Demography of Russia and
the Former Soviet Union
Lecture 8
Sociology SOCI 20182
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.
Life Table


Cohort life table as a simple
example
Consider survival in the cohort of
fruit flies born in the same time
Number of dying, d(x)
Number of survivors, l(x)
Number of survivors at the
beginning of the next age interval:
l(x+1) = l(x) – d(x)
Probability of death in the age
interval:
q(x) = d(x)/l(x)
Probability of death, q(x)
Person-years lived in the interval, L(x)
Lx = x
lx + lx +
x
2
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)
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
Life expectancy, e(x)


T(x) = L(x) + … + Lω
where Lω 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, …,ω
Life Tables for Human Populations



In the majority of cases life tables for
humans are constructed for
hypothetic birth cohort using crosssectional 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
Formula for q(x) using
age-specific mortality rates
qx =
Mx
1 + (1
ax ) Mx
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.
Life table probabilities of death, q(x), for
men in Russia and USA. 2005
1
0
10
20
30
40
50
60
log(q(x))
0.1
0.01
0.001
0.0001
Age
Russia
USA
70
80
90
100
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
Life table number of survivors, l(x), for men
in Russia and USA. 2005.
120000
100000
80000
Russia
60000
USA
40000
20000
0
0
10
20
30
40
50
60
70
80
90
100
Life table number of dying, d(x), for men in
Russia and USA. 2005
Russia
USA
3500
3000
d(x)
2500
2000
1500
1000
500
0
0
10
20
30
40
50
Age
60
70
80
90
100
e(x)
Life expectancy, e(x), for men in Russia and
USA. 2005
80
70
60
50
40
30
20
10
0
Russia
USA
0
10
20
30
40
50
Age
60
70
80
90 100
Trends in life expectancy for men
in Russia, USA and Estonia
Trends in life expectancy for
women in Russia, USA and Estonia
Distribution of life expectancy,
Men, 1999
Distribution of life expectancy,
Women, 1999
Mortality reversal




Situation when the usual time trend of declining
mortality is reversed (mortality is increasing over
time).
Observed in sub-Saharan Africa (AIDS
epidemic), Eastern Europe, and FSU countries
including Russia.
Mortality Reversal in FSU countries and Russia is
particularly strong among male population, with
excess mortality at ages about 35-55 years.
Particularly high increase in mortality from
violence and accidents among manual workers
and low education groups.
Decline of life expectancy at age 15
between 1998-2005. Men
Decline of life expectancy at age 15
between 1998-2005. Women
Recent changes in life expectancy in Russia
Men
Women
80.00
Life expectancy at birth
75.00
70.00
65.00
60.00
55.00
Source: Goskomstat Russia
20
08
20
06
20
04
20
02
20
00
19
98
19
96
19
94
19
92
19
90
50.00
The theory of epidemiological
transition

Omran, Abdel R. 1971. The
epidemiologic transition: A theory of
the epidemiology of population
change. Milbank Memorial Fund
Quaterly, 29: 509-538
Definition

The epidemiologic transition is that
process by which the pattern of
mortality and disease is transformed
from one of high mortality among
infants and children and episodic famine
and epidemic affecting all age groups to
one of degenerative and man-made
diseases (such as those attributed to
smoking) affecting principally the
elderly. (Encyclopedia Britannica)
Stages of the Epidemiologic
Transition



Pestilence and Famine
Receding Pandemics
Degenerative and man-made diseases
Three stages of epidemiological
transition (Omran)



“The Age of Pestilence and Famine when
mortality is high and fluctuating, thus
precluding sustained population growth.”
LE – 20-40 years
“The Age of Receding Pandemics when
mortality declines progressively. LE
increases steadily from 30 to 50 years.
Sustained population growth
“The Age of Degenerative and Man-Made
Diseases when mortality continues to
decline and eventually approaches
stability.” LE exceeds 50 years.
•The shifts in disease patterns in
the 19th century were primarily
related to changing in socioeconomic development.
In the 20th Century more related
with disease control activities
independent of socio-economic
development:
e.g. Mexico, China
The fourth stage


It was believed that by the 1970s life
expectancy reached a plateau
corresponding to the biological limit to
human life
However around that time many Western
countries started to demonstrate an
increase in life expectancy mainly due to
successful prevention and treatment of
cardiovascular disease. This resulted in a
rapid decline of mortality, particularly at
older ages.
Historical changes in the
Gompertz-Makeham
mortality components
μ(x) = A + R e
Makeham component
declined in history (from
1900 to 1970) to very low
values close to zero
αx
Gompertz component
remained relatively
stable during this
period
Gavrilov et al. 1983. Human life span stopped increasing: Why?
Gerontology, 29(3): 176-180
Available: http://longevity-science.org/Mortality-Limits-1983.pdf
Historical Changes in Mortality
Swedish Females
1
1925
1960
1980
1999
Log (Hazard Rate)
0.1
0.01
0.001
0.0001
0
20
40
60
Age
Data source: Human Mortality Database
80
100
Epidemiologic transition in Russia


Soviet Union successfully passed all
three stages of epidemiologic
transition
However Soviet health care system
could not respond to the challenges
of growing mortality from noncommunicable diseases
The “Semashko” model of 1918



The health care system was under the
centralized control of the state, which
financed services as part of national social
and economic development plans.
All health care personnel became
employees of the centralized state, which
paid salaries and provided supplies to all
medical institutions.
The main policy orientation throughout
this period was to increase numbers of
hospital beds and medical personnel.
Initial successes of governmentcontrolled model of health care



Russia made massive strides in arresting
the spread of infectious diseases.
Drastic epidemic control measures were
implemented against the spread of
tuberculosis, typhoid fever, typhus, malaria
and cholera.
Community prevention approaches, routine
check-ups, improvements in urban
sanitation and hygiene, quarantines, etc.
Moscow kindergarten, 1930s
Vaccination in
rural
Turkmenistan,
1930s
Before World War II
Life expectancy (both sexes)
80
70
60
50
40
30
20
10
0
59
47
47
63
Russia
43
32
France
USA
1900
1938
Catching up with the West
Life expectancy in 1965
80
70
60
50
40
30
20
10
0
64.3 67.3 66.8
73.4 74.7 73.7
Russia
France
USA
Men
Women
Stagnation after 1965
Mortality reversal




Situation when the usual time trend of declining
mortality is reversed (mortality is increasing over
time).
Observed in sub-Saharan Africa (AIDS
epidemic), Eastern Europe, and FSU countries
including Russia.
Mortality Reversal in FSU countries and Russia is
particularly strong among male population, with
excess mortality at ages about 35-55 years.
Particularly high increase in mortality from
violence and accidents among manual workers
and low education groups.
Decline of life expectancy at age 15
between 1998-2005. Men
Decline of life expectancy at age 15
between 1998-2005. Women
Decomposition of the U.S.-Russia
gap in life expectancy by cause
USA – 1999; Russia – 2001. Source: Shkolnikov et a. Mortality reversal in Russia.
Decomposition of the U.S.-Russia
gap in life expectancy by cause
USA – 1999; Russia – 2001. Source: Shkolnikov et a. Mortality reversal in Russia.
Factors and Trends of Mortality
and Health in Russia
Sex Differentials of Mortality

U.S.
population
in 1999
Gender gap in life expectancy

In 1994 gender gap in life
expectancy in Russia reached 13.7
years – the largest difference in life
expectancy between sexes ever
recorded
Life table probability of death for
Russian men and women, 2005
1
0
10
20
30
40
50
60
log(q(x))
0.1
0.01
0.001
0.0001
Age
Men
Women
70
80
90
100
Life table number of dying for
Russian men and women, 2005
Men
Women
4000
3500
3000
d(x)
2500
2000
1500
1000
500
0
0
10
20
30
40
50
Age
60
70
80
90
100
Life expectancy in Russia
Females
Males
Both
75
70
65
60
Calendar year
2003
1999
1995
1991
1987
1983
1979
1975
1971
1967
1963
55
1959
Life expectancy
80
The Role of Education
LRC – Lipid Research Clinic study cohort in Moscow and St.Petersburg
Education and life expectancy at
working ages (20-69). Men, Russia
Source: Shkolnikov et al., SSM, 1998
Why educated people live longer in Russia?
Decomposition by cause of death
The role of alcohol consumption in
high mortality in Russia


The consumption of alcohol has deep
cultural roots in Russia where it typically
accompanied celebrations, signified
hospitality, and enhanced bonding among
acquaintances and friends.
It also was a tremendous sources of
revenue for the Soviet state which
exercised a monopoly on its production
and distribution.
Dynamics of alcohol consumption
in Russia

Liters of 100% alcohol per person per year
1 – V.Treml; 2 – Goskomstat estimate; 3-A.Nemtsov estimate; 4- sales of alcohol
Alcohol is a driving force of
mortality crisis in Russia
Gorbachev’s anti-alcohol
campaign, 1985-1987



Official sales of alcohol fell 51%
Real consumption fell 27%
Fall of alcohol sales was
compensated by alcohol selfproduction
Gorbachev anti-alcohol campaign

The favorable effect of the anti-alcohol campaign
on Russian mortality was strong and rapid.
Mortality began to decrease immediately after
the introduction of restrictions on the sale of
alcohol in June 1985 and continued month by
month in parallel with the reduction in alcohol
consumption (Shkolnikov and Vassin, 1994). The
largest mortality decrease was observed at adult
ages both for males and females during the year
1986. From 1984 to 1987 (mostly in 1986), life
expectancy at birth rose from 61.7 to 64.9 years
for males and from 73 to 74.3 years for females.
(From “Premature Death in the New
Independent States,” NAS, 1997)
Number of male deaths by month
before and after the anti-alcohol campaign

Number of deaths in thousand
Trends in the number of deaths

Millions of deaths
Contribution of different causes of
death to changes in LE, men
Contribution of different causes of
death to changes in LE, women
Age and cause components of LE
increase due to anti-alcohol campaign:
Men
Age and cause components of LE
increase due to anti-alcohol campaign:
Women
Major effects of anti-alcohol
campaign



The highest decrease of mortality in
regions with initial high levels of
mortality at adult ages
Regional inequality in mortality
decreased
Mortality decreased predominantly at
middle adult ages due to reduction in
external mortality and mortality from
cardiovascular diseases
Results of anti-alcohol campaign
Over 1 million lives were saved
 Alcohol consumption was decreased but still
remained high – 10.5-12.6 liter per person per
year in 1986-1991
 In 1984 estimated deaths due to direct and
indirect effects of alcohol were 525,000 deaths or
31.8% of all registered deaths (4.4% in USA,
3.1% in Canada in 1995)
 Anti-alcohol campaign decreased alcohol-related
number of deaths by 200,000
Estimates by A. Nemtsov.

Mortality reversal




Situation when the usual time trend of declining
mortality is reversed (mortality is increasing over
time).
Observed in sub-Saharan Africa (AIDS
epidemic), Eastern Europe, and FSU countries
including Russia.
Mortality Reversal in FSU countries and Russia is
particularly strong among male population, with
spikes of mortality at ages about 35-55 years.
Particularly high increase in mortality from
violence and accidents among manual workers
and low education groups.
In 1992 and 1998 Russia
experienced two serious
economic crises accompanied
by drop in personal income and
rapid impoverishment
Alcohol and Inflation

In 1992-1993 prices of alcohol increased
much less than personal salaries and the
general price index, which by June 1994
had increased to 1229 times its December
1992 level. Concurrently, prices of alcohol
rose to 421 times their prior levels. It is
not surprising that real alcohol
consumption in Russia increased sharply
during this period of economic crisis and
reduction in real wages
Total and alcohol-related mortality
during the market reforms


Total number of deaths in thousand (left)
Deaths from acute poisoning by alcohol (right)
Decline in alcohol quality during
the market reforms




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
--Change in all-cause mortality rates between 1990 and 1994 by age and sex, Russia
Notzon, F. C. et al. JAMA 1998;279:793-800.
Copyright restrictions may apply.
Decomposition of changes in LE by
cause of death, 1990-1994
Alcohol and suicide


Suicide (1) and accidental poisoning by alcohol (3) – left
Alcohol psychoses (2) - right
Drinking and Suicide


Number of suicides per 100,000 – left
Alcohol (l) per person per year
1 – suicides with alcohol in blood ; 3 – sober suicides (left); 2- alcohol consumption
Alcohol and cardiovascular
mortality


Alcohol intoxication is an additional
risk factor for cardiovascular
diseases
During anti-alcohol campaign
mortality from cardiovascular
diseases decreased mainly due to
atherosclerotic cardiosclerosis (by
19% in men) and stroke (by 8% in
men)
What about alcohol surrogates?



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
Northern Structure of Alcohol
Consumption

An example of Sweden
Consumption of hard liquors and
life expectancy
Alcohol-related policy
Explanations of Mortality Crisis in
1992-1994


Psychological Stress (and alcohol)
Hypothesis (Shapiro, 1995; Cornia,
Paniccia, 1995; Shkolnikov et al.,
1998)
Selection Hypothesis (‘selection of
alcoholics’) by Avdeev, Blum,
Zakharov, Andreev, 1997.
Other Hypotheses (less supported
by evidence)



Mass impoverishment and malnutrition –
if this hypothesis is true then infant
mortality should increase
Deterioration of the health care system –
if this hypothesis is true then again infant
mortality should increase
Environmental pollution – environmental
pollution should increase during 19921994 while in fact it decreased
Protective role of education during
1992-1994 crisis



Mortality of adult men with higher
education level increased from 1989 to
1994 by 35% vs 57% for men with
lower education level
Mortality of adult women with higher
education level increased by only 8%
compared to 30% for women with
lower education level
Source: Shkolnikov et al., SSM, 1998
Suggested Factors of Mortality Increase
During the Transition Period
Rapid
Impoverishment
Social Stress
Cardiovascular
Diseases, Suicide
Cheap Alcohol
Injuries
Expensive
Medicine
Diabetes, Asthma
Selection
Growth of
Delinquency
Tuberculosis
Drug Dependence
Sexually Transmitted
Diseases
Age Profile of Suicide Mortality in Russia:
1981-2001
Males
Females
Life Expectancy in Russia
Russia
Year
Males Females
China
India
1992
1993
1994
1995
2000
2006
2006
2006
62.0
58.9
57.6
58.3
58.8
60.4
72.0
62.0
73.8
71.9
71.2
71.7
71.7
73.2
75.0
64.0