alcohol‐related topics expressed as a proportion of queries on that day on any topic. These daily likelihoods were smoothed using a 14‐day moving average for Scotland and England separately.
There were substantial peaks in queries about MUP itself, cheap sources of alcohol and online alcohol outlets at the time of introduction of MUP in May 2018 in Scotland but not England. These were relatively short‐lived. Queries related to intoxication and alcohol problems did not show a MUP peak but were appreciably higher in Scotland than in England throughout 2018.
Analysis of internet search engine queries appears to show that a fraction of people in Scotland may have considered circumventing minimum unit pricing in 2018 by looking for online alcohol retailers. The overall higher levels of queries related to alcohol problems in Scotland compared with England mirrors the corresponding differences in alcohol consumption and harms between the countries.
The article scrutinizes one of the most acute problems in Russian society – the continued high level of separations among first unions. According to the official statistics data, Russia has consistently held a leading position in terms of divorce rates among European countries. Recent estimates of period total divorce rates suggest that 30–40% of marriages contracted in the 1970-1980s and 50–60% of marriages contracted in the last two decades have a chance of being dissolved. The authors use materials from the panel part of the sample survey «Parents and children, men and women in the family and society» to examine the stability of first unions formed in 1945–2010 – either direct marriage, marriage after cohabitation or cohabitation in partnership cohorts. The results suggest an increase in the proportion of dissolved marriages from 14% in the marital cohorts of 1945–1954 to 30% in marital cohorts of 1980–1989. In these cohorts, «direct» marriages were more stable than marriages, which followed cohabitations. However, it is not so obvious for marriages preceded by cohabitations in the 1990s. Authors conclude that the average duration of a dissolved marriage and the average age of women at the time of the dissolution of the marriage has decreased. Cohabitation remains the least stable form of union with an average duration of 4–5 years. Childless unions break up 2 times more often both among marriages and cohabitations. There has been also a decrease in the average number of children in all types of broken unions with children. Based on results formulated at the final part of the article the authors suggest that the «direct» marriage without prior cohabitation become a less attractive form of union that might positively affect the stability of Russian marriages by reducing the probability of divorce due to such grounds of divorce as incompatibility in characters, views and beliefs, especially in the initial years of joint life.
Objective To examine the prevalence of atrial fibrillation (AF), its impacts on cardiovascular disease (CVD) and all-cause mortality, and the associations between AF and inflammatory and serum biomarkers in a population-based sample of Muscovites. Methods The study is a secondary analysis of data from the Stress, Aging and Health in Russia (SAHR) survey that includes information on 1800 individuals with an average age of 68.5 years at baseline, and on their subsequent mortality during 7.4 years on average. AF is detected by 12-lead electrocardiogram (ECG) and 24-hour Holter monitoring. The statistical analysis includes proportional hazard and logistic regression models. Results Of the 1732 participants with relevant Holter data, AF was detected in 100 (74 by ECG and Holter, 26 by Holter only). The prevalence of AF was 5.8% for men and 7.4% for women. The fully adjusted model showed strongly elevated hazard of CVD and all-cause mortality in men and women with long non-self-limiting AF (LAF). LAF was found to be negatively associated with elevated total and low-density lipoprotein cholesterol and to be positively associated with elevated markers of inflammation in women. Conclusions The study assessed for the first time the prevalence and the risks of death related to AF among older Russians. LAF was shown to be a strong and independent predictor of CVD and all-cause mortality. AF is unlikely to contribute to the large excess male mortality in Russia. The finding that one-quarter of AF cases were detected only by Holter monitoring demonstrates the usefulness of diagnostics with prolonged ECG registration
There is currently an increase in the number of heat waves occurring worldwide. Moscow experienced the effects of an extreme heat wave in 2010, which resulted in more than 10,000 extra deaths and significant economic damage. This study conducted a comprehensive assessment of the social risks existing during the occurrence of heat waves and allowed us to identify the spatial heterogeneity of the city in terms of thermal risk and the consequences for public health. Using a detailed simulation of the meteorological regime based on the COSMO-CLM regional climate model and the physiologically equivalent temperature (PET), a spatial assessment of thermal stress in the summer of 2010 was carried out. Based on statistical data, the components of social risk (vulnerabilities and adaptive capacity of the population) were calculated and mapped. We also performed an analysis of their changes in 2010–2017. A significant differentiation of the territory of Moscow has been revealed in terms of the thermal stress and vulnerability of the population to heat waves. The spatial pattern of thermal stress agrees quite well with the excess deaths observed during the period from July to August 2010. The identified negative trend of increasing vulnerability of the population has grown in most districts of Moscow. The adaptive capacity has been reduced in most of Moscow. The growth of adaptive capacity mainly affects the most prosperous areas of the city.
Background. Prior studies on spatial inequalities in mortality in Russia were restricted to the highest level of administrative division, ignoring variations within the regions. Using mortality data for 2239 districts, this study is the first analysis to capture the scale of the mortality divide at a more detailed level.
Methods. Age- standardised death rates are calculated using aggregated deaths for 2008–2012 and population exposures from the 2010 census. Inequality indices and decomposition are applied to quantify both the total mortality disparities across the districts and the contributions of the variations between and within regions.
Results. Regional variations in mortality mask one- third (males) and one- half (females) of the inequalities observed at the district level. A comparison of the 5% of individuals residing in the districts with the highest and the lowest mortality shows a gap of 15.5 years for males and 10.3 years for females. The lowest life expectancy levels are in the shrinking areas of the Far East and Northwest of Russia. The highest life expectancy clusters are in the intercity districts of Moscow and Saint Petersburg, and in several science cities. Life expectancy in these best- practice districts is close to the national averages of Poland and Estonia, but is still substantially below the averages in Western countries.
Conclusion. The large between- regional and within- regional disparities suggest that national- level mortality could be lowered if these disparities are reduced by improving health in the laggard areas. This can be achieved by introducing policies that promote health convergence both within and between the Russian regions.
Little is known about the burden of common mental disorders in Russia despite high levels of suicide and alcohol-related mortality. Here we investigated levels of symptoms, self-reports of ever having received a diagnosis and treatment of anxiety and depression in two Russian cities.
The study population was men and women aged 35–69 years old participating in cross-sectional population-based studies in the cities of Arkhangelsk and Novosibirsk (2015–18). Participants completed an interview which included the PHQ-9 and GAD-7 scales, questions on whether participants had ever received a diagnosis of depression or anxiety, and health service use in the past year. Participants also reported current medication use and medications were coded in line with the WHO anatomical therapeutic classification (ATC). Depression was defined as PHQ-9 ≥ 10 and Anxiety as GAD-7 ≥ 10.
Age-standardised prevalence of PHQ-9 ≥ 10 was 10.7% in women and 5.4% in men (GAD-7 ≥ 10 6.2% in women; 3.0% in men). Among those with PHQ-9 ≥ 10 17% reported ever having been diagnosed with depression (equivalent finding for anxiety 29%). Only 1.5% of those with PHQ-9 ≥ 10 reported using anti-depressants and 0.6% of those with GAD-7 ≥ 10 reported using anxiolytics. No men with PHQ-9 ≥ 10 and/or GAD-7 ≥ 10 reported use of anti-depressants or anxiolytics. Use of health services increased with increasing severity of both depression and anxiety.
There was a large gap between symptoms and reporting of past diagnosis and treatment of common mental disorders in two Russian cities. Interventions aimed at improving mental health literacy and reducing stigma could be of benefit in closing this substantial treatment gap.
Background. The Russian Federation has very high cardiovascular disease (CVD) mortality rates compared with countries of similar economic development. This cross-sectional study compares the characteristics of CVD-free participants with and without recent primary care contact to ascertain their CVD risk and health status.
Methods. A total of 2774 participants aged 40–69 years with no self-reported CVD history were selected from a population-based study conducted in Arkhangelsk and Novosibirsk, Russian Federation, 2015–2018. A range of co-variates related to socio-demographics, health and health behaviours were included. Recent primary care contact was defined as seeing primary care doctor in the past year or having attended a general health check under the 2013 Dispansarisation programme.
Results. The proportion with no recent primary care contact was 32.3% (95% CI 29.7% to 35.0%) in males, 16.3% (95% CI 14.6% to 18.2%) in females, and 23.1% (95% CI 21.6% to 24.7%) overall. In gender-specific age-adjusted analyses, no recent contact was also associated with low education, smoking, very good to excellent self-rated health, no chest pain, CVD 10-year SCORE risk 5+%, absence of hypertension control, absence of hypertension awareness and absence of care-intensive conditions. Among those with no contact: 37% current smokers, 34% with 5+% 10-year CVD risk, 32% untreated hypertension, 20% non-anginal chest pain, 18% problem drinkers, 14% uncontrolled hypertension and 9% Grade 1–2 angina. The proportion without general health check attendance was 54.6%.
Conclusion. Primary care and community interventions would be required to proactively reach sections of 40–69 year olds currently not in contact with primary care services to reduce their CVD risk through diagnosis, treatment, lifestyle recommendations and active follow-up.
Surprisingly few attempts have been made to quantify the simultaneous contribution of well-established risk factors to CVD mortality differences between countries. We aimed to develop and critically appraise an approach to doing so, applying it to the substantial CVD mortality gap between Russia and Norway using survey data in three cities and mortality risks from the Emerging Risk Factor Collaboration. We estimated the absolute and relative differences in CVD mortality at ages 40–69 years between countries attributable to the risk factors, under the counterfactual that the age- and sex-specific risk factor profile in Russia was as in Norway, and vice-versa. Under the counterfactual that Russia had the Norwegian risk factor profile, the absolute age-standardized CVD mortality gap would decline by 33.3% (95% CI 25.1–40.1) among men and 22.1% (10.4–31.3) among women. In relative terms, the mortality rate ratio (Russia/Norway) would decline from 9–10 to 7–8. Under the counterfactual that Norway had the Russian risk factor profile, the mortality gap reduced less. Well-established CVD risk factors account for a third of the male and around a quarter of the female CVD mortality gap between Russia and Norway. However, these estimates are based on widely held epidemiological assumptions that deserve further scrutiny.
Introduction and Aims.Eastern Europe is known to suffer from a large burden of alcohol-related mortality. However,persisting unfavourable conditions at the national level mask variation at the sub-national level. We aim to explore spatialpatterns of cause-specific mortality across four post-communist countries: Belarus, Lithuania, Poland and Russia (Europeanpart).Design and Methods.We use official mortality data routinely collected over 1179 districts and cities. The analysisrefers to males aged 20–64 years and covers the period 2006–2014. Mortality variation is mainly assessed by means of thestandardised mortality ratio.Getis-Ord Gi*statisticis employed to detect hot and cold spots of alcohol-related mortality.Results.Alcohol-related mortality exhibits a gradient from very high levels in northwestern Russia to low levels in southernPoland. Spatial transitions from higher to lower mortality are not explicitly demarcated by national boundaries. Within thesecountries, hot spots of alcohol-related mortality dominate the territories of northwestern and western Russia, eastern and north-western Belarus, southeastern Lithuania, and eastern and central Poland.Discussion and Conclusions.The observedmortality gradient is likely associated with the spread of alcohol epidemics from the European part of Russia to the other coun-tries, which appears to have started more than a century ago. Contemporary socioeconomic and demographic factors should betaken into account when developing anti-alcohol policies. The same is true for the peculiarities of culture, norms, traditionsand behavioural patterns observed in specific geographical areas of the four countries. Reducing alcohol-related harm in theareas identified as hot spots should be prioritised.
Dissimilarities in the approaches used to certify or code underlying causes of death may diminish the usefulness and reliability of cause-of-death statistics. Consistency of cause-specific mortality data within a given country can be regarded as one of the criteria for evaluating data quality. In the present paper, we assess the subnational consistency of cause-of-death statistics in four countries: Russia, Germany, the U.S., and France. We estimate the shares of major groups of causes in the mortality structures of subnational entities (regions), and compare them with the inter-regional average values. Next, we visualize the deviations on heat map matrices. This allows us to pinpoint the cases that deviate the most with respect to regions and causes of death, as well as the causes with high levels of within-country variability, and the regions with unique mortality structure. Among the countries that we examined, France has the most consistent cause-of-death data across its regions, while Russia has the largest number of outliers. We also found that causes of death that do not have strict diagnostic criteria (e.g., ill-defined) tend to display higher variability, while the shares of causes that are easier to diagnose as underlying are more stable across the regions.
Introduction and Aims
In the 1990s, a strong inverse relationship between life expectancy (LE) in Russia and mortality from alcohol poisoning was observed. This association is remarkable as this cause accounts for less than 2% of deaths each year. It can be explained by treating the alcohol poisoning mortality as the best available measure in Russia of the population prevalence of harmful drinking in any year which in turn associated with mortality from a wide range of causes. This study analyses the evolving relationship of LE with this mortality‐based measure of harmful drinking since 1965, and places it in a policy context.
Design and Methods
We examine three periods: 1965–1984, a period of gradual LE decline; 1984–2003, a period of massive LE fluctuations; and 2003–2017, a period of LE improvement. Pearson's correlation coefficients and a linear relationship between annual changes in LE and alcohol poisoning were estimated for each period.
The strongest negative correlation between changes in LE and alcohol poisonings was found in 1984–2003. Over the period 2003–2017 a consistent positive LE trend emerged that was statistically independent of alcohol poisoning.
Discussion and Conclusions
These results suggest that in the period from the mid‐2000s a growth of LE in Russia was to a large extent independent of changes in the population prevalence of harmful drinking. While there has been a reduction in mortality at ages 15–64, at older ages mortality reduction unrelated to alcohol has become an increasingly important driver of overall mortality improvements.
The study aims at identifying long-term trends and patterns of current smoking by age, gender, and education in Russia, including the most recent period from 2008 during which tobacco control policies were implemented, and to estimate the impact on mortality of any reductions in prevalence. We present an in-depth analysis based on an unprecedentedly large array of survey data.
We examined pooled micro-data on smoking from 17 rounds of the Russian Longitudinal Monitoring Study of 1996–2016, 11 other surveys conducted in Russia in 1975–2017, and two comparator surveys from England and the USA. Standardization by age and education, regression and meta-analysis were used to estimate trends in the prevalence of current smoking by gender, age, and educational patterns.
From the mid-1970s to the mid-2000s smoking prevalence among men was relatively stable at around 60%, after which time prevalence declined in every age and educational group. Among women, trends in smoking were more heterogeneous. Prevalence more than doubled above the age of 55 years from very low levels (< 5%). At younger ages, there were steep increases until the mid-2000s after which prevalence has declined. Trends differed by educational level, with women in the lowest educational category accounting for most of the long-term increase. We estimate that the decline in male smoking may have contributed 6.2% of the observed reduction in cardiovascular deaths among men in the period 2008–16.
The implementation of an effective tobacco control strategy in Russia starting in 2008 coincided with a decline in smoking prevalence among men from what had been stable, high levels over many decades regardless of age and education. Among women, the declines have been more uneven, with young women showing recent downturns, while the smoking prevalence in middle age has increased, particularly among those with minimal education. Among men, these positive changes will have made a small contribution to the reduction in mortality seen in Russia since 2005.
Uncontrolled hypertension is a major cardiovascular risk factor. We examined uncontrolled hypertension and differences in treatment regimens between a high-risk country, Russia, and low-risk Norway to gain better understanding of the underlying factors.
Population-based survey data on 40–69 year olds with hypertension defined as taking antihypertensives and/or having high blood pressure (140+/90+ mmHg) were obtained from Know Your Heart Study (KYH, N = 2284), Russian Federation (2015–2018) and seventh wave of The Tromsø Study (Tromsø 7, N = 5939), Norway (2015–2016). Uncontrolled hypertension was studied in the subset taking antihypertensives (KYH: N = 1584; Tromsø 7: 2792)and defined as having high blood pressure (140+/90+ mmHg). Apparent treatment resistant hypertension (aTRH) was defined as individuals with uncontrolled hypertension on 3+ OR controlled on 4+ antihypertensive classes in the same subset.
Among all those with hypertension regardless of treatment status, control of blood pressure was achieved in 22% of men (KYH and Tromsø 7), while among women it was 33% in Tromsø 7 and 43% in KYH. When the analysis was limited to those on treatment for hypertension, the percentage uncontrolled was higher in KYH (47.8%, CI 95 44.6–50.9%) than Tromsø 7 (38.2, 36.1–40.5%). The corresponding figures for aTRH were 9.8% (8.2–11.7%) and 5.7% (4.8–6.8%).
Antihypertensive monotherapies were more common than combinations and used by 58% in Tromsø 7 and 44% in KYH. In both KYH and Tromsø 7, untreated hypertension was higher in men, those with no GP visit in the past year and problem drinkers. In both studies, aTRH was associated with older age, CVD history, obesity, and diabetes. In Tromsø 7, also male gender and any drinking. In KYH, also chronic kidney disease.
There is considerable scope for promoting combination therapies in line with European treatment guidelines in both study populations. The factors associated with untreated hypertension overlap with known correlates of treatment non-adherence and health check non-attendance. In contrast, aTRH was characterised by obesity and underlying comorbidities potentially complicating treatment.