Transcript Gender Specific Effects of Early

Russia and Eastern Europe
Natalia S. Gavrilova
Leonid A. Gavrilov
Center on Aging
NORC and The University of Chicago
Chicago, Illinois, USA
Russia now



The largest country in the world by
the area (United States is the 3rd)
The 2nd country by the number of
immigrants (after the United States)
The 10th rank by population number 141,377,752 people on July 2007
(United States has the 5th rank)
Russia now




The 10th economy by GDP (CIA World
Factbook). But only 75th by per capita
GDP ($14,600)
The third largest reserves of foreign
exchange and gold - $470 billion
(after China and Japan)
The largest reserves of natural gas
The second in the world by oil
production but the 9th by oil reserves
GDP per capita at current prices
(dollars) in Russia and other
countries
Country
1990
2000
2010
2012
Russia
3840
1768
10618
14178
China
347
932
4375
6070
Kazakhstan
1849
1266
9380
12455
Ukraine
1746
637
2962
3872
Belarus
1835
1044
5818
6726
Finland
27852
23528
44098
45741
Bulgaria
2350
1613
6459
7004
Mexico
3815
6582
8916
9795
Source: http://data.un.org
Demographic Indicators of Russia
and Mexico
Indicator
Russia
Mexico
Infant mortality per 1000 live births
7.4
15
Total fertility rate (mean number of children
per woman)
1.7
2.2
Percent of persons 65+ years of age
13
6
Men
64
75
Women
76
79
74
78
Life expectancy:
Proportion of urban population, %
Source: Population Reference Bureau. 2013 World Population Data Sheet.
Background on Mortality in
Russia
Before the World War II
Life expectancy (both sexes)
80
70
60
50
40
30
20
10
0
59
47
47
63
Russia
43
32
France
USA
1900
1938
Catching up with the West
Life expectancy in 1965
80
70
60
50
40
30
20
10
0
64.3 67.3 66.8
73.4 74.7 73.7
Russia
France
USA
Men
Women
Stagnation after 1965
In 1992 and 1998 Russia
experienced two serious
economic crises accompanied
by drop in personal income and
rapid impoverishment
GDP Crisis
Russia: Trends in life expectancy
Mortality reversal




Situation when the usual time trend of declining
mortality is reversed (mortality is increasing over
time).
Observed in sub-Saharan Africa (AIDS
epidemic), Eastern Europe, and FSU countries
including Russia.
Mortality Reversal in FSU countries and Russia is
particularly strong among male population, with
excess mortality at ages about 35-55 years.
Particularly high increase in mortality from
violence and accidents among manual workers
and low education groups.
Current trends in life expectancy in
Moscow and some Eastern European
countries
Life table probabilities of death, q(x), for
men in Russia and USA. 2005
1
0
10
20
30
40
50
60
log(q(x))
0.1
0.01
0.001
0.0001
Age
Russia
USA
70
80
90
100
Ethnic Differentials in Mortality
Trends in Life Expectancy: Men
Russia
Kyrgyzstan
65.00
63.00
61.00
59.00
57.00
55.00
19
80
19
82
19
84
19
86
19
88
19
90
19
92
19
94
19
96
19
98
20
00
20
02
20
04
20
06
20
08
20
10
Life expectancy
67.00
Calendar year
Trends in Life Expectancy: Women
Russia
Kyrgyzstan
76.00
74.00
73.00
72.00
71.00
70.00
Calendar year
2010
2008
2006
2004
2002
2000
1998
1996
1994
1992
1990
1988
1986
1984
1982
69.00
1980
Life expectancy
75.00
Based on the Study of Ethnic
Differentials in Adult
Mortality in Kyrgyzstan
Michel Guillot (PI), University of
Wisconsin-Madison
Natalia Gavrilova, University of Chicago
Tetyana Pudrovska, University of
Wisconsin-Madison
Demography, 2011, 48(3): 1081-1104
Background on Kyrgyzstan





Former Soviet republic; became
independent in 1991
Population: 5.2 million (2006)
Experienced a severe economic
depression after break-up of Soviet
Union
GNI per capita = 440 USD; 28th poorest
country in the world (2005)
48% of population below national
poverty line (2001)
2008 Workshop, Bishkek
Ethnic Groups in Kyrgyzstan



Native Central Asian groups: Kazakh,
Kyrgyz, Tajik, Turkmen, Uzbek (Sunni
Muslims)
Slavs: Russian, Ukrainian,
Bielorussian
Kyrgyzstan, 1999 census:
Central Asians: 79% of pop. (Kyrgyz 65%)
 Slavs: 14% of pop. (Russian 12%)

Recorded trends in adult mortality (20-60 years)
Kyrgyzstan, 40q20
0.30
0.10
0.20
q2060
0.10
0.20
q2060
0.30
0.40
Females
0.40
Males
1960
1970
1980
y ear
1990
2000
1960
1970
1980
y ear
1990
2000
russian
ky rgy z
russian
ky rgy z
slv
cas
slv
cas
Mortality paradox?

Soviet period: Russians/Slavs
occupied dominant positions in the
socio-economic structure of
Central Asian societies (Kahn
1993)
Mortality paradox?




Slavic females more educated than
Central Asian females (1989 and 1999
censuses)
Slavic males: educational advantage not
so clear – varies by age (1989 and 1999
censuses)
Slavic households less poor than Central
Asians (1993 World Bank poverty
survey)
Infant mortality lower among Slavs
(Soviet and post-Soviet period)
Proportion of individuals with post-secondary education,
by age and ethnicity, in 1989 census.
Females
SLAVIC (Russian, Ukrainian, Belorussian), 1989
CENTRAL ASIAN (Kyrgyz, Uzbek), 1989
0.300
Proportion higher education
0.250
0.200
0.150
0.100
0.050
0.000
20-24
25-29
30-34
35-39
40-44
45-49
50-54
55-59
60-64
Mortality paradox?




Slavic females more educated than
Central Asian females (1989 and 1999
censuses)
Slavic males: educational advantage not
so clear – varies by age (1989 and 1999
censuses)
Slavic households less poor than Central
Asians (1993 World Bank poverty
survey)
Infant mortality lower among Slavs
(Soviet and post-Soviet period)
Proportion of individuals with post-secondary education, by
age and ethnicity, in 1989 census. Males.
SLAVIC (Russian, Ukrainian, Belorussian), 1989
CENTRAL ASIAN (Kyrgyz, Uzbek), 1989
0.250
Proportion higher education
0.200
0.150
0.100
0.050
0.000
20-24
25-29
30-34
35-39
40-44
45-49
50-54
55-59
60-64
Mortality paradox?




Slavic females more educated than
Central Asian females (1989 and 1999
censuses)
Slavic males: educational advantage not
so clear – varies by age (1989 and 1999
censuses)
Slavic households less poor than Central
Asians (1993 World Bank poverty
survey)
Infant mortality lower among Slavs
(Soviet and post-Soviet period)
Mortality paradox?




Slavic females more educated than
Central Asian females (1989 and 1999
censuses)
Slavic males: educational advantage not
so clear – varies by age (1989 and 1999
censuses)
Slavic households less poor than Central
Asians (1993 World Bank poverty
survey)
Infant mortality lower among Slavs
(Soviet and post-Soviet period)
IMR by ethnicity, 1958-2003, Kyrgyzstan
30
20
10
IMR
40
50
Urban areas
1960
1970
1980
year
Central Asians
1990
Slavs
2000
Data

Unpublished population and death
tabulations since 1959



collected from local archives
Individual census records – 1999
Individual death records – 19981999

obtained from national statistical office
Possible explanations for
mortality paradox



Data artifacts
Migration effects (esp. 1989-99)
Cultural effects
Data artifacts?

Could the lower recorded mortality
among Central Asian adults be due to
lower data quality among them
(coverage of deaths, age
misreporting)?
Migration effects?


1/3 of Russian population has left
Kyrgyzstan since 1991
Could the increased disparity
between Russian and Kyrgyz adult
mortality be due to selective
migration (healthy migrant effect)?
Cultural effects?

Culture may affect mortality in various
ways:
individual health and lifestyle behaviors (e.g., diet,
smoking, alcohol, use of preventive care)
 family structure and social networks (denser social
networks may produce lower stress levels and
better health)


Could different cultural practices among
Slavs and Central Asians explain the
observed mortality differentials?
Data artifacts?

Intercensal estimates of death
registration coverage above age 60
(Guillot, 2004):
90+ % as early as 1959 in urban areas
 coverage in rural areas was low initially
(~50%) but caught up with urban areas in
1980s
 Total population: 92% for 1989-99 period


Adult deaths (20-59) usually better
reported than deaths 60+
Kyrgyzstan, 40q20, Urban areas
0.30
0.20
0.10
0.10
0.20
q2060
0.30
0.40
Females
0.40
Males
1960
1970
1980
y ear
1990
2000
1960
1970
1980
y ear
1990
2000
russian
ky rgy z
russian
ky rgy z
slv
cas
slv
cas
Health selection?
Russians in KG vs. Russia, 40q20
0.40
0.50
Females
0.10
0.20
0.30
q2060
0.30
0.20
0.10
q2060
0.40
0.50
Males
1960
1970
1980
y ear
Russians in KG
1990
2000
Russia
1960
1970
1980
y ear
Russians in KG
1990
2000
Russia
Cohort-specific changes in educational
attainment, Males, 1989-99
SLAVIC, 1989
SLAVIC, 1999
0.300
Proportion higher education
0.250
0.200
0.150
0.100
0.050
0.000
Age in 1989: 20-24
Age in 1999: 30-34
25-29
35-39
30-34
40-44
35-39
45-49
40-44
50-54
45-49
55-59
50-54
60-64
55-59
65-69
60-64
70-74
65-69
75-79
70-74
80-84
75-79
85-89
80-84
90-94
Cohort-specific changes in educational
attainment, Females, 1989-99
SLAVIC, 1989
SLAVIC, 1999
0.300
Proportion higher education
0.250
0.200
0.150
0.100
0.050
0.000
Age in 1989:
Age in 1999:
20-24
30-34
25-29
35-39
30-34
40-44
35-39
45-49
40-44
50-54
45-49
55-59
50-54
60-64
55-59
65-69
60-64
70-74
65-69
75-79
70-74
80-84
75-79
85-89
80-84
90-94
Cultural effects?


Analysis of causes of death by
ethnicity, 1998-99
Calculations based on micro-data
Deaths: vital registration (1998-99)
 Exposure: census (March 1999)
 Ages 20-59
 Ethnicity: Central Asians vs. Slavs
 ~20,000 death records; ~2.2 million
census records

Age-standardized Death Rates at
working ages (per 100000), 1998-99,
by cause and ethnicity, Males
Infectious/par. diseases
- incl. TB
Neoplasms
CVD
CA
Slavs
- incl. IHD
Respiratory diseases
Digestive diseases
Injuries/poisoning
Other causes
0
50
100
150
200
250
Contribution of causes of death to the difference
in life expectancy at working ages (40e20)
between Slavs and Central Asians
Males (total difference = 2.90 years)
1.8
1.6
1.4
1.2
1.0
0.8
0.6
0.4
0.2
au
se
s
O
th
e
rc
ju
ri
es
In
C
V
R
D
es
pi
ra
to
ry
D
is
.
D
ig
es
t iv
e
D
is
.
pl
as
m
s
N
eo
In
fe
ct
io
ns
0.0
ho
m
un
de
te
rm
in
ed
su
ic
id
e
.
ic
id
ac
e
cid
.p
oi
al
so
lo
ni
ng
th
er
ac
ci
d.
tra
ca
ns
us
po
.
rt
ac
ci
ac
de
ci
nt
de
s
nt
al
dr
ow
ac
c.
ni
ca
ng
us
./e
ac
le
ct
c.
r.c
m
ec
ur
ha
n.
su
ffo
ca
t.
ot
he
r
in
ju
ry
ac
ci
d.
po
is
on
./a
lco
h
Age-standardized Death Rates at working
ages (per 100,000). Detailed Injuries, Males
50
45
40
Slavs
CA
35
30
25
20
15
10
5
0
Age-standardized Death Rates at
working ages (per 100,000), 1998-99,
by cause and ethnicity, Females
Infectious/par. diseases
- incl. TB
Neoplasms
CVD
- incl. IHD
Respiratory diseases
Digestive diseases
CA
Slavs
Injuries/poisoning
Other causes
0
10
20
30
40
50
60
70
80
Contribution of causes of death to the difference
in life expectancy at working ages (40e20)
between Slavs and Central Asians
Females (total difference = .28 years)
0.35
0.30
0.25
0.20
0.15
0.10
0.05
au
se
s
O
th
e
rc
ju
rie
s
In
Di
s.
e
es
t iv
CV
D
pl
as
m
s
Di
s.
Di
g
-0.10
Re
sp
ir a
to
ry
In
-0.05
Ne
o
fe
ct
io
ns
0.00
.
su
ic
id
e
.a
cc
id
en
t.c
tra
au
ns
s.
po
rt
ac
ci
ac
de
ci
nt
d.
s
ca
us
e
ac
by
c.
fir
ca
e
us
./e
le
ac
ct
ci
r.c
de
ur
nt
al
dr
ow
ni
ng
al
lo
o.
ic
id
ac
e
ci
d.
po
iso
in
ju
ni
ry
ng
un
de
te
rm
in
ed
ho
m
ac
ci
d.
po
is
on
./a
lco
h
Age-standardized Death Rates at working
ages (per 100,000)
Detailed Injuries, Females
9
8
7
Slavs
CA
6
5
4
3
2
1
0
Alcohol-related Causes of Death
(Chronic alcoholism, Alcohol psychoses, Alcohol cirrhosis of the
liver, Accidental poisoning by alcohol)
Age-standardized Death Rates at working ages (per
100,000)
50
45
CA
Slavs
40
35
30
25
20
15
10
5
0
Males
Females
Multivariate analysis







Do ethnic mortality differentials at adult ages
remain once we account for differences in
education and urban/rural residence?
Negative binomial regression
Dependent variable: deaths from all causes;
deaths by major cause (7)
Explanatory variables: exposure, dummy
variables for age, ethnicity, urban/rural
residence, education (3 cat.)
Males and Females analyzed separately
Model 1: age, ethnicity
Model 2: age, ethnicity, education, residence
Males, all causes of death
In
e
s.
ie
s
di
s.
di
ju
r
es
t iv
Di
g
y
Re
sp
ir a
to
r
CV
D
pl
as
m
s
ns
ca
us
es
fe
ct
io
Ne
o
In
Al
l
Risk Ratio Slavs/CA
Males
3.5
3.0
2.5
2.0
Model 1
1.5
Model 2
1.0
0.5
0.0
Risk Ratio Slavs/CA
Females
3.5
3.0
2.5
2.0
Model 1
Model 2
1.5
NS NS
1.0
NS
NS NS
NS NS
NS
0.5
au
se
s
ie
s
O
th
e
rc
ju
r
In
CV
Re
D
sp
ir a
to
ry
Di
s.
Di
ge
st
iv
e
Di
s.
pl
as
m
s
Ne
o
ns
fe
ct
io
In
Al
l
C
au
se
s
0.0
Conclusions



Excess mortality among adult Slavs
(Soviet and post-Soviet period) is
not likely due to data artifacts or
migration effects
Excess mortality due to important
ethnic differences in cause-specific
mortality – alcohol and suicide in
particular
Differences remain unexplained by
education or residence
Conclusions

Role of cultural characteristics?
Alcohol tied to cultural practices (“culture
of alcohol” among Russians; Impact of
Islam for Central Asians)
 Denser social networks and stronger social
support among Central Asian ethnic
groups?

Further developments
Divergent paths for adult mortality
in Russia and Central Asia:
Evidence from Kyrgyzstan

Guillot, M, Gavrilova, N, Torgasheva, L,
Denisenko, M. Divergent Paths for Adult
Mortality in Russia and Central Asia:
Evidence from Kyrgyzstan. PLOS ONE,
2013, 8(10): e75314, DOI:
10.1371/journal.pone.0075314


Study of autopsies in Barnaul during
1990-2004 (Zaridze et al., 2009)
Among 5732 autopsied men aged 3569 years who were reported to have
died from circulatory diseases 49%
had alcohol detected in their blood
and in 21% concentration of ethanol
was 4g/l and higher (lethal dose)
Of 5880 autopsied men aged 35-69
years who were reported to have died
from injuries 76% had alcohol in their
blood and in 38% concentration of
ethanol was 4g/l and higher
Trends in Life Expectancy: Men
Russia
Kyrgyzstan
65.00
63.00
61.00
59.00
57.00
55.00
19
80
19
82
19
84
19
86
19
88
19
90
19
92
19
94
19
96
19
98
20
00
20
02
20
04
20
06
20
08
20
10
Life expectancy
67.00
Calendar year
Trends in Life Expectancy: Women
Russia
Kyrgyzstan
76.00
74.00
73.00
72.00
71.00
70.00
Calendar year
2010
2008
2006
2004
2002
2000
1998
1996
1994
1992
1990
1988
1986
1984
1982
69.00
1980
Life expectancy
75.00
40M20
(Russia) – 40M20 (Kyrgyzstan), 1979-2009, all
causes and strongly alcohol related causes
Framework for Understanding Health
Crisis in Russia vs. Central Asia
Russia
Kyrgyzstan
(Central Asia?)
Infant
mortality
Declined
Stalled
Adult
mortality
Large increase
Moderate increase
Explanatory
framework
Greater importance Greater importance of
of detrimental adult health care
health behaviors
deterioration
Mortality of disabled people in
Russia, 2011
q(x) как функция возраста, полулогарифмическая
шкала
1
1
1 10 19 28 37 46 55 64 73 82 91 100
1 10 19 28 37 46 55 64 73 82 91 100
0.1
0.01
q(x) как функция возраста, полулогарифмическая
шкала
0.1
мужчин
ы
0.001
0.001
0.0001
0.0001
Men
Source: Pension Fund of Russia
женщин
ы
0.01
Women
Acknowledgements



National Statistical Committee of the
Kyrgyz Republic
Zarylbek Kudabaev, Orozmat
Abdykalykov, Liudmila Torgashova,
Larissa Mimbaeva, Elena
Komandirova and Mikhail Denisenko
NICHD: R03 HD38752, R01
HD045531
Biomarkers in Population-Based
Aging and Longevity Research
Natalia Gavrilova, Ph.D.
Stacy Tessler Lindau, MD, MAPP
CCBAR Supported by the National Institutes of Health (P30 AG012857)
NSHAP Supported by the National Institutes of Health (5R01AG021487)
including:
National Institute on Aging
Office of Research on Women's Health
Office of AIDS Research
Office of Behavioral and Social Sciences Research
Chicago Core on Biomarkers in
Population-Based Aging Research
CCBAR website
http://biomarkers.uchicago.edu/
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