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Background: The dramatic increase in mortality in Russia and Ukraine in the late 1980s and 1990s has been due to increases in certain causes of death, particularly cardiovascular disease and accidents and violence. In contrast, there has been a slight fall in mortality from cancer.Methods: This paper presents an analysis of trends and patterns in cancer mortality and examines four possible explanations for its recent fall: changes in data collection; cohort effects; competing mortality from other causes of death; and improvements in health care.Results: All contribute to some extent to the observed changes, with each affecting predominantly different age groups. There is evidence of a significant underrecording of cancer deaths among the elderly especially in rural areas and of significant changes in coding practices in the early 1990s. Competing mortality from cardiovascular diseases and accidents can explain some reduction in male deaths from cancer in middle age. Birth cohort effects can explain some reduction among males after early middle age and among females at all ages. The impact of changes in health care are more difficult to identify with certainty but there is evidence of reduced deaths from childhood leukaemia.Implications: Recent changes in mortality in Russia are complex and their understanding will require a multidisciplinary approach embracing demography, epidemiology and health services research. [ABSTRACT FROM AUTHOR]

Editorial. Considers how the public health situation in Russia is grave. Mortality and life expectancy rates for the 1990s; Study by Notzon et al in the same issue which helps to redress the health problems by outlining the dimensions of the crisis; Factors on which the health of the Russian population will depend.

Since the mid-2000s, after a few decades of negative trends and fluctuations, Russia has experienced the longest and most stable period of life expectancy increasing for the entire period of observation which was determined not only by a decrease in mortality at the middle ages, but also at the old ages. This period has been marked by a very fast increase in life expectancy of Muscovites. The paper shows that the mortality at old ages in Moscow systematically deviates from the patterns observed in economically developed countries with reliable mortality statistics. We assume that experience of these countries is applicable to regions of Russia. Based on this assumption the adjusted estimates of life expectancy at old ages in Moscow and Russia were calculated, as well as effect of the underestimation of mortality over age 80 on life expectancy at birth and at the age of retirement.

The aim of the study was to compare different types of QT correction, establish age norms of QT duration, and assess associations between QT duration and heart rate (HR) in children. The sample comprised 0-18-year-old children (n=5909) selected from general population. The study examined several existing formulas of corrected QT (Bazett, Fridericia, Framingham, and Hodges) and modified Bazett formula developed for healthy children. The analysis demonstrated that neither formula enabled complete exclusion of the correlation between QT and RR intervals. Among existing formulas, Bazett formula provided maximum possible elimination of the HR influence on QT duration. Modified Bazett formula, developed by us, provided even less correlation of QT and RR intervals. Therefore, we recommend implementing modified Bazett formula to pediatric practice.

The investigation of socio-economic differences in mortality in Russia was effectively prohibited in the Soviet period. The extent and nature of any such differences is of considerable interest given the very different principles upon which Russian society has been organised for most of this century compared to the West where socio-economic differences in health have been extensively documented. Using cross-sectional data on mortality in Russia around the 1979 and 1989 Censuses, we have analysed mortality gradients according to length of education. Our results show that educational differences in mortality are at least as big as seen in Western countries, and are most similar to the recently reported differences observed for other former communist countries such as the Czech Republic, Estonia and Hungary. As observed in many other countries the strength of association of mortality with education declines with age, varies by cause of death and is generally stronger among men than women. Differentials are particularly large for accidents and violence, where for men and women the mortality rate among those with primary or basic secondary education is over twice that of people with higher education. Even larger effects are seen for causes directly related to alcohol (including alcoholic cirrhosis and accidental poisoning by alcohol), and for infectious and parasitic diseases and respiratory diseases. These educational differences may in part be related to educational differences in alcohol consumption. Of particular significance is the fact that there are indications that socio-economic differences in mortality have widened considerably in the 1990s, a period during which there was a huge increase in the national burden of alcohol-related deaths. This widening of socio-economic differences at this time suggest that these increases in consumption were especially acute among those with less education. At a more general level the fact that large educational differences in mortality were seen in Russia in 1979 and 1989, prior to the collapse of the Soviet Union, is very striking and informative. In this period there was a far weaker association between income and education than is seen in the West, suggesting that the education effects are unlikely to be driven by underlying differences in financial resources. The protective effect of education, in the Russian context at least, has been driven by more subtle and mechanisms. The apparent widening of socio-economic mortality differences since the collapse of the Soviet Union suggests that the transformation underway in Russian society requires a strengthening of the public health function.

Background: According to published data, between 1984 and 1994 mortality rates in Russia initially underwent a rapid decline followed by an even steeper increase. In 1994, male life expectancy at birth was 57.6 years, having fallen by 6.2 years since 1990. There has been concern that such striking fluctuations in mortality are an artefact, although, among other factors, alcohol consumption has been implicated., Methods: We analysed the age-specific and cause-specific patterns of mortality decrease and increase by use of data from a newly reconstructed mortality series for Russia so that we could examine the plausibility of various explanations for the mortality trends., Findings: All major causes of death, with the exception of neoplasms, showed declines in mortality between 1984 and 1987 and increases between 1987 and 1994. In relative terms, these tended to be largest for the age-group 40-50 years; surprisingly, they were of the same magnitude among women and men. The largest declines and subsequent increases in proportional terms were observed for alcohol-related deaths and accidents and violence. However, pronounced effects were also seen for deaths from infections, circulatory disease, and respiratory disease. No substantial variations were seen for neoplasms., Interpretation: The stability of mortality from neoplasms in contrast to other causes over the period 1984-94 largely precludes the possibility that the changes in life expectancy are mainly an artefact, particularly one due to underestimation of the population. Although factors such as nutrition and health services may be involved, the evidence is that substantial changes in alcohol consumption over the period could plausibly explain the main features of the mortality fluctuations observed. These results provide a major challenge to public health in Russia and to our understanding of the determinants of alcohol consumption and its role in explaining mortality patterns within and between many other countries.