Economic change, crime, and mortality crisis in Russia: regional analysis
BMJ 1998; 317 doi: https://doi.org/10.1136/bmj.317.7154.312 (Published 01 August 1998) Cite this as: BMJ 1998;317:312
- Peder Walberg, medical studenta,
- Martin McKee, professor of European public healthb,
- Vladimir Shkolnikov, head of laboratory for analysis and prognosis of population mortalityc,
- Laurent Chenet, research fellowb,
- David A Leon, reader in epidemiologyb
- aDepartment of Public Health and Caring Sciences, University of Uppsala, S-751 85 Uppsala, Sweden
- bEuropean Centre on Health of Societies in Transition, London School of Hygiene and Tropical Medicine, London WC1E 7HT
- cCentre of Demography and Human Ecology, Institute for Economic Forecasting, 117418 Moscow, Russian Federation
- Correspondence to: Professor McKee m.mckee@lshtm.ac.uk
- Accepted 23 April 1998
Abstract
Objective: To identify which aspects of socioeconomic change were associated with the steep decline in life expectancy in Russia between 1990 and 1994.
Design: Regression analysis of regional data, with percentage fall in male life expectancy as dependent variable and a range of socioeconomic measures reflecting transition, change in income, inequity, and social cohesion as independent variables. Determination of contribution of deaths from major causes and in each age group to changes in both male and female life expectancy at birth in regions with the smallest and largest declines.
Setting: Regions (oblasts) of European Russia(excluding Siberia and those in the Caucasus affected by the Chechen war).
Subjects: The population of European Russia.
Results: The fall in life expectancy at birth varied widely between regions, with declines for men and women highly correlated. The regions with the largest falls were predominantly urban, with high rates of labour turnover, large increases in recorded crime, and a higher average but unequal distribution of household income. For both men and women increasing rates of death between the ages of 30 and 60 years accounted for most of the fall in life expectancy, with the greatest contributions being from conditions directly or indirectly associated with heavy alcohol consumption.
Conclusions: The decline in life expectancy in Russia in the 1990s cannot be attributed simply to impoverishment. Instead, the impact of social and economic transition, exacerbated by a lack of social cohesion, seems to have played a major part. The evidence that alcohol is an important proximate cause of premature death in Russia is strengthened.
Footnotes
- Accepted 23 April 1998