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Background: Research on the aetiology of sudden cardiac death among young men in Russia strongly suggests an association with binge drinking. However, the possibility remains that such deaths are misclassified as being attributable to cardiovascular disease when they are really caused by acute alcohol poisoning.Objective: To describe postmortem levels of blood alcohol in Russian men dying from various causes and so determine whether deaths from alcohol poisoning are being misclassified as cardiovascular deaths.Setting: Ishevsk, capital of the Udmurt Republic, situated in the Ural region of the Russian Federation.Methods: The study was part of a larger one on adult mortality. The study sample was 309 deaths among men aged 20-55 dying between August 1998 and March 1999 from other than neoplasms, infectious diseases or unspecified causes and on whom necropsy records could be obtained. Information on cause of death was extracted from death certificates and data on postmortem blood alcohol concentration (BAC) from forensic records. Blood alcohol concentrations were adjusted where necessary to allow for delay in necropsy.Results: Medium or greater levels of intoxication occurred in a quarter of those recorded as dying from cardiovascular disease but in over half of those dying from external causes. BAC levels consistent with at least strong intoxication were seen in 13.5% of deaths from cardiovascular disease and 27.1% from external causes. No cardiovascular deaths had BAC at levels usually thought to be fatal while this level was seen in 26% of deaths from accidental poisoning.Conclusion: Evidence of recent consumption of alcohol is common among Russian men dying under the age of 55, with severe intoxication common where death is from external causes. However, the high death rates from cardiovascular disease in Russia cannot be explained by misclassification of deaths attributable to acute alcohol poisoning. This study thus resolves one of the outstanding controversies in the story of alcohol and cardiovascular disease in the former Soviet Union. [ABSTRACT FROM AUTHOR]

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]

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. [ABSTRACT FROM AUTHOR]

Background: Intra-annual excess mortality is the most reliable measure of losses of lives due to short-term risk factors. The objectives of our study are (i) to estimate excess mortality across German states in the course of the coronavirus disease 2019 (COVID-19) pandemic years 2020 and 2021 and (ii) to identify possible regional-level determinants of spatial inequality in pandemic-related excess mortality., Methods: We use weekly mortality data series for the calculation of weekly death rates, standardized by age for each federal state of Germany. We estimate the expected level of mortality as state-specific mortality trends and excess mortality in 2020 and 2021. We explore ecological statistical relationships between excess mortality, COVID-19 morbidity, and selected regional socioeconomic indicators using fixed-effects regression models., Results: Our study shows that during the first pandemic year, there was South-to-North gradient in excess mortality in Germany, with excess mortality being higher in the South. Over the course of the second pandemic year 2021, this gradient changed to become an East-to-West gradient, with excess mortality being higher in the East. The results of the study show stronger effects of COVID-19 morbidity on excess mortality in East Germany. State-level indicators reflecting economic activity, employment, and capacity of intensive care units show significant correlations with excess mortality across the states., Conclusions: The results show pronounced state-level differences in the magnitude of excess mortality during the COVID-19 pandemic in Germany. Economic activity, employment and capacity of intensive care units were the most important state-level characteristics associated with the observed spatial variations in excess mortality., (© The Author(s) 2023. Published by Oxford University Press on behalf of the European Public Health Association.)

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., Competing Interests: We declare no competing interests., (© 2023 The Author(s).)

Estimating excess mortality is challenging. The metric depends on the expected mortality level, which can differ based on given choices, such as the method and the time series length used to estimate the baseline. However, these choices are often arbitrary, and are not subject to any sensitivity analysis. We bring to light the importance of carefully choosing the inputs and methods used to estimate excess mortality. Drawing on data from 26 countries, we investigate how sensitive excess mortality is to the choice of the mortality index, the number of years included in the reference period, the method, and the time unit of the death series. We employ two mortality indices, three reference periods, two data time units, and four methods for estimating the baseline. We show that excess mortality estimates can vary substantially when these factors are changed, and that the largest variations stem from the choice of the mortality index and the method. We also find that the magnitude of the variation in excess mortality is country-specific, resulting in cross-country rankings changes. Finally, based on our findings, we provide guidelines for estimating excess mortality., (© 2022 The Authors. Population and Development Review published by Wiley Periodicals LLC on behalf of Population Council.)

Excess mortality has been used to measure the impact of COVID-19 over time and across countries. But what baseline should be chosen? We propose two novel approaches: an alternative retrospective baseline derived from the lowest weekly death rates achieved in previous years and a within-year baseline based on the average of the 13 lowest weekly death rates within the same year. These baselines express normative levels of the lowest feasible target death rates. The excess death rates calculated from these baselines are not distorted by past mortality peaks and do not treat non-pandemic winter mortality excesses as inevitable. We obtained weekly series for 35 industrialized countries from the Human Mortality Database for 2000-2020. Observed, baseline and excess mortalities were measured by age-standardized death rates. We assessed weekly and annual excess death rates driven by the COVID-19 pandemic in 2020 and those related to seasonal respiratory infections in earlier years. There was a distinct geographic pattern with high excess death rates in Eastern Europe followed by parts of the UK, and countries of Southern and Western Europe. Some Asia-Pacific and Scandinavian countries experienced lower excess mortality. In 2020 and earlier years, the alternative retrospective and the within-year excess mortality figures were higher than estimates based on conventional metrics. While the latter were typically negative or close to zero in years without extraordinary epidemics, the alternative estimates were substantial. Cumulation of this "usual" excess over 2-3 years results in human losses comparable to those caused by COVID-19. Challenging the view that non-pandemic seasonal winter mortality is inevitable would focus attention on reducing premature mortality in many countries. As SARS-CoV-2 is unlikely to be the last respiratory pathogen with the potential to cause a pandemic, such measures would also strengthen global resilience in the face of similar threats in the future., Competing Interests: The authors declare no competing interests., (© 2022 Published by Elsevier Ltd.)

Background: Socioeconomic inequalities in cardiovascular (CVD) health outcomes are well documented. While Russia has one of the highest levels of CVD mortality in the world, the literature on contemporary socio-economic inequalities in biomarker CVD risk factors is sparse. This paper aims to assess the extent and the direction of SEP inequalities in established physiological CVD risk biomarkers, and to explore the role of lifestyle factors in explaining SEP inequalities in physiological CVD risk biomarkers., Methods: We used cross-sectional data from a general population-based survey of Russians aged 35-69 years living in two cities (n = 4540, Know Your Heart study 2015-18). Logistic models were used to assess the associations between raised physiological risk biomarkers levels (blood pressure levels, cholesterol levels, triglycerides, HbA1C, and C-reactive protein) and socioeconomic position (SEP) (education and household financial constraints) adjusting for age, obesity, smoking, alcohol and health-care seeking behavior., Results: High education was negatively associated with a raised risk of blood pressure (systolic and diastolic) and C-reactive protein for both men and women. High education was positively associated with total cholesterol, with higher HDL levels among women, and with low triglycerides and HbA1c levels among men. For the remaining risk biomarkers, we found little statistical support for SEP inequalities. Adjustment for lifestyle factors, and particularly BMI and waist-hip ratio, led to a reduction in the observed SEP inequalities in raised biomarkers risk levels, especially among women. High financial constraints were weakly associated with high risk biomarkers levels, except for strong evidence for an association with C-reactive protein (men)., Conclusions: Notable differences in risk biomarkers inequalities were observed according to the SEP measure employed. Clear educational inequalities in raised physiological risk biomarkers levels, particularly in blood pressure and C-reactive protein were seen in Russia and are partly explained by lifestyle factors, particularly obesity among women. These findings provide evidence-based information on the need for tackling health inequalities in the Russian population, which may help to further contribute to CVD mortality decline., (© 2022. The Author(s).)

This article addresses two unresolved methodological issues related to prior research on Russia that was based on census-unlinked data and did not account for the substantial increase in the share of death records with missing information on education. The study uses a proportional mortality analysis method relying on a case-control framework, together with a plausible imputation-based solution for the redistribution of the unknown education on death records. The new results suggest that high levels of inequality persist, but they do not support recent findings indicating that the educational gap in life expectancy has substantially widened., (© The Author(s) 2021. Published by Oxford University Press on behalf of the European Public Health Association.)

Population-based data on coronavirus disease in Russia and on the immunogenicity of the Sputnik V vaccine are sparse. In a survey of 1,080 residents of Arkhangelsk 40-75 years of age, 65% were seropositive for IgG. Fifteen percent of participants had been vaccinated; of those, 97% were seropositive.

Background: There is considerable variation in mortality rates from myocardial infarction (MI) across high-income countries, some of which may be artefactual., Methods: Time trends in mortality rates from ischaemic heart disease (IHD) and MI were analysed for a set of high-income countries from the end of the 1970s. Using individual-level mortality data from Russia (2005-2017) and Norway (2005-2016), we investigated factors associated with the proportion of total IHD deaths certified as due to MI., Results: In most countries, MI mortality rates have dramatically declined from the 1970s. However, the share of MI in total IHD deaths varies substantially across countries. In Russia, only 12% of IHD deaths had MI assigned as the underlying cause vs 63% in Norway. IHD deaths occurring outside of hospital without autopsy were far less likely to be assigned as MI in Russia (2%) than in Norway (59%)., Conclusions: Although established international criteria for MI require specific clinical or post-mortem evidence, it appears that certifying specialists in different countries may interpret these criteria differently. At one extreme, Russian doctors may only assign MI as a cause of death when there is specific pathophysiological evidence. At the other extreme, their counterparts in Norway may be willing to specify MI as the cause even when this evidence is not available. Internationally established criteria for MI diagnosis are challenging to apply for out-of-hospital deaths. Differences between countries in how certifiers interpret these criteria may account for at least some of the international variation in MI mortality rates., (© The Author(s) 2021. Published by Oxford University Press on behalf of the International Epidemiological Association.)

Background: Russia has been portrayed in media as having one of the highest death tolls due to the COVID-19 pandemic in the world. However, the precise scale of excess mortality is still unclear. We provide the first estimates of excess mortality in Russia as a whole and its regions in 2020, placing this in an international context., Methods: We used monthly death rates for Russia and 83 regions plus the equivalent for 36 comparator countries. Expected mortality was derived in two ways using averages in the same months in preceding years and the same averages adjusted for secular trends. Excess death rates were estimated for the whole year and the last 3 quarters. We also estimated the relationships between excess mortality and reported COVID-19 cases and deaths across countries and Russian regions., Results: Estimating excess deaths rates based on the trend-adjusted average, Russia had the highest excess mortality of any of the 37 countries considered. Using the simple average, Russia had the third highest. Most of the excess deaths were recorded in the 4th quarter of 2020 and the level and trajectory of excess mortality in Russia and most of Eastern European countries differed from that in Western countries. While both the cumulative number of COVID-19 cases and deaths showed positive correlations with excess mortality across countries (r=0.65 and r=0.75, p<0.001), the association across the Russian regions was, surprisingly, negative for cases (r=-0.34, p<0.01) and deaths (r=-0.09, p=0.42). When we replaced reported deaths with final data from death certificates the correlation was positive (r=0.38, p<0.001)., Conclusion: Russia has one of the largest absolute burden of excess mortality in 2020 but there is a counter-intuitive negative association between excess mortality and cumulative incidence at the regional level. Under-recording of COVID-19 cases seems to be a problem in some regions., (© 2021 The Authors.)

Background: Hypertension is recognized as an important contributor to high cardiovascular mortality in Russia. A comprehensive analysis of data from Russian studies that measured blood pressure in population-based samples has not been previously undertaken. This study aims to identify trends and patterns in mean blood pressure and the prevalence of hypertension in Russia over the most recent 40 years., Methods: We obtained anonymized individual records of blood pressure measurements from 14 surveys conducted in Russia in 1975-2017 relating to a total of 137,687 individuals. For comparative purposes we obtained equivalent data from 4 surveys in the USA and England for 23,864 individuals. A meta-regression on aggregated data adjusted for education was undertaken to estimate time trends in mean systolic and diastolic blood pressure, the prevalence of elevated blood pressure (> 140/90 mmHg), and hypertension (defined as elevated blood pressure and/or the use of blood pressure-lowering) medication. A meta-analysis of pooled individual-level data was used to assess male-female differences in blood pressure and hypertension., Results: During the period 1975-2017 mean blood pressure, the prevalence of elevated blood pressure and hypertension remained stable among Russian men. Among Russian women, mean systolic blood pressure decreased at an annual rate of 0.25 mmHg (p < 0.1) at age 35-54 years and by 0.8 mmHg (p < 0.01) at ages 55 and over. The prevalence of elevated blood pressure also decreased by 0.8% per year (p < 0.01), but the prevalence of hypertension remained stable. Mean blood pressure and prevalence of hypertension were higher in Russia compared to the USA and England at all ages and for both sexes., Conclusions: In contrast to the generally observed downward trend in elevated blood pressure in many other countries, levels in Russia have changed little over the past 40 years, although there are some positive trends among women. Improved strategies to bring down the high levels of mean blood pressure and hypertension in Russia compared to countries such as England and the USA are important to further reduce the high burden of CVD in Russia., (© 2021. The Author(s).)

Background: Identifying individuals with low grip strength is an initial step in many operational definitions of sarcopenia. As evidence indicates that contemporaneous Russian populations may have lower mean levels of grip strength than other populations in northern Europe, we aimed to: compare grip strength in Russian and Norwegian populations by age and sex; investigate whether height, body mass index, education, smoking status, alcohol use and health status explain observed differences and; examine implications for case-finding low muscle strength., Methods: We used harmonized cross-sectional data on grip strength and covariates for participants aged 40-69 years from the Russian Know Your Heart study (KYH) (n = 3833) and the seventh survey of the Norwegian Tromsø Study (n = 5598). Maximum grip strength (kg) was assessed using the same protocol and device in both studies. Grip strength by age, sex and study was modelled using linear regression and between-study differences were predicted from these models. Sex-specific age-standardized differences in grip strength and in prevalence of low muscle strength were estimated using the European population standard of 2013., Results: Normal ranges of maximum grip strength in both studies combined were 33.8 to 67.0 kg in men and 18.7 to 40.1 kg in women. Mean grip strength was higher among Tromsø than KYH study participants and this difference did not vary markedly by age or sex. Adjustment for covariates, most notably height, attenuated between-study differences but these differences were still evident at younger ages. For example, estimated between-study differences in mean grip strength in fully adjusted models were 2.2 kg [95% confidence interval (CI) 1.4, 3.1] at 40 years and 1.0 kg (95% CI 0.5, 1.5) at 65 years in men (age × study interaction P = 0.09) and 1.1 kg (95% CI 0.4, 1.9) at age 40 years and -0.2 kg (95% CI -0.7, 0.3) at 65 years in women (age × study interaction P < 0.01)., Conclusions: We found between-study differences in mean grip strength that are likely to translate into greater future risk of sarcopenia and poorer prospects of healthy ageing for Russian than Norwegian study participants. For example, the average Russian participant had a similar level of grip strength to a Norwegian participant 7 years older. Our findings suggest these differences may have their origins in childhood highlighting the need to consider interventions in early life to prevent sarcopenia., (© 2021 The Authors. Journal of Cachexia, Sarcopenia and Muscle published by John Wiley & Sons Ltd on behalf of Society on Sarcopenia, Cachexia and Wasting Disorders.)

Competing Interests: We declare no competing interests.

The COVID-19 pandemic has revealed substantial coverage and quality gaps in existing international and national statistical monitoring systems. It is striking that obtaining timely, accurate, and comparable across countries data in order to adequately respond to unexpected epidemiological threats is very challenging. The most robust and reliable approach to quantify the mortality burden due to short-term risk factors is based on estimating weekly excess deaths. This approach is more reliable than monitoring deaths with COVID-19 diagnosis or calculating incidence or fatality rates affected by numerous problems such as testing coverage and comparability of diagnostic approaches. In response to the emerging data challenges, a new data resource on weekly mortality has been established. The Short-term Mortality Fluctuations (STMF, available at www.mortality.org ) data series is the first international database providing open-access harmonized, uniform, and fully documented data on weekly all-cause mortality. The STMF online vizualisation tool provides an opportunity to perform a quick assessment of the excess weekly mortality in one or several countries by means of an interactive graphical interface., (© 2021. The Author(s).)

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.

The COVID-19 pandemic stimulated the interest of scientists, decision makers and the general public in short-term mortality fluctuations caused by epidemics and other natural or man-made disasters. To address this interest and provide a basis for further research, in May 2020, the Short-term Mortality Fluctuations data series was launched as a new section of the Human Mortality Database. At present, this unique data resource provides weekly mortality death counts and rates by age and sex for 38 countries and regions. The main objective of this paper is to detail the web-based application for visualizing and analyzing the excess mortality based on the Short-term Mortality Fluctuation data series. The application yields a visual representation of the database that enhances the understanding of the underlying data. Besides, it enables the users to explore data on weekly mortality and excess mortality across years and countries. The contribution of this paper is twofold. First, to describe a visualization tool that aims to facilitate research on short-term mortality fluctuations. Second, to provide a comprehensive open-source software solution for demographic data to encourage data holders to promote their datasets in a visual framework., Competing Interests: The authors have declared that no competing interests exist.

Introduction and Aims: In the 1990s, a strong inverse relationship between life expectancy (LE) in Russia and mortality from alcohol poisoning was observed. This association is remarkable as this cause accounts for less than 2% of deaths each year. It can be explained by treating the alcohol poisoning mortality as the best available measure in Russia of the population prevalence of harmful drinking in any year which in turn associated with mortality from a wide range of causes. This study analyses the evolving relationship of LE with this mortality-based measure of harmful drinking since 1965, and places it in a policy context., Design and Methods: We examine three periods: 1965-1984, a period of gradual LE decline; 1984-2003, a period of massive LE fluctuations; and 2003-2017, a period of LE improvement. Pearson's correlation coefficients and a linear relationship between annual changes in LE and alcohol poisoning were estimated for each period., Results: The strongest negative correlation between changes in LE and alcohol poisonings was found in 1984-2003. Over the period 2003-2017 a consistent positive LE trend emerged that was statistically independent of alcohol poisoning., Discussion and Conclusions: These results suggest that in the period from the mid-2000s a growth of LE in Russia was to a large extent independent of changes in the population prevalence of harmful drinking. While there has been a reduction in mortality at ages 15-64, at older ages mortality reduction unrelated to alcohol has become an increasingly important driver of overall mortality improvements., (© 2020 The Authors. Drug and Alcohol Review published by John Wiley & Sons Australia, Ltd on behalf of Australasian Professional Society on Alcohol and other Drugs.)

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.

Background: Prior studies on spatial inequalities in mortality in Russia were restricted to the highest level of administrative division, ignoring variations within the regions. Using mortality data for 2239 districts, this study is the first analysis to capture the scale of the mortality divide at a more detailed level., Methods: Age-standardised death rates are calculated using aggregated deaths for 2008-2012 and population exposures from the 2010 census. Inequality indices and decomposition are applied to quantify both the total mortality disparities across the districts and the contributions of the variations between and within regions., Results: Regional variations in mortality mask one-third (males) and one-half (females) of the inequalities observed at the district level. A comparison of the 5% of individuals residing in the districts with the highest and the lowest mortality shows a gap of 15.5 years for males and 10.3 years for females. The lowest life expectancy levels are in the shrinking areas of the Far East and Northwest of Russia. The highest life expectancy clusters are in the intercity districts of Moscow and Saint Petersburg, and in several science cities. Life expectancy in these best-practice districts is close to the national averages of Poland and Estonia, but is still substantially below the averages in Western countries., Conclusion: The large between-regional and within-regional disparities suggest that national-level mortality could be lowered if these disparities are reduced by improving health in the laggard areas. This can be achieved by introducing policies that promote health convergence both within and between the Russian regions., Competing Interests: Competing interests: None declared., (© Author(s) (or their employer(s)) 2020. Re-use permitted under CC BY-NC. No commercial re-use. See rights and permissions. Published by BMJ.)

Objective: To examine the prevalence of atrial fibrillation (AF), its impacts on cardiovascular disease (CVD) and all-cause mortality, and the associations between AF and inflammatory and serum biomarkers in a population-based sample of Muscovites., Methods: The study is a secondary analysis of data from the Stress, Aging and Health in Russia (SAHR) survey that includes information on 1800 individuals with an average age of 68.5 years at baseline, and on their subsequent mortality during 7.4 years on average. AF is detected by 12-lead electrocardiogram (ECG) and 24-hour Holter monitoring. The statistical analysis includes proportional hazard and logistic regression models., Results: Of the 1732 participants with relevant Holter data, AF was detected in 100 (74 by ECG and Holter, 26 by Holter only). The prevalence of AF was 5.8% for men and 7.4% for women. The fully adjusted model showed strongly elevated hazard of CVD and all-cause mortality in men and women with long non-self-limiting AF (LAF). LAF was found to be negatively associated with elevated total and low-density lipoprotein cholesterol and to be positively associated with elevated markers of inflammation in women., Conclusions: The study assessed for the first time the prevalence and the risks of death related to AF among older Russians. LAF was shown to be a strong and independent predictor of CVD and all-cause mortality. AF is unlikely to contribute to the large excess male mortality in Russia. The finding that one-quarter of AF cases were detected only by Holter monitoring demonstrates the usefulness of diagnostics with prolonged ECG registration., (Institute of Geriatric Cardiology.)

Background: Since 2010, the rate of improvement in life expectancy in the UK has slowed. We aimed to put this trend in the context of changes over the long term and in relation to a group of other high-income countries., Methods: We compared sex-specific trends in life expectancy since 1970 and age-specific mortality in England and Wales with median values for 22 high-income countries (in western Europe, Australia, Canada, New Zealand, Japan, and the USA). We used annual mortality data (1970-2016) from the Human Mortality Database., Findings: Until 2011-16, male life expectancy in England and Wales followed the median life expectancy of the comparator group. By contrast, female life expectancy was below the median and is among the lowest of the countries considered. In 2011-16, the rate of improvement in life expectancy slowed sharply for both sexes in England and Wales, and slowed more moderately in the comparator group because of negative trends in all adult age groups. This deceleration resulted in a widening gap between England and Wales and the comparators from 2011 onwards. Since the mid-2000s, for the first time, mortality rates in England and Wales among people aged 25-50 years were appreciably higher than in the comparator group., Interpretation: Although many countries have seen slower increases in life expectancy since 2011, trends in England and Wales are among the worst. The poor performance of female life expectancy over the long-term is in part driven by the relative timing of the smoking epidemic across countries. The previously overlooked higher mortality among young working-age adults in England and Wales relative to other countries deserves urgent attention., Funding: None., (Copyright © 2019 The Author(s). Published by Elsevier Ltd. This is an Open Access article under the CC BY 4.0 license. Published by Elsevier Ltd.. All rights reserved.)

Objectives: To assess disparities in mortality by socioeconomic status in Germany., Design and Participants: We analyse a large administrative dataset of the German Pension Fund (DRV), including 27 million person-years of exposure and 42 000 deaths in 2013. The data cover the economically active population, stratified by sex and by East and West., Outcome Measures: Age-standardised mortality rates and Poisson regression mortality rate ratios (MRRs)., Results: The risk of dying increases with decreasing income: the MRRs of the lowest to the highest income quintile are 4.66 (95% CI 4.48 to 4.85) among men and 3.06 (95% CI 2.90 to 3.23) among women. The impact of income attenuates after controlling for education and other explanatory variables, especially for females. In the fully controlled model for females, individual income is a weaker predictor of mortality, but there is a clear educational mortality gradient. In the fully controlled model, the MRRs of the unemployed to the employed are 2.09 (95% CI 2.03 to 2.15) among men and 2.01 (95% CI 1.92 to 2.10) among women. The risk of dying is around half as high among foreigners as among German citizens. The socioeconomic disparities are greater among East than West German men., Conclusions: Low socioeconomic status is a major determinant of excess adult mortality in Germany. The persisting East-West differences in male adult mortality can be explained by the higher socioeconomic status of men living in the West, rather than by contextual differences between East and West. These differences can be further monitored using DRV data., Competing Interests: Competing interests: None declared., (© Author(s) (or their employer(s)) 2019. Re-use permitted under CC BY-NC. No commercial re-use. See rights and permissions. Published by BMJ.)

Research indicates that women have higher levels of physical disability and depression and lower scores on physical performance tests compared to men, while the evidence for gender differences in self-rated health is equivocal. Scholars note that these patterns may be related to women over-reporting and men under-reporting health problems, but gender differences in reporting behaviors have not been rigorously tested. Using Wave 1 of the Survey of Health, Ageing and Retirement in Europe (SHARE), the present study investigates the extent to which adjusting for differences in reporting behavior modifies gender differences in general health. We also examine whether men and women's reporting behaviors are consistent across different levels of education. After adjusting for reporting heterogeneity, gender differences in both poor and good health widened. However, we found no clear gender-specific patterns in reporting either poor or good health. Our findings also do not provide convincing evidence that education is an important determinant of general health reporting, although the female disadvantage in poor health and the male advantage in good health were more apparent in lower than higher education groups at all ages. The results challenge prevailing stereotypes that women over-report and men under-report health problems and highlight the importance of attending to health problems reported by women and men with equal care., (Copyright © 2019 The Authors. Published by Elsevier Ltd.. All rights reserved.)

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., (Copyright © 2019 The Author(s). Published by Elsevier Ltd. This is an Open Access article under the CC BY 4.0 license. Published by Elsevier Ltd.. All rights reserved.)

Russia has one of the highest rates of cardiovascular disease in the world. The International Project on Cardiovascular Disease in Russia (IPCDR) was set up to understand the reasons for this. A substantial component of this study was the Know Your Heart Study devoted to characterising the nature and causes of cardiovascular disease in Russia by conducting large cross-sectional surveys in two Russian cities Novosibirsk and Arkhangelsk. The study population was 4542 men and women aged 35-69 years recruited from the general population. Fieldwork took place between 2015-18. There were two study components: 1) a baseline interview to collect information on socio-demographic characteristics and cardiovascular risk factors, usually conducted at home, and 2) a comprehensive health check at a primary care clinic which included detailed examination of the cardiovascular system. In this paper we describe in detail the rationale for, design and conduct of these studies., Competing Interests: No competing interests were disclosed.

Background: This study compares handgrip strength and its association with mortality across studies conducted in Moscow, Denmark, and England., Materials: The data collected by the Study of Stress, Aging, and Health in Russia, the Study of Middle-Aged Danish Twins and the Longitudinal Study of Aging Danish Twins, and the English Longitudinal Study of Ageing was utilized., Results: Among the male participants, the age-standardized grip strength was 2 kg and 1 kg lower in Russia than in Denmark and in England, respectively. The age-standardized grip strength among the female participants was 1.9 kg and 1.6 kg lower in Russia than in Denmark and in England, respectively. In Moscow, a one-kilogram increase in grip strength was associated with a 4% (hazard ratio [HR] = 0.96, 95% confidence interval [CI]: 0.94, 0.99) reduction in mortality among men and a 10% (HR = 0.90, 95%CI: 0.86, 0.94) among women. Meanwhile, a one-kilogram increase in grip strength was associated with a 6% (HR = 0.94, 95%CI: 0.93, 0.95) and an 8% (HR = 0.92, 95%CI: 0.90, 0.94) decrease in mortality among Danish men and women, respectively, and with a 2% (HR = 0.98, 95%CI: 0.97, 0.99) and a 3% (HR = 0.97, 95%CI: 0.95, 0.98) reduction in mortality among the English men and women, respectively., Conclusion: The study suggests that, although absolute grip strength values appear to vary across the Muscovite, Danish, and English samples, the degree to which grip strength is predictive of mortality is comparable across national populations with diverse socioeconomic and health profiles and life expectancy levels.

This study proposes a new decomposition method that permits a difference in an aggregate measure at a final time point to be split into additive components corresponding to the initial differences in the event rates of the measure and differences in trends in these underlying event rates. For instance, when studying divergence in life expectancy, this method allows researchers to more easily contrast age-specific mortality trends between populations by controlling for initial age-specific mortality differences. Two approaches are assessed: (1) an additive change method that uses logic similar to cause-of-death decomposition, and (2) a contour decomposition method that extends the stepwise replacement algorithm along an age-period demographic contour. The two approaches produce similar results, but the contour method is more widely applicable. We provide a full description of the contour replacement method and examples of its application to life expectancy and lifetime disparity differences between the United States and England and Wales in the period 1980-2010.

Background: Although excessive alcohol-related mortality in the post-Soviet countries remains the major public health threat, determinants of this phenomenon are still poorly understood., Aims: We assess simultaneously individual- and area-level factors associated with an elevated risk of alcohol-related mortality among Lithuanian males aged 30-64., Methods: Our analysis is based on a census-linked dataset containing information on individual- and area-level characteristics and death events which occurred between March 1st, 2011 and December 31st, 2013. We limit the analysis to a few causes of death which are directly linked to excessive alcohol consumption: accidental poisonings by alcohol (X45) and liver cirrhosis (K70 and K74). Multilevel Poisson regression models with random intercepts are applied to estimate mortality rate ratios (MRR)., Results: The selected individual-level characteristics are important predictors of alcohol-related mortality, whereas area-level variables show much less pronounced or insignificant effects. Compared to married men, never married (MRR = 1.9, CI:1.6-2.2), divorced (MRR = 2.6, CI:2.3-2.9), and widowed (MRR = 2.4, CI: 1.8-3.1) men are disadvantaged groups. Men who have the lowest level of educational attainment have the highest mortality risk (MRR = 1.7 CI:1.4-2.1). Being unemployed is associated with a five-fold risk of alcohol-related death (MRR = 5.1, CI: 4.4-5.9), even after adjusting for all other individual variables. Lithuanian males have an advantage over Russian (MRR = 1.3, CI:1.1-1.6) and Polish (MRR = 1.8, CI: 1.5-2.2) males. After adjusting for all individual characteristics, only two out of seven area-level variables-i.e., the share of ethnic minorities in the population and the election turnout-have statistically significant direct associations. These variables contribute to a higher risk of alcohol-related mortality at the individual level., Conclusions: The huge and increasing socio-economic disparities in alcohol-related mortality indicate that recently implemented anti-alcohol measures in Lithuania should be reinforced by specific measures targeting the most disadvantaged population groups and geographical areas.

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.

After several decades of negative trends and short-term fluctuations, life expectancy has been increasing in Russia since 2004. Between 2003 and 2014, the length of life rose by 6.6 years among males and by 4.6 years among females. While positive trends in life expectancy are observed in all regions of Russia, these trends are unfolding differently in different regions. First, regions entered the phase of life expectancy growth at different points in time. Second, the age- and cause-specific components of the gains in life expectancy and the number of years added vary noticeably. In this paper, we apply decomposition techniques-specifically, the stepwise replacement algorithm-to examine the age- and cause-specific components of the changes in inter-regional disparities during the current period of health improvement. The absolute inter-regional disparities in length of life, measured by the population-weighted standard deviation, decreased slightly between 2003 and 2014, from 3.3 to 3.2 years for males, and from 2.0 to 1.8 years for females. The decomposition of these small changes by ages and causes of death shows that these shifts were the result of diverse effects of mortality convergence at young and middle ages, and of mortality divergence at older ages. With respect to causes of death, the convergence is mainly attributable to external causes, while the inter-regional divergence of trends is largely determined by cardiovascular diseases. The two major cities, Moscow and Saint Petersburg, are currently pioneering mortality improvements in Russia and are making the largest contributions to the inter-regional divergence.

Background: Over the past half century the global tendency for improvements in longevity has been uneven across countries. This has resulted in widening of inter-country disparities in life expectancy. Moreover, the pattern of divergence appears to be driven in part by processes at the level of country groupings defined in geopolitical terms. A systematic quantitative analysis of this phenomenon has not been possible using demographic decomposition approaches as these have not been suitably adapted for this purpose. In this paper we present an elaboration of conventional decomposition techniques to provide a toolkit for analysis of the inter-country variance, and illustrate its use by analyzing trends in life expectancy in developed countries over a 40-year period., Methods: We analyze trends in the population-weighted variance of life expectancy at birth across 36 developed countries and three country groups over the period 1970-2010. We have modified existing decomposition approaches using the stepwise replacement algorithm to compute age components of changes in the total variance as well as variance between and within groups of Established Market Economies (EME), Central and Eastern Europe (CEE), and the Former Soviet Union (FSU). The method is generally applicable to the decomposition of temporal changes in any aggregate index based on a set of populations., Results: The divergence in life expectancy between developed countries has generally increased over the study period. This tendency dominated from the beginning of 1970s to the early 2000s, and reversed only after 2005. From 1970 to 2010, the total standard deviation of life expectancy increased from 2.0 to 5.6 years among men and from 1.0 to 3.6 years among women. This was determined by the between-group effects due to polarization between the EME and the FSU. The latter contrast was largely fueled by the long-term health crisis in Russia. With respect to age, the increase in the overall divergence was attributable to between-country differences in mortality changes at ages 15-64 years compared to those aged 65 and older. The within-group variance increased, especially among women. This change was mostly produced by growing mortality differences at ages 65 and older., Conclusions: From the early 1970s to the mid-2000s, the strong divergence in life expectancy across developed countries was largely determined by the between-group variance and mortality polarization linked to the East-West geopolitical division.

Background: Understanding the socioeconomic and regional divides in disability prevalence in India has considerable relevance for designing public health policies and programs., Objectives: The aim of the present study is to quantify the prevalence of disability by gender, region (rural and urban; states and districts), and caste. We also examine the association between disability prevalence and the major socio-demographic and socioeconomic characteristics of the districts in India., Methods: Age-standardized disability prevalence (ASDP) was calculated using 2011 census data and applying the WHO World Standard Population. A regression analysis was carried out to examine the association between disability prevalence and demographic and socioeconomic characteristics across districts of India., Results: The study found that ASDP varies substantially across districts and is higher among women, rural dwellers, and members of scheduled tribes (STs) and scheduled castes (SCs). The regression model showed that the disability rate in districts rises with increasing proportions of the population who are urban dwellers, aged 65 or older, members of STs, and living in dilapidated housing; and that the disability prevalence decreases with increasing proportions of the female population who are literate, and of the general population who are working and have access to safe drinking water., Conclusion: As the burden of disability falls disproportionately across geographic regions and socioeconomic groups, public health policies in India should take this variation into account. The definition of disability used in the census should be modified to generate internationally comparable estimates of disability prevalence.

Background Our aim in this study is to provide a systematic assessment of the site-specific cancer survival rates of patients with different educational levels, using population-based census-linked registry data covering the entire population of Lithuania. Material and methods The study is based on the linkage between all records of the 2001 population census and all records from Lithuanian Cancer Registry (cancer incidence) and Statistics Lithuania (deaths) for the period between 6 April 2001 and 31 December 2009. Results For the vast majority of cancer sites we found an inverse gradient in survival, with the worst survival indicators in the lowest educational group. We estimated that 18.6% of the deaths in Lithuanian cancer patients could have potentially been postponed, if all the patients had the same cancer mortality as the patients with the highest educational level. Conclusion Our findings offer a warning that although the survival rates of cancer patients are improving, this progress hides disparities between different groups of patients.

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.

There are large socioeconomic disparities in adult mortality in Russia, although the biological mechanisms are not well understood. With data from the study of Stress, Aging, and Health in Russia (SAHR), we use Gompertz hazard models to assess the relationship between educational attainment and mortality among older adults in Moscow and to evaluate biomarkers associated with inflammation, neuroendocrine function, heart rate variability, and clinical cardiovascular and metabolic risk as potential mediators of that relationship. We do this by assessing the extent to which the addition of biomarker variables into hazard models of mortality attenuates the association between educational attainment and mortality. We find that an additional year of education is associated with about 5% lower risk of age-specific all-cause and cardiovascular mortality. Inflammation biomarkers are best able to account for this relationship, explaining 25% of the education-all-cause mortality association, and 35% of the education-cardiovascular mortality association. Clinical markers perform next best, accounting for 13% and 23% of the relationship between education and all-cause and cardiovascular mortality, respectively. Although heart rate biomarkers are strongly associated with subsequent mortality, they explain very little of the education-mortality link. Neuroendocrine biomarkers fail to account for any portion of the link. These findings suggest that inflammation may be important for understanding mortality disparities by socioeconomic status., Competing Interests: statement: No author has an actual or potential conflict of interest., (Copyright © 2016. Published by Elsevier Ltd.)

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.