The intersection of life expectancy and gender in a transitional state: the case of Russia

Hazardous alcohol consumption in slow- and fast-privatized Russian industrial towns

Hazardous drinking, defined as the consumption of homemade, unofficially made alcohol and non-beverages, is prevalent and accounts for a high proportion of alcohol-related deaths in Russia. Individual-level characteristics are important explanations of hazardous drinking, but they are unlikely to explain spatial variation in this type of alcohol consumption. Areas that attracted insufficient attention in the research of hazardous drinking are the legacy of industrialization and the speed of economic reforms, mainly through the privatization policy of major enterprises in the 1990s. Applying mixed-effects logistic regressions to a unique dataset from 30 industrial towns in the European part of Russia, we find that in addition to individual-level characteristics such as gender, age, marital status, education, social isolation, labor market status, and material deprivation, the types of towns where informants' relatives resided such as industrial structure and speed of privatization also accounted for the variance in hazardous alcohol consumption among both male and female populations of the analyzed towns.

Gender gap in life expectancy in India and role of age groups: A comparison between before and after male - female life expectancy at birth crossover

To assess the gender gap in life expectancy at birth in India and its major states as well as the timing of male-female life expectancy at birth crossover. To analyze the age-specific contributions to the changing gender differences before and after the crossover at the national and sub-national levels. We have used sample-survey-based age-specific mortality data available for the periods 1970–2018 to construct abridged life tables. The contribution of different age groups to the gender gap is estimated by using Arriaga’s method of decomposition. During 1981–85 female life expectancy at birth caught up with male life expectancy at birth for India and by 2005 all major states completed the crossover. The male-female crossover in life expectancy at the national level in the early 80s is remarkable in the face of continued female disadvantage from birth till adolescence, even for some richer states. We provide evidence that gender difference in longevity in favour of females is largely a function of adult age groups and younger age groups contribute negatively to the gender gap in life expectancy at birth in most states. Juxtaposing the results from contribution in an absolute number of years and their relative contribution change before and after the crossover, it is established that although the adult and old age groups contribute the highest in the absolute number of years before and after the crossover, the contribution of the reproductive age groups and childhood years in the recent time is most relevant in relative terms.

Health disparities in Russia at the regional and global scales

BACKGROUND

The capacity for health comparisons, including the accurate comparison of indicators, is necessary for a comprehensive evaluation of well-being in places where people live. An important issue is the assessment of within-country heterogeneity for geographically extensive countries. The aim of this study was to assess the spatial and temporal changes in health status in Russia and to compare these regional changes with global trends.

METHODS

The index, which considers the infant mortality rate and the male and female life expectancy at birth, was used for this purpose. Homogeneous territorial groups were identified using principal component analysis and multivariate ranking procedures. Trend analysis of individual indicators included in the index was also performed to assess the changes over the past 20 years (1990-2017).

RESULTS

The study indicated a trend towards convergence in health indicators worldwide, which is largely due to changes in infant mortality. It also revealed that the trend of increasing life expectancy in many regions of Russia is not statistically significant. Significant interregional heterogeneity of health status in Russia was identified according to the application of typological ranking. The regions were characterized by similar index values until the mid-1990s.

CONCLUSIONS

The strong spatial inequality in health of population was found in Russia. While many regions of Russia were comparable to the countries in the high-income group in terms of GDP, the progress in health was less pronounced. Perhaps this can be explained by intraregional inequality, expressed by significant fluctuations in income levels.

TRIAL REGISTRATION

Not applicable.

Past and Future Alcohol-Attributable Mortality in Europe

Although alcohol consumption is an important public health issue in Europe, estimates of future alcohol-attributable mortality for European countries are rare, and only apply to the short-term future. We project (age-specific) alcohol-attributable mortality up to 2060 in 26 European countries, after a careful assessment of past trends. For this purpose we used population-level country-, sex-, age- (20-84) and year-specific (1990-2016) alcohol-attributable mortality fractions (AAMF) from the Global Burden of Disease (GBD) study, which we adjusted at older ages. To these data we apply an advanced age-period-cohort projection methodology, that avoids unrealistic future differences and crossovers between sexes and countries. We project that in the future, AAMF levels will decline in all countries, and will converge across countries and sexes. For 2060, projected AAMF are, on average, 5.1% among men and 1.4% among women, whereas in 2016 these levels were 10.1% and 3.3%, respectively. For men, AAMF is projected to be higher in Eastern and South-western Europe than in North-western Europe. All in all, the share of mortality due to alcohol is projected to eventually decline in all 26 European countries. Achieving these projected declines will, however, require strong ongoing public health action, particularly for selected Eastern and North-western European countries.

Socio-Demographic Determinants of Mortality from Chronic Noncommunicable Diseases in Women of Reproductive Age in the Republic of Georgia: Evidence from the National Reproductive Age Mortality Study (2014)

Purpose

Worldwide, noncommunicable diseases (NCDs) are the leading cause of premature death of women, taking the highest toll in developing countries. This study aimed to identify key socio-demographic determinants of NCD mortality in reproductive-aged women (15-49 years) in Georgia.

Materials and Methods

The study employed the verbal autopsy data from the second National Reproductive Age Mortality Survey 2014. Univariate and multivariate logistic regression models were fitted to explore the association between each risk factor and NCD mortality, measured by crude and adjusted odds ratio (AOR) with respective 95% confidence intervals (95% CI).

Results

In the final sample of 843 women, 586 (69.5%) deaths were attributed to NCDs, the majority of which occurred outside a hospital (72.7%) and among women aged 45-49 years (46.8%), ethnic Georgians (85.2%), urban residents (60.1%), those being married (60.6%), unemployed (75.1%) or having secondary and higher education (69.5%), but with nearly equal distribution across the wealth quintiles. After multivariate adjustment, the odds of dying from NCDs were significantly higher in women aged 45-49 years (AOR=17.69, 95% CI= 9.35 to 33.50), those being least educated (AOR=1.55, 95% CI= 1.01 to 2.37) and unemployed (AOR=1.47, 95% CI= 1.01 to 2.14) compared, respectively, to their youngest (15-24 years), more educated and employed counterparts. Strikingly, the adjusted odds were significantly lower in "other" ethnic minorities (AOR=0.29, 95% CI= 0.14 to 0.61) relative to ethnic Georgians. Contrariwise, there were no significant associations between NCD mortality and women's marital or wealth status, place of residence (rural/urban) or place of death.

Conclusion

Age, ethnicity, education, and employment were found to be strong independent predictors of young women's NCD mortality in Georgia. Further research on root causes of inequalities in mortality across the socioeconomic spectrum is warranted to inform equity- and life course-based multisectoral, integrated policy responses that would be conducive to enhancing women's survival during and beyond reproduction.

Alcohol and gender gaps in life expectancy in eight Central and Eastern European countries

Background

Gender differences in life expectancy (LE) have been traditionally large in Central and Eastern Europe (CEE), and alcohol has been hypothesized to be one of its main determinants. We examined the role of alcohol in gender differences in LE in Estonia, Lithuania, Latvia, Moldova, Poland, Romania, Russia and Ukraine, and changes in this role from 1965 until 2012.

Methods

We decomposed the gender differences in LE at birth into alcohol- and non-alcohol-related mortality. We examined causes of death wholly attributable to alcohol over the whole period, and estimated from 1990 onwards additional alcohol-attributable mortality by using alcohol-attributable fractions from the Global Burden of Disease study.

Results

In the eight CEE countries, women's advantage in LE relative to men increased from 7.3 years on average in 1965 to 10.0 years on average in 2012. All alcohol-attributable mortality contributed 1.9 years on average (uncertainty intervals (UI): 1.2-2.5; 18.8%) to the gender differences from 1990 to 2012. Its relative contribution increased in most countries until around 2005, and declined thereafter, resulting in a contribution of at least 15% in 2012. The absolute contribution of alcohol to the LE gender gap was strongly correlated with the overall LE gender differences (Pearson's r > 0.75), except in Poland and Estonia.

Conclusions

Despite recent declines, the contribution of sex differences in excessive alcohol consumption to the LE gender gap is substantial, and should not be neglected. Tackling gender differences in alcohol consumption and alcohol-attributable mortality would contribute to further progress in reducing mortality.

HIV Stigma and Unhealthy Alcohol Use Among People Living with HIV in Russia

Unhealthy alcohol use, highly prevalent in the Russian Federation (Russia), is associated with HIV risk behaviors among people living with HIV (PLWH). HIV stigma contributes to the HIV risk environment in Russia. To examine HIV stigma among Russian PLWH and to explore its association with unhealthy alcohol use, we conducted a longitudinal analysis of 700 PLWH in St. Petersburg, Russia. We assessed the association between alcohol dependence and HIV stigma measured at baseline and 12 months follow-up. Participants with alcohol dependence (n = 446) reported significantly higher HIV stigma scores over time than those without dependence (n = 254) (adjusted mean difference 0.60, 95% CI 0.03-1.17; p = 0.04). In secondary analyses, we examined recent risky alcohol use and did not detect an association with HIV stigma. Alcohol dependence is associated with high HIV stigma among Russian PLWH but the nature of the association is conjectural. HIV prevention efforts in Russia that address alcohol use disorders hold potential to mitigate HIV-related stigma and its possible adverse effects among PLWH.

Aspects of corporate wellness programs: comparisons of customer satisfaction

Purpose

With the passage of the Affordable Health Care Act in the USA, many companies are investing in corporate wellness programs as a way to reduce healthcare costs and increase productivity of their workforces. Increasing healthcare expenditures and the pandemic of obesity and chronic diseases are driving forces to the development and implementation of workplace wellness programs across the globe. Companies expect to experience a return on their investment through lower healthcare costs and increased productivity. The paper aims to discuss these issues.

Design/methodology/approach

In this study, 109 business professionals were surveyed (primarily almost equally divided between Russian and Americans citizens) to examine their health-promoting and health risk behaviors. Demographics were compared in an effort to identify the key differences in order to pinpoint development opportunities to increase efficiencies among target populations.

Findings

According to the results, nationality was related to certain differences in health-promoting behaviors, participation rates and frequency of wellness programs offered by employers. No differences were found among different age groups. The results indicated that not even a single wellness program design is appropriate for all companies or even one company across all locations.

Research limitations/implications

Although there were no general conclusions have been drawn nor have the influencing factors for the different behaviors of the various target groups been adequately examined in this exploratory study, there were baselines developed for future research.

Originality/value

Few empirical studies exists that measure the perceived value of corporate wellness programs, especially among different cultural settings. In effect, wellness programs need to be developed specifically for the target population, with considerations to perceived value differences.

Social capital - a mixed blessing for women? A cross-sectional study of different forms of social relations and self-rated depression in Moscow

BACKGROUND

Depression is a major health problem worldwide, especially among women. The condition has been related to a number of factors, such as alcohol consumption, economic situation and, more recently, to social capital. However, there have been relatively few studies about the social capital-depression relationship in Eastern Europe. This paper aims to fill this gap by examining the association between different forms of social capital and self-rated depression in Moscow. Differences between men and women will also be examined, with a special focus on women.

METHODS

Data was obtained from the Moscow Health Survey, which was conducted in 2004 with 1190 Muscovites aged 18 years or above. For depression, a single-item self-reported measure was used. Social capital was operationalised through five questions about different forms of social relations. Logistic regression analysis was undertaken to estimate the association between social capital and self-rated depression, separately for men and women.

RESULTS

More women (48 %) than men (36 %) reported that they had felt depressed during the last year. An association was found between social capital and reported depression only among women. Women who were divorced or widowed or who had little contact with relatives had higher odds of reporting depression than those with more family contact. Women who regularly engaged with people from different age groups outside of their families were also more likely to report depression than those with less regular contact.

CONCLUSIONS

Social capital can be a mixed blessing for women. Different forms of social relations can lead to different health outcomes, both positive and negative. Although the family is important for women's mental health in Moscow, extra-familial relations across age groups can be mentally distressing. This suggests that even though social capital can be a valuable resource for mental health, some of its forms can be mentally deleterious to maintain, especially for women. More research is needed on both sides to social capital. A special focus should be placed on bridging social relations among women in order to better understand the complex association between social capital and depression in Russia and elsewhere.

Caring for Strangers: Aging, Traditional Medicine, and Collective Self-care in Post-socialist Russia

This article explores how aging patients in Russia assemble strategies of care in the face of commercialization of medical services and public health discourses and initiatives aimed at improving the population's lifestyle habits. By focusing on how the formation of pensioner publics intersects with the health-seeking trajectories of elderly patients, it tracks an emerging ethic of collective self-care-a form of therapeutic collectivity that challenges articulations of good health as primarily an extension of personal responsibility or solely as a corollary of access to medical resources. By drawing on traditional medicine, these pensioners rely on and advocate for stranger intimacies that offer tactics for survival in the present through the care of (and for) a shared and embodied post-socialist condition of social, economic, and bodily precarity.

Economic Security, Social Cohesion, and Depression Disparities in Post-transition Societies: A Comparison of Older Adults in China and Russia

Although both China and Russia have experienced several decades of market reform, initial evidence suggests that this structural change has compromised mental and physical health among the Russian population but not the Chinese population. Using data from the World Health Organization Study on Global AGEing and Adult Health (2007-2010), this study examines the factors associated with the disparity in depression between older adults in China and their Russian counterparts, all of whom experienced market transition in the prime of their lives (N = 10,896). Results show that the lower level of depression among Chinese respondents is attributable to higher levels of economic security and social cohesion as well as stronger effects of economic and social resources on depression, while health-rating style is likely a minor factor. The study advances the sociological understanding of global/comparative mental health by considering the effects of macrolevel political, economic, social, and cultural conditions.

Prevalence and characteristics of suicide attempters and ideators among acutely admitted psychiatric hospital patients in northwest Russia and northern Norway

BACKGROUND

More knowledge about suicidality and suicide risk profiles in acute psychiatric hospital patients (both first-time and chronic patients) is needed. While numerous factors are associated with suicidality in such populations, these may differ across cultures. Better understanding of factors underlying suicide risk can be informed by cross-cultural studies, and can aid development of therapeutic and preventive measures.

METHODS

An explorative, cross-sectional cohort study was carried out. Acutely admitted patients at one psychiatric hospital in northwest Russia and two in northern Norway were included. At admission, demographic, clinical, and service use data were collected, in addition to an assessment of suicidal ideation and attempts, comprising five dichotomic questions. Data from 358 Norwegian and 465 Russian patients were analyzed with univariate and multivariate statistics. Within each cohort, attempters and ideators were compared with patients not reporting any suicidality.

RESULTS

The observed prevalence of suicidal ideation and attempts was significantly higher in the Norwegian cohort than in the Russian cohort (χ(2) = 168.1, p < 0,001). Norwegian suicidal ideators and attempters had more depressed moods, more personality disorders, and greater problems with alcohol/drugs, but fewer psychotic disorders, cognitive problems or overactivity than non-suicidal patients. Russian suicidal ideators and attempters were younger, more often unemployed, had more depressed mood and adjustment disorders, but had fewer psychotic disorders and less alcohol/drug use than the non-suicidal patients.

CONCLUSIONS

Rates of suicidal ideation and non-fatal attempts in Norwegian patients were intermediate between those previously reported for patients admitted for the first time and those typical of chronic patients. However, the significantly lower rates of suicidal ideation and non-fatal attempts in our Russian cohort as compared with the Norwegian, contrasted with what might be expected in a region with much higher suicide rates than in northern Norway. We suggest that suicide-related stigma in Russia may reduce both patient reporting and clinicians' recognition of suicidality. In both cohorts, overlapping risk profiles of ideators and attempters may indicate that ideators should be carefully evaluated and monitored, particularly those with depressed moods, alcohol/substance abuse disorders, and inadequate treatment continuity.

Population health and status of epidemiology: WHO European Region I

BACKGROUND

This article of the International Epidemiological Association commissioned paper series stocktakes the population health and status of epidemiology in 21 of the 53 countries of the WHO European Region. By United Nations geographical classification, these countries belong to Eastern Europe, Western Asia and South-Central Asia.

METHODS

Published data were used to describe population health indicators and risk factors. Epidemiological training and research was assessed based on author knowledge, information searches and E-mail survey of experts. Bibliometric analyses determined epidemiological publication outputs.

RESULTS

Between-country differences in life expectancy, amount and profile of disease burden and prevalence of risk factors are marked. Epidemiological training is affected by ongoing structural reforms of educational systems. Training is advanced in Israel and several Eastern European countries. Epidemiological research is mainly university-based in most countries, but predominantly conducted by governmental research institutes in several countries of the former Soviet Union. Funding is generally external and limited, partially due to competition from and prioritization of biomedical research. Multiple relevant professional societies exist, especially in Poland, the Czech Republic and Hungary. Few of the region's 39 epidemiological academic journals have international currency. The number of epidemiological publications per population is highest for Israel and lowest for South-Central Asian countries.

CONCLUSIONS

Epidemiological capacity will continue to be heterogeneous across the region and depend more on countries' individual historical, social, political and economic conditions and contexts than their epidemiologists' successive efforts. National and international research funding, and within- and between-country collaborations should be enhanced, especially for South-Central Asian countries.

Socioeconomic inequalities in all-cause mortality in the Czech Republic, Russia, Poland and Lithuania in the 2000s: findings from the HAPIEE Study

BACKGROUND

Relatively large socioeconomic inequalities in health and mortality have been observed in Central and Eastern Europe (CEE) and the former Soviet Union (FSU). Yet comparative data are sparse and virtually all studies include only education. The aim of this study is to quantify and compare socioeconomic inequalities in all-cause mortality during the 2000s in urban population samples from four CEE/FSU countries, by three different measures of socioeconomic position (SEP) (education, difficulty buying food and household amenities), reflecting different aspects of SEP.

METHODS

Data from the prospective population-based HAPIEE (Health, Alcohol, and Psychosocial factors in Eastern Europe) study were used. The baseline survey (2002-2005) included 16 812 men and 19 180 women aged 45-69 years in Novosibirsk (Russia), Krakow (Poland), Kaunas (Lithuania) and seven Czech towns. Deaths in the cohorts were identified through mortality registers. Data were analysed by direct standardisation and Cox regression, quantifying absolute and relative SEP differences.

RESULTS

Mortality inequalities by the three SEP indicators were observed in all samples. The magnitude of inequalities varied according to gender, country and SEP measure. As expected, given the high mortality rates in Russian men, largest absolute inequalities were found among Russian men (educational slope index of inequality was 19.4 per 1000 person-years). Largest relative inequalities were observed in Czech men and Lithuanian subjects. Disadvantage by all three SEP measures remained strongly associated with increased mortality after adjusting for the other SEP indicators.

CONCLUSIONS

The results emphasise the importance of all SEP measures for understanding mortality inequalities in CEE/FSU.