Mortality and Causes of Death in 20th-Century Ukraine (Demographic Research Monographs)
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More recently, much attention has been paid to poor trends in midlife mortality among white Americans, particularly females Case and Deaton ; Montez and Zajacova As Gillespie et al. Our results offer further proof of the independence of the two measures during long periods with atypical mortality schedules and illustrate the need to monitor lifespan variation for a complete picture of population health.
At the same time, our results revealed a paradox of sorts. On the one hand, between-country differences in lifespan variation were more stable than between-country differences in life expectancy. On the other hand, changes in lifespan variation were more sensitive to year-to-year mortality fluctuations than life expectancy, particularly when viewed on a relative scale.
Measures of dispersion are more sensitive to mortality change in early midlife than life expectancy van Raalte and Caswell Mortality between ages 25 and 50 experienced larger changes in response to crises than older-adult mortality over the period as shown clearly in Fig. Meanwhile, mortality differences over older working ages and among the early retired have a larger impact on life expectancy than life disparity: these ages are found on either side of the threshold age, with mortality declines or increases often offsetting each other, so that the net impact is no change in lifespan variation.
As a result, the combination of mortality changes over younger ages with growing mortality differences at older-adult ages can lead to widening between-country inequalities in life expectancy alongside stable differences in life disparity. The impact of alcohol on mortality has been extensively studied in Russia, which experienced the largest mortality swings in the region Leon et al.
Alcohol-related mortality is also known to have played an important role in mortality trends since the s in BC and other countries of the FSU Jasilionis et al. To date, only Shkolnikov et al. We extended this cause-of-death analysis to include more countries Belarus, Czech Republic, Estonia, Latvia, Lithuania, Poland, Russia, and Ukraine and focused on the — post-Soviet years. Fluctuating alcohol-related mortality was an important component of the moving life disparity trends in the countries of the former Soviet Union, although it occurred to different degrees in each region and manifested itself in different causes.
Over young ages, we found evidence of a large role for the reduction in mortality from external causes, including traffic accidents, in BC throughout the period and in Russia, Belarus, and Ukraine from onward. That these causes often co-moved with mortality directly attributable to alcohol over these ages is suggestive that healthier patterns of alcohol consumption were contributing to these reductions in life disparity. At older ages, between-country differences in mortality reduction seemed to be driven by the extent of mortality reduction from circulatory diseases.
Alcohol consumption was not the only factor that explained mortality trajectories in the region, nor was it the sole explanation for the difference between this region and Western European countries in terms of life expectancy and lifespan variation levels. Other factors, such as environmental pollution, medical care, smoking behaviors, and diet, have been important determinants of health outcomes in this region since at least Bobak and Marmot Indeed, the strong declines in circulatory disease mortality in BC Jasilionis et al.
In contrast to BC and other FSU countries, the smoother trends in life disparity found in CE were driven by sustained declines in circulatory disease and cancers, with external causes playing a much smaller role and no change in mortality directly attributable to alcohol. We additionally identified a recent stagnation since in lifespan variation in Russia.
As our decomposition results after suggest, this stagnation could be a result of a slowdown in mortality improvements below age 60 offset by larger progress above this age. Timonin et al. Preventing external-cause mortality at young ages has been previously highlighted as an immediate way to reduce lifespan variability and differences in life disparity between populations. Firebaugh et al. In this sense, most reductions in life disparity in the region were caused by improvements in mortality at young ages after , particularly in mortality from external causes.
Mortality associated with the most hazardous forms of alcohol consumption, such as mortality from alcoholic liver disease or poisoning by exposure to alcohol, did not play a central role in lifespan variation levels or trends—perhaps in part because these are small causes of death to begin with in comparison with much larger causes of death, such as circulatory disease or external causes.
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Nevertheless, some countries Lithuania, Russia, and Latvia did show large mortality improvements in these conditions, which caused compression of mortality at young ages. These differences were previously noted as a partial explanation for different mortality trends in Lithuania and Belarus Grigoriev et al.
Therefore, analyzing lifespan dispersion together with life expectancy contributes to a deeper understanding of the impact of changing mortality trends on population health. Our results show not only that CEE countries experienced high lifespan variation and consequently greater fluctuation in the predictability of lifespan but also that life expectancy and life disparity were able to move independently, particularly in periods of stagnation in life expectancy.
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These uncommon findings, opposing those observed in most developed countries, show that expansion compression levels do not necessarily mean lower higher life expectancy or mortality deterioration improvements when the yearly changes over time are taken into account. Open access funding provided by Max Planck Society. Both authors thank Pavel Grigoriev and Domantas Jasilionis for helpful comments on an earlier version of the manuscript, and the anonymous reviewers for their helpful comments and suggestions.
For this reason, they are plotted separately from other ages with a different scale used on the x -axis in the online appendix. The decline was near monotonic in most countries, with only minor differences between countries, especially when compared with the much larger between-country differences at other ages.
Thus, this adjustment should be seen as a conservative rather than realistic adjustment to test the robustness of our findings. Alyson van Raalte, Email: ed. National Center for Biotechnology Information , U. Published online Nov Author information Copyright and License information Disclaimer. Corresponding author. This article has been cited by other articles in PMC.
Electronic supplementary material The online version of this article Keywords: Causes of death, Alcohol consumption, Mortality, Health inequalities, Decomposition techniques. Introduction The twentieth century was marked by sizable improvements in mortality and health in most countries in the world World Health Organization Data and Methods. Dispersion Measure and Demographic Methods For each population, we investigated life expectancy and lifespan variation since birth.
Data We used all-cause death counts, population exposures, and period life tables from the Human Mortality Database for 12 countries from to the most recent year available in the data set. Cause-of-Death Classification We grouped causes of death into the following broad categories, with a harmonized time series from to deaths wholly attributable to alcohol, circulatory disease, transport accidents, other external causes, infectious and respiratory diseases, cancers, and the remaining causes.
Table 1 Classification of causes of death amenable to alcohol consumption. Category ICD Codes 1. Open in a separate window. Results Age-Specific Rates of Mortality Improvement For a descriptive look at age-specific mortality change over the period, we first examined the average annual rate of mortality improvement Rau et al. Age-Specific Decomposition In Figs. Limitations The limitations of our study should be mentioned. Discussion We analyzed and compared a long time series of life disparity for 12 countries from CEE.
Electronic supplementary material ESM 1 2. Acknowledgments Open access funding provided by Max Planck Society. Funding Open access funding provided by Max Planck Society. Footnotes 1 Using the package ecp in R.
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Commemorating the victims of the Great Famine (Holodomor) in the former USSR
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