problems with mortality data in russia natalia s. gavrilova victoria g. semyonova galina n....
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Problems with Mortality Data in Russia
Natalia S. GavrilovaVictoria G. Semyonova
Galina N. EvdokushkinaAlla E. Ivanova
Leonid A. Gavrilov
Center on Aging, NORC/University of ChicagoCentral Research Public Health Institute, Moscow, Russia
In 1992 and 1998 Russia experienced two serious
economic crises accompanied with drop in personal income
and rapid impoverishment
Life Expectancy in Russia
Russia Year Males Females
1992 62.0 73.8
1993 58.9 71.9
1994 57.6 71.2
1995 58.3 71.7
1997 60.8 72.9
2000 58.8 71.7
China 1995 69.0 73.0
India 1995 62.4 63.4
Pace of Growth of Age-Adjusted Mortality
in 1989-2000 for Classes of Causes of Death
0
1
2
3
4
5
6
7
8
9
All causes Injuries Ill-Def.C. Infections
MalesFemales
Is this increase in mortality from ill-defined conditions
related to more cases of deaths from senility?
Age Profile of Mortality from Ill-Defined Conditions in Russia
Males Females
Age
0 20 40 60 80
Age
-Spe
cific
Mor
talit
y R
ate
per
100,
000
0
50
100
150
200
20011991
Age
0 20 40 60 80
Age
-Spe
cific
Mor
talit
y pe
r 10
0,00
0
0
20
40
60
80
100
120
140
160
20011991
Top Five Causes of Death for Young Adult Males (20-24)
1990 2001Injuries Injuries
Neoplasms Symptoms, Signs and Ill-Defined Conditions
Diseases of Circulatory System
Infectious Diseases
Symptoms, Signs and Ill-Defined Conditions
Neoplasms
Diseases of Nervous System and Sens.Organs
Diseases of Respiratory System
Top Five Causes of Death for Young Adult Females (20-24)
1990 2001Injuries Injuries
Neoplasms Neoplasms
Diseases of Circulatory System
Diseases of Circulatory System
Complications of Pregnancy and Childbearing
Symptoms, Signs and Ill-Defined Conditions
Diseases of Nervous System and Sens.Organs
Infectious Diseases
What Causes of Death Are Hidden Behind the Ill-Defined
Conditions?
We Used Individual Death Certificates With More Detailed Description of
Circumstances of Death Collected by Kirov Department of Health
Kirov is a Typical Russian Region with Lower than Average Mortality from
Ill-Defined Conditions
Age-Adjusted Mortality from Injuries in 1996 for Russian Males Aged 0-64 yearsData from the WebAtlas Project (http://sci.aha.ru/ATL)
Deaths from Ill-Defined Conditions in Kirov Region of Russia in 2003
• Sudden infant death (R95) 3.3%• Decomposition in water (river, well, pond) (R99) 13.0% • Decomposition at home (R99) 53.5%• Decomposition in garden, summer house (R99) 1.7% • Decomposition in forest or field (R99) 6.0%• Decomposition in nonresidential building, on the street
(R99) 12.3% • Decomposition in water pipe (R99) 0.7%• Decomposition on the cemetery (R99) 0.3% • Decomposition in bath, lavatory or barn (R99) 1.0% • Decomposition in other place (R99) 5.5%• unknown (R99) 2.3%• senility (R54) 0.3%
Ill-defined conditions and external deaths of
undetermined intent are two sides of the same coin
It appears that both causes of death are used for concealing
criminal cases of violent death
Top Five Causes of External Mortality in Russia and Moscow in 2001
Russia MoscowSuicide Accidental Falls
Undetermined Injury Undetermined Injury
Homicide All Other Accidental Causes
Accidental Poisoning by Alcohol
Homicide
All Other Accidental Causes
Suicide
Social Background of Current Degradation
in Russian Mortality Statistics
Transition period was accompanied by unprecedented growth
of crime rate and homicide mortality
Tendencies of Intentional Murders in Russia and the United States
Time, years
1988 1990 1992 1994 1996 1998 2000 2002
Reco
rded
In
ten
tio
nal
Ho
mic
ide (
co
mp
lete
d)
per
100,0
00
4
6
8
10
12
14
16
18
20
22
24
Russia
United States
Trends in Homicide Victimization Rates for Young and Middle-Aged Adults
Data from Russian Vital Statistics
Males Females
Year
1988 1990 1992 1994 1996 1998 2000 2002
Mo
rtal
ity
Rat
e x
100,
000
20
30
40
50
60
70
80
90
20-24
45-49
Year
1988 1990 1992 1994 1996 1998 2000 2002
Mo
rtal
ity
Rat
e x
100,
000
0
5
10
15
20
25
20-24
45-49
Age Profile of Homicide Mortality in Russia: 1981-2002
Age
0 20 40 60 80
Ho
mic
ide
dea
ths
per
100
,000
mal
es
0
20
40
60
802002
1991
1981
Age
0 20 40 60 80
Ho
micid
e death
s per 100,000 m
ales
0
5
10
15
20
25
2002
1991
1981
Males Females
Traditionally high rate of
alcohol-related mortality
increased further during the 1990s
Age Profiles of Mortality from Accidental Poisoning by Alcohol
Data from Russian Vital Statistics
Age
0 20 40 60 80 100
Mo
rta
lity
Ra
te x
10
0,0
00
0
20
40
60
80
100
120
2001
1981
1991
Age
0 20 40 60 80 100
Mo
rta
lity
Ra
te x
10
0,0
00
0
10
20
30
40
2001
1981
1991
Males Females
Rapid increase in the number
of abandon children and
children without parental
support during the last decade
Social structure of young (16-39) males died in 2004 in Kirov region
Social group CVD Injury Ill-DC Total
Military 1 21 - 23
Blue-collar 18 152 9 186
Unemployed 44 168 7 257
Students - 18 - 18
White-collar, businessmen
2 15 3 23
Period of reforms, started in the mid 1980s, resulted in qualitative changes in the
pattern of Russian mortality.
These changes may be summarized as marginalization of Russian mortality
The main characteristics of marginalization are
• Degradation of cause of death structure
• Misrepresentation of real mortality pattern
• Formation of specific social portrait of deceased in the age groups of maximal risk (young and middle working ages)
Conclusions
• Analysis of Russian mortality statistics suggests that official levels of homicide mortality in Russia may be significantly underestimated
• Rapid growth of deaths coded as “Symptoms, signs and abnormal clinical and laboratory findings” may mask real level of external mortality
Acknowledgments
This study was made possible thanks to:
• generous support from the National Institute on Aging (pilot project to the Center of Aging), and
• stimulating working environment at the Center on Aging, NORC/University of Chicago
•We also are grateful to Elena Dubrovina, a head of Kirov Division of Health Statistics, for invaluable
help in data collection