1. Problems with Mortality Data in Russia Natalia S. Gavrilova Victoria G. Semyonova Galina N. Evdokushkina Alla E. Ivanova Leonid A. Gavrilov Center on Aging, NORC/University of Chicago Central Research Public Health Institute, Moscow, Russia

2. In 1992 and 1998 Russia experienced two serious economic crises accompanied with drop in personal income and rapid impoverishment

3. Life Expectancy in Russia RussiaYearMalesFemales 199262.073.8 199358.971.9 199457.671.2 199558.371.7 199760.872.9 200058.871.7 China199569.073.0 India199562.463.4

4. Pace of Growth of Age-Adjusted Mortality in 1989-2000 for Classes of Causes of Death

5. Is this increase in mortality from ill-defined conditions related to more cases of deaths from senility?

6. Age Profile of Mortality from Ill-Defined Conditions in Russia MalesFemales

7. Top Five Causes of Death for Young Adult Males (20-24) 19902001 Injuries NeoplasmsSymptoms, 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

8. Top Five Causes of Death for Young Adult Females (20-24) 19902001 Injuries Neoplasms Diseases of Circulatory System Complications of Pregnancy and Childbearing Symptoms, Signs and Ill- Defined Conditions Diseases of Nervous System and Sens.Organs Infectious Diseases

9. What Causes of Death Are Hidden Behind the Ill-Defined Conditions?

10. 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

11. Age-Adjusted Mortality from Injuries in 1996 for Russian Males Aged 0-64 years Data from the WebAtlas Project (http://sci.aha.ru/ATL)

12. 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%

13. Ill-defined conditions and external deaths of undetermined intent are two sides of the same coin It appears that both causes of death are used for concealing criminal cases of violent death

14. Top Five Causes of External Mortality in Russia and Moscow in 2001 RussiaMoscow SuicideAccidental Falls Undetermined Injury HomicideAll Other Accidental Causes Accidental Poisoning by Alcohol Homicide All Other Accidental Causes Suicide

15. Social Background of Current Degradation in Russian Mortality Statistics

16. Transition period was accompanied by unprecedented growth of crime rate and homicide mortality

17. Tendencies of Intentional Murders in Russia and the United States

18. Trends in Homicide Victimization Rates for Young and Middle-Aged Adults Data from Russian Vital Statistics MalesFemales

19. Age Profile of Homicide Mortality in Russia: 1981-2002 Males Females

20. Traditionally high rate of alcohol-related mortality increased further during the 1990s

21. Age Profiles of Mortality from Accidental Poisoning by Alcohol Data from Russian Vital Statistics MalesFemales

22. Rapid increase in the number of abandon children and children without parental support during the last decade

23. Social structure of young (16-39) males died in 2004 in Kirov region Social groupCVDInjuryIll-DCTotal Military121-23 Blue-collar181529186 Unemployed441687257 Students-18- White-collar, businessmen 215323

24. Period of reforms, started in the mid 1980s, resulted in qualitative changes in the pattern of Russian mortality. These changes may be summarized as marginalization of Russian mortality

25. The main characteristics of marginalization are Degradation of cause of death structure Misrepresentation of real mortality pattern Formation of specific social portrait of deceased in the age groups of maximal risk (young and middle working ages)

26. Conclusions Analysis of Russian mortality statistics suggests that official levels of homicide mortality in Russia may be significantly underestimated Rapid growth of deaths coded as “Symptoms, signs and abnormal clinical and laboratory findings” may mask real level of external mortality

27. Acknowledgments This study was made possible thanks to: generous support from the National Institute on Aging (pilot project to the Center of Aging), and stimulating working environment at the Center on Aging, NORC/University of Chicago We also are grateful to Elena Dubrovina, a head of Kirov Division of Health Statistics, for invaluable help in data collection