Suchergebnisse

Après avoir divergé au temps de la division, les espérances de vie est- et ouest-allemandes ont convergé depuis la réunification. Même si le rattrapage n'est pas tout à fait complet pour les hommes, amélioration du système de santé et changements de comportements individuels ont permis à l'Allemagne de l'est de combler l'essentiel de son retard.

During the 1990s, the sex ratio at birth increased considerably and simultaneously in the three independent Caucasian countries, Armenia, Azerbaijan, and Georgia. At the end of the first decade of the twenty‐first century, levels remain abnormally high in Armenia and Azerbaijan (above 114 male births per 100 female births) and show erratic trends in Georgia. Analyzing data from demographic surveys carried out around 2005, we confirm the persistence of high sex ratios in these three countries and document significant differences in fertility intentions and behavior according to the sex of the previous child or children that constitute evidence of the practice of sex‐selective abortion. These countries combine societal features and medical systems that make this phenomenon possible: son preference in a context of low fertility and the possibility of prenatal sex selection given easy access to ultrasound screening and induced abortion. Why high sex ratios are observed only in these three countries of the sub‐region remains, however, an open question.

With the collapse of the Soviet Union, Caucasian countries experienced remarkable migration flows, political conflicts, and deterioration of civil registration systems. The reassessment of Armenian and Georgian population after censuses carried out in the early 2000s enables to re-estimate recent mortality levels in both countries. Vital statistics since the 1980s are presented and discussed. Infant mortality is corrected according to sample surveys, and mortality above age 60 estimated through model life tables. On the basis of these estimates, trends in life expectancy were similar in the two countries, unfavourable during the 1990s, especially for males for whom the health progress, notably in Georgia, is still low.

International audience ; Before the collapse of the Soviet Union, Belarus, Lithuania, and Russia were quite comparable in terms of their socioeconomic development. Despite some differences in overall mortality levels, the three former Soviet republics were also very close to each other in terms of directions of mortality trends and age- and cause-specific mortality patterns. After 1991, all the three countries experienced substantial political and social transformations, and the challenges associated with the transition from a socialist to a market economy system. The sudden changes brought numerous problems, such as rapid growth in unemployment, falling standards of living, and growing social and income inequalities. These factors contributed to the significant deterioration of the health situation in all the countries, but the size and the nature of the mortality crisis was different in Belarus than it was in Lithuania and Russia. The marked similarities in socioeconomic and mortality trends in the countries up to 1991 contrast with their notable divergence during the subsequent years. The nature and success of market reforms seems to be the most plausible explanation for these differences. Russia and Lithuania have chosen more radical forms of economic and political transformations, which have led to massive privatization campaigns. The reforms were more sustainable and systematic in Lithuania than in Russia. By contrast, Belarus has chosen a gradual and slow transition path. Recent mortality trends in Belarus are explored in detail here, and are contrasted with those observed in Lithuania and Russia. Including a cause-of-death analysis sheds more light on the plausible determinants of the variations in mortality levels between the countries.

Before the collapse of the Soviet Union, Belarus, Lithuania, and Russia were quite comparable in terms of their socioeconomic development. Despite some differences in overall mortality levels, the three former Soviet republics were also very close to each other in terms of directions of mortality trends and age- and cause-specific mortality patterns. After 1991, all the three countries experienced substantial political and social transformations, and the challenges associated with the transition from a socialist to a market economy system. The sudden changes brought numerous problems, such as rapid growth in unemployment, falling standards of living, and growing social and income inequalities. These factors contributed to the significant deterioration of the health situation in all the countries, but the size and the nature of the mortality crisis was different in Belarus than it was in Lithuania and Russia. The marked similarities in socioeconomic and mortality trends in the countries up to 1991 contrast with their notable divergence during the subsequent years. The nature and success of market reforms seems to be the most plausible explanation for these differences. Russia and Lithuania have chosen more radical forms of economic and political transformations, which have led to massive privatization campaigns. The reforms were more sustainable and systematic in Lithuania than in Russia. By contrast, Belarus has chosen a gradual and slow transition path. Recent mortality trends in Belarus are explored in detail here, and are contrasted with those observed in Lithuania and Russia. Including a cause-of-death analysis sheds more light on the plausible determinants of the variations in mortality levels between the countries.

The health situation in Russia has often been characterized as a long‐running crisis. From the 1960s until the beginning of the 2000s, the declining life expectancy trend was substantially interrupted only twice: once in the mid‐1980s as a result of Gorbachev's anti‐alcohol campaign, and again at the end of the 1990s as a result of the "rebound" effect following the dramatic rise in mortality associated with the acute socioeconomic crisis. In both cases, the progress made proved to be short‐lived. A third mortality decline in Russia began in 2003 and is still ongoing. We investigate the components and driving forces of this new development, in particular the role played by cardiovascular diseases. Using cause‐specific mortality data, we identify the main features of the recent improvements and compare these features with those observed in selected European countries, specifically France, Poland, and Estonia. Our aim is to gauge whether the features of the improvements in these countries are similar to those of the recent advancements made in Russia. Although the recent improvements in Russia have features in common with initial stages of prior mortality declines in other countries and may support optimism about the future, a return to mortality stagnation cannot be ruled out.

Résumé L'analyse de la mortalité par cause repose principalement sur l'étude de la cause principale du décès. Notre point de vue est que cette approche n'est pas suffisante. Dans un nombre croissant de pays, toutes les causes reportées par les médecins sur les certificats de décès (ou «causes multiples») sont enregistrées et codées. Ces données peuvent être utilisées de deux façons principales: pour réévaluer le poids d'une cause particulière dans la mortalité ou pour examiner comment les causes sont associées les unes avec les autres. Dans cet article, nous nous appuyons sur une analyse des causes multiples de décès développée dans le cadre d'un projet comparatif franco-italien pour évaluer la qualité de ces données et pour montrer, tout particulièrement dans le contexte du vieillissement démographique, la pertinence de cette approche pour les politiques de santé publique. Summary Cause-specific mortality analysis is based predominantly on examination of the un­derlying cause of death. Our view is that this single-cause approach is not sufficient. With increasing data availability and technical developments in favor of better data quality, the time has come to consider all items of information reported by certifying physicians on death certificates (i. e. the multiple causes). These data can be used in two main ways: either to reassess the role played by a given cause in mortality, or to examine how causes combine with one another. In this paper, we rely on our experience of multiple cause-of-death (MCOD) analysis in the framework of a French-Italian comparative project to provide information on data quality, and to show that, especially in the context of population aging, MCOD analysis is a very relevant tool for public health policy.

Le nombre de décès aux très grands âges a considérablement augmenté dans les deux dernières décennies. Le décompte exact de ces décès que documente la base de données internationale sur la longévité n'est établi qu'après un processus strict de validation de l'âge. Ce sont essentiellement des femmes qui atteignent ces grands âges. Les supercentenaires (110 ans ou plus) sont surreprésentés aux Antilles.