Mortality disparities across Russia: evidence from a small area analysis

Sergey Timonin, National Research University Higher School of Economics
Vladimir M. Shkolnikov, Max-Planck Institute for Demographic Research and New Economic School, Russia
Evgeni Andreev, Max-Planck Institute for Demographic Research

During the last decade, life expectancy in Russia has finally begun increasing after four decades of negative trends and fluctuations. However, it still remains much lower compared to developed countries and some developing countries, and much more must be done to close the gap. Within this general context, health disparities within the country, including spatial disparities, are a major concern. While the better-off population groups are on the path to reducing mortality, large population groups are still exposed to very high mortality. Previously, spatial differentials in mortality could only be accessed at a level of large regions (“oblasts”). This resulted in aggregate patterns, with much heterogeneity being hidden. To the best of our knowledge, this is the first exploration into mortality disparities across 2,369 small areas, or districts (“rayons”). The mortality data (age- and sex-specific number of deaths) have been obtained for the districts from the vital registration anonymous micro-data on all deaths that occurred in Russia between January 1, 2008 and December 31, 2012; the population denominator was obtained from the 2010 all-population census. We computed the age-standardized death rates from deaths over the 5-year period around the 2010 census as a numerator and the census population multiplied by five. The spatial mortality distribution was estimated with statistical quantities, including several measures of absolute and relative inequality. Then we ordered all the districts by their SDR values and divided districts into eight groups based on population percentiles, with two 5% groups of the lowest mortality, two 5% groups of the highest mortality and four 20% groups in between. The group-specific life expectancy values were compared with corresponding values in a number of countries with different mortality levels. Finally, the public health impact of the spatial disparities was assessed with the population attributable fraction (PAF).