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Suggested citation

Notzon FC, Komarov YM, Ermakov SP, et al. Vital and health statistics: Russian

Federation and United States, selected years 1985–2000 with an overview of

Russian mortality in the 1990s. National Center for Health Statistics. Vital

Health Stat 5(11). 2003.

Library of Congress Cataloging-in-Publication Data

Vital and health statistics: Russian Federation and United States, selected years

1985-2000.

p. cm. — (Vital and health statistics. Series 5, International vital and

health statistics report ; no. 11) (DHHS publication ; no. (PHS) 2003-1487)

January 2003’’

ISBN 0-8406-0587-0

1. Russia (Federation)—Statistics, Vital. 2. Russian (Federation)—

Statistics, Medical. 3. United States—Statistics, Vital. 4. United States

—Statistics. 5. Health status indicators—Russia (Federation)—Statistics. 6.

Health status indicators—United States—Statistics. I. National Center for Health

Statistics (U.S.) II. Series. III. Vital and health statistics. Series 5. Comparative

international vital and health statistics reports ; no. 11.

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Printed on acid-free paper.
Series 5, Number 11

Vital and Health Statistics: Russian

Federation and United States,

Selected Years 1985–2000 With An

Overview of Russian Mortality in the

1990s

International Vital and Health Statistics

Reports

U.S. DEPARTMENT OF HEALTH AND HUMAN SERVICES

Centers for Disease Control and Prevention

National Center for Health Statistics

Hyattsville, Maryland

June 2003

DHHS Publication No. (PHS) 2003-1487
National Center for Health Statistics

Edward J. Sondik, Ph.D., Director

Jack R. Anderson, Deputy Director

Jack R. Anderson, Acting Associate Director for

International Statistics

Jennifer H. Madans, Ph.D., Associate Director for Science

Lawrence H. Cox, Ph.D., Associate Director for Research

and Methodology

Diane M. Makuc, Dr.P.H., Acting Associate Director for

Analysis, Epidemiology, and Health Promotion

P. Douglas Williams, Acting Associate Director for Data

Standards, Program Development, and Extramural Programs

Edward L. Hunter, Associate Director for Planning, Budget,

and Legislation

Jennifer H. Madans, Ph.D., Acting Associate Director for

Vital and Health Statistics Systems

Gina M. Martin, Acting Associate Director for

Management and Operations

Charles J. Rothwell, Associate Director for Information

Technology and Services

Office of International Statistics

Jack R. Anderson, Acting Associate Director for

International Statistics

Central Public Health Research Institute

Professor Yuri M. Komarov, M.D., Ph.D., D.Sc., Honorable

Scientist of the Russian Federation, Director-General

‘‘MedSocEconomInform’’

A. I. Savinykh, M.D., Ph.D., Deputy Director-General for

Coordination and Public Health
In memory of

John M. Eisenberg

Director of the Agency for Healthcare Research and Quality

Dedication

This report is dedicated to the

memory of John M. Eisenberg, Director

of the Agency for Healthcare Research

and Quality (AHRQ). Dr. Eisenberg

passed away on March 10, 2002,

following a yearlong illness. He had

served as the director of AHRQ since

1997, during which time he

reinvigorated the organization and

developed a focus on health care quality.

He was also an important participant in

U.S. and Russian collaborations on

health, serving as Secretary Donna

Shalala’s key advisor on U.S.-Russian

collaboration since 1998.

Dr. Eisenberg brought a keen

intellect and wide-ranging interests to all

of his activities, and this was certainly

true of his involvement in the health

collaboration between our two countries.

He was committed to the idea of

improving the quality of health care

through evidence, and he saw no

borders. He wanted every health care

system in the world to have access to

the latest scientific evidence as the basis

of its clinical practice, while being

mindful of the differences in cultures

and systems. ‘‘Globalize the Evidence,

Localize the Decisionmaking’’ was one

of his favorite quotes.

He was a collaborator, a mentor, a

coordinator, and a friend to us all. And

we will sorely miss him.

iii
Preface

This report is the third ina series

providing comparative vital and health

statistics data for the Russian Federation

and the United States. The publication is a joint effort by the Centers for Disease

Control and Prevention’s (CDC)

National Center for Health Statistics

(NCHS) in the United States and the

Central Public Health Research Institute

(CPHRI), Ministry of Health of the

Russian Federation.

The purpose of the current report is

to update vital and health statistics data

previously published for the two

countries, and to provide an overview of

mortality trends in the Russian

Federation in the last decade. The vital

and health statistics section of the report

makes available information ona variety

of health measures for the populations

of the Russian Federation and the

United States. The data are presented in a comparative format to enhance the

reader’s understanding of health status

in both countries. The report includesa

discussion of data quality issues to assist

the reader in understanding limitations

in the accuracy, coverage, or

comparability of the information

presented. The overview of Russian

mortality trends summarizes recent

changes in Russian mortality by age

group and by cause of death and

considers risk factors and other issues

underlying these trends. The mortality

review updates earlier work by the

authors for the years 1990–94 (1).

The vital and health statistics

section of the report contains 23 tables

on population size, natural increase in

population, birth rates, abortions, life

expectancy, infant mortality, death rates,

reportable diseases, human

immunodeficiency virus/acquired

immunodeficiency syndrome (HIV/

AIDS), levels of health personnel,

hospital utilization, and ambulatory care.

The report also includes selected tables

on mortality by urban and rural area of

the Russian Federation. Data are

provided for selected years from 1985 to

2000, with the focus on the 1990s. The

mortality overview for the Russian

Federation includes six tables and

several figures providing detailed

information on recent mortality trends.

The complete report is available as

an Acrobat PDF file on the Internet

through the NCHS home page. The

direct Uniform Resource Locator (URL)

address is: http://www.cdc.gov/nchs

.

For answers to questions about this

report, contact:

Data Dissemination Branch

National Center for Health Statistics

Centers for Disease Control and

Prevention

3311Toledo Road, Room 5412

Hyattsville, MD 20782 Tel: (301) 458-4636

E-mail: nchsquery@cdc.gov

v
Foreword by Professor

Yuri M. Komarov

This is the third digest of vital and

health statistics compiled by Russian

and American specialists. And for the

third time, Edward J. Sondik, the

Director of NCHS, and I have been

honored to write a foreword for this

report. The first digest was published in

1995 by NCHS and was comprised of

statistical data for 1980–93. In their

joint statement, the Secretary of the U.S.

Department of Health and Human

Services and the Minister of Health of

the Russian Federation praised the

results of this teamwork. The second

compilation presented a comparative

analysis of statistics of maternal and

child health, an important issue in both

countries. This work was done within

the framework of the Russian-American

Committee for Economic and

Technological Cooperation and then

published in 1999 both in English and

Russian. There are essential differences

between Russian and American

statistical systems and records,

definitions, criteria, classifications, and

methods of calculation and analysis;

however, there is also the need to make

statistical data comparable. These factors

defined the scientific and creative nature

of this project. The present report

includes a comparative analysis of

statistical data for the last decade of the

20th century. It also contains a review

of mortality trends in Russia in the

1990s, reflecting scientific interest in

this topic.

The factors that determine the size,

structure, and composition of the

Russian Federation population have

developed over several decades. The

birth rate began to decline in the late

1980s, but for several years, net

migration compensated for the decline

in natality. In the 1990s, the continued

decline in births and the rise in

mortality, along with a gradual reduction

of immigrants, led to a declining

population. The population of Russia

reached a peak of 148.3 million in 1992

and has been falling since, declining by

400,000–500,000 annually in recent

years, and reaching 144.8 million in

2001. According to some predictions, by

2040 the population level may have

fallen back to the that of 1926.

The quality of family life has also

suffered in recent years. The number of

marriages has declined, the number of

divorces has increased, and the birth rate

for unmarried women has doubled in the

last 10 years. These trends, along with

very high mortality among working-age

men, have led to a growing number of

single mothers. There are 5.2 million

single-parent families in Russia now.

There are about 680,000 orphans, which

is just as many as there were in Russia

after World War II, except that now, in

95 percent of cases, these children have

living parents.

Although the abortion rate has

decreased 52 percent in the past 10

years, this index is still 6 times higher

than in the United States. Reducing the

number of unwanted pregnancies and

abortions is an important part of

government policy. We can achieve this

if the educational standard of society

improves, people become aware of the

need to care for their health,

contraceptives become widely available

(now less than one-quarter of women

use modern methods of contraception),

and other changes occur.

Childhood and adolescent health is

also a major concern in Russia. This is

why in 2002 the Ministry of Health

began a large-scale clinical medical

examination (preventive checkups with

followup observation where necessary)

of all children and adolescents. This

program is an attempt to restore the

health care system that existed in the

former Soviet Union, but with

improvements in many areas.

Still the most urgent socioeconomic,

political, and medical-demographic

problem is the mortality rate, which is

one of the highest in the world. Every

year more than 2 million people die in

Russia, and the mortality rate is 1.7

times higher than the birth rate. Russia’s

mortality rate is not always registered

fully and correctly, nor is the real cause

of death always identified accurately.

Nevertheless, with such large data sets,

statistical errors cannot be a significant

factor. The highest levels of mortality

have been registered in the central

regions of Russia (the regions of Tver,

Tula, Ivanovo, Pskov, and Novgorod),

and in the Republic of Tyva.

Mortality rose rapidly from 1992 to

1994, the direct result of the changed

socioeconomic living conditions. After

1994 the mortality rate decreased

slightly, because by that time, many of

those who had not been able to adapt to

the new lifestyle had already become

impoverished and had died. This trend

lasted until the economic crisis of 1998,

when, quite abruptly, many middle-class

Russians became poor, leading to the

rise in mortality in 1999 and following

years. The main reasons for the

mortality rate growth since 1999 are

considered to be a worsening of

socioeconomic living conditions of the

majority of the population, people’s

constant exposure to stress, and growing

alcohol abuse.

A comparison of standardized rates

between Russia and the United States

shows that in Russia the rate of suicide

is 4.0 times higher; homicide, 3.6 times

higher; death from cerebrovascular

disease, 6.4 times higher; and death

from heart disease, 2.0 times higher. But

at least 40 percent of all deaths are

potentially preventable if there is correct

and timely prevention and treatment,

i.e., a proper health care system.

Cardiovascular diseases account for

55 percent of all deaths, but many of

these decedents were already elderly.

Many people do not live to the age at

which they could be expected to die of

cardiovascular diseases, because they die

at earlier ages from neoplasms,

respiratory and digestive system

diseases, and especially from infections,

injuries, and violence, with the peak of

deaths occurring at ages 35–45 years. If

we calculate the number of years of life

lost due to these diseases, we see they

are a greater burden than are

cardiovascular diseases.

An examination of specific causes

of death provides many examples of the

need to improve the organization and

quality of medical care in the Russian

Federation. For example, rising

vi
mortality from pneumonia is not due to

changes in etiology or the nature of this

disease but to inadequate prevention and

ambulatory health care, resulting in

undiagnosed, neglected, and

incompletely cured cases. Mortality due

to digestive system diseases is highest in

regions of Russia where urgent health

care is underdeveloped. The rise in

mortality due to tuberculosis is not due

to an increase in cases but to the

deterioration of the primary and

secondary systems for prevention and

early-stage diagnosis. The lack of

effective treatment of tuberculosis

among prisoners has led to the spread of

the disease in prisons, and after releases

of large groups of prisoners, in the

civilian population as well.

In summary, this report not only

compares vital and health statisticsin

Russia and the UnitedStates but also

makes it possibletoidentify major health

problems, consider national health care

strategy, and point out the need to improve

thereliability, quality, and comparability of

demographic and medical statistics. This

collaboration has provided an opportunity

forspecialists of both countriesto better

understand each other and to enrich

themselves with new knowledge, ideas, and

methods. Within the framework

ofthis

cooperationwith NCHS,a number of

activities have been carried out in Russia.

These activitiesinclude training workshops

on theuse of the International

ClassificationofDiseases, 10th Revision

(ICD–10),the development of an

automated system forthe coding of causes

of death, and (in collaborationwith the

Open SocietyInstitute)improvementsin

medical statisticsofTula oblast and

Stavropol krai. We would like to express our

gratitude to the governing bodies and

staffof NCHS for their contribution to

this joint work on vital and health

statistics.

ProfessorYuri M. Komarov

Ph.D. Medicine, D.Sc. Medicine

Honorable Scientist of the Russian

Federation Vice-President of the Russian

Medical Association

vii
Foreword by

Edward J. Sondik

For nearly 10 years, NCHS and the

CPHRI, formerly MedSocEconomInform, of the Russian Federation have

carried out a cooperative program on

health statistics. This collaboration

began under a memorandum of

understanding and has continued as part

of the binational U.S.-Russia Health

Committee, a component of the

U.S.-Russia Joint Commission on

Economic and Technological

Cooperation. Under this program, we

have sought to share information,

improve the quality and comparability

of our health data, and publish joint

reports.

In the area of joint reports, we have

published broad overviews of health

data in both countries and reports

focusing on specific topics of mutual

interest. The first report compared vital

and health statistics data on a range of

topics, while the second report focused

on maternal and child health status in

both countries. We also published a

journal article focusing on the reasons

for the decline in life expectancy in

Russia in the early 1990s. The current

report updates our initial publication on

vital and health statistics and also

revisits the issue of mortality trends in

Russia.

In both countries, much has

changed in the area of health since the

publication of our first report. Life

expectancy improved dramatically in

Russia in the mid-1990s, followed by a

renewed decline that coincided with the

economic difficulties beginning in 1998.

Improvements in vaccination coverage

eliminated the diphtheria epidemic in

Russia, but strong growth in the number

of tuberculosis and AIDS cases has

presented new challenges to the Russian

health care system. In the United States,

improvements in life expectancy have

slowed markedly compared with the

gains of the 1980s, although mortality

due to HIV/AIDS has declined

dramatically. In the area of health

expenditures, renewed rapid growth in

health care costs is complicating efforts

to expand health insurance coverage.

Cooperation between our two

organizations is not limited to the

publication of joint reports. We have

collaborated for several years on

activities designed to improve the

quality and completeness of vital

statistics data in Russia. This

collaboration has included the revision

of the content of vital event certificates,

the development of computer-based

training software for the coding of

causes of death, and the evaluation of

vital statistics data collected in Russia.

We are combining information from

death certificates and coroners’

certificates to better understand the

causes of injury death in Russia.

Currently we are focusing on the

development of an electronic database

system for data entry, editing, and

tabulation of vital statistics data, and the

installation of this system in various

territories of Russia. Included in this

activity is the preparation of an

automated system for the coding of

cause-of-death information, which will

produce mortality data coded according

to the full International Classification of

Diseases, 10th Revision (ICD) for the

first time in Russia. We would like to

thank the National Institute of Child

Health and Human Development and the

National Institute on Alcohol Abuse and

Alcoholism, National Institutes of

Health; the Office of Global Health, the

CDC; the Agency for Healthcare

Research and Quality; and the Open

Society Institute for their financial

assistance in several of these activities.

We want to thank our colleagues at

the CPHRI for their involvement in our

joint projects. We have learned much

about our respective health data systems,

and about each other, in the course of

our collaboration, and we hope that it

will continue into the future.

Edward J. Sondik, Ph.D.

Director

National Center for Health Statistics

viii
Contents

Dedication................................................................................................ iii

Preface .................................................................................................. iv

Foreword by Yuri M. Komarov ............................................................................... v

Foreword by Edward J. Sondik .............................................................................. vii

Abstract .................................................................................................. 1

Overview of Russian Mortality in the 1990s..................................................................... 1

Methods .................................................................................................. 1

Results ................................................................................................... 2

Trends up to 1994 ........................................................................................ 2

Trends from 1994 to 1998 ................................................................................. 3

Trends from 1998 to 2000 ................................................................................. 7

Discussion ................................................................................................ 8

Economy ............................................................................................... 8

Alcohol................................................................................................. 8

Tobacco ................................................................................................ 8

Nutrition................................................................................................ 9

Stress and Depression ..................................................................................... 9

Health Care System....................................................................................... 9

Principal Contributions to the Change in Life Expectancy ........................................................ 9

Conclusion ............................................................................................... 10

References ............................................................................................... 10

Vital and Health Statistics: Russian Federation and United States................................................... 13

Highlights................................................................................................ 15

Population ............................................................................................. 15

Characteristics of Live Births .............................................................................. 16

Abortion ............................................................................................... 17

Life Expectancy......................................................................................... 18

Infant Mortality ......................................................................................... 19

Mortality .............................................................................................. 20

Communicable Diseases .................................................................................. 21

Immunization Coverage .................................................................................. 22

HIV Infection and AIDS .................................................................................. 23

Health Care Personnel.................................................................................... 24

Health Resources and Services............................................................................. 25

Text Tables

A. Life expectancy and age-adjusted mortality rates, Russian Federation and United States, selected years 1990–2000 ..... 3

B. Number of live births and deaths and natural increase in population: Russian Federation and United States, selected

years 1985–2000..................................................................................... 3

C. Economic indicators, Russian Federation 1991–2000........................................................ 4

D. Age-adjusted death rates for selected causes of death, by sex: Russian Federation and United States, 1990–2000....... 5

ix
E. Contribution of change in mortality from each age group to the change in life expectancy, Russian Federation, 1994–98

and 1998–2000 ...................................................................................... 6

F. Contribution of change in mortality from each cause of death to the change in life expectancy, Russian Federation,

1994–98 and 1998–2000 .............................................................................. 6

Detailed Tables

1. Resident population, by age and sex: Russian Federation and United States, selected years 1985–2000 .............. 26

2. Number of live births and deaths and natural increase in population: Russian Federation and United States, selected

years 1985–2000.................................................................................... 28

3. Birth rates: Russian Federation and United States, selected years 1985–2000 ................................... 28

4. Percent of live births by selected characteristics: Russian Federation and United States, selected years 1985–2000 .... 29

5. Number and percent distribution of abortions, according to age of woman: Russian Federation and United States,

selected years 1985–2000............................................................................. 30

6. Life expectancy at birth, by sex: Russian Federation and United States, selected years 1985–2000.................. 31

7. Infant mortality, late fetal mortality, and perinatal mortality rates: Russian Federation and United States, selected

years 1985–2000.................................................................................... 32

8. Maternal mortality rate, by causes of death: Russian Federation and United States, selected years 1985–2000 ........ 33

9. Death rates from all causes, by age and sex: Russian Federation and United States, selected years 1985–2000........ 34

10. Age-adjusted death rates for selected causes of death, by sex: Russian Federation, 1990–2000..................... 36

11. Age-adjusted death rates for selected causes of death, by sex: United States, selected years 1985–99 ............... 38

12. Rates of selected notifiable diseases, by type of disease: Russian Federation and United States, selected years

1985–2000......................................................................................... 40

13. Rates of immunization coverage (percent) in children: Russian Federation and United States, selected years

1991–2000......................................................................................... 41

14. Number of persons with HIV or acquired immunodeficiency syndrome, and deaths due to HIV, by sex and age:

Russian Federation and United States, selected years 1985–2001 ............................................. 42

15. Number of providers per 10,000 population, by specialty: Russian Federation and United States, selected years

1985–2000......................................................................................... 43

16. Number of hospitals and beds per 10,000 population, by hospital type and bed size: Russian Federation and

United States, selected years 1985–2000................................................................. 44

17. Number of outpatient care contacts per person, by year and type of contact: Russian Federation and United States,

selected years 1985–2000............................................................................. 45

18. Average length of stay and rate of discharges and surgical operations per 1,000 population: Russian Federation and

United States, selected years 1985–2000................................................................. 46

Appendix Tables

I. Life expectancy at birth, by sex and urban-rural status, Russian Federation, selected years 1985–2000 ................. 47

II. Infant mortality, late fetal mortality, and perinatal mortality rates, by urban-rural status, Russian Federation, selected years

1985–2000............................................................................................... 48

III. Death rates from all causes, by sex, age, and urban-rural status, Russian Federation, 1994–2000 ...................... 49

IV. Age-adjusted death rates for selected causes of death, by sex, Russian Federation, 1990–2000, urban settlements ........ 50

V. Age-adjusted death rates for selected causes of death, by sex, Russian Federation, 1990–2000, rural settlements ......... 51

VI European standard 100,000 population used to adjust death rates ............................................... 52

Appendix Glossary

Glossary of Terms ......................................................................................... 52

Figures

Figure 1. Life expectancy, Russian Federation and United States, 1962–2000 .......................................... 2

Figure 2. Change in all-cause mortality rates, by age and sex, Russian Federation 1994–98............................... 4

Figure 3. Change in all-cause mortality rates, by age and sex Russian Federation 1998–2000 ............................. 7

x
Figure 4a. Live births and deaths, Russian Federation 1990–2000 .................................................. 15

Figure 4b. Live births and deaths, United States 1990–2000 ....................................................... 15

Figure 5. Percent of women receiving prenatal care in first trimester: Russian Federation and United States, 1990–2000 ...... 16

Figure 6. Number of abortions, Russian Federation and United States, 1990–2000 ..................................... 17

Figure 7. Life expectancy at birth, Russian Federation and United States, 1990–2000 .................................. 18

Figure 8. Infant mortality by age at death, Russian Federation and United States, 1999 ................................. 19

Figure 9. Leading causes of death, Russian Federation and United States, 1999 ....................................... 20

Figure 10a. Incidence of communicable diseases, Russian Federation 1991–2000 ...................................... 21

Figure 10b. Incidence of communicable diseases, Russian Federation and United States, 2000 ........................... 21

Figure 11. Immunization coverage rates, Russian Federation and United States, 2000 .................................. 22

Figure 12. HIV/AIDS cases, Russian Federation and United States, 1991–2001 ....................................... 23

Figure 13. Physician specialization, Russian Federation and United States, 2000....................................... 24

Figure 14a. Average length of hospital stay, Russian Federation and United States, 1990–2000 ........................... 25

Figure 14b. Rates of hospital discharge and inpatient surgery, Russian Federation and United States, 2000 ................. 25

xi
This report provides comparative vital

and health statistics data for recent years Vital and Health Statistics:

for the Russian Federation and the United

States.

the Ministry

Statistical

of Health

data

of

for

Russia

Russia

and

are

from

from Russian Federation and United

Goskomstat, the central statistical

organization of Russia. Information for the States, Selected Years

United States comes from various data

systems of the Centers for Disease

Control and Prevention’s (CDC) National 1985–2000 with an Overview of

Center for Health Statistics (NCHS) as

well as other parts of the Department of Russian Mortality in the 1990s

Health and Human Services.

The initial section of the report

summarizes information on recent by Francis C. Notzon, Ph.D., Office of International Statistics; Yuri

mortality trends in the Russian Federation. M. Komarov, M.D., Ph.D., D.Sc.; Sergei P. Ermakov, Ph.D., D.Sc.;

During the 1990s, Russia experienced a Alexei I. Savinykh, M.D., Central Public Health Research Institute,

major increase in mortality from 1990 to

1994, a substantial reduction in mortality Ministry of Health of Russia; Michelle B. Hanson, Juan Albertorio

from 1994 to 1998, and another major

increase from 1998 to 2000. The mortality

overview uses tables and figures to Overview of Russian 1990s, with a focus on the years after

describe mortality changes by age group, 1994. It also assesses changes in other

sex, and cause of death, and to determine Mortality in the 1990s aspects of Russian society over the same

the contribution of each of these to time period. The analysis presented

changes in life expectancy. The overview below thus continues earlier findings

also considers risk factors and other The first decade of the Russian reported by the authors for the period issues underlying these trends, in an Federation has been fraught with 1990–94 (1). It also represents one part attempt to understand the impact of major economic, political, and social of the continuing collaboration between mortality determinants on changes in life problems. Health status also declined the CPHRI of Russia and NCHS. expectancy.

statistics uses tables, figures, and

commentary to present information on

many different health measures for the

as reported extensively in scholarly

journals and the press (1–5). The health

situation reached a low point in 1994,

Methods

populations of the two countries. Topics

covered include population size, fertility,

when male life expectancy at birth fell

below 58 years. Health trends in Russia nformation on births, deaths,

life expectancy, infant mortality, death improved after 1994, with both men and economic measures, and other

rates, communicable diseases, and women regaining more than half of the variables for Russia were obtained

various health personnel and health

resource measures. The commentary

years of life expectancy lost in the

earlier period. These improvements are

from Goskomstat of Russia (the central

statistical office) and other sources.

The section on vital and health severely in the first half of the decade,

I

includes a discussion of data quality less well known in the West, as they Comparative data on births and deaths

issues that affect the accuracy and

comparability of the information presented. generated less academic and journalistic in the United States were provided by

Data are provided for selected years from attention. More recently, however, both NCHS. As with our previous analysis,

1985 to 2000. In addition to national data, the economy and health status of Russia we used life tables prepared by CPHRI

mortality information on urban and rural have again deteriorated. for the detailed assessment of mortality

subgroups

glossary of terms at the end of the report erratic trends in mortality and their To compare mortality risks over

provides additional information on relationship to other factors within time, we calculated the percent change

definitions and data sources and Russia, this report examines changes in in age-specific mortality during the three

limitations. the leading causes of death over the distinct mortality intervals of the 1990s:

in Russia is provided. A In order to better understand the trends after 1994.

Keywords: United States c Russia c

fertility c mortality c infant mortality c The authors gratefully acknowledge the assistance of the American and Russian specialists in compiling

morbidity c abortion c immunization c data for this report. Collection and tabulation of the Russian data were carried out by Irina N. Veselkova,

the Head of the Demography Division of the Central Public Health Research Institute. Significant technical communicable diseases c hospitals c support was provided by Elmira I. Pogorelova, the Head of the ICD-10 Training and Research Unit of the

health care utilization same Institute. This report was edited by Demarius V. Miller, typeset by Annette F. Holman and Margaret

C. Avery, graphics produced by Michael W. Jones, and printing managed by Patricia Wilson and Joan

Burton of the Publications Branch, Division of Data Services.

Page 1
Page 2 [ Series 5, No. 11

1990–94, 1994–98, and 1998 to the

present. However, changes in

age-specific mortality may not provide a

complete picture of the impact of

mortality changes on a population. The

effect of changes in age-specific

mortality on life expectancy depend on

which age group is affected: the

younger the age group, the greater the

impact of mortality change on life

expectancy, as increased (or reduced)

deaths at younger ages will result in

larger changes in the number of

life-years lived. To assess more

accurately the impact of changes in

mortality by age group, we applied a

life-table partitioning technique (6,7).

The partitioning technique provides a

more accurate assessment of the effect

on life expectancy of changes in

age-specific mortality, by combining

information on relative change in

mortality rates with data on the absolute

level of mortality.

We also calculated age-adjusted

mortality rates for selected causes of

death for the key years of 1990, 1994,

1998, and 2000, using the direct method

of adjustment. As in our previous

analysis, we used the World Health

Organization (WHO) ‘‘old’’ European

standard population (8). We used these

rates to assess cause-specific mortality

risks over time in Russia. We also

applied the same life-table partitioning

technique to determine the contribution

of selected causes of death to changes in

life expectancy during the 1990s.

Beginning in 1999, the

responsibility for coding causes of death

was shifted from Goskomstat to the

Ministry of Health. Under the new

system, physicians are responsible for

coding the underlying cause of death

using the ICD–10 (9). This is a major

change from the previous system, in

which Goskomstat staff coded the

underlying cause of death using a

summary list of about 200 causes of

death. In practice, however, the

information available to users has not

changed greatly, as Goskomstat

continues to tabulate mortality data

according to a summary list of causes of

death. The summary list undergoes

modification with each revision of the

ICD and was expanded to 254 causes in

1999 in accordance with the

introduction of the 10th revision of the origin, complications of medical and

ICD. These changes have not had a surgical care, and operations of war.

major impact on the broad cause

categories used in this report, with the

exception of motor vehicle deaths. For Results

these, it was necessary to broaden the

category to include all transportation

accidents to ensure good comparability Trends up to 1994

over time in Russia, as well as

comparability between Russia and the Detailed mortality trends in Russia

United States. All of the other cause before 1990 and in the period 1990–94,

groups presented here are the same as have been described elsewhere (1).

those used in the earlier report. These trends can be summarized as

Among the leading causes of death, follows: From 1960 through the

alcohol continues to be very important mid-1980s, male life expectancy

in Russia, and so we retained the cause gradually declined, while female life

category ‘‘other alcohol-related causes.’’ expectancy remained unchanged

This category combines data on deaths (figure 1). Life expectancy for both

due to alcohol-dependence syndrome sexes rose abruptly from 1985 through

and alcohol poisoning, although the 1987, largely as the result of the

preponderance of deaths due to alcohol antialcohol campaign initiated by

intoxication are coded to alcohol Mikhail Gorbachev soon after he

poisoning in Russia. became the new leader of the Soviet

The cause group ‘‘other injuries’’ is Union. As the success of the antianother important category of mortality alcohol campaign faded, mortality rates

in Russia. This cause group represents rose and continued to rise through the

all unintentional-injury deaths, with the first chaotic years of the Russian

exception of motor vehicle crash deaths Federation. From 1990 to 1994, the

and alcohol-poisoning deaths, plus age-adjusted mortality rate rose by

deaths due to events of undetermined one-third, male life expectancy declined

by more than 6 years, to 57.7 years, and

Figure 1. Life expectancy, Russian Federation and United States, 1962–2000
Series 5, No. 11 [ Page 3

Table A. Life expectancy and age-adjusted mortality rates, Russian Federation and economic difficulties in Russia.

United States, selected years 1990–2000 Following the breakup of the Soviet

Life expectancy Union, the Russian Federation

Russian Federation United States experienced an extended period of

hyperinflation and negative economic

Year Total Male Female Total Male Female growth. Economic restructuring,

1990 ........................... 69.3 63.8 74.4 75.4 71.8 78.8

1994 ........................... 64.1 57.7 71.2 75.7 72.4 79.0

1998 ........................... 67.2 61.3 73.2 76.7 73.8 79.5

2000 ........................... 65.3 59.0 72.2 76.9 74.1 79.5

Change in life expectancy

1990–94 ......................... –5.2 –6.1 –3.2 0.3 0.6 0.2

1994–98 ......................... 3.1 3.6 2.0 1.0 1.4 0.5

1998–00 ......................... –1.9 –2.3 –1.0 0.2 0.3 0.0

Age-adjusted mortality rate

1990 ........................... 1,192.7 1,688.4 892.2 803.4 1,035.3 628.8

1994 ........................... 1,581.6 2,290.5 1,098.4 784.7 996.4 621.8

1998 ........................... 1,323.7 1,847.0 957.4 741.4 909.8 607.7

2000 ........................... 1,461.2 2,075.6 1,020.6 735.7 889.6 610.8

Percent change in mortality rates

1990–94 ......................... 32.6 35.7 23.1 –2.3 –3.8 –1.1

1994–98 ......................... –16.3 –19.4 –12.8 –5.5 –8.7 –2.3

1998–00 ......................... 10.4 12.4 6.6 –0.8 –2.2 0.5

0.0 Quantity more than zero but less than 0.05.

SOURCES: Russian Federation: Life expectancy, Central Public Health Research Institute; Mortality rates, Goskomstat. United

States: Centers for Disease Control and Prevention, National Center for Health Statistics, Division of Vital Statistics.

female life expectancy fell by more than

3 years, to 71.2 years (table A). Over

the same interval, U.S. life expectancy

rose by a modest amount.

Although mortality rose in every

age group, the majority of the increase

occurred among adults 25–64 years of

age. Much of the rise in mortality was

due to cardiovascular disease,

unintentional and intentional injuries,

and alcohol-related causes of death.

Combined with a sharp drop in the birth

rate, the mortality rise led to a

significant excess in deaths over births

by 1994 (table B). Although the return

migration of ethnic Russians from other

parts of the former Soviet Union offset

much of this excess of deaths over

births, the Russian population had

stopped growing by 1993.

The 1990–94 period also can be

characterized as a time of severe

Table B. Number of live births and deaths and natural increase in population: Russian

Federation and United States, selected years 1985–2000

Russian Federation United States

Natural Natural

Live increase Live increase

Year births Deaths in population1 births Deaths in population1

intended to develop a market economy

as quickly as possible, led to the closing

of enterprises, wage cuts, and growing

unemployment, which rapidly increased

the number of Russians living in

poverty (table C).

Trends from 1994 to 1998

Economic and social conditions

gradually began to improve in Russia in

the mid-1990s, and at the same time,

mortality began to decline from the

1994 peak. Although negative economic

growth continued for several years, the

Russian government was able to reduce

inflation to a more manageable level

from 1995 to mid-1998 (table C).

Reported information on economic

growth probably understated the true

increase in economic activity during the

decade, as tax avoidance became

increasingly common during the 1990s

(10).

The annual number of deaths fell by

more than 300,000 from 1994 to 1998,

but a continuing decline in births

produced a substantial excess of deaths

over births. The return migration of

ethnic Russians gradually fell off after

1994, resulting in slow but consistently

negative population growth. By 1998

the population of Russia had declined to

146.5 million, almost 2 million below

the 1992 peak of 148.3 million

(table B).

The age-adjusted mortality rate for

all causes of death declined by more

than 16 percent from 1994 to 1998, the

1985 ............... 2,375,147 1,625,266 749,881 3,760,561 2,086,440 1,674,121

1990 ............... 1,988,858 1,655,993 332,865 4,158,212 2,148,463 2,009,749

1991 ............... 1,794,626 1,690,657 103,969 4,110,907 2,169,518 1,941,389

1992 ............... 1,587,644 1,807,441 –219,797 4,065,014 2,175,613 1,889,401

1993 ............... 1,378,983 2,129,339 –750,356 4,000,240 2,268,553 1,731,687

1994 ............... 1,408,159 2,301,366 –893,207 3,952,767 2,278,994 1,673,773

1995 ............... 1,363,806 2,203,811 –840,005 3,889,589 2,312,132 1,577,457

1996 ............... 1,304,638 2,082,249 –777,611 3,891,494 2,314,690 1,576,804

1997 ............... 1,259,943 2,015,779 –755,836 3,880,894 2,314,245 1,566,649

1998 ............... 1,283,292 1,988,744 –705,452 3,941,553 2,337,256 1,604,297

1999 ............... 1,214,689 2,144,316 –929,627 3,959,417 2,391,399 1,568,018

2000 ............... 1,266,800 2,225,332 –958,532 4,058,814 2,403,351 1,655,463

1Increase is number of births mimus number of deaths.

SOURCES: Russian Federation: Goskomstat; United States: Centers for Disease Control and Prevention, National Center for

Health Statistics, Division of Vital Statistics.

male rate dropping by 19 percent and

the female rate by 13 percent (table A).

In the same time period, U.S.

age-adjusted mortality fell 6 percent. In

Russia, male life expectancy rose by 3.6

years to 61.3 years, restoring nearly

60 percent of the years lost in the

previous interval. Female life

expectancy rose by 2 years, to 73.2

years, making up nearly two-thirds of

the earlier loss. The male-female

differential in life expectancy in Russia

fell from 13.5 years in 1994 to 11.9
- - -

- - - - - -

Page 4 [ Series 5, No. 11

Table C. Economic indicators, Russian Federation 1991–2000

1991 1992 1993 1994 1995 1996 1997 1998 1999 2000

Annual growth rate, per capita gross

domestic product ................. –11.4 –14.6 –8.5 –12.7 –3.6 –3.1 1.3 –4.5 5.8 8.9

Percent unemployed ............... - - - 4.9 5.5 7.5 8.8 9.3 9.0 11.5 12.6 10.4

Annual percent change in consumer prices . 1,353.0 876.0 307.0 198.0 48.0 14.6 27.8 85.8 20.8

Percent of population below poverty level . . 29.8 30.9 23.1 26.2 21.4 21.2 24.6 34.1

– – –Data not available.

SOURCES: Per capita gross domestic product and percent unemployed, Economist Intelligence Unit; consumer prices and population below poverty level, Russian Economic Trends.

Figure 2. Change in all-cause mortality rates by age and sex, Russian Federation 1994–98

years in 1998 but remained higher than

in other industrialized countries.

All-cause mortality rates declined

for all age groups and both sexes in the

interval from 1994 to 1998, with the

exception of women 15–24 years of age

(figure 2). For both men and women, the

largest declines were in the age groups

between 25 and 64 years. The group age

15–24 years experienced the smallest

decline in mortality (–4 percent), with

the female death rate in this age group

remaining unchanged during the

interval. Mortality rates declined

substantially in the very young and very

old age groups.

With the exception of female breast

cancer, mortality rates for all major

causes of death declined significantly

from 1994 to 1998 (table D). The

reductions in mortality due to diseases

of the heart and cerebrovascular diseases

eliminated a major part of the 1990–94

increases for these causes, in particular

for diseases of the heart. Cancer

mortality for all sites, essentially

unchanged from 1990 to 1994, declined

by 6 percent in the 1994–98 period.

Mortality due to other alcohol-related

causes increased the most from 1990 to

1994 (+258 percent) and declined by the

largest amount from 1994 to 1998

(-56 percent). In 1998, however,

mortality due to alcohol-related causes

remained nearly 60 percent above the

1990 level. Other mortality rates that

increased dramatically in the earlier

period—intentional and unintentional

injuries, liver diseases, and pneumonia

and influenza—declined through 1998

but also remained substantially above

their 1990 levels. Mortality due to

transport accidents exhibited a different

pattern, declining by 4 percent in the

1990–94 period and an additional

20 percent by 1998. Despite these

changes, Russian mortality in 1998

remained much higher than in the

United States for many causes of death:

1.8 times higher for diseases of the

heart, 6.0 times higher for stroke, about

3.5 times higher for suicide and

homicide, and eight times higher for

other alcohol-related causes. Russian

mortality was lower than the U.S. level

for pneumonia, influenza, and chronic

obstructive pulmonary disease (COPD),

and was approximately equal to the U.S.

rate for malignant neoplasms.

The impact of these mortality

changes can also be measured in terms

of their contribution to the change in

life expectancy, using the partitioning

technique previously described. Table E

provides the contribution of the

mortality change in each age group to

the change in life expectancy for men,

women, and the total population. For

men, the results show substantially the

same pattern as the earlier information,

based on mortality rates: The majority

of the change in life expectancy took

place in the age group 25–64 years

(82 percent). For women, the largest part

of the change in life expectancy was in

the age interval 35 to 74 years

(75 percent). The majority of the

life-expectancy change took place in the

active adult population for the following

reasons: First, mortality declines in the

younger age groups were relatively

small and thus had little effect on life
Series 5, No. 11 [ Page 5

Table D. Age-adjusted death rates for selected causes of death, by sex: Russian Federation and United States, 1990–2000

Russia mortality rates Russia percent change U.S. mortality rates Russia and U.S. ratio

Sex and cause of death1 1990 1994 1998 2000 1990–94 1994–98 1998–00 1990 1994 1998 19992 1990 1994 1998

All causes

Total ............................. 1,192.8 1,581.8 1,323.8 1,461.2 32.6 –16.3 10.4 803.4 784.7 741.4 744.4 1.48 2.02 1.79

Male ............................. 1,688.5 2,290.8 1,847.1 2,075.6 35.7 –19.4 12.4 1,035.3 996.4 909.8 905.9 1.63 2.30 2.03

Female ........................... 892.3 1,098.7 957.5 1,020.6 23.1 –12.9 6.6 628.8 621.8 607.7 614.9 1.42 1.77 1.58

Infectious diseases (001–139)

Total ............................. 12.8 21.1 19.5 25.0 64.5 –7.5 28.1 21.3 27.2 17.1 17.2 0.60 0.78 1.14

Male ............................. 22.0 36.9 34.5 44.2 67.6 –6.5 28.1 31.7 40.7 21.7 21.6 0.69 0.91 1.59

Female ........................... 5.8 8.2 6.9 8.5 39.9 –15.4 23.1 11.6 14.5 13.0 13.2 0.50 0.56 0.53

Diseases of heart (390–398, 401–429)

Total ............................. 367.9 477.9 390.8 445.7 29.9 –18.2 14.0 262.5 243.6 220.5 219.0 1.40 1.96 1.77

Male ............................. 505.7 690.9 548.1 636.4 36.6 –20.7 16.1 344.7 315.8 279.6 275.5 1.47 2.19 1.96

Female ........................... 286.5 342.5 288.9 318.3 19.5 –15.6 10.2 200.6 188.0 173.2 173.4 1.43 1.82 1.67

Cerebrovascular diseases (430–438)

Total ............................. 245.6 297.0 278.3 297.4 20.9 –6.3 6.9 50.7 48.8 46.1 44.8 4.84 6.08 6.04

Male ............................. 287.4 355.8 317.8 347.4 23.8 –10.7 9.3 53.9 51.9 47.3 46.0 5.33 6.85 6.72

Female ........................... 224.4 262.9 251.7 263.7 17.2 –4.3 4.8 48.0 46.1 44.4 43.3 4.68 5.70 5.67

Malignant neoplasms (140–208)

Total ............................. 201.5 204.5 192.4 192.4 1.5 –5.9 0.0 200.0 196.0 185.0 183.6 1.01 1.04 1.04

Male ............................. 315.0 314.3 289.2 287.1 –0.2 –8.0 –0.7 253.5 244.8 226.5 223.8 1.24 1.28 1.28

Female ........................... 140.6 141.8 136.7 137.3 0.9 –3.6 0.5 164.2 163.0 155.8 154.9 0.86 0.87 0.88

Malignant neoplasms of the respiratory system

(160–165)

Total ............................. 49.9 50.9 44.9 43.8 2.0 –11.8 –2.5 60.0 58.9 54.8 53.9 0.83 0.87 0.82

Male ............................. 116.2 115.9 101.6 98.8 –0.3 –12.4 –2.7 90.4 84.5 74.6 72.9 1.29 1.37 1.36

Female ........................... 11.8 11.5 10.1 9.7 –2.2 –12.3 –3.9 37.6 39.7 39.7 39.3 0.31 0.29 0.25

Malignant neoplasms of the breast (174)

Female ........................... 19.2 22.1 23.6 24.1 15.5 6.8 1.9 32.1 29.8 26.5 25.5 0.60 0.74 0.89

Pneumonia and influenza (480–483, 485–487)

Total ............................. 10.3 21.9 15.4 25.6 111.6 –29.4 65.8 27.4 25.3 25.8 25.1 0.38 0.86 0.60

Male ............................. 15.7 37.1 25.4 43.6 137.0 –31.6 71.7 35.7 32.5 31.6 29.9 0.44 1.14 0.80

Female ........................... 6.8 10.0 7.9 11.7 47.1 –21.8 49.0 22.4 21.0 22.1 21.9 0.30 0.48 0.36

Chronic obstructive pulmonary diseases (490–496)

Total ............................. 35.7 41.3 30.3 36.4 15.8 –26.7 20.1 31.8 34.3 35.1 36.4 1.12 1.20 0.86

Male ............................. 69.8 82.4 60.9 72.5 18.0 –26.1 19.1 45.7 45.6 44.1 45.2 1.53 1.81 1.38

Female ........................... 20.8 21.0 15.2 16.9 0.8 –27.4 10.9 23.3 27.4 29.4 30.6 0.90 0.77 0.52

Chronic liver diseases and cirrhosis

(571.0–571.3, 571.5, 571.6)

Total ............................. 9.9 18.8 14.2 17.6 89.3 –24.2 23.8 11.2 10.2 9.4 9.4 0.89 1.83 1.50

Male ............................. 15.0 27.1 20.6 24.6 80.5 –23.9 19.5 15.9 14.6 13.4 13.4 0.94 1.85 1.53

Female ........................... 6.8 12.8 9.7 12.3 88.2 –24.5 26.9 7.0 6.3 5.9 5.8 0.97 2.02 1.65

Other alcohol-related causes (303,305.0,E860)

Total ............................. 12.5 44.9 19.9 27.9 257.8 –55.6 39.9 2.8 2.7 2.5 2.4 4.48 16.61 7.97

Male ............................. 21.5 74.2 33.5 46.3 245.2 –54.9 38.3 4.7 4.5 4.1 4.1 4.57 16.48 8.16

Female ........................... 4.7 19.2 8.2 11.9 306.8 –57.2 44.9 1.2 1.1 1.1 1.0 3.93 17.45 7.47

Motor vehicle and other transport accidents

(E800–E848)

Total ............................. 29.0 27.8 22.2 25.8 –4.3 –20.3 16.4 19.3 17.0 16.6 16.9 1.50 1.63 1.33

Male ............................. 48.6 45.3 34.6 40.7 –6.8 –23.8 17.7 27.9 24.1 23.3 23.9 1.74 1.88 1.48

Female ........................... 11.7 12.1 10.9 12.3 3.1 –9.4 12.6 11.2 10.4 10.4 10.3 1.04 1.16 1.05

Suicide (E950–E959)

Total ............................. 27.0 41.7 34.2 37.4 54.6 –18.0 9.4 12.3 11.8 11.1 10.5 2.20 3.54 3.09

Male ............................. 47.5 76.4 62.2 69.0 60.8 –18.5 10.9 20.7 19.9 18.6 17.7 2.29 3.83 3.35

Female ........................... 10.5 12.5 10.4 10.5 19.0 –16.5 0.7 4.8 4.4 4.3 4.0 2.18 2.82 2.45

Homicide and legal intervention (E960–E978)

Total ............................. 14.1 31.4 21.9 26.9 122.5 –30.1 22.6 9.5 9.3 6.7 6.3 1.49 3.37 3.29

Male ............................. 22.4 50.3 34.6 42.6 125.0 –31.3 23.3 15.0 14.8 10.3 9.7 1.49 3.39 3.34

Female ........................... 6.4 13.9 10.3 12.6 117.0 –26.3 22.9 4.0 3.8 3.0 2.9 1.60 3.64 3.38

Other external causes (E850–E859, E861–E943)

Total ............................. 53.9 107.4 86.0 95.8 99.1 –19.9 11.4 17.2 17.4 18.0 17.1 3.14 6.18 4.77

Male ............................. 89.9 181.3 143.9 162.9 101.6 –20.6 13.2 25.5 25.7 25.8 24.7 3.53 7.04 5.57

Female ........................... 22.8 43.5 35.5 37.2 90.7 –18.4 4.9 9.9 10.0 11.0 17.6 2.31 4.35 3.22

0.0 Quantity more than zero but less than 0.05.

1Cause of death codes are from the International Classification of Diseases, Ninth Revision.

2Rates were modified with the comparability ratios developed in the comparability study between ICD–9 and ICD–10 carried out by the National Center for Health Statistics and reported in the

Technical Notes, Deaths, Final Data for 1999. National vital statistics reports; vol 49, no 8. Hyattsville, Maryland: NCHS, 2001.

NOTE: Age adjusted using as standard population the European standard 100,000 population prepared by the World Health Organization (see Appendix).

SOURCES: Russian Federation: Goskomstat; United States: Centers for Disease Control and Prevention, National Center for Health Statistics, Division of Vital Statistics.
Page 6 [ Series 5, No. 11

Table E. Contribution of change in mortality from each age group to the change in life expectancy, Russia, 1994–98 and 1998–2000

Both sexes Males Females

Age Years Percent Years Percent Years Percent

1994–1998

Total ......................... 3.14 1.00 3.71 1.00 2.03 1.00

0 ........................... 0.13 0.04 0.14 0.04 0.11 0.05

1–4 years ...................... 0.03 0.01 0.03 0.01 0.04 0.02

5–14 years ..................... 0.03 0.01 0.04 0.01 0.02 0.01

15–24 years .................... 0.03 0.01 0.04 0.01 0.00 0.00

25–34 years .................... 0.28 0.09 0.42 0.11 0.08 0.04

35–44 years .................... 0.69 0.22 0.90 0.24 0.33 0.16

45–54 years .................... 0.90 0.29 1.09 0.29 0.52 0.25

55–64 years .................... 0.64 0.20 0.67 0.18 0.45 0.22

65–74 years .................... 0.19 0.06 0.21 0.06 0.24 0.12

75–84 years .................... 0.15 0.05 0.12 0.03 0.18 0.09

85 years and over ................. 0.06 0.02 0.04 0.01 0.08 0.04

1998–2000

Total ......................... –1.79 1.00 –2.26 1.00 –0.92 1.00

0 ........................... 0.07 –0.04 0.07 –0.03 0.06 –0.06

1–4 years ...................... –0.01 0.01 –0.01 0.00 –0.01 0.01

5–14 years ..................... 0.00 0.00 0.00 0.00 0.01 –0.01

15–24 years .................... –0.15 0.08 –0.23 0.10 –0.04 0.04

25–34 years .................... –0.27 0.15 –0.37 0.17 –0.10 0.11

35–44 years .................... 0.33 0.18 –0.43 0.19 –0.15 0.16

45–54 years .................... –0.44 0.25 –0.56 0.25 –0.23 0.25

55–64 years .................... –0.38 0.21 –0.46 0.20 –0.23 0.25

65–74 years .................... –0.20 0.11 –0.21 0.09 –0.13 0.14

75–84 years .................... –0.04 0.02 –0.04 0.02 –0.05 0.05

85 years and over ................. –0.03 0.02 –0.01 0.00 –0.05 0.05

0.0 Quantity more than zero but less than 0.05.

Table F. Contribution of change in mortality from each cause of death to the change in life expectancy, Russia, 1994–98 and 1998–2000

Both sexes Males Females

Cause Years Percent Years Percent Years Percent

1994–1998

All causes ....................... 3.14 100.0 3.71 100.0 2.03 100.0

Infectious diseases ................. 0.02 0.7 0.03 0.9 –0.02 –0.9

Diseases of the heart ................ 0.87 27.9 0.97 26.1 0.69 33.8

Cerebrovascular diseases ............. 0.18 5.6 0.19 5.1 0.17 8.2

Malignant neoplasms ................ 0.14 4.6 0.18 5.0 0.08 3.7

Pneumonia and influenza ............. 0.10 3.3 0.14 3.8 0.06 2.9

Chronic obstructive pulmonary diseases .... 0.09 3.0 0.11 3.0 0.09 4.2

Chronic liver disease and cirrhosis ....... 0.06 1.9 0.06 1.6 0.04 2.1

Other alcohol-related causes ........... 0.39 12.5 0.47 12.7 0.24 11.6

Motor vehicle and other transport accidents . . 0.11 3.5 0.12 3.1 –0.03 –1.7

Other external causes ............... 0.35 11.1 0.51 13.9 –0.19 –9.5

Suicide ........................ 0.12 3.9 0.20 5.3 0.05 2.7

Homicide ....................... 0.18 5.6 0.17 4.5 0.08 3.8

Remainder ...................... 0.52 16.5 0.56 15.1 0.79 39.0

1998–2000

All causes ....................... –1.79 100.0 –2.26 100.0 –0.92 100.0

Infectious diseases ................. –0.09 5.3 –0.13 5.7 –0.04 3.8

Diseases of the heart ................ –0.59 33.1 –0.68 30.0 –0.40 43.0

Cerebrovascular diseases ............. –0.17 9.6 –0.18 8.0 –0.14 14.8

Malignant neoplasms ................ 0.01 –0.6 0.02 –1.0 0.00 –0.1

Pneumonia and influenza ............. –0.13 7.3 –0.17 7.5 –0.06 6.4

Chronic obstructive pulmonary diseases .... –0.05 3.0 –0.08 3.3 –0.02 1.6

Chronic liver disease and cirrhosis ....... –0.05 2.9 –0.05 2.3 –0.05 5.2

Other alcohol-related causes ........... –0.13 7.2 –0.16 7.1 –0.07 7.6

Motor vehicle and other transport accidents . . –0.07 3.8 –0.09 4.1 –0.03 3.2

Other external causes ............... –0.18 10.2 –0.28 12.4 –0.03 3.2

Suicide ........................ –0.07 3.7 –0.10 4.6 –0.01 0.9

Homicide ....................... –0.09 4.8 –0.10 4.6 –0.05 5.9

Remainder ...................... –0.18 9.9 –0.26 11.4 –0.04 4.3

0.0 Quantity more than zero but less than 0.05.
Series 5, No. 11 [ Page 7

Figure 3. Change in all-cause mortality rates by age and sex, Russian Federation

1998–2000

expectancy; second, there was a major

decline in mortality in the middle-age

groups; and third, mortality declines in

the elderly had only a small effect on

life expectancy, as explained earlier.

In table F, the same approach was

applied to measure the contribution of

each cause of death to the change in life

expectancy. The largest single

contributor was diseases of the heart;

combining this cause with

cerebrovascular diseases accounted for

about one-third of the change between

1994 and 1998. The other major

contributor to the improvement in life

expectancy was external causes of death

(transport, other external causes,

suicides, and homicides). Reductions in

deaths due to these unintentional and

intentional injuries accounted for nearly

one-quarter of the total change.

Combining the external causes of death

with other alcohol-related causes

accounted for 37 percent of the rise in

life expectancy. For men, the

contribution of cardiovascular diseases

was smaller than for women (31 versus

42 percent). Cancer and pneumonia were

larger contributors to the change in life

expectancy for men than for women.

Although female mortality due to other

external causes declined during the

interval, an increase in female deaths at

young ages (15–29 years) resulted in a

net reduction in life expectancy due to

this cause. A similar pattern in

transport-accident deaths also reduced

female life expectancy. These changes,

along with small increases in female

mortality due to breast cancer and

infectious diseases offset some of the

gains in female life expectancy from the

other cause-of-death categories.

In summary, mortality from most

causes of death declined over the

1994–98 interval, substantially reducing

the very high death rate of 1994. Even

with these declines, however, most

cause-specific death rates in 1998 were

substantially greater than in 1990, with

the exception of malignant neoplasms,

COPD, and transport accidents. In terms

of life expectancy at birth, male life

expectancy remained 2.5 years below

the 1990 level, and female life

expectancy was 1.2 years below the

1990 figure.

Trends from 1998 to 2000

Another economic crisis began in

mid-1998. The economic collapse led to

a sharp increase in inflation and rising

unemployment (table C). The rate of

inflation gradually declined in late 1999

and 2000, and positive economic growth

returned. The combination of inflation

and unemployment, however, led to

growing economic inequality and an

increase (to 34 percent) in the proportion

of the population below the poverty

level.

In the period following the onset of

the economic crisis, the gains of

1995–98 began to unravel. In 1999,

there was a sharp rise in the number of

deaths and a decline in the number of

births (table B). In 2000, however, the

mortality increase was only half the

increase of the previous year, and the

number of births rose substantially.

Nevertheless, between 1998 and 2000,

the age-adjusted mortality rate due to all

causes rose by 10 percent, with the male

rate increasing by 12 percent and the

female rate by 7 percent (table A). Life

expectancy declined by 1.9 years, to

65.3 years. Male life expectancy fell 2.3

years, to 59.0 years, while life

expectancy for women dropped 1.0

years, to 72.2 years. For both men and

women, life expectancy fell below the

level recorded in 1996. As with the rise

in the number of deaths, the bulk of the

decline in life expectancy occurred in

1999.

From 1998 to 2000, all-cause

mortality rates rose substantially for the

age groups 15–74 years, while rates for

most of the other age groups remained

stable or were only slightly increased

(figure 3). A major exception was the

infant death rate, which fell by more

than 6 percent. Unlike the 1994–98

interval, mortality rates for the 15–24

year age group changed (increased)

substantially for both men and women.

The mortality increase from 1998 to

2000 was reflected in all of the selected

causes of death, with the exception of

malignant neoplasms (unchanged from

1998). The largest relative increases

were in pneumonia and influenza

(66 percent), other alcohol-related causes

(40 percent), infectious diseases

(28 percent), chronic liver disease and

cirrhosis (24 percent), and homicides

(23 percent). The majority of the

increase took place in 1999, with

substantially lower rates of increase for

most causes of death in 2000. For

example, in 2000 the age-adjusted death
Page 8 [ Series 5, No. 11

rate for cancer and for suicide declined

by 1 percent, the infectious disease

death rate rose by only 1 percent, and

the death rates for cerebrovascular

diseases and for transport accidents rose

by 3 percent. The major exceptions to

this trend were the two alcohol-related

causes of death: The death rate for

chronic liver disease and cirrhosis rose

by 14 percent in 2000 (versus 8 percent

in 1999), and the death rate for other

alcohol-related causes rose by 24 percent

in 2000 (compared with 13 percent in

1999).

The pattern of mortality change by

age group was somewhat different when

using the life-expectancy approach. For

men and women, the 15–74 year age

interval was the largest contributor to

the fall in life expectancy, but for

women, the age groups 75–84 and 85

years and over also made substantial

contributions to the decline in life

expectancy. For both sexes combined,

all age groups contributed to the fall in

life expectancy, with the exception of

infants and those aged 5–14 years.

Applying the life-expectancy

analysis to cause-specific mortality also

produced somewhat different results

than those reported above. Infectious

disease mortality rose sharply in 1999

and 2000, largely because of a

significant increase in tuberculosis

mortality, and accounted for 6 percent of

the fall in life expectancy. Diseases of

the heart and cerebrovascular diseases

remained the leading contributors, but

their contribution—more than 43 percent

of the total decline in life expectancy—

was greater than their contribution to

change in 1994–98. Conversely, the

impact of changes in mortality due to

external causes and alcohol-related

causes was smaller than in the earlier

period: These cause groups accounted

for more than 30 percent of the fall in

life expectancy in 1998–2000, compared

with 36 percent of the change in the

earlier period.

Cause-specific contributions to the

change in life expectancy were

somewhat different for men than for

women. The contribution of infectious

diseases was substantially larger for men

than for women, and the same was true

for suicide and other injuries. However,

the contribution of cardiovascular

disease was much larger for women

than for men, 57 versus 38 percent.

Discussion

Mortality trends in Russia have

exhibited three distinct patterns in the

1990s, rising sharply from 1990 to

1994, declining to a lesser extent

through 1998, and turning upward again

in 1999–2000. Although the mortality

increase in 2000 was substantially

smaller than in 1999, it is uncertain

when, or to what extent, Russian

mortality rates will decline. In sum, the

difficult era of adjustment following the

breakup of the Soviet Union continues.

Although many factors are

contributing to the persistently high

mortality of the 1990s, data-quality

issues cannot account for these trends.

First, it would be difficult to identify

data-quality issues that could lead to a

one-third increase in mortality in the

first half of the decade, followed by a

16-percent decline through 1998, and

then another 10-percent increase by

2000. Second, data-quality problems in

the area of vital statistics typically lead

to understatement of vital rates, not

overstatement. Several studies have

examined data quality issues and

concluded that these problems cannot

account for the mortality increase of the

early 1990s (1,5).

The sharp swings in mortality over

the decade, and the scale of these

changes, indicate some fundamental and

far-reaching problems affecting the state

of health in Russia. We consider several

factors that may have contributed

separately or jointly to recent mortality

trends.

Economy

Economic conditions can affect

health status in a variety of ways,

creating a cascade of events that can

lead to improvement or deterioration in

health. Hyperinflation, wage reductions,

and unemployment pushed many

middle- class Russians below the

poverty level during the 1990s. Declines

in living standards were especially

dramatic for retirees, whose pensions

failed to keep pace with rapid price

increases (11). The economic turmoil

and rise in poverty that characterized, in

particular, the first half of the decade

and the end of the decade led to a

profound deterioration of the health care

system, an inability to obtain necessary

medication, increasing nutritional

deficiencies, and a sharp rise in stress

and depression (4,12,13). The

accompanying decline in governmental

and social controls may have played a

key role in the rise of homicides and

suicides in Russia, along with the sharp

increase in per capita alcohol

consumption. The economy clearly is

not the only factor accounting for these

problems, but it is an important part of

the story. In addition, many of these

problems tend to reinforce each other

through a negative feedback loop.

It should also be noted that

economic conditions are far from

uniform across Russia. One change that

has taken place during the 1990s is the

growing concentration of wealth in

Moscow (10). The relative prosperity of

Moscow and the stability of the city’s

health care system are in marked

contrast to other Russian cities, and the

disparity is even greater in comparison

to rural areas. A similar differential

exists for mortality: All-cause mortality

rates were nearly equal for urban

Russia, rural Russia, and Moscow from

1990 to 1995, but by 2000 the Russian

urban death rate was 16 percent above

the Moscow rate, and Russian rural

mortality was 20 percent higher than the

Moscow rate.

Alcohol

The role of alcohol in the health

trends of the 1990s has been

emphasized in virtually every study of

Russian health during the decade

(5,14–16). The direct impact of alcohol

consumption on health is reflected in the

rise of mortality due to alcohol

poisoning and indirectly in the

increasing levels of homicides, suicides,

and deaths due to other injuries such as

occupational injuries and drowning.

Chronic alcoholism also plays a role in

certain chronic diseases such as stroke.

Binge drinking has been proposed as an

explanation for much of the rise in heart
Series 5, No. 11 [ Page 9

disease deaths, although this has yet to

be confirmed (14). The sharp swings in

mortality due to alcohol-related causes

are noteworthy for their size and their

rough correspondence with economic

trends.

Tobacco

The prevalence of smoking in

Russian adults has historically been high

and was about 60 percent for men and

10 percent for women at the beginning

of the 1990s (1). Based on survey

information for Russia, smoking

prevalence has increased for adult men

and women over the decade of the

1990s (17). By 2000 the adult male

smoking rate had increased slightly,

from 60.0 percent in 1992 to

63.5 percent, while the female rate had

nearly doubled, from 7.3 to 14.2 percent.

However, smoking rates increased

gradually over the decade and were not

consistent with the large and rapid

swings in mortality. Tobacco

consumption in Russia thus is an

important risk factor associated with the

historically high levels of mortality from

heart disease and other leading causes of

death but does not explain the mortality

trends of the 1990s.

Nutrition

Numerous studies have noted a

variety of problems with the Russian

diet, particularly the very high level of

fat consumption and inadequate

quantities of fresh fruits and vegetables

(12, 18,19). These are historic problems,

however, that predate the problems of

the 1990s. Recent declines in per capita

income have reduced the consumption

of certain foodstuffs, such as meat and

fresh fruits and vegetables (20).

Declining living standards also may

have led to a reduction in fat

consumption, but the net effect on

nutritional status is clearly negative.

Stress and Depression

The effect of stress and depression

on Russian health status was readily

apparent in the very high suicide level

of the early 1990s. The Russian death

rate due to suicide was 3.5 times the

U.S. rate in 1994. Less well known was

that, within Russia, the rural suicide rate

was more than 50 percent greater than

the urban rate, reflecting the more

difficult economic situation and

hopelessness of rural Russia. This

differential remained roughly the same

at the end of the decade. Rising levels

of stress, depression, and hopelessness

may explain in part the rise in alcohol

consumption in Russia, with alcohol and

depression tending to reinforce each

other.

Stress and depression also can play

an important role in the development of

chronic diseases and are frequently cited

by Russian health experts as factors in

the mortality rise of the 1990s. Research

in the United States and Western Europe

is beginning to explain the mechanisms

by which stress and depression can lead

to cardiovascular disease (21–23).

Similar factors no doubt also account

for part of the recent rise in

cardiovascular mortality in Russia.

Health Care System

Government spending on the

Russian health care system declined

drastically over the 1990s (12, 24). The

decreasing health budget translates into

inadequate supplies and equipment,

insufficient staff, and in some cases, to

the elimination of hospitals and clinics.

The net effect is a decline in the level

of care provided, which undoubtedly has

contributed to the rise in mortality. At

the same time, Russia continues to

maintain excess capacity in hospitals

and beds, and the system would benefit

from some reductions. Nevertheless, the

reductions in hospitals and beds that

have taken place to date have been

primarily in rural areas. Overall, the

deterioration of the health care system

has disproportionately affected the rural

areas of Russia (24).

Principal Contributors to

the Change in Life

Expectancy

Just as in the 1990–94 period, two

major categories of causes of death

accounted for the majority of the rise in

life expectancy in 1994–98 and the

renewed decline in 1999–2000:

cardiovascular diseases and external

causes of death. The fact that the same

causes of death can account for both

major increases and decreases in life

expectancy implies there are external

factors underlying these rapid swings in

mortality.

External Causes of Death

With the exception of transport

deaths, external-cause mortality in

Russia remains extremely high in

comparison to other industrialized

countries. The seesaw trends in

mortality due to external causes are no

doubt the result of many factors, but

alcohol consumption and changes in the

level of governmental and social

controls are, in all likelihood, major

contributors to the trends in deaths due

to homicides, suicides, and most

unintentional injuries.

Deaths due to transport accidents

have not consistently followed the trend

for all external-cause deaths, for reasons

that are not clear. Despite the apparent

rapid rise in alcohol consumption in

1990–94, and the accompanying

dramatic increase in all external-cause

deaths, the mortality rate due to

transport accidents declined. The

reduction in transport mortality may

have been due to a general decrease in

driving during the interval, the result of

the economic crisis. In the 1994–98

period, transport deaths and all

external-cause deaths jointly declined,

even though the improved economic

conditions arguably led to increased

driving, which could have raised the

number of transport deaths. In this case

the impact of decreased alcohol

consumption—as reflected in a decrease

in alcohol-related deaths—may have had

the stronger influence on transport

mortality. In the 1998–2000 period, the

rise in alcohol-related deaths, which

coincided with the economic downturn

in Russia, again may have been the

most important influence on transport

mortality, even though economic

problems may well have resulted in

decreased driving.
Page 10 [ Series 5, No. 11

Cardiovascular Diseases

The wide swings in cardiovascular

mortality during the 1990s are also

difficult to explain. Similar trends in

alcohol consumption (as implied by the

rise in alcohol-related deaths), the

availability of pharmaceuticals, and

stress and depression imply that these

factors may have played a role in

cardiovascular disease trends, but the

importance of these factors is unclear.

Some of the fluctuations in

cardiovascular deaths may have been

due to a tendency of Russian physicians

to overdiagnose cardiovascular disease

as a cause of death (25). The historically

high levels of heart disease in Russia

are consistent with risk-factor levels in

existence before 1990, including high

consumption of alcohol and tobacco,

poor diet and insufficient physical

activity, along with deficient control of

hypertension (25,26).

Malignant Neoplasms

The mortality rate due to malignant

neoplasms stands out because the rate

changed very little in Russia in the

1990s. Despite wide swings in death

rates for almost every major cause of

death, the cancer death rate rose only

slightly in the first half of the decade

and decreased by about 6 percent

between 1994 and 2000. Such a pattern

makes sense, as one would not expect

rapid changes in cancer death rates in

response to recent changes in risk

factors; instead, any increases in the

cancer mortality rate may not be evident

for one or two decades into the future.

The declines in cancer mortality in the

1990s may well be the result of

premature deaths of middle-aged

Russians due to other causes,

eliminating a substantial number of

people who would otherwise be at risk

of developing cancer. The one exception

to the overall trend was the continuous

rise in breast cancer over the 1990s.

Infectious Diseases

Through most of the decade,

infectious diseases were not a major

factor in mortality trends. However, by

2000 the impact of infectious-disease

deaths had grown substantially,

accounting for 5 percent of the decline

in life expectancy in 1999 and 2000.

The increasing role of infectious

diseases is largely the result of rapid

growth in tuberculosis cases, and

particularly of multidrug-resistant

tuberculosis. Based on reported

cause-of-death data, the level of human

immunodeficiency virus (HIV)AIDS)

mortality remains small, although the

number of deaths due to HIV doubled

between 1999 and 2000. Given the rapid

growth of HIV-positive cases in recent

years, the death rate due to HIV is

certain to accelerate sharply in the near

future.

Conclusion

The decade of the 1990s included

three distinct trends in life expectancy: a

rapid decline through 1994, substantial

improvement from 1995 to 1998, and a

renewed decline in 1999–2000. In each

of these intervals, the young and

middle-aged population (25–64 years)

was the most affected; cardiovascular

diseases and external causes of death

were the main contributors to these

trends. Yet the scale of these mortality

trends, and the frequency with which

they were reversed, indicate that

external factors likely played an

important role. Such factors include

economic and social conditions, excess

alcohol consumption and other poor

personal health behaviors, and an

inadequate health care system.

It remains to be seen what the

mortality trends of the second decade of

the Russian Federation will be.

Improving life expectancy will require

social stability, economic growth

without hyperinflation, and

improvements in the health care system.

Public health efforts to address alcohol

consumption and other risk factors,

along with programs to reverse the

spread of infectious diseases, such as

tuberculosis and HIV/AIDS, will be

essential to improve health status in

Russia.

Mortality data for 2001 show a

continued decline in life expectancy,

although the downward trend slowed

considerably from 1999–2000, and may

be nearly at an end. Economic growth in

recent years may be a factor in the

leveling off of life expectancy, along

with other improvements. Continued

economic growth may contribute to

future increases in life expectancy,

particularly if the economic

improvements spread beyond Moscow

and other major cities.

References

1. Notzon FC, Komarov YM, Ermakov

SP, et al. Causes of declining life

expectancy in Russia. JAMA

279:793–800. 1998.

2. National Center for Health Statistics.

Vital and health statistics: Russian

Federation and United States, selected

years 1980–93. Vital Health Stat 5(9).

1995.

3. Mesle F, Shkolnikov V, Hertich V,

Vallin J. Tendences recents de la

mortalite par cause en Russie, 1965–93.

In: Dossiers et Recherches. Vol. 50.

Paris, France: Institut National d’Etudes

Demographiques. 1995.

4. Chen LC, Wittgenstein F, McKeon D.

The upsurge in mortality in Russia:

causes and policy implications.

Population Development Review

22:517–30. 1996.

5. Leon DA, Chenet L, Shkolinkov VM,

et al. Huge variation in Russian

mortality rates 1984–94: artefact,

alcohol, or what? Lancet 350:383–88.

1997.

6. Arriaga EE. Measuring and explaining

the change in life expectancies.

Demography 21:83–96. 1984.

7. Arriaga EE. Changing trends in

mortality decline during the last

decades. In: Ruzicka L, Wunsch G,

Kane P, eds. Differential Mortality:

Methodological Issues and Biosocial

Factors. Oxford, England: Clarendon

Press. 1989.

8. World Health Organization. World

Health Statistics Annual 1996. Geneva,

Switzerland: World Health

Organization. 1998.

9. International Classification of Diseases,

Tenth Revision. Geneva, Switzerland:

World Health Organization. 1992.

10. Country Profile 2001: Russia.

Economist Intelligence Unit. London.

2001.

11. Rush D, Welch K. The first year of

hyperinflation in the former Soviet

Union: nutritional deprivation among
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elderly pensioners, 1992. Am J Pub

Health 86:361–67. 1996.

12. Tulchinsky TH, Varavikova EA.

Addressing the epidemiologic transition

in the former Soviet Union: strategies

for health system and public health

reform in Russia. Am J Pub Health

86:313–20. 1996.

13. Wines M. An ailing Russia lives a

tough life that’s getting shorter. New

York Times. December 3, 2000.

14. Shkolnikov V, McKee M, Leon DA.

Changes in life expectancy in Russia in

the mid-1990s. Lancet 357:917–21.

2001.

15. Treml VG. Soviet and Russian statistics

on alcohol consumption and abuse. In:

Bobadilla JL, Costello CA, Mitchell F,

eds. Premature Deaths in the New

Independent States. Washington, DC:

National Academy Press (220). 1997.

16. Nemtsov A. Alcohol Related Mortality

in Russia, 1980–1990s. Moscow: 2001.

17. Zohoori N, Gleiter K, Popkin BM.

Monitoring health conditions in the

Russian Federation: the Russian

Longitudinal Monitoring Survey

1992–2000. Report submitted to the

U.S. Agency for International

Development. Chapel Hill, N.C.:

Carolina Population Center, University

of North Carolina at Chapel Hill. 2001.

18. Light DW. Russia: Perestroika for

health care? Lancet 339:236. 1992.

19. Matilainen TKM, Puska P, Berg MK, et

al. Health-related behaviors in the

republic of Karelia, Russia, and North

Karelia, Finland. International Journal

of Behavioral Medicine 1:285–304.

1994.

20. Popkin B, Zohoori N, Kohlmeier L, et

al. Nutritional risk factors in the former

Soviet Union. In: Bobadilla JL,

Costello CA, Mitchell F, eds. Premature

Death in the New Independent States.

Washington, DC: National Academy

Press. 1997.

21. Pratt LA, Ford DE, Crum RM,

Armenian HK, et al. Depression,

psychotropic medication, and risk of

myocardial infarction. Circulation

94:3123–9. 1996.

22. Anda R, Williamson D, Jones D, et al.

Depressed affect, hopelessness, and the

risk of ischemic heart disease in a

cohort of U.S. adults. Epidemiology

4:285–94. 1993.

23. Carney RM, Saunders RD, Freedland

KE, Stein P, et al. Association of

depression with reduced heart rate

variability in coronary artery disease.

Am J Cardiol 76:562–4. 1995.

24. Klugman J, Scheiber G. Health reform

in Russia and Central Asia. Paper

presented at Workshop on Economic

Transformation of Households and

Health. Task Force on Economics in

Transition, National Research

Council/National Academy of Sciences.

Washington, DC: September 7–8, 1995.

25. Puska P, Matilainen T, Jousilahti P, et

al. Cardiovascular risk factors in the

Republic of Karelia, Russia, and in

North Karelia, Finland. International

Journal of Epidemiology 22:1048–55.

1993.

26. Cooper R. Rising death rates in the

Soviet Union: the impact of coronary

heart disease. N Eng J Med 304:1259–

65. 1981.
Vital and Health Statistics: Russian Federation and United States
Series 5, No. 11 [ Page 15

Highlights 960,000 in 2000. The impact on

total population growth was

moderated by the return migration

of ethnic Russians from other parts

of the former Soviet Union to the

Russian Federation during the

1990s.

United States

+

+

+

Figure 4a. Live births and deaths, Russian Federation 1990–2000

+

Population

Russian Federation

+ The total population reached its

highest level, 148.3 million, in 1992

and declined thereafter. The total

population in 2000 was 145.2

million.

+ Between 1990 and 2000, the

population under 5 years of age

experienced the greatest reduction in

The population grew by about

9.6 percent between 1990 and 2000,

to an estimated level of 275.3

million.

The population under age 5 years

grew by only 1.3 percent between

1990 and 2000, reflecting the

gradual decline in birth rates during

the 1990s.

The elderly population grew rapidly,

with the population aged 65 years

and over increasing by nearly

10.6 percent between 1990 and

2000. The age group that increased

the most during this period was the

population age 85 years and over,

which grew by nearly one-third.

Growth of the elderly population

will continue in the future, as the

age group 45–64 years grew by

25 percent during the same interval.

The excess of live births over deaths

has moderated slightly since the

recent peak of 2.0 million in 1990,

but this surplus was still 1.7 million

in 2000.

Figure 4b. Live births and deaths, United States 1990–2000

size, declining by 45 percent to 6.4

million.

+ The age group that increased the

most was the population 65 years of

age or over, which grew by

23 percent between 1990 and 2000.

+ The annual number of deaths

exceeded the annual number of live

births in every year since 1992. This

population deficit reached almost

900,000 in 1994 and was about
Page 16 [ Series 5, No. 11

Characteristics of Live

Births

Figure 5. Percent of women receiving prenatal care in first trimester: Russian Federation

and United States, 1990–2000

Russian Federation

+ The major factor behind the

population decrease has been the

reduction in the annual number of

births, not the rise in deaths. Since

1990 the birth rate, or the number of

live births per 1,000 population, has

declined by 35 percent, while the

annual number of births has

declined by nearly 725,000. The

fertility rate, defined as the number

of births per 1,000 women 15–44

years of age has decreased by

37 percent.

+ In 1990 the Russian birth rate was

20 percent lower than the U.S. rate.

Because of the much larger decline

in Russian fertility during the 1990s,

by 2000 the birth rate was

43 percent below the U.S. rate.

+ The proportion of births to

unmarried women has increased

substantially, from 14.6 percent in

1990 to 28 percent in 2000.

+ As fertility has declined, more

health resources are being devoted

to insuring the survival of newborns.

For example, the adequacy of

prenatal care gradually improved

during the 1990s, with the

proportion of women initiating

prenatal care in the first trimester

increasing to nearly 76 percent in

2000.

United States

+ From 1990 to 1997, the annual

number of live births declined

slowly, dropping to 3.9 million in

1997. The number of live births

increased in the following 2 years,

exceeding 4 million births in 2000.

+ After rising rapidly through the

1980s and early 1990s, the

proportion of live births to

unmarried women leveled off in the

middle of the decade. However, in

1998 this proportion began to rise

again, reaching 33.2 percent in 2000.

+ The proportion of women initiating

prenatal care in the first trimester of

pregnancy has risen slowly but

consistently since 1990. By 2000,

women reported that their first

prenatal visit took place in the first

trimester for 83 percent of live

births.
Series 5, No. 11 [ Page 17

Abortion

Figure 6. Number of abortions, Russian Federation and United States, 1990–2000

Russian Federation

+ The level of abortions declined

sharply in the 1990s: The rate of

abortions per 1,000 women of

childbearing age dropped by

52 percent from 1990 to 2000.

+ The ratio of abortions per 100 live

births and stillbirths fell much more

slowly than the number of abortions,

declining by only 18 percent during

the 1990s. The slower rate of

decline was due to the rapid

decrease in the number of live births

during the decade. The 2000 ratio of

168.7 was 28 percent below the

peak rate of 235, recorded in 1993.

+ The increased availability of

contraceptives in Russia was

certainly part of the explanation for

the declining number of abortions.

Another possible factor was the

rising level of divorces. Some of the

decline in abortions, however, may

be due to the increasing use of

private providers for abortion

services.

+ In 1990 the Russian abortion ratio

was six times the U.S. ratio. Despite

a decrease in the Russian abortion

ratio after 1993, the Russian figure

was 6.6 times the U.S. ratio in 1997.

The Russian abortion ratio dropped

substantially after 1997, but this

may only return the Russia-U.S.

differential to the 1990 level.

United States

+ The number of abortions declined

by 15 percent from 1990 to 1997. In

1998, reports were not received

from 4 of the 52 reporting areas.

Based on trend data from the 48

areas that reported in 1998, the

number of abortions declined by

about 2 percent from 1997 to 1998.

+ The ratio of abortions per 100 live

births declined by 12 percent from

1990 to 1997, to 30.5. The decline

was continuous throughout the

1990s, with the exception of a small

increase in 1996. Using trend data

from the 48 reporting areas, the

abortion ratio declined by about

4 percent from 1997 to 1998.

+ The rate of abortions per 1,000

women of childbearing age declined

by 21 percent from 1990 to 1997.

+ The largest declines in the U.S.

abortion ratio from 1990 to 1998

were for teenagers and women age

30 years and over.
Page 18 [ Series 5, No. 11

Life Expectancy

Figure 7. Life expectancy at birth, Russian Federation and United States, 1990–2000

Russian Federation

+ Life expectancy declined

dramatically in the early 1990s.

From 1990 to 1994, overall life

expectancy fell by more than 5

years, to 64.0 years. The decline in

male life expectancy was even more

striking, falling by more than 6

years to 57.6 years in 1994.

+ Following 1994, life expectancy rose

rapidly through 1998 but declined

again in 1999 and 2000. By 1998

overall life expectancy had regained

3 of the 5 years lost earlier in the

decade. Male life expectancy rose

by nearly 4 years, while female life

expectancy increased by almost 2

years. The decline in life expectancy

after 1998 affected both men and

women, resulting in a 1.7-year

decrease in overall life expectancy

to 65.3 years, or 3.9 years less than

in 1990.

+ The gap between male and female

life expectancy in Russia is the

largest of all industrialized countries.

This difference grew to 13.6 years

in 1994 but declined through 1998.

However, the gap grew to 13.2 years

in 2000.

United States

+ Although there were some small

declines in life expectancy in the

early 1990s, the general trend in the

United States has been regular

increases in life expectancy. By

2000 this measure was 1.5 years

higher than in 1990.

+ Annual changes in life expectancy

are much smaller in the United

States than in Russia. Typical annual

U.S. changes are in the 0.2–0.3-year

range, with the largest change being

0.6 years for men in 1996. Annual

changes in Russia have been much

larger, particularly for men, with

year-to-year increases or decreases

of 1 year or more.

+ Although life expectancy is higher

in the United States than in Russia,

particularly for men, the U.S. figures

are lower than in many other

industrialized countries. International

life expectancy figures from the

1990s rank U.S. men and U.S.

women 19th among industrialized

counties.
Series 5, No. 11 [ Page 19

Infant Mortality

Figure 8. Infant mortality by age at death, Russian Federation and United States, 1999

Russian Federation

+ During the 1990s, the infant

mortality rate peaked at 19.9 in

1993 and declined continuously

through 1998. Infant mortality rose

slightly in 1999, to 16.9, but fell

substantially in 2000, to 15.3.

However, infant mortality remains

seriously understated because of the

Russian practice of not reporting

infant deaths during the first week

of life for very preterm or very low

birthweight infants.

+ The 1993–2000 decline was roughly

the same for both neonatal and

postneonatal mortality: Both rates

declined by about 23 percent over

the interval.

+ Official infant mortality rates are not

calculated according to the

international formula. The

international formula divides the

number of infant deaths in a year by

the number of live births in the

same year. The official Russian

formula uses a denominator that

combines one-third of live births in

the previous year with two-thirds of

live births in the current year.

United States

+ Since 1990, the infant mortality rate

has fallen by 25 percent, to 6.9 in

2000. Most of the improvement took

place in the early 1990s, and there

has been little change since 1996.

+ The neonatal mortality rate declined

by 21 percent from 1990 to 2000,

while postneonatal mortality fell by

32 percent. The neonatal mortality

decline was due in part to the

introduction of surfactants, which

led to declines in neonatal mortality

from respiratory distress syndrome

in the late 1980s and early 1990s.

The declines in postneonatal

mortality have taken place

throughout the 1990s, due to

declines in deaths from sudden

infant death syndrome (SIDS),

congenital anomalies, and injuries.

+ Although the U.S. infant mortality

rate is less than half the Russian

rate, the U.S. rate is higher than in

many other industrialized countries.

In 2000, the United States ranked

28th in terms of infant mortality

among all industrialized countries.
Page 20 [ Series 5, No. 11

Mortality

Figure 9. Leading causes of death, Russian Federation and United States, 1999

+

+

+

in 2000 the Russian rate remained

nearly twice the U.S. rate.

Death rates decreased in all age

groups during the 1990s, but the

largest relative decreases took place

in the population under 35 years of

age. Within this age group, the

greatest percent reduction occurred

among children under 5 years of

age.

From 1990 to 1999, there were

reductions in mortality due to all

major causes, with the exception of

chronic obstructive pulmonary

disease. The most important

contributors to the overall decline in

mortality were cardiovascular

diseases and malignant neoplasms.

In 1999 age-adjusted U.S. death

rates were 18 percent higher than in

Russia for pneumonia and influenza.

The death rate for malignant

neoplasms was nearly equal in both

Russian Federation countries.

+ There have been at least two major

fluctuations in Russian mortality

during the 1990s. From 1990 to

1994, the age-adjusted mortality

rate increased by nearly one-third,

the result of severe economic and

social changes brought about by

the breakup of the Soviet Union.

Mortality rates declined by

16 percent from 1994 to 1998, but

mortality rose by 10 percent in

1999–2000.

+ The largest relative increases in

mortality from 1990 to 1994 were in

the adult population, spanning the ages

of 15 to 64 years. Conversely, the

largest percent decrease in mortality

during the 1994–98 period was among

adults 25 to 64 years of age. In

1999–2000, large increases occurred

for ages 15–64 years.

+ From 1990 to 1994, there were sharp

increases in deaths due to all major

causes of death with the exception of

malignant neoplasms. The most

important contributors to the overall

rise in mortality were cardiovascular

diseases and deaths due to

unintentional injury or violence. From

1994 to 1998, death rates declined for

virtually all causes; the most important

contributors to the decline were again

cardiovascular disease and external

causes of death. In 2000, death rates

increased for infectious and parasitic

diseases by 28 percent, and

unintentional injury and violence by 10

percent.

+ In 1999 Russian age-adjusted death

rates substantially exceeded U.S. rates

for many causes of death. The ratio of

Russian to U.S. rates was 2.0 for

diseases of the heart, 6.4 for

cerebrovascular diseases, 1.6 for

chronic liver diseases and cirrhosis, 3.6

for suicides, and 4.0 for homicides.

+ Maternal mortality in 2000 was 39.7

deaths per 100,000 live births,

25 percent below the peak rate of 53.3

in 1995. Nevertheless, maternal

mortality in Russia remains more than

four times higher than in the United

States. About one-quarter of all

maternal deaths are due to abortions,

primarily illegal abortions.

United States

+ The age-adjusted death rate declined

by 8 percent from 1990 to 2000. In

1994 the Russian death rate was

more than double the U.S. rate, and
Series 5, No. 11 [ Page 21

Communicable Diseases

Figure 10a. Incidence of communicable diseases, Russian Federation 1991–2000

Figure 10b. Incidence of communicable diseases, Russian Federation and United States,

Improved immunization eliminated

all cases of poliomyelitis caused by

wild polio virus in Russia after

1996.

+ Rates of certain diseases increased

dramatically during the 1990s. The

rate of tuberculosis nearly tripled

from 1991 to 2000. The syphilis rate

increased by a factor of 40 before

declining substantially in 1999 and

2000.

+ The trend in hepatitis case rates has

varied significantly by type of

hepatitis. The rate of hepatitis A in

2000 was only one-third the 1991

rate, although the rate increased

substantially in 2000. Both hepatitis

B and C have risen sharply,

however, with hepatitis B doubling

and hepatitis C increasing by a

factor of 7 by 2000.

+ The reported rate of gonorrhea

declined by more than 50 percent

from 1993 to 1998, but rose by

18 percent in 1999–2000. The

gonorrhea rate in 1998 was

25 percent below the reported rate

for the United States.

United States

+ Rates of most reportable diseases

declined continuously after 1992.

Some of the largest declines were

hepatitis A (down 61 percent from

1990), hepatitis B (down

65 percent), gonorrhea (down

52 percent), and syphilis (down

79 percent).

+ Although the case rates for most

reportable diseases are generally

higher in Russia than in the United

States, the differentials are very

large for certain diseases. In 2000

the Russian rate for hepatitis B was

14.4 times the U.S. rate; for

tuberculosis the Russian rate was 15

times higher, and for syphilis it was

14.3 times the U.S. rate.

2000

Russian Federation

+ Rates of most reportable diseases

rose sharply in the early and

mid-1990s, but almost all of these

have declined in recent years. One

example is the diphtheria rate, which

rose by a factor of 34 from 1991 to

1994, but was below its 1991 level

by 2000, thanks to major

improvements in immunization

coverage. Another example is the

rate of pertussis, which rose by

more than 50 percent by 1994 before

declining.

+ A poliomyelitis outbreak in the

Chechen Republic, where

immunization efforts dropped

substantially in the mid-1990s,

affected 154 children in 1995.
Page 22 [ Series 5, No. 11

Immunization Coverage + An essential part of future

improvements in immunization

coverage will be the development of

State- and community-based

computerized immunization

registries to identify children

needing vaccination.

Figure 11. Immunization coverage rates, Russian Federation and United States, 2000

Russian Federation

+ The vast improvement in

immunization coverage achieved in

Russia during the 1990s helps to

explain the declines in incidence

rates for many communicable

diseases. The immunization rate for

four or more doses of diphtheria/

tetanus rose continuously from

68.7 percent in 1991 to 98.3 percent

in 1999 before falling slightly to

95.6 percent in 2000. The

achievement of 95 percent coverage

in 1996 and later years helps to

explain the dramatic decline in the

diphtheria rate in 1996.

+ The coverage rate for four or more

doses of pertussis rose from only

59 percent in 1991 to 93.9 percent in

2000. Although the immunization

rate for pertussis lagged behind the

level achieved for diphtheria/tetanus,

the rate of pertussis cases has

dropped to nearly the level reported

in 1990.

+ By 2000 the immunization rates for

most vaccines were higher in Russia

than in the United States. The rates

of diphtheria/tetanus and pertussis

vaccinations were substantially

higher in Russia, at 95.6 and

93.9 percent versus 81.7 percent for

the combined DTP vaccine in the

United States. Nearly 97 percent of

Russian children received three or

more doses of polio vaccine in

2000, against 90 percent in the

United States. The coverage rate for

measles vaccine was also

substantially higher in Russia.

United States

+ Immunization coverage rates have

increased substantially in the United

States since 1993, when the

Childhood Immunization Initiative

was implemented, but coverage

levels have fallen slightly in recent

years. The coverage rate for four or

more doses of DTP vaccine rose

from 76 percent in 1994 to

84 percent in 1998 but dropped to

82 percent in 2000. For polio, the

immunization rate for three doses or

more rose from 83 percent in 1994

to 91 percent in 1998 but fell below

90 percent in 2000.

+ The rapid rise in coverage for

hepatitis B vaccine, from 8 percent

in 1992 to 90 percent in 2000,

accounts for some of the recent

decline in the hepatitis B case rate.
Series 5, No. 11 [ Page 23

HIV Infection and AIDS

Figure 12. HIV/AIDS cases, Russian Federation and United States, 1991–2001

Russian Federation

+ The level of HIV cases was very

low in the late 1980s and early

1990s, because of limited interaction

between the population of the Soviet

Union and other nations. However,

the number of cases of HIV

infection rose dramatically in Russia

during the 1990s. The annual

number of reported cases rose from

84 in 1991 to 5,466 in 1998 and

87,614 in 2001. Information and

health education campaigns are

urgently needed, particularly

programs aimed at Russian youths.

+ Through most of the 1990s, the HIV

incidence rate was very low and

thought to be severely

underreported. The rapid increase in

HIV cases after 1998 has raised the

incidence rate substantially but the

rate is still considered underreported.

+ The number of AIDS cases and

AIDS deaths was also very small

during the 1990s and considered

underreported. The number of AIDS

cases and deaths rose substantially

in 2000 and 2001 but these figures

are still likely to be underestimated.

United States

+ The number of AIDS cases more

than doubled in 1993, the result of a

revision in the AIDS definition to

include a broader range of

AIDS-indicator diseases and

conditions. Since 1993, however, the

number of AIDS cases has declined

continuously. In 2001 the number of

persons diagnosed with AIDS was

less than half the 1993 figure. The

decrease was somewhat less for

women 13 years of age and over

than for men of the same age.

+ The decline in the number of AIDS

deaths has been even greater than

the decline in the number of AIDS

cases. Since the peak in 1995, the

number of deaths among men age

13 years and over has declined by

71 percent; deaths among women in

the same age group have fallen by

56 percent. Among children 12 years

of age or under, the number of

deaths has fallen by 79 percent since

the peak year of 1994. Beginning in

1998, HIV infection no longer

figured among the 15 leading causes

of death in the United States.
Page 24 [ Series 5, No. 11

Health Care Personnel

Figure 13. Physican specialization, Russian Federation and United States, 2000

Russian Federation

+ The physician/population ratio

changed very little in Russia from

1990 to 2000, despite a significant

reduction in government spending

on health care. The number of

physicians per 10,000 population

actually rose slightly over the 1990s,

as did the ratio for certain

specialties.

+ The physician-to-population ratio for

family physicians and internists

declined slightly through 1996. In

later years the ratio grew, reflecting

the new emphasis of the Ministry of

Health on family medicine.

+ The level of physician specialization

is slightly greater in Russia than in

the United States. Less than

one-quarter of all physicians were

general family practice or internal

medicine practitioners in Russia in

2000, compared with one-third of

non-Federal, office-based physicians

in the United States.

+ The major change in health

personnel in the 1990s was the

decline in provider/population ratios

for physician assistants, down by

54 percent, and the 51 percent

decline for midwives. The decline in

midwives may be the result of the

severe drop in the number of births

in Russia. However, the physician

assistants, also known as feldshers,

are the first point of contact with the

health care system for the rural

population. The sharp drop in the

number of physician assistants

indicates a serious deterioration of

the rural health care system.

United States

+ The number of physicians per

10,000 population increased in the

United States during the 1990s for

both general practitioners and

specialists. Increases were highest

for pediatricians and internal

medicine practitioners, reflecting

ongoing changes in the organization

of health care in the United States.

+ The provider/population ratio for

registered nurses grew by 16 percent

from 1990 to 1999, indicative of

efforts to control escalating health

care costs. The nurse/population

ratio was substantially higher in the

United States than in Russia.

+ The physician/population ratio in the

United States is about half the ratio

in Russia, but the Russian definition

of a physician contains categories

not included in the U.S. definition,

such as inactive physicians,

sanitary-epidemiological physicians,

and physiotherapists.
Series 5, No. 11 [ Page 25

Health Resources and

Services

+

system less dependent on

hospital-based care, but the changes

have been very gradual. Since 1990

the average length of a hospital stay

has dropped by 7 percent, and the

discharge rate has declined by

2 percent. The outpatient surgical

procedure rate has grown by

37 percent, but the inpatient surgical

procedure rate has increased by

16 percent as well.

The Russian health care system

remains highly hospital centered,

even after the reductions of the

1990s. In 1999 Russia had more

than two times the number of

hospitals in the United States and

nearly four times the number of

Figure 14a. Average length of hospital stay, Russian Federation and United States,

1990–2000

Figure 14b. Rates of hospital discharge and inpatient surgery, Russian Federation and

United States, 2000

Russian Federation

+ Since 1990 the Russian health care

system has substantially reduced

both the number of hospitals (down

16 percent) and the number of beds

per 10,000 population (down

16 percent). The hospital closures

have affected primarily medium and

small hospitals, including city

hospitals (down 23 percent), rayon

(regional) hospitals (down

beds per 10,000 population. The

Russian discharge rate was more

than twice the U.S. rate. The

average Russian hospital stay was

more than three times the length of

stay in the United States, although

the Russian average may be inflated

by the inclusion of long-stay

hospitals.

United States

+ The number of hospitals fell by

9 percent during the 1990s. Most of

the closures were of medium and

large hospitals, the opposite of the

pattern in Russia. The largest

reduction in beds took place in

medium-sized hospitals.

+ Efforts to reduce the cost of health

care in the United States can be

seen in the 25 percent reduction in

the average length of a hospital stay

and the 8 percent decline in hospital

discharge rates since 1990. Although

the rate of surgical operations has

increased, a growing proportion of

these are performed on an outpatient

basis. In 2000 the U.S. rate of

surgical operations in hospitals was

about three times the rate in Russia.

19 percent), and rural hospitals

(down 31 percent). The largest

hospitals have increased slightly in

number over the decade. Roughly

equal numbers of beds have been

eliminated from the medium and the

small hospitals. The net effect of

these changes has been a reduction

in the availability of care in rural

areas.

+ Other aspects of Russian health care

have begun to change toward a
e and sex: Russian Federation and United States, selected years 1985–2000

All Under 1–4 5–14 15–24 25–34 35–44 45–54 55–64 65–74 75–84 85 years

idents 1 year years years years years years years years years years and over

Page 26[ Series5, No.11

444,187 2,356,758 9,147,605 20,604,916 20,993,186 25,191,767 16,204,174 19,129,215 15,599,878 8,629,684 4,800,442 786,562913,047 2,042,649 9,472,425 22,446,402 19,709,319 24,675,511 21,676,613 16,548,721 16,502,192 8,609,347 5,268,041 961,827244,835 1,870,366 9,091,489 22,766,281 19,810,056 24,058,606 22,726,686 16,043,405 16,458,415 9,217,642 5,186,105 1,015,784310,174 1,680,008 8,511,358 23,123,387 20,026,600 23,334,571 23,357,050 15,669,662 16,525,533 10,000,225 5,016,311 1,065,469

145,911 1,480,467 7,819,486 23,411,771 20,348,922 22,536,113 23,941,809 15,228,511 16,658,582 10,762,688 4,855,254 1,102,308

967,813 1,409,618 7,106,850 23,540,111 20,733,995 21,826,445 24,350,080 15,035,818 16,713,924 11,409,294 4,712,581 1,129,097773,657 1,392,301 6,494,163 23,475,826 21,070,849 21,205,942 24,628,655 15,145,024 16,662,239 11,975,828 4,555,947 1,166,883373,009 1,331,932 6,005,840 23,176,061 21,320,745 20,624,647 24,881,259 15,423,481 16,574,153 12,399,702 4,419,912 1,215,277938,319 1,278,971 5,640,602 22,619,126 21,570,718 20,185,756 24,974,060 16,162,970 16,234,275 12,650,735 4,345,277 1,275,829533,492 1,270,105 5,420,605 21,734,940 21,935,580 19,892,112 24,936,563 17,425,774 15,556,846 12,647,221 4,385,971 1,327,775943,393 1,247,988 5,273,255 20,697,501 22,335,307 19,734,426 24,645,896 18,891,360 14,850,879 12,370,244 4,531,142 1,365,395189,156 1,237,828 5,118,833 19,678,294 22,650,919 19,755,023 24,108,160 20,266,172 14,132,054 12,118,105 4,750,888 1,372,880

438,950 1,203,729 4,667,286 10,464,373 10,590,598 12,791,354 7,970,451 8,929,434 6,103,645 2,517,775 1,061,812 138,493266,204 1,046,981 4,829,681 11,397,039 10,059,661 12,477,908 10,747,471 7,747,552 7,012,977 2,564,501 1,223,983 158,450481,089 958,645 4,642,122 11,561,824 10,112,724 12,157,406 11,266,195 7,516,747 7,078,842 2,815,595 1,201,677 169,312562,474 861,576 4,351,791 11,747,232 10,235,144 11,773,602 11,575,696 7,357,830 7,157,643 3,161,508 1,159,884 180,568528,088 760,501 4,004,697 11,901,131 10,415,918 11,360,626 11,854,079 7,169,595 7,234,700 3,512,562 1,124,084 190,195479,594 723,589 3,645,851 11,976,893 10,608,190 11,026,042 12,044,104 7,100,050 7,248,913 3,814,639 1,093,115 198,208387,481 713,720 3,333,605 11,957,113 10,748,361 10,758,464 12,166,261 7,167,697 7,206,558 4,068,947 1,056,871 209,884158,893 682,951 3,082,204 11,813,865 10,842,046 10,495,626 12,274,597 7,312,289 7,143,208 4,262,864 1,025,631 223,612926,337 656,481 2,893,532 11,538,375 10,943,983 10,289,432 12,316,076 7,673,757 6,968,729 4,399,770 1,008,516 237,686717,053 652,367 2,779,117 11,097,150 11,112,094 10,147,865 12,295,644 8,269,424 6,651,276 445,980 1,015,013 251,123405,752 641,652 2,703,604 10,575,971 11,306,036 10,063,275 12,149,718 8,944,895 6,313,411 4,392,236 1,053,530 261,424991,254 636,896 2,626,212 10,060,771 11,462,184 10,060,431 11,879,547 9,568,154 5,969,851 4,342,753 1,119,608 264,847005,237 1,153,029 4,480,319 10,140,543 10,402,588 12,400,413 8,233,723 10,199,781 9,496,233 6,111,909 3,738,630 648,069646,843 995,668 4,642,744 11,049,363 9,649,658 12,197,603 10,929,142 8,801,169 9,489,215 6,044,846 4,044,058 803,377763,746 911,721 4,449,367 11,204,457 9,697,332 11,901,200 11,460,491 8,526,658 9,379,573 6,402,047 3,984,428 846,472747,700 818,432 4,159,567 11,376,155 9,791,456 11,560,969 11,781,354 8,311,832 9,367,890 6,838,717 3,856,427 884,901617,823 719,966 3,814,789 11,510,640 9,933,004 11,175,487 12,087,730 8,058,916 9,423,882 7,250,126 3,731,170 912,113488,219 686,029 3,460,999 11,563,218 10,125,805 10,800,403 12,305,976 7,935,768 9,465,011 7,594,655 3,619,466 930,889386,176 678,581 3,160,558 11,518,713 10,322,488 10,447,478 12,462,394 7,977,327 9,455,681 7,906,881 3,499,076 956,999

214,116 648,981 2,923,636 11,362,196 10,478,699 10,129,021 12,606,662 8,111,192 9,430,945 8,136,838 3,394,281 991,665

011,982 622,490 2,740,070 11,080,751 10,626,735 9,896,324 12,657,984 8,489,213 9,265,546 8,250,965 3,336,761 1,038,143

816,439 617,738 2,641,488 10,637,790 10,823,486 9,744,247 12,640,919 9,156,350 8,905,570 8,201,241 3,370,958 1,076,652537,641 606,336 2,569,651 10,121,530 11,029,271 9,671,151 12,496,178 9,946,465 8,537,468 7,978,008 3,477,612 1,103,971197,902 600,932 2,492,621 9,617,523 11,188,735 9,694,592 12,228,613 10,698,018 8,162,203 7,775,352 3,631,280 1,108,033
e and sex: Russian Federation and United States, selected years 1985–2000—Con.

All Under 1–4 5–14 15–24 25–34 35–44 45–54 55–64 65–74 75–84 85 years

idents 1 year years years years years years years years years years and over

Number in thousands

7,924 3,679 14,163 33,692 39,992 41,696 31,691 22,459 22,135 16,859 8,890 2,667

8,710 3,946 14,812 35,095 37,013 43,161 37,435 25,057 21,113 18,045 10,012 3,021

2,177 4,011 15,210 35,909 36,399 42,876 39,273 25,739 21,005 18,280 10,314 3,160

5,078 4,000 15,512 36,451 36,147 42,445 39,906 27,415 20,925 18,460 10,559 3,256

7,783 3,917 15,774 37,050 36,030 41,875 40,784 28,657 20,922 18,640 10,720 3,413

0,341 3,870 15,857 37,611 35,943 41,354 41,659 29,871 21,018 18,712 10,925 3,522

2,755 3,848 15,743 38,134 35,947 40,873 42,468 31,079 21,131 18,759 11,145 3,628

5,284 3,769 15,516 38,422 36,221 40,368 43,393 32,370 21,361 18,669 11,430 3,762

7,636 3,797 15,353 38,778 36,580 39,610 43,998 33,633 21,813 18,499 11,706 3,871

0,299 3,776 15,190 39,163 37,213 38,774 44,520 34,585 22,676 18,395 11,952 4,054

2,691 3,820 15,122 39,495 37,774 37,936 44,813 35,802 23,389 18,218 12,147 4,175

5,265 3,847 15,149 39,674 38,367 37,431 44,892 37,153 23,974 18,168 12,314 4,296

5,730 1,882 7,245 17,247 20,276 20,793 15,594 10,917 10,384 7,339 3,292 761

1,239 2,018 7,581 17,971 18,915 21,564 18,510 12,232 9,955 7,907 3,745 841

2,979 2,052 7,784 18,388 18,609 21,427 19,432 12,563 9,932 8,022 3,888 881

4,480 2,043 7,937 18,668 18,478 21,232 19,768 13,398 9,914 8,125 4,008 909

5,800 2,005 8,071 18,972 18,399 20,942 20,204 14,001 9,927 8,236 4,097 946

7,076 1,981 8,114 19,260 18,347 20,677 20,649 14,591 9,983 8,290 4,206 980

8,314 1,970 8,055 19,529 18,352 20,432 21,062 15,182 10,044 8,342 4,330 1,017

9,810 1,928 7,940 19,681 18,618 20,191 21,569 15,837 10,166 8,325 4,486 1,070

1,018 1,943 7,858 19,861 18,806 19,810 21,883 16,457 10,390 8,269 4,629 1,112

2,046 1,929 7,767 20,050 19,042 19,254 22,101 16,900 10,806 8,250 4,761 1,187

3,277 1,952 7,731 20,220 19,334 18,826 22,254 17,499 11,150 8,199 4,871 1,240

4,626 1,965 7,742 20,309 19,636 18,600 22,307 18,171 11,434 8,204 4,963 1,293

2,194 1,796 6,918 16,446 19,716 20,903 16,097 11,543 11,751 9,520 5,598 1,906

7,471 1,928 7,231 17,124 18,098 21,596 18,925 12,824 11,158 10,139 6,267 2,180

9,198 1,959 7,426 17,520 17,790 21,450 19,840 13,177 11,073 10,258 6,426 2,279

0,597 1,957 7,575 17,783 17,669 21,212 20,139 14,018 11,011 10,335 6,551 2,347

1,983 1,912 7,703 18,078 17,630 20,933 20,580 14,657 10,996 10,403 6,623 2,467

3,265 1,889 7,743 18,352 17,595 20,677 21,011 15,279 11,034 10,422 6,719 2,542

4,441 1,878 7,688 18,606 17,595 20,441 21,406 15,897 11,087 10,417 6,815 2,611

5,474 1,841 7,577 18,741 17,604 20,177 21,825 16,533 11,195 10,345 6,944 2,692

6,618 1,854 7,495 18,917 17,774 19,799 22,115 17,176 11,422 10,230 7,077 2,759

8,252 1,847 7,423 19,113 18,172 19,521 22,419 17,685 11,870 10,146 7,191 2,866

9,414 1,868 7,392 19,276 18,439 19,110 22,558 18,303 12,239 10,020 7,276 2,935

0,639 1,882 7,407 19,365 18,731 18,831 22,585 18,982 12,540 9,964 7,350 3,003

al because of rounding.

ed States: Centers for Disease Control and Prevention, National Center for Health Statistics, Division of Vital Statistics.

Series5, No.11[ Page 27
Page 28 [ Series 5, No. 11

Table 2. Number of live births and deaths and natural increase in population: Russian Federation and United States, selected years

1985–2000

Russian Federation United States

Natural Natural

increase increase

Year Live births Deaths in population1 Live births Deaths in population1

1985 .............................. 2,375,147 1,625,266 749,881 3,760,561 2,086,440 1,674,121

1990 .............................. 1,988,858 1,655,993 332,865 4,158,212 2,148,463 2,009,749

1991 .............................. 1,794,626 1,690,657 103,969 4,110,907 2,169,518 1,941,389

1992 .............................. 1,587,644 1,807,441 –219,797 4,065,014 2,175,613 1,889,401

1993 .............................. 1,378,983 2,129,339 –750,356 4,000,240 2,268,553 1,731,687

1994 .............................. 1,408,159 2,301,366 –893,207 3,952,767 2,278,994 1,673,773

1995 .............................. 1,363,806 2,203,811 –840,005 3,889,589 2,312,132 1,577,457

1996 .............................. 1,304,638 2,082,249 –777,611 3,891,494 2,314,690 1,576,804

1997 .............................. 1,259,943 2,015,779 –755,836 3,880,894 2,314,245 1,566,649

1998 .............................. 1,283,292 1,988,744 –705,452 3,941,553 2,337,256 1,604,297

1999 .............................. 1,214,689 2,144,316 –929,627 3,959,417 2,391,399 1,568,018

2000 .............................. 1,266,800 2,225,332 –958,532 4,058,814 2,403,351 1,655,463

1Increase is number of births minus number of deaths.

SOURCES: Russian Federation: Goskomstat; United States: Centers for Disease Control and Prevention, National Center for Health Statistics, Division of Vital Statistics.

Table 3. Birth rates: Russian Federation and United States, selected years 1985–2000

Live births per 1,000

Live births per 1,000 population women 15–44 years of age

Russian

Federation

United

States

Russian

Federation

United

Year States

1985 .......................................... 16.6 15.8 65.7 66.3

1990 .......................................... 13.4 16.7 60.6 70.9

1991 .......................................... 12.1 16.3 54.2 69.6

1992 .......................................... 10.7 15.9 47.9 68.9

1993 .......................................... 9.4 15.5 41.5 67.6

1994 .......................................... 9.6 15.2 42.4 66.7

1995 .......................................... 9.3 14.8 41.0 65.6

1996 .......................................... 8.9 14.7 39.3 65.3

1997 .......................................... 8.6 14.5 38.0 65.0

1998 .......................................... 8.8 14.6 38.6 65.6

1999 .......................................... 8.3 14.5 36.6 65.9

2000 .......................................... 8.7 14.7 38.3 67.5

SOURCES: Russian Federation: Goskomstat; United States: Centers for Disease Control and Prevention, National Center for Health Statistics, Division of Vital Statistics.
Series 5, No. 11 [ Page 29

Table 4. Percent of live births by selected characteristics: Russian Federation and United States, selected years 1985–2000

Percent of live births

Prenatal care

Low Mother initiated in

Year birthweight1 not married first trimester

Russian Federation

1985 .......................................... 5.6 12.0 72.7

1990 .......................................... 5.7 14.6 68.8

1991 .......................................... 5.7 16.0 68.5

1992 .......................................... 5.9 17.2 70.0

1993 .......................................... 6.1 18.2 71.2

1994 .......................................... 6.2 19.6 72.0

1995 .......................................... 6.2 21.1 71.8

1996 .......................................... 6.2 23.0 72.7

1997 .......................................... 6.3 25.3 72.9

1998 .......................................... 6.3 27.0 73.2

1999 .......................................... 6.7 27.9 74.8

2000 .......................................... 6.4 28.0 76.0

United States

1985 .......................................... 6.8 22.0 76.2

1990 .......................................... 7.0 28.0 75.8

1991 .......................................... 7.1 29.5 76.2

1992 .......................................... 7.1 30.1 77.7

1993 .......................................... 7.2 31.0 78.9

1994 .......................................... 7.3 32.6 80.2

1995 .......................................... 7.3 32.2 81.3

1996 .......................................... 7.4 32.4 81.9

1997 .......................................... 7.5 32.4 82.5

1998 .......................................... 7.6 32.8 82.8

1999 .......................................... 7.8 33.0 83.2

2000 .......................................... 7.6 33.2 83.2

1 Less than 2,500 grams.

SOURCES: Russian Federation: Goskomstat, Ministry of Health; United States: Centers for Disease Control and Prevention, National Center for Health Statistics, Division of Vital Statistics.
- - - - - -

- - - - - -

--- ---

- - - - - - - - - - - - - - - - - - --- ---

- - - - - - - - -

- - - - - -

- - - - - -

- - - - - -- - - - - -- - - - - -- - - - - -- - - - - -

- - - - - -

- - - - - -

- - - - - -

- - - - - -

- - - - - -

bution of abortions, according to age of woman: Russian Federation and United States, selected years 1985–2000

1985 1990 1991 1992 1993 1994 1995 1996 1997 1998 1999 2000

Page 30[ Series5, No.11

.. 4,257,581 3,920,287 3,525,904 3,265,718 2,977,935 2,808,103 2,574,834 2,469,198 2,320,948 2,210,166 2,059,702 1,961,539

.. 4,454,400 4,103,400 3,608,400 3,436,700 3,244,000 3,060,200 2,766,400 2,652,000 2,498,100 2,346,100 2,181,200 2,138,800

Abortions per 1,000 women 15–49 years of age

.. 121.5 114.0 100.3 95.0 88.4 82.4 72.6 69.3 64.9 60.6 56.2 55.0

Abortions per 100 live births and stillbirths

.. 187.4 205.9 200.7 216.1 235.0 217.0 202.6 203.0 201.6 182.6 179.4 168.7

Percent distribution of abortions by age of woman

.. 100.0 100.0 100.0 100.0 100.0 100.0 100.0 100.0 100.0 100.0 100.0 100.0

.. - - - - - - 0.2 0.1 0.2 0.1 0.1 0.1 0.1 0.1 0.1 0.1

..

- - - - - - 71.6 70.8 70.3 68.9 68.4 69.4 68.8 68.5 69.0 69.6

9.9 10.0 10.8 10.9 10.9 10.2 10.2 10.2 9.8 10.0

..

.. 18.3 19.1 18.8 20.1 20.5 20.3 20.9 21.2 21.1 20.3

.. 1,328,570 1,429,577 1,388,937 1,359,145 1,330,414 1,267,415 1,210,883 1,225,937 1,186,039 884,2731

.. 908,243 934,549 900,141 884,2731

Abortions per 1,000 women 15–49 years of age

.. 21.2 21.8 21.0 20.3 19.8 18.7 17.7 17.7 17.2

Abortions per 100 live births

.. 35.4 34.5 33.9 33.5 33.4 32.1 31.1 31.4 30.6 26.2

.. 137.6 84.4 76.7 79.0 74.4 70.4 66.7 72.3 72.9 74.5

.. 68.8 51.5 46.2 44.0 44.0 41.5 39.9 41.5 40.7 38.8.. 38.6 37.7 37.8 37.6 38.4 36.4 34.9 35.5 34.4 32.7.. 21.7 22.0 22.1 22.2 22.7 22.2 22.1 22.7 22.3 21.5.. 19.9 19.1 18.7 18.3 18.0 17.2 16.5 16.5 16.0 15.7.. 33.6 27.3 26.2 25.6 24.8 23.4 22.4 22.0 20.8 19.7

.. 62.3 50.1 46.9 45.4 43.0 41.2 38.7 37.6 35.0 33.3

Percent distribution of abortions by age of woman

.. 100.0 100.0 100.0 100.0 100.0 100.0 100.0 100.0 100.0 100.0

.. 26.3 22.4 21.0 20.1 20.0 20.2 20.1 20.3 20.1 19.8

.. 34.7 33.2 34.4 34.5 34.4 33.5 32.5 31.9 31.7 31.8

.. 39.0 44.4 44.6 45.4 45.6 46.3 47.4 47.8 48.2 48.4

bortion data. Alaska, California, New Hampshire, and Oklahoma did not report abortion data.

h departments and by hospitals and other medical facilities.

Maternal and Child Health Services, 1997. United States: Centers for Disease Control and Prevention, National Center for Health Statistics, Health United States, selected years; Centers for Disease Control

e 7, 2002. MMWR 51:ss-3. 2002.
Series 5, No. 11 [ Page 31

Table 6. Life expectancy at birth, by sex: Russian Federation and United States, selected years 1985–2000

Russian Federation

Total Male Female United States

Year Official1 Estimated2 Official1 Estimated2 Official1 Estimated2 Total Male Female

19853 ................... 69.3 68.2 63.8 62.7 74.0 73.3 74.7 71.1 78.2

1990 .................... 69.2 69.3 63.8 63.8 74.3 74.4 75.4 71.8 78.8

1991 .................... 69.0 69.0 63.5 63.5 74.3 74.3 75.5 72.0 78.9

1992 .................... 67.9 67.9 62.0 62.1 73.8 73.8 75.8 72.3 79.1

1993 .................... 65.1 65.3 58.9 59.1 71.9 72.0 75.5 72.2 78.8

1994 .................... 64.0 64.1 57.6 57.7 71.2 71.2 75.7 72.4 79.0

1995 .................... 64.6 64.7 58.3 58.4 71.7 71.7 75.8 72.5 78.9

1996 .................... 65.9 66.0 59.8 59.9 72.5 72.5 76.1 73.1 79.1

1997 .................... 66.6 66.9 60.8 61.1 72.9 73.0 76.5 73.6 79.4

1998 .................... 67.0 67.2 61.3 61.4 72.9 73.2 76.7 73.8 79.5

1999 .................... 65.9 66.1 59.9 60.1 72.4 72.5 76.7 73.9 79.4

2000 .................... 65.3 65.4 59.0 59.2 72.2 72.3 76.9 74.1 79.5

1Official rate from Goskomstat.

2Estimated rate from Central Public Health Research Institute.

3Russian Federation data for 1985–86.

SOURCES: Russian Federation: Goskomstat; Central Public Health Research Institute; United States: Centers for Disease Control and Prevention, National Center for Health Statistics, Division of Vital

Statistics.
- - - - - - - - -

Page 32 [ Series 5, No. 11

Table 7. Infant mortality, late fetal mortality, and perinatal mortality rates: Russian Federation and United States, selected years 1985–2000

Infant mortality rate Neonatal3

Late fetal Perinatal

Under Under mortality mortality

Year International1 Russian2 28 days 7 days Postneonatal3 rate4 rate5

Deaths per 1,000 live births

Russian Federation

1985 ........................... 20.8 20.7 11.1 8.6 9.6 9.3 17.8

1990 ........................... 17.6 17.4 11.1 9.0 6.3 9.1 17.9

1991 ........................... 18.1 17.8 11.0 8.9 6.8 8.7 17.5

1992 ........................... 18.4 18.0 11.5 9.0 6.5 8.3 17.2

1993 ........................... 20.3 19.9 12.1 9.6 7.8 7.8 17.4

1994 ........................... 18.6 18.6 11.8 9.2 6.8 7.8 17.0

1995 ........................... 18.2 18.1 11.0 8.4 7.1 7.4 15.8

1996 ........................... 17.5 17.4 10.8 8.1 6.6 7.8 15.9

1997 ........................... 17.3 17.2 10.6 7.8 6.6 8.0 15.8

1998 ........................... 16.4 16.5 10.1 7.5 6.4 7.5 15.0

1999 ........................... 17.1 16.9 10.3 7.0 7.2 7.2 14.2

2000 ........................... 15.2 15.3 9.3 6.5 6.0 6.7 13.2

United States

1985 ........................... 10.6 . . . 7.0 5.8 3.7 4.9 10.7

1990 ........................... 9.2 . . . 5.8 4.8 3.4 4.3 9.1

1991 ........................... 8.9 . . . 5.6 4.6 3.4 4.1 8.7

1992 ........................... 8.5 . . . 5.4 4.4 3.1 4.1 8.5

1993 ........................... 8.4 . . . 5.3 4.3 3.1 3.8 8.1

1994 ........................... 8.0 . . . 5.1 4.2 2.9 3.7 7.9

1995 ........................... 7.6 . . . 4.9 4.0 2.7 3.6 7.6

1996 ........................... 7.3 . . . 4.8 3.8 2.5 3.6 7.4

1997 ........................... 7.2 . . . 4.8 3.8 2.5 3.5 7.3

1998 ........................... 7.2 . . . 4.8 3.8 2.4 3.4 7.2

1999 ........................... 7.1 . . . 4.7 3.8 2.3 3.4 7.1

2000 ........................... 6.9 4.6 2.3 3.2

. . . Category not applicable.

- - - Data not available.

1Infant (under 1 year of age) deaths per 1,000 live births in the same year.

2Infant (under 1 year of age) deaths per 1,000 live births (1/3 from the previous year plus 2/3 from the current year).

3Neonatal (under 28 days), early neonatal (under 7 days), and postneonatal (28–364 days) deaths.

4Number of fetal deaths of 28 weeks or more gestation per 1,000 live births plus late fetal deaths.

5Number of late fetal deaths plus infant deaths within 7 days of birth per 1,000 live births plus late fetal deaths.

SOURCES: Russian Federation: Goskomstat; United States: Centers for Disease Control and Prevention, National Center for Health Statistics, Division of Vital Statistics.
causes of death: Russian Federation and United States, selected years 1985–2000

1 1985 1990 1991 1992 1993 1994 1995 1996 1997 1998 1999 2000

.................. 54.0 47.4 52.4 50.8 51.6 52.3 53.3 48.9 50.2 44.0 44.2 39.7

.................. 3.2 3.2 4.4 4.7 3.8 4.1 3.9 3.5 4.3 3.1 4.0 2.6

.................. 1.8 0.8 1.1 1.4 1.7 1.5 1.5 1.2 1.9 1.6 1.3 3.0

.................. 19.7 12.8 11.9 10.9 13.1 11.7 10.9 10.1 10.3 8.4 9.4 6.6

40, 641.1–641.9, 666) .... 5.3 6.4 7.1 7.2 7.1 6.2 6.7 6.5 5.7 5.8 8.1 6.6

.................. 5.6 5.7 7.7 5.8 6.2 6.4 5.3 6.4 5.3 4.1 5.7 5.7

.................. 1.8 1.7 1.6 2.3 1.7 2.3 2.4 2.6 2.4 1.7 1.9 1.4

659.2, 659.4–659.9,

.................. 16.6 16.7 18.7 18.5 17.5 20.2 22.7 18.6 20.3 19.3 13.9 13.7

.................. 7.8 8.2 7.9 7.8 7.5 8.3 7.1 7.6 8.4 7.1 9.9 9.8

.................. 0.9 1.0 0.8 0.7 0.8 0.6 0.5 0.6 0.6 (*)2 (*)2 0.6

..................

..................

(*)2

(*)2

(*)2(*)2

(*)2

(*)2

(*)2(*)2

(*)2(*)2

(*)2(*)2

(*)2(*)2

(*)2(*)2

(*)2(*)2

(*)2(*)2

(*)2(*)2

(*)2(*)2

40–641, 666) .......... 1.1 1.1 0.9 1.0 1.0 1.2 0.9 1.0 1.1 0.6 1.1 0.7

.................. 0.9 1.5 1.6 1.3 1.1 1.7 1.2 1.0 1.6 1.2 2.3 1.8

.................. 2.4 2.4 2.4 2.3 2.5 2.6 2.4 2.6 3.2 2.5 2.1 2.3

1–665, 667–669) ....... 2.2 1.4 1.3 1.5 1.2 1.3 1.4 1.4 1.2 1.5 4.0 4.0

ecision.

Classification of Diseases, Ninth Revision.

ed States: Centers for Disease Control and Prevention, National Center for Health Statistics, Division of Vital Statistics.

Series5, No.11[ Page 33
s, by age and sex: Russian Federation and United States, selected years 1985–2000

Russian Federation

1985 1990 1991 1992 1993 1994 1995 1996 1997 1998 1999 2000

Page 34[ Series5, No.11

. 1,226.2 1,192.7 1,198.1 1,264.7 1,474.5 1,581.6 1,506.1 1,413.4 1,355.5 1,323.7 1,416.7 1,461.2

. 1,116.6 1,118.2 1,138.6 1,214.9 1,428.8 1,555.3 1,491.3 1,412.9 1,371.9 1,357.2 1,469.3 1,532.7

. 2,094.4 1,717.8 1,737.2 1,738.6 1,880.8 1,854.5 1,784.1 1,713.7 1,699.4 1,661.0 1,661.2 1,558.1

. 135.6 98.5 100.6 99.4 108.4 104.8 108.3 97.9 99.9 94.3 102.9 99.3

. 52.0 48.9 55.2 53.3 54.8 51.2 53.9 47.5 44.2 45.6 47.6 45.5

. 136.8 139.7 145.3 164.2 190.7 199.6 215.2 202.3 186.9 192.5 209.1 224.6. 244.1 238.5 255.0 303.8 377.3 412.6 403.5 365.8 330.5 329.5 366.4 401.2. 440.0 418.0 443.0 530.5 703.1 797.5 747.3 647.5 571.2 553.0 624.0 679.1. 908.7 930.9 952.0 1,090.7 1,379.5 1,544.2 1,409.3 1,222.7 1,063.0 1,035.3 1,178.4 1,287.5. 1,736.9 1,877.0 1,897.8 2,014.0 2,393.7 2,657.5 2,458.5 2,264.9 2,156.9 2,108.9 2,349.5 2,515.7. 3,939.1 3,571.5 3,538.0 3,654.7 4,181.1 4,437.8 4,290.2 4,195.2 4,219.8 4,221.0 4,511.7 4,650.4. 8,672.8 8,664.8 8,703.0 8,834.0 9,804.3 10,231.8 9,771.1 9,485.7 9,370.4 9,002.0 9,158.9 8,948.6

. 21,197.9 20,161.0 19,720.1 19,873.6 21,815.6 21,899.6 21,126.1 20,427.9 20,221.4 19,763.4 20,630.4 20,512.3

. 1,771.5 1,688.4 1,699.0 1,803.7 2,128.0 2,290.5 2,158.8 2,002.4 1,899.1 1,847.0 1,991.6 2,075.6

. 1,169.1 1,156.4 1,188.7 1,303.3 1,585.8 1,765.2 1,682.8 1,566.9 1,492.2 1,475.2 1,626.4 1,735.2

. 2,408.6 1,976.2 1,995.6 2,000.8 2,131.9 2,127.5 2,027.7 1,964.4 1,940.3 1,889.6 1,873.3 1,766.1

. 152.8 110.9 114.1 113.5 119.4 116.0 120.9 109.8 107.9 105.2 113.4 109.6

. 67.4 64.2 73.1 69.6 70.0 64.5 68.2 59.4 57.0 57.0 60.6 58.0

. 215.8 209.4 217.6 246.8 289.3 304.2 331.8 311.6 283.9 292.5 319.5 348.9. 390.3 381.8 407.0 490.7 611.5 665.8 645.7 583.0 520.4 518.4 578.8 638.3. 694.8 648.3 688.1 834.4 1,116.9 1,269.6 1,189.5 1,028.4 904.4 875.4 987.7 1,082.1. 1,422.2 1,443.4 1,476.6 1,712.8 2,173.4 2,438.5 2,219.7 1,920.0 1,653.1 1,615.5 1,847.9 2,037.2. 2,755.6 2,887.7 2,907.8 3,094.4 3,731.1 4,176.7 3,867.8 3,550.5 3,369.4 3,297.8 3,720.9 4,012.4. 6,075.0 5,411.4 5,362.2 5,506.7 6,371.1 6,741.0 6,451.9 6,248.3 6,246.7 6,220.9 6,707.4 6,960.7. 11,747.5 11,461.5 11,535.7 11,618.6 13,013.4 13,359.6 12,529.2 12,034.9 11,848.7 11,378.9 11,596.6 11,496.8

. 23,475.6 22,600.8 22,204.0 22,283.6 23,896.0 23,661.0 21,803.9 20,467.1 20,159.4 19,293.3 20,011.2 19,757.8

. 915.7 892.2 889.6 918.5 1,041.0 1,098.4 1,052.4 1,002.9 979.6 957.4 1,008.9 1,020.6

. 1,071.4 1,084.7 1,094.4 1,136.8 1,289.9 1,369.5 1,321.9 1,276.8 1,265.5 1,252.9 1,330.7 1,354.4

. 1,766.3 1,446.0 1,465.5 1,462.6 1,629.7 1,566.6 1,527.9 1,449.8 1,445.3 1,419.7 1,436.7 1,337.6

. 117.5 85.6 86.5 84.6 96.8 93.0 95.0 85.3 91.5 82.8 91.8 88.4

. 36.1 33.2 36.8 36.4 39.1 37.5 39.1 35.1 30.9 33.7 34.1 32.5

. 56.5 67.0 69.9 77.7 87.3 90.0 93.8 89.3 87.0 89.8 96.0 97.2

. 93.3 91.8 99.7 113.4 139.2 154.1 154.2 140.8 133.0 132.9 145.4 155.1

. 193.3 191.5 202.0 232.0 297.2 335.4 315.6 276.6 247.0 239.4 270.3 287.5

. 459.2 479.7 489.6 540.0 673.3 744.0 681.1 594.1 529.6 511.3 576.3 617.0

. 1,082.1 1,130.0 1,135.5 1,188.6 1,367.0 1,494.0 1,384.4 1,291.1 1,245.0 1,221.0 1,335.3 1,421.0

. 3,059.2 2,790.9 2,735.8 2,798.6 3,120.1 3,280.9 3,177.8 3,119.6 3,138.9 3,136.9 3,302.8 3,360.1

. 7,799.4 7,818.3 7,848.6 7,996.4 8,837.5 9,287.2 8,938.0 8,715.5 8,621.4 8,286.3 8,420.5 8,162.9

. 20,711.2 19,679.8 19,223.3 19,381.8 21,376.3 21,524.6 20,977.5 20,419.0 20,235.6 19,873.0 20,777.0 20,692.6
s, by age and sex: Russian Federation and United States, selected years 1985–2000—Con.

United States

1985 1990 1991 1992 1993 1994 1995 1996 1997 1998 1999 2000

. 848.8 803.4 792.5 779.3 794.5 784.7 781.6 766.7 751.9 741.4 744.4 735.7

. 876.9 863.8 860.3 852.9 880.0 875.4 880.0 872.5 864.7 864.7 877.0 873.1

. 1,088.1 971.9 916.6 865.7 854.4 819.3 768.8 755.7 738.7 751.3 731.4 728.7

. 51.8 46.8 47.4 43.6 44.8 42.9 40.6 38.3 35.8 34.6 34.7 32.9

. 26.5 24.0 23.6 22.5 23.4 22.5 22.5 21.7 20.8 19.9 19.2 18.7

. 94.9 99.2 100.1 95.6 98.5 98.0 95.3 89.6 86.2 82.3 81.2 81.6

. 124.4 139.2 139.1 137.8 142.4 143.3 141.3 126.7 115.0 109.6 108.3 108.1. 207.7 223.2 224.4 228.8 235.5 238.8 240.8 221.3 203.2 199.6 199.2 200.0. 519.3 473.4 468.8 456.1 460.0 461.6 460.1 445.9 430.8 423.5 427.3 431.6. 1,294.2 1,196.9 1,181.0 1,151.7 1,154.7 1,128.2 1,114.5 1,094.1 1,063.6 1,030.7 1,021.8 1,004.6. 2,862.8 2,648.6 2,618.5 2,588.9 2,617.1 2,584.9 2,563.5 2,538.4 2,509.8 2,495.1 2,484.3 2,428.6. 6,398.7 6,007.2 5,890.0 5,775.5 5,951.6 5,860.2 5,851.8 5,803.1 5,728.2 5,703.2 5,751.3 5,688.4

. 15,712.4 15,327.4 15,107.6 14,972.9 15,481.7 15,296.7 15,469.5 15,327.2 15,345.2 15,111.7 15,476.1 15,321.5

. 1,104.8 1,035.3 1,018.5 998.8 1,013.8 996.4 985.8 956.9 931.5 909.8 905.9 889.6

. 948.6 918.4 912.1 901.6 923.5 915.0 914.1 896.4 880.8 876.4 882.0 874.7

. 1,219.9 1,082.8 1,023.8 956.6 945.8 899.4 843.8 828.0 812.8 818.2 801.5 799.9

. 58.5 52.4 52.0 48.0 49.5 47.3 44.8 42.2 39.7 37.6 38.5 36.5

. 31.8 28.5 28.7 27.2 27.4 26.9 26.7 25.4 24.0 23.4 22.2 21.7

. 138.9 147.4 148.0 141.8 146.2 145.8 140.5 130.6 124.0 119.3 115.9 117.5. 179.6 204.3 204.0 202.0 208.6 208.8 204.7 178.6 160.1 151.7 150.2 149.9. 278.9 310.4 311.6 318.7 328.6 332.9 333.0 298.1 265.7 258.5 256.7 256.9. 671.6 610.3 605.2 591.7 596.0 599.4 598.9 573.8 550.5 542.8 546.7 552.5. 1,711.4 1,553.4 1,524.7 1,481.5 1,479.9 1,444.3 1,416.7 1,388.7 1,336.6 1,296.9 1,280.0 1,253.5. 3,856.3 3,491.5 3,438.7 3,374.4 3,394.8 3,332.3 3,284.6 3,233.4 3,191.2 3,143.7 3,109.3 3,015.7. 8,501.6 7,888.6 7,689.0 7,482.7 7,653.2 7,440.9 7,377.1 7,249.8 7,116.1 7,019.2 6,999.8 6,854.7

. 18,614.1 18,056.6 17,800.6 17,740.4 18,257.2 17,972.3 17,978.9 17,547.7 17,461.9 16,763.3 16,931.3 16,605.4

. 658.6 628.8 621.5 612.5 627.1 621.8 623.3 618.1 611.7 607.7 614.9 610.8

. 809.1 812.0 811.0 806.5 838.6 837.6 847.3 849.7 849.2 853.5 872.2 871.6

. 950.6 855.7 804.4 770.8 758.6 735.5 690.1 680.0 661.1 681.3 658.1 654.3

. 44.8 41.0 42.7 39.0 39.9 38.2 36.2 34.3 31.8 31.4 30.8 29.1

. 21.0 19.3 18.3 17.5 19.1 17.9 18.2 17.8 17.4 16.2 16.1 15.6

. 49.6 49.0 50.0 47.2 48.6 48.2 48.1 46.2 46.3 43.5 44.7 44.0. 69.4 74.2 74.2 73.5 76.2 77.8 77.9 74.7 69.9 68.1 66.9 66.7. 138.7 137.9 139.0 140.5 144.0 146.4 150.1 145.4 141.4 141.5 142.5 143.9. 375.2 342.7 338.8 326.4 330.0 330.1 327.6 323.3 316.1 309.6 313.1 315.8. 925.6 878.8 872.8 854.7 861.0 842.2 840.8 826.7 815.2 788.4 786.5 777.7. 2,096.9 1,991.2 1,976.8 1,971.4 2,001.4 1,990.3 1,986.1 1,979.0 1,959.0 1,967.7 1,972.9 1,945.1. 5,162.1 4,883.1 4,801.4 4,731.1 4,899.0 4,870.9 4,882.7 4,868.3 4,820.5 4,831.9 4,915.4 4,900.9

. 14,553.9 14,274.3 14,066.6 13,901.0 14,416.9 14,265.3 14,492.4 14,444.7 14,492.3 14,427.4 14,861.1 14,768.6

the European standard 100,000 population prepared by the World Health Organization (see Appendix).

ed States: Centers for Disease Control and Prevention, National Center for Health Statistics, Division of Vital Statistics.

Series5, No.11[ Page 35
for selected causes of death, by sex: Russian Federation, 1990–2000

of death1 1990 1991 1992 1993 1994 1995 1996 1997 1998 1999 2000

Deaths per 100,000 population

es

Page 36[ Series5, No.11

....................... 1,192.8 1,198.3 1,264.9 1,474.8 1,581.8 1,506.4 1,413.6 1,355.6 1,323.8 1,416.7 1,461.2

....................... 1,688.5 1,699.1 1,803.9 2,128.3 2,290.8 2,159.1 2,002.6 1,899.2 1,847.1 1,991.6 2,075.6

....................... 892.3 889.8 918.7 1,041.3 1,098.7 1,052.6 1,003.1 979.7 957.5 1,008.9 1,020.6

....................... 12.8 12.8 14.0 18.4 21.1 21.8 22.2 21.2 19.5 24.8 25.0

....................... 22.0 21.8 24.5 32.3 36.9 37.9 39.5 37.9 34.5 44.3 44.2

....................... 5.8 5.7 5.6 7.2 8.2 8.4 7.5 7.0 6.9 8.3 8.5

....................... 367.9 360.9 372.0 442.7 477.9 443.4 417.4 400.2 390.8 429.5 445.7

....................... 505.7 506.4 526.5 634.7 690.9 635.9 590.6 561.0 548.1 606.4 636.4

....................... 286.5 277.8 280.3 324.8 342.5 319.2 305.0 296.2 288.9 313.1 318.3

....................... 245.6 242.2 247.4 277.1 297.0 287.4 277.9 278.3 278.3 288.9 297.4

....................... 287.4 282.3 288.3 328.7 355.8 338.3 322.7 320.8 317.8 332.5 347.4

....................... 224.4 221.0 225.3 248.5 262.9 256.1 249.4 250.9 251.7 259.0 263.7

....................... 201.5 202.6 204.3 205.5 204.5 200.0 194.9 193.6 192.4 193.3 192.4

....................... 315.0 316.3 316.5 319.7 314.3 305.0 296.0 292.8 289.2 290.0 287.1

....................... 140.6 140.7 142.1 141.2 141.8 139.7 137.2 137.1 136.7 137.6 137.3

em (160–165)

....................... 49.9 50.4 50.8 51.5 50.9 48.9 46.7 41.8 44.9 44.0 43.8

....................... 116.2 116.9 116.6 117.6 115.9 111.2 105.9 93.7 101.6 100.0 98.8

....................... 11.8 11.5 11.7 11.6 11.5 10.8 10.4 10.4 10.1 9.6 9.7

....................... 19.2 19.8 21.0 21.4 22.1 22.0 22.6 23.2 23.6 23.8 24.1

87)

....................... 10.3 10.1 11.9 18.8 21.9 21.8 18.6 16.5 15.4 21.3 25.6

....................... 15.7 15.1 19.1 30.7 37.1 36.8 31.1 26.8 25.4 35.3 43.6

....................... 6.8 6.8 6.7 9.8 10.0 10.1 8.9 8.7 7.9 10.5 11.7

0–496)

....................... 35.7 33.0 33.3 39.5 41.3 36.5 34.7 34.1 30.3 36.1 36.0

....................... 69.8 64.7 65.2 78.6 82.4 72.4 68.9 67.4 60.9 72.4 71.6

....................... 20.8 18.9 18.8 20.8 21.0 18.7 17.8 17.6 15.2 17.4 16.6

–571.3, 571.5, 571.6)

....................... 9.9 9.9 10.6 14.1 18.8 20.4 17.7 15.2 14.2 15.4 17.6

....................... 15.0 14.9 15.7 20.5 27.1 29.8 25.9 22.3 20.6 22.5 24.6

....................... 6.8 6.9 7.4 9.9 12.8 13.6 11.8 10.1 9.7 10.2 12.3

860)

....................... 12.5 12.7 19.6 35.2 44.9 37.2 28.7 21.9 19.9 22.5 27.9

....................... 21.5 21.8 33.5 58.6 74.2 62.0 48.0 36.7 33.5 37.4 46.3

....................... 4.7 4.7 7.4 14.6 19.2 15.5 11.8 9.1 8.2 9.7 11.9

(E800–E848)

....................... 29.0 30.5 29.9 30.1 27.8 25.4 22.2 20.8 22.2 25.0 25.8

....................... 48.6 50.8 49.4 49.4 45.3 40.9 35.2 32.4 34.6 39.7 40.7

....................... 11.7 12.7 12.4 12.8 12.1 11.5 10.5 10.3 10.9 11.8 12.3

....................... 27.0 26.9 31.3 38.0 41.7 41.0 38.7 36.6 34.2 37.7 37.4

....................... 47.5 47.6 55.8 68.9 76.4 74.1 70.7 66.6 62.2 68.7 69.0

....................... 10.5 10.1 10.9 12.1 12.5 12.7 11.5 11.2 10.4 11.5 10.5
for selected causes of death, by sex: Russian Federation, 1990–2000—Con.

of death1 1990 1991 1992 1993 1994 1995 1996 1997 1998 1999 2000

Deaths per 100,000 population

8)

....................... 14.1 15.1 22.6 29.7 31.4 29.8 25.7 23.1 21.9 25.1 26.9

....................... 22.4 24.1 36.4 47.5 50.3 47.6 40.5 36.5 34.6 39.3 42.6

....................... 6.4 6.7 9.7 13.2 13.9 13.3 11.9 10.7 10.3 12.0 12.6

E943, E980–E999)

....................... 53.9 59.2 71.7 96.2 107.4 106.9 94.6 84.1 86.0 91.2 95.8

....................... 89.9 99.1 120.3 161.8 181.3 180.1 158.7 140.7 143.9 154.0 162.9

....................... 22.8 24.3 29.1 39.4 43.5 43.0 38.7 35.0 35.5 36.6 37.2

International Classification of Diseases, Ninth Revision; for 1999–2000, cause of death codes are from the International Classification of Diseases, Tenth Revision.

the European standard 100,000 population prepared by the World Health Organization (see Appendix).

Series5, No.11[ Page 37
for selected causes of death, by sex: United States, selected years 1985–99

ath1 1985 1990 1991 1992 1993 1994 1995 1996 1997 1998 19992

Deaths per 100,000 population

Page 38[ Series5, No.11

............... 848.8 803.4 792.5 779.3 794.5 784.7 781.6 766.7 751.9 741.4 744.4

............... 1,104.8 1,035.3 1,018.5 998.8 1,013.8 996.4 985.8 956.9 931.5 909.8 905.9

............... 658.6 628.8 621.5 612.5 627.1 621.8 623.3 618.1 611.7 607.7 614.9

............... 11.4 21.3 22.7 23.9 25.6 27.2 27.5 23.0 17.8 17.1 17.2

............... 14.5 31.7 34.1 36.0 38.3 40.7 40.5 32.2 23.0 21.7 21.6

............... 8.9 11.6 12.1 12.6 13.6 14.5 15.2 14.3 13.0 13.0 13.2

............... 308.8 262.5 256.0 249.5 252.0 243.6 240.4 233.9 227.3 220.5 219.0

............... 411.8 344.7 335.1 325.7 327.6 315.8 310.0 300.0 290.6 279.6 275.5

............... 231.6 200.6 195.9 191.5 194.2 188.0 186.3 182.0 177.2 173.2 173.4

............... 59.3 50.7 49.1 48.1 48.8 48.8 49.3 48.8 47.7 46.1 44.8

............... 63.0 53.9 52.4 51.2 52.1 51.9 51.9 51.2 50.1 47.3 46.0

............... 56.1 48.0 46.2 45.4 46.1 46.1 46.8 46.4 45.5 44.4 43.3

............... 197.1 200.0 199.5 197.8 197.6 196.0 194.2 191.3 188.2 185.0 183.6

............... 250.2 253.5 251.7 248.9 248.2 244.8 241.1 236.3 231.3 226.5 223.8

............... 161.3 164.2 164.4 163.5 163.4 163.0 162.4 160.2 158.3 155.8 154.9

em (160–165)

............... 56.0 60.0 59.9 59.6 59.7 58.9 58.4 57.8 57.2 54.8 53.9

............... 88.9 90.4 89.2 87.1 86.7 84.5 82.9 81.1 79.5 74.6 72.9

............... 31.7 37.6 38.1 39.1 39.5 39.7 40.1 40.2 40.4 39.7 39.3

............... 32.1 32.1 31.6 30.6 30.2 29.8 29.5 28.4 27.2 26.5 25.5

87)

............... 25.9 27.4 26.0 24.7 26.3 25.3 25.2 24.9 25.1 25.8 25.1

............... 35.2 35.7 34.0 32.4 33.9 32.5 32.0 31.2 31.4 31.6 29.9

............... 20.5 22.4 21.3 20.1 21.7 21.0 21.0 20.9 21.2 22.1 21.9

0–496)

............... 29.9 31.8 32.5 32.3 34.8 34.3 34.1 34.5 34.8 35.1 36.4

............... 46.8 45.7 45.5 44.6 47.0 45.6 44.9 44.2 44.6 44.1 45.2

............... 19.4 23.3 24.6 24.7 27.3 27.4 27.5 28.4 28.7 29.4 30.6

–571.3, 571.5, 571.6)

............... 12.5 11.2 10.8 10.5 10.3 10.2 10.0 9.8 9.6 9.4 9.4

............... 17.7 15.9 15.3 15.1 14.6 14.6 14.3 13.9 13.6 13.4 13.4

............... 8.0 7.0 6.9 6.4 6.4 6.3 6.1 6.0 6.0 5.9 5.8

860)

............... 2.5 2.8 2.7 2.7 2.7 2.7 2.7 2.6 2.5 2.5 2.4

............... 4.1 4.7 4.5 4.5 4.5 4.5 4.5 4.2 4.1 4.1 4.1

............... 1.1 1.2 1.1 1.1 1.1 1.1 1.1 1.1 1.1 1.1 1.0

(E800–E848)

............... 19.7 19.3 17.8 16.8 16.8 17.0 17.1 17.1 16.8 16.6 16.9

............... 29.0 27.9 25.7 24.1 24.1 24.1 24.2 23.9 23.4 23.3 23.9

............... 10.9 11.2 10.4 9.9 10.0 10.4 10.5 10.7 10.6 10.4 10.3
tes for selected causes of death, by sex: United States, selected years 1985–99—Con.

of death1 1985 1990 1991 1992 1993 1994 1995 1996 1997 1998 19992

Deaths per 100,000 population

................... 12.4 12.3 12.1 11.8 11.9 11.8 11.7 11.4 11.2 11.1 10.5

................... 20.5 20.7 20.5 19.9 20.1 19.9 19.9 19.4 18.8 18.6 17.7

................... 5.2 4.8 4.7 4.6 4.6 4.4 4.3 4.3 4.3 4.3 4.0

–E978)

................... 8.0 9.5 10.0 9.6 9.8 9.3 8.6 7.8 7.3 6.7 6.3

................... 12.3 15.0 15.8 15.3 15.4 14.8 13.3 12.1 11.4 10.3 9.7

................... 3.8 4.0 4.3 4.0 4.2 3.8 3.8 3.4 3.2 3.0 2.9

861–E949)

................... 17.8 17.2 17.0 16.8 17.5 17.4 17.5 17.6 17.7 18.0 17.1

................... 26.2 25.5 25.2 24.9 25.8 25.7 25.7 25.5 25.6 25.8 24.7

................... 10.5 9.9 9.9 9.6 10.1 10.0 10.2 10.6 10.5 11.0 17.6

Classification of Diseases, Ninth Revision.

developed in the comparability study between ICD–9 and ICD–10 carried out by the National Center for Health Statistics and reported in the Technical Notes, Deaths, Final Data for 1999. National vital

HS. 2001.

the European standard 100,000 population prepared by the World Health Organization (see Appendix).

tion, National Center for Health Statistics, Division of Vital Statistics.

Series5, No.11[ Page 39
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diseases, by type of disease: Russian Federation and United States, selected years 1985–2000

1985 1990 1991 1992 1993 1994 1995 1996 1997 1998 1999 2000

Cases per 100,000 population

. 1.26 2.63 10.28 26.83 24.11 9.29 2.75 0.96 0.57 0.53

Page 40[ Series5, No.11

. 165.55 117.22 110.12 109.86 123.68 87.61 50.43 34.01 30.34 57.30

. 17.95 18.09 22.29 26.90 35.65 36.02 36.63 35.87 43.95 42.53

. 3.14 6.78 8.43 9.14 11.59 21.01 21.10

. 191.69 136.17 133.92 141.23 167.49 133.69 97.65 83.68 98.55 125.40

. 0.14 0.11 0.13 0.24 0.28 0.41 0.54 0.74 0.54 0.55

. 3.95 3.49 3.55 3.86 3.35 3.39 3.06 2.69 2.59 2.70

. 24.63 23.56 30.22 27.97 36.05 47.41 69.92 98.94 48.41 28.08

. 20.83 16.18 26.62 32.85 13.96 9.39 18.51 19.15 15.23 20.50

. 0.01 0.01 0.00 0.01 0.10 0.00 10.00 10.00 10.00 0.01

. 13.79 12.52 50.26 19.38 4.49 5.55 1.96 4.24 5.09 3.32

. 7.22 13.42 33.82 85.56 177.23 263.41 276.10 233.80 186.17 165.30

. 128.64 169.58 230.18 203.90 173.64 138.36 113.65 102.64 119.50 121.50

. 34.00 35.84 42.92 47.86 57.51 67.21 73.61 75.71 61.70 90.30

. 0.00 0.00 0.00 0.00 – 0.00 – 0.01 0.01 0.00 0.00 0.00

. 10.03 12.64 9.67 9.06 9.40 10.29 12.13 11.70 11.22 8.59 6.25 4.91

. 11.50 8.48 7.14 6.32 5.18 4.81 4.19 4.01 3.90 3.80 2.82 2.95

. 1.76 1.03 1.42 2.36 1.86 1.78 1.78 1.41 1.43 1.30 1.14 1.17

. 0.44 0.52 0.51 0.43 0.55 0.47 0.55 0.68 0.75 0.60 0.61 0.57

. 1.04 0.99 0.84 0.84 1.02 1.11 1.25 1.30 1.24 1.01 0.92 0.83

. 1.30 2.17 1.72 1.03 0.66 0.60 0.35 0.29 0.27 0.25 0.14 0.13

. 1.50 1.84 1.08 1.60 2.55 1.77 1.97 2.94 2.46 2.74 2.67 2.88

. 1.18 11.17 3.82 0.88 0.12 0.37 0.12 0.20 0.06 0.04 0.04 0.03

. 0.26 0.45 0.56 0.06 0.07 0.09 0.05 0.10 0.07 0.13 0.10 0.06

. 28.50 53.80 51.69 45.03 39.70 32.00 26.20 19.97 17.39 14.19 13.07 11.58

. 384.28 276.60 249.48 201.60 172.40 168.40 149.50 122.80 121.40 132.88 133.20 131.65

. 9.30 10.33 10.42 10.46 9.82 9.36 8.70 8.04 7.42 6.79 6.43 6.01

rtments.

n was used to calculate all rates except sexually transmitted diseases, for which the civilian resident population was used prior to 1991. Population data from those States where diseases were not

calculation.

r Sanitary and Epidemiological Surveillance, Ministry of Health; Goskomstat; United States: Centers for Disease Control and Prevention. Summary of notifiable diseases, United States, 2000. Morbidity and

Public Health Service. 2002.
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Series 5, No. 11 [ Page 41

Table 13. Rates of immunization coverage (percent) in children: Russian Federation and United States, selected years 1991–2000

Country and vaccine No. doses 1991 1992 1993 1994 1995 1996 1997 1998 1999 2000

Russian Federation1 Percent

Diphtheria/tetanus toxoids ............ 4 or more 68.7 72.6 79.2 88.1 92.7 95.1 95.6 97.3 98.3 95.6

Pertussis vaccine ................. 4 or more 58.7 62.0 65.2 71.7 81.0 86.9 88.8 92.6 95.7 93.9

Parotitis vaccine2 ................. 1 56.8 61.7 66.9 71.2 77.1 83.4 86.8 94.4 97.7 95.3

Poliomyelitis vaccine (OPV) ........... 3 or more 71.5 69.0 82.2 87.5 91.6 96.8 98.0 98.8 99.1 96.8

Measles vaccine2 ................. 1 78.7 82.6 88.2 91.3 94.2 95.3 96.3 97.6 98.8 96.7

BCG ......................... 1 88.3 86.2 87.0 95.5 96.2 98.9 97.2 98.1 95.8 96.2

United States3,4

Combined series (4:3:1:3)5 ........... . . . 69 74 77 76 79 78.4 76.2

DTP6 ......................... 4 or more 76 79 81 81 84 83.3 81.7

Polio ......................... 4 or more 72 79 83 88 91 91 91 89.6 89.5

Measles-containing7 ............... 1 83 84 89 90 91 91 92 91.5 90.5

Hib8 ......................... 3 or more 28 55 86 92 92 93 93 93.5 93.4

Hepatitis B ..................... 3 or more 8 16 37 68 82 84 87 88.1 90.3

. . . Category not applicable.

- - - Data not available.

1Includes children 12–23 months of age.

2Measles, mumps, and rubella used as single antigens or as combined vaccine (MMR) with locally produced preparations or imported preparations registered appropriately.

3Includes children 19–35 months of age.

4Final estimates of data from the U.S. National Immunization Survey include an adjustment for children with missing immunization provider data.

5The 4:3:1:3 combined series consists of four doses of diphtheria-tetanus-pertussis (DTP) vaccine, three doses of polio vaccine, one dose of a measles-containing vaccine, and three doses of

haemophilus influenzae type b (Hib) vaccine.

6Diphtheria-tetanus-pertussis vaccine.

7Respondents were asked about measles-containing or MMR (measles-mumps-rubella) vaccines.

8Haemophilus influenzae type b (Hib) vaccine.

NOTE: Final estimates of data from the National Immunization Survey include an adjustment for children with missing immunization provider data.

SOURCES: Russian Federation: Ministry of Health, Federal Center of the State Sanitary and Epidemiologic Surveillance; United States: Centers for Disease Control and Prevention (1992–93) Health

Interview Survey, National Center for Health Statistics; (1994–98) National Immunization Survey, National Immunization Program; (1992) unpublished Hepatitis B data.
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IV or acquired immunodeficiency syndrome, and deaths due to HIV, by sex and age: Russian Federation and United States, selected years

1985 1990 1991 1992 1993 1994 1995 1996 1997 1998 1999 2000 2001

Page 42[ Series5, No.11

Number of persons, by year of report

. - - - - - - 84 88 107 161 196 3,720 4,007 5,466 15,936 59,190 87,614

. - - - - - - 15 18 11 24 18 29 48 43 - - - 398 457

Number of deaths due to HIV

. - - - - - - - - - [- - - 50 ---] [--- 98 ---] 40 --- 279 330

Number of persons, by year of report

. 8,160 41,459 43,393 45,687 101,488 76,706 70,455 65,929 57,651 45,811 44,630 40,836 41,587

. 7,505 36,188 37,366 38,989 84,751 62,489 56,719 52,186 44,803 35,052 34,047 30,202 30,749

. 524 4,546 5,362 5,954 15,870 13,246 12,991 13,093 12,405 10,393 10,329 9,996 10,667

. 131 725 665 744 867 971 745 650 443 366 254 188 171

Number of deaths due to HIV

. 22,224 25,867 29,118 31,867 35,421 35,723 25,094 12,801 10,242

. 2,642 3,344 4,080 4,955 6,241 6,952 5,692 3,550 3,089

. 309 334 355 435 446 432 337 159 92

r Sanitary and Epidemiological Surveillance, Ministry of Health; United States: Centers for Disease Control and Prevention, National Center for HIV, STD, and TB prevention, Division of HIV/AIDS
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Series 5, No. 11 [ Page 43

Table 15. Number of providers per 10,000 population, by specialty: Russian Federation and United States, selected years 1985–2000

Country and provider type 1985 1990 1991 1992 1993 1994 1995 1996 1997 1998 1999 2000

Russian Federation Personnel per 10,000 population

All physicians1 ................... 43.2 45.0 42.6 43.0 43.4 43.3 44.5 45.7 46.2 46.7 47.1 47.2

Family physicians and internal medicine . . 10.8 11.5 11.1 11.3 11.3 11.5 10.5 10.8 9.6 10.6 10.7 11.0

Pediatrics2 .................... 22.9 24.5 23.3 23.5 24.2 24.0 24.6 25.6 25.5 25.5 26.3 28.5

Obstetrics and gynecology3 ......... 4.8 5.2 4.9 5.0 5.1 5.0 5.2 5.4 5.4 5.3 5.4 5.5

Surgery ...................... 4.7 5.6 5.2 5.3 5.3 5.6 5.8 6.0 6.1 6.0 6.2 4.3

Ophthalmology ................. 0.9 1.0 1.0 1.0 1.0 1.0 1.0 1.0 1.0 1.0 1.1 1.1

Otolaryngology ................. 0.8 0.8 0.8 0.8 0.8 0.8 0.8 0.8 0.8 0.8 0.9 0.9

Neurology .................... 1.1 1.2 1.2 1.2 1.3 1.3 1.4 1.4 1.5 1.5 1.5 1.6

Psychiatry and narcology ........... 1.2 1.5 1.3 1.4 1.3 1.3 1.3 1.5 1.5 1.5 1.6 1.6

Dentists ...................... 2.8 3.3 3.2 3.1 3.4 3.1 3.3 3.5 3.5 3.7 3.8 3.9

Nursing personnel, total ............. 122.4 124.5 115.8 115.3 113.1 109.7 111.0 112.7 111.5 111.4 111.3 108.4

Physician assistants (feldshers) ....... 26.5 27.9 23.8 22.5 20.2 17.8 18.6 18.1 17.5 16.3 15.9 12.8

Midwives ..................... 23.5 20.3 16.6 16.3 16.4 14.8 14.5 13.8 13.5 12.1 11.9 10.0

Nurses4 ...................... 60.5 67.1 62.6 63.4 64.3 67.8 68.4 66.8 66.6 65.7 66.2 70.3

Laboratory assistants (feldsherslaborants) .................... 4.7 5.7 5.9 4.9 6.5 5.6 5.8 6.9 7.0 6.8 6.8 7.4

X-ray technicians ................ 1.5 1.9 1.7 1.7 1.7 1.8 1.8 1.8 1.8 1.8 1.8 2.0

United States

All active physicians ............... 20.9 22.0 22.7 22.9 23.3 23.8 24.3 24.8 24.7 24.5 25.1

Non-Federal office-based physicians .... 13.8 14.5 . . . 15.2 15.5 15.6 16.3 16.8 17.1 17.3 17.4 17.8

Family practice ................. 2.3 2.3 2.3 2.3 2.2 2.3 2.3 2.3 2.4 2.4 2.5

Internal medicine ................ 2.2 2.3 2.6 2.6 2.6 2.8 2.9 3.0 3.1 3.1 3.2

Pediatrics2 .................... 4.3 4.9 5.2 5.4 5.5 5.9 6.1 6.4 6.6 6.9 7.2

Obstetrics and gynecology3 ......... 1.9 2.0 2.1 2.1 2.1 2.2 2.2 2.2 2.3 2.2 2.3

General surgery ................. 1.0 0.9 1.0 0.9 0.9 0.9 1.0 1.0 1.0 1.0 0.9

Ophthalmology ................. 0.5 0.4 0.5 0.5 0.5 0.6 0.6 0.6 0.6 0.6 0.6

Otolaryngology ................. 0.2 0.3 0.3 0.3 0.3 0.3 0.3 0.3 0.3 0.3 0.3

Orthopedic surgery ............... 0.5 0.6 0.6 0.6 0.6 0.7 0.7 0.7 0.7 0.6 0.6

Neurology .................... 0.2 0.1 0.2 0.3 0.3 0.3 0.3 0.3 0.3 0.3 0.3

Psychiatry .................... 0.8 0.8 0.9 0.9 0.9 0.9 0.9 0.9 0.9 0.9 0.9

Dentists ....................... 5.7 5.9 6.3 6.2 6.0 6.0 6.0 5.9 5.9 6.0 6.1

Registered Nurses ................ 64.4 72.0 69.7 74.2 75.5 78.5 80.5 81.5 82.3 82.8 83.3

- - - Data not available.

1Includes dentists and both active and nonactive physicians who are not retired, residents and interns, sanitary-epidemiological doctors, dentists, and physiotherapists.

2Per 10,000 children 0–14 years of age.

3Per 10,000 females.

4Nurses refers to all types of nurses.

SOURCES: Russian Federation: Goskomstat; United States: Bidese, C.M., and Danais, D.B.: Physician Characteristics and Distribution in the United States, 1982 Chicago. American Medical

Association, 1982; Roback, G.A., Mead, D., and Randolph, L.L.: Physician Characteristics and Distribution in the United States, 1986 Chicago. American Medical Association, 1986; Roback, G.A.,

Randolph, L.L., and Seidman, B.: Physician Characteristics and Distribution in the United States, 1990; 1992; 1993. Chicago. American Medical Association, 1990; 1992; 1993. Pasko, T., Seidman, B.,

and Birkhead, S.: Physician Characteristics and Distribution in the United States, 2000–2001; 2001–2002. Chicago. American Medical Association, 2000. (Copyrights 1982, 1986, 1990, 1992, 1993,

2000, 2001; used with the permission of the American Medical Association).
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beds per 10,000 population, by hospital type and bed size: Russian Federation and United States, selected years 1985–2000

1985 1990 1991 1992 1993 1994 1995 1996 1997 1998 1999 2000

Page 44[ Series5, No.11

Number of hospitals

...... 12,526 12,726 12,711 12,599 12,575 12,272 12,064 11,841 11,499 11,136 10,910 10,704

12,031 12,149 12,065 11,869 11,781 11,523 11,387 11,087 10,771 10,450 10,195 9,946

...... - - - 84 84 86 87 86 86 86 87 88 95 93

...... 2,234 2,193 2,138 2,107 2,053 2,002 1,947 1,904 1,831 1,781 1,727

419 405 396 413 423 418 421 417 411 407 392

) ..... 1,781 1,798 1,807 1,810 1,799 1,778 1,786 1,776 1,775 1,769 1,765 1,765

...... 329 324 316 312 307 299 294 282 267 262 246 263

...... 4,701 4,813 4,818 4,709 4,676 4,522 4,409 4,185 3,923 3,665 3,474 3,310

nics

sing

...... - - - 473 495 507 510 520 555 568 598 632 654 645

care

...... 410 578 646 730 794 748 677 754 728 686 715 758

Beds per 10,000 population

...... 134.6 137.5 134.8 130.7 129.4 127.6 126.1 123.9 121 117.8 114.6 115.9

130.3 130.5 127.1 121.5 120.8 118.6 118.2 116.2 113.6 110.9 108.2 108.7

...... 5.5 5.5 5.5 5.5 5.4 5.4 5.4 5.4 5.4 5.5 5.5

...... 35.3 34.8 33.4 33.1 32.8 32.3 31.7 30.9 30.1 29.8 29.0

...... 5.1 4.9 4.6 4.7 4.8 4.8 4.8 4.7 4.6 4.6 4.6

) ..... 29.5 30.4 29.9 29.1 28.5 27.8 27.7 27.4 26.7 26.0 25.9 25.8

...... 2.4 2.3 2.2 2.1 2.1 2.1 2.1 2.0 1.9 1.9 1.8 2.0

...... 10.8 10.5 10.3 9.9 9.6 9.0 8.7 8.1 7.3 6.7 6.5 5.9

nics

sing

...... - - - 17 16.6 16.6 15.9 15.7 15.7 15.7 15.7 15.7 15.9 14.9

care

...... 4.3 7.0 7.7 9.2 8.6 8.4 8.1 7.4 7.7 6.6 7.3 7.2

Number of hospitals

...... 5,732 5,384 5,342 5,292 5,261 5,229 5,194 5,134 5,057 5,015 4,956 4,915

...... 3,996 3,730 3,699 3,661 3,639 3,623 3,663 3,634 3,571 3,582 3,534 3,489

...... 1,417 1,369 1,362 1,338 1,337 1,333 1,267 1,249 1,231 1,179 1,168 1,179

...... 319 285 281 293 285 273 264 251 255 254 254 247

Beds per 10,000 population

...... 42.1 37.3 36.6 36.1 35.6 34.6 33.2 32.5 31.9 31.1 30.4 29.9

...... 14.4 12.6 12.4 12.2 12.1 11.8 11.8 11.7 11.2 11.2 10.9 10.5

...... 18.4 16.8 16.5 16.0 15.9 15.5 14.6 14.3 14.0 13.3 13.0 13.0

...... 9.2 7.9 7.7 7.9 7.7 7.3 6.9 6.5 6.7 6.6 6.5 6.4

atric and tuberculosis and other respiratory disease hospitals.

stry of Health; United States: American Hospital Association: Hospital Statistics, 1981, 1986, 1991–2002 Editions. Chicago, 1981, 1986, 1991–2002 (Copyrights 1981, 1986, 1991–2002: Used with the
contacts per person, by year and type of contact: Russian Federation and United States, selected years 1985–2000

1985 1990 1991 1992 1993 1994 1995 1996 1997 1998 1999 2000

Contacts per person

. 11.1 9.5 9.3 9.0 9.2 9.2 9.1 9.1 9.1 9.1 9.3 9.4

. 10.7 9.2 9.0 8.7 8.9 8.9 8.7 8.8 8.8 8.8 8.9 9.0

. 0.4 0.3 0.3 0.3 0.3 0.3 0.4 0.3 0.3 0.3 0.4 0.4

. 5.3 5.5 5.8 6.0 6.1 6.1 7.0 5.9 - - - - - - - - - - - -

. 3.0 3.3 3.3 3.3 3.4 3.4 3.6 3.2 - - - - - - - - - - - -

. 0.8 0.7 0.8 0.9 0.8 0.8 1.0 0.7 - - - - - - - - - - - -

. 0.7 0.7 0.7 0.7 0.7 0.8 0.8 0.7 - - - - - - - - - - - -

. 0.8 0.8 0.9 1.1 1.2 1.1 1.6 1.2 - - - - - - - - - - - -

ers to a visit to a state physician’s office; visits to private physicians are not included. For the United States, ‘‘hospital outpatient department’’ includes hospital outpatient clinic, emergency room, and other

; United States: Centers for Disease Control and Prevention, National Center for Health Statistics, Division of Health Interview Statistics: Data from the National Health Interview Survey.

Series5, No.11[ Page 45
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- - - - - - - - - - - - - - - - - - - - - - - - - - -

d rate of discharges and surgical operations per 1,000 population: Russian Federation and United States, selected years 1985–2000

1985 1990 1991 1992 1993 1994 1995 1996 1997 1998 1999 2000

Page 46[ Series5, No.11

Number of days

... 17.0 6.6 16.7 17.0 16.8 16.8 16.8 16.9 16.6 16.3 15.8 15.4

Rate per 1,000 population

... 236.7 222.5 213.3 205.1 211.4 229.9 216.6 211.5 207.5 209.0 208.0 217.5

... 45.5 42.9 41.5 41.8 42.2 43.6 44.0 44.5 45.1 47.0 47.9 49.6

... - - - 30.2 32.1 34.6 36.6 36.3 39.3 38.4 38.3 39.6 39.6 41.3

Number of days

... 6.6 6.5 6.5 6.2 6.1 5.8 5.4 5.3 5.1 5.1 5.0 4.9

Rate per 1,000 population

... 151.4 125.2 125.0 122.8 120.9 119.8 118.0 116.0 116.1 117.9 117.8 114.9

... 157.9 152.7 153.3 152.1 153.8 151.5 145.0

... 107.9 113.6 120.1

population.

; United States: Centers for Disease Control and Prevention, National Center for Health Statistics, Division of Health Care Statistics: Data from the National Hospital Discharge Survey and the National
Series 5, No. 11 [ Page 47

Appendix

Urban-Rural data for

the Russian Federation

Tables

Table I. Life expectancy at birth, by sex and urban-rural status: Russian Federation, selected years 1985–2000

Male Female

Year Total Urban Rural Total Urban Rural

19852 ........................ 63.8 64.5 61.8 74.0 74.0 73.6

1990 ......................... 63.8 64.4 62.0 74.3 74.4 73.9

1991 ......................... 63.5 64.1 61.7 74.3 74.3 73.9

1992 ......................... 62.0 62.5 60.7 73.8 73.8 73.5

1993 ......................... 58.9 59.3 57.9 71.9 72.0 71.5

1994 ......................... 57.6 57.9 56.8 71.2 71.3 70.8

1995 ......................... 58.3 58.5 57.7 71.7 71.8 71.5

1996 ......................... 59.8 60.2 58.4 72.5 72.7 71.9

1997 ......................... 60.8 61.4 58.9 72.9 73.1 72.3

1998 ......................... 61.3 61.8 59.9 72.9 73.1 72.3

1999 ......................... 59.9 60.4 58.6 72.4 72.7 71.6

2000 ......................... 59.0 59.4 58.0 72.2 72.4 71.6

1Russian Federation: Goskomstat data for 1985–86.

SOURCE: Goskomstat.
Page 48 [ Series 5, No. 11

Table II. Infant mortality, late fetal mortality, and perinatal mortality rates, by urban-rural status: Russian Federation, selected years

1985–2000

Neonatal1

Late fetal Perinatal

Under Under mortality mortality

Year and status Infant1 28 days 7 days Postneonatal1 rate2 rate3

1985: Total ..................... 20.7 11.1 8.5 9.6 9.3 17.8

Urban ........................ 19.8 12.6 9.9 7.2 10.1 20.0

Rural ......................... 22.8 7.7 5.3 15.1 7.3 12.6

1990: Total ..................... 17.4 11.1 8.9 6.3 9.1 17.9

Urban ........................ 17.0 12.0 9.9 5.0 9.6 19.5

Rural ......................... 18.3 8.9 6.9 9.4 7.5 14.4

1991: Total ..................... 17.8 11.0 8.8 6.8 8.7 17.5

Urban ........................ 17.2 12.0 9.7 5.2 9.4 19.1

Rural ......................... 19.1 9.3 7.1 9.8 7.2 14.3

1992: Total ..................... 18.0 11.5 8.9 6.5 8.3 17.2

Urban ........................ 17.6 12.3 9.7 5.3 8.8 18.5

Rural ......................... 19.1 9.8 7.4 9.3 7.4 14.8

1993: Total ..................... 19.9 12.0 9.6 7.9 7.8 17.4

Urban ........................ 19.2 12.6 8.2 6.6 6.6 14.8

Rural ......................... 21.4 10.3 10.3 11.1 8.4 18.7

1994: Total ..................... 18.6 11.8 9.2 6.8 7.8 17.0

Urban ........................ 17.9 12.3 9.7 5.6 8.2 17.9

Rural ......................... 20.1 9.8 8.1 10.3 6.9 15.0

1995: Total ..................... 18.1 11.0 8.4 7.1 7.4 15.8

Urban ........................ 17.4 12.0 8.8 5.4 7.9 16.7

Rural ......................... 19.8 9.5 7.6 10.3 6.4 14.0

1996: Total ..................... 17.4 10.8 8.1 6.6 7.8 15.9

Urban ........................ 16.4 11.4 8.3 5.0 8.2 16.5

Rural ......................... 19.4 9.4 7.6 10.0 7.0 14.6

1997: Total ..................... 17.2 10.6 7.8 6.6 8.0 15.8

Urban ........................ 16.1 11.0 7.9 5.1 8.5 16.4

Rural ......................... 19.6 9.6 7.6 10.0 6.9 14.5

1998: Total ..................... 16.5 10.1 7.5 6.4 7.5 15.0

Urban ........................ 15.7 10.7 7.6 5.0 7.9 15.5

Rural ......................... 18.3 9.0 7.2 9.3 6.9 14.1

1999: Total ..................... 16.9 10.3 7.0 6.6 7.2 14.2

Urban ........................ 16.1 11.1 7.2 5.0 7.6 14.8

Rural ......................... 18.8 9.2 6.5 9.6 6.4 12.9

2000: Total ..................... 15.3 9.3 6.5 6.0 6.7 13.2

Urban ........................ 14.7 10.0 6.6 4.7 7.1 13.7

Rural ......................... 16.8 8.2 6.2 8.6 5.7 11.9

1Infant (under 1 year of age), neonatal (under 28 days), early neonatal (under 7 days), and postneonatal (28–385 days).

2Number of fetal deaths of 28 weeks or more gestation per 1,000 live births plus late fetal deaths.

3Number of late fetal deaths plus infant deaths within 7 days of birth per 1,000 live births plus late fetal deaths.

SOURCE: Goskomstat.
Series 5, No. 11 [ Page 49

Table III. Death rates from all causes, by sex, age, and urban-rural status: Russian Federation, 1994–2000

Urban Rural

Sex and age 1994 1995 1996 1997 1998 1999 2000 1994 1995 1996 1997 1998 1999 2000

Both sexes

All ages, age-adjusted . . 1,587.2 1,514.9 1,400.4 1,334.7 1,314.4 1,417.4 1,466.9 1,596.0 1,499.9 1,458.7 1,428.3 1,383.1 1471.3 1,515.6

All ages, crude ....... 1,496.1 1,442.0 1,345.0 1,294.4 1,289.8 1,408.1 1,477.6 1,715.1 1,624.3 1,596.1 1,581.0 1,539.3 1,634.4 1,681.1

Under 1 year ........ 1,799.0 1,720.9 1,632.5 1,599.6 1,591.3 1,592.7 1,510.6 1,969.9 1,917.5 1,888.3 1,917.6 1,814.0 1,811.5 1,664.4

1–4 years .......... 85.1 88.8 77.5 78.8 74.2 83.6 80.8 146.5 148.7 140.2 143.9 137.0 144.4 139.3

5–14 years ......... 47.0 50.3 43.0 39.7 41.9 43.3 41.1 61.4 62.3 57.8 54.5 54.1 57.3 55.2

15–24 years ........ 185.4 203.5 188.1 175.2 183.7 201.9 219.5 243.1 250.3 244.3 220.5 217.5 229.2 238.4

25–34 years ........ 395.3 388.5 345.3 306.1 310.2 347.1 386.1 462.7 447.7 427.3 404.5 389.7 427.0 448.8

35–44 years ........ 784.1 739.0 627.7 543.0 528.2 601.5 663.2 841.1 773.7 708.8 656.7 626.8 689.9 724.7

45–54 years ........ 1,521.9 1,395.1 1,187.6 1,016.0 995.6 1,142.2 1,258.0 1,620.0 1,458.9 1,348.0 1,231.7 1,177.1 1,305.8 1,388.8

55–64 years ........ 2,644.8 2,450.9 2,215.1 2,071.9 2,032.5 2,275.4 2,432.0 2,688.0 2,477.1 2,390.8 2,376.7 2,310.8 2,549.1 2,747.9

65–74 years ........ 4,493.2 4,358.2 4,209.3 4,203.5 4,221.8 4,509.3 4,627.5 4,314.8 4,140.5 4,164.4 4,255.2 4,219.3 4,516.8 4,700.6

75–84 years ........ 10,459.3 10,026.0 9,625.6 9,466.1 9,120.3 9,309.2 9,085.4 9,780.8 9,258.9 9,198.6 9,169.0 8,747.2 8,830.6 8,645.9

85 years and over ..... 22,304.2 21,748.4 20,739.4 20,672.6 20,309.5 21,433.7 21,403.4 21,202.3 20,064.8 19,897.6 19,450.8 18,820.0 19,229.1 18,954.4

Male

All ages, age-adjusted . . 2,270.7 2,139.7 1,954.1 1,840.6 1,807.6 1,971.9 2,070.3 2,289.7 2,128.0 2,046.8 1,993.6 1,929.2 2,062.9 2,143.8

All ages, crude ....... 1,735.3 1,662.2 1,520.6 1,429.6 1,422.0 1,581.6 1,700.0 1,844.8 1,737.5 1,689.6 1,658.3 1,616.5 1,744.7 1,827.7

Under 1 year ........ 2,063.3 1,956.5 1,876.3 1,818.7 1,820.0 1,803.7 1,713.6 2,261.2 2,178.0 2,154.3 2,207.6 2,042.7 2,026.4 1,884.1

1–4 years .......... 94.4 99.2 87.2 85.5 83.8 92.9 91.3 161.9 165.9 156.6 154.7 151.0 157.7 149.2

5–14 years ......... 59.0 63.0 54.1 51.1 51.9 54.8 52.0 77.8 80.3 71.7 70.4 68.6 73.4 71.2

15–24 years ........ 280.7 315.2 291.7 267.7 281.7 310.7 342.6 374.2 379.9 367.9 328.9 322.0 342.8 365.7

25–34 years ........ 640.0 619.4 547.7 479.7 484.9 544.2 611.0 737.7 721.3 687.5 643.4 621.9 687.0 724.4

35–44 years ........ 1,266.1 1,192.0 1,009.6 870.8 844.5 961.3 1,070.4 1,280.4 1,182.3 1,082.2 998.7 960.7 1,059.5 1,113.6

45–54 years ........ 2,423.2 2,220.2 1,885.0 1,597.6 1,571.8 1,815.1 2,021.3 2,488.4 2,218.1 2,037.0 1,838.6 1,760.5 1,954.4 2,087.6

55–64 years ........ 4,206.6 3,899.0 3,502.2 3,258.0 3,195.5 3,632.7 3,912.5 4,108.2 3,794.5 3,666.8 3,644.9 3,556.4 3,948.8 4,278.1

65–74 years ........ 6,758.3 6,516.8 6,218.9 6,184.7 6,184.8 6,675.9 6,910.4 6,701.7 6,307.8 6,312.5 6,379.9 6,297.9 6,774.5 7,067.4

75–84 years ........ 13,370.2 12,591.6 11,982.2 11,753.2 11,295.9 11,561.7 11,477.7 13,335.2 12,383.5 12,160.1 12,078.6 11,579.8 11,680.6 11,542.6

85 years and over ..... 24,106.0 22,186.9 20,811.7 20,473.0 19,689.2 20,724.5 20,499.5 22,792.3 21,056.6 19,784.2 19,524.7 18,471.7 18,501.6 18,174.7

Female

All ages, age-adjusted . . 1,116.9 1,076.3 1,013.3 985.6 970.9 1,028.4 1,040.4 1,102.0 1,042.7 1,024.9 1,015.4 981.2 1,028.9 1,042.7

All ages, crude ....... 1,285.6 1,248.6 1,191.1 1,176.0 1,174.3 1,256.7 1,284.0 1,598.4 1,522.1 1,511.5 1,510.9 1,469.3 1,534.1 1,547.8

Under 1 year ........ 1,519.9 1,472.9 1,375.6 1,367.5 1,349.3 1,369.1 1,295.0 1,663.5 1,643.9 1,609.1 1,614.3 1,573.5 1,584.8 1,432.8

1–4 years .......... 75.4 77.8 67.2 71.8 64.1 73.8 69.7 130.4 130.6 122.9 132.6 122.3 130.4 128.8

5–14 years ......... 34.5 37.1 31.5 27.9 31.4 31.3 29.7 44.5 43.7 43.4 38.0 39.0 40.5 38.6

15–24 years ........ 86.7 89.4 83.2 82.1 85.1 92.6 96.0 100.4 107.5 107.9 101.8 103.6 105.7 100.5

25–34 years ........ 150.4 153.4 136.8 126.3 128.5 142.1 152.8 165.2 156.5 152.9 153.4 146.6 155.9 162.7

35–44 years ........ 330.1 313.6 270.3 236.4 232.2 264.6 282.1 354.4 322.4 298.1 282.0 262.5 288.3 304.4

45–54 years ........ 730.0 670.5 575.5 505.9 491.9 557.4 599.6 793.7 720.1 664.5 620.5 585.7 647.9 681.3

55–64 years ........ 1,479.1 1,374.8 1,263.1 1,199.8 1,182.3 1,291.9 1,369.6 1,531.2 1,408.9 1,364.6 1,365.9 1,326.6 1,456.2 1,568.0

65–74 years ........ 3,341.9 3,243.4 3,159.3 3,154.1 3,167.9 3,331.2 3,372.5 3,147.1 3,034.0 3,032.4 3,105.7 3,068.5 3,240.0 3,332.3

75–84 years ........ 9,523.0 9,200.9 8,869.6 8,736.6 8,434.1 8,600.8 8,324.0 8,839.8 8,432.6 8,412.2 8,388.1 7,978.7 8,037.1 7,815.1

85 years and over ..... 21,899.4 21,646.4 20,722.0 20,721.8 20,466.0 21,616.1 21,638.7 20,895.0 19,869.0 19,920.3 19,436.0 18,890.2 19,376.6 19,113.1

NOTE: Age adjusted using as standard population the European standard 100,000 population prepared by the World Health Organization (see appendix).

SOURCE: Goskomstat.
Page 50 [ Series 5, No. 11

Table IV. Age-adjusted death rates for selected causes of death, by sex, Russian Federation, 1990–2000, urban settlements

Sex and cause of death 1990 1991 1992 1993 1994 1995 1996 1997 1998 1999 2000

All causes

Total ......................... 1,188.4 1,194.3 1,263.1 1,478.0 1,585.3 1,516.2 1,402.2 1,334.0 1,308.6 1,406.2 1,452.5

Male ......................... 1,662.9 1,675.5 1,785.5 2,123.0 2,290.3 2,166.0 1,979.3 1,857.6 1,813.3 1,966.8 2,056.3

Female ....................... 901.6 899.1 928.2 1,052.1 1,107.9 1,067.1 1,004.1 975.7 958.8 1,013.7 1,025.2

Diseases of heart (390–398, 401–429)

Total ......................... 354.5 350.5 361.8 435.0 471.4 438.1 405.2 383.9 376.6 415.8 431.7

Male ......................... 492.9 492.8 513.7 627.9 687.4 633.4 576.7 539.8 530.1 590.3 619.6

Female ....................... 273.8 268.1 270.5 316.0 333.7 311.9 294.1 283.5 276.7 302.1 307.1

Cerebrovascular diseases (430–438)

Total ......................... 262.9 260.1 266.0 297.9 318.7 311.7 297.6 297.5 297.9 311.0 318.6

Male ......................... 302.5 298.6 305.2 347.9 376.7 361.9 341.1 337.9 333.7 351.2 366.9

Female ....................... 241.7 238.8 243.8 269.3 284.0 279.8 269.2 270.5 272.4 282.1 285.5

Malignant neoplasms (140–208)

Total ......................... 216.3 216.9 217.8 219.1 216.8 211.3 205.9 204.1 202.2 203.7 202.6

Male ......................... 331.9 332.9 331.6 335.2 328.0 316.9 307.5 304.0 299.4 301.4 297.6

Female ....................... 155.0 154.5 155.5 154.7 154.7 151.8 149.0 148.5 147.6 148.8 148.8

Malignant neoplasms of the respiratory

system (160–165)

Total ......................... 51.0 51.4 51.5 52.0 51.0 48.9 46.3 45.6 44.5 43.5 43.1

Male ......................... 118.6 119.3 118.2 119.1 116.5 111.7 105.7 104.1 101.4 99.8 97.9

Female ....................... 12.6 12.3 12.5 12.3 12.2 11.4 10.9 11.0 10.5 10.0 10.2

Malignant neoplasms of the breast (174)

Female ....................... 21.8 22.4 23.6 24.2 24.9 24.5 25.1 25.8 26.1 26.3 26.7

Pneumonia and influenza (480–483,

485–487)

Total ......................... 9.7 9.4 11.5 19.2 23.0 22.7 19.1 16.3 15.5 21.8 27.2

Male ......................... 15.0 14.3 19.0 32.4 40.2 39.7 32.9 27.2 26.4 37.2 47.5

Female ....................... 6.3 6.2 6.2 9.3 9.9 9.8 8.5 8.3 7.5 10.4 12.1

Chronic obstructive pulmonary diseases

(490–496)

Total ......................... 29.1 27.3 27.4 32.4 33.8 29.6 27.5 26.6 23.5 27.1 27.2

Male ......................... 57.6 54.3 54.5 65.3 68.4 59.7 55.8 53.4 48.1 56.0 56.6

Female ....................... 16.9 15.5 15.3 16.9 17.0 15.0 13.8 13.7 11.8 13.0 12.6

Chronic liver diseases and cirrhosis

(571.0–571.3, 571.5, 571.6)

Total ......................... 9.5 9.6 10.4 14.4 19.4 21.1 18.1 15.1 14.2 15.6 17.9

Male ......................... 14.4 14.5 15.4 20.8 28.1 31.0 26.5 22.5 20.6 22.7 25.1

Female ....................... 6.6 6.7 7.2 10.2 13.2 14.1 12.0 9.9 9.8 10.5 12.4

Other alcohol-related causes (303, 305.0,

E860)

Total ......................... 11.3 11.4 18.6 33.9 43.5 36.9 27.7 20.6 18.8 21.4 26.6

Male ......................... 19.7 20.0 32.3 57.6 73.4 62.6 47.3 35.1 32.0 36.1 45.0

Female ....................... 4.1 4.0 6.7 13.6 18.2 15.2 11.3 8.4 7.6 9.1 11.3

Motor vehicle and other transport accidents

(E800–E848)

Total ......................... 26.0 27.6 27.8 28.3 26.2 24.1 20.8 19.6 21.0 23.4 24.4

Male ......................... 42.8 45.3 45.4 46.0 42.3 38.2 32.5 30.1 32.3 36.7 38.1

Female ....................... 11.7 12.6 12.5 13.0 12.4 11.9 10.5 10.4 11.1 11.8 12.5

Suicide (E950–E959)

Total ......................... 24.7 25.1 29.0 34.5 37.1 37.0 34.4 31.9 29.8 32.8 32.0

Male ......................... 43.2 44.2 51.3 62.2 67.9 66.7 62.9 58.1 54.2 59.4 59.1

Female ....................... 10.4 10.0 10.9 11.8 11.9 12.2 10.9 10.4 9.7 10.8 9.6

Homicide and legal intervention (E960–E978)

Total ......................... 13.4 14.6 22.4 30.1 31.8 30.5 25.9 22.8 21.7 25.0 26.9

Male ......................... 21.5 23.6 36.5 48.9 51.7 49.5 41.3 36.6 34.6 39.5 43.0

Female ....................... 6.0 6.3 9.6 13.0 13.8 13.4 11.9 10.5 10.1 12.1 12.6

Other external causes (E850–E859,

E861–E943, E980–E999)

Total ......................... 50.1 54.7 69.2 95.2 107.4 107.5 93.4 81.4 84.2 90.4 95.1

Male ......................... 83.8 92.211 117.4 162.1 183.7 183.1 158.2 138.1 142.6 154.4 163.8

Female ....................... 21.4 22.7 28.2 38.5 42.8 43.2 38.1 33.4 34.6 36.1 36.3

NOTE: Age adjusted using as standard population the European standard 100,000 population prepared by the World Health Organization (see appendix).

SOURCE: Goskomstat.
Series 5, No. 11 [ Page 51

Table V. Age-adjusted death rates for selected causes of death, by sex, Russian Federation, 1990–2000, rural settlements

Sex and cause of death 1990 1991 1992 1993 1994 1995 1996 1997 1998 1999 2000

All causes

Total .............................. 1,222.8 1,228.3 1,287.3 1,483.5 1,586.2 1,495.0 1,454.8 1,426.0 1,378.2 1,460.5 1,499.1

Male .............................. 1,767.7 1,774.2 1,862.7 2,152.9 2,300.3 2,147.6 2,069.1 2,014.0 1,942.0 2,063.1 2,129.9

Female ............................ 882.8 881.5 909.3 1,028.1 1,086.3 1,028.9 1,010.6 1,002.7 967.8 1,012.7 1,025.2

Diseases of heart (390–398, 401–429)

Total .............................. 395.4 384.5 395.3 461.1 492.4 455.3 446.5 441.1 426.5 463.6 480.4

Male .............................. 546.5 539.0 557.3 651.7 699.1 640.8 624.2 613.9 593.1 644.9 675.3

Female ............................ 312.8 299.5 302.4 345.3 362.2 336.6 330.8 328.4 316.4 341.3 347.2

Cerebrovascular diseases (430–438)

Total .............................. 213.9 209.3 213.5 239.1 257.8 243.3 243.5 244.8 243.6 248.4 259.2

Male .............................. 256.1 248.4 253.0 288.3 311.9 288.3 284.3 284.6 284.0 291.4 304.6

Female ............................ 194.0 189.6 193.2 212.7 226.7 215.4 216.5 218.9 217.0 219.2 227.2

Malignant neoplasms (140–208)

Total .............................. 171.6 173.4 177.2 178.4 180.2 177.5 173.5 173.4 173.3 172.7 172.0

Male .............................. 278.9 280.0 284.0 286.7 286.0 280.3 272.1 269.8 267.9 265.9 265.6

Female ............................ 111.0 112.2 114.6 113.3 115.0 114.8 112.4 113.2 113.8 113.6 112.3

Malignant neoplasms of the respiratory system

(160–165)

Total .............................. 48.6 49.2 50.2 51.6 52.2 50.1 48.9 48.3 47.4 46.7 46.7

Male .............................. 111.8 112.3 114.1 115.6 116.1 111.8 108.0 106.8 103.6 102.2 102.3

Female ............................ 10.2 10.1 10.2 10.5 10.3 9.7 9.7 9.4 9.4 9.1 8.9

Malignant neoplasms of the breast (174)

Female ............................ 12.9 13.8 15.1 14.9 15.6 16.2 16.4 16.9 17.7 17.6 17.4

Pneumonia and influenza (480–483, 485–487)

Total .............................. 12.0 11.8 12.7 17.0 18.3 18.5 17.0 16.7 15.0 19.7 20.7

Male .............................. 17.4 16.7 19.1 25.3 28.4 28.4 25.8 25.3 22.7 30.4 32.8

Female ............................ 8.2 8.1 7.9 10.5 9.8 10.3 9.6 9.7 8.6 10.9 10.6

Chronic obstructive pulmonary diseases (490–496)

Total .............................. 50.1 45.8 46.7 55.7 58.4 52.3 51.4 51.6 46.5 56.4 57.2

Male .............................. 97.9 89.3 90.6 109.8 115.1 102.2 99.9 101.0 91.3 111.4 115.1

Female ............................ 28.8 25.9 26.1 29.0 29.3 26.4 26.3 26.0 22.9 26.9 25.8

Chronic liver diseases and cirrhosis (571.0–571.3,

571.5, 571.6)

Total .............................. 10.9 10.6 10.9 13.2 16.7 18.1 16.4 15.4 14.0 14.8 16.7

Male .............................. 16.4 16.0 16.1 19.6 24.0 26.4 24.1 21.7 20.5 21.6 23.0

Female ............................ 7.4 7.4 7.6 8.8 11.4 12.0 10.9 10.7 9.3 9.5 11.7

Other alcohol-related causes (303, 305.0, E860)

Total .............................. 16.4 17.0 23.2 39.4 48.9 38.4 31.7 26.4 23.6 26.1 31.6

Male .............................. 26.8 27.5 37.4 62.2 77.0 61.4 50.4 41.9 37.9 41.3 50.4

Female ............................ 6.6 7.0 9.3 17.5 22.2 16.4 13.8 11.5 10.0 11.5 13.9

Motor vehicle and other transport accidents

(E800–E848)

Total .............................. 39.4 40.6 37.4 36.4 33.3 30.1 27.0 24.7 25.9 30.2 30.3

Male .............................. 67.0 68.3 62.5 60.4 55.2 49.3 43.7 39.4 41.5 48.7 48.6

Female ............................ 12.4 13.5 12.8 12.8 11.7 11.0 10.5 10.3 10.6 12.1 12.1

Suicide (E950–E959)

Total .............................. 34.6 33.3 39.0 49.2 55.9 53.5 52.1 51.0 47.8 52.9 53.9

Male .............................. 60.8 58.5 69.3 88.5 101.0 95.6 93.5 91.5 85.5 95.3 97.2

Female ............................ 11.4 10.9 11.6 13.5 14.8 14.6 13.7 13.8 13.0 13.9 13.6

Homicide and legal intervention (E960–E978)

Total .............................. 16.4 16.7 23.3 28.8 30.4 27.6 25.2 23.9 22.7 25.3 27.2

Male .............................. 25.0 25.6 36.3 43.6 46.5 42.4 38.6 36.5 34.5 38.9 41.8

Female ............................ 7.8 7.8 10.2 14.0 14.3 13.2 12.0 11.4 10.9 12.0 13.0

Other external causes (E850–E859, E861–E943,

E980–E999)

Total .............................. 67.2 74.2 80.9 101.6 110.0 106.9 100.1 93.3 92.3 93.5 98.1

Male .............................. 110.0 121.4 132.2 165.0 178.6 175.0 163.2 150.3 150.0 152.6 159.8

Female ............................ 27.4 30.0 32.4 42.4 45.4 42.4 40.8 39.7 38.2 38.2 40.0

NOTE: Age adjusted using as standard population the European standard 100,000 population prepared by the World Health Organization (see appendix).

SOURCE: Goskomstat.
Page 52 [ Series 5, No. 11

Appendix Glossary

Glossary of Terms

This glossary is an alphabetical

listing of terms used in this report. It

includes cross-references to related

terms and synonyms and International

Classification of Diseases (ICD) codes

for cause of death and diagnostic and

procedure categories.

Abortion—The Centers for Disease

Control and Prevention’s (CDC)

surveillance program counts legal

abortions only. For surveillance

purposes, legal abortion is defined as a

procedure performed by a licensed

physician or someone acting under the

supervision of a licensed physician to

induce the termination of a pregnancy.

Acquired immunodeficiency

syndrome (AIDS)—All 50 States and

the District of Columbia report AIDS

cases to CDC using a uniform case

definition and case report form. The

case reporting definitions were expanded

in 1985 (MMWR 1985; 34:373–5);

1987 (MMWR 1987; 36 (supp. no. 1S):

1S-15S); and 1993 (MMWR 1993; 41

(supp. no. RR-17)). These data are

published semiannually by CDC in

HIV/AIDS Surveillance Report. See

related Human immunodeficiency virus

(HIV) infection.

Age adjustment—Age adjustment,

using the direct method, is the

application of age-specific rates in a

population to a standardized age

distribution in order to eliminate the

differences in observed rates that result

from age differences in the population.

This adjustment is usually done when

comparing two or more populations at

one point in time or one population at

two or more points in time.

In this report the death rates are

age-adjusted to the European standard

100,000 population (table VI). CPHRI

performed all of their calculations for

age-adjusted mortality rates for Russia

using the 19 age groups shown in

table VI. NCHS combined the values

from table VI into 11 age groups in

calculating age-adjusted rates for the

United States. Age-adjusted rates for the

United States are customarily calculated

Table VI. European standard 100,000

population used to adjust death rates

Standard

Age 100,000

All ages ................ 100,000

Under 1 year ............. 1,600

1–4 years ............... 6,400

5–9 years ............... 7,000

10–14 years ............. 7,000

15–19 years ............. 7,000

20–24 years ............. 7,000

25–29 years ............. 7,000

30–34 years ............. 7,000

35–39 years ............. 7,000

40–44 years ............. 7,000

45–49 years ............. 7,000

50–54 years ............. 7,000

55–59 years ............. 6,000

60–64 years ............. 5,000

65–69 years ............. 4,000

70–74 years ............. 3,000

75–79 years ............. 2,000

80–84 years ............. 1,000

85 years and over .......... 1,000

SOURCE: World Health Organization. 1996 World Health

Statistics. Geneva. 1998.

using the U.S. 2000 standard population,

thus the age-adjusted rates for the

United States shown in this report will

differ from previously published ones.

Average length of stay—The

average length of stay is computed by

dividing the total number of days of

care (counting the date of admission but

not the date of discharge) by the number

of patients admitted (Russian

Federation) or discharged (United

States). See related Discharge.

Bed—Any bed that is set up and

staffed for use by inpatients is counted

as a bed in a facility. For the American

Hospital Association, the count is of the

average number of beds, cribs, and

pediatric bassinets during an entire

reporting period. The World Health

Organization, as well as the Russian

Federation, defines a hospital bed as one

regularly maintained and staffed for the

accommodation and full-time care of a

succession of inpatients and situated in a

part of the hospital where continuous

medical care for inpatients is provided.

In Russia the bed is the unit for

determining State financial support. See

related Hospital.

Birth rate—See Rate: Birth and

related rates.

Birthweight—The first weight of a

newborn obtained after birth. Low

birthweight is defined as less than 2,500

grams or 5 pounds 8 ounces.

Cause of death—For the purpose of

national mortality statistics, every death

is attributed to one underlying condition,

based on the information reported on the

death certificate and using international

rules for selecting the underlying cause

of death from the reported conditions.

The International Classification of

Diseases, Ninth Revision (ICD–9) was

used for coding cause of death in both

countries for the period 1979–98, and

the International Classification of

Diseases, Tenth Revision (ICD–10) was

implemented in 1999. Prior to 1999,

Russia used a short list of 175 causes to

code and tabulate deaths by cause; the

short list was based on ICD–9.

Beginning in 1999, the Ministry of

Health of Russia was given

responsibility for coding causes of

death, and began doing so using the full

version of ICD–10. Goskomstat, the

central statistical bureau of Russia, uses

a short version of ICD–10 for the

tabulation and publication of mortality

statistics for Russia.

Central Public Health Research

Institute—The state institution in the

Russian Federation that is responsible

for investigation of the health of the

population, scientific support of health

reform and medical statistics, and

training of health service and public

health managers for the Russian

Federation. Also known as

MedSocEconomInform.

Crude birth rate; crude death

rate—See Rate: Birth and related rates;

Death and related rates.

Death rate—See Rate: Death rates.

Diagnosis—See First-listed

diagnosis.

Discharge—The National Health

Interview Survey defines a hospital

discharge as the completion of any

continuous period of stay of 1 night or

more in a hospital as an inpatient, not

including the period of stay of a well

newborn infant. According to the

National Hospital Discharge Survey,

American Hospital Association, and

National Master Facility Inventory,

discharge is the formal release of an

inpatient by a hospital (excluding

newborn infants), that is, the termination

of a period of hospitalization (including
Series 5, No. 11 [ Page 53

stays of 0 nights) by death or by

disposition to a place of residence,

nursing home, or another hospital. See

related Average length of stay.

Early neonatal mortality rate—See

Rate; Death and related rates.

Federal Center for Sanitary and

Epidemiologic Surveillance (SES) —In

the Russian Federation, this is the

governmental body responsible for

epidemiological health and organization

of public hygiene.

Feldsher—Russian paramedical

personnel, similar to a U.S. physician

assistant. The feldsher serves as the first

point of contact of the rural population

with the health care system. Feldshers

provide first aid, treat minor illnesses,

administer immunizations, and improve

sanitation and hygiene. They are

supervised by a physician from a rural

hospital. Feldsher-midwife posts serve

villages and collective farms.

Fertility rate—See Rate: Birth and

related rates.

Fetal death—In the World Health

Organization’s definition, which has also

been adopted by the United Nations, the

United States, and the Russian

Federation, a fetal death is death before

the complete expulsion or extraction

from its mother of a product of

conception, irrespective of the duration

of pregnancy; the death is indicated by

the fact that after such separation, the

fetus does not breathe or show any other

evidence of life, such as heartbeat,

umbilical cord pulsation, or definite

movement of voluntary muscles. For

statistical purposes, fetal deaths are

classified according to gestational age.

In this report tabulations are shown for

fetal deaths with stated or presumed

gestation of 28 weeks or more, also

known as late fetal deaths or stillbirths.

See related Live birth; Rate: Death and

related rates.

First-listed diagnosis—In the

National Hospital Discharge Survey this

is the first recorded final diagnosis on

the medical record face sheet (summary

sheet).

Gestation—For the National Vital

Statistics System and the CDC’s

Abortion Surveillance, the period of

gestation is defined as beginning with

the first day of the last normal

menstrual period and ending with the

day of birth or day of termination of

pregnancy. See related Abortion; Fetal

death; Live birth.

Goskomstat—State Statistical

Committee of the Russian Federation.

Goskomstat is responsible for collecting

and publishing population estimates,

vital statistics, and other data from other

ministries and Federal agencies.

Gross Domestic Product

(GDP)—GDP is the market value of the

goods and services produced by labor

and property located in the United

States. As long as the labor and property

are located in the United States, the

suppliers (that is, the workers and, for

property, the owners) may be either U.S.

residents or residents of the rest of the

world.

HIV—See Human

immunodeficiency virus infection.

Hospital—Hospitals are licensed

institutions with at least six beds in the

United States and normally 15 beds or

more in Russia. The primary function of

a hospital is to provide diagnostic and

therapeutic patient services for medical

conditions by an organized physician

staff and to have continuous nursing

services under the supervision of

registered nurses. See related Average

length of stay; Bed.

Short-stay hospitals—in the United

States are those in which the average

length of stay is less than 30 days. In

Russia there are only general hospitals,

which have both long- and short-stay

patients.

Specialty hospitals, such as

psychiatric, tuberculosis, chronic

disease, rehabilitation, maternity, and

alcoholic or narcotic provide a particular

type of service to the majority of their

patients.

Human immunodeficiency virus

(HIV) infection—(For mortality coding)

Beginning with data for 1987, NCHS

introduced category numbers *042–*044

for classifying and coding HIV infection

as a cause of death. The asterisk before

the category numbers indicates that

these codes are not part of the

International Classification of Diseases,

Ninth Revision (ICD–9). Beginning with

1987, death statistics for HIV infection

are not strictly comparable with data for

earlier years. Starting with data year

1999 and the introduction of the

International Classification of Diseases,

Tenth Revision (ICD–10), the title for

this cause of death changed to HIV

disease from HIV infection and the ICD

codes changed to B20–B24.

For morbidity coding diagnosis data

are coded using the International

Classification of Diseases, Ninth

Revision, Clinical Modification

(ICD–9–CM). During 1984 and 1985,

only data for AIDS (ICD–9–CM 279.19)

were included. Beginning with data for

1986, discharges with a diagnosis of

HIV infection (ICD–9–CM 042–044,

279.19, and 795.8) were included. See

related Acquired immunodeficiency

syndrome; Cause of death; International

Classification of Diseases; International

Classification of Diseases, Ninth

Revision, Clinical Modification.

ICD; ICD codes—See Cause of

death; International Classification of

Diseases, Ninth Revision.

Incidence—Incidence is the number

of cases of disease having their onset

during a prescribed period of time. It is

often expressed as a rate (for example,

the incidence of measles per 1,000

children 5–14 years of age during a

specified year). Incidence is a measure

of morbidity or other events that occur

within a specified period of time. See

related Prevalence.

Infant death—An infant death is

the death of a live-born child before his

or her first birthday. Deaths in the first

year of life may be further classified

according to age as neonatal and

postneonatal. Neonatal deaths are those

that occur during the first 27 days of

life; postneonatal deaths are those that

occur between 28 days and 1 year of

age. See Live birth; Rate: Death and

related rates.

International Classification of

Diseases (ICD)—The International

Classification of Diseases (ICD)

provides the ground rules for coding and

classifying cause-of-death data. The ICD

is developed collaboratively between the

World Health Organization (WHO) and

10 international collaborating centers.

The purpose of the ICD is to promote

international comparability in the

collection, classification, processing, and

presentation of health statistics. Since

the beginning of the century, the ICD

has been modified about once every 10
Page 54 [ Series 5, No. 11

years, except for the 20-year interval

between ICD–9 and ICD–10. The

purpose of the revisions is to stay

abreast with advances in medical

science. New revisions usually introduce

major disruptions in time series of

mortality statistics. See related Cause of

death; International Classification of

Diseases, Ninth Revision, Clinical

Modification.

International Classification of

Diseases, Ninth Revision, Clinical

Modification (ICD–9–CM)—The

ICD–9–CM is based on and is

completely compatible with the

International Classification of Diseases,

Ninth Revision. The ICD–9–CM is used

to code morbidity data, and the ICD–9

is used to code mortality data.

ICD–9 and ICD–9–CM are arranged

in 17 main chapters. Most of the

diseases are arranged according to their

principal anatomical site, with special

chapters for infective and parasitic

diseases; neoplasms; endocrine,

metabolic, and nutritional diseases;

mental diseases; complications of

pregnancy and childbirth; certain

diseases peculiar to the perinatal period;

and ill-defined conditions. In addition,

two supplemental classifications are

provided: the classification of factors

influencing health status and contact

with health service and the classification

of external causes of injury and

poisoning. See related International

Classification of Diseases.

Late fetal death rate—See Rate:

Death and related rates.

Life expectancy—Life expectancy

is the average number of years of life

remaining to a person at a particular age

and is based on a given set of

age-specific death rates, generally the

mortality conditions existing in the

period mentioned. Life expectancy may

be determined by race, sex, or other

characteristics, using age-specific death

rates for the population with that

characteristic. See related Rate: Death

and related rates.

Live birth—In 1967 the WHO

defined a live birth as the complete

expulsion or extraction from its mother

of a product of conception, irrespective

of the duration of the pregnancy, which,

after such separation, breathes or shows

any other evidence of life such as

heartbeat, umbilical cord pulsation, or

definite movement of voluntary muscles,

whether the umbilical cord has been cut

or the placenta is attached. Each product

of such a birth is considered live born.

The United Nations and NCHS also

adopted this definition at that time. The

Russian Federation adopted the

definition in 1993.

The classification of very preterm

births in Russia differs from the WHO

definition. Infants weighing less than

1,000 grams at birth, or less than 28

weeks gestation, or less than 35

centimeters birth length must survive 7

days to be reported as live births. If the

infant dies before completing the

seventh day of life, neither the live birth

nor the infant death is reported. See

related Rate: Birth and related rates;

Death and related rates.

Live-birth order—This item from

the birth certificate refers to the total

number of live births the mother has

had, including the present birth as

recorded on the birth certificate. Fetal

deaths are excluded. See related Live

birth.

Low birthweight—See Birthweight.

Marital status—Marital status is

classified into the categories of married

and unmarried. The term ‘‘married’’

encompasses all married people

including those separated from their

spouses. Unmarried includes those who

are single (never married), divorced, or

widowed.

Maternal mortality rate—See Rate:

Death and related rates.

National Center for Health

Statistics (NCHS)—The principal vital

and health statistics agency of the U.S.

Federal Government. NCHS is part of

the Centers for Disease Control and

Prevention (CDC), U.S. Department of

Health and Human Services.

Neonatal mortality rate—See Rate:

Death and related rates.

Notifiable disease—A notifiable

disease is one that, when diagnosed,

health providers are required, usually by

law, to report to State or local public

health officials. Notifiable diseases are

those of public interest by reason of

their contagiousness, severity, or

frequency.

Oblast—Administrative division

used in the Russian Federation. Russia

is divided into oblasts, or territories,

with a population ranging from half a

million to several million persons.

Perinatal mortality rate, ratio—See

Rate: Death and related rates.

Physician—In the United States,

physicians are licensed doctors of

medicine or osteopathy, as follows:

Active (or professionally active)

physicians—are currently practicing

medicine, regardless of the number of

hours worked per week.

Federal physicians—are employed

by the Federal Government; non-Federal

or civilian physicians are not.

Office-based physicians—spend the

plurality of their time working in

practices based in private offices.

Hospital-based physicians—spend

the plurality of their time as salaried

physicians in hospitals.

In the Russian Federation, a

physician is a person who received a

high medical education from a medical

institute or from the medical faculty of a

university and who has the legal right to

practice medicine. The term ‘‘physician’’

also includes sanitary-epidemiological,

dental, and physiotherapeutic

practitioners. Data from the Russian

Federation on numbers of physicians do

not distinguish between active and

nonactive physicians or interns and

residents in training.

Physician specialty—A physician

specialty is any specific branch of

medicine in which a physician may

concentrate. Data from the United States

are based on physician self-reports of

their primary area of specialty. Physician

data are broadly categorized into two

general areas of practice: generalists and

specialists. See related Physician.

Population—Census bureaus collect

and publish data on populations in the

Russian Federation and the United

States according to several different

definitions. Various statistical systems

then use the appropriate population for

calculating rates.

Resident population—is the

population living in a country. It

includes members of the military and

their families living in that country. It

excludes international military, naval,

and diplomatic personnel and their

families located in that country and

residing in embassies or similar quarters.
Series 5, No. 11 [ Page 55

Also excluded are international workers

and international students living in the

country and citizens living abroad. The

resident population is usually the

denominator when calculating birth and

death rates and incidence of disease.

Postneonatal mortality rate—See

Rate: Death and related rates.

Prevalence—Prevalence is the

number of cases of a disease, infected

persons, or persons with some other

attribute present during a particular

interval of time. It is often expressed as

a rate (for example, the prevalence of

diabetes per 1,000 persons during a

year). See related Incidence.

Procedure—A procedure is defined

as a surgical or nonsurgical operation,

diagnostic procedure, or special

treatment assigned by a physician and

recorded on the medical record of a

patient discharged from the inpatient

service of a short-stay hospital.

Procedures are classified as diagnostic

and other nonsurgical procedures, or as

surgical operations.

Rate—A rate is a measure of some

event, disease, or condition in relation to

a unit of population, along with some

specification of time.

Birth and related rates

Birth rate—is calculated by

dividing the number of live births in a

population in a given year by the

midyear resident population. It is

expressed as the number of live births

per 1,000 population. The rate may be

restricted to births to females of specific

age, race, marital status, or geographic

location (specific rate), or it may be

related to the entire population (crude

rate). See related Live birth.

Fertility rate—is the number of live

births per 1,000 females of reproductive

age, that is, 15–44 years.

Death and related rates

Death rate—is calculated by

dividing the number of deaths in a

population in a year by the midyear

resident population. (For census years in

the United States, rates are based on

populations as of April 1.) Death rates

are expressed as the number of deaths

per 1,000 or per 100,000 population.

The rate may be restricted to deaths in

specific age, race, sex, or geographic

groups or from specific causes of death

(specific rate) or it may be related to the

entire population (crude rate).

Fetal death rate—is the number of

fetal deaths with stated or presumed

gestation of 20 weeks or more divided

by the sum of live births plus fetal

deaths, stated per 1,000 live births plus

fetal deaths. Late fetal death rate or

stillbirth is the number of fetal deaths

with stated or presumed gestation of 28

weeks or more divided by the sum of

live births plus late fetal deaths, stated

per 1,000 live births plus late fetal

deaths. See related Fetal death.

Infant mortality rate—recommended

by the United Nations is calculated by

dividing the number of infant deaths

during a year by the number of live

births reported in the same year. It is

expressed as the number of infant deaths

per 1,000 live births. The infant

mortality rate used by Goskomstat of

Russia differs in terms of the

denominator: Rather than use the

number of live births in the same year,

Goskomstat uses a formula that is

roughly equal to the sum of one-third of

live births from the previous year plus

two-thirds of live births from the current

year. Because of this difference in

denominators, infant mortality rates for

Russia calculated according to the

Goskomstat formula will differ from

those based on the UN-recommended

infant mortality rate.

Neonatal mortality—rate is the

number of deaths of children under 28

days of age, per 1,000 live births.

Postneonatal mortality rate is the

number of deaths of children that occur

28–365 days after birth, per 1,000 live

births. See related Infant death.

Perinatal—relates to the period

surrounding the birth event. Rates and

ratios are based on events reported in a

calendar year. Perinatal mortality rate is

the sum of late fetal deaths plus infant

deaths within 7 days of birth, divided by

the sum of live births plus late fetal

deaths, stated per 1,000 live births plus

late fetal deaths. Perinatal mortality

ratio is the sum of late fetal deaths plus

infant deaths within 7 days of birth,

divided by the number of live births,

stated per 1,000 live births. See related

Fetal death; Infant death; Live birth.

Maternal death—is one for which

the certifying physician has designated a

maternal condition as the underlying

cause of death. Maternal conditions are

those assigned to complications of

pregnancy, childbirth, and the

puerperium. The maternal mortality

rate, which indicates the likelihood that

a pregnant female will die from

maternal causes, is the number of

maternal deaths per 1,000 live births.

The number of live births used in the

denominator is an approximation of the

population of pregnant females who are

at risk of a maternal death.

Rayon—Subdivision of Russian

oblast, or territory, ranging in size from

a few thousand persons in rural areas to

half a million persons or more in large

cities.

Resident population—See

Population.

Registered Nurse—In the United

States only, a registered nurse is an

individual who has completed one of the

following nurse training programs:

baccalaureate education, which requires

at least 4 years of college or university;

associate degree programs, which are

based in community colleges and are

usually 2 years long; and diploma

programs, which are based in hospitals

and are usually 3 years.

Stillbirth—See Rate: Death and

related rates.