Spatial patterns of male alcohol-related mortality in Belarus, Lithuania, Poland and Russia.

INTRODUCTION AND AIMS: Eastern Europe is known to suffer from a large burden of alcohol-related mortality. However, persisting unfavourable conditions at the national level mask variation at the sub-national level. We aim to explore spatial patterns of cause-specific mortality across four post-communist countries: Belarus, Lithuania, Poland and Russia (European part). DESIGN AND METHODS: We use official mortality data routinely collected over 1179 districts and cities. The analysis refers to males aged 20-64 years and covers the period 2006-2014. Mortality variation is mainly assessed by means of the standardised mortality ratio. Getis-Ord Gi* statistic is employed to detect hot and cold spots of alcohol-related mortality. RESULTS: Alcohol-related mortality exhibits a gradient from very high levels in northwestern Russia to low levels in southern Poland. Spatial transitions from higher to lower mortality are not explicitly demarcated by national boundaries. Within these countries, hot spots of alcohol-related mortality dominate the territories of northwestern and western Russia, eastern and northwestern Belarus, southeastern Lithuania, and eastern and central Poland. DISCUSSION AND CONCLUSIONS: The observed mortality gradient is likely associated with the spread of alcohol epidemics from the European part of Russia to the other countries, which appears to have started more than a century ago. Contemporary socioeconomic and demographic factors should be taken into account when developing anti-alcohol policies. The same is true for the peculiarities of culture, norms, traditions and behavioural patterns observed in specific geographical areas of the four countries. Reducing alcohol-related harm in the areas identified as hot spots should be prioritised.

Adult mortality patterns in the former Soviet Union's southern tier: Armenia and Georgia in comparative perspective.

BACKGROUND: While the health crisis in the former USSR has been well-documented in the case of Russia and other northern former Soviet republics, little is known about countries located in the southern tier of the region, i.e., the Caucasus and Central Asia. OBJECTIVE: This paper presents new mortality information from two Caucasian countries, Georgia and Armenia. Results are compared with information from two relevant countries previously examined in the literature, Kyrgyzstan and Russia. METHODS: Using official statistics (with adjustments when necessary), we compare adult mortality patterns in the four countries since 1979, for all causes and by cause for the recent period. For Kyrgyzstan results are presented by ethnicity, as its mortality levels have been impacted by its large Slavic population. RESULTS: Adult mortality patterns in Armenia and Georgia have been more favorable than in Russia. This appears to be due to a large extent to lower mortality from alcohol-related causes. Mortality patterns in these Caucasian republics resemble those observed in Kyrgyzstan, especially when considering the native portion of the population. CONCLUSIONS: As far as mortality is concerned, Armenia and Georgia have weathered the collapse of the Soviet Union better than Russia. These results document a distinct southern tier pattern of adult mortality in the former Soviet Union. CONTRIBUTION: This article enriches our understanding of the health crisis in the former Soviet Union by bringing new information from two lesser-known countries and further documenting the scale of heterogeneity in mortality experiences across this vast region.

Reconstructing Long-Term Coherent Cause-of-Death Series, a Necessary Step for Analyzing Trends.

Every time the classification of causes of death is changed, time series of deaths by cause are disrupted in more or less profound ways. When changes involve only the merging of several items or splitting a single item into several new categories, the problems caused by these ruptures are not too difficult to solve. A more or less severe imbroglio occurs, however, each time a new item results from recombining portions of different split items. Sometimes, but very rarely, some countries proceed to a bridge coding during the year of transition, which can help reconstruct coherent time series. This article first summarizes the general principles of the method developed for France by Meslé and Vallin to reconstruct complete series for France from 1925 to 1999 in the detailed list of the 9th WHO International Classification of Diseases (ICD), doing so by successively bridging a posteriori the five versions of the ICD that were in use during that period. Second, it reports on several methodological improvements that have been developed with the aim to reconstruct and analyze mortality trends by cause in sixteen industrialized countries.

Identifying potential differences in cause-of-death coding practices across Russian regions.

BACKGROUND: Reliable and comparable data on causes of death are crucial for public health analysis, but the usefulness of these data can be markedly diminished when the approach to coding is not standardized across territories and/or over time. Because the Russian system of producing information on causes of death is highly decentralized, there may be discrepancies in the coding practices employed across the country. In this study, we evaluate the uniformity of cause-of-death coding practices across Russian regions using an indirect method. METHODS: Based on 2002-2012 mortality data, we estimate the prevalence of the major causes of death (70 causes) in the mortality structures of 52 Russian regions. For each region-cause combination we measured the degree to which the share of a certain cause in the mortality structure of a certain region deviates from the respective inter-regional average share. We use heat map visualization and a regression model to determine whether there is regularity in the causes and the regions that is more likely to deviate from the average level across all regions. In addition to analyzing the comparability of cause-specific mortality structures in a spatial dimension, we examine the regional cause-of-death time series to identify the causes with temporal trends that vary greatly across regions. RESULTS: A high level of consistency was found both across regions and over time for transport accidents, most of the neoplasms, congenital malformations, and perinatal conditions. However, a high degree of inconsistency was found for mental and behavioral disorders, diseases of the nervous system, endocrine disorders, ill-defined causes of death, and certain cardiovascular diseases. This finding suggests that the coding practices for these causes of death are not uniform across regions. The level of consistency improves when causes of death can be grouped into broader diagnostic categories. CONCLUSION: This systematic analysis allows us to present a broader picture of the quality of cause-of-death coding at the regional level. For some causes of death, there is a high degree of variance across regions in the likelihood that these causes will be chosen as the underlying causes. In addition, for some causes of death the mortality statistics reflect the coding practices, rather than the real epidemiological situation.

Spatial variation of male alcohol-related mortality in Belarus and Lithuania.

BACKGROUND: Numerous studies have addressed the problem of hazardous alcohol consumption, alcohol-related causes of death and their relationship to persisting excess male mortality in the countries of the former USSR. Yet relatively little is known about the geographical patterns of alcohol-related mortality within these countries and the cross-border continuities of such patterns. This study aims at identifying the spatial distribution and the cross-border patterns of adult male mortality from alcohol poisonings and liver cirrhosis in Belarus and Lithuania. METHODS: We use cause-specific mortality data for 2003-2007. We employ spatial econometric techniques to detect 'hot spots' of alcohol-related mortality across the combined territory of the two countries. RESULTS: Specific patterns associated with extremely high rates of mortality from alcohol poisoning can be observed in Belarus, particularly in the areas bordering Russia and Lithuania. Meanwhile, patterns of alcohol-induced liver disease dominate in Lithuania, and continue across the border from eastern Lithuania into north-western Belarus. CONCLUSIONS: The districts located along the Belarusian-Lithuanian border appear to be especially problematic, as they suffer from an enormous burden of alcohol consumption. The situation is particularly severe on the Belarusian side, where there are extremely high levels of mortality from both alcohol poisoning and liver cirrhosis. These areas should be considered primary targets for antialcohol policies.

Differential patterns of age-related mortality increase in middle age and old age.

It is often assumed that aging is a uniform process throughout adulthood because of the approximately linear increase of logarithmic mortality. We explored this assumption by analyzing cause-specific mortality increases in France (1979-1994). Rising rapidly at ages 30-54 years ("middle age") are death rates from malignant neoplasms at various sites, acute myocardial infarction, hypertensive disease, and liver cirrhosis. Steeply increasing at 65-89 years ("old age") are death rates from certain infectious diseases, particularly of the respiratory system; certain types of accidents; nonalcoholic mental disorders (probably due mainly to Alzheimer's disease and senile dementia); heart failure; cerebrovascular disease; and some "vague" categories. The processes at work may be fundamentally different in these two life history stages, such that the mortality rise in middle age reflects specific chronic diseases that develop prematurely in some high-risk individuals, whereas the mortality increase in old age is dominated by senescent processes that eventually raise the vulnerability of almost all individuals to multiple pathologies.

A new estimate of Ukrainian population losses during the crises of the 1930s and 1940s.

Ukraine experienced two very acute demographic crises during the Soviet era: the 1933 famine and the Second World War. While different estimates of total losses have been produced previously, we have tried here to distinguish the specific impact of the crises on mortality from their impact on fertility and migration. Taking into account all existing sources of registered data and estimates, a painstaking reconstruction of annual demographic changes has been produced and complete annual life tables have been computed for the years 1926-59. Life expectancy at birth fell to a level as low as 10 years for females and 7 for males in 1933 and plateaued around 25 for females and 15 for males in the period 1941-44.