|
|
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]
|
|
|