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Vladimir M Shkolnikov

Publications and source records attributed to Vladimir M Shkolnikov.

10 recordsLinked to original sources
PubMed2006

Linked versus unlinked estimates of mortality and length of life by education and marital status: evidence from the first record linkage study in Lithuania.

Earlier studies have found large and increasing with time differences in mortality by education and marital status in post-Soviet countries. Their results are based on independent tabulations of population and deaths counts (unlinked data). The present study provides the first census-linked estimates of group-specific mortality and the first comparison between census-linked and unlinked mortality estimates for a post-Soviet country. The study is based on a data set linking 140,000 deaths occurring in 2001-2004 in Lithuania with the population census of 2001. The same socio-demographic information about the deceased is available from both the census and death records. Cross-tabulations and Poisson regressions are used to compare linked and unlinked data. Linked and unlinked estimates of life expectancies and mortality rate ratios are calculated with standard life table techniques and Poisson regressions. For the two socio-demographic variables under study, the values from the death records partly differ from those from the census records. The deviations are especially significant for education, with 72-73%, 66-67%, and 82-84% matching for higher education, secondary education, and lower education, respectively. For marital status, deviations are less frequent. For education and marital status, unlinked estimates tend to overstate mortality in disadvantaged groups and they understate mortality in advantaged groups. The differences in inter-group life expectancy and the mortality rate ratios thus are significantly overestimated in the unlinked data. Socio-demographic differences in mortality previously observed in Lithuania and possibly other post-Soviet countries are overestimated. The growth in inequalities over the 1990s is real but might be overstated. The results of this study confirm the existence of large and widening health inequalities but call for better data.

Adult↗
PubMed2006

The changing relation between education and life expectancy in central and eastern Europe in the 1990s.

BACKGROUND: The political and social transition in central and eastern Europe has been generally associated with widening educational differences in life expectancy. However, interpretation of these findings is complicated because the size of educational categories within the population has also changed. It is therefore important to disentangle these two phenomena. SETTING: The Czech Republic, Estonia, the Russian Federation and, as a western European reference, Finland, in two periods, 1988-89 and 1998-99. METHODS: Life tables were calculated in three categories: university; secondary; and less than secondary education. Changes in life expectancy were decomposed into contributions of population composition and within-category mortality. RESULTS: In Finland and the Czech Republic improvements are seen in all educational groups, with only a slight widening of the educational differences. Over 80% of the total life expectancy increase is attributable to improved mortality within educational categories. In Estonia and Russia, less favourable overall trends coincide with a dramatic widening of the educational gap. A decrease in life expectancy in those with low and middle education has been compensated for, to a small degree in Russia but a greater extent in Estonia, by improvements among those with higher education and by the improved population composition. For highly educated Estonians, the gains were seen at all ages, the greatest at age > or =60 years. In Russia mortality increased in those <60 years although compensated for by improvements at older ages. CONCLUSIONS: Russia and Estonia exhibit much less equitable transitions compared with the Czech Republic. Analyses of trends in health inequalities should capture the changing population composition. In Russia and Estonia an improved educational structure prevented an even greater decline in life expectancy. The highly educated Estonians can potentially catalyse a wider health progress.

Adult↗
PubMed2004

Health expectancy in the Russian Federation: a new perspective on the health divide in Europe.

OBJECTIVES: To compare life expectancy and healthy life expectancy in the Russian Federation and in countries of Eastern and Western Europe. METHODS: WHO mortality data and data on self-reported health from the World Values Survey and the Russian Longitudinal Monitoring Survey were used to compare the above three regions. Life expectancy was calculated using Sullivan's method, with years of life lived divided into healthy and unhealthy. The gap in healthy life expectancy between the Russian Federation and Western Europe was examined by decomposing the difference by gender and age. FINDINGS: The probability of remaining alive and healthy declines faster in the Russian Federation than in Western Europe, with the gap between Eastern Europe and the Russian Federation widening at older ages. In the Russian Federation, this rapid decline is due mainly to the high probability of death or of poor health for men and women, respectively. CONCLUSIONS: There is a large toll of premature male mortality in the Russian Federation but there also appears to be a substantial burden of ill-health among women. As in other countries, the responses of men and women to adversity differ, leading to premature death in men but survival in a poor state of health in women. Epidemiological studies including objective measures of health would help policy-makers to estimate more precisely the scale and nature of this problem. Policy-makers must recognize that health expectancy in the Russian Federation is reduced in both men and women.

Europe↗
PubMed2004

The peculiar pattern of mortality of Jews in Moscow, 1993-95.

Russian Jews, particularly men, have a large mortality advantage compared with the general Russian population. We consider possible explanations for this advantage using data on 445,000 deaths in Moscow, 1993-95. Log-linear analysis of the distribution of deaths by sex, age, ethnic group, and cause of death reveals a relatively high concentration of endogenous causes and a relatively low concentration of exogenous and behaviourally induced causes among Jews. There is also a significant concentration of deaths from breast cancer among Jewish women. Mortality estimates using the 1994 micro-census population as the denominator reveal an 11-year Russian-Jewish gap in the life expectancy of males at age 20, but only a 2-year life-expectancy gap for women. Only 40 per cent of the Russian-Jewish difference for men, but the entire difference for women, can be eliminated by adjustment for educational differences between the two ethnic groups. Similarities with other Jewish populations and possible explanations are discussed.

Age Distribution↗
PubMed2003

The evolving pattern of avoidable mortality in Russia.

BACKGROUND: Life expectancy at birth in Russia is over 12 years less than in western Europe. This study explores the possible role of medical care in explaining this gap by examining the evolving pattern of mortality amenable to timely and effective medical care in Russia compared with Estonia, Latvia, and Lithuania, and the UK. METHODS: Analysis of standardized death rates from causes amenable to health care (treatable) or inter-sectoral health policies (preventable) in all regions and decomposition of differences in life expectancy between Russia and the UK by age, sex, and cause of death for the period 1965-1999/2000. RESULTS: Death rates from treatable causes remained stable between the mid-1960s and mid-1980s in Russia and the Baltic republics while steadily falling in the UK to less than half the rate in Russia. In the 1990s, rates increased in the former Soviet republics, reaching a peak in 1994 but reversing again in Russia in 1998. Deaths from causes amenable to inter-sectoral health interventions were higher in the UK in 1965 than in the Soviet Union but subsequently fell steadily while they increased in the East. Between 1965 and 1999, the male life expectancy gap between Russia and the UK rose from 3.6 to 15.1 years (women: 1.6 and 7.4 years). Treatable causes became an increasingly important contributor to this gap, accounting for almost 3 years by the end of the 1990s in men and 2 years in women. In Russia, elimination of treatable causes of death would have increased life expectancy by 2.9 years in men in 1995/99 compared with 1.2 years in the UK (women: 3.3 and 1.8 years), suggesting that, were the outcomes of health care achieved in the UK to be obtained in Russia, life expectancy for men might improve by about 1.7 years and for women by about 1.5 years. CONCLUSIONS: Our findings suggest that the Soviet health care system has failed to match the achievements of the West over the past three decades, highlighting the need to establish a system that provides effective and equitable care for the Russian population.

Adolescent↗
PubMed2002

The changing nature of murder in Russia.

The death rate from homicide in Russia increased rapidly during the 1990 s. It is now about 20 times higher than in western Europe and is among the highest recorded anywhere in the world. However, this issue has received little attention so far from public health researchers or policymakers. This paper describes the changing nature of homicide during the 1990 s in Russia as a whole and, in more detail, in the Udmurt Republic. The study uses data from three sources: routine mortality data for Russia from 1970 to 1999; statistics on criminal investigations and convictions in Russia between 1990 and 1997; and an in-depth study of homicide trial records in the Udmurt Republic in 1989-1991 and 1998.Deaths from homicide increased between 1970 and 1985, falling slightly during the 1985 anti-alcohol campaign and then resuming their increase until 1994. Another fall in the late 1990 s was arrested in 1998, with an increase in 1999. By 1999 the age standardised homicide death rate in Russia was 81% higher than in 1990, an increase almost twice that of all causes of death combined. Throughout the 1990 s about 10% of those convicted of homicide were female. Of those homicides leading to convictions in the Udmurt Republic, 71% of those killed by males were male, as were 76% of those killed by females. Killings of women by men often involved sexual assaults. In Russia as a whole, about 80% of those convicted of homicide were reported to be under the influence of alcohol at the time. In the Udmurt Republic, where data on both offender and victim were available, victims were also commonly intoxicated. The nature of homicide in Russia has changed considerably in less than a decade, with many more now involving aggravating circumstances, such as murder to conceal another crime, in association with robbery or rape, or by a group of people. Although still a small proportion of the total convicted, the number of murders by hired killers is also on the rise. The characteristics of those convicted of homicide have also changed during the 1990 s. They are now younger, less likely to have previous convictions, and to have a more diverse range of educational levels. The previous urban-rural gap, with higher levels in rural areas, has also narrowed.

Adolescent↗
PubMed2002

What targets for international development policies are appropriate for improving health in Russia?

BACKGROUND: The OECD countries and the United Nations have agreed to co-ordinate their work around a series of International Development Targets. The targets for health are based on improvements in infant, child and maternal mortality. Progress towards these goals will be used to assess the effectiveness of development policies. OBJECTIVES: To assess the potential impact of achievement of the International Development Targets on health in Russia, and to identify possible alternatives that may be more relevant to transition countries. DESIGN: The study covered the population of the Russian Federation from 1995-99. The effects of reducing infant, child and maternal mortality on Russian life expectancy at birth were modelled using construction of life tables. Three scenarios were modelled, reducing rates to those of the best performing regions in Russia, those required to achieve the International Development Targets and current UK rates. The results were compared with the effect on life expectancy at birth of policies to reduce adult mortality in different ways. RESULTS: Achieving the International Development Targets for infant, child and maternal mortality (66.7 and 75% reductions) will contribute very little to improving life expectancy in Russia (0.96 years). In contrast, even a 20% reduction in adult mortality would give rise to an increase in male life expectancy at birth of 1.86 years. CONCLUSION: Targets for health improvement in transition countries such as Russia should take account of adult mortality as well as the indicators contained in the International Development Targets.

Adult↗
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Alcohol Drinking↗