Ethnic Differentials of Mortality in Russia and the Role of Socio-economic Conditions Natalia S....

Ethnic Differentials of Mortality in Russia and the

Role of Socio-economic ConditionsNatalia S. Gavrilova*

Alla E. Ivanova**Victoria G. Semyonova**

Leonid A. Gavrilov*

Center on Aging, NORC and the University of Chicago, Chicago*

Institute of Public Health and Social Development, Moscow, Russia**

Background Ethnic Russians in the Former Soviet Union had

higher mortality at working ages compared to many other ethnic groups.

In 1989 ethnic Russians had the lowest life expectancy compared to many other ethnic groups (Andreev et al., 1992).

Earlier study: Differences between Latvians and Russians were equal to 16-17 years for life expectancy, and more than two-fold differences for infant mortality (Novoselsky 1916). These differences were related not only to the living conditions but also to religion and cultural traditions.

Life expectancy of some ethnic groups in the Former USSR in

1988-1989

Source: Andreev et al., 1992

In Many Republics of the Former Soviet Union Ethnic

Differentials in Mortality Increased After the

Independence

Ethnicity and Mortality in Estonia:Ethnic differences increased after

independence

Ethnic Composition 2009

Data from Statistics Estonia Leinsalu, 2004, Figure 1, p. 584

Ethnicity and Mortality in Kyrgyzstan:Ethnic differences also increased after

independenceRecorded trends in adult mortality (20-60 years)

0.10

0.20

0.30

0.40

q206

0

1960 1970 1980 1990 2000y ear

russian ky rgy zslv cas

Males

0.10

0.20

0.30

0.40

q206

0

1960 1970 1980 1990 2000y ear

russian ky rgy zslv cas

Females

Kyrgyzstan, 40q20

Source: Guillot et al., 2007

Current problems in studying ethnic mortality

in Russia1997 Russian state law on vital

statistics: Ethnicity (and many other

characteristics) was excluded from the official (ZAGS) death certificates and hence from the official mortality statistics

This information still remains in medical death certificates, although in many cases it is not recorded

Our Approach To use a proportion of ethnic Russians

in population (taken from 2002 census) as a measure of ethnic composition that may affect mortality

Outcome variable: Mortality at working ages (15-59 years) in 78 Russian regions in 2003.

Control for alcohol consumption and socio-economic and demographic variables (Rosstat publications and database)

Mortality of men at working ages and proportion of Russians in population

r=0.51 (p<0.001)

Mortality of women at working ages and proportion of Russians in

population

r=0.33 (p<0.005)

Explanatory variables Proportion of ethnic Russians in region Proxy for alcohol consumption (deaths per

100,000 persons of working age due to alcohol poisoning)

Socio-economic characteristics: Gini coefficient, gross regional product, unemployment, poverty, price index (measure of inflation), percent of educated workforce

Demographic characteristics: divorce rate, net migration rate, number of women per 1000 men

The Model Ordinary least squares regression

Initial model: Ln (Mortality rate15-59) = α + β1 (gini) + β2

(grp)+β3 (migration) + β4 (russians) + β5 (poverty) + β6 (divorce) + β7 (sex ratio) + β8 (unemployment) + β9 (urban) + β10 (alcohol) + β11 (education) + β12 (price index)

Statistically significant variable interactions were also found and added to the model.

Variables with significant effects on mortality for both men and

womenRegression coefficients (p-value)

Variable Men Women

Russians 0.0018 (0.007) 0.0025 (0.003)

Unemployment 0.3175 (0.032) -0.0217 (0.001)

Price Index (Inflation) 0.0435 (0.001) 1.3316 (0.015)

% Urban population 0.3175 (0.032) 0.0052 (0.001)

Unemployment x Alcohol

0.0004 (<0.001) 0.0005 (<0.001)

Migration x Alcohol 0.00003 (0.003) 0.00005 (0.002)

Adjusted R2 0.82 0.81

Russians and alcohol

Studies of ethnic mortality in Estonia and Kyrgyzstan showed that significant proportions of excess deaths among Russians is due to causes related to alcohol consumption.

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)

0

5

10

15

20

25

30

35

40

45

50

Males Females

CASlavs

Source: Guillot et al., 2007

Russians and alcohol

We may expect that proportion of Russians and alcohol consumption should be strongly correlated

However, correlation between these two variables turn out to be small and non-significant: r=0.13 (p=0.26)

Alcohol consumption and proportion of ethnic Russians in population

r=0.13 (p=0.26)

Alcohol consumption and proportion of ethnic Russians in population

when Tyva and Altay are excluded

r=0.31 (p=0.0063)

What about interaction between alcohol and

unemployment? This may be an indicator of population

marginalization (high proportion of socially disadapted people – unemployed, homeless, low-skilled, etc.)

Source: Ivanova AE, Semyonova VG , Dubrovina E (2004). Marginalization of Russian mortality. Demoscope Weekly [Russian electronic edition].

Social structure of young men (16-39) died in 2004 in Kirov region

Source: Ivanova et al., 2004

Conclusions Proportion of Russians is a significant

independent predictor of regional mortality at working age in Russia (for both men and women)

However, correlation between proportion of Russians and alcohol consumption is more complex, because some ethnic minorities in Russia demonstrate both high mortality and high consumption of alcohol

Limitations: cross-sectional study, problems with measurement