P. Walberg et al., ECONOMIC-CHANGE, CRIME, AND MORTALITY CRISIS IN RUSSIA - REGIONAL-ANALYSIS, BMJ. British medical journal, 317(7154), 1998, pp. 312-318
Objective: To identify which aspects of socioeconomic change were asso
ciated with the steep decline in life expectancy in Russia between 199
0 and 1994. Design: Regression analysis of regional data, with percent
age fall in male life expectancy as dependent variable and a range of
socioeconomic measures reflecting transition, change in income, inequi
ty, and social cohesion as independent variables. Determination of con
tribution of deaths from major causes and in each age group to changes
in both male and female life expectancy at birth in regions with the
smallest and largest declines. Setting: Regions (oblasts) of European
Russia (excluding Siberia and those in the Caucasus affected by the Ch
echen war). Subjects: The population of European Russia. Results: The
fall in life expectancy at birth varied widely between regions, with d
eclines for men and women highly correlated. The regions with the larg
est falls were predominantly urban, with high rates of labour turnover
, large increases in recorded crime, and a higher average but unequal
distribution of household income. For both men and women increasing ra
tes of death between the ages of 30 and 60 years accounted for most of
the fall in life expectancy, with the greatest contributions being fr
om conditions directly or indirectly associated with heavy alcohol con
sumption. Conclusions: The decline in life expectancy in Russia in the
1990s cannot be attributed simply to impoverishment Instead, the impa
ct of social and economic transition, exacerbated by a lack of social
cohesion, seems to have played a major part, The evidence that alcohol
is an important proximate cause of premature death in Russia is stren
gthened.