Transcript Problems with Mortality Data in Russia

Problems with Mortality Data
in Russia
Natalia S. Gavrilova
Victoria G. Semyonova
Galina N. Evdokushkina
Alla E. Ivanova
Leonid A. Gavrilov
Center on Aging, NORC/University of Chicago
Central 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
China
India
1992
1993
1994
1995
1997
2000
1995
1995
62.0
58.9
57.6
58.3
60.8
58.8
69.0
62.4
73.8
71.9
71.2
71.7
72.9
71.7
73.0
63.4
Pace of Growth of Age-Adjusted Mortality
in 1989-2000 for Classes of Causes of Death
9
8
7
6
5
Males
Females
4
3
2
1
0
All causes
Injuries
Ill-Def.C.
Infections
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
160
140
2001
1991
Age-Specific Mortality per 100,000
Age-Specific Mortality Rate per 100,000
200
150
100
50
120
2001
1991
100
80
60
40
20
0
0
0
20
40
Age
60
80
0
20
40
Age
60
80
Top Five Causes of Death for
Young Adult Males (20-24)
1990
2001
Injuries
Injuries
Neoplasms
Symptoms, Signs and IllDefined Conditions
Infectious Diseases
Diseases of Circulatory
System
Symptoms, Signs and Ill- Neoplasms
Defined Conditions
Diseases of Nervous
Diseases of Respiratory
System and Sens.Organs System
Top Five Causes of Death for
Young Adult Females (20-24)
1990
2001
Injuries
Injuries
Neoplasms
Neoplasms
Diseases of Circulatory
System
Complications of
Pregnancy and
Childbearing
Diseases of Nervous
System and Sens.Organs
Diseases of Circulatory
System
Symptoms, Signs and IllDefined Conditions
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 years
Data from the WebAtlas Project (http://sci.aha.ru/ATL)
Deaths from Ill-Defined Conditions in
Kirov Region of Russia in 2003
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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
Moscow
Suicide
Accidental Falls
Undetermined Injury
Undetermined Injury
Homicide
All Other Accidental
Causes
Accidental Poisoning by Homicide
Alcohol
All Other Accidental
Suicide
Causes
Social Background
of Current Degradation
in Russian Mortality Statistics
Transition period was accompanied
by unprecedented growth
of crime rate and homicide mortality
Recorded Intentional Homicide (completed) per 100,000
Tendencies of Intentional Murders
in Russia and the United States
24
22
Russia
20
18
16
14
12
10
8
United States
6
4
1988
1990
1992
1994
1996
Time, years
1998
2000
2002
Trends in Homicide Victimization Rates
for Young and Middle-Aged Adults
Data from Russian Vital Statistics
25
90
80
45-49
45-49
Mortality Rate x 100,000
Mortality Rate x 100,000
20
70
60
20-24
50
40
15
20-24
10
5
30
20
1988
1990
1992
1994
1996
Year
Males
1998
2000
2002
0
1988
1990
1992
1994
1996
Year
Females
1998
2000
2002
Age Profile of Homicide Mortality
in Russia: 1981-2002
Females
Males
25
Homicide deaths per 100,000 males
80
2002
2002
20
60
15
1991
1981
40
1981
10
1991
20
5
0
20
40
Age
60
80
Homicide deaths pe
0
0
0
20
40
60
Age
80
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
120
40
2001
1981
Mortality Rate x 100,000
Mortality Rate x 100,000
100
2001
80
60
1991
40
30
1981
20
1991
10
20
0
0
0
20
40
60
Age
Males
80
100
0
20
40
60
Age
Females
80
100
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
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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