Abstract
Study objective: This study examined the change in ethnic differences in mortality in Estonia 1989–2000.
Design: Two unlinked cross sectional census based analyses were compared. Total and cause specific mortality was analysed for ethnic Estonians and Russians. The absolute differences in mortality were evaluated through life expectancy at birth and age standardised mortality rates. Relative differences were assessed by mortality rate ratios with 95% confidence intervals, calculated using Poisson regression.
Setting: Estonia before and after the fall of the Soviet Union.
Participants: Individual cause specific death data for 1987–1990 (69 549 deaths) and for 1999–2000 (33 809 deaths) came from the national mortality database. Population denominators came from the population censuses of 1989 and 2000.
Main results: In the period 1989–2000, ethnic differences in life expectancy increased from 0.4 years to 6.1 years among men and from 0.6 years to 3.5 years among women. In 2000, Russians had a higher mortality than Estonians in all age groups and for almost all selected causes of death. The largest differences were found for some alcohol related causes of death especially in 2000.
Conclusions: Political and economic upheaval, increasing poverty, and alcohol consumption can be considered the main underlying causes of the widening ethnic mortality gap.
Full Text
The Full Text of this article is available as a PDF (85.2 KB).
Selected References
These references are in PubMed. This may not be the complete list of references from this article.
- Aluoja Anu, Leinsalu Mall, Shlik Jakov, Vasar Veiko, Luuk Kersti. Symptoms of depression in the Estonian population: prevalence, sociodemographic correlates and social adjustment. J Affect Disord. 2004 Jan;78(1):27–35. doi: 10.1016/s0165-0327(02)00179-9. [DOI] [PubMed] [Google Scholar]
- Bobak M., Skodova Z., Pisa Z., Poledne R., Marmot M. Political changes and trends in cardiovascular risk factors in the Czech Republic, 1985-92. J Epidemiol Community Health. 1997 Jun;51(3):272–277. doi: 10.1136/jech.51.3.272. [DOI] [PMC free article] [PubMed] [Google Scholar]
- Chaturvedi N. Ethnicity as an epidemiological determinant--crudely racist or crucially important? Int J Epidemiol. 2001 Oct;30(5):925–927. doi: 10.1093/ije/30.5.925. [DOI] [PubMed] [Google Scholar]
- Kaufman J. S., Cooper R. S. Commentary: considerations for use of racial/ethnic classification in etiologic research. Am J Epidemiol. 2001 Aug 15;154(4):291–298. doi: 10.1093/aje/154.4.291. [DOI] [PubMed] [Google Scholar]
- Kiefe Catarina I. Race/ethnicity and cancer survival: the elusive target of biological differences. JAMA. 2002 Apr 24;287(16):2138–2139. doi: 10.1001/jama.287.16.2138. [DOI] [PubMed] [Google Scholar]
- Leinsalu Mall. Social variation in self-rated health in Estonia: a cross-sectional study. Soc Sci Med. 2002 Sep;55(5):847–861. doi: 10.1016/s0277-9536(01)00221-0. [DOI] [PubMed] [Google Scholar]
- Leinsalu Mall, Vågerö Denny, Kunst Anton E. Estonia 1989-2000: enormous increase in mortality differences by education. Int J Epidemiol. 2003 Dec;32(6):1081–1087. doi: 10.1093/ije/dyg192. [DOI] [PubMed] [Google Scholar]
- Leon D. A., Chenet L., Shkolnikov V. M., Zakharov S., Shapiro J., Rakhmanova G., Vassin S., McKee M. Huge variation in Russian mortality rates 1984-94: artefact, alcohol, or what? Lancet. 1997 Aug 9;350(9075):383–388. doi: 10.1016/S0140-6736(97)03360-6. [DOI] [PubMed] [Google Scholar]
- Leon D. A., Davey Smith G. Infant mortality, stomach cancer, stroke, and coronary heart disease: ecological analysis. BMJ. 2000 Jun 24;320(7251):1705–1706. doi: 10.1136/bmj.320.7251.1705. [DOI] [PMC free article] [PubMed] [Google Scholar]
- Leon D. A., Koupilova I., Lithell H. O., Berglund L., Mohsen R., Vagero D., Lithell U. B., McKeigue P. M. Failure to realise growth potential in utero and adult obesity in relation to blood pressure in 50 year old Swedish men. BMJ. 1996 Feb 17;312(7028):401–406. doi: 10.1136/bmj.312.7028.401. [DOI] [PMC free article] [PubMed] [Google Scholar]
- McKee M., Shkolnikov V. Understanding the toll of premature death among men in eastern Europe. BMJ. 2001 Nov 3;323(7320):1051–1055. doi: 10.1136/bmj.323.7320.1051. [DOI] [PMC free article] [PubMed] [Google Scholar]
- Modin Bitte. Born out of wedlock and never married--it breaks a man's heart. Soc Sci Med. 2003 Aug;57(3):487–501. doi: 10.1016/s0277-9536(02)00374-x. [DOI] [PubMed] [Google Scholar]
- Shkolnikov V. M., Leon D. A., Adamets S., Andreev E., Deev A. Educational level and adult mortality in Russia: an analysis of routine data 1979 to 1994. Soc Sci Med. 1998 Aug;47(3):357–369. doi: 10.1016/s0277-9536(98)00096-3. [DOI] [PubMed] [Google Scholar]
- Smith G. D. Learning to live with complexity: ethnicity, socioeconomic position, and health in Britain and the United States. Am J Public Health. 2000 Nov;90(11):1694–1698. doi: 10.2105/ajph.90.11.1694. [DOI] [PMC free article] [PubMed] [Google Scholar]
- Smith G. D., Neaton J. D., Wentworth D., Stamler R., Stamler J. Socioeconomic differentials in mortality risk among men screened for the Multiple Risk Factor Intervention Trial: I. White men. Am J Public Health. 1996 Apr;86(4):486–496. doi: 10.2105/ajph.86.4.486. [DOI] [PMC free article] [PubMed] [Google Scholar]
- Thomas Alan J., Kalaria Rajesh N., O'Brien John T. Depression and vascular disease: what is the relationship? J Affect Disord. 2004 Apr;79(1-3):81–95. doi: 10.1016/S0165-0327(02)00349-X. [DOI] [PubMed] [Google Scholar]
- Thomas S. B. The color line: race matters in the elimination of health disparities. Am J Public Health. 2001 Jul;91(7):1046–1048. doi: 10.2105/ajph.91.7.1046. [DOI] [PMC free article] [PubMed] [Google Scholar]
- Valkonen T. Male mortality from ischaemic heart disease in Finland: relation to region of birth and region of residence. Eur J Popul. 1987 Nov;3(1):61–83. doi: 10.1007/BF01797092. [DOI] [PubMed] [Google Scholar]
- Volozh Olga, Solodkaya Eleonora, Abina Jelena, Kaup Reet, Goldsteine Gundega, Olferiev Aleksei, Deev Alexander. Some biological cardiovascular risk factors and diet in samples of the male population of Tallinn, Estonia in 1984/1985 and 1992/1993. Eur J Public Health. 2002 Mar;12(1):16–21. doi: 10.1093/eurpub/12.1.16. [DOI] [PubMed] [Google Scholar]
- Vågerö D. Region of birth and mortality among black Americans. Am J Public Health. 1997 May;87(5):724–726. doi: 10.2105/ajph.87.5.724. [DOI] [PMC free article] [PubMed] [Google Scholar]
- Williams D. R. Race and health: basic questions, emerging directions. Ann Epidemiol. 1997 Jul;7(5):322–333. doi: 10.1016/s1047-2797(97)00051-3. [DOI] [PubMed] [Google Scholar]