Mortality Patterns in the Russian Federation: Indirect Technique Using Widowhood Data. (Research)
Bobak, Martin, Murphy, Michael, Pikhart, Hynek, Martikainen, Pekka, Rose, Richard, Marmot, Michael, Bulletin of the World Health Organization
During the Russian mortality crisis, mortality increased dramatically between 1987-94. Since then, it has fluctuated enormously in absolute terms. Between 1990-95, for example, the rise in mortality was equivalent to more than 2 million additional deaths above long-term mortality rates (1). Although the mortality fluctuations are real (2-6), their scale raises questions about the quality of official vital statistics data in the Russian Federation. It is also questionable whether official estimates accurately identify groups in the population that are at high risk of death, especially given that extensive mortality data are not available. By combining death certification data and microcensus data, it was inferred that mortality rates were particularly high in men and among people with low education (7), but this finding was based on official data and may be affected by biases similar to those in routine data. It would be useful, therefore, to be able to assess the mortality patterns in Russia using data independent from vital registration.
A striking feature of previously collected data was the high proportion of widows (8). Russian population data also show a large deficit of men at middle and older ages (9). Between 1970-93, for example, the sex differential in life expectancy at birth was approximately 11 years in Russia, compared with an average of about six years in European countries (6).
Besides implying a large excess lifetime male mortality, the foregoing data suggested a way to estimate mortality without relying on national vital statistics. If vital registration data are unavailable, relatives are the ones most likely to be able to provide information about the deceased. Most people have a living close relative, and relatives will usually be in a good position to report the circumstances of a close relative; in many cases, they will have resided together for years and, as we show later, relatives generally remain in contact with each other. Furthermore, demographers have long used survival data on spouses, siblings or parents in population surveys to estimate mortality in populations where vital status data were unavailable or unreliable (10-12). In this paper, we report on a similar, indirect demographic approach in the Russian Federation. The main goal was to investigate whether such an approach could complement routine death registration data, and help elucidate the determinants of mortality.
The survey was commissioned by the New Russian Barometer survey programme, which is primarily focused on social and political attitudes (13), and was conducted by the Russian Agency for Public Opinion Research in February 2000. The sample data, which was collected through interviews across a multistage stratified random population, represented a cross-sectional survey of a national sample of the Russian population. The Russian Federation was stratified into 22 regions, with each region further stratified into urban and rural areas. Within this framework, the number of towns and settlements included in the study was proportional to the size of the regional populations; the specific towns and settlements in the study were chosen at random.
At each randomly selected primary sampling unit (location) an address was randomly selected and interviewers were instructed to seek a face-to-face interview at every n-th eligible household. At each address, the interviewer asked for a respondent who matched an age-sex-education grid. In total, 2396 households containing an eligible respondent were identified, and 1600 completed interviews were achieved, an overall response rate of 67%.
In addition to questions on age, gender, socioeconomic characteristics, and social and political attitudes, the participants were asked: whether they had ever been married and, if so, the year of the first marriage, and how old they and their first spouse were at the time; whether the first spouse was still alive at the time of the survey and, if not, how old he/she was when he/she died; and what was the cause of his/her death (if known) (10, 11). …