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Between 1995-1999 there was significant regional variation in life expectancy, infant, child mortality and maternal mortality in Russia.
Life Expectancy
In 1995-1999 average life expectancy at birth in Russia was 66.05 years. There were considerable variations across the regions but in general the Eastern region had worse life expectancy than Western regions (figure 3). The two regions with the lowest life expectancy were The Republic of Tuva (56.5 years) and Sakalin region (61.6 years). The highest life expectancy was recorded in the North Caucasian Republics of Ingushetia (72.3 years) and Dagestan (70.5 years). After excluding the four North Caucasian Republics, Belgorod Oblast has the next highest life expectancy at birth for both sexes (68.6 years) and is known to have good death registration data.
Regional variation in life expectancy at birth in Russia (1995-1999)
Infant and Child Mortality (1-4 year olds)
Between 1995-1999 the average Infant Mortality rate for Russia was 17.2 deaths per 1000 births. Infant Mortality rates ranged from 11.7 in St Petersburg City and Leningrad Oblast to over 32 in the Republic of Tuva (32.3) and Chucki autonomous Okrug (32.1). In general, the lowest levels of infant mortality rate were found in the Northern and central parts of European Russia. Rates were generally higher in the East with many of the highest rates in territories located in Southern Siberia. We found that there was no relationship between infant mortality rate and fertility levels in the regions of Russia between 1995-1999.
The average death rate in Russia for 1-4 year olds was 4.1 deaths per 1000. This varied from 2.3 (Murmansk oblast) to 14.6 (Republic of Tuva). The areas with the lowest levels of mortality in the 1-4 year age group are concentrated in the centre and north of European Russia, while the highest mortality rates are concentrated in the east, particularly in Southern Siberia.
Regional variation in infant mortality rates (per 1000) in Russia (1995-1999)
Regional variation in probability of death at ages 1-4 (per 1000) in Russia (1995-1999)
Maternal Mortality
Between 1995 and 1999 the maternal mortality rate in Russia was 48.2 per 100,000 live births. Across the regions maternal mortality varied nearly 10 times, ranging, from 15.9 in Ingushetia to 152 in the Republic of Tuva. The highest rates of maternal mortality are in eastern territories. The lowest rates of maternal mortality are mainly in European Russia and in two North Caucasian Republics. However, the very low maternal mortality in North Caucasian republics might result from under-registration as discussed earlier. We found that there was no significant correlation between rates of abortion (number of therapeutic abortion per 1000 women ages 15-49) and maternal mortality rates across the regions. This is surprising, as abortion is still the largest cause of maternal mortality in Russia.
The 3-10 fold differences in infant, child and maternal mortality, as well as the 7 year difference in life expectancy reflect consistent regional patterns of ill health across Russia. These indicators reveal that the poorest health is consistently found in Eastern regions of Russia (the worst off being the Republic of Tuva), while the best health is found in the West, particularly the northern and central parts of European Russia.
Regional variation in maternal mortality rates per 100,000 in Russia (1995-1999)
The role of alcohol
This project has provided important new insights into the role of alcohol in premature mortality in this region. The suspicion that alcohol was much more important than had previously been recognised arose from the observation that death rates from certain causes fell substantially between 1985 and 1986, coinciding with what is now recognised as, at least initially, a strikingly successful anti-alcohol campaign. The campaign was, however, short-lived, and as its effectiveness declined, coinciding with extensive production of illicit alcohol, deaths from those causes and in those age groups that had seen an earlier improvement began to increase again. Importantly, after 1991, when the Soviet Union broke up, it was again these cases of death that contributed most to the catastrophic decline in life expectancy.
For many of the causes of death involved, a link with alcohol was uncontroversial. Examples include injuries and violence and acute alcohol poisoning. The argument concerning cardiovascular disease, which behaved in the same way, was more problematic. A widely held view, based on many large studies in western countries, is that alcohol, at least when consumed regularly and in moderate amounts reduces the risk of heart disease. Thus it is difficult to see how a reduction in alcohol consumption could lead to a fall in cardiovascular deaths, or a rise in consumption to an increase in deaths.
In a survey of alcohol consumption in Russia we confirmed what was widely known, that drinking typically took place in binges, with large quantities of, typically, vodka, consumed at one go. We then undertook a systematic review of the published literature on alcohol and heart disease. This showed that few studies had looked at the pattern of drinking, simply averaging consumption over a week. Those few studies that did consistently found a strong association between binge drinking, measured either directly or indirectly (such as problem drinking, arrests for drunkenness etc.) and death from heart disease. The association was strongest with sudden cardiac death.
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