demography of russia and the former soviet union lecture 8 sociology soci 20182
TRANSCRIPT
Demography of Russia and the Former Soviet Union
Lecture 8
Sociology SOCI 20182
The Concept of Life Table Life table is a classic demographic format of
describing a population's mortality experience with age.
Life Table is built of a number of standard numerical columns representing various indicators of mortality and survival.
The concept of life table was first suggested in 1662 by John Graunt.
Before the 17th century, death was believed to be a magical or sacred phenomenon that could not and should not be quantified. The invention of life table was a scientific breakthrough in mortality studies.
Life Table
Cohort life table as a simple example
Consider survival in the cohort of fruit flies born in the same time
Number of dying, d(x)
Number of survivors, l(x)
Number of survivors at the beginning of the next age
interval:
l(x+1) = l(x) – d(x)
Probability of death in the age interval:
q(x) = d(x)/l(x)
Probability of death, q(x)
Person-years lived in the interval, L(x)
L x = xl x l x x + +
2 L(x) are needed to calculate life
expectancy. Life expectancy, e(x), is defined as an average number of years lived after certain age.
L(x) are also used in calculation of net reproduction rate (NRR)
Calculation of life expectancy, e(x)
Life expectancy at birth is estimated as an area below the survival curve divided by the number of individuals at birth
Life expectancy, e(x)
T(x) = L(x) + … + Lω where Lω is L(x) for the last age
interval. Summation starts from the last
age interval and goes back to the age at which life expectancy is calculated.
e(x) = T(x)/l(x) where x = 0, 1, …,ω
Life Tables for Human Populations
In the majority of cases life tables for humans are constructed for hypothetic birth cohort using cross-sectional data
Such life tables are called period life tables
Construction of period life tables starts from q(x) values rather than l(x) or d(x) as in the case of experimental animals
Formula for q(x) using age-specific mortality rates
q x =M x
1 ( )1 a x M x + a(x) called the fraction of the last interval of life is usually equal to 0.5 for all ages except for the first age (from 0 to 1)
Having q(x) calculated, data for all other life table columns are estimated using standard formulas.
Life table probabilities of death, q(x), for men in Russia and USA. 2005
0.0001
0.001
0.01
0.1
1
0 10 20 30 40 50 60 70 80 90 100
Age
log
(q(x
))
Russia USA
Period life table for hypothetical population
Number of survivors, l(x), at the beginning is equal to 100,000
This initial number of l(x) is called the radix of life table
Life table number of survivors, l(x), for men in Russia and USA. 2005.
0
20000
40000
60000
80000
100000
120000
0 10 20 30 40 50 60 70 80 90 100
Russia
USA
Life table number of dying, d(x), for men in Russia and USA. 2005
0
500
1000
1500
2000
2500
3000
3500
0 10 20 30 40 50 60 70 80 90 100
Age
d(x
)
Russia USA
Life expectancy, e(x), for men in Russia and USA. 2005
0
10
20
30
40
50
60
70
80
0 10 20 30 40 50 60 70 80 90 100
Age
e(x)
Russia
USA
Trends in life expectancy for men in Russia, USA and
Estonia
Trends in life expectancy for women in Russia, USA and
Estonia
Distribution of life expectancy, Men, 1999
Distribution of life expectancy, Women, 1999
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.
Decline of life expectancy at age 15 between 1998-2005. Men
Decline of life expectancy at age 15 between 1998-2005. Women
Recent changes in life expectancy in Russia
50.00
55.00
60.00
65.00
70.00
75.00
80.00L
ife e
xp
ecta
ncy a
t b
irth
Men Women
Source: Goskomstat Russia
The theory of epidemiological transition
Omran, Abdel R. 1971. The epidemiologic transition: A theory of the epidemiology of population change. Milbank Memorial Fund Quaterly, 29: 509-538
Definition
The epidemiologic transition is that process by which the pattern of mortality and disease is transformed from one of high mortality among infants and children and episodic famine and epidemic affecting all age groups to one of degenerative and man-made diseases (such as those attributed to smoking) affecting principally the elderly. (Encyclopedia Britannica)
Stages of the Epidemiologic Transition
Pestilence and Famine Receding Pandemics Degenerative and man-made
diseases
Three stages of epidemiological transition
(Omran) “The Age of Pestilence and Famine
when mortality is high and fluctuating, thus precluding sustained population growth.” LE – 20-40 years
“The Age of Receding Pandemics when mortality declines progressively. LE increases steadily from 30 to 50 years. Sustained population growth
“The Age of Degenerative and Man-Made Diseases when mortality continues to decline and eventually approaches stability.” LE exceeds 50 years.
•The shifts in disease patterns in the 19th century were primarily related to changing in socio-economic development.
In the 20th Century more related with disease control activities independent of socio-economic development:e.g. Mexico, China
The fourth stage It was believed that by the 1970s life
expectancy reached a plateau corresponding to the biological limit to human life
However around that time many Western countries started to demonstrate an increase in life expectancy mainly due to successful prevention and treatment of cardiovascular disease. This resulted in a rapid decline of mortality, particularly at older ages.
Historical changes in the Gompertz-Makeham
mortality components
μ(x) = A + R e αx
Makeham component declined in history (from 1900 to 1970) to very low values close to zero
Gompertz component remained relatively stable during this period
Gavrilov et al. 1983. Human life span stopped increasing: Why? Gerontology, 29(3): 176-180
Available: http://longevity-science.org/Mortality-Limits-1983.pdf
Historical Changes in Mortality Swedish Females
Age
0 20 40 60 80 100
Lo
g (
Ha
zard
Ra
te)
0.0001
0.001
0.01
0.1
1
1925196019801999
Data source: Human Mortality Database
Epidemiologic transition in Russia
Soviet Union successfully passed all three stages of epidemiologic transition
However Soviet health care system could not respond to the challenges of growing mortality from non-communicable diseases
The “Semashko” model of 1918
The health care system was under the centralized control of the state, which financed services as part of national social and economic development plans.
All health care personnel became employees of the centralized state, which paid salaries and provided supplies to all medical institutions.
The main policy orientation throughout this period was to increase numbers of hospital beds and medical personnel.
Initial successes of government-controlled model of health care
Russia made massive strides in arresting the spread of infectious diseases.
Drastic epidemic control measures were implemented against the spread of tuberculosis, typhoid fever, typhus, malaria and cholera.
Community prevention approaches, routine check-ups, improvements in urban sanitation and hygiene, quarantines, etc.
Moscow kindergarten, 1930s
Vaccination in rural
Turkmenistan, 1930s
Before World War II
Life expectancy (both sexes)
32
43
59
47
63
47
01020304050607080
1900 1938
Russia
France
USA
Catching up with the West
Life expectancy in 1965
64.373.4 74.7
66.873.7
67.3
01020304050607080
Men Women
Russia
France
USA
Stagnation after 1965
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.
Decline of life expectancy at age 15 between 1998-2005. Men
Decline of life expectancy at age 15 between 1998-2005. Women
Decomposition of the U.S.-Russia gap in life expectancy
by cause
USA – 1999; Russia – 2001. Source: Shkolnikov et a. Mortality reversal in Russia.
Decomposition of the U.S.-Russia gap in life expectancy
by cause
USA – 1999; Russia – 2001. Source: Shkolnikov et a. Mortality reversal in Russia.
Factors and Trends of Mortality and Health in Russia
Sex Differentials of Mortality
U.S. population in 1999
Gender gap in life expectancy
In 1994 gender gap in life expectancy in Russia reached 13.7 years – the largest difference in life expectancy between sexes ever recorded
Life table probability of death for Russian men and women,
2005
0.0001
0.001
0.01
0.1
1
0 10 20 30 40 50 60 70 80 90 100
Age
log
(q(x
))
Men Women
Life table number of dying for Russian men and women, 2005
0
500
1000
1500
2000
2500
3000
3500
4000
0 10 20 30 40 50 60 70 80 90 100
Age
d(x
)
Men Women
Life expectancy in Russia
55
60
65
70
75
80
1959
1963
1967
1971
1975
1979
1983
1987
1991
1995
1999
2003
Calendar year
Lif
e e
xp
ecta
ncy
Females Males Both
The Role of Education
LRC – Lipid Research Clinic study cohort in Moscow and St.Petersburg
Education and life expectancy at working ages (20-69). Men,
Russia
Source: Shkolnikov et al., SSM, 1998
Why educated people live longer in
Russia? Decomposition by cause of death
The role of alcohol consumption in high mortality in Russia
The consumption of alcohol has deep cultural roots in Russia where it typically accompanied celebrations, signified hospitality, and enhanced bonding among acquaintances and friends.
It also was a tremendous sources of revenue for the Soviet state which exercised a monopoly on its production and distribution.
Dynamics of alcohol consumption in Russia
Liters of 100% alcohol per person per year
1 – V.Treml; 2 – Goskomstat estimate; 3-A.Nemtsov estimate; 4- sales of alcohol
Alcohol is a driving force of mortality crisis in Russia
Gorbachev’s anti-alcohol campaign, 1985-1987
Official sales of alcohol fell 51% Real consumption fell 27% Fall of alcohol sales was
compensated by alcohol self-production
Gorbachev anti-alcohol campaign
The favorable effect of the anti-alcohol campaign on Russian mortality was strong and rapid. Mortality began to decrease immediately after the introduction of restrictions on the sale of alcohol in June 1985 and continued month by month in parallel with the reduction in alcohol consumption (Shkolnikov and Vassin, 1994). The largest mortality decrease was observed at adult ages both for males and females during the year 1986. From 1984 to 1987 (mostly in 1986), life expectancy at birth rose from 61.7 to 64.9 years for males and from 73 to 74.3 years for females. (From “Premature Death in the New Independent States,” NAS, 1997)
Number of male deaths by monthbefore and after the anti-alcohol
campaign Number of deaths in thousand
Trends in the number of deaths
Millions of deaths
Contribution of different causes of death to changes in
LE, men
Contribution of different causes of death to changes in
LE, women
Age and cause components of LE increase due to anti-alcohol
campaign: Men
Age and cause components of LE increase due to anti-alcohol
campaign: Women
Major effects of anti-alcohol campaign
The highest decrease of mortality in regions with initial high levels of mortality at adult ages
Regional inequality in mortality decreased
Mortality decreased predominantly at middle adult ages due to reduction in external mortality and mortality from cardiovascular diseases
Results of anti-alcohol campaign
Over 1 million lives were saved Alcohol consumption was decreased but still
remained high – 10.5-12.6 liter per person per year in 1986-1991
In 1984 estimated deaths due to direct and indirect effects of alcohol were 525,000 deaths or 31.8% of all registered deaths (4.4% in USA, 3.1% in Canada in 1995)
Anti-alcohol campaign decreased alcohol-related number of deaths by 200,000
Estimates by A. Nemtsov.
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 spikes of mortality at ages about 35-55 years.
Particularly high increase in mortality from violence and accidents among manual workers and low education groups.
In 1992 and 1998 Russia experienced two serious
economic crises accompanied by drop in
personal income and rapid impoverishment
Alcohol and Inflation
In 1992-1993 prices of alcohol increased much less than personal salaries and the general price index, which by June 1994 had increased to 1229 times its December 1992 level. Concurrently, prices of alcohol rose to 421 times their prior levels. It is not surprising that real alcohol consumption in Russia increased sharply during this period of economic crisis and reduction in real wages
Total and alcohol-related mortality during the market
reforms Total number of deaths in thousand (left) Deaths from acute poisoning by alcohol (right)
Decline in alcohol quality during the market reforms
In 1992 state monopoly on alcohol sales was abolished
Self-production of alcohol became not profitable but over 20% of alcohol sales included technical alcohol
Sample control tests showed that proportion of below quality standards alcohol was 5.6% in 1992 and 30.4% in 1994
Imported alcohol had even lower quality: 67.2% below quality standards
Copyright restrictions may apply.
Notzon, F. C. et al. JAMA 1998;279:793-800.
--Change in all-cause mortality rates between 1990 and 1994 by age and sex, Russia
Decomposition of changes in LE by cause of death, 1990-
1994
Alcohol and suicide Suicide (1) and accidental poisoning by alcohol (3) – left Alcohol psychoses (2) - right
Drinking and Suicide
Number of suicides per 100,000 – left Alcohol (l) per person per year
1 – suicides with alcohol in blood ; 3 – sober suicides (left); 2- alcohol consumption
Alcohol and cardiovascular mortality
Alcohol intoxication is an additional risk factor for cardiovascular diseases
During anti-alcohol campaign mortality from cardiovascular diseases decreased mainly due to atherosclerotic cardiosclerosis (by 19% in men) and stroke (by 8% in men)
What about alcohol surrogates?
Alcohol surrogates – non-food liquids containing ethanol (polishing liquids, perfume, pharmaceutical tinctures, etc.)
Alcohol surrogates are cheap, so they are attractive to poor persons. May be the only source of ethanol for impoverished persons.
47% of men who used surrogates were unemployed. Only 13% of men not used surrogates were unemployed
Northern Structure of Alcohol Consumption
An example of Sweden
Consumption of hard liquors and life expectancy
Alcohol-related policy
Explanations of Mortality Crisis in 1992-1994
Psychological Stress (and alcohol) Hypothesis (Shapiro, 1995; Cornia, Paniccia, 1995; Shkolnikov et al., 1998)
Selection Hypothesis (‘selection of alcoholics’) by Avdeev, Blum, Zakharov, Andreev, 1997.
Other Hypotheses (less supported by evidence)
Mass impoverishment and malnutrition – if this hypothesis is true then infant mortality should increase
Deterioration of the health care system – if this hypothesis is true then again infant mortality should increase
Environmental pollution – environmental pollution should increase during 1992-1994 while in fact it decreased
Protective role of education during 1992-1994 crisis
Mortality of adult men with higher education level increased from 1989 to 1994 by 35% vs 57% for men with lower education level
Mortality of adult women with higher education level increased by only 8% compared to 30% for women with lower education level
Source: Shkolnikov et al., SSM, 1998
Suggested Factors of Mortality Increase During the Transition
Period
Rapid Impoverishment
Growth of Delinquency
Cheap Alcohol
Expensive Medicine
Tuberculosis
Drug Dependence
Sexually Transmitted Diseases
Social StressCardiovascular Diseases, Suicide
Injuries
Diabetes, Asthma
SelectionSelection
Age Profile of Suicide Mortality in Russia: 1981-2001
Males Females
Life Expectancy in Russia
Russia Year Males
Females
1992
62.0 73.8
1993
58.9 71.9
1994
57.6 71.2
1995
58.3 71.7
2000
58.8 71.7
2006
60.4 73.2
China 2006
72.0 75.0
India 2006
62.0 64.0