Gender Specific Effects of Early-Life Events on Adult Lifespan

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Causes of death and their classification

• Established by the World Health Organization as
  International Classification of Diseases (ICD)
• Has several revisions. The most recent revision
  is the 10th revision. Adopted by most countries
  in the mid 1990s

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Classification of causes of death in Russia

• Classification of causes of death used in the
  Soviet statistical forms was different from WHO
  classification.
• Form 5 (later called form C51) had 185 causes of
  death.
• Main differences between WHO and Soviet
  classification are found in the groups of CVD and
  injuries

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New classification of causes of death in Russia

• After dissolution of the Soviet Union most FSU
  countries continued to use the old classification
  of causes of death
• In 1999 Russia adopted a new classification of
  causes of death corresponding to the 10th ICD
  revision
• Still incompatible with the WHO classification

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Selected Causes of Death
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Major causes of death within the group of
injuries. Men
??????? ? ??., Demoscope Weekly, N181-182, 2004
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Major causes of death within the group of
injuries. Women
??????? ? ??., Demoscope Weekly, N181-182, 2004
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Degradation of mortality statistics in Russia
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Pace of Growth of Age-Adjusted Mortality in
1989-2000 for Classes of Causes of Death
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Proportion of deaths from ill-defined conditions
is a measure of quality of mortality
statisticsProportion higher than 5 indicates
poor qualityIn developed countries most deaths
from ill-defined conditions are diagnosed at
older ages
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Is this increase in mortality from ill-defined
conditions related to more cases of deaths from
senility?
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Age Profile of Mortality from Ill-Defined
Conditions in Russia
Males
Females
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Top Five Causes of Death for Young Adult Males
(20-24)
1990 2001
Injuries Injuries
Neoplasms Symptoms, Signs and Ill-Defined Conditions
Diseases of Circulatory System Infectious Diseases
Symptoms, Signs and Ill-Defined Conditions Neoplasms
Diseases of Nervous System and Sens.Organs Diseases of Respiratory System
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Top Five Causes of Death for Young Adult Females
(20-24)
1990 2001
Injuries Injuries
Neoplasms Neoplasms
Diseases of Circulatory System Diseases of Circulatory System
Complications of Pregnancy and Childbearing Symptoms, Signs and Ill-Defined Conditions
Diseases of Nervous System and Sens.Organs Infectious Diseases
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Which Causes of Death Are Hidden Behind the
Ill-Defined Conditions?
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We Used Individual Death Certificates With More
Detailed Description of Circumstances of Death
Collected by Kirov Department of Health Kirov
is a Typical Russian Region with Lower than
Average Mortality from Ill-Defined Conditions
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Age-Adjusted Mortality from Injuries in 1996 for
Russian Males Aged 0-64 yearsData from the
WebAtlas Project (http//sci.aha.ru/ATL)
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Deaths from Ill-Defined Conditions in Kirov
Region of Russia in 2003

• Sudden infant death (R95)
  3.3
• Decomposition in water (river, well, pond) (R99)
  13.0
• Decomposition at home (R99)
  53.5
• Decomposition in garden, summer house (R99)
  1.7
• Decomposition in forest or field (R99)
  6.0
• Decomposition in nonresidential building, on the
  street (R99)
  
  12.3
• Decomposition in water pipe (R99)
  0.7
• Decomposition on the cemetery (R99)
  0.3
• Decomposition in bath, lavatory or barn (R99)
  1.0
• Decomposition in other place (R99)
  5.5
• unknown (R99)
  2.3
• senility (R54)
  0.3

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Ill-defined conditions and external deaths of
undetermined intent are two sides of the same
coinIt appears that both causes of death may be
used for concealing criminal cases of violent
death
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Mortality in Moscow city
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Top Five Causes of External Mortality in Russia
and Moscow in 2001
Russia Moscow
Suicide Accidental Falls
Undetermined Injury Undetermined Injury
Homicide All Other Accidental Causes
Accidental Poisoning by Alcohol Homicide
All Other Accidental Causes Suicide
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Autopsies in Russia

• Autopsies are used to verify cause of death
• Autopsy is mandatory for violent death, death of
  woman during pregnancy, labor or postpartum
  period, death of infant below 1 year, death from
  cancer not supported morphologically, death from
  any infectious disease

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Situation with medical examiner services

• Only 34-48 of jobs are filled by physicians
• 38-54 of jobs are filled by histologists
• 35 of workers reached retirement age

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Additional reading

• Gavrilova N.S., Semyonova V.G., Dubrovina E.,
  Evdokushkina G.N., Ivanova A.E., Gavrilov L.A.
  Russian Mortality Crisis and the Quality of Vital
  Statistics. Population Research and Policy
  Review, 2008, 27 551-574.

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Measures of Mortality

• Crude Death Rate
• Age-Specific Death Rates (Age-Specific Mortality
  Rates)
• Age-Adjusted Mortality Rates (Standardized
  Mortality Rates)
• Life Expectancy (at birth or other age)
• Measures of Infant Mortality

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Crude Death Rate

• Number of deaths in a population during a
  specified time period, divided by the population
  size "at risk" of dying during that study period.
  
• For one-year period, Crude Death Rate,
• CDR  Deaths in that year /mid-year
  population size
• x 1,000  to adjust for standard-sized
  population of 1,000 persons
• mid-year population total population for
  July 1

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Crude Death Rate Pros and Cons

• Pros - Easy to calculate, and require less
  detailed data than other mortality measures -
  Useful for calculation of the rate of natural
  increase (crude birth rate minus crude death
  rate)
• Cons - Depends on population age structure
  (proportions of younger and older people)

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Trends in crude death rates (per 1,000) for
Russia, USA and Estonia
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Distribution of crude death rates (per 1,000) in
Russia, 2003
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Age-Specific Death Rates (ASDR) or Age-Specific
Mortality Rates (ASMR)

• Number of deaths in a specific age group during a
  specified time period, divided by the size of
  this specific age group during that study period.
  Example For one-year study period,
  Age-Specific Death Rates, ASDR for males at age
  45-49 years    Deaths to males aged 45-49 in
  that year / Number of males aged 45-49 at
  mid-year x 1,000  to adjust for standard-sized
  population of 1,000 persons of that age.

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Age-Specific Death Rates Pros and Cons

• Pros - Allows to study mortality by age (and
  sex)
• Cons - Requires detailed data on deaths by age
  (not always available for developing countries,
  war and crisis periods, historical studies)

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Infant Mortality Rate, IMR

• Proportion of infants who die in their first year
  Number of deaths under age one during a
  specified time period, divided by the number of
  live births For one-year period, Infant
  Mortality Rate

x 1,000  to standardize per 1,000 live births
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Infant Mortality Rate Pros and Cons

• Pros
• - Sensitive indicator of overall health
  conditions in a country, particularly child
  health
• - Useful for indirect estimates of mortality in
  other age groups through imputation, using the
  so-called "model life tables"
• Cons
• - Requires accurate data on births and infant
  deaths (not always available for developing
  countries, war and crisis periods, historical
  studies)

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Changes in infant mortality in Russia, USA and
Estonia
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Definition of live birth in the USSR was not
consistent with WHO definition

• WHO definition of live birth "the complete
  expulsion or extraction from its mother of a
  product of conception, irrespective of the
  duration of pregnancy which, after such
  separation, breathes or shows any other evidence
  of life, such as beating of the heart, pulsation
  of the umbilical cord or definitive movement of
  voluntary muscles, whether or not the umbilical
  cord has been cut or the placenta is attached.
• The Soviet Union adopted a less inclusive
  definition, excluding infants born before 28
  weeks and those weighing less than 1000 grams,
  regardless of signs of life.
• Soviet definition resulted in underestimation of
  infant mortality
• After getting independence, many FSU countries
  adopted WHO definition of live birth

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Distribution of infant mortality in Russian
regions, 2003
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????????????????? ??????????

• ????????????????? ??????????? (?????? ?????)
• ????????????????? ????????? ??????????
• ????????????? ???? ?????????? ?????

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Age-adjusted death rate (ADR), standardized death
rate (SDR) or age-standardized death rate (ASDR)

• Death rate expected if the studied population had
  the age distribution of another "standard"
  population (arbitrary chosen for the purpose of
  comparison). Calculated as weighted average 
  (with weights being proportions of the "standard"
  population at each age)

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Age-Adjusted Death Rate or Age-Standardized
Death Rate

• Direct method of age standardization

• Mui is mortality rate in the studied population
  at age i
• Psi number of persons at age i in the standard
  population. Ps total standard population.

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Age-Adjusted Death Rate or Age-Standardized
Death Rate

• Pros - Allows comparison of death rates of
  populations despite differences in their age
  distribution
• Cons - Requires data on death rates by age (not
  always available for developing countries, war
  and crisis periods, historical studies) -
  Results of comparison may depend on the arbitrary
  choice of standard.

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????????????????? ????????? ?????????? ???
Standardized mortality ratio
??? Du - ????????? ????? ??????? ? ?????????
?????????, Msi - ??????????? ?????????? ?
??????????? ????????? ? ?????????? ?????? i, Pui
- ??????????? ????????? ? ?????????? ?????? i ???
????????? ?????????
43
????????????????? ????????? ??????????

• ??????? ???????????? ??? ????????? ???????? ?
  ?????? ?????? ??????
• ?? ??????????? ????????????? ?????? ??????????
  ????????????? ??????? ?? ???? ??????

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????????????? ???? ?????????? ????? Potential
Years of Life Lost (PYLL)
??? T - ??????? ?????????? ???????, ??
???????? ?????????????? ????????? (?????? 70 ???
65 ???), x - ???????? ????????????????
??????????? ?????????.
?????????? ???? ????????????? ?????
?????????????? ??? ????? ???????????? ?????
??????? ?? ????????? ???? ? ?????? ??????????
??????
??????????? ?????????? ??? ????????????? ?????
?????????????? ??????????????   RatePYLL
PYLL/Pu ??? Pu - ??????????? ?????????? ?????????
? ???????? ?? 1 ?? T.
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The Concept of Life Table

• Life table is a classic demographic format of
  describing a population's mortality experience
  with age. Life Table is built of a number of
  standard numerical columns representing various
  indicators of mortality and survival. The
  concept of life table was first suggested in 1662
  by John Graunt. Before the 17th century, death
  was believed to be a magical or sacred phenomenon
  that could not and should not be quantified.  The
  invention of life table was a scientific
  breakthrough in mortality studies.

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Life Table

• Cohort life table as a simple example
• Consider survival in the cohort of fruit flies
  born in the same time

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Number of dying, d(x)
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Number of survivors, l(x)
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Number of survivors at the beginning of the next
age interval

• l(x1) l(x) d(x)

Probability of death in the age interval
q(x) d(x)/l(x)
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Probability of death, q(x)
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Person-years lived in the interval, L(x)
L(x) are needed to calculate life expectancy.
Life expectancy, e(x), is defined as an average
number of years lived after certain age. L(x) are
also used in calculation of net reproduction rate
(NRR)
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Calculation of life expectancy, e(x)
Life expectancy at birth is estimated as an area
below the survival curve divided by the number of
individuals at birth
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Life expectancy, e(x)

• T(x) L(x) L?
• where L? is L(x) for the last age interval.
• Summation starts from the last age interval
  and goes back to the age at which life expectancy
  is calculated.
• e(x) T(x)/l(x)
• where x 0, 1, ,?

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Life Tables for Human Populations

• In the majority of cases life tables for humans
  are constructed for hypothetic birth cohort using
  cross-sectional data
• Such life tables are called period life tables
• Construction of period life tables starts from
  q(x) values rather than l(x) or d(x) as in the
  case of experimental animals

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Formula for q(x) using age-specific mortality
rates
a(x) called the fraction of the last interval of
life is usually equal to 0.5 for all ages except
for the first age (from 0 to 1) Having q(x)
calculated, data for all other life table columns
are estimated using standard formulas.
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Life table probabilities of death, q(x), for men
in Russia and USA. 2005
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Period life table for hypothetical population

• Number of survivors, l(x), at the beginning is
  equal to 100,000
• This initial number of l(x) is called the radix
  of life table

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Life table number of survivors, l(x), for men in
Russia and USA. 2005.
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Life table number of dying, d(x), for men in
Russia and USA. 2005
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Life expectancy, e(x), for men in Russia and USA.
2005
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Trends in life expectancy for men in Russia, USA
and Estonia
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Distribution of life expectancy, Men, 1999
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Special methods based on life table approach

• ??????? ?????????? ?????????????? ???????
• ??????? ?????????? ??? ?????????? ??????? ??????
• ???????????? ????????? ????????????????? ?????

64
??????? ?????????? ?????????????? ???????

• Multiple decrement life tables
• ????? ???????????? ??? ?????????? ??????
  ?????????? ?? ????????
• ?????????? ?????? ?? ????????? ??????

65
??????? ?????????? ?????????????? ??????? ?????
??????????

• ????????? ??????? ??????? ?????????? ?? ????
  ??????
• ?????????? ??????????? ?????? ?? ??????? k

66
??????? ?????????? ?????????????? ??????? ?????
?????????? (???????????)

• ?????????? ????? ??????????? ?? ??????? k ?
  ????????? (x, xn)
• ?????????? ????? ???????? ?? ???????? y ??? ???,
  ??? ? ??????? ??????????? ????? ????? ?? ???????
  k

67
??????? ?????????? ?????????????? ??????? ?????
?????????? (???????????)

• ?????????? ??????????? ??????? ?? ?????? ???????
  ? ??????? ?????
• lk/l0
• ?????????? ??????? ????????? ??????? ???????,
  ????????? ?????????????? Lkx ? Tkx
• ?????????????? ??? ?? ??? ?????????
  ????????????????? ????? ? ??????? ???????

68
??????? ????????? ??????? ?????? ?? ????????,
??????? ??????
????? ?., ?????? ? ????? 2006
69
??????????? ??? ?????????????? ??????? ??
?????????? ????? ?? ???? ????? ?????? ?????? (??
100 ??????????), ??????? ??????
??? ? ???????. ?????? ??? ????? ?., ?????? ?
????? 2006
70
????????? ????????? ?????????? ?????? ?????? ?
???????? ?????. 1965 ???
????? ?., ?????? ? ????? 2006
71
????????? ????????? ?????????? ?????? ?????? ?
???????? ?????. 2004 ???
????? ?., ?????? ? ????? 2006
72
???????????? ????????????????? ????? ?? ????????
? ???????? ??????
73
????? ????????????

• ????????? ????????? (1982), ????????? (1982) ?
  ???????? (1984)

74
???????????? ?? ????????
??? ???????? lx, Lx, Tx ???????????? ?????
??????????? ???????? ?? ??????? ???????
??????????, ? ??????? 1 ? 2 ????????????? ??
?????????? ? ???????, ? ????????? 1 ? ????????? 2
?????????????? (?? ???? ???? ????????????
??????????).
?????????? ?????????? ??????? ??????? ??????????
??? ???? ???????????? ?????????
75
???????????? ?? ????????
????????? ???????? ?????????? ????????
76
???????????? ?????? ????????? ?????? ? ????????
?? ????????????????? ?????
??? Rix ?????????? ????????? ??????? ?? ??????? i
? ?????????? ?????? (x, xn), ?? ???? Dix/Dx. ?
?????? ?????? Dix ????????????? ???????????? ????
??????? ?? ??????? i ? ?????????? ????????? (x,
xn), ? Dx - ?????????????? ????? ??????? ??
???? ??????.
77
???????????? ?? ???????? ??????
??????? (1) ? (2) ???????????? ????????????
??????????. ???????? mx ???????????? ?????????
????????????? ?????????? ?? ???? ??????, ???????
????? ???????? ?? ??????? ??????? ??????????,
????????? mx dx/Lx. ? ?????? ??????? ????????
?x ????????????? ?????? ???????? ? ?????????? ??
???? ?????? ? ?????????? ????????? (x, xn) ?
??????????? ???????? ? ?????????
????????????????? ?????. ????? ????????, ??? ?
????? ???
78
Decomposition of the U.S.-Russia gap in life
expectancy by cause
USA 1999 Russia 2001. Source Shkolnikov et
a. Mortality reversal in Russia.
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Decomposition of the U.S.-Russia gap in life
expectancy by cause
USA 1999 Russia 2001. Source Shkolnikov et
a. Mortality reversal in Russia.
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Contribution of different causes of death to
changes in LE, men
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Contribution of different causes of death to
changes in LE, women
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Age and cause components of LE increase due to
anti-alcohol campaign Men
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Age and cause components of LE increase due to
anti-alcohol campaign Women
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Contribution of causes of death to 40e20(CA) -
40e20(Slav)Males (total difference 2.90 years)
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Contribution of causes of death to 40e20(CA) -
40e20(Slav)Females (total difference .28 years)
86
Additional reading

• Preston S. H., Heuveline P., Guillot M.
  Demography. Measuring and modeling population
  processes. Blackwell Publ., Oxford, 2001.
•  

87
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88
??????? ?????????? ??? ?????????? ??????? ??????

• ?????????? ???????? ???????????? ????????????
  ??????????
• ????? ????? (1978) ????????? ??????????????????
  ?????????? ?? ????????? ??????

89
???????? ??????? ??? ??????? ??????? ??????????
??? ?????????? ??????? ??????
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? ???????, ? ??? ????, ??? ?????????? ????????? ?
??????, ????? ??????? ?????? k ?????????.
??????????? ?????????????????? rk ????? ????????
?? ????????? ??????????? ????? ??????? ? ??????
?????????? ?????????