Sex Differences in Mortality in Russia
Author: Marina Vergeles, vergeles@rocketmail.com
Department: Vishnevsky Institute of Demography
University: HSE University, Russian Federation
Supervisor: Sergey Timonin
Year of completion: In progress
Language of dissertation: Russian and English
Keywords:
mortality
, sex differences
, avoidable mortality
, Russia
Areas of Research:
Population
, Health
Abstract
The sex gap in life expectancy (LE) at birth is currently narrowing in all high-income countries. Previous research on Western European and English-speaking (WE&ES) countries suggested that smoking-related mortality at ages 50+ was largely responsible for both widening and subsequent narrowing of the gap. However, countries of Central and Eastern Europe (CEE) have had particularly high excess male mortality at young and middle ages that couldn’t be fully attributed to the smoking-related causes.
We use the Human Mortality Database to examine the patterns and time trends in sex differences in LE across 41 high-income countries and 7 country groups from 1959 to 2014. Contour decomposition is applied to estimate the contribution of different ages to the narrowing of the sex gap.
While the UK was the first country to reach the peak in the sex gap in 1969, Greece did it half a century later, in 2009. The largest male disadvantage in LE was observed in Russia in 2005 (13.7 years), Israel had a peak in 1999 with just 4.4 years. There is a persistent difference between countries and particularly country groups in the age-specific contribution to the maximum sex gap. In WE&ES countries ages older than 50 play the major role in determining the sex gap while CEE countries have high excess male mortality in young and middle ages (20-50). The narrowing of the sex gap in CEE countries hasn’t substantially changed the age contribution.
Differences in the sex gap between countries add a new dimension to a previously established East-West mortality divide. Country specifics must be taken into account to develop public health policies aimed at reducing sex mortality inequalities.
At the second part we used depersonalized individual mortality records and population counts provided by the Federal State Statistics Service of Russia to explore trends in age-standardised death rates from preventable causes and causes amenable to healthcare. Andreev’s decomposition method was used to estimate the contribution of avoidable causes of death to the sex gap in LE. The sex gap in LE at birth has been narrowing since 2005 (13.5 years) and has reached 10 years by 2019. External causes of death have been the biggest contributor to the sex gap in LE during the entire study period. Avoidable mortality at ages 0-74 years accounts for 73% of the total sex gap in 2019, where 29% (more than 2 years) is mortality from external causes and 26% (1.9 years) – mortality from ischaemic heart disease. Male/female SDR ratios did not change for the majority of causes of death during the study period. The narrowing of the sex gap observed since 2005 can be attributed to the convergence of mortality rates from smoking-related cancers, tuberculosis and HIV. Despite the recent narrowing, sex gap in LE in Russia is still one of the biggest in the world and its magnitude cannot be explained fully by traditional risk factors like smoking. Country specifics must be taken into account to develop public health policies aimed at reducing sex mortality inequalities.
