Draft version. Do not cite without permission of the authors.

First World Congress on Men’s HealthVienna 2-4 November 2001

Men’s health in Central and Eastern Europe as reflected by the toll of

premature death

by Martin McKee and Vladimir M. Shkolnikov London School of Hygiene and Tropical Medicine Max Planck Institute for Demographic Research

Old women there were lots, but few old men.

The things that bent old women broke old men.

Boris Slutsky (1999)

St. Petersburg

Dubrovnik

Trieste

Lines dividing Europe. Two versions of eastern part.

General trends in life expectancyGeneral trends in life expectancy

Trends in life expectancy at birth after the World War IIin selected western and eastern countries

Trends in life expectancy at birth after the World War IIin selected western and eastern countries

40

45

50

55

60

65

70

75

80

85

1945 1955 1965 1975 1985 1995

FranceJapan

United States

Russia

Poland

MALES

Life expectancy (years)

40

45

50

55

60

65

70

75

80

85

1945 1955 1965 1975 1985 1995

France Japan

United States

Russia

Poland

FEMALES

Life expectancy (years)

Values of life expectancy at birth for men and women in Russia, EE and EU

Values of life expectancy at birth for men and women in Russia, EE and EU

Males FemalesYearRussia EE EU Russia EE EU

1970 63.0 66.3 68.6 73.5 71.9 74.91980 61.4 66.8 70.7 73.0 73.6 77.51984 61.7 67.1 71.8 73.0 74.1 78.61987 649 67.2 72.6 74.3 74.0 79.31991 63.6 66.8 73.2 74.4 74.9 80.01992 62.0 66.9 73.5 73.8 75.1 80.31993 59.0 67.2 73.6 71.9 75.3 80.31994 57.5 67.2 74.0 71.1 75.4 80.61995 58.2 67.3 74.0 71.8 75.6 80.71996 59.8 67.8 74.4 72.5 75.7 81.01997 61.0 68.0 74.9 73.0 76.0 81.21998 61.4 68.4 - 73.3 76.3 -1999 60.0 68.6 - 72.5 76.4 -2000 59.1 - - 72.3 - -

Gender gap in life expectancy at birth for three groups of European countries

Gender gap in life expectancy at birth for three groups of European countries

Russia

France

Belarus

Uzbekistan

Kyrgyzstan

Iceland

Albania

Hungary

Latvia

UK

Poland

0

2

4

6

8

10

12

14ye

ars

Western Europe Central& Eastern Europe

Former Soviet Union

Age- and cause-of-death patternsAge- and cause-of-death patterns

Proportional changes in age-specific death rates: France, Poland and RussiaProportional changes in age-specific death rates: France, Poland and Russia

0,0

0,5

1,0

1,5

2,0

2,5

0 5 -9 1 5 -

1 9

2 5 -

2 9

3 5 -

3 9

4 5 -

4 9

5 5 -

5 9

6 5 -

6 9

7 5 -

7 9

8 5 +

Ra

pp

ort

FRANCE

0,0

0,5

1,0

1,5

2,0

2,5

0 5 -9 1 5 -

1 9

2 5 -

2 9

3 5 -

3 9

4 5 -

4 9

5 5 -

5 9

6 5 -

6 9

7 5 -

7 9

8 5 +

Ra

pp

ort

RUSSIE

0,0

0,5

1,0

1,5

2,0

2,5

0 5 -9 1 5 -

1 9

2 5 -

2 9

3 5 -

3 9

4 5 -

4 9

5 5 -

5 9

6 5 -

6 9

7 5 -

7 9

8 5 +

Ra

pp

ort

FRANCE

0,0

0,5

1,0

1,5

2,0

2,5

0 5 -9 1 5 -

1 9

2 5 -

2 9

3 5 -

3 9

4 5 -

4 9

5 5 -

5 9

6 5 -

6 9

7 5 -

7 9

8 5 +

Ra

pp

ort

POLOGNE

0,0

0,5

1,0

1,5

2,0

2,5

0 5 -9 1 5 -

1 9

2 5 -

2 9

3 5 -

3 9

4 5 -

4 9

5 5 -

5 9

6 5 -

6 9

7 5 -

7 9

8 5 +

Ra

pp

ort

RUSSIE

0,02,0

0 5-9 15-

19

25-

29

35-

39

45-

49

55-

59

65-

69

75-

79

85+

???

??

??

??

??

??

.

??

??

???

??

?

1965 1980 1987 1994 1997

HOMMES

FEMMES

0,0

0,5

1,0

1,5

2,0

2,5

0 5 -9 1 5 -

1 9

2 5 -

2 9

3 5 -

3 9

4 5 -

4 9

5 5 -

5 9

6 5 -

6 9

7 5 -

7 9

8 5 +R

ap

po

rt

POLOGNE

Age patterns of excess mortality in CEE and former Soviet Union in 1997

Age patterns of excess mortality in CEE and former Soviet Union in 1997

1.0

1.5

2.0

2.5

3.0

3.5

4.0

4.5

15-24 25-34 35-44 45-54 55-64 65-74

age group

ratio

(w

este

rn e

urop

e=1)

CEE male

FSU male

CEE female

FSU female

-0.2

0.0

0.2

0.4

0.6

0.8

1.0

1.2

1.4

1.6

0

5-9

15-1

9

25-2

9

35-3

9

45-4

9

55-5

9

65-6

9

75-7

9

85+

Age

Dif

fere

nce i

n e

0,

years

Acc/Violence

Other diseases

Digestive

Respiratory

CVD

Cancers

Infectious

1965Difference in life expectancy between women and men = 9.1 years

-0.2

0.0

0.2

0.4

0.6

0.8

1.0

1.2

1.4

1.6

0

5-9

15-1

9

25-2

9

35-3

9

45-4

9

55-5

9

65-6

9

75-7

9

85+

Age

Dif

fere

nce i

n e

0,

years Acc/Violence

Other diseases

Digestive

Respiratory

CVD

Cancers

Infectious

1994Difference in life expectancy between women and men = 13.5 years

Age and cause-specific

contributions to the gender gap in life expectancy at birth in 1965 and 1994 in Russia

Age and cause-specific

contributions to the gender gap in life expectancy at birth in 1965 and 1994 in Russia

Age-cardiovascular components of the gender gap in LE: Russia, 1965 and 1997Age-cardiovascular components of the gender gap in LE: Russia, 1965 and 1997

-0.1

0

0.1

0.2

0.3

0.4

0.5

0.6

0.7

0 1 5 10 15 20 25 30 35 40 45 50 55 60 65 70 75 80 85

1997

Contribution (years)

-0.1

0

0.1

0.2

0.3

0.4

0.5

0.6

0.7

0 1 5 10 15 20 25 30 35 40 45 50 55 60 65 70 75 80 85

1965

Contribution (years)

Rheumatic heart diseases Hypertension

Ischaemic heart diseases Other heart diseases

Cerebrovascular diseases Other circulatory diseases

Comparison of age-specific death rates by CVD and by all causes but CVD in Russia (1998) to

those in the West (1992-95)

Comparison of age-specific death rates by CVD and by all causes but CVD in Russia (1998) to

those in the West (1992-95)

0.0

0.5

1.0

1.5

2.0

2.5

3.0

3.5

4.0

4.5

5.0

0

5-9

15-1

9

25-2

9

35-3

9

45-4

9

55-5

9

65-6

9

75-7

9

85+

Age

RA

TIO

: Ru

ssia

/ "W

est"

CVD, Russia,1998

All but CVD, Russia,1998

MALES

0.0

0.5

1.0

1.5

2.0

2.5

3.0

3.5

4.0

0

5-9

15-1

9

25-2

9

35-3

9

45-4

9

55-5

9

65-6

9

75-7

9

85+

Age

RA

TIO

: Ru

ssia

/ "W

est" CVD, Russia,

1998

All but CVD, Russia,1998

FEMALES

Concentration of excess male mortality in certain population

groups

Concentration of excess male mortality in certain population

groups

Non-manual workers Manual workers Rate of changeAge group 1975 1985 1975 1985 Non-manualManual20-24 0.00112 0.00101 0.00243 0.00138 0.90 0.5730-34 0.00113 0.00108 0.00158 0.00229 0.96 1.4540-44 0.00230 0.00239 0.00265 0.00519 1.04 1.9650-54 0.00659 0.00671 0.00615 0.01216 1.02 1.9860-64 0.02066 0.01699 0.01454 0.03399 0.82 2.3470+ 0.06825 0.04752 0.09700 0.10437 0.70 1.08

Proportional changes in age-specific mortality rates in Bulgaria between 1975 and 1985

(Carlson and Tsvetarsky, 1992)

Proportional changes in age-specific mortality rates in Bulgaria between 1975 and 1985

(Carlson and Tsvetarsky, 1992)

Proportional changes in age-specific mortality rates in Hungary between 1960 and 1984

(Carlson, 1989)

Proportional changes in age-specific mortality rates in Hungary between 1960 and 1984

(Carlson, 1989)

Non-manual workers Manual workers Rate of changeAge group 1960 1984 1960 1984 Non-manualManual20-24 1.254 0.759 1.463 1.644 0.61 1.1230-34 1.439 1.133 1.852 3.280 0.79 1.7740-44 2.955 3.132 3.132 8.043 1.06 2.5750-54 7.534 10.219 8.596 16.871 1.36 1.9660-64 26.190 23.658 22.483 34.560 0.90 1.54

Educational level** Males Females Difference

Upper educational class 44.8 47.8 3.0including:Higher (or university) and incomplete higher 45.6 48.0 2.4Secondary specialized 44.1 47.7 3.6

Lower educational class 40.7 46.5 5.8including:Secondary 40.8 46.3 5.5Incomplete secondary, primary and incompl. primary 39.4 45.7 6.3

Total 42.0 47.0 5.0* Source: Shkolnikov, Leon, et al, 1998** Higher (university) and incomplete higher education is 13-17 years in length, secondary specializededucation is 12-14 years in length, secondary education is 10-11 years in length

Gender gap in life expectancy within the range of ages 20-69 in Russia by educational level in 1979 and 1989

Gender gap in life expectancy within the range of ages 20-69 in Russia by educational level in 1979 and 1989

Probability of surviving per 1000 Life expectancy 20-69, yearsMen Women Difference Men Women Difference

Total 486 745 259 42.5 47.1 4.6

Married 516 763 247 43.3 47.4 4.1Never married 139 579 440 34.6 44.0 9.4Widowed 318 705 387 36.1 45.5 9.4Divorced 380 776 396 40.1 47.2 7.1

Probability of surviving and life expectancy 20-69 by marital status in 1988-89 in Russia

Probability of surviving and life expectancy 20-69 by marital status in 1988-89 in Russia

MALES FEMALES

Period TotalUniversity,incompleteuniv. andsecondary

special

Secondary,incompletesecondaryand lower

TotalHigher,

incompletehigher andsecondary

special

Secondary,incomplete

secondary andlower

1988-89 100 68 111 100 72 1041993-94 149 92 174 124 77 135

Proportional increase,Per cent 49% 35% 57% 24% 8% 30%

Standardized mortality ratios in 1988-89 and 1993-94 for higher and lower educational classes by sex: age 16 and over.

(Level of mortality of the total Russian population in 1988-89 = 100)

Standardized mortality ratios in 1988-89 and 1993-94 for higher and lower educational classes by sex: age 16 and over.

(Level of mortality of the total Russian population in 1988-89 = 100)

Males FemalesRussians Jews Russians Jews

Total 38.25 ± 0.12 48.48 ± 0.82 49.69 ± 0.11 52.11 ± 0.70Higher and incomplete higher 46.18 ± 0.21 50.21 ± 0.86 53.79 ± 0.22 54.41 ± 0.81Secondary special 41.15 ± 0.30 49.08 ± 2.42 51.81 ± 0.26 52.25 ± 2.03Secondary 32.34 ± 0.21 38.38 ± 3.26 45.17 ± 0.23 45.71 ± 3.18Incomplete secondary andlower

28.82 ± 0.50 26.66 ± 12.50 44.03 ± 0.66 36.50 ± 10.20

Higher, incomplete higher andsecondary special

44.40 ± 0.17 50.17 ± 0.81 52.92 ± 0.17 54.24 ± 0.75

Secondary, incompletesecondary and lower

32.36 ± 0.19 38.30 ± 3.44 46.58 ± 0.20 44.55 ± 3.43

With education structure ofRussians

42.00 47.53

Life expectancy at age 25 by education with 95% confidential limits: Russians and Jews in the City of

Moscow in 1993-95.

Life expectancy at age 25 by education with 95% confidential limits: Russians and Jews in the City of

Moscow in 1993-95.

To what extent premature death of men in Russia is attributable to social

status and health behaviours?

To what extent premature death of men in Russia is attributable to social

status and health behaviours?

Udmurt Republic

Clogit ORs from the Udmurt “verbal autopsy” study. Models with and

without adjustment for other risk

factors.

Case-control study of male deaths at age 20-55 in the

Udmurt Republic (Russia) in 1998-99

Clogit ORs from the Udmurt “verbal autopsy” study. Models with and

without adjustment for other risk

factors.

Case-control study of male deaths at age 20-55 in the

Udmurt Republic (Russia) in 1998-99

Circulatory diseases, 134 pairs External causes, 247 pairs

Model 1:No

adjustment

Model 2:Adjustment

for othervariables

Model 1:No

adjustment

Model 2:Adjustment

for othervariables

Employed or student 1.00 1.00 1.00 1.00

Unemployed 1.91(1.03-3.56)

1.58(0.77-3.26)

3.63(2.17-6.08)

2.52(1.43-4.43)

Disability pensioner 3.81(1.77-8.16)

3.59(1.47-8.75)

1.45(0.58-3.65)

1.13(0.42-3.04)

Married 1.00 1.00 1.00 1.00

Divorced or widowed 1.10(0.49-2.45)

0.97(0.37-2.57)

3.54(1.71-7.35)

1.93(0.85-4.39)

Never married 1.17(0.50-2.79)

1.56(0.53-4.50)

2.19(1.13-4.22)

1.99(0.95-4.17)

University 1.00 1.00 1.00 1.00

Secondary specialised 1.89(0.63-4.69)

1.29(0.48-3.63)

1.46(0.76-2.81)

1.14(0.55-2.39)

Secondary and lower levels 2.19(1.14-4.19)

1.21(0.55-2.67)

1.58(0.95-2.63)

1.10(0.55-2.39)

Smoking No 1.00 1.00 1.00 1.00

Yes 2.44(1.36-4.36)

1.99(0.99-3.95)

1.68(1.10-2.56)

1.24(0.76-2.02)

Alcohol 2-3/week ormore

No 1.00 1.00 1.00 1.00

Yes 1.65(0.95-2.88)

1.02(0.49-2.12)

2.61(1.69-4.03)

1.51(0.91-2.51)

Periods of heavydrinking

No 1.00 1.00 1.00 1.00

Yes 4.21(2.35-7.55)

3.54(1.76-7.13)

2.65(1.69-4.17)

1.75(1.02-3.00)

Being under arrestfor 3 days or more

No 1.00 1.00 1.00 1.00

Yes 4.67(1.93-11.27)

2.20(0.83-5.82)

2.72(1.59-4.67)

1.52(0.81-2.82)