Economic crises, stress and mortality in Russia. P

GavrilovaN.S.etal.EconomicCrises,Stress,andMortalityinRussia1PaperpresentedatThePopulationAssociationofAmerica2001AnnualMeeting(Session106“Violence,Stress,andHealth”).March28-31,2001WashingtonEconomicCrises,StressandMortalityinRussiaNataliaS.Gavrilova*,GalinaN.Evdokushkina**,VictoriaG.Semyonova**,LeonidA.Gavrilov*(*)CenteronAging,NORC/UniversityofChicago,1155East60thStreet,Chicago,IL60637(**)CentralResearchInstituteofPublicHealthandInformatics,Moscow,Russia.Addressforcorrespondence:Dr.NataliaS.Gavrilova,CenteronAgingNORC/UniversityofChicago1155East60thStreet,Chicago,IL60637Fax:[phone];Phone:[phone]E-mail:[e-mail],Stress,andMortalityinRussia2AbstractIn1992and1998Russiaexperiencedtwoeconomiccrisesthatledtodramaticimpoverishmentofpopulation,socialanxiety,andfollowedbymortalitysurges.Thisstudyanalyzesage-andsex-specificmortalityfromviolentcausesinRussiaafterthe1992and1998economiccrises,usingofficialstatisticaldata.Accidents,injuriesandalcoholpoisoningdemonstratedthemostrapidrelativeincreaseinmortalityforbothsexesduringthefirst1992crisis.Suicidemortalitysurgewasparticularlyhighinmaleswhilehomicidedynamicswasrelativelysimilarforbothsexes.Theresponsetothe1998crisiswasdifferent:therelativerateofhomicideincreasewasparticularlyhighamongwomenwhilesuicidedynamicsdidnotdemonstrateprofoundsexdifferences.Ourfindingssuggestthattheeffectsofthefirstcrisisarerelatedtostressandself-directedviolence,whilethesecondcrisisisassociatedwithviolenceagainstotherpersons(especiallywomen).Furtherstudyofhomicideandsuicidemortalityfoundspecificresponsestocrisisofdifferentagegroupsinthecaseofsuicidemortalityandtheleadingroleofalcoholconsumptioninhomicidemortality.Analysisofgenderdifferencesinsuicideandhomicidemortalityshowedincreasingdisadvantageofworkingagemalesinthecaseofsuicidesandincreasingdisadvantageofyoungfemalesinthecaseofhomicides.Factoranalysisofviolentmortalityrevealed3majorunderlyingfactorsexplainingover92percentofvariationinexternalmortalitywhichcanberelatedtoalcohol,violence,andstress.Theeffectofalcoholfactoronviolentmortalityisdominatingalthoughitsroleintherecentyearsdecreasedwhiletwootherfactorsincreasedafter1992.Thus,violenceandstressaretheissuesofmajorconcerninexplainingthemostrecenttendenciesofmortalityincreasefromviolentcauses.SupportedinpartbythegrantfromtheMacArthurFoundation.GavrilovaN.S.etal.EconomicCrises,Stress,andMortalityinRussia3IntroductionIn1992and1998Russiaexperiencedtwoseriouseconomiccrisesaccompaniedwithdropinpersonalincomeandrapidimpoverishment.Inbothcases,adverseeconomicchangeswerefollowedbymortalityincrease.From1992to1994lifeexpectancyofRussianmalesdroppedfrom63.8to57.7years.Femalelifeexpectancydroppedfrom74.4yearsto71.2years.Thisdecreaseinlifeexpectancycoincidedintimewiththeintroductionofpainfuleconomicexperiments('reforms')inRussia,leadingtoarapiddecreaseinrealwagesandpensions,nearlycompletelossofpersonalsavings,andatremendousincreaseinthepovertyrate.Themaincausesofdeaththatcontributedtothismortalitydeclinewerediseasesofthecirculatorysystem,accidents,poisoningandinjuries,diseasesoftherespiratorysystem.After1995mortalityinRussiademonstratedslowbutstabledecrease.However,inAugust1998Russiaexperiencedanothereconomiccrisis(crashofthebankingsystem)resultinginmassimpoverishment.Shortlyafterthiscrisismortalitystartedtogrowagainandmalelifeexpectancydroppedfrom61.0in1998to59.7yearsin1999,whilefemalelifeexpectancydroppedfrom72.6to71.9years.Inbothcasespopulationatworkingagesappearedtobethemostvulnerableagegroupwhilechildrenandtheelderlywerenotsignificantlyaffected(Notzonetal.,1998).ThefirsteconomiccrisisinRussia(calledalsoashocktherapy)occurredin1992afterpoliticaldecisiontoaccomplisharapidtransitiontomarketeconomy.Thefirststepinthisdirectionwasacompleteabolitionofpricecontrolbythegovernment.Asaresult,consumerpricesgrew3.5timesfasterthanwagesin1992(1stquarter,Goskomstat,1993)andexplodedby2500%fortheentire1992calendaryear(Klugman,Braithwaite,1998).Thegrossdomesticproduct(GDP)fellmorethan40percentduring1991-96asaresultofoutputcollapse(EBRD,1997;Klugman,Braithwaite,1998).ThenumberofpoorhouseholdsinRussiarosesharplyafterearly1993,reachingarecord35percentofthepopulationlivingbelowtheofficialpovertylinebytheendof1995(Klugman,Braithwaite,1998;Zohoorietal.,1998).Theaveragerealearningsfellbyone-halfin1992andthenstabilizedaroundthislowlevel(Klugman,Braithwaite,1998).Shortlyafterthebeginningofeconomicreforms,Russiaexperiencedasignificantandsteepriseintotalage-specificmortalitythatresultedinthefalloflifeexpectancyto57.6yearsformalesandto71.2yearsforfemalesin1994(seeTable1).Thelossesinlifeexpectancyweremorethan5yearsformalesand3yearsforfemalescomparedtothelifeexpectancyinpre-crisis1991.Thesedecreasesarebeyondthepeacetimeexperienceofanyindustrializedcountry.CurrentlifeexpectancyinRussiaislowerthaninChinaandevenlessthaninsomecountriesofAfrica(seeTable1).Thus,theshockeffectofshocktherapywasachieved,butnotherapywasprovided.Table1abouthereThisphenomenonreceivedsignifica