1. Ethnic Differentials of Mortality in Russia and the Role of Socio-economic Conditions Natalia S. Gavrilova * Alla E. Ivanova ** Victoria G. Semyonova ** Leonid A. Gavrilov * Center on Aging, NORC and the University of Chicago, Chicago* Institute of Public Health and Social Development, Moscow, Russia**

2. Background Ethnic Russians in the Former Soviet Union had higher mortality at working ages compared to many other ethnic groups. In 1989 ethnic Russians had the lowest life expectancy compared to many other ethnic groups (Andreev et al., 1992). Earlier study: Differences between Latvians and Russians were equal to 16-17 years for life expectancy, and more than two-fold differences for infant mortality (Novoselsky 1916). These differences were related not only to the living conditions but also to religion and cultural traditions.

3. Life expectancy of some ethnic groups in the Former USSR in 1988-1989 Source: Andreev et al., 1992

4. In Many Republics of the Former Soviet Union Ethnic Differentials in Mortality Increased After the Independence

5. Ethnicity and Mortality in Estonia: Ethnic differences increased after independence Ethnic Composition 2009 Data from Statistics Estonia Leinsalu, 2004, Figure 1, p. 584

6. Ethnicity and Mortality in Kyrgyzstan: Ethnic differences also increased after independence Recorded trends in adult mortality (20-60 years) Source: Guillot et al., 2007

7. Current problems in studying ethnic mortality in Russia 1997 Russian state law on vital statistics: Ethnicity (and many other characteristics) was excluded from the official (ZAGS) death certificates and hence from the official mortality statistics This information still remains in medical death certificates, although in many cases it is not recorded

8. Our Approach To use a proportion of ethnic Russians in population (taken from 2002 census) as a measure of ethnic composition that may affect mortality Outcome variable: Mortality at working ages (15-59 years) in 78 Russian regions in 2003. Control for alcohol consumption and socio-economic and demographic variables (Rosstat publications and database)

9. Mortality of men at working ages and proportion of Russians in population r=0.51 (p<0.001)

10. Mortality of women at working ages and proportion of Russians in population r=0.33 (p<0.005)

11. Explanatory variables Proportion of ethnic Russians in region Proxy for alcohol consumption (deaths per 100,000 persons of working age due to alcohol poisoning) Socio-economic characteristics: Gini coefficient, gross regional product, unemployment, poverty, price index (measure of inflation), percent of educated workforce Demographic characteristics: divorce rate, net migration rate, number of women per 1000 men

12. The Model Ordinary least squares regression Initial model: Ln (Mortality rate 15-59 ) = α + β1 (gini) + β2 (grp)+β3 (migration) + β4 (russians) + β5 (poverty) + β6 (divorce) + β7 (sex ratio) + β8 (unemployment) + β9 (urban) + β10 (alcohol) + β11 (education) + β12 (price index) Statistically significant variable interactions were also found and added to the model.

13. Variables with significant effects on mortality for both men and women Regression coefficients (p-value) VariableMenWomen Russians0.0018 (0.007)0.0025 (0.003) Unemployment0.3175 (0.032)-0.0217 (0.001) Price Index (Inflation)0.0435 (0.001)1.3316 (0.015) % Urban population0.3175 (0.032)0.0052 (0.001) Unemployment x Alcohol0.0004 (<0.001)0.0005 (<0.001) Migration x Alcohol0.00003 (0.003)0.00005 (0.002) Adjusted R 2 0.820.81

14. Russians and alcohol Studies of ethnic mortality in Estonia and Kyrgyzstan showed that significant proportions of excess deaths among Russians is due to causes related to alcohol consumption.

15. Alcohol-related Causes of Death (Chronic alcoholism, Alcohol psychoses, Alcohol cirrhosis of the liver, Accidental poisoning by alcohol) Age-standardized Death Rates at working ages (per 100,000) Source: Guillot et al., 2007

16. Russians and alcohol We may expect that proportion of Russians and alcohol consumption should be strongly correlated However, correlation between these two variables turn out to be small and non- significant: r=0.13 (p=0.26)

17. Alcohol consumption and proportion of ethnic Russians in population r=0.13 (p=0.26)

18. Alcohol consumption and proportion of ethnic Russians in population when Tyva and Altay are excluded r=0.31 (p=0.0063)

19. What about interaction between alcohol and unemployment? This may be an indicator of population marginalization (high proportion of socially disadapted people – unemployed, homeless, low-skilled, etc.) Source: Ivanova AE, Semyonova VG, Dubrovina E (2004). Marginalization of Russian mortality. Demoscope Weekly [Russian electronic edition].

20. Social structure of young men (16-39) died in 2004 in Kirov region Source: Ivanova et al., 2004

21. Conclusions Proportion of Russians is a significant independent predictor of regional mortality at working age in Russia (for both men and women) However, correlation between proportion of Russians and alcohol consumption is more complex, because some ethnic minorities in Russia demonstrate both high mortality and high consumption of alcohol Limitations: cross-sectional study, problems with measurement