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Tursun-Zade R, Pushkina N, Andreychenko A, Denisova D, Bunakova A, Nazarova E, Komarov Y, Arseniev A, Nefedov A, Kozlov V, Timonin S, Okhotin A, Barchuk A. Sex differences in lung cancer incidence and mortality in Russia in the light of computed tomography usage expansion: breakpoint and age-period-cohort analyses. Cancer Epidemiol 2024; 93:102654. [PMID: 39216338 DOI: 10.1016/j.canep.2024.102654] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/15/2023] [Revised: 08/04/2024] [Accepted: 08/19/2024] [Indexed: 09/04/2024]
Abstract
BACKGROUND Russia has one of the highest lung cancer burdens globally, particularly in men. Mortality started to decline in the 1990s after the reduction in smoking prevalence. However, Russia's recent experience is largely unknown. This study aims to describe recent trends in the incidence and mortality of lung cancer in Russia along with the use of computed tomography (CT). METHODS We obtained incidence data from national cancer reports covering 1993-2021 and mortality and population data from the Russian Fertility and Mortality Database covering 1965-2021. The number of CT scanners was obtained from the OECD. Changes in age-standardized rates (Segi-Doll, per 100,000) were assessed using segmented regression and temporal effects using age-period-cohort analysis. RESULTS Lung cancer rates in men have been substantially higher than in women and have declined sharply since their peak in the 1990s. The latest breakpoints in incidence in women were in 2012 (95 % CI: 2000; 2014) from stagnation with an annual change of 0.7 % (-0.2; 1.5) to 3.4 % (1.6; 5.2) increase. In men, the decrease in incidence stopped in 2013 (2011; 2014) from -1.8 % (-2.1; -1.4) to 0.3 % (-0.7; 1.3). The growing number of CT scans accompanied the recent changes in incidence rates. Incidence declined sharply in 2020 in men and women. There were no substantial changes in declining mortality trends. Period effects were visible after 2012 when incidence rates increased and deviated from mortality. After accounting for the period effect, generations born after the 1950s had lower risks. CONCLUSION Increasing lung cancer incidence rates in Russia in the late 2010s, especially in women, and the stable mortality trends could be a possible sign of diagnostic or treatment period effect. The increased use of CT should be monitored for possible benefits and harms.
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Affiliation(s)
- Rustam Tursun-Zade
- ITMO University, Kronverkskiy Prospekt, 49, St. Petersburg 197101, Russia; OPIK, Departamento de Sociologia y Trabajo Social, Universidad del Pa´ıs Vasco (UPV/EHU), Barrio Sarriena s/n, 4894, Leioa 69007, Spain
| | - Nika Pushkina
- ITMO University, Kronverkskiy Prospekt, 49, St. Petersburg 197101, Russia; Research Institute of Phthisiopulmonology, Ligovskyi prospekt, 2-4, St. Petersburg 191036, Russia
| | - Anna Andreychenko
- ITMO University, Kronverkskiy Prospekt, 49, St. Petersburg 197101, Russia
| | - Daria Denisova
- ITMO University, Kronverkskiy Prospekt, 49, St. Petersburg 197101, Russia
| | - Anna Bunakova
- ITMO University, Kronverkskiy Prospekt, 49, St. Petersburg 197101, Russia
| | - Ekaterina Nazarova
- NN Petrov National Medical Research Center of Oncology, Pesochny, Leningradskaya Ulitsa 68, St. Petersburg 197758, Russia
| | - Yuri Komarov
- NN Petrov National Medical Research Center of Oncology, Pesochny, Leningradskaya Ulitsa 68, St. Petersburg 197758, Russia
| | - Andrei Arseniev
- NN Petrov National Medical Research Center of Oncology, Pesochny, Leningradskaya Ulitsa 68, St. Petersburg 197758, Russia
| | - Andrei Nefedov
- Research Institute of Phthisiopulmonology, Ligovskyi prospekt, 2-4, St. Petersburg 191036, Russia
| | - Vladimir Kozlov
- Leibniz Institute for East and Southeast European Studies (IOS), Landshuter Str. 4, Regensburg 93047, Germany
| | - Sergey Timonin
- School of Demography, Australian National University, 146 Ellery Crescent, Acton, ACT, Canberra 2601, Australia
| | - Artemiy Okhotin
- ITMO University, Kronverkskiy Prospekt, 49, St. Petersburg 197101, Russia; Tarusa District Hospital, Karla Libknekhta Ulitsa 16, Tarusa 249100, Russia
| | - Anton Barchuk
- ITMO University, Kronverkskiy Prospekt, 49, St. Petersburg 197101, Russia; Institute for Interdisciplinary Health Research, European University at St. Petersburg, Shpalernaya Ulitsa 1, St, Petersburg 191187, Russia.
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Nikoloski Z, Shkolnikov VM, Mossialos E. Preventable mortality in the Russian Federation: a retrospective, regional level study. THE LANCET REGIONAL HEALTH. EUROPE 2023; 29:100631. [PMID: 37180281 PMCID: PMC10172901 DOI: 10.1016/j.lanepe.2023.100631] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Figures] [Subscribe] [Scholar Register] [Received: 11/01/2022] [Revised: 03/17/2023] [Accepted: 03/20/2023] [Indexed: 05/16/2023]
Abstract
Background Avoidable mortality, including both treatable and preventable deaths, is frequently used as an indicator of health system performance. Whilst the term treatable mortality refers to deaths that might be averted by medical interventions, preventable mortality generally reflects the impact of system-wide health policies. The concept of preventable mortality has not been evaluated extensively in the Russian Federation, particularly at the regional or sub-national (oblast) level. Methods We calculated total preventable mortality as well as individual rates for males and females in each oblast using data from the Russian Fertility and Mortality Database (RusFMD) and computed the contributions of specific preventable causes of death to the overall rates. We also evaluated the relationship between preventable mortality and its main correlates during the years 2014-2018 using panel fixed effects modelling with variables that reflected both, behavioural risk factors and access to health care. Findings Overall preventable mortality in the Russian Federation has been on a downward trend. Whilst 548 preventable deaths per 100,000 person-years were reported in the year 2000, only 301 per 100,000 person-years were reported in 2018. Whilst mortality due to cancer, cardiovascular, and alcohol-related diseases has declined (albeit unevenly) amongst both males and females, deaths resulting from complications of diabetes and human immunodeficiency virus infection have increased. Our findings also revealed significant heterogeneity in preventable mortality at the oblast level. For example, in 2018, deaths due to preventable causes were concentrated primarily in Siberia and the Far East. Smoking and the availability of nurses were identified as significant correlates of preventable mortality at the oblast level. Interpretations Efforts designed to strengthen the current health care system, notably those serving the rural and less densely populated oblasts, might reduce the rate of preventable mortality in Russia. These efforts might be coupled with an ongoing focus on programs designed to reduce smoking. Funding None.
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Affiliation(s)
- Zlatko Nikoloski
- Department of Health Policy, London School of Economics and Political Science, Houghton Street, London WC2A 2AE, United Kingdom
- Corresponding author.
| | - Vladimir M. Shkolnikov
- Laboratory of Demographic Data, Max Planck Institute for Demographic Research, Rostock 18057, Germany
| | - Elias Mossialos
- Department of Health Policy, London School of Economics and Political Science, Houghton Street, London WC2A 2AE, United Kingdom
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Ji Y, Zhang Y, Yun Q, Chang C. Gender differences in social environmental changes associated with smoking: a cross-sectional study from Chinese internal migrants. BMJ Open 2022; 12:e058097. [PMID: 36414285 PMCID: PMC9685270 DOI: 10.1136/bmjopen-2021-058097] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/23/2022] Open
Abstract
OBJECTIVES To identify clues for women's tobacco control, this study analyses the gender differences in social environmental changes associated with smoking and the interaction between the environment and individuals' social integration. DESIGN, SETTING AND PARTICIPANTS A cross-sectional design and secondary analysis were used among Chinese internal migrants. Data were from the 2012 Migrant Dynamics Monitoring Survey in China with participants aged 15-59 years old (75 416 women and 83 140 men) who resided in cities for more than 1 month. PRIMARY AND SECONDARY OUTCOME MEASURES Social environmental changes were measured by differences in smoking prevalence and women's empowerment between the migrant-receiving province (MRP) and migrant-sending province (MSP). Social participation and duration of stay (DOS) were adopted as indicators of social integration. Stratified analysis and binary logistic regression models were used to determine the dependent variable (smoking status) and environmental changes after controlling for age, education, income and happiness. RESULTS Differences in the smoking prevalence environment (lower in MRP, OR 0.70, 95% CI 0.60 to 0.83; higher rate in MRP, OR 1.79, 95% CI 1.35 to 2.37) and women's empowerment (lower rate in MRP, OR 0.80, 95% CI 0.68 to 0.97; higher rate in MRP, OR 1.15, 95% CI 1.00 to 1.33) between MRP and MSP were positively correlated with women's smoking. In men, however, migrating to an area with lower smoking prevalence could not reduce smoking risk, whereas moving to an area with higher women's empowerment could. A long DOS was an independent risk factor for smoking in women (ranged from 1.20 to 2.00 in various environmental changes scenarios) but a protective factor for men. An interaction between environmental changes and social integration could not be verified. CONCLUSIONS Tobacco control strategies should consider gender differences, especially women who are experiencing social environmental changes.
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Affiliation(s)
- Ying Ji
- Department of Social Medicine and Health Education, School of Public Health, Peking University, Beijing, China
| | - Yan Zhang
- Institute of Nutrition and Food Hygiene, Beijing Centers for Diseases Control and Prevention, Beijing, China
| | - Qingping Yun
- Department of Social Medicine and Health Education, School of Public Health, Peking University, Beijing, China
| | - Chun Chang
- Department of Social Medicine and Health Education, School of Public Health, Peking University, Beijing, China
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Merkin A, Nikolaev A, Nikoforov I, Komarov A, Glover M. Trends in tobacco smoking and smoking cessation in Russia with a focus on Indigenous populations: A narrative review. GLOBAL EPIDEMIOLOGY 2021; 3:100043. [PMID: 37635728 PMCID: PMC10446109 DOI: 10.1016/j.gloepi.2020.100043] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/21/2020] [Revised: 10/23/2020] [Accepted: 11/23/2020] [Indexed: 11/29/2022] Open
Abstract
Introduction Tobacco smoking is one of the main preventable causes of illness and premature death. Globally, more than 7 million people die annually from diseases associated with smoking, and this number is projected to increase to 8 million per year by 2030. Wide disparities in smoking prevalence exist by gender, age, socioeconomic status, rurality and ethnicity. In several countries, smoking is disproportionately high among the Indigenous populations. Objective This review assesses the prevalence and harm of smoking and current trends in smoking cessation among the diverse multi-ethnic populations of Russia, with a particular emphasis on Indigenous populations. Data sources We systematically searched health, nursing, social science and grey literature databases and bibliographies for relevant studies. Search strings combined keywords related to smoking prevalence and smoking cessation with keywords related to Russia and the Indigenous populations of Russia. Study selection Studies were included if they were published between 1 January 2005 and 14 October 2020, and if they reported prevalence of tobacco smoking and/or activities and outcomes of a smoking cessation programme or ban in the Russian Federation. Conclusions Tobacco smoking is significant in the entire Russian population, a higher prevalence of smoking in Indigenous populations compared to the dominant Russian (Slavic) ethnic group is common. Smoking prevalence data for most of the Indigenous ethnic groups of Russia remains unclear. Tobacco control interventions for Indigenous groups are underdeveloped even though they have the potential to deliver proportionately greater reduction in smoking harm.
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Affiliation(s)
| | | | | | - Alexander Komarov
- National Centre for Development of Social Support and Rehabilitation, Moscow, Russia
| | - Marewa Glover
- Centre of Research Excellence: Indigenous Sovereignty & Smoking, Auckland, New Zealand
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Brainerd E. Mortality in Russia Since the Fall of the Soviet Union. COMPARATIVE ECONOMIC STUDIES 2021; 63:557-576. [PMID: 34728895 PMCID: PMC8553909 DOI: 10.1057/s41294-021-00169-w] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Subscribe] [Scholar Register] [Accepted: 09/07/2021] [Indexed: 05/25/2023]
Abstract
UNLABELLED Adult mortality increased enormously in Russia and other countries of the former Soviet Union when the Soviet system collapsed 30 years ago. What has happened to mortality in Russia since the fall of the Soviet Union? What explains the wide swings of mortality over time? This paper documents changes in mortality in Russia since 1989, and reviews the research in the economics and public health literature on the causes of the changes. The focus is on the post-2000 period, and the possible role played in recent declining mortality rates by Russia's alcohol and tobacco control policies. The two themes that emerge are (1) that government policies are critical for understanding both rising and falling male mortality over this period, and (2) that the underlying causes of the mortality crisis and its reversal are difficult to clearly identify empirically and remain, at best, partially understood, leaving much scope for future research on this issue. SUPPLEMENTARY INFORMATION The online version contains supplementary material available at 10.1057/s41294-021-00169-w.
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Tabyshova A, Estebesova B, Beishenbekova A, Sooronbaev T, Brakema EA, Chavannes NH, Postma MJ, van Boven JFM. Clinical Characteristics, Treatment Patterns and Economic Burden of COPD in Kyrgyzstan: A FRESH AIR Study. Int J Chron Obstruct Pulmon Dis 2021; 16:2833-2843. [PMID: 34703219 PMCID: PMC8523360 DOI: 10.2147/copd.s322778] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/07/2021] [Accepted: 09/13/2021] [Indexed: 11/30/2022] Open
Abstract
BACKGROUND COPD prevalence and mortality in Kyrgyzstan are high. Data on clinical and economic impact of COPD in Kyrgyzstan are scarce. This study was part of the FRESH AIR research project that focused on prevention, diagnosis and treatment of chronic lung diseases in low-resource settings. AIM We aimed to evaluate the clinical characteristics, treatment patterns and economic burden of COPD in Kyrgyzstan. METHODS A representative sample of patients with a spirometry-confirmed diagnosis of COPD was included. All patients were registered in one of the five major hospitals in Kyrgyzstan. Patients were surveyed on COPD risk factors, health-care utilization and patient reported outcomes (CCQ, MRC). Associations with high symptom burden (MRC score ≥4) and cost were assessed using logistic regression analyses. RESULTS A total of 306 patients were included with mean age 62.1 (SD: 11.2), 61.4% being male, mean BMI 26.9 (SD: 5.2) and mean monthly income $85.1 (SD: 75.4). Biomass was used for heating and cooking by 71.2% and 52.0%. Current and ex-smokers accounted 14.1% and 32%. Mean FEV1 was 46% (SD: 12.8), 71.9% had COPD GOLD III-IV and most frequent co-morbidities were hypertension (25.2%), diabetes (5.6%) and heart diseases (4.6%). Mean CCQ score was 2.0 (SD: 0.9) and MRC score 3.7 (SD: 0.9). Yearly mean number of hospital days due to COPD was 10.1 (SD: 3.9). Total annual per-patient costs of reimbursed health-care utilization ($107) and co-payments ($224, ie, 22% of patients' annual income) were $331. We found that only GOLD IV and hypertension were significantly associated with high symptom burden. Exacerbations and hypertension were significantly associated with high cost. CONCLUSION The clinical and economic burden of COPD on patients and the government in Kyrgyzstan is considerable. Notably, almost half of interviewed patients were current or ex-smokers and biomass exposure was high.
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Affiliation(s)
- Aizhamal Tabyshova
- Pulmonology Department, National Center of Cardiology and Internal Medicine Named After M.M. Mirrakhimov, Bishkek, Kyrgyzstan
- Department of Health Sciences, Unit of Global Health, University of Groningen, University Medical Center Groningen, Groningen, The Netherlands
| | - Bermet Estebesova
- Kyrgyz-Russian Slavic University (KRSU), Bishkek, Kyrgyzstan
- Primary Care Center of the Ministry of Internal Affairs, Bishkek, Kyrgyzstan
| | | | - Talant Sooronbaev
- Pulmonology Department, National Center of Cardiology and Internal Medicine Named After M.M. Mirrakhimov, Bishkek, Kyrgyzstan
| | - Evelyn A Brakema
- Department of Public Health and Primary Care, Leiden University Medical Center, Leiden, The Netherlands
| | - Niels H Chavannes
- Department of Public Health and Primary Care, Leiden University Medical Center, Leiden, The Netherlands
| | - Maarten J Postma
- Department of Health Sciences, Unit of Global Health, University of Groningen, University Medical Center Groningen, Groningen, The Netherlands
- Department of Economics, Econometrics & Finance, University of Groningen, Faculty of Economics & Business, Groningen, The Netherlands
- Department of Pharmacology & Therapy, Airlangga University, Surabaya, Indonesia
- Center of Excellence in Higher Education for Pharmaceutical Care Innovation, Universitas Padjadjaran, Bandung, Indonesia
| | - Job F M van Boven
- University of Groningen, University Medical Center Groningen, Groningen Research Institute for Asthma and COPD (GRIAC), Groningen, The Netherlands
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Christopoulou R, Mavropoulos G, Voucharas G. The Greek smoking epidemic from a life-course perspective. J Public Health (Oxf) 2021; 44:e479-e486. [PMID: 34498081 PMCID: PMC9715303 DOI: 10.1093/pubmed/fdab342] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/19/2020] [Revised: 05/28/2021] [Accepted: 08/17/2021] [Indexed: 01/19/2023] Open
Abstract
BACKGROUND Smoking rates in Greece are the highest recorded among OECD countries, but the historical and life-course evolution of smoking patterns is largely unknown. The present paper addresses this gap. METHODS We produce nationally representative life-course trajectories of smoking and related mortality of eight generations of Greek men and women. We estimate the smoking-mortality correlation conditional on several confounders and project the estimates forward. RESULTS We show that smoking prevalence among Greek men has plateaued at >60% for all but the youngest generation. For women, smoking prevalence is relatively lower, lags by several generations and follows a hump-shaped pattern. Smoking-attributable mortality is currently peaking for men (nearing 40% of total deaths) and is rising for women. We estimate that it takes ~20 years of smoking to maximize the smoking-mortality correlation (at 0.48 for men and 0.32 for women). Based on this estimation, we forecast that mortality rates will begin falling within the current decade. CONCLUSIONS The breadth of the Greek smoking epidemic has been high by international standards, reflecting the ineffective tobacco control efforts in the country. While smoking popularity fell during the Great Recession, policy vigilance is necessary to prevent a relapse once the economy recovers.
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Affiliation(s)
| | - Georgios Mavropoulos
- Department of Economic Sciences, University of Macedonia, 156 Egnatia Str, Thessaloniki 54636, Greece
| | - Georgios Voucharas
- Department of Economic Sciences, University of Macedonia, 156 Egnatia Str, Thessaloniki 54636, Greece
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Aistov A, Aleksandrova E, Gerry CJ. Voluntary private health insurance, health-related behaviours and health outcomes: evidence from Russia. THE EUROPEAN JOURNAL OF HEALTH ECONOMICS : HEPAC : HEALTH ECONOMICS IN PREVENTION AND CARE 2021; 22:281-309. [PMID: 33367963 PMCID: PMC7757736 DOI: 10.1007/s10198-020-01252-2] [Citation(s) in RCA: 4] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Figures] [Subscribe] [Scholar Register] [Received: 04/21/2020] [Accepted: 11/17/2020] [Indexed: 06/12/2023]
Abstract
This paper contributes to the discussion around ex-post (increased utilisation of health care) and ex-ante (changes in health behaviours) moral hazard in supplemental private health insurance. Applying a range of methodologies to data from the Russian Longitudinal Monitoring Survey-Higher School of Economics we exploit a selection mechanism in the data to compare the impact of workplace provided and individually purchased supplemental health insurance on the utilisation of health care, on a range of health behaviours and on self-assessed health. We find compelling policy-relevant evidence of ex-post moral hazard that confirms a theoretical prediction and empirical regularity found in other settings. In contrast to other empirical findings though, our data reveals evidence of ex-ante moral hazard demonstrated by clear behavioural differences between those with self-funded supplemental health insurance and those for whom the workplace finances the additional insurance. We find no evidence that either form of insurance is related to improved self-assessed health.
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Affiliation(s)
- Andrey Aistov
- National Research University Higher School of Economics, Nizhny Novgorod, Russian Federation
- Centre for Health Economics, Management, and Policy, National Research University Higher School of Economics, St. Petersburg, Russian Federation
| | - Ekaterina Aleksandrova
- Centre for Health Economics, Management, and Policy, National Research University Higher School of Economics, St. Petersburg, Russian Federation
| | - Christopher J Gerry
- Centre for Health Economics, Management, and Policy, National Research University Higher School of Economics, St. Petersburg, Russian Federation.
- Oxford School of Global and Area Studies, University of Oxford, Oxford, England.
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Shkolnikova MA, Ildarova RA, Jdanov DA, Shalnova SA, Shkolnikov VM. Prevalence, correlates, and mortality impacts of ventricular arrhythmia among older men and women: a population-based cohort study in Moscow. BMC Cardiovasc Disord 2021; 21:80. [PMID: 33557760 PMCID: PMC7871639 DOI: 10.1186/s12872-021-01883-0] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/28/2020] [Accepted: 01/24/2021] [Indexed: 11/21/2022] Open
Abstract
BACKGROUND In Russia, cardiovascular disease (CVD) mortality is high and the mortality gap between men and women is large. Conventional risk factors cannot explain these phenomena. Ventricular arrhythmia (VA) is an important contributor to the death toll in community-based populations. The study examines the prevalence and the mortality impacts of VA in men and women and the role of VA in the male mortality excess at older ages. METHODS This is a secondary analysis of data from the Stress, Aging, and Health in Russia (SAHR) study that was fielded in 2007-9 in Moscow (1800 individuals, mean age 68.8 years), with mean mortality follow-up of 7.4 years (416 deaths, 248 CVD deaths). Indicators reflecting the frequency and the complexity of VA were derived from 24-h ambulatory ECG recordings. Other covariates were: socio-demographic characteristics, conventional risk factors, markers of inflammation, reported myocardial infarction, and stroke. The impacts of VA and other variables on CVD and all-cause mortality among men and women were estimated with the proportional hazard models. We assessed the contributions of VAs to the male-female mortality gap using hazard models that do and do not include groups of the predictors. Logistic models were used to assess the associations between VA and other biomarkers. RESULTS VAs were about twice as prevalent among men as among women. In both sexes, they were significantly associated with CVD and all-cause mortality independently of conventional risk factors. The highest hazard ratios (HRs) for CVD death were found for the runs of ventricular premature complexes (VPCs) HR = 2.45, 95% CI 1.63-3.68 for men and 2.75, 95% CI 1.18-6.40 for women. The mortality impacts of the polymorphic VPCs were significant among men only (HR = 1.50, 95% CI 1.08-2.07). VA indicators can potentially explain 12.3% and 9.1% of the male-female gaps in mortality from CVD and all causes, respectively. VAs were associated with ECG-registered ischemic problems and reported MI, particularly among men. CONCLUSIONS VA indicators predicted mortality in older Muscovites independently of other risk factors, and have the potential to explain a non-trivial share of the excess male mortality. The latter may be related to more severe coronary problems in men compared to women.
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Affiliation(s)
- Maria A Shkolnikova
- Centre for Cardiac Arrhythmia, Pirogov Russian National Research Medical University, Taldomskaya 2, Moscow, Russian Federation, 125412
| | - Rukijat A Ildarova
- Centre for Cardiac Arrhythmia, Pirogov Russian National Research Medical University, Taldomskaya 2, Moscow, Russian Federation, 125412
| | - Dmitri A Jdanov
- Max Planck Institute for Demographic Research, Konrad-Zuse-Str. 1, 18057, Rostock, Germany
- National Research University Higher School of Economics, Bol'shoj Trehsvjatitel'skij Pereulok, Moscow, Russian Federation, 109028
| | - Svetlana A Shalnova
- National Research Center for Preventive Medicine, Petroverigskiy pereulok 10, Moscow, Russian Federation, 101990
| | - Vladimir M Shkolnikov
- Max Planck Institute for Demographic Research, Konrad-Zuse-Str. 1, 18057, Rostock, Germany.
- National Research University Higher School of Economics, Bol'shoj Trehsvjatitel'skij Pereulok, Moscow, Russian Federation, 109028.
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Podzolkov VI, Bragina AE, Druzhinina NA, Vasil'eva LV, Osadchiy KK, Dubchak AE, Khvalin EI. Relation between Tobacco Smoking/Electronic Smoking and Albuminuria/Vascular Stiffness in Young People without Cardiovascular Diseases. Kidney Blood Press Res 2020; 45:467-476. [PMID: 32434202 DOI: 10.1159/000507510] [Citation(s) in RCA: 15] [Impact Index Per Article: 3.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/22/2019] [Accepted: 03/24/2020] [Indexed: 01/03/2023] Open
Abstract
INTRODUCTION/OBJECTIVE Tobacco smoking is a well-known risk factor for cardiovascular and renal diseases. In recent years, alternative types of smoking, including vaping, have been becoming popular. The contribution of vape to vascular and renal injury is not known. We studied the relation between smoking of traditional/electronic cigarettes and arterial stiffness and albuminuria, which is also a vascular dysfunction marker. METHODS We examined 270 young volunteers without significant clinical cardiovascular diseases (mean age: 21.2 ± 2.3 years). Twenty-seven percent of the subjects in the study group were smokers; 69.9% of them smoked traditional cigarettes and 30.1% smoked electronic cigarettes. The urine albumin level was assessed by a dipstick test, and the augmentation index was determined by photoplethysmography. A linear correlation test and multiple regression analysis were applied. RESULTS The study groups did not differ in basic characteristics. The smokers demonstrated generally higher blood pressure levels and were overweight. Most of the smokers were male. In the groups of smokers, albuminuria was more frequent, especially among vapers (94 vs. 79% in tobacco smokers and 29% in nonsmokers). AU values (median [quartile 25; quartile 75]) were significantly higher in vapers (160 mg/L [150; 207.5]) vs. tobacco smokers (115 mg/L [60; 200]) and vs. nonsmokers (20 mg/L [10; 50]) (р < 0.05). Photoplethysmographic results showed relevant higher augmentation indices among tobacco smokers (-4, [-6.6; -1.9]) and vapers (-5.05 [-13.4; -3.3]) compared to nonsmokers (-16.2 [-23.9; -7]) (р < 0.05). Results of multiple regression analysis demonstrate that smoking of both traditional and electronic cigarettes is related to an increase in the albuminuria level and the augmentation index. CONCLUSIONS Smoking of both traditional and electronic cigarettes is related to albuminuria and an increase in the augmentation index, which is a noninvasive marker for arterial stiffness.
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Affiliation(s)
- Valery I Podzolkov
- 2nd Faculty Therapy Department, Federal State Autonomous Educational Institution of Higher Education, I.M. Sechenov First Moscow State Medical University of the Ministry of Health of the Russian Federation (Sechenov University), Moscow, Russian Federation
| | - Anna E Bragina
- 2nd Faculty Therapy Department, Federal State Autonomous Educational Institution of Higher Education, I.M. Sechenov First Moscow State Medical University of the Ministry of Health of the Russian Federation (Sechenov University), Moscow, Russian Federation,
| | - Natalya A Druzhinina
- 2nd Faculty Therapy Department, Federal State Autonomous Educational Institution of Higher Education, I.M. Sechenov First Moscow State Medical University of the Ministry of Health of the Russian Federation (Sechenov University), Moscow, Russian Federation
| | - Lubov V Vasil'eva
- 2nd Faculty Therapy Department, Federal State Autonomous Educational Institution of Higher Education, I.M. Sechenov First Moscow State Medical University of the Ministry of Health of the Russian Federation (Sechenov University), Moscow, Russian Federation
| | - Konstantin K Osadchiy
- 2nd Faculty Therapy Department, Federal State Autonomous Educational Institution of Higher Education, I.M. Sechenov First Moscow State Medical University of the Ministry of Health of the Russian Federation (Sechenov University), Moscow, Russian Federation
| | - Artem E Dubchak
- 2nd Faculty Therapy Department, Federal State Autonomous Educational Institution of Higher Education, I.M. Sechenov First Moscow State Medical University of the Ministry of Health of the Russian Federation (Sechenov University), Moscow, Russian Federation
| | - Evgeny I Khvalin
- 2nd Faculty Therapy Department, Federal State Autonomous Educational Institution of Higher Education, I.M. Sechenov First Moscow State Medical University of the Ministry of Health of the Russian Federation (Sechenov University), Moscow, Russian Federation
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Radaev V, Roshchina Y, Salnikova D. The Decline in Alcohol Consumption in Russia from 2006 to 2017: Do Birth Cohorts Matter? Alcohol Alcohol 2020; 55:323-335. [PMID: 32236444 DOI: 10.1093/alcalc/agaa017] [Citation(s) in RCA: 4] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/20/2019] [Revised: 02/10/2020] [Accepted: 02/22/2020] [Indexed: 11/13/2022] Open
Abstract
AIM Previous studies on youth drinking showed opposite trends for high-income and low-income countries. In Russia, a recent decline was observed in the prevalence of alcohol use, particularly among younger cohorts. This study aims at disentangling age and birth cohort effects to better understand the dynamics of abstinence and the volume of alcohol consumption. METHODS Data were collected from annual nationally representative panel surveys from 2006 to 2017. Data included 34,514 individuals aged 14-80. We estimated mixed-effects binary-choice models for percentage of abstainers and mixed-effects linear models with Heckman correction for alcohol volume. Integer variables of age and age-squared were used. Period was defined with a dummy variable using 2012 as the dividing line associated with a new Russian alcohol policy. Birth cohorts were defined as 13 groups from 1930-1939 to 2000-2003. Controls were per capita income, education, marital status, composition of households, body weight, ethnicity, residence type, regional per capita income and regional climate. RESULTS In both genders, percentage of abstainers increased and drinking volumes declined. Age for both genders showed u-shaped trend for abstinence and inverse u-shaped trend for alcohol volume. Controlling for age effects, cohorts born after 1990 demonstrated the strongest increase in abstinence for both genders and the strongest decrease in alcohol volume for males. The period of 2012-2017 had the effect of increasing the abstinence and decreasing the alcohol volume. CONCLUSION Downward trend in alcohol consumption in Russia is partially attributable to increased abstinence and reduced alcohol volume among younger cohorts.
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Affiliation(s)
- Vadim Radaev
- Laboratory for Studies in Economic Sociology, National Research University Higher School of Economics, 11 Myasnitskaya, Moscow 101000, Russian Federation
| | - Yana Roshchina
- Laboratory for Studies in Economic Sociology, National Research University Higher School of Economics, 11 Myasnitskaya, Moscow 101000, Russian Federation
| | - Daria Salnikova
- Department of Higher Mathematics, National Research University Higher School of Economics, 20 Myasnitskaya, Moscow 101000, Russian Federation
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Shkolnikov VM, Churilova E, Jdanov DA, Shalnova SA, Nilssen O, Kudryavtsev A, Cook S, Malyutina S, McKee M, Leon DA. Time trends in smoking in Russia in the light of recent tobacco control measures: synthesis of evidence from multiple sources. BMC Public Health 2020; 20:378. [PMID: 32293365 PMCID: PMC7092419 DOI: 10.1186/s12889-020-08464-4] [Citation(s) in RCA: 22] [Impact Index Per Article: 5.5] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/05/2019] [Accepted: 03/05/2020] [Indexed: 01/05/2023] Open
Abstract
BACKGROUND The study aims at identifying long-term trends and patterns of current smoking by age, gender, and education in Russia, including the most recent period from 2008 during which tobacco control policies were implemented, and to estimate the impact on mortality of any reductions in prevalence. We present an in-depth analysis based on an unprecedentedly large array of survey data. METHODS We examined pooled micro-data on smoking from 17 rounds of the Russian Longitudinal Monitoring Study of 1996-2016, 11 other surveys conducted in Russia in 1975-2017, and two comparator surveys from England and the USA. Standardization by age and education, regression and meta-analysis were used to estimate trends in the prevalence of current smoking by gender, age, and educational patterns. RESULTS From the mid-1970s to the mid-2000s smoking prevalence among men was relatively stable at around 60%, after which time prevalence declined in every age and educational group. Among women, trends in smoking were more heterogeneous. Prevalence more than doubled above the age of 55 years from very low levels (< 5%). At younger ages, there were steep increases until the mid-2000s after which prevalence has declined. Trends differed by educational level, with women in the lowest educational category accounting for most of the long-term increase. We estimate that the decline in male smoking may have contributed 6.2% of the observed reduction in cardiovascular deaths among men in the period 2008-16. CONCLUSIONS The implementation of an effective tobacco control strategy in Russia starting in 2008 coincided with a decline in smoking prevalence among men from what had been stable, high levels over many decades regardless of age and education. Among women, the declines have been more uneven, with young women showing recent downturns, while the smoking prevalence in middle age has increased, particularly among those with minimal education. Among men, these positive changes will have made a small contribution to the reduction in mortality seen in Russia since 2005.
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Affiliation(s)
- Vladimir M Shkolnikov
- Max Planck Institute for Demographic Research, Konrad-Zuse-Str. 1, 18057, Rostock, Germany.
- National Research University Higher School of Economics, Bolshoy Trekhsvyatitelsiy pereulok 3, Moscow, Russian Federation, 109038.
| | - Elena Churilova
- National Research University Higher School of Economics, Bolshoy Trekhsvyatitelsiy pereulok 3, Moscow, Russian Federation, 109038
| | - Dmitry A Jdanov
- Max Planck Institute for Demographic Research, Konrad-Zuse-Str. 1, 18057, Rostock, Germany
- National Research University Higher School of Economics, Bolshoy Trekhsvyatitelsiy pereulok 3, Moscow, Russian Federation, 109038
| | - Svetlana A Shalnova
- National Medical Research Centre for Preventive Medicine, Petroverigskiy pereulok 10, Moscow, Russian Federation, 101990
| | - Odd Nilssen
- UiT the Arctic University of Norway, 9037, Tromsø, Norway
| | - Alexander Kudryavtsev
- Northern State Medical University, Troitskiy Avenue 51, Arkhangelsk, Russian Federation, 163000
| | - Sarah Cook
- London School of Hygiene & Tropical Medicine, WC1E 7HT, London, UK
| | - Sofia Malyutina
- Institute of Internal and Preventive Medicine, Siberian Branch of the Russian Academy of Sciences, Vladimirovsky spusk 2a, Novosibirsk, Russian Federation, 630003
| | - Martin McKee
- London School of Hygiene & Tropical Medicine, WC1E 7HT, London, UK
| | - David A Leon
- UiT the Arctic University of Norway, 9037, Tromsø, Norway
- London School of Hygiene & Tropical Medicine, WC1E 7HT, London, UK
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Gjika A, Zhllima E, Rama K, Imami D. Analysis of Tobacco Price Elasticity in Albania Using Household Level Data. INTERNATIONAL JOURNAL OF ENVIRONMENTAL RESEARCH AND PUBLIC HEALTH 2020; 17:E432. [PMID: 31936433 PMCID: PMC7014105 DOI: 10.3390/ijerph17020432] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Subscribe] [Scholar Register] [Received: 11/01/2019] [Revised: 12/20/2019] [Accepted: 12/24/2019] [Indexed: 12/01/2022]
Abstract
This paper analyzes the determinant factors of tobacco consumption in Albania, which is one of the countries with the highest smoking prevalence in Europe. To empirically estimate the elasticity of cigarettes demand in Albania, the paper uses the Living Standard Measurement Survey (LSMS) applying Deaton's (1988) demand model. This paper estimates an Almost Ideal Demand System (AIDS), which allows disentangling quality choice from exogenous price variations using unit values from cigarette consumption. Following Deaton's model, the results suggest that the demand for tobacco is inelastic, with a price elasticity of -0.57. The price elasticity appears to be within the range of elasticity estimates frequently reported for low- and middle-income countries. The results suggest that total expenditure, household size, male-to-female ratio, and adult ratio are important determinants of tobacco demand in Albania. The increase in the tobacco price, which has been mainly driven by increased excises, has demonstrated a significant impact on reducing tobacco consumption. Consequently, the Albanian government may engage in gradual increases in excise taxes given the inelastic tobacco demand.
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Affiliation(s)
- Aida Gjika
- Faculty of Economics, University of Tirana, Development Solutions Associates and CERGE-EI, 1001 Tirana, Albania;
| | - Edvin Zhllima
- Faculty of Economics and Agribusiness, Agricultural University of Tirana, Development Solutions Associates and CERGE-EI, 1029 Tirana, Albania;
| | - Klodjan Rama
- Faculty of Agriculture and Environment, Agricultural University of Tirana and Development Solutions Associates, 1029 Tirana, Albania;
| | - Drini Imami
- Faculty of Economics and Agribusiness, Agricultural University of Tirana, Development Solutions Associates and CERGE-EI, 1029 Tirana, Albania;
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Di Novi C, Marenzi A. The smoking epidemic across generations, genders, and educational groups: A matter of diffusion of innovations. ECONOMICS AND HUMAN BIOLOGY 2019; 33:155-168. [PMID: 30878945 DOI: 10.1016/j.ehb.2019.01.003] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Received: 06/26/2018] [Revised: 12/14/2018] [Accepted: 01/11/2019] [Indexed: 06/09/2023]
Abstract
This study determines whether the temporal variations in smoking habits across generations and genders and among groups with differing levels of education fit the pattern proposed by the theory of the diffusion of innovations (TDI) (Rogers, 2003). We focus on the Italian case and employ a pseudo-panel derived from repeated cross-sections of the annual household survey, "Aspects of Daily Life," that was part of the Multipurpose Survey carried out by the Italian National Statistical Office (ISTAT) for the period 1997 to 2012. The results confirm Rogers' TDI and show that smoking prevalence has declined over time and across age cohorts: Younger men of all educational levels and women with higher education are less likely to smoke than are those in other cohorts, while less-educated women who entered the smoking-diffusion process later than others are more likely to smoke. Hence, socio-economic differences in smoking continue to persist, especially for women. According to Rogers' TDI, smoking prevalence is expected to continue to decline, particularly among little-educated women.
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Affiliation(s)
- Cinzia Di Novi
- Department of Economics and Management, University of Pavia, via San Felice, 5, Pavia, Italy; Health, Econometrics and Data Group, University of York; LCSR, National Research University Higher School of Economics, Russian Federation.
| | - Anna Marenzi
- Department of Economics, Ca' Foscari University of Venice, Italy.
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Shkolnikov VM, Andreev EM, Tursun-Zade R, Leon DA. Patterns in the relationship between life expectancy and gross domestic product in Russia in 2005-15: a cross-sectional analysis. Lancet Public Health 2019; 4:e181-e188. [PMID: 30954143 PMCID: PMC6506569 DOI: 10.1016/s2468-2667(19)30036-2] [Citation(s) in RCA: 26] [Impact Index Per Article: 5.2] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/13/2018] [Revised: 02/04/2019] [Accepted: 02/13/2019] [Indexed: 11/25/2022]
Abstract
BACKGROUND Since 2005, Russia has made substantial progress, experiencing an almost doubling of per-capita gross domestic product by purchasing power parity (GDP [PPP]) to US$24 800 and witnessing a 6-year increase in life expectancy, reaching 71·4 years by 2015. Even greater gains in GDP (PPP) were seen for Moscow, the Russian capital, reaching $43 000 in 2015 and with a life expectancy of 75·5 years. We aimed to investigate whether mortality levels now seen in Russia are consistent with what would be expected given this new level of per-capita wealth. METHODS We used per-capita GDP (PPP) and life expectancy from 61 countries in 2014-15, plus those of Russia as a whole and its capital Moscow, to construct a Preston curve expressing the relationship between mortality and national wealth and to examine the positions of Russia and other populations relative to this curve. We adjusted life expectancy values for Moscow for underestimation of mortality at older ages. For comparison, we constructed another Preston curve based on the same set of countries for the year 2005. We used the stepwise replacement algorithm to decompose mortality differences between Russia or Moscow and comparator countries with similar incomes into age and cause-of-death components. FINDINGS Life expectancy in 2015 for both Russia and Moscow lay below the Preston-curve-based expectations by 6·5 years and 4·9 years, respectively. In 2015, Russia had a lower per-capita income than 36 of the comparator countries but lower life expectancy than 60 comparator countries. However, the gaps between the observed and the Preston-expected life expectancy values for Russia have diminished by about 25% since 2005, when the life expectancy gap was 8·9 years for Russia and 6·6 years for Moscow. When compared with countries with similar level of income, the largest part of the life expectancy deficit was produced by working-age mortality from external causes for Russia and cardiovascular disease at older ages for Moscow. INTERPRETATION Given the economic wealth of Russia, its life expectancy could be substantially higher. Sustaining the progress seen over the past decade depends on the ability of the Russian Government and society to devote adequate resources to people's health. FUNDING This work was partly funded through the International Project on Cardiovascular Disease in Russia supported by a Wellcome Trust Strategic Award (100217) and was supported by the Russian Academic Excellence Project 5-100.
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Affiliation(s)
- Vladimir M Shkolnikov
- Laboratory for Demographic Data, Max Planck Institute for Demographic Research, Rostock, Germany; International Laboratory for Population and Health, Research University Higher School of Economics, Moscow, Russia.
| | - Evgeny M Andreev
- International Laboratory for Population and Health, Research University Higher School of Economics, Moscow, Russia
| | - Rustam Tursun-Zade
- International Laboratory for Population and Health, Research University Higher School of Economics, Moscow, Russia
| | - David A Leon
- Department of Non-communicable Disease Epidemiology, London School of Hygiene & Tropical Medicine, London, UK; Department of Community Medicine, The Arctic University of Norway, Tromsø, Norway
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Kossova T, Kossova E, Sheluntcova M. Anti-smoking policy in Russia: Relevant factors and program planning. EVALUATION AND PROGRAM PLANNING 2018; 69:43-52. [PMID: 29674222 DOI: 10.1016/j.evalprogplan.2018.04.006] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Received: 03/17/2017] [Revised: 03/09/2018] [Accepted: 04/08/2018] [Indexed: 06/08/2023]
Abstract
In this paper, we consider anti-smoking policy in Russia and the socioeconomic factors that influence an individual's decision to smoke. Among various factors, we investigate the individual time preferences of Russians. To estimate individual time preferences, we use an experiment in which survey respondents are given hypothetical money prizes. We find that being middle-aged, being unmarried and having parents who smoke are positively correlated with both men and women's likelihood of taking up smoking in Russia. We consider the possible endogeneity of an individual's health status and find a positive relationship between smoking and the time preferences of Russians. Our findings confirm that decisionmakers should devote their efforts primarily to developing restrictive anti-smoking policy. The choice of policy measures should be guided by the individual characteristics of target population groups. Social advertising, public lectures and preventive care should be actively engaged in forming public attitudes towards smoking.
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Affiliation(s)
- Tatiana Kossova
- National Research University Higher School of Economics, 20 Myasnitskaya Street, Moscow 101000, Russia
| | - Elena Kossova
- National Research University Higher School of Economics, 20 Myasnitskaya Street, Moscow 101000, Russia
| | - Maria Sheluntcova
- National Research University Higher School of Economics, 20 Myasnitskaya Street, Moscow 101000, Russia.
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17
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Gugushvili A, McKee M, Azarova A, Murphy M, Irdam D, King L. Parental transmission of smoking among middle-aged and older populations in Russia and Belarus. Int J Public Health 2018; 63:349-358. [PMID: 29302722 PMCID: PMC5978922 DOI: 10.1007/s00038-017-1068-0] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/18/2016] [Revised: 06/12/2017] [Accepted: 12/14/2017] [Indexed: 11/21/2022] Open
Abstract
OBJECTIVES The very high rates of smoking among men and the rapid changes among women in the Post-Soviet countries mean that this region offers an opportunity to understand better the intergenerational role of parental influences on smoking. METHODS In this study, we exploit a unique data set, the PrivMort cohort study conducted in 30 Russian and 20 Belarusian towns in 2014-2015, which collects information on behaviours of middle-aged and older individuals and their parents, including smoking. We explored the associations between smoking by parents and their offspring using multiply imputed data sets and multilevel mixed-effect Poisson regressions. RESULTS Adjusting for a wide array of social origin, socio-demographic, and socio-economic variables, our analysis suggests that sons of regularly smoking fathers have prevalence ratios of 1.35 [95% confidence intervals (CI) 1.21-1.50] and 1.39 (CI 1.23-1.58) of smoking, while the figures for daughters of regularly smoking mothers are 1.91 (CI 1.40-2.61) and 2.30 (CI 1.61-3.28), respectively, in Russia and Belarus. CONCLUSIONS Intergenerational paternal and maternal influences on smoking should be taken into account in studies seeking to monitor the rates of smoking and the impact of tobacco control programmes.
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Affiliation(s)
- Alexi Gugushvili
- Department of Social Policy and Intervention and Nuffield College, University of Oxford, Barnett House, 32 Wellington Square, Oxford, OX1 2ER, UK.
- Department of Sociology, University of Cambridge, Cambridge, UK.
| | - Martin McKee
- London School of Hygiene and Tropical Medicine, London, UK
| | | | - Michael Murphy
- London School of Economics and Political Science, London, UK
| | - Darja Irdam
- Department of Sociology, University of Cambridge, Cambridge, UK
| | - Lawrence King
- Department of Sociology, University of Cambridge, Cambridge, UK
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18
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Reis AM, Quintal C, Lourenço Ó. Killing two birds with one stone? Association between tobacco and alcohol consumption. Public Health 2017; 154:136-143. [PMID: 29245020 DOI: 10.1016/j.puhe.2017.10.019] [Citation(s) in RCA: 7] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/05/2017] [Revised: 10/05/2017] [Accepted: 10/24/2017] [Indexed: 11/16/2022]
Abstract
OBJECTIVES Tobacco and excessive alcohol consumption are addictive behaviours, listed among the 10 leading risk factors that cause death and disability in the world, and health consequences are greater if their consumption is combined. There is sparse empirical evidence on the variables that influence the simultaneous consumption of tobacco and alcohol. This study aims to identify the variables that influence the joint decision to consume alcohol and tobacco, and that encourage drinkers to smoke. STUDY DESIGN The sample includes Portuguese adults, mainly aged 50 years and over, extracted from the Survey of Health, Ageing and Retirement in Europe, covering the year 2011. METHODS We propose a bivariate probit model, which allows us to model simultaneously the two goods, accounting for potential correlation between smoking and drinking decisions. RESULTS We identified the variables that influence joint consumption, and tobacco consumption among drinkers, which could be used as policy instruments to develop concerted policies. Prevention policies should focus on males, younger and more educated individuals, as well as on individuals with unhealthy eating habits, because these variables were statistically significant and increased joint consumption. In addition, these characteristics also should be regarded if we want to control tobacco consumption among alcohol consumers. CONCLUSIONS The analysis of the interdependence between alcohol and tobacco use presented in this article may allow reducing their consumption with a common intervention, enabling policymakers to 'kill two birds with one stone' and to achieve extended health and economic gains.
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Affiliation(s)
- A M Reis
- Faculty of Economics, University of Coimbra, Portuguese Health Regulation Authority, Av. Dias da Silva, 165 3004-512, Coimbra, Portugal.
| | - C Quintal
- CEISUC, CeBER and Faculty of Economics, University of Coimbra, Coimbra, Portugal
| | - Ó Lourenço
- CeBER and Faculty of Economics, University of Coimbra, Coimbra, Portugal
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Platts LG, Gerry CJ. Social inequalities in self-rated health in Ukraine in 2007: the role of psychosocial, material and behavioural factors. Eur J Public Health 2017; 27:211-217. [PMID: 28339514 DOI: 10.1093/eurpub/ckw143] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.1] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/13/2022] Open
Abstract
Background Despite Ukraine's large population, few studies have examined social inequalities in health. This study describes Ukrainian educational inequalities in self-rated health and assesses how far psychosocial, material and behavioural factors account for the education gradient in health. Methods Data were analyzed from the 2007 wave of the Ukrainian Longitudinal Monitoring Survey. Education was categorized as: lower secondary or less, upper secondary and tertiary. In logistic regressions of 5451 complete cases, stratified by gender, declaring less than average health was regressed on education, before and after adjusting for psychosocial, material and behavioural factors. Results In analyses adjusted for socio-demographic characteristics, compared with those educated up to lower secondary level, tertiary education was associated with lower risk of less than average health for both men and women. Including material factors (income quintiles, housing assets, labour market status) reduced the association between education and health by 55-64% in men and 35-47% in women. Inclusion of health behaviours (physical activity, smoking, alcohol consumption and body mass index) reduced the associations by 27-30% in men and 19-27% in women; in most cases including psychosocial factors (marital status, living alone, trust in family and friends) did not reduce the size of the associations. Including all potential explanatory factors reduced the associations by 68-84% in men and 43-60% in women. Conclusions The education gradient in self-rated health in Ukraine was partly accounted for by material and behavioural factors. In addition to health behaviours, policymakers should consider upstream determinants of health inequalities, such as joblessness and poverty.
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Affiliation(s)
- Loretta G Platts
- Stress Research Institute, Stockholm University, Stockholm, Sweden
| | - Christopher J Gerry
- International Centre for Health Economics, Management, and Policy, National Research University Higher School of Economics, Saint Petersburg, Russian Federation
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