ECONOMIC-CHANGE, CRIME, AND MORTALITY CRISIS IN RUSSIA - REGIONAL-ANALYSIS

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.