Gender Specific Effects of Early-Life Events on Adult Lifespan

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2
GDP per capita at current prices (dollars) in
Russia and other countries
Country 1990 2000 2010 2012
Russia 3840 1768 10618 14178
China 347 932 4375 6070
Kazakhstan 1849 1266 9380 12455
Ukraine 1746 637 2962 3872
Belarus 1835 1044 5818 6726
Finland 27852 23528 44098 45741
Bulgaria 2350 1613 6459 7004
Mexico 3815 6582 8916 9795
Source http//data.un.org
3
Demographic Indicators of Russia and Kazakhstan
Indicator Russia Kazakhstan
Infant mortality per 1000 live births 7.4 28
Total fertility rate (mean number of children per woman) 1.7 2.6
Percent of persons 65 years of age 13 7
Life expectancy
Men 64 64
Women 76 74
Proportion of urban population, 74 55
Source Population Reference Bureau. 2013 World
Population Data Sheet.
4
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?????? 1992 62.0 73.8
?????? 1993 58.9 71.9
?????? 1994 57.6 71.2
?????? 1997 60.8 72.9
?????? 2000 58.8 71.7
?????? 2012 64.6 75.9
????? 2013 73.0 77.3
????? 2013 66.4 68.7
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1964 ????
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1992 ??????? ???????

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??? ?????? ????? ? 63.8 ??? ? 1990 ?? 57.4 ??? ?
1994. ??? ?????? ????? ? 74.3 ??? ? 1990 ?? 71.1
??? ? 1994
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  35-55 ???.
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????? ???????? ??????? ?????? ?????? ?
???????????? ??? ??? ???????? ? ??????
???????? ?.????????, Demoscope Weekly, N
485-486, 2011
15
1998 ????? ????????????? ??????

• 28 ??????? 1998 ???? ?? ????? ?????????? ???????
  ?????????? ???????? ????????, ?????????????
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  ? ??????

16
?????? 1998 ???? ????????? ???????? ?????????? ?
??????
17
Russian President on Demographic Situation in
Russia(Address to Russian Parliament, May 10,
2006)

• Demographic problem is "the most urgent problem
  of modern Russia"
• Demographic situation is "critical"
• "We talked at lot on this topic but did little."
• Government is "too slow with unacceptable
  bureaucracy in resolving the problem"
• Suggested 10 year program with three priorities
• -- to decrease mortality
• -- effective migration policy
• -- to increase fertility

18
???? ????????? ????????????????? ????? ? ??????
????? 2003 ????
???????? ?.????????, Demoscope Weekly, N
485-486, 2011
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Russian President on How to Decrease
Mortality(Address to Russian Parliament, May 10,
2006)

• Program to prevent traffic accidents and improve
  road safety (high penalties for drunk driving)
• To eradicate production and import of alcohol
  surrogates (poisoned alcohol)
• National Project "Health" focused on prevention
  and treatment of cardiovascular diseases, and
  other major causes of death.
• Smoking ban in public places
• High taxes on hard liquors

20
????? ???????? ??????? ?????? ?????? ?
???????????? ???, 1990-2009
???????? ?.????????, Demoscope Weekly, N
485-486, 2011
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???????, ???????????? ? ?????????? ?? ???????
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???????? ???????? ? ???????????? ??????????
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??????????? ??????? ??????????? ???????? ????????
? 1990-? ?????
25
Age Profiles of Mortality from Accidental
Poisoning by AlcoholData from Russian Vital
Statistics
Males
Females
26
???????? ???????? ???????? ?? ????? ????????
??????

• In 1992 state monopoly on alcohol sales was
  abolished
• Self-production of alcohol became not profitable
  but over 20 of alcohol sales included technical
  alcohol
• Sample control tests showed that proportion of
  below quality standards alcohol was 5.6 in 1992
  and 30.4 in 1994
• Imported alcohol had even lower quality 67.2
  below quality standards

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????????? ????????

• Alcohol surrogates non-food liquids containing
  ethanol (polishing liquids, perfume,
  pharmaceutical tinctures, etc.)
• Alcohol surrogates are cheap, so they are
  attractive to poor persons. May be the only
  source of ethanol for impoverished persons.
• 47 of men who used surrogates were unemployed.
  Only 13 of men not used surrogates were
  unemployed

28
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?????????? ?????? ??????? ?????? (16-39 ???),
??????? ? 2004 ???? ? ????????? ???????
??????? ? ??., Demoscope
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????? ????????????, ??? ???? ?????????? ? 90-?
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?????????????? ?????????? ??????????????
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?????????? ? ??????? ? ?????? 1990-1999
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?????????????????? ???????? ? ?????????? ??
100000 ????????? (1991-1999)
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??????????? ???????????? ?? ???????????????
?????????? ??????? 20-69???, ??????
???????? Shkolnikov et al., SSM, 1998
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??????????? ????????? ????? ?????????
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  ???????? ?? ??????????? ??????????, ????????? ?
  2005?.

36
Current trends in life expectancy in Moscow and
some Eastern European countries
37
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  ???? ? ????????? ??????? (???????? ???????)

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????????? ????????????????? ????? ? ???????
?.???? ? 2012, ???????
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Ethnic Differentials in Mortality
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Based on the Study of Ethnic Differentials in
Adult Mortality in Kyrgyzstan

• Michel Guillot (PI), University of
  Wisconsin-Madison
• Natalia Gavrilova, University of Chicago
• Tetyana Pudrovska, University of Wisconsin-Madison

Demography, 2011, 48(3) 1081-1104
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Background on Kyrgyzstan

• Former Soviet republic became independent in
  1991
• Population 5.2 million (2006)
• Experienced a severe economic depression after
  break-up of Soviet Union
• GNI per capita 440 USD 28th poorest country
  in the world (2005)
• 48 of population below national poverty line
  (2001)

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2008 Workshop, Bishkek
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Workshop in Almaty, 2011
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Ethnic Groups in Kyrgyzstan

• Native Central Asian groups Kazakh, Kyrgyz,
  Tajik, Turkmen, Uzbek (Sunni Muslims)
• Slavs Russian, Ukrainian, Bielorussian
• Kyrgyzstan, 1999 census
• Central Asians 79 of pop. (Kyrgyz 65)
• Slavs 14 of pop. (Russian 12)

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Recorded trends in adult mortality (20-60 years)
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Mortality paradox?

• Soviet period Russians/Slavs occupied dominant
  positions in the socio-economic structure of
  Central Asian societies (Kahn 1993)

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Mortality paradox?

• Slavic females more educated than Central Asian
  females (1989 and 1999 censuses)
• Slavic males educational advantage not so clear
  varies by age (1989 and 1999 censuses)
• Slavic households less poor than Central Asians
  (1993 World Bank poverty survey)
• Infant mortality lower among Slavs (Soviet and
  post-Soviet period)

54
Proportion of individuals with post-secondary
education, by age and ethnicity, in 1989 census.
Females
55
Mortality paradox?

• Slavic females more educated than Central Asian
  females (1989 and 1999 censuses)
• Slavic males educational advantage not so clear
  varies by age (1989 and 1999 censuses)
• Slavic households less poor than Central Asians
  (1993 World Bank poverty survey)
• Infant mortality lower among Slavs (Soviet and
  post-Soviet period)

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Proportion of individuals with post-secondary
education, by age and ethnicity, in 1989 census.
Males.
57
Mortality paradox?

• Slavic females more educated than Central Asian
  females (1989 and 1999 censuses)
• Slavic males educational advantage not so clear
  varies by age (1989 and 1999 censuses)
• Slavic households less poor than Central Asians
  (1993 World Bank poverty survey)
• Infant mortality lower among Slavs (Soviet and
  post-Soviet period)

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Mortality paradox?

• Slavic females more educated than Central Asian
  females (1989 and 1999 censuses)
• Slavic males educational advantage not so clear
  varies by age (1989 and 1999 censuses)
• Slavic households less poor than Central Asians
  (1993 World Bank poverty survey)
• Infant mortality lower among Slavs (Soviet and
  post-Soviet period)

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IMR by ethnicity, 1958-2003, Kyrgyzstan
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Data

• Unpublished population and death tabulations
  since 1959
• collected from local archives
• Individual census records 1999
• Individual death records 1998-1999
• obtained from national statistical office

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Possible explanations for mortality paradox

• Data artifacts
• Migration effects (esp. 1989-99)
• Cultural effects

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Data artifacts?

• Could the lower recorded mortality among Central
  Asian adults be due to lower data quality among
  them (coverage of deaths, age misreporting)?

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Migration effects?

• 1/3 of Russian population has left Kyrgyzstan
  since 1991
• Could the increased disparity between Russian and
  Kyrgyz adult mortality be due to selective
  migration (healthy migrant effect)?

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Cultural effects?

• Culture may affect mortality in various ways
• individual health and lifestyle behaviors (e.g.,
  diet, smoking, alcohol, use of preventive care)
• family structure and social networks (denser
  social networks may produce lower stress levels
  and better health)
• Could different cultural practices among Slavs
  and Central Asians explain the observed mortality
  differentials?

68
Data artifacts?

• Intercensal estimates of death registration
  coverage above age 60 (Guillot, 2004)
• 90 as early as 1959 in urban areas
• coverage in rural areas was low initially (50)
  but caught up with urban areas in 1980s
• Total population 92 for 1989-99 period
• Adult deaths (20-59) usually better reported than
  deaths 60

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Health selection?
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Cohort-specific changes in educational
attainment, Males, 1989-99
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Cohort-specific changes in educational
attainment, Females, 1989-99
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Cultural effects?

• Analysis of causes of death by ethnicity, 1998-99
• Calculations based on micro-data
• Deaths vital registration (1998-99)
• Exposure census (March 1999)
• Ages 20-59
• Ethnicity Central Asians vs. Slavs
• 20,000 death records 2.2 million census
  records

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Age-standardized Death Rates at working ages (per
100000), 1998-99, by cause and ethnicity, Males
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Contribution of causes of death to the difference
in life expectancy at working ages (40e20)
between Slavs and Central Asians Males (total
difference 2.90 years)
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Age-standardized Death Rates at working ages (per
100,000). Detailed Injuries, Males
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Age-standardized Death Rates at working ages (per
100,000), 1998-99, by cause and ethnicity, Females
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Contribution of causes of death to the difference
in life expectancy at working ages (40e20)
between Slavs and Central Asians Females (total
difference .28 years)
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Age-standardized Death Rates at working ages (per
100,000) Detailed Injuries, Females
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Alcohol-related Causes of Death(Chronic
alcoholism, Alcohol psychoses, Alcohol cirrhosis
of the liver, Accidental poisoning by alcohol)
Age-standardized Death Rates at working ages
(per 100,000)
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Multivariate analysis

• Do ethnic mortality differentials at adult ages
  remain once we account for differences in
  education and urban/rural residence?
• Negative binomial regression
• Dependent variable deaths from all causes
  deaths by major cause (7)
• Explanatory variables exposure, dummy variables
  for age, ethnicity, urban/rural residence,
  education (3 cat.)
• Males and Females analyzed separately
• Model 1 age, ethnicity
• Model 2 age, ethnicity, education, residence

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Males, all causes of death
83
Risk Ratio Slavs/CAMales
84
Risk Ratio Slavs/CAFemales
NS
NS
NS
NS
NS
NS
NS
NS
85
Conclusions

• Excess mortality among adult Slavs (Soviet and
  post-Soviet period) is not likely due to data
  artifacts or migration effects
• Excess mortality due to important ethnic
  differences in cause-specific mortality alcohol
  and suicide in particular
• Differences remain unexplained by education or
  residence

86
Conclusions

• Role of cultural characteristics?
• Alcohol tied to cultural practices (culture of
  alcohol among Russians Impact of Islam for
  Central Asians)
• Denser social networks and stronger social
  support among Central Asian ethnic groups?

87
Divergent paths for adult mortality in Russia and
Central AsiaEvidence from Kyrgyzstan
Further developments

• Guillot, M, Gavrilova, N, Torgasheva, L,
  Denisenko, M.
• PLOS ONE, 2013, 8(10) e75314, DOI
  10.1371/journal.pone.0075314

88
Study of autopsies in Barnaul during 1990-2004
(Zaridze et al., 2009)

• Among 5732 autopsied men aged 35-69 years who
  were reported to have died from circulatory
  diseases 49 had alcohol detected in their blood
  and in 21 concentration of ethanol was 4g/l and
  higher (lethal dose)
• Of 5880 autopsied men aged 35-69 years who were
  reported to have died from injuries 76 had
  alcohol in their blood and in 38 concentration
  of ethanol was 4g/l and higher

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Trends in Life Expectancy Men
90
Trends in Life Expectancy Women
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40M20 (Russia) 40M20 (Kyrgyzstan), 1979-2009,
all causes and strongly alcohol related causes
92
Ethnicity, russification and excess mortality in
Kazakhstan
Further developments (2)

• Ethan J. Sharygin and Michel Guillot. Vienna
  Yearbook of Population Research 2013 (Vol. 11),
  pp. 213237

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94
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?? ??????? ?????????????? ??? ?????? ??????
??????, ????????? 1998-1999
?????? 1 ?????.?? ???????? ? ???????. ?????? 2
????????????? ?????. ?? ??? ????????? ?
???????????. ?????????? ?????????????.
95
Framework for Understanding Health Crisis in
Russia vs. Central Asia
Russia Kyrgyzstan (Central Asia?)
Infant mortality Declined Stalled
Adult mortality Large increase Moderate increase
Explanatory framework Greater importance of detrimental adult health behaviors Greater importance of health care deterioration
96
Acknowledgements

• National Statistical Committee of the Kyrgyz
  Republic
• Zarylbek Kudabaev, Orozmat Abdykalykov, Liudmila
  Torgashova, Larissa Mimbaeva, Elena Komandirova
  and Mikhail Denisenko
• NICHD R03 HD38752, R01 HD045531