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Book Chapter

Premature circulatory disease mortality in Russia: population- and individual-level evidence

Shkolnikov, V. M., Meslé, F., Leon, D. A.

In: Weidner, G. (Ed.): Heart disease: environment, stress and gender, 39-68 (2002)
NATO science series: Series I, Life and behavioural sciences
Amsterdam [et al.]: IOS Press.

ISBN 1-58603-082-5

Keywords: Russian Federation, alcoholism, cardiovascular diseases, cerebrovascular diseases, homicide, socio-economic conditions, suicide

Abstract

Mortality from circulatory diseases has been the greatest contributor to unfavorable changes in Russian life expectancy during the last 30 years. In the mid-1980s mortality from circulatory diseases experienced a short-term decrease, likely due to the anti-alcohol campaign of 1985. However, in the early 1990s there was a sharp increase in circulatory disease mortality, following socioeconomic crisis and rising alcohol consumption. This unusual trend, characteristic of Russia, the Ukraine and other countries of the former Soviet Union, stands in contrast to that of Western Europe, where mortality from circulatory diseases has been decreasing continuously. It also differs from mortality trends in Eastern Europe, where certain improvements have been achieved since the collapse of communism. Increasing mortality from ischemic heart disease and from cerebrovascular disorders are the biggest components of the overall increase in mortality from circulatory diseases in Russia. In proportional terms, mortality from "other" heart diseases experienced the greatest increase among other cardiovascular causes of death. Increases in circulatory disease mortality among men were greater than for women, and tended to occur at younger ages. Further, proportional mortality analyses on individual death records from the Udmurt Republic show that the risk of death at working ages from circulatory diseases is significantly elevated in people with low levels of education, although for men the educational gradient is stronger for external causes (accidents, homicides, suicides) and alcohol-related conditions. In addition, a case-control study based on "verbal autopsy" interviews suggests that the risk of cardiovascular death among men aged 20 to 55 is also increased among those who are unemployed or not married. The social-status differentials in cardiovascular mortality among working-age men are largely attributable to smoking and heavy alcohol drinking, which are also the most important factors in terms of population attributable risk.

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