Studies of adult mortality in Russia

To study determinants of adult mortality in Russia, we pursue several lines of research:

Participation in analyses of the Novosibirsk MONICA cohort.

Indirect demographic approach (convenience retrospective cohort).

A new prospective cohort study (see HAPIEE Study).

Novosibirsk MONICA cohort

We have a close collaboration with colleagues at the Institute of Internal Medicine, Siberian Branch of Russian Academy of Medical Sciences in Novosibirsk. Dr Sofia Malyutina, Prof Yuri Nikitin and other colleagues, who work with us on the HAPIEE Study, have organised the the Novosibirsk part of the WHO MONICA Project. They examined population samples in 1984, 1985/86, 1988/89 and 1994/95, and since then they have been following these subjects. We have jointly analysed the data on trends in alcohol consumption and on prospective predictors of mortality. We found that the trends in consumption are inconsistent with the hypothesis that alcohol underlies mortality trends in Russia in the early stages of societal transformation [Malyutina et al, Addiction, 2001]. We also found that cardiovascular mortality is not prospectively associated with binge drinking but it seems to be associated with frequent heavy drinking [Malyutina et al, Lancet, 2002]. In terms of socioeconomic predictors, education and marital status are powerful predictors of total and cardiovascular mortality in Novosibirsk and their effects are only partly explained by coronary risk factors.

Indirect demographic approach (convenience retrospective cohort) to study mortality in Russia.

The dramatic fluctuations in cardiovascular mortality Russia and other parts of the FSU in the 1980s and 1990s attracted considerable attention and pose an important scientific question. In Russia alone, there were more than 2 million extra deaths between 1989 and 1994, above deaths expected on the basis of long-term mortality rates. Identification of factors responsible for these massive changes is important for the Russian policy makers, but it would also provide a major insight into the determinants of health of populations. New prospective studies cannot investigate what happened in the past, and relevant data at the individual level are not available.

Demographers have long used indirect methodologies to estimate mortality in countries without reliable vital statistics. A number of indirect demographic methods using survey or census data, often called 'Brass techniques', have been developed to estimate mortality using information on the survival of close kin such as spouses and parents where conventional data are unavailable. These methods use simple information on the number of close kin such as spouses, parents and siblings and on how many of them have died. We modified the method for literate and numerate populations, and in collaboration with Prof R Rose, University of Strathclyde, and the Russian Agency of Public Research (VCIOM), we conducted two pilot studies in national samples of the Russian population to validate the method. The first pilot study focused on survival of spouses; the mortality risk estimates were remarkably similar to official Russian data, and the findings within the cohort were consistent with the literature (Bobak et al, Bulletin of WHO 2002; 80: 876-81). The second pilot study tested questions on socio-economic circumstances, smoking and drinking habits of siblings of the interviewed subjects; the results were consistent with the hypothesis that low education, smoking and heavy drinking are associated with increased risk of death from all causes and from cardiovascular diseases (Bobak et al, Epidemiology, 2003,14,603-611).

On the basis of these pilot studies, we commissioned an interview survey of a random sample of the Russian population during 2002, collecting data on survival and personal characteristics of their siblings, parents and spouses. 7172 respondents gave information on a total of 21,415 relatives. These relatives form a retrospective convenience cohort. Using these data we have examined a number of questions that are crucial to understanding of the mortality changes during transition, such as whether some groups were more vulnerable during the transition; what was the role of heavy or binge drinking and smoking; whether material hardship in childhood is associated with adult social status and risk of death; and whether there was a clustering of risk of death in families or in certain geographical areas. Results will be published during 2004.

This page last modified 10 August, 2005 by [Content Provider]