From the National Center for Health Statistics, Centers for Disease Control and Prevention, US Department of Health and Human Services, Hyattsville, Md (Dr Notzon); MedSocEconomInform and the Ministry of Health of Russia, Moscow (Drs Komarov and Ermakov); Department of Internal Medicine and Division of Nutritional Sciences, University of Illinois at Urbana-Champaign (Dr C. Sempos); the National Center for Chronic Disease Prevention and Health Promotion, the Centers for Disease Control and Prevention, US Department of Health and Human Services, Atlanta, Ga (Dr Marks); and the Mid-Atlantic Kaiser Permanente Medical Group, Gaithersburg, Md (Dr E. Sempos). Dr C. Sempos is now with the National Heart, Lung, and Blood Institute, National Institutes of Health, Bethesda, Md.
Context.— Russian life expectancy has fallen sharply in the 1990s, but the impact
of the major causes of death on that decline has not been measured.
Objective.— To assess the contribution of selected causes of death to the dramatic
decline in life expectancy in Russia in the years following the breakup of
the Soviet Union.
Design.— Mortality and natality data from the vital statistics systems of Russia
and the United States.
Setting.— Russia, 1990-1994.
Population.— Entire population of Russia.
Main Outcome Variables.— Mortality rates, life expectancy, and contribution to change in life
Methods.— Application of standard life-table methods to calculate life expectancy
by year, and a partitioning method to assess the contribution of specific
causes of death and age groups to the overall decline in life expectancy.
United States data presented for comparative purposes.
Results.— Age-adjusted mortality in Russia rose by almost 33% between 1990 and
1994. During that period, life expectancy for Russian men and women declined
dramatically from 63.8 and 74.4 years to 57.7 and 71.2 years, respectively,
while in the United States, life expectancy increased for both men and women
from 71.8 and 78.8 years to 72.4 and 79.0 years, respectively. More than 75%
of the decline in life expectancy was due to increased mortality rates for
ages 25 to 64 years. Overall, cardiovascular diseases (heart disease and stroke)
and injuries accounted for 65% of the decline in life expectancy while infectious
diseases, including pneumonia and influenza, accounted for 5.8%, chronic liver
diseases and cirrhosis for 2.4%, other alcohol-related causes for 9.6%, and
cancer for 0.7%. Increases in cardiovascular mortality accounted for 41.6%
of the decline in life expectancy for women and 33.4% for men, while increases
in mortality from injuries (eg, falls, occupational injuries, motor vehicle
crashes, suicides, and homicides) accounted for 32.8% of the decline in life
expectancy for men and 21.8% for women.
Conclusion.— The striking rise in Russian mortality is beyond the peacetime experience
of industrialized countries, with a 5-year decline in life expectancy in 4
years' time. Many factors appear to be operating simultaneously, including
economic and social instability, high rates of tobacco and alcohol consumption,
poor nutrition, depression, and deterioration of the health care system. Problems
in data quality and reporting appear unable to account for these findings.
These results clearly demonstrate that major declines in health and life expectancy
can take place rapidly.
Notzon FC, Komarov YM, Ermakov SP, Sempos CT, Marks JS, Sempos EV. Causes of Declining Life Expectancy in Russia. JAMA. 1998;279(10):793-800. doi:10.1001/jama.279.10.793