Elsevier

The Lancet

Volume 350, Issue 9075, 9 August 1997, Pages 383-388
The Lancet

Articles
Huge variation in Russian mortality rates 1984–94: artefact, alcohol, or what?

https://doi.org/10.1016/S0140-6736(97)03360-6Get rights and content

Summary

Background

According to published data, between 1984 and 1994 mortality rates in Russia initially underwent a rapid decline followed by an even steeper increase. In 1994, male life expectancy at birth was 57·6 years, having fallen by 6·2 years since 1990. There has been concern that such striking fluctuations in mortality are an artefact, although, among other factors, alcohol consumption has been implicated.

Methods

We analysed the age-specific and cause-specific patterns of mortality decrease and increase by use of data from a newly reconstructed mortality series for Russia so that we could examine the plausibility of various explanations for the mortality trends.

Findings

All major causes of death, with the exception of neoplasms, showed declines in mortality between 1984 and 1987 and increases between 1987 and 1994. In relative terms, these tended to be largest for the age-group 40–50 years; surprisingly, they were of the same magnitude among women and men. The largest declines and subsequent increases in proportional terms were observed for alcoholrelated deaths and accidents and violence. However, pronounced effects were also seen for deaths from infections, circulatory disease, and respiratory disease. No substantial variations were seen for neoplasms.

Interpretation

The stability of mortality from neoplasms in contrast to other causes over the period 1984–94 largely precludes the possibility that the changes in life expectancy are mainly an artefact, particularly one due to underestimation of the population. Although factors such as nutrition and health services may be involved, the evidence is that substantial changes in alcohol consumption over the period could plausibly explain the main features of the mortality fluctuations observed. These results provide a major challenge to public health in Russia and to our understanding of the determinants of alcohol consumption and its role in explaining mortality patterns within and between many other countries.

Introduction

The health status of the Russian population is poor and has declined since the collapse of the Soviet Union in 1991. Life expectancy at birth fell between 1990 and 1994 by 6·2 years for men (63·8 to 57·6) and by 3·4 years for women (74·4 to 71·0).1 Despite the severity of this decrease in life expectancy there have been few systematic analyses of mortality in Russia. One exception is the collaborative work of a group of Russian and French demographers,1 who have reconstructed a mortality series specific for age, sex, and cause for Russia from 1965 by going back to original data sources held by Goskomstat, the Russian state statistical agency.2 This series is largely free from the distortions introduced to the published data during the Soviet period to disguise mortality from cholera, plague, suicide, homicide, and work accidents. These data show that the severe decrease in life expectancy in the 1990s was preceded by a sharp increase during during the mid-1980s that coincided with the anti-alcohol campaign of the Gorbachev era,3 and that the causes of death associated most strongly with these fluctuations in life expectancy were alcohol related.4 The very magnitude of the fluctuations in life expectancy during the past decade raises questions about the validity of the underlying mortality rates. We now report the results of new further analyses of this reconstructed mortality series for Russia, and discuss how these patterns throw light on various explanations for the recent trends.

Section snippets

Methods

We used the reconstructed Russian mortality series published jointly by the Institut National d'Etudes Démographiques, Paris, and the Centre for Demography and Human Ecology, Moscow.1 These data were obtained in machine-readable form, and consisted of counts of deaths by cause, sex, 5-year age-group, and single calendar year of death, together with corresponding population denominators. The methods used to assemble the dataset have been described elsewhere.2 During the Soviet era and

Results

Between 1984 and 1987 life expectancy in both sexes increased sharply, whereas from 1987 to 1994 it declined (table 2). The sex differences in life expectancy are large in all years, but particularly in the latest period: in 1994 female life expectancy was more than 13 years longer than male life expectancy. Directly age-standardised mortality rates by cause and sex are shown in Table 3 for the years 1984, 1987, and 1994. For most causes of death, the variation in rates across the period

Discussion

The magnitude and steepness of the fluctuations in mortality rates and life expectancy reported here for Russia are without parallel in the modern era, with the exception of some other parts of the former Soviet Union.7 The data on life expectancy show clearly that in absolute terms men have been most affected by the recent fluctuations in mortality. However, in terms of relative mortality, women have been affected to almost the same degree as men, even for deaths from accidents and violence

Artefact

The collapse of the former Soviet Union was followed by substantial migration back to Russia of ethnic Russians who had been living elsewhere in the Union. If annual population estimates for Russia did not adequately account for the full extent of this influx, some element of the increase in mortality rates since 1987 might be explained on the assumption that there was no parallel underestimation of the number of deaths. However, this explanation is ruled out by the absence of any systematic

Alcohol

Alcohol is a specific factor that has attracted substantial attention in this context.11, 12 The decline in mortality in the mid-1980s and its subsequent rise parallels what is known about alcohol consumption in Russia.12 Consumption of alcohol started to decline in 1984 and fell even more rapidly with the introduction of Gorbachev's anti-alcohol campaign in 1985. State restrictions on supply and sale of alcohol, however, led to an increase in home brewing at the end of the 1980s. This trend

Other factors

Other factors, in addition to any role for alcohol, are clearly involved in explaining a proportion of the mortality trends in Russia. Since the late 1980s, rates of tuberculosis have started to increase in Russia and other parts of the former Soviet Union.31 Diet may have changed after the major political changes of the early 1990s and the growth of the free market economy. However, there are few reliable data for this period. Increases in alcohol consumption can lead to changes in the

Conclusions

The large fluctuations in mortality in Russia between 1984 and 1994 are unlikely to be the result of artefact, principally because mortality from all neoplasms did not show the same variations as other causes of death. Furthermore, the variation in mortality from other causes is consistent with what is known about variations in alcohol consumption, although better data on alcohol consumption are needed. The available evidence suggests, however, that the very high alcohol consumption, together

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