Gender Specific Effects of Early-Life Events on Adult Lifespan

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Causes of death and their classification

• Established by the World Health Organization as
  International Classification of Diseases (ICD)
• Has several revisions. The most recent revision
  is the 10th revision. Adopted by most countries
  in the mid 1990s

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Classification of causes of death in Russia

• Classification of causes of death used in the
  Soviet statistical forms was different from WHO
  classification.
• Form 5 (later called form C51) had 185 causes of
  death.
• Main differences between WHO and Soviet
  classification are found in the groups of CVD and
  injuries

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New classification of causes of death in Russia

• After dissolution of the Soviet Union most FSU
  countries continued to use the old classification
  of causes of death
• In 1999 Russia adopted a new classification of
  causes of death corresponding to the 10th ICD
  revision
• Still incompatible with the WHO classification

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Major causes of death within the group of
injuries. Men
??????? ? ??., Demoscope Weekly, N181-182, 2004
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Major causes of death within the group of
injuries. Women
??????? ? ??., Demoscope Weekly, N181-182, 2004
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Degradation of mortality statistics in Russia
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Pace of Growth of Age-Adjusted Mortality in
1989-2000 for Classes of Causes of Death
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Proportion of deaths from ill-defined conditions
is a measure of quality of mortality
statisticsProportion higher than 5 indicates
poor qualityIn developed countries most deaths
from ill-defined conditions are diagnosed at
older ages
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Is this increase in mortality from ill-defined
conditions related to more cases of deaths from
senility?
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Age Profile of Mortality from Ill-Defined
Conditions in Russia
Males
Females
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Top Five Causes of Death for Young Adult Males
(20-24)
1990 2001
Injuries Injuries
Neoplasms Symptoms, Signs and Ill-Defined Conditions
Diseases of Circulatory System Infectious Diseases
Symptoms, Signs and Ill-Defined Conditions Neoplasms
Diseases of Nervous System and Sens.Organs Diseases of Respiratory System
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Top Five Causes of Death for Young Adult Females
(20-24)
1990 2001
Injuries Injuries
Neoplasms Neoplasms
Diseases of Circulatory System Diseases of Circulatory System
Complications of Pregnancy and Childbearing Symptoms, Signs and Ill-Defined Conditions
Diseases of Nervous System and Sens.Organs Infectious Diseases
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What Causes of Death Are Hidden Behind the
Ill-Defined Conditions?
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We Used Individual Death Certificates With More
Detailed Description of Circumstances of Death
Collected by Kirov Department of Health Kirov
is a Typical Russian Region with Lower than
Average Mortality from Ill-Defined Conditions
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Age-Adjusted Mortality from Injuries in 1996 for
Russian Males Aged 0-64 yearsData from the
WebAtlas Project (http//sci.aha.ru/ATL)
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Deaths from Ill-Defined Conditions in Kirov
Region of Russia in 2003

• Sudden infant death (R95)
  3.3
• Decomposition in water (river, well, pond) (R99)
  13.0
• Decomposition at home (R99)
  53.5
• Decomposition in garden, summer house (R99)
  1.7
• Decomposition in forest or field (R99)
  6.0
• Decomposition in nonresidential building, on the
  street (R99)
  
  12.3
• Decomposition in water pipe (R99)
  0.7
• Decomposition on the cemetery (R99)
  0.3
• Decomposition in bath, lavatory or barn (R99)
  1.0
• Decomposition in other place (R99)
  5.5
• unknown (R99)
  2.3
• senility (R54)
  0.3

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Mortality in Moscow city
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Ill-defined conditions and external deaths of
undetermined intent are two sides of the same
coinIt appears that both causes of death may be
used for concealing criminal cases of violent
death
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Top Five Causes of External Mortality in Russia
and Moscow in 2001
Russia Moscow
Suicide Accidental Falls
Undetermined Injury Undetermined Injury
Homicide All Other Accidental Causes
Accidental Poisoning by Alcohol Homicide
All Other Accidental Causes Suicide
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Autopsies in Russia

• Autopsies are used to verify cause of death
• Autopsy is mandatory for violent death, death of
  woman during pregnancy, labor or postpartum
  period, death of infant below 1 year, death from
  cancer not supported morphologically, death from
  any infectious disease

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Situation with medical examiner services

• Only 34-48 of jobs are filled by physicians
• 38-54 of jobs are filled by histologists
• 35 of workers reached retirement age

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??????? ??????
????? ?., ?????? ? ????? 2006
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?????????? ????? ?? ???? ????? ?????? ?????? (??
100 ??????????), ??????? ??????
??? ? ???????. ?????? ??? ????? ?., ?????? ?
????? 2006
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???????? ?????. 1965 ???
????? ?., ?????? ? ????? 2006
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???????? ?????. 2004 ???
????? ?., ?????? ? ????? 2006
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Decomposition of the U.S.-Russia gap in life
expectancy by cause
USA 1999 Russia 2001. Source Shkolnikov et
a. Mortality reversal in Russia.
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Decomposition of the U.S.-Russia gap in life
expectancy by cause
USA 1999 Russia 2001. Source Shkolnikov et
a. Mortality reversal in Russia.
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Contribution of different causes of death to
changes in LE, men
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Contribution of different causes of death to
changes in LE, women
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Age and cause components of LE increase due to
anti-alcohol campaign Men
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Age and cause components of LE increase due to
anti-alcohol campaign Women
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Contribution of causes of death to 40e20(CA) -
40e20(Slav)Males (total difference 2.90 years)
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Contribution of causes of death to 40e20(CA) -
40e20(Slav)Females (total difference .28 years)