Suchergebnisse

AbstractThe twenty‐first century marked the beginning of rapid health improvements in Russia. In the late 2000s and the 2010s, there was already a moderate decrease in inter‐oblast mortality disparities, with the exception of the growing life expectancy (LE) advantage of Moscow and Saint Petersburg. We have used newly available data to explore LE changes from 2003–2005 to 2015–2017 and determinants of LE differences across settlements of different types and population sizes. We distinguished between three major segments of the LE distribution: Moscow and Saint Petersburg at the top, large‐ and medium‐sized cities in the middle, and smaller urban and rural areas lagging behind. The LE differences among these three groups increased, but the within‐group differences decreased. The gaps between bigger cities and the "periphery" within oblasts grew, and this part of the total dispersion had increased substantially by 2015–2017. Education, together with population size, explained 62 percent (for females) and 67 percent (for males) of LE variation across 292 geographic units in 2015–2017. Our results suggest that slower health progress in small urban and rural areas is an important obstacle to further mortality reduction at the national level and is a matter of public health concern.

BACKGROUND: Since 2005, Russia has made substantial progress, experiencing an almost doubling of per-capita gross domestic product by purchasing power parity (GDP [PPP]) to US$24 800 and witnessing a 6-year increase in life expectancy, reaching 71·4 years by 2015. Even greater gains in GDP (PPP) were seen for Moscow, the Russian capital, reaching $43 000 in 2015 and with a life expectancy of 75·5 years. We aimed to investigate whether mortality levels now seen in Russia are consistent with what would be expected given this new level of per-capita wealth. METHODS: We used per-capita GDP (PPP) and life expectancy from 61 countries in 2014-15, plus those of Russia as a whole and its capital Moscow, to construct a Preston curve expressing the relationship between mortality and national wealth and to examine the positions of Russia and other populations relative to this curve. We adjusted life expectancy values for Moscow for underestimation of mortality at older ages. For comparison, we constructed another Preston curve based on the same set of countries for the year 2005. We used the stepwise replacement algorithm to decompose mortality differences between Russia or Moscow and comparator countries with similar incomes into age and cause-of-death components. FINDINGS: Life expectancy in 2015 for both Russia and Moscow lay below the Preston-curve-based expectations by 6·5 years and 4·9 years, respectively. In 2015, Russia had a lower per-capita income than 36 of the comparator countries but lower life expectancy than 60 comparator countries. However, the gaps between the observed and the Preston-expected life expectancy values for Russia have diminished by about 25% since 2005, when the life expectancy gap was 8·9 years for Russia and 6·6 years for Moscow. When compared with countries with similar level of income, the largest part of the life expectancy deficit was produced by working-age mortality from external causes for Russia and cardiovascular disease at older ages for Moscow. INTERPRETATION: Given the economic wealth of Russia, its life expectancy could be substantially higher. Sustaining the progress seen over the past decade depends on the ability of the Russian Government and society to devote adequate resources to people's health. FUNDING: This work was partly funded through the International Project on Cardiovascular Disease in Russia supported by a Wellcome Trust Strategic Award (100217) and was supported by the Russian Academic Excellence Project 5-100.

We analyze trends in best‐practice life expectancy among female cohorts born from 1870 to 1950. Cohorts experience declining rather than constant death rates, and cohort life expectancy usually exceeds period life expectancy. Unobserved mortality rates in non‐extinct cohorts are estimated using the Lee‐Carter model for mortality in 1960–2008. Best‐practice cohort and period life expectancies increased nearly linearly. Across cohorts born from 1870 to 1920 the annual increase in cohort length of life was 0.43 years. Across calendar years from 1870 to 2008, the annual increase was 0.28 years. Cohort life expectancy increased from 53.7 years in the 1870 cohort to 83.8 years in the 1950 cohort. The corresponding cohort/period longevity gap increased from 1.2 to 10.3 years. Among younger cohorts, survival to advanced ages is substantially higher than could have been anticipated by period mortality regimes when these cohorts were young or middle‐aged. A large proportion of the additional expected years of life are being lived at ages 65 and older. This substantially changes the balance between the stages of the life cycle.

Source at https://doi.org/10.1016/S2468-2667(19)30036-2. ; Background - Since 2005, Russia has made substantial progress, experiencing an almost doubling of per-capita gross domestic product by purchasing power parity (GDP [PPP]) to US$24 800 and witnessing a 6-year increase in life expectancy, reaching 71·4 years by 2015. Even greater gains in GDP (PPP) were seen for Moscow, the Russian capital, reaching $43 000 in 2015 and with a life expectancy of 75·5 years. We aimed to investigate whether mortality levels now seen in Russia are consistent with what would be expected given this new level of per-capita wealth. Methods - We used per-capita GDP (PPP) and life expectancy from 61 countries in 2014–15, plus those of Russia as a whole and its capital Moscow, to construct a Preston curve expressing the relationship between mortality and national wealth and to examine the positions of Russia and other populations relative to this curve. We adjusted life expectancy values for Moscow for underestimation of mortality at older ages. For comparison, we constructed another Preston curve based on the same set of countries for the year 2005. We used the stepwise replacement algorithm to decompose mortality differences between Russia or Moscow and comparator countries with similar incomes into age and cause-of-death components. Findings - Life expectancy in 2015 for both Russia and Moscow lay below the Preston-curve-based expectations by 6·5 years and 4·9 years, respectively. In 2015, Russia had a lower per-capita income than 36 of the comparator countries but lower life expectancy than 60 comparator countries. However, the gaps between the observed and the Preston-expected life expectancy values for Russia have diminished by about 25% since 2005, when the life expectancy gap was 8·9 years for Russia and 6·6 years for Moscow. When compared with countries with similar level of income, the largest part of the life expectancy deficit was produced by working-age mortality from external causes for Russia and cardiovascular disease at older ages for Moscow. Interpretation - Given the economic wealth of Russia, its life expectancy could be substantially higher. Sustaining the progress seen over the past decade depends on the ability of the Russian Government and society to devote adequate resources to people's health.

AbstractEstimating excess mortality is challenging. The metric depends on the expected mortality level, which can differ based on given choices, such as the method and the time series length used to estimate the baseline. However, these choices are often arbitrary, and are not subject to any sensitivity analysis. We bring to light the importance of carefully choosing the inputs and methods used to estimate excess mortality. Drawing on data from 26 countries, we investigate how sensitive excess mortality is to the choice of the mortality index, the number of years included in the reference period, the method, and the time unit of the death series. We employ two mortality indices, three reference periods, two data time units, and four methods for estimating the baseline. We show that excess mortality estimates can vary substantially when these factors are changed, and that the largest variations stem from the choice of the mortality index and the method. We also find that the magnitude of the variation in excess mortality is country‐specific, resulting in cross‐country rankings changes. Finally, based on our findings, we provide guidelines for estimating excess mortality.

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.

Les populations pionnières, bénéficiant les premières de l'augmentation de l'espérance de vie, ouvrent-elles pour les autres groupes la voie vers de meilleures chances de survie et de longévité ? Cette étude a pour but d'identifier dans quelle mesure, en Finlande, en Suède et en Norvège, la population qui n'appartient pas à cette avant-garde pourrait suivre les trajectoires de mortalité déjà tracées par les pionniers aux différents groupes d'âges et pour différentes causes de décès entre 1970 et 1995. Les résultats montrent qu'il n'y a pas eu de convergence systématique des trajectoires du reste de la population vers celles de l'avant-garde. Ils confirment au contraire la théorie selon laquelle chaque changement sanitaire majeur commence par induire une divergence dans les évolutions de mortalité. En effet, au niveau infranational, loin de connaître avec un certain délai les mêmes progrès que le groupe précurseur, le reste de la population suit son propre chemin de réduction de la mortalité, répondant à des déterminants différents. L'étude montre aussi qu'il faut un temps considérable pour que l'ensemble de la population atteigne les taux de survie dont l'avant-garde bénéficiait en début de période d'observation. C'est le cas notamment de la prévention et du traitement des maladies cardio-vasculaires.

Les pratiques de certification et de codage des causes initiales de décès ne sont pas toutes les mêmes, ce qui peut nuire à la pertinence et la fiabilité des statistiques de mortalité par cause. La cohérence de ces données au sein d'un même pays peut être considérée comme un critère de qualité. Cet article évalue la cohérence à l'échelle infranationale des statistiques sur les causes de décès en Russie, en Allemagne, aux États-Unis et en France. On estime la part respective des principaux groupes de causes dans les structures de mortalité régionales, et on les compare aux moyennes interrégionales. Ces écarts à la moyenne sont présentés sur des matrices de cartes thermiques qui permettent d'identifier les combinaisons cause-région les plus éloignées des moyennes, les causes présentant une forte variabilité infranationale, ainsi que les régions dont la structure de mortalité est particulière. C'est en France que les données sur les causes de décès sont les plus cohérentes d'une région à l'autre, et en Russie que la part des valeurs aberrantes est la plus élevée. On constate également des différences selon la difficulté à diagnostiquer les causes de décès : la variabilité interrégionale diminue avec le degré de spécificité des symptômes permettant le diagnostic. Plus le diagnostic est difficile, plus les écarts interrégionaux sont importants.

Résumé Jusqu'à présent, dans les pays d'Europe centrale et orientale autrefois sous régime communiste, la mesure des différences sociales de mortalité s'est toujours heurtée à l'impossibilité de coupler des données de recensement à des données d'état civil pour éviter le biais classique causé par l'incohérence entre le statut individuel observé au recensement et celui déclaré au moment du décès à l'état civil. L'étude dont les résultats sont présentés ici est l'une des toutes premières jamais réalisées dans un pays issu du bloc soviétique sur la base d'un couplage des données individuelles d'état civil avec celles d'un recensement, en l'occurrence les décès de 2001-2004 avec le recensement de 2001. L'étude porte sur les différences de mortalité par cause parmi les personnes âgées de plus de 30 ans selon le niveau d'instruction, l'état matrimonial, le groupe ethnique et le milieu de résidence. De fait, les résultats obtenus sont différents de ceux qu'aurait donnés l'approche agrégée traditionnelle, mais confirment l'existence de très fortes inégalités. Les maladies infectieuses et les conséquences de l'alcoolisme s'avèrent particulièrement discriminantes.