Citation
Andreeva, Elena (2005). Mortality due to external causes of death in the Russian Federation: spatial aspects and explanatory models. Master's thesis / Doctoral dissertation.Abstract
BackgroundDuring the socio-economic transition there was an epidemic increase of violent and accidental
mortality in the Russian Federation, which led to changes in the country’s mortality structure. At
present, external causes of death occupy the second place in the mortality rank of the total Russian
population. There are two main hypotheses in the literature, suggesting an explanation of violent mortality epidemics in Russia:
– transition itself may play the role of a “killer” (via stress or impoverishment); or
– a high level of alcohol consumption is the most important underlying factor.
Due to considerable difficulties in the identification of valid measurements of alcohol consumption
or transition-related stress, the “epidemic outbreak” of violent mortality remains largely unexplained.
Many terms are used loosely and interchangeably, including transition and stress. Various
ecological studies have widely employed alcohol poisoning mortality as a proxy measure of
heavy binge drinking or even alcohol consumption. However, there were no attempts to explore
aggregate-level determinants of this cause of death.
Aims and objectives
This study focused on three important causes of violent and accidental mortality – suicide, homicide
and accidental poisoning by alcohol. The overarching research aim was to clarify their
macro-level “aetiology” in the regions of transitional Russia. In support of this aim, four main objectives
were formulated:
(1) scrutiny of regional characteristics – with respect to economic structure and performance,
population living standards, climatic conditions etc – which are typical for high- and lowmortality
provinces;
(2) development of uniform conceptual frameworks for studying the determinants of violent
and alcohol-related mortality;
(3) identification of appropriate proxy measures which can be used to represent the particular
concepts in transitional Russia, and
(4) testing the conceptual frameworks with regional panel data.
Research methods and approaches
The suggested research study combined a variety of approaches. The descriptive approach revealed
enormous variations in the spatial distribution of violent and alcohol-related mortality rates.
We identified clusters of high- and low-mortality regions which have been found to possess common
characteristics of the population living standards, economic structure and performance, climatic
conditions etc. This regional diversity is deeply rooted in the country’s history; it is not a
total-lot product of the socioeconomic transition.
We suggested some basic pathways through which the regional environment may affect selected
causes of death. This has been done in order to address the specific challenges of time loosely
termed as a socioeconomic transition. This conceptual approach included the elaboration of the
psychosocial stress model and the model of marginalisation-related mortality among “never-dowell
alcoholics”.
Finally, the theoretical models of stress- and marginalisation-related mortality have been tested
with a pooled cross-sectional time series analysis of regional panel data. This analytical approach
enabled us to explore the specific “socioeconomic aetiology” of suicide, homicide and alcohol
poisoning mortality in Russia. We used annual data (1990-2001) on cause-specific mortality and
- 1 -its explanatory variables – mostly derived from official statistical sources – for 77 administrative
areas of the Russian Federation.
Main findings
Suicide and homicide demonstrated a remarkable similarity in their socioeconomic aetiology.
Age-adjusted mortality rates for these violent stress-induced causes of death were significantly
associated with some common measures of the:
– “core transition-related stressors” (losses of private savings, hyperinflation etc) and
– “insane social environment” (heavy binge drinking, social tension/disruption).
In addition, the same coping strategies have been found to significantly reduce the regional levels
of stress-related mortality – namely, complementary economic activities of the population.
There were, however, some important differences in the “best fitting” models of these stress-related
causes of death. They may indicate the presence of specific behavioural patterns, crucial for
the manifestation of non-premeditated homicide or non-impulsive suicide in definite stages of
stress. This hypothesis rests on Selye’s concept of phase-wise stress reactions, including Alarm,
Resistance and Exhaustion.
Higher susceptibility of homicide rates to acute unanticipated stressors, their affinity to risks linked
with both shadow and legal economic activities (“wild capitalism” markers) confirmed the hypothesis
of homicide manifestation in the Alarm stage of stress. Further, homicide rates were
sensitive to a lower access to educational resources, as well as to the challenge of higher living
and production costs in climatically disadvantaged areas.
Lacking economic activity turned out to be the strongest predictor of suicide mortality. Deficiency
of coping resources and behavioural patterns of “escape” are crucial for the last stage of stress –
Exhaustion, in which non-impulsive suicide is assumed to manifest. In addition, suicide rates
were explained by the factors related to severe economic depression (drastic decline in manufacturing
production and low chances to get employed), “rural effects” (measured by the volume
of agricultural production per capita) and the proxy-measure of lacking social cohesion/support.
As for the fatal accidental poisonings by alcohol, this study is the first empirical paper on their
determinants in the regions of Russia. Our aggregate-level results point out to a significant role of
hazardous drinking habits, which have been examined by urban/rural settings, access to educational
resources and ethnic composition of the regional populations.
To a substantial part, alcohol poisonings rates also depend on the extent of marginalisation-related
processes. The latter include two groups of factors: (1) those characterising rapid unfavourable
changes in the regional economic environment – measured, for instance, by the financial
losses of the population, as well as by the proxy of the economic restructuring and its “side effects”
– and (2) those related to anomie, alienation and social isolation – expressed by the rates
of divorces, abortions, crime and unemployment.
To approximate heavy binge drinking, we used alcohol poisoning mortality as an explanatory
variable in the models of suicide and homicide rates. It was a significant, but not the leading predictor
of stress-related mortality. We conclude, therefore, that heavy binge drinking should not be
regarded as the crucial determinant of mortality in Russia.
Key words:
suicide – homicide – stress – socioeconomic transition – heavy binge drinking – accidental poisoning
by alcohol – panel data analysis – ecological study