Demography of Russia and the Former Soviet Union

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Demography of Russia and the Former Soviet Union

• Lecture 8
• Sociology SOCI 20182

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Suggested Plan of Presentation by students

• Overall description of the country (geographic
  position, population, etc.)
• Trends in fertility and family formation after
  the independence
• Trends in mortality and health after the
  independence
• Population aging
• Migration
• Similarities and dissimilarities with Russia
• List of sources used (data sources and
  publications)

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Suggested Presentation Schedule

• May 12 Belarus, Lithuania, Estonia
• May 14 Armenia, Georgia, Uzbekistan
• Duration 15 min (15-20 slides)

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Mortality and Health in Russia
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General Overview of Mortality Topic
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Age Pattern of Mortality

• U.S. population in 1999

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The Gompertz-Makeham Law
Death rate is a sum of age-independent component
(Makeham term) and age-dependent component
(Gompertz function), which increases
exponentially with age.

• µ(x) A R e ax
• A Makeham term or background mortality
• R e ax age-dependent mortality x - age

risk of death
Aging component
Non-aging component
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Gompertz Law of Mortality in Fruit Flies

• Based on the life table for 2400 females of
  Drosophila melanogaster published by Hall (1969).
  
• Source Gavrilov, Gavrilova, The Biology of Life
  Span 1991

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Gompertz-Makeham Law of Mortality in Flour Beetles

• Based on the life table for 400 female flour
  beetles (Tribolium confusum Duval). published by
  Pearl and Miner (1941).
• Source Gavrilov, Gavrilova, The Biology of Life
  Span 1991

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Gompertz-Makeham Law of Mortality in Italian
Women

• Based on the official Italian period life table
  for 1964-1967.
• Source Gavrilov, Gavrilova, The Biology of Life
  Span 1991

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Measures of Mortality

• Crude Death Rate
• Age-Specific Death Rates (Age-Specific Mortality
  Rates)
• Age-Adjusted Mortality Rates (Standardized
  Mortality Rates)
• Life Expectancy (at birth or other age)
• Measures of Infant Mortality

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Crude Death Rate

• Number of deaths in a population during a
  specified time period, divided by the population
  size "at risk" of dying during that study period.
  
• For one-year period, Crude Death Rate,
• CDR  Deaths in that year /mid-year
  population size
• x 1,000  to adjust for standard-sized
  population of 1,000 persons
• mid-year population total population for
  July 1

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Crude Death Rate Pros and Cons

• Pros - Easy to calculate, and require less
  detailed data than other mortality measures -
  Useful for calculation of the rate of natural
  increase (crude birth rate minus crude death
  rate)
• Cons - Depends on population age structure
  (proportions of younger and older people)

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Trends in crude death rates (per 1,000) for
Russia, USA and Estonia
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Distribution of crude death rates (per 1,000) in
Russia, 2003
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Age-Specific Death Rates (ASDR) or Age-Specific
Mortality Rates (ASMR)

• Number of deaths in a specific age group during a
  specified time period, divided by the size of
  this specific age group during that study period.
  Example For one-year study period,
  Age-Specific Death Rates, ASDR for males at age
  45-49 years    Deaths to males aged 45-49 in
  that year / Number of males aged 45-49 at
  mid-year x 1,000  to adjust for standard-sized
  population of 1,000 persons of that age.

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Age-Specific Death Rates Pros and Cons

• Pros - Allows to study mortality by age (and
  sex)
• Cons - Requires detailed data on deaths by age
  (not always available for developing countries,
  war and crisis periods, historical studies)

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Infant Mortality Rate, IMR

• Proportion of infants who die in their first year
  Number of deaths under age one during a
  specified time period, divided by the number of
  live births For one-year period, Infant
  Mortality Rate

x 1,000  to standardize per 1,000 live births
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Infant Mortality Rate Pros and Cons

• Pros
• - Sensitive indicator of overall health
  conditions in a country, particularly child
  health
• - Useful for indirect estimates of mortality in
  other age groups through imputation, using the
  so-called "model life tables"
• Cons
• - Requires accurate data on births and infant
  deaths (not always available for developing
  countries, war and crisis periods, historical
  studies)

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Changes in infant mortality in Russia, USA and
Estonia
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Definition of live birth in the USSR was not
consistent with WHO definition

• WHO definition of live birth "the complete
  expulsion or extraction from its mother of a
  product of conception, irrespective of the
  duration of pregnancy which, after such
  separation, breathes or shows any other evidence
  of life, such as beating of the heart, pulsation
  of the umbilical cord or definitive movement of
  voluntary muscles, whether or not the umbilical
  cord has been cut or the placenta is attached.
• The Soviet Union adopted a less inclusive
  definition, excluding infants born before 28
  weeks and those weighing less than 1000 grams,
  regardless of signs of life.
• Soviet definition resulted in underestimation of
  infant mortality
• After getting independence, many FSU countries
  adopted WHO definition of live birth

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Distribution of infant mortality in Russian
regions, 2003
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Age-adjusted death rate (ADR), standardized death
rate (SDR) or age-standardized death rate (ASDR)

• Death rate expected if the studied population had
  the age distribution of another "standard"
  population (arbitrary chosen for the purpose of
  comparison). Calculated as weighted average 
  (with weights being proportions of the "standard"
  population at each age)

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Age-Adjusted Death Rate or Age-Standardized
Death Rate

• Direct method of age standardization

• Mui is mortality rate in the studied population
  at age i
• Psi number of persons at age i in the standard
  population. Ps total standard population.

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Age-Adjusted Death Rate or Age-Standardized
Death Rate

• Pros - Allows comparison of death rates of
  populations despite differences in their age
  distribution
• Cons - Requires data on death rates by age (not
  always available for developing countries, war
  and crisis periods, historical studies) -
  Results of comparison may depend on the arbitrary
  choice of standard.

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Typical standard populations

• European standard population and World standard
  population suggested by the World Health
  Organization
• In the United States 1940 U.S. standard
  population and 2000 U.S. standard population
  (applied around 2003)

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The Concept of Life Table

• Life table is a classic demographic format of
  describing a population's mortality experience
  with age. Life Table is built of a number of
  standard numerical columns representing various
  indicators of mortality and survival. The
  concept of life table was first suggested in 1662
  by John Graunt. Before the 17th century, death
  was believed to be a magical or sacred phenomenon
  that could not and should not be quantified.  The
  invention of life table was a scientific
  breakthrough in mortality studies.

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Life Table

• Cohort life table as a simple example
• Consider survival in the cohort of fruit flies
  born in the same time

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Number of dying, d(x)
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Number of survivors, l(x)
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Number of survivors at the beginning of the next
age interval

• l(x1) l(x) d(x)

Probability of death in the age interval
q(x) d(x)/l(x)
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Probability of death, q(x)
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Person-years lived in the interval, L(x)
L(x) are needed to calculate life expectancy.
Life expectancy, e(x), is defined as an average
number of years lived after certain age. L(x) are
also used in calculation of net reproduction rate
(NRR)
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Calculation of life expectancy, e(x)
Life expectancy at birth is estimated as an area
below the survival curve divided by the number of
individuals at birth
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Life expectancy, e(x)

• T(x) L(x) L?
• where L? is L(x) for the last age interval.
• Summation starts from the last age interval
  and goes back to the age at which life expectancy
  is calculated.
• e(x) T(x)/l(x)
• where x 0, 1, ,?

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Life Tables for Human Populations

• In the majority of cases life tables for humans
  are constructed for hypothetic birth cohort using
  cross-sectional data
• Such life tables are called period life tables
• Construction of period life tables starts from
  q(x) values rather than l(x) or d(x) as in the
  case of experimental animals

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Formula for q(x) using age-specific mortality
rates
a(x) called the fraction of the last interval of
life is usually equal to 0.5 for all ages except
for the first age (from 0 to 1) Having q(x)
calculated, data for all other life table columns
are estimated using standard formulas.
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Life table probabilities of death, q(x), for men
in Russia and USA. 2005
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Period life table for hypothetical population

• Number of survivors, l(x), at the beginning is
  equal to 100,000
• This initial number of l(x) is called the radix
  of life table

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Life table number of survivors, l(x), for men in
Russia and USA. 2005.
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Life table number of dying, d(x), for men in
Russia and USA. 2005
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Life expectancy, e(x), for men in Russia and USA.
2005
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Trends in life expectancy for men in Russia, USA
and Estonia
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Trends in life expectancy for women in Russia,
USA and Estonia
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Distribution of life expectancy, Men, 1999
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Distribution of life expectancy, Women, 1999
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The theory of epidemiological transition

• Omran, Abdel R. 1971. The epidemiologic
  transition A theory of the epidemiology of
  population change. Milbank Memorial Fund
  Quaterly, 29 509-538

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Definition

• The epidemiologic transition is that process by
  which the pattern of mortality and disease is
  transformed from one of high mortality among
  infants and children and episodic famine and
  epidemic affecting all age groups to one of
  degenerative and man-made diseases (such as those
  attributed to smoking) affecting principally the
  elderly. (Encyclopedia Britannica)

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Stages of the Epidemiologic Transition

• Pestilence and Famine
• Receding Pandemics
• Degenerative and man-made diseases

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Three stages of epidemiological transition (Omran)

• The Age of Pestilence and Famine when mortality
  is high and fluctuating, thus precluding
  sustained population growth. LE 20-40 years
• The Age of Receding Pandemics when mortality
  declines progressively. LE increases steadily
  from 30 to 50 years. Sustained population growth
• The Age of Degenerative and Man-Made Diseases
  when mortality continues to decline and
  eventually approaches stability. LE exceeds 50
  years.

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The shifts in disease patterns in the 19th
century were primarily related to changing in
socio-economic development.With the 20th
Century more related with disease control
activities independent of socio-economic
developmente.g. Mexico, China
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The fourth stage

• It was believed that by the 1970s life expectancy
  reached a plateau corresponding to the biological
  limit to human life
• However around that time many Western countries
  started to demonstrate an increase in life
  expectancy mainly due to successful prevention
  and treatment of cardiovascular disease. This
  resulted in a rapid decline of mortality,
  particularly at older ages.

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Historical changes in the Gompertz-Makeham
mortality components

• µ(x) A R e ax

Makeham component declined in history (from 1900
to 1970) to very low values close to zero
Gompertz component remained relatively stable
during this period
Gavrilov et al. 1983. Human life span stopped
increasing Why? Gerontology, 29(3)
176-180 Available http//longevity-science.org/Mo
rtality-Limits-1983.pdf
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Historical Changes in Mortality Swedish Females
Data source Human Mortality Database
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Epidemiologic transition in Russia

• Soviet Union successfully passed all three stages
  of epidemiologic transition
• However Soviet health care system could not
  respond to the challenges of growing mortality
  from non-communicable diseases

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The Semashko model of 1918

• The health care system was under the centralized
  control of the state, which financed services as
  part of national social and economic development
  plans.
• All health care personnel became employees of the
  centralized state, which paid salaries and
  provided supplies to all medical institutions.
• The main policy orientation throughout this
  period was to increase numbers of hospital beds
  and medical personnel.

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Initial successes of government-controlled model
of health care

• Russia made massive strides in arresting the
  spread of infectious diseases.
• Drastic epidemic control measures were
  implemented against the spread of tuberculosis,
  typhoid fever, typhus, malaria and cholera.
• Community prevention approaches, routine
  check-ups, improvements in urban sanitation and
  hygiene, quarantines, etc.

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Moscow kindergarten, 1930s
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Vaccination in rural Turkmenistan, 1930s
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Before World War IILife expectancy (both sexes)
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Catching up with the WestLife expectancy in 1965
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Stagnation after 1965
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Mortality reversal

• Situation when the usual time trend of declining
  mortality is reversed (mortality is increasing
  over time).
• Observed in sub-Saharan Africa (AIDS epidemic), 
  Eastern Europe, and FSU countries including
  Russia.
• Mortality Reversal in FSU countries and Russia is
  particularly strong among male population, with
  excess mortality at ages about 35-55 years.
• Particularly high increase in mortality from
  violence and accidents among manual workers and
  low education groups.

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Decline of life expectancy at age 15 between
1998-2005. Men
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Decline of life expectancy at age 15 between
1998-2005. Women