Maternal and child health statistics: Russian Federation and United States, selected years 1985-95.

This report provides comparative maternal and child health data for recent years for the Russian Federation and the United States. Statistical data for Russia are from the Ministry of Health of Russia and from Goskomstat, the central statistical organization of Russia. Information for the United States comes from various data systems of the National Center for Health Statistics as well as other parts of the Department of Health and Human Services. A background section provides a description of each country's health care system and national guidelines for maternal and child health care. This information is intended to assist the reader in interpreting the subsequent sections on various aspects of maternal and child health. The report uses tables, figures, and commentary to present information on many different health measures for mothers, infants, children, and adolescents in the two countries. Topics covered include population size, prenatal and obstetrical care, abortions, natality, breastfeeding, mortality, immunization, communicable diseases, and other morbidity measures. The commentary includes a discussion of data quality issues that affect the accuracy and comparability of the information presented. Data are provided for selected years from 1985 to 1995. When available, additional detail is provided for key subgroups of each population: for the Russian Federation, urban and rural populations; for the United States, black and white racial groups. A glossary of terms at the end of the report provides additional information on definitions and data sources and limitations.

Cold related mortalities and protection against cold in Yakutsk, eastern Siberia: observation and interview study.

OBJECTIVE: To assess how effectively measures adopted in extreme cold in Yakutsk control winter mortality. DESIGN: Interviews to assess outdoor clothing and measure indoor temperatures; regressions of these and of delayed cause-specific mortalities on temperature. Setting Yakutsk, east Siberia, Russia. SUBJECTS: All people aged 50-59 and 65-74 years living within 400 km of Yakutsk during 1989-95 and sample of 1002 men and women who agreed to be interviewed. MAIN OUTCOME MEASURES: Daily mortality from all causes and from ischaemic heart, cerebrovascular, and respiratory disease. RESULTS: Mean temperature for October-March 1989-95 was -26.6 degreesC. At 10.2 degrees C people wore 3.30 (95% confidence interval 3.08 to 3.53) layers of clothing outdoors, increasing to 4.39 (4.13 to 4.66; P<0. 0001) layers at -20 degrees C. Thick coats, often of fur, replaced anoraks as temperature fell to -48.2 degrees C. 82% of people went out each day when temperatures were 10.2 degrees C to -20 degrees C, but below -20 degrees C the proportion fell steadily to 44% (35% to 53%) at -48.2 degrees C (P<0.001), and overall shivering outdoors did not increase. Living room temperature was 17.9 (17.2 to 18.5) degrees C at 10.2 degrees C outdoors, 19.6 (18.8 to 20.4) degrees C at -20 degrees C, and 19.1 (18.6 to 19.6) degrees C at -48.2 degrees C. Mortality from all causes and from ischaemic heart and respiratory disease was unaffected by the fall in temperature. Mortality from respiratory disease (daily deaths per million) rose from 4.7 (4.3 to 5.1) to 5.1 (4.4 to 5.7) (P=0.03), but this was offset by a fall in deaths from injury. CONCLUSIONS: People in Yakutsk wore very warm clothing, and in extremely cold weather stayed indoors in warm housing, preventing the increases in mortality seen in winter in milder regions of the world. Only respiratory mortality rose, perhaps because of breathing cold air.

Winter mortality and cold stress in Yekaterinburg, Russia: interview survey.

OBJECTIVES: To evaluate how mortality and protective measures against exposure to cold change as temperatures fall between October and March in a region of Russia with a mean winter temperature below -6 degrees C. DESIGN: Interview to assess factors associated with cold stress both indoors and outdoors, to measure temperatures in living room, and to survey unheated rooms. SETTING: Sverdlovsk Oblast (district), Yekaterinburg, Russia. SUBJECTS: Residents aged 50-59 and 65-74 living within approximately 140 km of Yekaterinburg in Sverdlovsk Oblast. Survey of sample of 1000 residents equally distributed by sex and age groups. MAIN OUTCOME MEASURES: Regression analysis was used to relate data on indoor heating and temperatures, the amount of clothing worn, the amount of physical activity, and shivering while outside, to outdoor temperature; results were compared with mortality patterns for ischaemic heart disease, cerebrovascular disease, respiratory disease, and mortality from all causes. RESULTS: As mean daily temperatures fell to 0 degree C the amount of clothing worn outdoors increased, physical activity while outdoors became more continuous, and only 11 (6.6%) of the 167 people surveyed who went outdoors at temperatures above 0 degree C reported shivering. The mean temperature in living rooms in the evening remained above 21.9 degrees C. Mortality from ischaemic heart disease, cerebrovascular disease, respiratory disease, and all causes did not change. As the temperature fell below 0 degree C the number of items of clothing worn plateaued at 16.0 and the number of layers at 3.7. With regression analysis, shivering outdoors was found to increase progressively to 34.6% (P < 0.001) of excursions at -25 degrees C, and mortality (after declining slightly) rose progressively (all cause mortality rose by 1.15% for each 1 degree C drop in temperature from 0 degree C to -29.6 degrees C, 95% confidence interval 0.97% to 1.32%). 94.2% of bedrooms were directly heated, and evening temperatures in the living room averaged 19.8 degrees C even when outside temperatures reached -25 degrees C. CONCLUSIONS: Outdoor cold stress and mortality in Yekaterinburg increased only when the mean daily temperature dropped below 0 degree C. At temperatures down to 0 degree C cold stress and excess mortality were prevented by increasing the number of items of clothing worn and the amount of physical activity outdoors in combination with maintaining warmth in houses.

Causes of declining life expectancy in Russia.

CONTEXT: Russian life expectancy has fallen sharply in the 1990s, but the impact of the major causes of death on that decline has not been measured. OBJECTIVE: To assess the contribution of selected causes of death to the dramatic decline in life expectancy in Russia in the years following the breakup of the Soviet Union. DESIGN: Mortality and natality data from the vital statistics systems of Russia and the United States. SETTING: Russia, 1990-1994. POPULATION: Entire population of Russia. MAIN OUTCOME VARIABLES: Mortality rates, life expectancy, and contribution to change in life expectancy. METHODS: Application of standard life-table methods to calculate life expectancy by year, and a partitioning method to assess the contribution of specific causes of death and age groups to the overall decline in life expectancy. United States data presented for comparative purposes. RESULTS: Age-adjusted mortality in Russia rose by almost 33% between 1990 and 1994. During that period, life expectancy for Russian men and women declined dramatically from 63.8 and 74.4 years to 57.7 and 71.2 years, respectively, while in the United States, life expectancy increased for both men and women from 71.8 and 78.8 years to 72.4 and 79.0 years, respectively. More than 75% of the decline in life expectancy was due to increased mortality rates for ages 25 to 64 years. Overall, cardiovascular diseases (heart disease and stroke) and injuries accounted for 65% of the decline in life expectancy while infectious diseases, including pneumonia and influenza, accounted for 5.8%, chronic liver diseases and cirrhosis for 2.4%, other alcohol-related causes for 9.6%, and cancer for 0.7%. Increases in cardiovascular mortality accounted for 41.6% of the decline in life expectancy for women and 33.4% for men, while increases in mortality from injuries (eg, falls, occupational injuries, motor vehicle crashes, suicides, and homicides) accounted for 32.8% of the decline in life expectancy for men and 21.8% for women. CONCLUSION: The striking rise in Russian mortality is beyond the peacetime experience of industrialized countries, with a 5-year decline in life expectancy in 4 years' time. Many factors appear to be operating simultaneously, including economic and social instability, high rates of tobacco and alcohol consumption, poor nutrition, depression, and deterioration of the health care system. Problems in data quality and reporting appear unable to account for these findings. These results clearly demonstrate that major declines in health and life expectancy can take place rapidly.

[The effect of industrial-occupational factors on the life expectancy of metallurgists]. / Vliianie proizvodstvenno-professional'nykh faktorov na prodolzhitel'nost' zhizni metallurgov.

The authors designed a method to evaluate possible influence of occupational hazards on lower life expectancy. Initial application of the method proved that average life expectancy of metallurgists is shorter by 2.6 years vs that of general male population in Tula Province.

Economic aspects of health.

This study described in this article was undertaken to assess the possibility of getting a general picture of the public health situation to be used in such economically oriented models as cost-benefit, cost-effectiveness and cost-utility. Problems of data bases encountered in this assessment of various republics, regions and administrative entities are also considered. New mathematicodemographic statistical models and a family of potential factographic automated information reference systems (FAIRS) based on these models and designed to be utilized in projects, programmes and regional systems of public health are analysed.