Commentary on the article by Nemtsov et al.(2019, this issue)
Research indicates that women have higher levels of physical disability and depression and lower scores on physical performance tests compared to men, while the evidence for gender differences in self-rated health is equivocal. Scholars note that these patterns may be related to women over-reporting and men under-reporting health problems, but gender differences in reporting behaviors have not been rigorously tested. Using Wave 1 of the Survey of Health, Ageing and Retirement in Europe (SHARE), the present study investigates the extent to which adjusting for differences in reporting behavior modifies gender differences in general health. We also examine whether men and women's reporting behaviors are consistent across different levels of education. After adjusting for reporting heterogeneity, gender differences in both poor and good health widened. However, we found no clear gender-specific patterns in reporting either poor or good health. Our findings also do not provide convincing evidence that education is an important determinant of general health reporting, although the female disadvantage in poor health and the male advantage in good health were more apparent in lower than higher education groups at all ages. The results challenge prevailing stereotypes that women over-report and men under-report health problems and highlight the importance of attending to health problems reported by women and men with equal care.
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.
Background: Since 2005, Russia has made substantial progress, experiencing an almost doubling of per-capita gross domestic product by purchasing power parity (GDP [PPP]) to US$24 800 and witnessing a 6-year increase in life expectancy, reaching 71·4 years by 2015. Even greater gains in GDP (PPP) were seen for Moscow, the Russian capital, reaching $43 000 in 2015 and with a life expectancy of 75·5 years. We aimed to investigate whether mortality levels now seen in Russia are consistent with what would be expected given this new level of per-capita wealth.
Methods: We used per-capita GDP (PPP) and life expectancy from 61 countries in 2014–15, plus those of Russia as a whole and its capital Moscow, to construct a Preston curve expressing the relationship between mortality and national wealth and to examine the positions of Russia and other populations relative to this curve. We adjusted life expectancy values for Moscow for underestimation of mortality at older ages. For comparison, we constructed another Preston curve based on the same set of countries for the year 2005. We used the stepwise replacement algorithm to decompose mortality differences between Russia or Moscow and comparator countries with similar incomes into age and cause-of-death components.
Findings: Life expectancy in 2015 for both Russia and Moscow lay below the Preston-curve-based expectations by 6·5 years and 4·9 years, respectively. In 2015, Russia had a lower per-capita income than 36 of the comparator countries but lower life expectancy than 60 comparator countries. However, the gaps between the observed and the Preston-expected life expectancy values for Russia have diminished by about 25% since 2005, when the life expectancy gap was 8·9 years for Russia and 6·6 years for Moscow. When compared with countries with similar level of income, the largest part of the life expectancy deficit was produced by working-age mortality from external causes for Russia and cardiovascular disease at older ages for Moscow.
Interpretation: Given the economic wealth of Russia, its life expectancy could be substantially higher. Sustaining the progress seen over the past decade depends on the ability of the Russian Government and society to devote adequate resources to people’s health.
The article presents the author’s reflections on theories in general and demographic theories in particular. The epidemiological transition, i.e. periodization of changes in the structure of causes of death, proposed by A.R. Omran in 1971 and later raised to the rank of theory, is taken as an example. The author points out the insufficiency of Omran’s concept to explain the contemporary mortality trends and suggests possible directions of theorizing that would enable correlating the new stage of life expectancy growth with the notion of “epidemiological transition”.
Objectives. To assess disparities in mortality by socioeconomic status in Germany.
Design and participants. We analyse a large administrative dataset of the German Pension Fund (DRV), including 27 million person-years of exposure and 42 000 deaths in 2013. The data cover the economically active population, stratified by sex and by East and West.
Outcome measures. Age-standardised mortality rates and Poisson regression mortality rate ratios (MRRs).
Results. The risk of dying increases with decreasing income: the MRRs of the lowest to the highest income quintile are 4.66 (95% CI 4.48 to 4.85) among men and 3.06 (95% CI 2.90 to 3.23) among women. The impact of income attenuates after controlling for education and other explanatory variables, especially for females. In the fully controlled model for females, individual income is a weaker predictor of mortality, but there is a clear educational mortality gradient. In the fully controlled model, the MRRs of the unemployed to the employed are 2.09 (95% CI 2.03 to 2.15) among men and 2.01 (95% CI 1.92 to 2.10) among women. The risk of dying is around half as high among foreigners as among German citizens. The socioeconomic disparities are greater among East than West German men.
Conclusions. Low socioeconomic status is a major determinant of excess adult mortality in Germany. The persisting East-West differences in male adult mortality can be explained by the higher socioeconomic status of men living in the West, rather than by contextual differences between East and West. These differences can be further monitored using DRV data.
Background Although estimates of socioeconomic mortality disparities in Germany exist, the trends in these disparities since the 1990s are still unknown. This study examines mortality trends across socioeconomic groups since the late 1990s among retired German men aged 65 and above.
Methods Large administrative data sets were used to estimate mortality among retired German men, grouped according to their working-life biographies. The data covered the years 1997–2016 and included more than 84.1 million person-years and 4.3 million deaths. Individual pension entitlements served as a measure of lifetime income. Changes in total life expectancy at age 65 over time were decomposed into effects of group-specific mortality improvements and effects of compositional change.
Results Over the two decades studied, male mortality declined in all income groups in both German regions. As mortality improved more rapidly among higher status groups, the social gradient in mortality widened. Since 1997, the distribution of pension entitlements of retired East German men has shifted substantially downwards. As a result, the impact of the most disadvantaged group on total mortality has increased and has partly attenuated the overall improvement.
Conclusion Our results demonstrate that socioeconomic deprivation has substantial effects on levels of mortality in postreunification Germany. While East German retirees initially profited from the transition to the West German pension system, subsequent cohorts had to face challenges associated with the transition to the market economy. The results suggest that postreunification unemployment and status decline had delayed effects on old-age mortality in East Germany.
Since 2010, the rate of improvement in life expectancy in the UK has slowed. We aimed to put this trend in the context of changes over the long term and in relation to a group of other high-income countries.
We compared sex-specific trends in life expectancy since 1970 and age-specific mortality in England and Wales with median values for 22 high-income countries (in western Europe, Australia, Canada, New Zealand, Japan, and the USA). We used annual mortality data (1970–2016) from the Human Mortality Database.
Until 2011–16, male life expectancy in England and Wales followed the median life expectancy of the comparator group. By contrast, female life expectancy was below the median and is among the lowest of the countries considered. In 2011–16, the rate of improvement in life expectancy slowed sharply for both sexes in England and Wales, and slowed more moderately in the comparator group because of negative trends in all adult age groups. This deceleration resulted in a widening gap between England and Wales and the comparators from 2011 onwards. Since the mid-2000s, for the first time, mortality rates in England and Wales among people aged 25–50 years were appreciably higher than in the comparator group.
Although many countries have seen slower increases in life expectancy since 2011, trends in England and Wales are among the worst. The poor performance of female life expectancy over the long-term is in part driven by the relative timing of the smoking epidemic across countries. The previously overlooked higher mortality among young working-age adults in England and Wales relative to other countries deserves urgent attention.
Data from a well-functioning regional population-based cancer registry makes it possible to calculate a system of indicators characterizing the level of cancer morbidity and mortality of regional population at a certain period of time. These indicators are similar in their characteristics to those of life-tables and are virtually independent of the population’s age structure. To some extent they are also independent of the past levels of cancer morbidity and mortality. Unfortunately, the scope of analysis of data from Russian regional population-based cancer registries is limited. The completeness of incidence and mortality records also remains unknown. We have conducted an analysis of data from 5 regional population-based cancer registries of the North-West Federal District of Russia for early 2002 to late 2013. This article was designed as a comparative study of two time periods: 2002-2007 and 2008-2013. We have analyzed the changes in incidence and mortality (lethality) from the most common groups of malignant neoplasms. We have analyzed the levels and dynamics of age-standardized incidence and mortality rates alongside tabular indicators such as the total number of incident cases, the total number of deaths, the average age at malignant disease onset, the average life expectancy of those ill with cancer, etc. The main purpose is to demonstrate the effectiveness of the proposed analytical methods and the entire range of possible research capabilities that will become available should open access to data from Russian population-based cancer registries be granted.
Moscow is the region with the highest life expectancy in Russia. The country’s largest city, it has high incomes, a special population structure and a high concentration of all resources, including in the healthcare sector, which is given special attention by the city authorities. In some periods, the changes in life expectancy in Moscow have been unique compared to most other regions of Russia. The difference in life expectancy between Moscow and Russia in the period from the mid-1990s to the mid-2000s was mainly due to lower mortality in middle age. Since the mid-2000s, the main contribution to the difference in life expectancy has been shifting to old age mortality. Given the overall rapid decline of mortality in Moscow since then, changes in the mortality rates and life expectancy of certain age groups seem implausible. The quality of population and mortality data has a significant impact on the accuracy of estimates of mortality indicators and requires special attention in the case of Moscow. In particular, the number of people at advanced ages in Moscow is likely to be overestimated, which affects mortality rates in this age group. Peculiarities of mortality by causes of death in Moscow generally correspond to the average Russian trends; however, in Moscow a more rapid decrease in mortality from neoplasms is observed, as well as more realistic age-specific death rates in older age groups.
To derive reliable demographic indicators, appropriate data on population exposures are needed. Access to such data is becoming increasingly challenging in many countries due to factors such as the growing diversity of international migration patterns and the trend towards replacing full censuses with register-based censuses. Germany represents a particularly challenging case in this respect. Before Germany implemented its first register-based census in 2011, the country had not conducted a census for more than two decades. This census revealed that the number of people living in Germany in 2011 was about 1.5 million lower than the previous official post-censal population estimates for that year indicated. It is likely that a large portion of this discrepancy had existed for quite some time prior to 2011. Due to the long inter-censal period, the Federal Statistical Office of Germany decided not to produce backward-adjusted population estimates by single-year ages and sex for the whole period. The main aim of this paper is thus to make such detailed adjusted inter-censal population estimates available. While we have to take the peculiarities of the German case into account, our evaluation of different strategies offers important insights for developing a generalised methodology to adjust inter-censal population estimates for globalised countries that face challenges in ensuring the proper registration of migration events. We discuss four alternative approaches for deriving adjusted inter-censal population estimates. The results suggest that even for a rather complicated case like Germany, a relatively simple approach seems to work reasonably well. Finally, we demonstrate to what extent the implemented adjustments affect mortality indicators. The adjusted inter-censal population estimates for Germany and its federal states are provided in the online data appendix.
The mortality of advanced-age residents of Russia has remained stable and high for several decades. However, the steady increase in life expectancy that started in the mid-2000s is largely due to decreased mortality among the elderly. The decrease in mortality among Moscow residents over age 80 was especially large during this period. We found evidence of a systematic deviation of these dynamics from the patterns observed in countries with reliable mortality statistics. Assuming that the patterns observed in these countries are applicable to Russia, we took the possible underestimation of mortality into account and corrected the life expectancy estimates for the residents of Moscow, Russia, and the Central Federal District at age 80, at retirement age, and at birth.
Russia has one of the highest rates of cardiovascular disease in the world. The International Project on Cardiovascular Disease in Russia (IPCDR) was set up to understand the reasons for this. A substantial component of this study was the Know Your Heart Study devoted to characterising the nature and causes of cardiovascular disease in Russia by conducting large cross-sectional surveys in two Russian cities Novosibirsk and Arkhangelsk. The study population was 4542 men and women aged 35-69 years recruited from the general population. Fieldwork took place between 2015-18. There were two study components: 1) a baseline interview to collect information on socio-demographic characteristics and cardiovascular risk factors, usually conducted at home, and 2) a comprehensive health check at a primary care clinic which included detailed examination of the cardiovascular system. In this paper we describe in detail the rationale for, design and conduct of these studies.
Background: Russia has the largest area of any country in the world and has one of the highest cardiovascular mortality rates. Over the past decade, the number of facilities able to perform percutaneous coronary interventions (PCIs) has increased substantially. We quantify the extent to which the constraints of geography make equitable access to this effective technology difficult to achieve. Methods: Hospitals performing PCIs in 2010 and 2015 were identified and combined with data on the population of districts throughout the country. A network analysis tool was used to calculate road-travel times to the nearest PCI facility for those aged 40+ years. Results: The number of PCI facilities increased from 144 to 260 between 2010 and 2015. Overall, the median travel time to the closest PCI facility was 48minutes in 2015, down from 73 minutes in 2010. Two-thirds of the urban population were within 60 minutes’ travel time to a PCI facility in 2015, but only one-fifth of the rural population. Creating 67 new PCI facilities in currently underserved urban districts would increase the population share within 60 minutes’ travel to 62% of the population, benefiting an additional 5.7 million people currently lacking adequate access. Conclusions: There have been considerable but uneven improvements in timely access to PCI facilities in Russia between 2010 and 2015. Russia has not achieved the level of access seen in other large countries with dispersed populations, such as Australian and Canada. However, creating a relatively small number of further PCI facilities could improve access substantially, thereby reducing inequality.
The problem of excess mortality in Russia has not lost its relevance. The situation is complicated by the high level of spatial inequality in health, which is usually measured at the regional level in our country. This work is one of the first attempts to look at the dynamics and extent of spatial inequality in health in Russia at the sub-regional level, by contrasting the "center/core" (in our case, represented by the largest Russian cities) with the "periphery" (the rest of the country). Cities with a population of over a million people were chosen based on the spatial hierarchy that exists in Russia, according to which the highest level of social and economic development is concentrated in the largest cities. As a rule, a higher level of development of human capital corresponds to lower mortality. Using data provided by Rosstat we calculated life expectancy at birth for Russian cities with a population of over a million people in 1989-2016. The results fully coincided with our expectations: the polarization in the health level between the largest Russian cities and the rest of the country has significantly increased in the last twenty-five years, which is a reflection of those centripetal processes that have been taking place in our country during this period. Russian cities with a population of over a million people are attractive destinations for both internal and external migrants, and thus acquire among other things a much more educated population. Since people with higher education take better care of their health, having a more educated population is undoubtedly an essential advantage of bigger cities over the periphery when it comes to the overall health level. Without solving the structural problems that restrain social and economic development outside the largest agglomerations, convergence in mortality rates between cities with a population of over a million people and the surrounding territories is hardly possible.
This is the 23rd issue of Annual Series of Analytical reports regularly published by the HSE Institute of Demography since 1993. The recent report conducts the detailed analysis of the current situation in Russia’s demography in the context of its long-term evolution and demographic tendencies as seen through the prism of main demographic processes, such as marriage, birth and death rates, family planning, international and internal (intra-Russian) migration, changes in population, and age structure of Russia’s population. The analysis is based on the official data of the Federal State Statistics service of Russian Federation, ministries and government agencies of Russian Federation, international organizations and national statistics services of other countries as well as local estimates (acquired by using these resources), the results of special sampling studies, and the materials of scholarly publications. The book is designed for the researchers that work in the field of demography and similar disciplines as well as decision-making employees, workers of government organizations of all levels, and instructors and students of secondary and postsecondary professional schools.
This paper aims to estimate the cancer mortality and morbidity derivatives for the Russian population given the limited access to medical and demographic data. The multiple decrement life table method also known as the population model of cancer was originally proposed by J. Duchêne and makes it possible to assess otherwise inaccessible indicators, such as the prevalence of cancer in the Russian population. Applying this model to the publicly available data on cancer mortality and morbidity, we were able to estimate the following indicators for the Russian population: average age at malignant neoplasms (MN) diagnosis, the average duration of disease, the prevalence of MN, and an average age at death from MN. We aimed to determine whether the prevalence of MN is increasing in the Russian Federation and whether this growth is occurring due to the expansion of morbidity.
It was found that the average age at cancer diagnosis, along with the average age at death from cancer, is increasing in the Russian population, with the primacy of the latter. These processes are in turn resulting in an increase of the average number of years lived with cancer, hence justifying the claim for an expansion of morbidity. This phenomenon, along with the increase in the incidence of MN, is the cause of the increase in MN prevalence in Russia.
Localizations with the highest and lowest MN prevalence were identified, as well as localizations for which the expansion of morbidity phenomenon does not occur. It was found that in Russia the general trend is for the expansion of morbidity, expressed in an increase in the number of years lived in an imperfect health condition. MN of the lip, oral cavity and oesophagus (C00 - C15) in women is the only localization for which this phenomenon is not observed. This localization is the only exception to the otherwise observed expansion of morbidity. The main limitations and drawbacks of the study are discussed in a separate section.
The collapse of the USSR, transition to market economy and structural changes in society had given start to the family and marriage transformation in Russia and post-soviet countries of Eastern Europe. Estonia is one of the examples of rapid deinstitutionalization of marriage, widespread of cohabitations and nonmarital births. At the same time, since first post-war decades Estonia accepted the Russian migrants throughout a long time. Research shows that adaptation of the Russian population in Estonia has proceeded slowly, and patterns of matrimonial behavior of the Russian migrants and their descendants in Estonia tend to be closer to base patterns of ethnical Russians observed in Russia. In this article the UN ECE ‘Generations and Gender’ Survey data were used to estimate and compare fertility behavior among the Russian and Estonian population in Estonia and Russians in Russia. Our results show the significant changes in reproductive behavior among Estonians and Russians in Estonia, but the probabilities of first births among Russians in Russia are stable across generations. The probabilities of second births were increasing from one generation to other among Estonians women, but contrary, decreased among Russians both in Estonia and Russia. The contribution of births in high-order unions to total number of births significantly sincreased both among Estonians and Russian population in Russia, as well as among Russian migrants in Estonia. At the same time, the reproductive behavior of Russians in Estonia has common features with behavior of the Russian population in Russia: the share of births in the unregistered unions is less, and length of the time interval between the first and second births in the continuous union is bigger, than for Estonians. However, there are signs of some changes in reproductive behavior among Russians in Estonia born after 1970.