Summary_Danilova (Региональный анализ смертности по причинам смерти в России)

National Research UniversityHigher School of EconomicsAs a manuscriptInna DanilovaRegional analysis of mortality by causes of death in RussiaThesis Summary for the purpose of obtaining PhD in Sociology HSEAcademic supervisor:PhD in EconomicsAnatoly VishnevskyMoscow, 2018Mortality indicators may be a valuable characteristic of examining differentaspects of a population’s well-being: its economic and social development, quality ofhealth care services, personal values in health and safety, etc.

Mortality decline and lifeexpectancy growth are an essential goal for Russia. The Presidential Order of May 7,2018 lists the increase of life expectancy to 78 years1 as one of the priorities of nationaldevelopment (in the year 2015, life expectancy at birth in Russia was 71.4 years forboth sexes).High mortality in Russia attracts much attention, yet most studies devoted to thistopic use the mortality indicators calculated for the country as a whole.

Not manystudies perform mortality analyses at the subnational level. However, mortalityindicators for the total Russian population comprise a considerable variability ofindicators calculated for various territories within Russia. In 2015, at the regional level,life expectancy at birth in Russia deviated from 63.1 years in the Tuva Republic to 80.1years in the Ingushetia Republic2; a gap of 17 years. Standard deviation (not weightedby population size of the regions) was 2.4 years. To compare, standard deviation acrossthe regions of the European Union countries (NUTS2 level)3 is the same 2.4 years,while the gap between the minimum and the maximum life expectancies (73.5 years inNorth-West region of Bulgaria and 84.5 years in Madrid autonomous community) wasjust 11.0 years. While some level of mortality inequality is inevitable, extremely highinequality indicates that there is an unequal distribution of some resources essential forthe health and safety of a population.To reach the goal of life expectancy growth set for Russia in the most effectiveway, it would be best to shrink mortality inequality at the regional level following the1The Presidential Order of May 7, 2018 «On National Goals and Strategic Objectives of the Russian Federation through to2024».2These estimates were officially published by the Federal Statistics Service of the Russian Federation.

However it is worthto mention that the accuracy of these estimates for certain regions including the Ingush Republic is questionable(Andreev E. On the accuracy of Russian Censuses // Voprosy Statistiki. 2006. №11. P. 21-35; Bogoyavlensky D. Were allRussian nationalities calculated correctly? // Демоскоп Weekly. – 2008. – № 319-320).3URL: http://ec.europa.eu/eurostat/web/products-datasets/product?code=tgs00101decline of mortality at the national level, allowing those regions lagging behind in lifeexpectancy to catch up with the leaders. To understand how to reduce interregionalinequality in life expectancy, and what interventions should be organized for it, acomplex analysis of regional patterns of mortality by age and causes of death is needed.This paper presents such an analysis.Mortality analysis at the subnational level is essential for identifying regionalpeculiarities in mortality and for planning territory-oriented programs for its decline.Such analyses allow us to identify and systematize the most effective programs aimed atmortality reductions in different territories, which in turn can lead to implementation ofprograms at the Federal level and assessment of the results of these programs.Previous studies on this topicDemographic and epidemiological studies rely on the analysis of mortalitypatterns and trends by age and causes of death and a theoretical understanding thereof.Concepts which build a theoretical framework for the current study were presented inthe papers of B.Ault, J Bourgeois-Pichat, T.Frejka, J.Frenk, R.Hackenberg, R.Lozano,A.Olshansky, A.Omran, R.Rogers, F.Mesle, and J.Vallin.

The works of these authorslinked the evolution of cause-specific mortality structure with the change of all-causemortality level and life expectancy. In the Russian literature, theoretical interpretationof the evolution of mortality patterns was presented in the studies of A.G.Vishnevsky.The analysis of life expectancy trends in Russia during the Soviet era wasperformedbyA.G.Vishnevsky,E.M.Andreev,M.S.Bedny,R.M.Dmitrieva,V.K.Ovcharov,R.N.Biryukova,B.C.Urlanis,V.A.Bystrova,K.Yu.Shaburov,V.M.Shkolnikov, and others. However, until the late 1980s these researchers had onlylimited access to the demographic data. It was even prohibited to publish someindicators. Consequently, the number of studies devoted to mortality analysis under theSoviet regime was low, and the studies themselves were not well detailed4.In “Glasnost” period of the late 1980s mortality data became more readilyavailable for researchers.

During the joint project of the Center of Human Demographyand Ecology (Moscow) and the National Institute of Demographic Studies (Paris) dataon death counts by causes of death in Russia during the Soviet period that were held inGoskomstat, Ministry of Healthcare of the Russian Federation, and the Russian StateArchive were collected, verified, and digitalized. This laborious process, coupled withwork on the reconstruction of continuous mortality trends by causes of death performedby F.Meslé, V.M.Shkolnikov, J.Vallin, V.Ertrish and E.M.Andreev, allowed mortalitytrends in Russia (also by causes of death) to be analyzed for a longer time period.Newly opened access to this mortality data highlighted the unfavorable trends inRussian mortality.This data availability as well as the unique mortality trends observed in Russiaattracted much interest on the part of demographers, epidemiologists, and otherresearchers who were pursuing the analysis of different aspects of Russian mortality.

Alarge contribution to the mortality analysis in this period was made by E.M.Andreev,O.I.Antonova, D.D.Bogoyavlensky, A.G.Vishnevsky, L.A.Gavrilov, N.S.Gavrilova,E.V.Dubrovina,A.E.Ivanova,V.G.Semenova, T.L.Kharkova,E.A.Kvasha,V.M.Shkolnikov,A.V.Nemtsov,T.P.Sabgayda,D.Leon, M.McKee,F.Mesle,W.Pridemore, J.Vallin, and others. Their papers extensively described the dynamics andstructure of Russian mortality. The hypotheses of the factors affecting mortality levelsin Russia were also set out in these papers.The Russian mortality crisis of the mid-1960s – early 2000s has been studiedquite explicitly. In particular, the studies of A.V.Nemtsov and V.M.Shkolnikov4Vishnevsky A.G., Shkolnikov V., Vassin S. A. Epidemiological Transition and Regional Contrasts.

// Genus (Roma). 1991. V.XVLII. № 3-4. P. 79-100; Meslé, F., Shkolnikov, V. M., Hertrich, V., & Vallin, J. (1996). Tendances récentes de la mortalitépar cause en Russie 1965-1994. Série: Données statistiques No 2. Paris: INED.highlighted a clear link between alcohol consumption and mortality fluctuations inRussia. The Izhevsk Family Studies held in the city of Izhevsk5 helped prove thatalcohol consumption in Russia influences not only mortality from alcohol-relatedcauses and external causes of death, but also it influences mortality from circulatorydiseases.

Analyses of the influence of other factors – including smoking, social andpsychological stress, and underdevelopment of healthcare services – were performed byG.Cornia, W.Cockerham, M.Field, D.Holmes, D.Leon, R.Paniccia, K.Danishevsky,V.M.Shkolnikov, and others.Much has been written about the unfinished epidemiological transition in Russia(A.G.Vishnevsky, V.M.Shkolnikov).

There was even an opinion of a reverseepidemiological transition in Russia, which aimed to highlight the regressive characterof mortality trends in Russia (V.Semenova).After almost half a century of negative tendencies in mortality, a sustained vectorof growing life expectancy was eventually established in Russia starting in the middleof the first decade of the 21st century. In recent years studies devoted to the currentperiod of mortality decline and life expectancy growth have been published in Russia(E.M.Andreev,A.G.Vishnevsky,E.A.Kvasha,T.L.Kharkova,V.M.Shkolnikov,P.Grigoriev, D.Leon, and others).

These authors highlight that life expectancy growth inRussia still has a recovering character to a great extent, compensating for the earlierdecline. However, some of these studies also show that the favorable tendencies of therecent period of life expectancy growth in Russia are also related to a large extent to themortality decline stemming from circulatory diseases among the elderly.

The latter is anew tendency for Russia, one which may indicate that Russia is moving towards a newstage of epidemiological transition. This new stage is known as the cardiovascular5URL: http://www.ifsmetadata.info/revolution6, as mortality reductions from circulatory diseases among the elderly arecontributing the most to the further growth of life expectancy.Mortality trends and patterns in Russia are studied at the national level quiteexplicitly.

Although there is some research on subnational mortality in Russia, thesepatterns are still understudied. Spatial mortality peculiarities have been examined byE.M.Andreev, S.A.Vassin, E.A.Kvasha, T.L.Kharkova, V.M.Shkolnikov, H.Vallin,G.Cornia, and others. A North-West mortality gradient, manifested through the growingmortality levels while moving from the south to north and from the west to east, hasbeen identified and described. Spatial analyses of mortality from specific groups ofcauses of death: external causes, neoplasms, circulatory diseases, have been performedin the studies of E.M.Andreev, O.I.Antonova, A.G.Vishnevsky, S.V.Kondrichin,Yu.V.Razvodovsky, and S.A. Timonin.The Institute of Demography of HSE regularly addresses issues of regionalinequality in mortality and life expectancy.

In its annual demographic reports“Population of Russia”, a special section in the Chapter ”Mortality and life expectancy“is devoted to the regional differences in mortality.Studies devoted to the regional analysis of mortality are still quite fragmentaryand tend to reduce the analysis to the description of the statistical data. The interrelationbetween mortality differences in life expectancy and mortality differences in mortalitylevels from specific causes of death as well as the interrelation between national andsubnational mortality indicators are still understudied. In addition, the studies which areconducted do not pay enough attention to the issue of quality and comparability ofcause-specific mortality data gathered by the regions.