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.
- health inequalities
- spatial analysis
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Contributors ST, VS and DJ conceived the research question and designed the study. ST and EA collected the mortality data. ST conducted the statistical analysis, interpreted the results and wrote the first and subsequent drafts of the manuscript. ST, DJ and VS contributed to the interpretation of the data and to revisions of the manuscript. All authors approved the final version of the submitted manuscript.
Funding The paper was prepared within the framework of the Basic Research Program at HSE University, and was funded by the Russian Academic Excellence Project '5-100'. The work of ST on GIS mapping was partly supported by the Russian Foundation for Basic Research (research project no 18-05-60037).
Competing interests None declared.
Patient consent for publication Not required.
Provenance and peer review Not commissioned; internally peer reviewed.
Data availability statement Data can be obtained upon reasonable request.
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