• A
  • A
  • A
  • ABC
  • ABC
  • ABC
  • А
  • А
  • А
  • А
  • А
Regular version of the site
For visually-impairedUser profile (HSE staff only)SearchMenu

Geographic inequality in mortality and life expectancy in Russia: causes of death and risk factors

Priority areas of development: sociology
2020

Goal of research

To assess the scope and dynamics of inequality in mortality and life expectancy in Russia at different territorial levels, as well as to develop methodological approaches to assessing spatial inequality and identifying geographical differences; determine the causes of death and socio-demographic determinants.

Methodology

Modern demographic methods, such as standardization, decomposition (including stepwise replacement and contour method), life table construction, including multi-status and Lexis surfaces, are used; statistical methods, in particular logistic regression and hierarchical cluster analysis; geographic: cartographic visualization, spatial assessment, identification of spatial clusters of increased / decreased mortality based on the calculation of local Moran's indices. Special attention is paid to the development of methodological approaches for the spatio-temporal assessment of the mortality rate and the decomposition of differences (changes) in life expectancy.

Empirical base of research

Research information base includes two main types of data sources. The first type includes databases, which contain mortality data sorted out by age, sex, causes of death, such as the Russian Fertility and Mortality Database (RosBRiS), created and maintained by the laboratory team; The Human Mortality Database (HMD), which is the most authoritative source of reliable data on mortality in human populations; Cause of Death Database. These databases are developed and maintained by the collaboration of the laboratory staff with the colleagues from the Max Planck Institute for Demographic Research, the French Institute of Demography and the University of Berkeley.

The second type of data is depersonalized microdata about all the deaths in Russia for the period from 01.01.2000 to 31.12.2019, provided by the Federal State Service (Rosstat). Processing and systematization of the provided data allows us:

  • to form a database of indicators of infant mortality depending on the socio-demographic characteristics of the mother;

  • to form a database of mortality rates by age and sex by municipalities (districts) of the Russian Federation for 2008-2012.

  • create a database of weekly mortality rates for a new dataset - Database of short-term fluctuations in mortality

Results of research

We analyzed the geographical disparities in mortality in Russia at the level of districts, municipal districts and urban districts, which demonstrated new evidence of a strikingly large spatial gap in mortality in Russia. We have shown that all previous studies, which were based on the data at regional level, concealed a significant share of differences in mortality rates within them. Depending on the indicators of inequality used, it was shown that inter-district differences in mortality are 1.3–2.6 times higher than interregional inequality. The decomposition results also confirmed that of the total inter-district dispersion in mortality, interregional variation explains only one third for men and half for women. Even more striking is the finding that there is a huge gap in life expectancy (almost 16 years for men and more than 10 years for women) between the group of areas with the best and worst performance, each accounting for 5% of the total population.

In our opinion, the revealed level of spatial differences is completely unacceptable, which prompted us to turn to the analysis of the differentiation of infant mortality depending on the level of education of the mother. It turned out that infant mortality among children of women with higher education is two times lower than among other children. This is due to such causes of death, such as conditions that arise in the perinatal period which are certainly amenable at the modern level of medicine development. The death of a child from this cause is almost always either a consequence of an obstetrician's mistake, or the result of poor patronage of a pregnant woman.

We also examine in detail how life expectancy and mortality rates have changed in England and Wales. Particular interest in this topic is due to the fact that in England and Wales there was an increase in the mortality rate of men of working age, the same development that caused a drop in life expectancy in Russia in 1965-2003. The analysis for England and Wales reveals some hidden threats that exists in Russia, but the public is not yet alarmed, in particular huge economic inequality and slower progress in regions with low life expectancy. The study for England and Wales created a methodological groundwork that will be used in the further work of the laboratory.

In 2020, the Laboratory staff published 8 articles in international journals indexed in Q1/Q2 Web of Science, 1 book chapter Q1/Q2 Web of Science, in as well as 2 articles in Russian periodicals; 5 articles are under review. In 2020, the Laboratory staff presented 15 reports at international conferences and seminars (including those held online); 2 young employees took part in international academic mobility programs. In the period from 07.10 to 25.11.2020, the Laboratory held the International Autumn Online School "New Frontiers of Demographic Research", which was attended by 39 post-graduate students and young employees from Russia, New Zealand, China, Kazakhstan, Ukraine, Belarus, Moldova, Hungary, Italy, Germany, Czech Republic, Serbia, Turkey, UAE, Argentina and Brazil; Leading demographers and epidemiologists from the Max Planck Institute for Demographic Research (Germany), the Vienna Institute of Demography (Austria), the London School of Hygiene and Tropical Medicine (Great Britain), the Federal Institute for Demographic Research (Germany), and the National Institute of Oncology (Lithuania) acted as teachers. On the initiative of the Laboratory, a scientific seminar "Contemporary demography" is regularly held, within the framework of which 4 presentations by leading Russian and foreign researchers took place in 2020 on the most relevant topics - "Short-term fluctuations in mortality: collection of weekly mortality data", "Problems of assessing and interpreting the burden of mortality from COVID-19","COVID-19: quantifying the pandemic and its impact on the mortality rate", "Inequality in the infant mortality rate among the population of modern Russia".

Level of implementation, recommendations on implementation or outcomes of the implementation of the results

The developed methodological approaches and the obtained empirical results of assessing the spatial inequality in mortality and life expectancy at the regional and municipal levels can be used by the Ministry of Health of the Russian Federation, as well as other executive authorities in the development of programs and projects aimed at reducing the burden of premature mortality in Russia.

Publications:


Shkolnikov V., Jdanov D. The International Database on Longevity: Data Resource Profile, in: Exceptional Lifespans, Series: Demographic Research Monographs.: Springer, 2021. С. 13-25. 
Cook S., Kudryavtsev A. V., Bobrova N., Saburova L., Denisova D., Malyutina S., Lewis G., Leon D. A. Prevalence of symptoms, ever having received a diagnosis and treatment of depression and anxiety, and associations with health service use amongst the general population in two Russian cities // BMC Psychiatry. 2020. Vol. 20. P. 537-. doi
Trias-Llimós S., Pennells L., Tverdal A., Kudryavtsev A., Malyutina S., Hopstock L. A., Iakunchykova O., Nikitin Y., Magnus P., Kaptoge S., Di A. E., Leon D. A. Quantifying the contribution of established risk factors to cardiovascular mortality differences between Russia and Norway // Scientific Reports. 2020. Vol. 10. No. 20796. P. 1-8. doi
Petersen J., Malyutina S., Ryabikov A., Kontsevaya A., Kudryavtsev A. V., Eggen A. E., McKee Martin, Cook S., Hopstock L. A., Schirmer H., Leon D. A. Uncontrolled and apparent treatment resistant hypertension: a cross-sectional study of Russian and Norwegian 40–69 year olds // BMC Cardiovascular Disorders. 2020. Vol. 20. No. 135. P. 1-11. doi
Petersen J., Kontsevaya A., McKee Martin, Kudryavtsev A. V., Malyutina S., Cook S., Leon D. A. Untreated hypertension in Russian 35-69 year olds - a cross-sectional study // PLoS ONE. 2020. Vol. 15. No. 5. P. 1-12. doi
lakunchykova O., Averina M., Wilsgaard T., Watkins H., Malyutina S., Ragino Y., Keogh R. H., Kudryavtsev A., Govorun V., Cook S., Schrimer H., Eggen A. E., Hopstock L. A., Leon D. A. Why does Russia have such high cardiovascular mortality rates? Comparisons of blood-based biomarkers with Norway implicate non-ischaemic cardiac damage // Journal of Epidemiology and Community Health. 2020. Vol. 74. P. 698-704. doi
Grigoriev P., Jasilionis D., Klusener S., Timonin S., Andreev E. M., Meslé F., Vallin J. Spatial patterns of male alcohol-related mortality in Belarus, Lithuania, Poland and Russia // Drug and Alcohol Review. 2020. Vol. 39. P. 835-845. doi
Zemtsov S., Shartova N., Varentsov M., Konstantinov P., Kidyaeva V., Shchur A., Timonin S., Grishchenko M. Y. Intraurban social risk and mortality patterns during extreme heat events: A case study of Moscow, 2010-2017 // Health and Place. 2020. Vol. 66. P. 1-14. doi
Jdanov D., Jasilionis D., Shkolnikov V., Barbieri M. Human Mortality Database, in: Encyclopedia of Gerontology and Population Aging.: Springer, 2021.