Elsevier

The Lancet

Volume 357, Issue 9260, 24 March 2001, Pages 917-921
The Lancet

Articles
Changes in life expectancy in Russia in the mid-1990s

https://doi.org/10.1016/S0140-6736(00)04212-4Get rights and content

Summary

Background

Between 1987 and 1994, life expectancy in Russia declined substantially. Between 1994 and 1998, this trend reversed, and mortality rates returned to those of the early 1980s. Although the decline in life expectancy has been examined previously, much less is known about the subsequent improvement in mortality rates. We used recently published cause-specific mortality data up to 1998 to clarify this issue.

Methods

Changes in cause-specific death rates at ages 15–74 years were examined. Rates for 1998 were compared with those for 1994 (the year of lowest life expectancy) and for 1991 (the year the Soviet Union broke up).

Findings

Death rates among children fell steadily throughout the 1990s, and those in elderly people changed little. The reduction in mortality since 1994 was mainly due to a decrease in the death rate among middle-aged adults, which had increased until 1994. Deaths among those aged 15–30 years, which rose during 1991–94, remained high. Some causes of death, such as stomach cancer and road-traffic accidents, declined throughout the 1990s, whereas others, such as breast and prostate cancers and tuberculosis, increased. The decline in mortality since 1994 was, however, mainly due to a reduction in the rate of deaths from a group of causes associated with alcohol consumption.

Interpretation

The changing life expectancy in Russia is a consequence of a complex pattern of trends in different causes of death, some of which have their origins long in the past, and others that result from contemporary circumstances. This study provides further support for the view that alcohol has played an important part in the fluctuations in life expectancy in Russia in the 1990s, although there remains a need for a much better understanding of the factors underlying these continuing changes.

Introduction

Life expectancy in Russia has fluctuated substantially over the past 35 years (figure 1). After remaining at a low level throughout the mid-1960s, it improved greatly after 1985, but had declined to its earlier level by the early 1990s. After 1991, when the Soviet Union broke up, the decline in life expectancy accelerated steeply, and by 1994, it had reached a level not seen since the 1950s. From 1994, however, there was a striking and largely unexpected improvement.1 By 1998, this upward trend stopped at a level amost exactly the same as that in 1984.

We have previously analysed the initial phases of these fluctuations (up to 1994).2 The improvement in 1985 coincided with a wide-ranging and highly effective anti-alcohol campaign started by the then General Secretary of the Soviet Communist party, Mikhail Gorbachev.3 The subsequent deterioration happened with the collapse of the campaign, and the accelerated decline after 1991 took place as the Soviet Union ended and Russia began painful economic reforms. The improvement in life expectancy at birth and the subsequent deterioration between 1985 and 1994 were driven predominantly by concurrent changes in some causes of death, particularly those associated directly or indirectly with alcohol consumption.1 The age-groups most affected by these mortality fluctuations were young and middle-aged adults, especially men. Smaller changes in mortality among the elderly were seen, whereas among children, death rates improved continuously after 1991.

The findings of our initial study showed that these changes in life expectancy could not be attributed to chance, or problems with either the numerator or population denominator, and suggested that alcohol might have had an important role.4 That study, and others, focused mainly on the period up to 1994.5 Little attention has been given to the subsequent improvement in life expectancy, the scale of which has been much greater than expected and the reasons for which remain unclear. We have now used recently-published cause-specific mortality data up to and including 1998 to try to clarify this uncertainty.

Section snippets

Methods

Mortality data were extracted from the reconstructed Russian mortality series published jointly by the Institut National d'Etudes Démographiques, Paris, France, and the Centre for Demography and Human Ecology, Moscow, Russia.6 These data consisted of deaths by cause, sex, 5-year age group, and single calendar year of death, together with corresponding population denominators. Data were assembled from national mortality statistics collated from annual tabular returns from each of the 88 (73

Results

By 1998, overall life expectancy had recovered from the decline of the early 1990s, and had reached a level similar to that of the mid-1980s for both men and women. Variation in mortality rates in the 1990s was highly dependent on age. Each curve shown in figure 2 represents the proportional change in total mortality rates at different ages for selected years relative to rates in 1991. Death rates among children fell throughout the 1990s, and mortality in the elderly seems to have been affected

Discussion

The improvement in life expectancy in Russia between 1994 and 1998 was larger than expected even a few years ago, and almost succeeded in reversing the rapid decline in life expectancy associated with the break-up of the Soviet Union. As with the earlier increase in mortality during 1991–94, the decline since 1994 showed great heterogeneity by age. Mortality of children and the elderly changed little, with most of the improvement occurring in the age group 25–60 years, largely offsetting the

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