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Suggested Citation

Notzon FC, Komarov YM, Korotkova AV, Ermakov SP, et al. Maternal and child

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

1985–95. National Center for Health Statistics. Vital Health Stat 5(10). 1999.

Library of Congress Cataloging-in-Publication Data

Maternal and child health statistics : Russian Federation and United States,

selected years 1985–95.

p. cm. — (DHHS publication ; no. (PHS) 99-1486) (Vital and health

statistics. Series 5, International vital and health statistics reports ; no. 10)

‘‘March 1999’’—Cover.

Includes bibliographical references.

ISBN 0-8406-0545-5

1. Maternal health services—Russia (Federation)—Statistics. 2. Infant

health services—Russia (Federation)—Statistics. 3. Maternal health

services—United States—Statistics. 4. Infant health services—United

States—Statistics. 5. Infants—Russia (Federation)—Mortality—Statistics. 6.

Pregnant women—Health and hygiene—Russia (Federation)—Statistics. 7.

Infants—United States—Mortality—Statistics. 8. Pregnant women—Health and

hygiene—United States—Statistics. 9. —Russia (Federation)—Statistics, Vital.

10. —Russia (Federation)—Statistics, Medical. 11. —United States—Statistics,

Vital. 12. —United States—Statistics, Medical. 13. Vital Statistics—Russia. I.

National Center for Health Statistics (U.S.) II. Series. III. Series: Vital and health

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no. 10.

[DNLM: 1. Maternal Welfare—Russia—statistics. 2. Maternal

Welfare—United States—statistics. 3. Child Welfare—Russia—statistics. 4.

Child Welfare—United States—Statistics. 5. Vital Statistics—United States. W2

A N148ve no. 10 1999]

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Printed on acid-free paper.
Maternal and Child Health

Statistics: Russian Federation

and United States, Selected

Years 1985–95

Series 5:

International Vital and Health

Statistics Reports

No. 10

Hyattsville, Maryland

March 1999

DHHS Publication No. (PHS) 99-1486

8-0310 (3/99)

Vital and

Health Statistics

U.S. DEPARTMENT OF HEALTH AND HUMAN SERVICES

Centers for Disease Control and Prevention

National Center for Health Statistics
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

Lester R. Curtin, Ph.D., Acting Associate Director for

Research and Methodology

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

Analysis, Epidemiology, and Health Promotion

Paul D. 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

Stephen E. Nieberding, Associate Director for Management

Charles J. Rothwell, Associate Director for Data Processing

and Services

Office of International Statistics

Jack R. Anderson, Acting Associate Director for

International Statistics

The Public Health Research Institute

‘‘MedSocEconomInform’’

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

Scientist of the Russian Federation, Director-General

V. F. Martynenko, Ph.D., Honorable Scientist of the Russian

Federation, Deputy Director-General for Informatics

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

Coordination and International Health
Preface

This report is the second in a series

providing comparative vital and health

statistics data for the Russian Federation

and the United States. The publication is

a joint effort by the National Center for

Health Statistics of the Centers for

Disease Control and Prevention in the

United States and the Public Health

Institute, MedSocEconomInform,

Ministry of Health of the Russian

Federation.

The focus of the current report is on

maternal and child health statistics in

the two countries. Using tables, figures,

and commentary, this report makes

available information on a broad range

of health measures for mothers, infants,

children, and adolescents in the Russian

Federation and the United States. The

data are presented in a comparative

format to enhance the reader’s

understanding of maternal and child

health status in both countries. The

report includes a discussion of data

quality issues to assist the reader in

understanding limitations in the

accuracy, coverage, or comparability of

the information presented. A background

section provides a brief description of

the organization of each country’s health

care system, as well as an outline of

national guidelines for the provision of

maternal and child health care.

This report contains 24 tables

covering population size, prenatal and

obstetrical care, abortions, natality data,

breastfeeding practices, mortality data

including leading causes of death,

immunization rates, communicable

diseases, and other morbidity measures.

Data are provided for selected years

from 1985 to 1995, with the focus on

the 1990’s. The report provides

additional detail, when available, for key

subgroups of each population: In the

Russian Federation, data are presented

for urban and rural regions; in the

United States, for black and white racial

groups. In the final section of the report,

a glossary of terms provides additional

detail on differences in definitions

between the two countries.

The complete report is available as

an Acrobat.pdf file on the Internet

through the NCHS home page on the

World Wide Web. The direct Uniform

Locator Code (URL) address is:

www.cdc.gov/nchswww/

For answers to questions about this

report, contact:

Data Dissemination Branch

National Center for Health Statistics

Centers for Disease Control and

Prevention

6525 Belcrest Road, Room 1064

Hyattsville, Maryland 20782

phone: 301–436-8500

E-mail: nchsquery@cdc.gov

iii
Foreword by Yuri M.

Komarov

Once again, it is my privilege to

introduce a joint report of the National

Center for Health Statistics of the

United States and the Public Health

Institute, MedSocEconomInform, of the

Russian Federation. The cooperation

between these two well-known and

respected organizations began in 1993

and continues now within the

framework of the Gore-Chernomyrdin

Commission.

The first report, Vital and Health

Statistics: Russian Federation and

United States, Selected Years 1980–93,

took 2 years to prepare and was widely

disseminated after its 1995 publication.

The task of assembling comparative data

required creativity because the records

systems, definitions, criteria, and

methods of calculation and analysis

differed substantially between the

countries. Many health care indicators

were measured differently, making

standardization and comparison difficult.

Therefore, this report contains not only

presentations of data but also

explanations of the comparative analysis

process.

In Russia, the medical-demographic

picture of health in recent years is

complicated. At the beginning of 1997,

the Russian population was 147.5

million (data supplied from

Goskomstat), a decline of 0.5 million

from 1996. The number of deaths was

1.6 times higher than the number of

births during the first 11 months of

1997, as in 1995–96. Seventy-two of

Russia’s 89 regions experienced natural

population loss in 1997, and in 25 of

them, the number of deaths was 2–3

times the number of births.

The trend of declining numbers of

births continued in 1997. Nationwide,

approximately 1,158,900 births occurred

between January and November of

1997, which is 3.6 percent less than the

same period in 1996. The average

number of newborns per 100 women

was about 126 (for simple replacement

of the population, this rate must not be

lower than 215).

The reproductive health of women

in Russia is greatly affected by the lack

of reliable contraceptives. Although the

number of induced abortions is

declining, the birth/abortion ratio (1:2)

is almost unchanged. Because the

prevention of unwanted pregnancy and

its complications can greatly influence

maternal mortality, government

programs to improve access to family

planning need to be strengthened.

Data for 1995–96 and the first 9

months of 1997 indicate an increase in

the number of marriages and a decrease

in the number of divorces. From January

to September of 1997, the number of

divorces per 1,000 marriages declined

from 642 to 574, compared with the

same time period of the previous year.

It is important to note the

improvement in mortality in Russia

since 1995. The number of deaths per

1,000 population decreased from 15.7 in

1994 to 14.2 in 1996. For the first 9

months of 1997, this indicator was 13.9

but this mortality rate continues to be

one of the highest in Europe. The

decrease in mortality in 1995–97

occurred in all the main cause-of-death

categories, particularly deaths from

accidents, poisonings, and injuries.

During 1994–96 mortality from

circulatory diseases declined by

9.1 percent; from accidents, poisonings,

and injuries, by 17.0 percent (among

these, alcohol poisoning by 39.4

percent, suicide by 6.2 percent, and

homicide by 18.1 percent); and from

respiratory diseases, by 14.5 percent.

Data for 1997 confirm this trend.

The extremely high mortality rate

for working-age men (16–59 years) is

2.5–5.0 times higher in Russia than in

the West European countries, the United

States, and Japan. If this rate continues,

only one-half of males that are now age

16 will survive to age 60.

Infant mortality is declining slowly

(in 1996, by 6 percent; in 1995, by 3

percent). The 1996 level was 17.4 per

1,000 live births, a rate 3–4 times higher

than in other developed countries. The

decline of infant mortality rates since

1993 reflects not only the economic

improvement in Russia but also the

increased commitment to addressing this

problem at both the State (oblast) and

local levels. Much has already been

done to improve the quality of maternal

and child health care, and

MedSocEconomInform analysts estimate

that infant mortality in 1997 will be

16.9 per 1,000, and in 1998 will

decrease to 16.5 per 1,000. Compared

with other countries, there are

considerable declines in infant deaths.

Although diseases of the perinatal

period and congenital abnormalities are

the cause of 67 percent of all child

deaths, other causes of death may be

more likely sources for future reductions

in infant mortality. For example,

although the infant mortality rate is

three times higher in Russia than in

Germany, differentials are much higher

for certain causes of infant death: 2.3

times higher in Russia for congenital

malformations, 2.3 times higher for

conditions of the perinatal period, 7.1

times higher for injuries and poisonings,

18.8 times higher for infections, 27.3

times higher for respiratory diseases,

and 48.9 times higher for pneumonia.

These differentials point to potentially

preventable infant deaths in Russia.

Maternal mortality rates in Russia

during 1990–95 showed a small increase

of 11.3 percent (from 47.4 to 53.3 per

100,000 live births). From 1995 to

1996, maternal mortality declined

8.3 percent, and it is estimated that the

1997 rate will be 48.6.

MedSocEconomInform analysts forecast

that the maternal mortality rate in 1998

will be about 47.5 per 100,000 live

births, but it is necessary to remember

that the recent decline in the number of

births influences this rate. Russian

experts believe that the main cause of

the reduction in maternal mortality is

the decline in the number of deaths

from abortions and pregnancy

complications.

After a long period of decline in

life expectancy in Russia, some

improvement has been noticed since

1995. The 1996 figure for men increased

to 58.9 years (from 57.6 in 1994) and

for women to 72.5 years (from 71.2 in

1994). The considerable gap in life

expectancy (12.7 years) between genders

remains, but available data for 1997

iv
indicate an improvement in life

expectancy to 66.9 years (average for

both sexes), and to 61.0 years for men

and to 73.1 for women. This trend is

expected to continue in 1998.

We hope that this report, which on

the Russian side included the

participation of the Administration for

Maternal and Child Health Protection,

will prove useful and we are ready to

consider any notes and suggestions

concerning this work.

Our work with NCHS continues in

several directions: (1) improvement and

experimental application of certificate of

birth, certificate of death, and certificate

of infant death reporting; (2) further

development of computer programs for

training in the use of the International

Classification of Diseases, Tenth

Revision (ICD–10); and (3) continued

development of computer systems for

the coding of the underlying cause of

death.

This report is devoted to some of

the most pressing problems of health

and health care. During the development

of this publication, specialists from both

countries have come to understand each

other better and enrich themselves with

new knowledge and ideas. We express

sincere gratitude to the director and staff

of NCHS for their invaluable

contribution to the cooperation between

our organizations in the preparation of

this publication.

Professor Yuri M. Komarov, M.D.,

Ph.D., D.Sc.

Distinguished Scientist of the Russian

Federation

Director General, Public Health

Research Institute

MedSocEconomInform (Russia)

v
Foreword by

Edward J. Sondik

Since 1993 the National Center for

Health Statistics (NCHS), Centers for

Disease Control and Prevention (CDC),

of the United States and the Public

Health Institute (MedSocEconomInform)

of the Russian Federation have pursued

an active program of cooperation in

health statistics. Initially through a

memorandum of understanding between

the two agencies and later as a part of

the binational Gore-Chernomyrdin

Commission, our two organizations have

sought to share information, improve the

quality and comparability of our health

data, and publish joint reports.

In the area of joint reports, our

intention is to publish both broad

overviews of health data in the two

countries and reports focusing on

specific topics of mutual interest. The

first report, published in 1995, provided

comparative vital and health statistics

data on a wide range of topics. The

current publication, the second in the

series, falls into the category of a

special topic report, in this case

providing data on maternal and child

health status in both nations.

It is appropriate that maternal and

child health should be the subject of our

first special topic report, as the future of

both our countries literally depends on

the well-being of both mothers and

children. Our ability to ensure the best

outcomes for our mothers and children

depends in turn on our access to timely,

accurate, and complete information on

their condition. This report provides

comparable data on mothers’ health

during pregnancy and delivery, on

childhood illness and causes of death,

and other subjects. It certainly cannot

provide information on every aspect of

maternal and child health, but by

providing a snapshot of what we know

and what we can compare between our

two nations, this publication presents a

challenge to the statistical agencies of

both countries to do better.

The data contained in this report

show generally positive trends in

maternal and child health measures

during the first half of the 1990’s.

Preliminary data for 1996 indicate

continued improvement for most

measures. For example, the teenage

birth rate declined 4 percent from 1995

to 1996, continuing a consistent decline

that began in 1991. The proportion of

women initiating prenatal care in the

first trimester of pregnancy rose to 82

percent in 1996, with increases reported

for all major racial and ethnic groups.

The infant mortality rate fell by over 5

percent, from 7.6 in 1995 to 7.2 in

1996. Reductions in childhood death

rates also were reported in 1996. Not all

of the changes were positive, however:

the percentage of births to unmarried

women rose slightly, to 32.4 percent in

1996, and the low birth weight rate rose

to 7.4 percent, from 7.3 percent in 1995.

In addition to maternal and child

health, NCHS and

MedSocEconomInform will continue to

cooperate in several other areas under

the general heading of health statistics.

In the area of joint reports, we intend to

update our general report on vital and

health statistics at regular intervals and

to publish other reports on topics of

mutual interest. NCHS is assisting

MedSocEconomInform with the

evaluation and revision of the statistical

content of birth and death certificates

used in the Russian Federation. Both

agencies are engaged in a program to

begin the use of the International

Classification of Diseases (ICD), 10th

Revision, in the Russian Federation

through the development of electronic

training software and the organization of

ICD training courses.

MedSocEconomInform is an active

participant in the NCHS-sponsored

International Collaborative Effort on the

Automation of Mortality Statistics.

Finally, both organizations intend to

conduct other collaborative projects as

the need arises and to continue to

engage in scientific exchange programs.

We wish to thank the National Institute

of Child Health and Human

Development, National Institutes of

Health, and the Office of Global Health,

CDC, for their financial and technical

assistance to several of these activities.

We would like to express our

gratitude to our colleagues at

MedSocEconomInform for all of their

contributions to our joint projects. It has

been a pleasure to work with them on

all of these activities. We believe that

this cooperation has been mutually

beneficial, and it is our sincere hope that

it will continue into the future.

Edward J. Sondik, Ph.D.

Director

National Center for Health Statistics

vi
Contents

Preface . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . iii

Foreword by Yuri M. Komarov . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . iv

Foreword by Edward J. Sondik . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . vi

Introduction............................................................................................. 1

Background ............................................................................................. 1

Health Care System of the Russian Federation............................................................... 1

Health Care System of the United States ................................................................... 4

Prenatal Care............................................................................................ 9

Complications of Pregnancy . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 10

Abortions. . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 11

Method of Delivery . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 12

Birth Order . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 13

Births to Unmarried Women . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 14

Births by Age of Mother . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 15

Infant Mortality. . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 16

Maternal Mortality . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 17

Childhood Mortality: 1–4 Years of Age . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 18

Childhood Mortality: 5–9 Years of Age . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 19

Childhood Mortality: 10–14 Years of Age . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 20

Childhood Mortality: 15–19 Years of Age . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 21

Immunizations. . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 22

Morbidity in the Russian Federation . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 23

Hospitalization in the United States . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 24

Communicable Diseases in the Russian Federation . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 25

Communicable Diseases in the United States. . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 26

Detailed Tables . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 27

Appendix. . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 54

Glossary . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 54

Figures

1. Percent of women receiving prenatal care: Russian Federation and United States, 1995........................... 9

2. Rates of selected complications of pregnancy: Russian Federation and United States, 1995. . . . . . . . . . . . . . . . . . . . . . . 10

3. Rates of abortion: Russian Federation and United States, 1995. . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 11

4. Rates of cesarean section delivery: Russian Federation and United States, 1990–95 . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 12

5. Percent distribution of live births, according to birth order: Russian Federation and United States, 1995 . . . . . . . . . . . . 13

vii
6. Percent of births to unmarried women: Russian Federation and United States, 1995. . . . . . . . . . . . . . . . . . . . . . . . . . . . . 14

7. Age-specific birth rates: Russian Federation and United States, 1995 . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 15

8. Infant mortality rates: Russian Federation and United States, 1990–95. . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 16

9. Rates of maternal mortality: Russian Federation and United States, 1995 . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 17

10. Rates of mortality for children 1–4 years of age, by cause: Russian Federation and United States, 1995 . . . . . . . . . . . . 18

11. Rates of mortality for children 5–9 years of age, by cause: Russian Federation and United States, 1995 . . . . . . . . . . . . 19

12. Rates of mortality for children 10–14 years of age, by cause: Russian Federation and United States, 1995 . . . . . . . . . . 20

13. Rates of mortality for children 15–19 years of age, by cause: Russian Federation and United States, 1995 . . . . . . . . . . 21

14. Rates of immunization coverage: Russian Federation and United States, 1995 . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 22

15. Rates of childhood morbidity, by disease: Russian Federation, 1995 . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 23

16. Hospital discharge rates, by diagnosis and age: United States, 1995. . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 24

17. Communicable disease rates, by age group and disease: Russian Federation, 1995 . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 25

18. Communicable disease rates, by age group and disease: United States, 1995 . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 26

Detailed Tables

1. Resident population by age and sex: Russian Federation and United States, selected years 1985–95 . . . . . . . . . . . . . . . 27

2. Percent of mothers beginning prenatal care in the first trimester and percent with late or no care: Russian Federation

and United States, selected years 1985–95 . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 29

3. Rates of live birth with selected medical risk factors: Russian Federation and the United States, selected years

1985–95 . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 29

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

selected years 1985–95 . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 30

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

selected years 1985–95 . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 31

6. Number and rate of births, by method of delivery: Russian Federation and United States, selected years 1985–95 . . . 31

7. Rate of live births, by complication of labor and delivery: Russian Federation and United States, selected years

1985–95 . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 32

8. Number and percent distribution of live births, according to birthweight: Russian Federation and United States,

selected years 1985–95 . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 32

9. Number and percent distribution of live births, according to urban-rural region, race, and birth order: Russian

Federation and United States, selected years 1985–95 . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 33

10. Number and percent of live births to unmarried mothers, by urban-rural region or race: Russian Federation and

United States, selected years 1985–95 . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 34

11. Rate of live births, by age of mother: Russian Federation and United States, selected years 1985–95 . . . . . . . . . . . . . . 35

12. Childhood death rates from all causes, by age, sex, urban-rural region, or race: Russian Federation and United States,

selected years 1985–95 . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 36

13. Infant mortality rates, by age at death: Russian Federation and United States, selected years 1985–95 . . . . . . . . . . . . . 38

14. Infant mortality rates per 100,000 live births, by sex and selected causes: Russian Federation and United States,

1990–95 . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 39

15. Maternal mortality rates, by cause of death: Russian Federation, selected years 1985–95 . . . . . . . . . . . . . . . . . . . . . . . . 40

16. Percent of children breastfed, by selected characteristics: Russian Federation and United States, selected years

1985–95 . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 41

17. Mortality rates per 100,000 population 1–4 years of age, by cause and sex: Russian Federation and United States,

1990–95 . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 42

18. Mortality rates per 100,000 population 5–9 years of age, by cause and sex: Russian Federation and United States,

1990–95 . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 44

19. Mortality rates per 100,000 population 10–14 years of age, by cause and sex: Russian Federation and United States,

1990–95 . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 46

20. Mortality rates per 100,000 population 15–19 years of age, by cause and sex: Russian Federation and United States,

1990–95 . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 48

21. Immunization coverage: Russian Federation and United States, selected years 1987–95 . . . . . . . . . . . . . . . . . . . . . . . . . 49

22. Childhood morbidity rates per 100,000 population: Russian Federation, 1990–95 . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 50

23. Hospital discharge rates per 100,000 population, by diagnosis and age: United States, 1990–95 . . . . . . . . . . . . . . . . . . 51

24. Rates of selected notifiable diseases, by type of disease and age group: Russian Federation and United States,

1990–95 . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 53

viii
This report provides comparative

maternal and child health data for

recent years for the Russian Federation

and the United States. Statistical data

for Russia are from the Ministry of

Health of Russia and from Goskomstat,

the central statistical organization of

Russia. Information for the United

States comes from various data

systems of the National Center for

Health Statistics as well as other parts

of the Department of Health and

Human Services.

A background section provides a

description of each country’s health

care system and national guidelines for

maternal and child health care. This

information is intended to assist the

reader in interpreting the subsequent

sections on various aspects of maternal

and child health.

The report uses tables, figures, and

commentary to present information on

many different health measures for

mothers, infants, children, and

adolescents in the two countries. Topics

covered include population size,

prenatal and obstetrical care, abortions,

natality, breastfeeding, mortality,

immunization, communicable diseases,

and other morbidity measures. The

commentary includes a discussion of

data quality issues that affect the

accuracy and comparability of the

information presented. Data are

provided for selected years from 1985

to 1995. When available, additional

detail is provided for key subgroups of

each population: for the Russian

Federation, urban and rural

populations; for the United States, black

and white racial groups. A glossary of

terms at the end of the report provides

additional information on definitions and

data sources and limitations.

Keywords: maternal and child

health c United States c Russia c

fertility c mortality c infant mortality c

morbidity c prenatal care c abortion c

immunization c communicable

diseases

Maternal and Child Health

Statistics: Russian Federation

and United States, Selected

Years 1985–95

by Francis C. Notzon, Ph.D., Offıce of International Statistics; Yuri

M. Komarov, M.D., Ph.D., D.Sc., Anna V. Korotkova, Ph.D., Sergei P.

Ermakov, Ph.D., D.Sc., Alexei I. Savinykh, M.D., Elena Sharapova,

M.D., Ph.D., D.Sc., Public Health Institute, MedSocEconomInform,

Ministry of Health of Russia; Dina I. Zelinskaya, M.D., Ph.D., D.Sc.,

Administration for Maternal and Child Health Protection, Ministry of

Health of Russia; Tracy L. Armstrong, Ph.D., Offıce of International

Statistics; Michele Kiely, Dr.P.H., Maternal and Child Health Bureau,

Health Resources and Services Administration.

Introduction

Maternal and child health is

essential to the well-being and

future growth of all nations.

This is certainly true of the Russian

Federation and the United States, both

of which maintain active maternal and

child health programs. Our objective in

this report is to provide a snapshot of a

broad range of maternal and child health

measures and trends in both countries in

as comparable a fashion as possible, to

provide information on the current status

and recent changes in maternal and

child health, and to facilitate

cross-country comparisions. We have

attempted to enhance data comparability

by limiting the information presented to

variables with comparable definitions

and categories. Where this is not

possible, we have documented the

differences in comparability. For

example, data on mortality by cause

includes ICD codes for each cause of

death to enhance the comparability of

mortality data and to alert the reader to

limitations in comparability for certain

causes of death. Finally, the report

provides a basic description of each

nation’s health care system and

guidelines for maternal and child health

care. The system information is intended

particularly for readers with limited

knowledge of the health care system in

one or both countries.

Background

Health Care System of the

Russian Federation

The provision of health care in the

Russian Federation is primarily a

government responsibility, as it was in

the era of the Soviet Union. However,

important changes have occurred,

particularly efforts to gradually change

the method of financing health care

from a system of government allocation

of funds to a system based on employer

contributions. Despite these changes in

Page 1

The authors gratefully acknowledge the review and very helpful suggestions provided by Marian Willinger,

M.D., National Institute for Child Health and Human Development, National Institutes of Health; and Kate

Rickard, Ph.D., and others of the Agency for Health Care Policy and Research. The report was edited by

Gail Johnson and typeset by Annette F. Holman and Margaret C. Avery, graphics were produced by Jarmila

Ogburn and Dorothy Day, and printing managed by Joan Burton and Patricia Wilson of the Publications

Branch, Division of Data Services.
financing, the overall responsibility for

health care continues to reside in the

central government, in terms of the

provision of care, the establishment of

norms and standards for care, and the

maintenance of the necessary health

infrastructure. Although a limited

number of private practice physicians

and private hospitals have appeared in

recent years, mostly in major cities, a

central objective of the health care

system continues to be the assurance of

universal access to care.

The Ministry of Health is the most

important provider of health care in the

Russian Federation. Other providers do

exist, however, including the Ministry of

Defense, Ministry of Transport, and

other government organizations, as well

as a small private sector. The description

provided in this section focuses mainly

on the health care system of the

Ministry of Health.

The organization of health care

within the Russian Federation is based

on the administrative divisions of the

country. The nation is divided into

oblasts (territories), each with half a

million to several million people. Each

oblast is in turn divided into urban and

rural rayons, with populations ranging

from a few thousand in rural areas to

half a million or more in large cities.

Rayons are divided into smaller

uchastocks (districts) for the

organization of care within the rayons.

In urban areas, polyclinics serve as

the central source of primary care.

Separate polyclinics provide care for

adults, children, and industrial workers,

as well as women’s consultation clinics

for obstetric and maternity care. The

area served by the polyclinic is divided

into uchastocks, each served by a

physician who provides treatment and/or

referral to specialists within the

polyclinic or to hospital-based

specialists. Depending on the type of

polyclinic concerned, an uchastock

physician serves one of the following

populations: an adult population of

2,000, a child population of 800–1,000,

or a factory or group of factories with

2,000 workers.

Because rural populations are much

more dispersed, paramedical personnel

are the first point of contact with the

health system in these areas. Most

villages and collective farms have

feldsher-midwife posts to provide first

aid, treat minor illnesses, administer

immunizations, and improve sanitation

and hygiene. The feldsher (similar to a

physician assistant) and midwife are

supervised by a physician from the rural

hospital. Serious illnesses can be

referred to rural hospitals or to more

specialized hospitals at the rayon or

oblast level.

The Russian Federation has a large

number of health facilities, almost all

publicly owned. In 1993 there were

12,500 hospitals of all types, with a

total of 1.9 million beds, or 13 beds per

1,000 population. Hospitals in Russia

are organized according to the regional

system of health services. The smallest

general hospitals (25–150 beds) serve

the rural (uchastock) areas with an

average population of 4,000. The largest

village in each rural area has a larger

rural hospital (50–250 beds) with an

outpatient clinic. Rayon central

hospitals, located in the central city of

each rayon, have 150–750 beds,

numerous specialties, and an outpatient

clinic, and serve 40,000–150,000 people.

The oblast central hospital (800–2,000

beds) is located in the largest city of the

oblast and has a full range of specialties

as well as outpatient consulting. The

central oblast hospital serves a

population of 400,000 to 5 million

people. There are also oblast specialty

hospitals in the central city of the oblast,

for such areas as pediatrics, psychiatric

care, oncology, tuberculosis, sexually

transmitted diseases, and others. In

addition to the Ministry of Health oblast

specialty hospitals, the central city of

each oblast has its own specialty

hospitals as well.

Other groups and government

ministries operate their own health

facilities, separate from the polyclinics

and hospitals of the Ministry of Health.

Industrial enterprises operate their own

clinics for workers as well as their own

hospitals and sanatoria. As mentioned

earlier, the Ministry of Defense,

Ministry of Transport, and others also

operate their own systems of health

care. Some of these facilities offer a

higher level of care than the facilities of

the Ministry of Health.

As the large number of hospitals

and beds indicates, the Russian health

care system is very hospital-centered.

There is a high rate of hospitalization

(206 discharges per 1,000 population in

1996) and a long average length of stay

(16.9 days in 1996). Both of these

measures are higher than most

industrialized countries and substantially

higher than those of the United States.

The dependence on hospital-based care

makes Russian health care relatively

expensive.

The Russian health care system also

relies on a large number of physicians

and other health care workers. In 1996

there were more than 600,000

physicians in Russia, or about 409 per

100,000 population. Although this is

almost twice the active

physician-to-population ratio of the

United States, the Russian definition

includes many categories not included in

the United States, such as dentists,

nonactive physicians, and

physiotherapists. Since 1995, dentists

have been excluded from the physician

category and are counted as mid-level

medical personnel. Russian physicians

tend to be highly specialized, as in the

United States. In the Russian Federation,

there are 83 different physician

specialties. About one-quarter of Russian

physicians were general family practice

or internal medicine practitioners in

1993, compared with about one-third of

non-Federal office-based physicians in

the United States. Recently, the training

of general practitioners has begun in the

Russian Federation. At present, there are

640 such general practitioners in Russia.

The Russian system also relies on a

large number of paramedical personnel,

particularly feldshers and midwives in

rural areas.

The education of Russian physicians

is entirely government controlled, with

all medical schools following a standard

curriculum established by the Ministry

of Health in cooperation with the

Ministry of Education. Medical

education takes 6 years, plus a 1-year

internship. Previously, interns were sent

to different areas of the country

according to the need for physicians and

the preferences of the graduate. After

completing the internship, the physician

served 3 years of compulsory service,

Page 2 [ Series 5, No. 10
usually in the same area as the

internship.

The financing of the Russian health

care system is in transition at present.

The system inherited from the Soviets

was completely financed with revenues

from the central and territorial (oblast)

governments. Reform of the health care

system began in the early 1990’s, based

on a transition to a payroll-tax-based

system known as the Mandatory Health

Insurance Fund (MHIF). The Health

Insurance Act of 1991 identifies two

sources of revenue for the health care

system: first, employer contributions to

the territorial MHIF and Federal MHIF,

equivalent to 3.2 and 0.4 percent of

payroll, respectively; second, local

government contributions to the

territorial MHIF’s for the nonworking

population and direct financing of

various health programs. Each of the 88

territories has its own separate territorial

MHIF. The territorial fund acts as a

third party to purchase health care and

form contractual relationships with

public and private hospitals and

polyclinics. The objective is to enhance

quality of care and ensure consumer

protection by allowing competition.

To date this transition has had some

success but still faces many challenges.

The serious economic decline in Russia

during the 1990’s has reduced funding

for the health care system. Another

problem is the continuing need to

address structural distortions in the

health care system. Further modification

of the MHIF model may be required to

ensure the success of health reform in

Russia.

Maternal and Child Health

Practice Guidelines of the

Russian Federation

Guidelines for Prenatal Care

Prenatal care in the Russian

Federation is covered by basic medical

insurance and as such is free to all

women. The standards for obstetric care

involve a comprehensive baseline

assessment of the pregnant woman’s

health status, a determination of risk

factors that will require special care

during pregnancy or delivery, and

continued surveillance of health status

and risk factors throughout the

pregnancy. Standard prenatal care for

routine pregnancies requires an average

of 14 prenatal care visits, as follows:

+ Before 12 weeks: monthly visits

+ From 12 to 30 weeks: visits every 2

weeks

+ From 30 weeks to delivery: visits

every 1–2 weeks

The first prenatal care visit should

include obtaining a medical history of

the woman and her family, focusing on

risk factors for the pregnancy and

delivery, and on genetic disorders that

may affect the fetus. A comprehensive

physical examination should be

conducted, including recording of

weight, height, and other anthropometric

measures, measurement of blood

pressure, urinalysis, basic blood tests,

ultrasound, electrocardiogram, and tests

for various types of infections. The visit

should also include an assessment of

behavioral risk factors, including the use

of tobacco and alcohol as well as illegal

drugs. Information should be collected

on the woman’s circumstances,

including her residence, place of

employment, type of employment,

education, and marital status. Any

woman working in dangerous conditions

is given a letter for her employers

requesting that the employer modify her

work conditions. Finally, the pregnant

woman must visit the following

specialists: general practitioner (internal

medicine); dentist; ophthalmologist;

otolaryngologist; and other specialists as

needed for chronic diseases such as

diabetes, hypertension, and so on.

All followup visits include a

physical examination, recording of

weight, measurement of blood pressure,

and basic blood tests. An ultrasound

procedure is carried out at the first visit,

at 16–28 weeks, and at 36 weeks of

gestation. Twice during pregnancy,

blood tests are conducted for human

immunodeficiency virus (HIV), Rh type

determination, hepatitis B, and specific

antibodies for herpes, toxoplasmosis,

and others. General tests for infections

are also performed during pregnancy. In

urban areas women are subjected to

complete testing for infections; in rural

areas the testing is selective, depending

on the equipment available. Women at

Immunization schedule, Russian Federation

Age Vaccine

4–7 days . . . . . . . . . . . . . . . . . . . . . . BCG1 or BCG-M

3 months . . . . . . . . . . . . . . . . . . . . . . DTP2

, OPV3

4 months . . . . . . . . . . . . . . . . . . . . . . DTP, OPV

5 months . . . . . . . . . . . . . . . . . . . . . . DTP, OPV

12–15 months ................... Measles, mumps, rubella4

18 months . . . . . . . . . . . . . . . . . . . . . DTP, OPV (one dose)

24 months . . . . . . . . . . . . . . . . . . . . . OPV (one dose)

6 years . . . . . . . . . . . . . . . . . . . . . . . dTP, OPV; measles, mumps, rubella4

7 years . . . . . . . . . . . . . . . . . . . . . . . BCG5

11 years ....................... d

14 years . . . . . . . . . . . . . . . . . . . . . . . BCG6

16–17 years . . . . . . . . . . . . . . . . . . . . dT

Adults . . . . . . . . . . . . . . . . . . . . . . . . dT (one dose every 10 years)

1Tuberculosis vaccine.

2Diphtheria, tetanus, pertussis vaccine.

3Oral polio vaccine.

4Measles, mumps, rubella used as single antigens or as combined vaccine (MMR) with locally produced preparations or imported

preparations registered appropriately.

5Children not infected with tuberculosis should be immunized.

6Children not infected with tuberculosis and not immunized at 7 years should be immunized.

Hepatitis B vaccine schedule, Russian Federation

Dose Age (Schedule I) Age (Schedule II)

1st dose ................ Within 24 hours of birth (prior to BCG1

) 4–5 months

2nd dose ............... 1 month 5–6 months

3rd dose . . . . . . . . . . . . . . . . 5–6 months 12–13 months

1Tuberculosis vaccine.

Series 5, No. 10 [ Page 3
high risk of diabetes are tested at

intervals throughout the pregnancy, with

the frequency of testing dependent on

the level of risk.

Guidelines for Health Supervision of

Infants, Children, and Adolescents

Infant care involves both physicians

and nurses and includes both polyclinic

and home visits. For uncomplicated

deliveries the mother and child typically

remain in the hospital for 5–7 days

following delivery. The first doctor and

nurse visit is in the mother’s home,

taking place within a few days of

hospital discharge. The visit involves a

physical examination and an evaluation

of the newborn’s developmental

abilities. If the child is normal, the nurse

will continue to make weekly home

visits for the first month. For children

who are ill, the doctor will make home

visits as required during the first month

following birth.

Following the first month of life,

standard infant care continues to involve

visits with both physicians and nurses.

Normal children and their mothers must

visit the physician at the polyclinic at 1,

3, 6, 9, and 12 months of age for

physical examinations, routine

measurements, and administration of

immunizations as required. Nurses make

two additional home visits when the

infant is 2 months and 3 months of age.

Nurses also call mothers who do not

complete their polyclinic visits

according to the prescribed schedule, to

encourage them to visit the polyclinic

and to collect information on the child’s

health.

Routine care of children beyond 1

year of age does not involve a specific

schedule of visits, with the exception of

visits to receive required immunizations

(see the schedule of required

immunizations provided in the box

above). As required, the polyclinic nurse

calls the mother to remind her to bring

the child to the polyclinic for

immunization. At the time of the visit,

the child also receives a physical

examination, including measurement of

height, weight, and temperature, and

collection of blood and urine samples.

Other visits to the polyclinic are made

as needed.

Sources

Klugman K, Scheiber G. Health reform in

Russian and central Asia. Paper presented at:

National Academy of Sciences Conference

on the New Independent States. September

19–20, 1996.

Komarov YM, Yienonen M. Health reform

in the Russian Federation. In: New World

Health, pp. 28–30. 1997.

Raffel NK. Health services in the Union of

Soviet Socialist Republics. In: Raffel MW,

ed. Comparative Health Systems. University

Park, Pennsylvania: Pennsylvania University

Press. 1984.

Health Care System of the

United States

The U.S. health care system

encompasses a multitude of public and

private arrangements for the financing

and delivery of health care. The system

relies heavily on the provision of

payment for medical care through public

or private insurance. Regardless of the

type of insurance coverage, most

patients obtain health services directly

from privately employed physicians,

nurses, or other clinical practitioners

with only modest government oversight.

The health care system encompasses

a large number and variety of health

workers, with physicians often serving

as the primary decision makers. The

supply of physicians has grown rapidly

in recent years, with the ratio of

physicians per 100,000 population rising

from 153 in 1975 to 242 in 1995. The

level of specialization is higher in the

United States than in many other

countries but is similar to the degree of

specialization in Russia. Schools of

medicine and other professional schools

producing health personnel are

accredited by private organizations and

are not regulated by the Federal

Government, although graduates must be

licensed by the State in which they

intend to practice. About one-half of the

schools of medicine are State entities

with budgets and policies governed by

State legislatures.

About 23 percent of physicians

practicing in the United States obtained

their medical education at medical

schools outside the United States and

Canada. Many of these foreign medical

graduates are U.S. citizens. Most foreign

medical graduates, both those from the

United States and foreign nationals,

received their clinical training at U.S.

hospitals before entering practice.

Health facilities in the United States

may be either public or private

institutions. In 1994 there were 6,374

hospitals of all types in operation. The

largest category was short-stay general

hospitals, with 5,229 such hospitals

providing approximately 900,000 beds,

or 3.5 beds per 1,000 population. The

bulk of these hospitals were private,

almost three-quarters either voluntary

nonprofit or proprietary institutions in

1994. Most general hospitals have open

medical staffs, permitting physicians in

private practice to admit and treat

patients. Hospitals also operate their

own outpatient departments, including

emergency care departments, which

have become increasingly important

providers of general care in recent years.

Federal and State governments also

own or support hospitals. Four percent

of all hospitals are Federal and may be

either short- or long-term facilities that

provide care for several special groups,

including military personnel, veterans,

and reservation-based Native Americans.

Mental hospitals, which provide

long-term care, are mostly State

institutions. Local government hospitals,

which are primarily general hospitals,

are either small institutions in rural

areas or large facilities serving urban,

often inner-city poor populations.

Skilled nursing facilities (SNF’s)

provide long-term care for patients,

particularly the elderly, who require

nursing care but not the specialized

services available in hospitals. SNF’s

are primarily proprietary facilities and

are usually somewhat smaller than

general hospitals. In 1996 there were

about 16,800 SNF’s, with 1.8 million

beds.

Other health care facilities exist as

well in the United States, particularly a

variety of clinics providing ambulatory

care. The Federal Government provides

basic grants to support a national

network of more than 600 community

health centers, most of which also

derive operating revenue from State,

county, and local sources. State or local

governments also sponsor their own

Page 4 [ Series 5, No. 10
clinics for the provision of care to

low-income populations. Other clinics

provide care in schools or businesses or

are linked to public health agencies or

voluntary health organizations. An

increasing number are freestanding

proprietary clinics providing ambulatory

care on a for-profit basis.

The financing of health care in the

United States also is accomplished

through a combination of public and

private arrangements. Private health

insurance, obtained primarily through

employers with substantial cost-sharing

by employees, provided financing for

health care for 71 percent of Americans

under 65 years of age in 1995.

Medicaid, a Federal-State program to

finance care for poor and disabled

Americans, provided coverage for

11 percent of the population under 65

years of age. Health care for the elderly

is provided principally by the Federal

Medicare program, which provided basic

health insurance for 31.5 million persons

in 1995. More than 16 percent of the

population under age 65, about 39

million people, had no health insurance

coverage in 1995. Uninsured individuals

obtain access to health care through

out-of-pocket expenditures or by seeking

care at subsidized health facilities, such

as hospital emergency departments or

community health clinics.

The provision of health care in the

United States has become increasingly

costly over time. This has been the

result of many factors, including the

lack of cost controls on health spending,

the shift in financing from out-of-pocket

to health insurance arrangements and the

growing demand for better health,

among others. The result has been a

rising proportion of the gross domestic

product (GDP) devoted to the health

sector. In 1975 national health

expenditures represented 8 percent of the

GDP, whereas in 1995 health

expenditures accounted for 13.6 percent.

This proportion is significantly more

than that for other industrialized

countries.

Many aspects of the health care

system have undergone change in recent

years, largely in response to the rising

cost of medical care. The increasing

popularity of the concept of managed

care as a means to control health care

utilization and expenditures has had an

impact on many aspects of the system.

A major change has been the growing

popularity of health maintenance

organizations (HMO’s) and other

arrangements by which providers

contract to provide comprehensive

health care in exchange for fixed

capitated payments that do not vary with

the level or amount of services

provided. These arrangements are

distinguished from the traditional notion

of fee for service, providing an incentive

for preventive health care, reductions in

hospitalization rates and unnecessary

procedures, and more efficient use of

other providers and services. Managed

care also has accelerated an existing

trend among physicians to move from

solo to group practices. In addition to

the growth of HMO-type group

practices, many physicians in recent

years have joined physician provider

groups that offer services through

publicly and privately reimbursed health

plans. These plans do not have many of

the full management oversight practices

of HMO’s but do strive for more

efficient use of resources.

Cost-control measures have also

affected the supply and characteristics of

health personnel, the availability of

health facilities, and other aspects of the

health care system. The supply of

physicians will gradually level off in

future years, as fewer graduates of

foreign medical schools are allowed to

train and practice in the United States.

The growing use of primary physicians

in managed care organizations has led to

rising demand for general and family

physicians. Significant reductions in the

length of hospital stays and the growing

use of outpatient surgical procedures has

reduced demand for hospital beds,

which in turn has led to a reduction in

the number of hospitals and in the

supply of hospital beds.

As a result of these and other

changes, the proportion of GDP devoted

to health care remained essentially

unchanged between 1993 and 1995.

Actual expenditures on health continued

to grow, although at a slower pace.

However, continued upward pressure on

health expenditures from a variety of

sources is expected to continue in the

future. In the short run, consumer

reaction to the restrictive practices of

managed care may lead to legislation

limiting the ability of managed care

providers to restrict health services.

Further advances in medical technology

may fuel demand for additional, costly

services. The reactions of providers and

consumers to these forces may lead to

other major changes in the U.S. health

care system in the future.

Maternal and Child Health

Practice Guidelines of the

United States

Recommendations for health care

practice in the United States are

voluntary and are made by professional

health care associations, particularly

those associations whose members

specialize in that particular aspect of

health care, government agencies, and

health plans. In the area of maternal and

child health, two specialty professional

medical associations, the American

College of Obstetricians and

Gynecologists and the American

Academy of Pediatrics, in addition to

the American Medical Association and

numerous other professional

associations, have issued guidelines for

care. In addition, various government

agencies have issued guidelines (e.g.,

CDC issues guidelines for

immunization; the Department of

Agriculture issues nutrition guidelines

for pregnant and lactating women).

Periodic updates of the guidelines for

care are issued as required by changes

in medical knowledge and technology.

Guidelines for Prenatal Care

The American College of Obstetrics

and Gynecology recommends that

antepartum care focus on an evaluation

of the pregnant woman’s status and an

assessment of risk factors requiring

special antepartum or intrapartum care.

Prenatal care should begin as soon as

the pregnancy is confirmed, and for

women with uncomplicated pregnancies,

approximately 12–14 prenatal care visits

should take place according to the

following schedule:

+ Initial visit as soon as possible

following confirmation of pregnancy

+ Visits every 4 weeks during first 28

weeks of pregnancy

Series 5, No. 10 [ Page 5
+ Visits every 2–3 weeks until 36

weeks of gestation

+ Weekly visits thereafter until

delivery

Women with medical or obstetric

problems should be seen more

frequently, the number of visits and their

timing dependent on the nature and

severity of the problems.

The initial prenatal visit should

include a physical examination and the

collection of information from the

patient to establish an obstetric data

base. The information should include a

comprehensive health history for the

patient, a family and social history,

substance use, including alcohol,

tobacco, and illicit drugs, and the results

of the physical examination, laboratory

procedures, and risk assessment. As

soon as possible in the pregnancy, the

following laboratory tests should be

performed: hemoglobin or hematocrit;

urinalysis, including microscopic

examination or culture; blood group and

Rh type determination; rubella antibody

titer measurement; syphilis screening;

and cervical cytology. Additional

laboratory tests may be indicated by the

findings of the history, physical

examination, and initial tests. Additional

tests may include urine culture,

screening for diabetes or hepatitis B

virus, testing for sexually transmitted

diseases, and skin testing for

tuberculosis. The patient should be

offered a maternal serum alphafetoprotein screening for neural tube

defects in the fetus between 15 and 24

weeks of gestation. Patients should

receive HIV counseling and voluntary

testing.

At each followup visit, the physical

examination should include

measurement of blood pressure, weight,

fundal height, fetal heart rate, and, in

the later months of pregnancy,

assessment of fetal presentation. A

urinalysis for albumin and glucose also

should be performed at each visit.

Measurement of the hematocrit or

hemoglobin level should be repeated

early in the third trimester. Repeat tests

for sexually transmitted diseases should

be performed if the woman is in a

high-risk group. Unsensitized

Rh-negative women should have a

repeat antibody test at 28 weeks of

gestation. If the patient is still

unsensitized, she should receive Rho(D)

immunoglobulin prophylactically.

Various high-risk patients may be

counseled to undergo amniocentesis to

evaluate the fetus or assess the amniotic

fluid. Finally, prenatal diagnostic tests for

genetic disorders may be suggested based

on the results of antenatal screening.

The woman’s nutritional status

should be monitored throughout the

pregnancy. A vitamin-mineral

supplement should be given if the

woman’s dietary intake does not satisfy

the increased need for protein, iron,

folic acid, and other vitamins and

minerals during the pregnancy. Women

should be counseled on the benefits of

abstaining from alcohol and tobacco use

during pregnancy; consuming 0.4

milligrams per day of folic acid while

attempting pregnancy and in the first

trimester for prevention of neural tube

defects; and maintaining good control of

any preexisting medical conditions, such

as diabetes or hypertension. The patient

should be encouraged to maintain a

level of exercise appropriate to her

previous exercise conditioning and

pregnancy complications. The woman

and her family should be encouraged to

participate in childbirth education

classes.

Guidelines for Health Supervision of

Infants, Children, and Adolescents

In addition to guidelines issued by

the American Academy of Pediatrics, the

U.S. Preventive Services Task Force,

and the American Medical Association,

guidelines for the provision of health

services to children and their families

are provided by the Bright Futures

project, an activity of the Maternal and

Child Health Bureau (MCHB) of the

Health Resources and Services

Administration (HRSA). The guidelines

were developed by expert panels

involving representatives of numerous

professional medical associations,

including the American Academy of

Pediatrics. The guidelines developed by

this project have the support of these

medical associations as well as

voluntary health education organizations

and other groups.

The Bright Futures guidelines

provide broad-ranging assistance to the

physician to make health supervision

more comprehensive and intensive.

Although these guidelines involve

organizations beyond traditional medical

care, including dental care, early

intervention centers, mental health,

schools, family support centers, and

others, the guidelines provided here

focus on the medical aspects of health

supervision. The guidelines are

organized into four sections: infancy,

early childhood, middle childhood, and

adolescence.

Infancy (0–12 months)—Visits should

take place at the following ages:

prenatal, newborn (at hospital), 1 week,

1 month, 2 months, 4 months, 6 months,

and 9 months. Each visit should include

a physical examination, noting specific

factors such as jaundice (newborn),

strabismus (2 months), evidence of

abuse or neglect, and other factors, as

well as measurement of length, weight,

and head circumference. Visits should

also include age-appropriate discussions

with parents of infant nutrition,

lactation, home safety, and child care

arrangements. The health professional

should note developmental milestones

appropriate for the age, observe the

quality of parent-infant interaction, and

administer immunizations as indicated

on the schedule in this report. The

purpose of the prenatal visit is to initiate

and set the tone for the relationship

between the family and the health

professional.

Early childhood (1–5 years)—Visits

should take place at the following ages:

1 year, 15 months, 18 months, 2 years,

3 years, and 4 years. Each visit should

include a physical examination, noting

specific factors such as hip dysplasia (1

year), caries or other dental problems,

signs of abuse or neglect, and other

factors. The professional should record

length, weight, and weight for length on

a standard chart, and evaluate for

inadequate or excessive weight gain.

The health professional also should note

developmental milestones appropriate

for age and observe the quality of

parent-infant interaction. Screening

procedures should be carried out at the

Page 6 [ Series 5, No. 10
appropriate age, such as an assessment

of risk of high-dose lead exposure, lead

screening, tuberculin test, assessment of

risk for hyperlipidemia if indicated,

screening for vision, hearing, and blood

pressure. Immunizations should be

administered according to the schedule

provided in this report.

Middle childhood (5–11 years)—Visits

should take place at the following ages:

5 years, 6 years, 8 years, and 10 years.

The health professional should conduct

a physical examination as part of each

visit, noting factors such as scoliosis,

early puberty (for girls), the need for

dental care, and signs of abuse or

neglect. The professional should also

note developmental milestones

appropriate for age, observe the quality

of parent-child interaction, and carry out

screening procedures such as vision,

hearing, and blood pressure screening,

assessment of risk of high-dose lead

exposure, annual tuberculin test if

indicated, and at least one tuberculin test

at age 4–6 years, before school entry.

Immunizations should be administered

according to the prescribed schedule.

Adolescence (11–21 years)—Visits

should take place annually or as

required. Each visit should include a

physical examination, measuring and

recording height and weight, and noting

such factors as obesity, scoliosis, need

for dental care, signs of abuse, and

others. The adolescent should be

evaluated for sexual maturity, and

screening procedures should be carried

out for vision, hearing, and blood

pressure as required; annual hematocrit

or hemoglobin screening for women if

risk factors are present; and annual

tuberculin screening if indicated or

tuberculin test at least once at 14–16

years of age. Hyperlipidemia screening

should be carried out if risk factors are

present, and the blood cholesterol level

should be measured once at 19–21 years

of age. For sexually active adolescents,

annual screening should be done for

gonorrhea and chlamydia, and an annual

Pap smear for sexually active females.

Syphilis and/or HIV screening should be

carried out if the adolescent asks to be

tested or if risk factors are present. The

health professional should administer

immunizations according to the

following schedule.

Sources

American Academy of Pediatrics. Guidelines

for perinatal care. American Academy of

Pediatrics and American College of

Obstetricians and Gynecologists, 4th edition.

Elk Grove, Illinois, and Washington, D.C.

1997.

Centers for Disease Control and Prevention.

MMWR 47(1). 1998.

Green M, ed. Bright Futures: Guidelines for

Health Supervision of Infants, Children, and

Adolescents. Arlington, Virginia: National

Center for Education in Maternal and Child

Health. 1994.

De Lew N, Greenburg G, Kinchen K. A

layman’s guide to the U.S. health care

system. Health Care Financing Review

14:151–169. 1992.

National Center for Health Statistics. Health,

United States, 1996–97 and Injury

Chartbook. Hyattsville, Maryland. 1997.

Raffel MW. Health services in the United

States of America. In: Raffel MW, ed.

Comparative Health Systems. University

Park, Pennsylvania: Pennsylvania University

Press. 1984.

Roemer MI. An Introduction to the U.S.

Health Care System. New York: Springer

Publishing Co. 1982.

U.S. Preventive Services Task Force. Guide

to Preventive Service, 2nd edition.

Baltimore: Williams and Williams. 1996.

Vistnes JP, Monheit AC. Health insurance

status of the civilian noninstitutionalized

population, 1996. MEPS Research Findings

No. 1. Rockville, Maryland: Agency for

Health Care Policy and Research. 1997.

Series 5, No. 10[ Page 7
Childhood immunization schedule, United States

Page 8 [ Series 5, No. 10

1

This schedule indicates the recommended age for routine administration of currently licensed childhood vaccines. Some combination vaccines are

available and may be used whenever administration of all components of the vaccine is indicated. Providers should consult the manufacturers’ package

inserts for detailed recommendations.

2

Infants born to HBsAg-negative mothers should receive 2.5 μg of Merck vaccine (Recombivax HB) or 10 mg of SmithKline Beecham (SB) vaccine

(Engerix-B). The 2nd dose should be administered 1 mo after the 1st dose.

Infants born to HBsAg-positive mothers should receive 0.5 mL hepatitis B immune globulin (HBIG) within 12 hrs of birth, and either 5 μg of Merck vaccine

(Recombivax HB) or 10 μg of SB vaccine (Engerix-B) at a separate site. The 2nd dose is recommended at 1–2 mos of age and the 3rd dose at 6 mos

of age.

Infants born to mothers whose HBsAg status is unknown should receive either 5 μg of Merck vaccine (Recombivax HB) or 10 μg of SB vaccine

(Engerix-B) within 12 hrs of birth. The 2nd dose of vaccine is recommended at 1 mo of age and the 3rd dose at 6 mos of age. Blood should be drawn at

the time of delivery to determine the mother’s HBsAg status; if it is positive, the infant should receive HBIG as soon as possible (no later than 1 wk of age).

The dosage and timing of subsequent vaccine doses should be based upon the mother’s HBsAg status.

3

Children and adolescents who have not been vaccinated against hepatitis B in infancy may begin the series during any childhood visit. Those who have

not previously received 3 doses of hepatitis B vaccine should initiate or complete the series during the 11–12 year-old visit. The 2nd dose should be

administered at least 1 mo after the 1st dose, and the 3rd dose should be administered at least 4 mos after the 1st dose, and at least 2mos after the 2nd

dose.

4

DTaP (diphtheria and tetanus toxoids and acellular pertussis vaccine) is the preferred vaccine for all doses in the vaccination series, including completion

of the series in children who have received 1 dose of whole-cell DTP vaccine. Whole-cell DTP is an acceptable alternative to DTaP. The 4th dose of DTaP

may be administered as early as 12 mos of age, provided 6 mos have elapsed since the 3rd dose, and if the child is considered unlikely to return at 15–18

mos of age. Td (tetanus and diphtheria toxoids, adsorbed, for adult use) is recommended at 11–12 yrs of age if at least 5 yrs have elapsed since the last

dose of DTP, DTaP, or DT. Subsequent routine Td boosters are recommended every 10 yrs.

5

Three H. influenzae type b (Hib) conjugate vaccines are licensed for infant use. If PRP-OMP (PedvaxHIB7 [Merck]) is administered at 2 and 4 mos of

age, a dose at 6 mos is not required. After completing the primary series, any Hib conjugate vaccine may be used as a booster.

6

Two poliovirus vaccines are currently licensed in the US: inactivated poliovirus vaccine (IPV) and oral poliovirus vaccine (OPV). The following schedules

are all acceptable by the ACIP, the AAP, and the AAFP, and parents and providers may choose among them:

1. IPV at 2 and 4 mos; OPV at 12–18 mos and 4–6 yrs

2. IPV at 2, 4, 12–18 mos, and 4–6 yrs

3. OPV at 2, 4, 6–18 mos, and 4–6 yrs

The ACIP routinely recommends schedule 1. IPV is the only poliovirus vaccine recommended for immunocompromised persons and their household

contacts.

7

The 2nd dose of MMR is routinely recommended at 4–6 yrs of age or at 11–12 yrs of age, but may be administered during any visit, provided at least

1 mo has elapsed since receipt of the 1st dose, and that both doses are administered at or after 12 mos of age.

8

Susceptible children may receive Varicella vaccine (Var) during any visit after the 1st birthday, and unvaccinated persons who lack a reliable history of

chickenpox should be vaccinated during the 11–12 year-old visit. Susceptible persons 13 yrs of age should receive 2 doses, at least 1 mo apart.

SOURCE: Approved by the Advisory Committee on Immunization Practices (ACIP), the American Academy of Pediatrics (AAP), and the American

Academy of Family Physicians (AAFP). Centers for Disease Control and Prevention. MMWR 47(1). 1998.
Russian Federation

+ The proportion of women beginning

prenatal care in the first trimester of

pregnancy rose gradually during the

1990’s. This improvement in care

despite worsening economic

conditions may be partly due to the

large decline in fertility over the

same time period. In 1994 and 1995,

about 72 percent of women initiated

prenatal care in the first trimester.

+ Prenatal care statistics are based on

visits by pregnant women to

government polyclinics for women.

The statistics cover live births as

well as fetal deaths. Information is

not available on pregnant women

receiving private care or care from

the polyclinics of other government

ministries, nor on women receiving

no prenatal care.

United States

+ After stagnating in the late 1980’s,

the proportion of women beginning

prenatal care in the first trimester

gradually improved from 1990 to

1995. The proportion receiving early

prenatal care rose to 81 percent in

1995, with improvements achieved

for all racial and ethnic groups, in

particular those groups with the

lowest levels of early care.

+ The proportion of women receiving

late or no care rose from 1985 to

1990 but declined consistently

during the 1990’s. In 1995,

4.2 percent of women began prenatal

care late or received no care.

+ Information on the initiation of

prenatal care and the number of

prenatal visits is recorded on the

statistical portion of the birth

certificate. The information is

provided by the mother at the time

of delivery.

Series 5, No. 10 [ Page 9

Prenatal Care

Figure 1. Percent of women receiving prenatal care: Russian Federation and United States, 1995
Russian Federation

+ More than 20 percent of pregnant

women were diagnosed with anemia

at the time of delivery in 1995,

compared with 6.5 percent in 1990.

These high levels of anemia are

indicative of growing nutritional and

other health problems in Russia.

+ The rate of eclampsia and

preeclampsia rose from 90 per 1,000

deliveries in 1990 to 157 in 1995.

Hypertension and renal disease rates

nearly doubled in the same interval,

from 44 in 1990 to 87 in 1995.

+ In Russia the diagnostic criterion for

anemia is a hemoglobin level of

100–110, which is somewhat less

restrictive than the U.S. standard of

100. Nevertheless, this does not

explain the difference in the level of

anemia in the two countries.

+ These statistics are based on women

receiving care from government

health facilities. Information on

women obtaining care from private

facilities or other government

polyclinics is not available.

United States

+ The levels of anemia, diabetes,

genital herpes, pregnancy-induced

hypertension, and renal disease

increased 10–30 percent in the

1990’s. Rates of eclampsia,

incompetent cervix, and uterine

bleeding decreased over the interval.

+ The prevalence of most medical risk

factors was much lower in the

United States than in Russia. The

Russian rates were 10 times higher

for anemia and cardiovascular

disease. However, the prevalence of

diabetes during pregnancy in Russia

was substantially lower than the

rates reported in the United States.

+ This information is recorded on the

birth certificate and is available for

all live births. Evaluation studies of

birth certificate data have found that

medical conditions are

underreported, particularly

complications such as anemia,

diabetes, and hypertension.

Page 10 [ Series 5, No. 10

Complications of

Pregnancy

Figure 2. Rates of selected complications of pregnancy: Russian Federation and United States, 1995
Russian Federation

+ The number of abortions declined

by 35 percent between 1990 and

1995. However, the rate of abortions

per 100 live births declined by only

3 percent in the same interval

because of a steep decline in the

number of live births. In 1995 the

abortion rate per 100 births was 190,

about 6 times the U.S. rate.

+ Abortion reporting includes miniabortions, which are abortions

performed before the 6th week of

pregnancy. Mini-abortions represent

one-quarter of all abortions

performed.

+ The Ministry of Health (MOH)

statistics substantially understate the

true level of abortions, as they do

not include abortions performed in

the private sector or in the facilities

of other government ministries. The

combined report of abortions in

table 5 is approximately 7 percent

higher than the MOH figure for

1995 but is still considered to

understate the true level of

abortions.

United States

+ The number of abortions performed

declined by 15 percent during the

1990’s. This is reflected in both the

abortion rate per 1,000 women of

childbearing ages (19-percent

decline from 1990 to 1995) and in

the rate of abortions per 100 live

births (10-percent decline).

+ The proportion of abortions

performed on women under 20 years

of age in the United States is almost

two times the rate for the same age

group in Russia.

+ National abortion statistics are

obtained from the 50 States and

other reporting areas through central

health agencies and hospitals. The

total number of abortions reported

by the national abortion surveillance

system in 1994 is about 9 percent

below the level estimated by the

Alan Guttmacher Institute.

Series 5, No. 10 [ Page 11

Abortions

Figure 3. Rates of abortion: Russian Federation and United States, 1995
Russian Federation

+ The cesarean section delivery rate

has risen steadily in recent years,

increasing from 3.3 percent of

deliveries in 1985 to 10.1 percent in

1995. This increase may be partly

the result of a rise in complications

of delivery but is also in part the

result of an expansion of the official

indications for cesarean section

delivery.

+ The delivery rate for operative

vaginal deliveries (vacuum

extraction, forceps) has declined

slightly over the same interval,

although the rate was very low even

in 1985. The delivery rate for all

interventions combined rose from

4.4 percent in 1985 to 10.7 percent

in 1995.

+ Method-of-delivery statistics are

based on all deliveries, both live

births and stillbirths, occurring in

government health facilities.

United States

+ The proportion of births delivered

by cesarean section fell consistently

from 1990 to 1995, from

22.7 percent to 20.8 percent of all

live births. This decline is the result

of both a reduction in the primary

cesarean section rate, that is,

cesarean deliveries to women

without a previous cesarean birth,

and a rise in the rate of vaginal

births to women with a previous

cesarean delivery.

+ The combined delivery rate for

vacuum extraction and forceps

deliveries has changed very little in

the 1990’s, although the preferred

method for operative vaginal

deliveries in 1995 was vacuum

extraction, whereas forceps was the

preferred method in 1990.

+ Since 1989 information on method

of delivery has been recorded on the

birth certificate for all live births.

Page 12 [ Series 5, No. 10

Method of Delivery

Figure 4. Rates of cesarean section delivery: Russian Federation and United States, 1990–95
Russian Federation

+ The proportion of births that are first

births rose rapidly, from 45 percent

of all births in 1985 to almost 60

percent in 1995. This large rise in

first births was a part of the

significant decline in fertility that

took place in Russia in this interval.

A growing proportion of women

have limited their childbearing to a

single birth, although some of these

women may be be postponing

additional births because of

economic considerations.

+ By 1995 the pattern of fertility was

very different from the United

States, with first births accounting

for almost 60 percent of all live

births, compared with only 42

percent in the United States.

+ The proportion of births that are first

births rose at a similar rate in both

urban and rural areas, the result of

rapid fertility declines in both

regions.

United States

+ The proportion of births that are first

births has changed very little in

recent years. The share of first births

declined slightly from 41.6 percent

in 1985 to 40.3 percent in 1992 but

returned to 41.6 percent in 1995.

+ The proportion of births that are

third and higher order was much

higher in the United States than in

Russia, 26 percent versus 12 percent

in 1995. Even before the rapid

fertility decline in Russia, U.S.

women were much more likely to

have higher-order births than

Russian women: In 1985 the level

of third- and higher-order births was

25 percent in the United States and

16 percent in Russia.

+ The distribution of births by birth

order was much more similar for

U.S. white and black women than

for urban versus rural women in

Russia.

Series 5, No. 10 [ Page 13

Birth Order

Figure 5. Percent distribution of live births, according to birth order: Russian Federation and United States, 1995
Russian Federation

+ From 1985 to 1990, the proportion

of births to unmarried women rose

3.7 percent annually, but between

1990 and 1995 the average annual

growth rate was 7.6 percent. The

year of fastest increase was 1991

(9.6 percent above the previous

year), followed by 1994 and 1995.

+ In 1995 the proportion of births to

unmarried women in Russia was

one-third lower than in the United

States, 21.1 percent versus 32.2

percent.

+ The increase in births to unmarried

women in the 1990’s was much

more rapid in urban areas (8.8

percent per year) than in rural areas

(5.2 percent per year). As a result,

by 1995 there was little difference in

the proportion of births to unmarried

women by region.

United States

+ The percent of births to unmarried

women rose continuously from 1985

to 1994, but declined by about 1

percent in 1995. The decline in this

measure, the first since 1951,

occurred in both white and black

births.

+ The proportion of births to

unmarried women continued to be

much higher among black women

(70 percent) than among white

women (25 percent). However,

births to unmarried women

increased much more rapidly in the

white population in recent years,

rising by 4.4 percent annually for

white women and only 1 percent for

black women. As a result, the

difference in the proportion of births

to unmarried women by race in

1995 was much smaller than in

1985.

Page 14 [ Series 5, No. 10

Births to Unmarried

Women

Figure 6. Percent of births to unmarried women: Russian Federation and United States, 1990–95
Russian Federation

+ The fertility rate (births per 1,000

women 15–49 years of age) has

fallen sharply in recent years. From

1985 to 1995, the fertility rate

declined by 45 percent, and just in

the 1990–95 period, the rate dropped

by 35 percent. The decline was

especially sharp through 1993,

changed very little in 1994, but

declined again in 1995.

+ The decline in fertility occurred in

all age groups and was particularly

large for women 20–24 years of age,

the group with the highest level of

childbearing. The declines in

age-specific fertility rates were

compounded by the drop in the

number of women in this age group

during the 1990’s.

+ The downturn in fertility has been

severe in both urban and rural areas,

although the urban decrease has

been slightly larger, thus increasing

the urban-rural fertility differential.

United States

+ The fertility rate declined by about

10 percent between 1990 and 1995.

Because fertility rose during the late

1980’s, however, the 1995 level was

only about 5 percent below the rate

in 1985. The U.S. fertility rate was

about 60 percent above the Russian

rate in 1995.

+ Age-specific birth rates showed

different trends between 1990 and

1995. Rates declined for all age

groups under age 30 but rose for all

women 30 years of age and over.

+ The black fertility rate has fallen

much more than the white rate

during the 1990’s, 18 percent versus

8 percent. Under 30 years of age,

the black age-specific fertility rates

have fallen more than the rates for

white women, and black women 30

years of age and over did not

experience increases in fertility.

Series 5, No. 10 [ Page 15

Births by Age of

Mother

Figure 7. Age-specific birth rates: Russian Federation and United States, 1995
Russian Federation

+ The infant mortality rate rose from

17.4 infant deaths per 1,000 live

births in 1990 to 19.9 in 1993. The

rate declined thereafter to a level of

18.1 in 1995.

+ The peak infant mortality rate in

1993 was the result of increases in

both neonatal and postneonatal

mortality. It was reflective of the

difficult economic conditions during

that year and of changes in the

definition of a live birth introduced

in 1993.

+ Leading causes of infant death were

conditions originating in the

perinatal period, congenital

anomalies, pneumonia and influenza,

and infectious disease.

+ The Russian definition of a live

birth introduced in 1993 recognizes

the four signs of life specified in the

standard definition of the World

Health Organization but continues to

differ in the treatment of very

preterm births. In Russia very

preterm infants (those weighing less

than 1,000 grams, or less than 28

weeks gestation, or less than 35

centimeters birth length) must

survive 7 days before they are

considered live births. Correction for

this difference in definition would

increase the infant mortality rate by

about 25 percent, according to

various analyses.

United States

+ Infant mortality declined by 17

percent from 1990 to 1995 and by

28 percent in the 1985–95 interval.

The decline in the black infant

mortality rate was especially large in

1994 and 1995, but continued

declines in the white infant mortality

rate meant that black infant

mortality remained about 2.4 times

that of white infants in 1995. This

disparity is far larger than the

rural-urban differences in infant

mortality in Russia.

+ Declines in the 1990’s occurred in

both neonatal and postneonatal

mortality, although the decline in

neonatal mortality was somewhat

larger. The improved survivability of

neonates was largely the result of

the use of surfactants to treat the

respiratory problems common to

premature births. A part of the

improvement in postneonatal

survival was the result of reductions

in deaths attributed to sudden infant

death syndrome (SIDS).

+ Leading causes of infant death in

the 1990’s were conditions

originating in the perinatal period,

congenital anomalies, and SIDS.

Page 16 [ Series 5, No. 10

Infant Mortality

Figure 8. Infant mortality rates: Russian Federation and United States, 1990–95
Russian Federation

+ The rate of maternal mortality has

increased by 12 percent during the

1990’s and by 1995 was almost as

high as in 1985. The Russian rate is

about seven times the maternal

mortality rate in the United States.

+ Almost one-quarter of all maternal

deaths were attributable to abortionrelated causes in 1995, the vast

majority due to abortions other than

legally induced pregnancy

terminations. The death rate from

other abortions has declined to

nearly one-half the level reported in

1985. The 1995 rate for other

abortions is also lower than the peak

rate for the 1990’s, which occurred

in 1993.

United States

+ The 1995 maternal mortality rate

was lower than the 1990 rate,

although there is no consistent trend

over the interval.

+ The proportion of maternal deaths

attributable to abortions, both legal

and illegal, is essentially zero. The

numbers of deaths from these causes

were too low to permit calculation

of reliable mortality rates.

+ Maternal mortality rates in table 15

are based on deaths specifically

coded to maternal causes of death.

Series 5, No. 10 [ Page 17

Maternal Mortality

Figure 9. Rates of maternal mortality: Russian Federation and United States, 1995
Russian Federation

+ The mortality rate for children 1–4

years of age increased by 10 percent

between 1990 and 1995, reaching

peak rates of 108 deaths per 100,000

population in 1993 and 1995. Time

trends have been roughly the same

for males and females.

+ The leading causes of death for this

age group are accidents, congenital

anomalies, pneumonia and influenza,

and infectious diseases. Death rates

rose between 1990 and 1995 for

congenital anomalies, pneumonia

and influenza, and infectious

diseases. Although still low, the

death rate for homicides doubled

during the interval; deaths resulting

from motor vehicle accidents

declined.

+ Russian mortality for all causes

combined was about 2.7 times the

U.S. rate. The largest Russian

excesses were for pneumonia and

influenza, congenital anomalies, and

accidents. Much higher Russian

rates were reported for accidental

poisoning and drowning.

United States

+ The mortality rate for all causes

combined declined by 13 percent in

the 1990–95 interval, although the

trend was not consistently

downward.

+ Major contributors to the declining

death rate were reductions in deaths

resulting from accidents, congenital

anomalies, and neoplasms. Within

the accident category, the largest

reductions were for motor vehicle

accidents and accidents caused by

fires.

+ For both cardiovascular diseases and

homicides, the U.S. death rate is

roughly twice the Russian rate. The

death rate for motor vehicle

accidents is the same in the two

countries.

Page 18 [ Series 5, No. 10

Childhood Mortality:

1–4 Years of Age

Figure 10. Rates of mortality for children 1–4 years of age, by cause: Russian Federation and United States, 1995
Russian Federation

+ Mortality from all causes followed

no consistent trend between 1990

and 1995, and the 1995 rate was

only slightly above the 1990 level.

The most important mortality

increases during the interval were

attributable to accidents, infectious

diseases, and pneumonia and

influenza, although these increases

were not large. Motor vehicle deaths

declined substantially over the

interval.

+ The most important causes of death

for children 5–9 years of age were

accidents, neoplasms, and diseases

of the nervous system. Drownings

alone accounted for almost

20 percent of deaths.

+ The largest excess mortality for

Russia, compared with the United

States, exists for accidents and

pneumonia and influenza. Excess

Russian mortality is particularly

large for drowning and accidental

poisoning.

United States

+ The leading causes of death in this

age group were accidents and

neoplasms. About one-quarter of all

deaths were from motor vehicle

accidents alone.

+ The 1995 death rate was 11 percent

below the 1990 rate. With the

exception of 1993, mortality for

children 5–9 years of age has fallen

consistently in the 1990’s. The most

important declines in deaths were

those from accidents, neoplasms,

and congenital anomalies.

+ Mortality from infectious and

parasitic diseases increased between

1990 and 1995, primarily because of

a 50 percent rise in the death rate

from HIV infection.

Series 5, No. 10 [ Page 19

Childhood Mortality:

5–9 Years of Age

Figure 11. Rates of mortality for children 5–9 years of age, by cause: Russian Federation and United States, 1995
Russian Federation

+ The 1995 mortality rate was

18 percent above the 1990 level,

although there was no consistent

trend in mortality over the interval.

The largest contributors to this

increase were accidents, diseases of

the nervous system, suicides, and

homicides.

+ The leading causes of death in the

10–14 age group in 1995 were

accidents, neoplasms, diseases of the

nervous system, and suicides.

Drownings accounted for more than

15 percent of all deaths.

+ Between 1990 and 1995, death rates

declined for neoplasms, congenital

anomalies, and transport and motor

vehicle accidents.

+ Russian mortality rates significantly

exceeded U.S. rates for accidents,

neoplasms, diseases of the nervous

system, and suicides. The Russian

death rate attributable to drowning

was nearly 7 times the U.S. rate in

1995.

United States

+ The leading causes of death in 1995

were accidents, neoplasms,

homicides, and suicides. About

one-quarter of all deaths in the

10–14 age group were the result of

motor vehicle accidents.

+ The mortality rate from all causes

reached its lowest point in 1992 but

by 1995 had risen to nearly the level

reported in 1990. The post-1992

increase was primarily the result of

increasing deaths from motor

vehicle accidents.

+ In 1995 about 40 percent of deaths

were attributable to accidents,

24 percent the result of motor

vehicle accidents. Suicides and

homicides accounted for 7 percent

and 8 percent of deaths, respectively.

+ U.S. death rates exceed Russian

rates for homicide and

cardiovascular diseases; death rates

are about the same in both countries

for motor vehicle accidents.

Page 20 [ Series 5, No. 10

Childhood Mortality:

10–14 Years of Age

Figure 12. Rates of mortality for children 10–14 years of age, by cause: Russian Federation and United States, 1995
Russian Federation

+ The mortality rate rose by more than

44 percent between 1990 and 1995.

The largest contributors to this

increase were the external causes of

death: accidents, suicides, and

homicides. Suicide mortality rose by

one-half during the interval and

accounted for about 14 percent of all

deaths in 1995. Mortality from

alcohol poisoning tripled from 1990

to 1994 and then declined in 1995.

The homicide rate also declined

after 1993, but the 1995 rate was

still nearly twice the 1990 level.

+ Despite the rapid rise in death rates,

mortality from certain causes of

death declined, including neoplasms,

transport accidents, and especially

motor vehicle accidents.

United States

+ The leading causes of death in 1995

were the external causes, including

accidents, suicides, and homicides.

Motor vehicle accidents were the

single most important cause of

death, resulting in more than

one-third of all deaths in the group

15–19 years of age.

+ The death rate for all causes

declined by about 5 percent from

1990 to 1995. The major

contributors to this drop were

declines in deaths resulting from

accidents, particularly motor vehicle

accidents, suicides, and neoplasms.

Increases occurred in mortality

attributable to homicides and

cardiovascular diseases.

+ The U.S. death rate for all causes

was about one-half the Russian rate.

The most important contributors to

the Russian excess in mortality were

suicides, drownings, and neoplasms.

Series 5, No. 10 [ Page 21

Childhood Mortality:

15–19 Years of Age

Figure 13. Rates of mortality for children 15–19 years of age, by cause: Russian Federation and United States, 1995
Russian Federation

+ Immunization rates for all diseases

fell in the late 1980’s and early

1990’s, about the time of the

breakup of the Soviet Union, but

have improved in recent years.

+ Only about two-thirds of infants

received diphtheria immunization in

1991, but the coverage rate

improved rapidly in following years,

reaching almost 93 percent in 1995.

+ By 1995 the highest immunization

coverage rates were attained for

measles (94 percent), tuberculosis

(96 percent), and diphtheria and

tetanus. The lowest coverage rates

were for pertussis (81 percent) and

mumps (77 percent).

United States

+ Coverage rates for children 19–35

months of age were lowest in the

early 1990’s and have improved

since then. It should be noted that

the age group of children used in

measuring immunization coverage

rates differs from those used in

Russia.

+ By 1995 coverage rates were highest

for diphtheria and tetanus

(95 percent), pertussis (95 percent),

and haemophilus influenzae B

(92 percent). The low immunization

rate for hepatitis B (68 percent) is

reflective of the fact that this was

not a recommended vaccine until

1991. Haemophilus influenzae B

vaccine also was not recommended

until 1991.

Page 22 [ Series 5, No. 10

Immunizations

Figure 14. Rates of immunization coverage: Russian Federation and United States, 1995
0–14 Years of Age

+ There was no consistent trend in allcause morbidity between 1990 and

1995, but the 1995 rate was about

4 percent above the 1990 level.

+ The most important cause of

morbidity by far was respiratory

diseases, which accounted for more

than 60 percent of all illnesses. The

next most important diagnoses were

infectious diseases and diseases of

the nervous system.

+ Although injury was the leading

cause of death for children 1–14

years of age, injuries accounted for

only 6 percent of all morbidity.

+ Information on morbidity was based

on ambulatory visits to Ministry of

Health (MOH) polyclinics or visits

to MOH hospitals. Rates were based

on the initial diagnosis of a

condition; repeat visits for the same

disease were excluded from these

statistics. Data are presented for

Russia only, as comparable

information for the United States

was not available.

15–17 Years of Age

+ The overall morbidity rate for all

diseases rose sharply, increasing by

24 percent from 1990 to 1995.

Morbidity rates nearly doubled for

infectious diseases, neoplasms,

genitourinary system diseases, and

others. Increases in the morbidity

rate were reported for every disease

category.

+ The most important diagnosis

remained respiratory diseases,

accounting for one-half of all

morbidity in 1995, although the

morbidity rate increased by only a

small amount between 1990 and

1995. Injury accounted for almost

13 percent of all morbidity, more

than twice the proportion for

children 0–14 years of age.

Series 5, No. 10 [ Page 23

Morbidity in the

Russian Federation

Figure 15. Rates of childhood morbidity, by disease: Russian Federation, 1995
+ Respiratory diseases were the

leading diagnosis by far in the group

1–4 years of age, accounting for

more than 40 percent of all hospital

discharges in 1995. Respiratory

diseases were also the leading

diagnosis for children 5–9 years of

age. For both age groups, injuries

were the second leading diagnosis.

+ For children 10–14 years of age,

injuries were the leading diagnosis,

accounting for 18 percent of

discharges in 1995, closely followed

by respiratory diseases. For the

population 15–19 years of age,

childbirth and complications of

pregnancy were the predominant

diagnoses, accounting for almost

one-half of all discharges. The

second most important diagnosis

was for injuries, representing almost

13 percent of discharges.

+ Discharge rates for all causes

combined fell from 1990 to 1993 in

all age groups, a continuation of a

long-term decline in hospitalization.

The rates rose in 1994 and 1995 for

children in the groups age 1–4, 5–9,

and 10–14 years of age. Discharge

rates for those 15–19 years of age

rose in 1994 but in 1995 resumed

the long-term decline.

+ Hospital discharge data are obtained

from hospital inpatient information.

The discharge diagnoses presented

here are based on the first-listed

diagnosis from the inpatient record.

Multiple hospital stays by a patient

in the same year for the same illness

are each counted separately in this

data system.

Page 24 [ Series 5, No. 10

Hospitalization in the

United States

Figure 16. Hospital discharge rates, by diagnosis and age: United States, 1995
+ The incidence of diphtheria among

children 0–14 years of age rose

rapidly after 1990, particularly in

1994. The 1995 rate declined

11 percent from the 1994 peak.

+ Hepatitis rates among children 0–14

years of age declined by more than

50 percent from 1990 to 1995 but

remained far higher than the level

among U.S. children.

+ Gonorrhea rates more than doubled

among children 0–14 years of age

from 1990 to 1994, but declined by

13 percent in 1995. For adolescents

15–17 years of age, the pattern was

similar: The rate rose sharply from

1990 to 1993 but declined

substantially in 1994 and 1995.

+ Syphilis rates rose dramatically

among those 0–14 and 15–17 years

of age, increasing almost fiftyfold

from 1990 to 1995. The Russian rate

for adolescents 15–17 years of age

was almost 30 times the U.S. rate

for those age 15–19 in 1995.

+ Among children 0–14 years of age,

tuberculosis rates rose by two-thirds

from 1990 to 1995. For adolescents

15–17 years of age, the rate of

tuberculosis rose by 29 percent from

1990 to 1995.

Series 5, No. 10 [ Page 25

Communicable

Diseases in the Russian

Federation

Figure 17. Communicable disease rates, by age group and disease: Russian Federation, 1995
+ Hepatitis A continued to be an

important communicable disease in

all four age groups, but particularly

among children 5–9 years of age. In

all four age groups, the incidence

rate fell from 1990 to 1993 but rose

thereafter.

+ The acquired immunodeficiency

syndrome (AIDS) rate for children

0–4 years of age declined by

one-third from 1992 to 1995, largely

as a result of the use of zidovudine

(ZDV) to prevent transmission of

HIV infection from pregnant women

to their children. The AIDS rate for

children 15–19 years of age rose

slightly during the interval.

+ Diphtheria cases continued to be

very rare in the United States. From

1990 to 1995, fewer than five cases

were reported annually for all ages

combined.

+ Although gonorrhea rates for those

15–19 years of age declined

substantially from 1990 to 1995, the

1995 rate was three times the

Russian rate for adolescents 15–17

years of age.

+ Tuberculosis rates in children 0–4

and 5–9 years of age changed very

little during the 1990–95 interval.

The rate dropped by one-third for

adolescents 10–14 years of age over

the same interval. For those 15–19

years of age, the rate rose in 1991

but declined thereafter.

Page 26 [ Series 5, No. 10

Communicable

Diseases in the

United States

Figure 18. Communicable disease rates, by age group and disease: United States, 1995
Table 1. Resident population, by age and sex: Russian Federation and United States, selected years 1985–95

Country, sex, and age 1985 1990 1991 1992 1993 1994 1995

Russian Federation Population

All persons ................... 143,444,187 147,913,047 148,244,835 148,310,174 148,145,911 147,967,813 147,773,657

Under 1 year .................. 2,356,758 2,042,649 1,870,366 1,680,008 1,480,467 1,409,618 1,392,301

1–4 years .................... 9,147,605 9,472,425 9,091,489 8,511,358 7,819,486 7,106,850 6,494,163

5–9 years .................... 20,604,91611,691,208 11,913,690 12,126,688 12,141,940 11,959,349 11,653,397

10–14 years .................. 10,755,194 10,852,591 10,996,699 11,269,831 11,580,762 11,822,429

15–19 years .................. 20,993,18610,184,768 10,309,644 10,417,212 10,532,870 10,690,270 10,829,347

20–24 years .................. 9,524,551 9,500,412 9,609,388 9,816,052 10,043,725 10,241,502

25–29 years .................. 25,191,76711,724,325 11,056,487 10,421,363 9,886,834 9,582,798 9,518,320

30–34 years .................. 12,951,186 13,002,119 12,913,208 12,649,279 12,243,647 11,687,622

35–39 years .................. 16,204,17412,023,228 12,232,708 12,390,233 12,596,068 12,753,689 12,829,740

40–44 years .................. 9,653,385 10,493,978 10,966,817 11,345,741 11,596,391 11,798,915

45–49 years .................. 19,129,2156,127,910 5,596,816 5,881,605 6,798,010 8,080,991 9,345,513

50–54 years .................. 10,420,811 10,446,589 9,788,057 8,430,501 6,954,827 5,799,511

55–64 years .................. 15,599,878 16,502,192 16,458,415 16,525,533 16,658,582 16,713,924 16,662,239

65 years and over ............... 14,216,688 14,839,215 15,419,531 16,082,005 16,720,250 17,250,972 17,698,658

All males .................... 66,438,950 69,266,204 69,481,089 69,562,474 69,528,088 69,479,594 69,387,481

Under 1 year .................. 1,203,729 1,046,981 958,645 861,576 760,501 723,589 713,720

1–4 years .................... 4,667,286 4,829,681 4,642,122 4,351,791 4,004,697 3,645,851 3,333,605

5–9 years .................... 10,464,3735,940,615 6,057,032 6,168,816 6,181,399 6,096,195 5,949,649

10–14 years .................. 5,456,424 5,504,792 5,578,416 5,719,732 5,880,698 6,007,464

15–19 years .................. 10,590,598 5,179,862 5,225,929 5,274,609 5,334,736 5,420,061 5,493,675

20–24 years .................. 4,879,799 4,886,795 4,960,535 5,081,182 5,188,129 5,254,686

25–29 years .................. 12,791,3545,955,419 5,610,753 5,274,783 4,996,908 4,864,378 4,872,946

30–34 years .................. 6,522,489 6,546,653 6,498,819 6,363,718 6,161,664 5,885,518

35–39 years .................. 7,970,4515,993,677 6,095,483 6,172,658 6,271,523 6,347,427 6,380,945

40–44 years .................. 4,753,794 5,170,712 5,403,038 5,582,556 5,696,677 5,785,316

45–49 years .................. 8,929,434 2,919,455 2,683,243 2,839,814 3,288,501 3,901,547 4,499,834

50–54 years .................. 4,828,097 4,833,504 4,518,016 3,881,094 3,198,503 2,667,863

55–64 years .................. 6,103,645 7,012,977 7,078,842 7,157,643 7,234,700 7,248,913 7,206,558

65 years and over ............... 3,718,080 3,946,934 4,186,584 4,501,960 4,826,841 5,105,962 5,335,702

All females ................... 77,005,237 78,646,843 78,763,746 78,747,700 78,617,823 78,488,219 78,386,176

Under 1 year .................. 1,153,029 995,668 911,721 818,432 719,966 686,029 678,581

1–4 years .................... 4,480,319 4,642,744 4,449,367 4,159,567 3,814,789 3,460,999 3,160,558

5–9 years .................... 10,140,5435,750,593 5,856,658 5,957,872 5,960,541 5,863,154 5,703,748

10–14 years .................. 5,298,770 5,347,799 5,418,283 5,550,099 5,700,064 5,814,965

15–19 years .................. 10,402,5885,004,906 5,083,715 5,142,603 5,198,134 5,270,209 5,335,672

20–24 years .................. 4,644,752 4,613,617 4,648,853 4,734,870 4,855,596 4,986,816

25–29 years .................. 12,400,4135,768,906 5,445,734 5,146,580 4,889,926 4,718,420 4,645,374

30–34 years .................. 6,428,697 6,455,466 6,414,389 6,285,561 6,081,983 5,802,104

35–39 years .................. 8,233,723 6,029,551 6,137,225 6,217,575 6,324,545 6,406,262 6,448,795

40–44 years .................. 4,899,591 5,323,266 5,563,779 5,763,185 5,899,714 6,013,599

45–49 years .................. 10,199,7813,208,455 2,913,573 3,041,791 3,509,509 4,179,444 4,845,679

50–54 years .................. 5,592,714 5,613,085 5,270,041 4,549,407 3,756,324 3,131,648

55–64 years .................. 9,496,233 9,489,215 9,379,573 9,367,890 9,423,882 9,465,011 9,455,681

65 years and over ............... 10,498,608 10,892,281 11,232,947 11,580,045 11,893,409 12,145,010 12,362,956

United States

All persons ................... 237,031,000 248,709,873 252,177,000 255,077,536 257,783,004 260,340,990 262,755,269

Under 1 year .................. 3,736,000 3,945,974 4,011,000 4,000,022 3,916,861 3,870,185 3,848,106

1–4 years .................... 14,268,000 14,811,673 15,210,000 15,512,163 15,773,936 15,856,964 15,743,042

5–9 years .................... 16,823,000 18,034,778 18,237,000 18,346,734 18,529,227 18,858,601 19,219,956

10–14 years .................. 17,101,000 17,060,469 17,671,000 18,104,763 18,520,991 18,752,722 18,914,532

15–19 years .................. 18,390,000 17,881,711 17,205,000 17,102,010 17,267,076 17,616,398 18,064,517

20–24 years .................. 20,365,000 19,131,578 19,194,000 19,044,674 18,762,450 18,326,487 17,882,118

25–29 years .................. 21,381,000 21,327,869 20,718,000 20,179,515 19,624,729 19,176,882 19,005,343

30–34 years .................. 20,035,000 21,832,857 22,159,000 22,265,313 22,250,693 22,177,231 21,867,796

35–39 years .................. 17,528,000 19,845,733 20,518,000 21,099,450 21,586,589 21,960,620 22,248,914

40–44 years .................. 13,975,000 17,589,034 18,754,000 18,807,033 19,197,415 19,698,738 20,218,804

45–49 years .................. 11,618,000 13,743,577 14,095,000 15,360,366 15,930,621 16,679,272 17,448,898

50–54 years .................. 10,937,000 11,313,073 11,645,000 12,055,022 12,726,857 13,191,287 13,629,862

55–64 years .................. 22,335,000 21,112,652 21,005,000 20,925,480 20,922,207 21,017,594 21,131,084

65 years and over ............... 28,539,000 31,078,895 31,754,000 32,274,991 32,773,352 33,158,009 33,532,297

}

}

}

}

}

}

}

}

}

}

}

}

}

}

}

Series 5, No. 10 [ Page 27
Table 1. Resident population, by age and sex: Russian Federation and United States, selected years 1985–95—Con.

Country, sex, and age 1985 1990 1991 1992 1993 1994 1995

United States—Con. Population

All males .................... 114,611,000 121,239,348 122,978,000 124,480,133 125,800,418 127,076,429 128,313,797

Under 1 year .................. 1,912,000 2,018,404 2,052,000 2,043,149 2,004,642 1,980,754 1,969,872

1–4 years .................... 7,300,000 7,580,624 7,784,000 7,937,437 8,070,831 8,113,681 8,055,333

5–9 years .................... 8,609,000 9,232,031 9,337,000 9,394,593 9,487,562 9,657,111 9,843,300

10–14 years .................. 8,762,000 8,738,800 9,051,000 9,273,557 9,484,450 9,602,417 9,685,241

15–19 years .................. 9,298,000 9,172,834 8,834,000 8,777,737 8,857,340 9,036,127 9,265,025

20–24 years .................. 9,948,000 9,742,551 9,775,000 9,700,261 9,542,139 9,311,333 9,087,045

25–29 years .................. 10,556,000 10,702,497 10,393,000 10,132,317 9,849,242 9,618,804 9,529,765

30–34 years .................. 9,886,000 10,861,819 11,034,000 11,100,169 11,092,820 11,057,956 10,902,150

35–39 years .................. 8,569,000 9,833,180 10,174,000 10,480,175 10,726,947 10,920,180 11,071,207

40–44 years .................. 6,810,000 8,676,472 9,258,000 9,287,583 9,477,158 9,728,390 9,990,475

45–49 years .................. 5,651,000 6,739,157 6,907,000 7,540,194 7,814,997 8,180,810 8,559,836

50–54 years .................. 5,276,000 5,493,144 5,656,000 5,857,409 6,185,931 6,410,309 6,621,815

55–64 years .................. 10,498,000 9,955,069 9,932,000 9,914,051 9,926,630 9,983,492 10,044,058

65 years and over ............... 11,536,000 12,492,766 12,791,000 13,041,501 13,279,729 13,475,065 13,688,675

All females ................... 122,420,000 127,470,525 129,198,000 130,597,403 131,982,586 133,264,561 134,441,472

Under 1 year .................. 1,824,000 1,927,570 1,959,000 1,956,873 1,912,219 1,889,431 1,878,234

1–4 years .................... 6,968,000 7,231,049 7,426,000 7,574,726 7,703,105 7,743,283 7,687,709

5–9 years .................... 8,214,000 8,802,747 8,900,000 8,952,141 9,041,665 9,201,490 9,376,656

10–14 years .................. 8,339,000 8,321,669 8,620,000 8,831,206 9,036,541 9,150,305 9,229,291

15–19 years .................. 9,092,000 8,708,877 8,371,000 8,324,273 8,409,736 8,580,271 8,799,492

20–24 years .................. 10,417,000 9,389,027 9,419,000 9,344,413 9,220,311 9,015,154 8,795,073

25–29 years .................. 10,825,000 10,625,372 10,325,000 10,047,198 9,775,487 9,558,078 9,475,578

30–34 years .................. 10,149,000 10,971,038 11,125,000 11,165,144 11,157,873 11,119,275 10,965,646

35–39 years .................. 8,959,000 10,012,553 10,344,000 10,619,275 10,859,642 11,040,440 11,177,707

40–44 years .................. 7,165,000 8,912,562 9,496,000 9,519,450 9,720,257 9,970,348 10,228,329

45–49 years .................. 5,967,000 7,004,420 7,188,000 7,820,172 8,115,624 8,498,462 8,889,062

50–54 years .................. 5,661,000 5,819,929 5,989,000 6,197,613 6,540,926 6,780,978 7,008,047

55–64 years .................. 11,837,000 11,157,583 11,073,000 11,011,429 10,995,577 11,034,102 11,087,026

65 years and over ............... 17,003,000 18,586,129 18,963,000 19,233,490 19,493,623 19,682,944 19,843,622

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

Page 28 [ Series 5, No. 10
Table 2. Percent of mothers beginning prenatal care in the first trimester and percent with late or no care: Russian Federation and

United States, selected years 1985–95

Country and care level 1985 1990 1991 1992 1993 1994 1995

Russian Federation

Number of pregnant women receiving care in Ministry of

Health prenatal polyclinics .................. 2,333,501 1,952,049 1,717,364 1,501,741 1,397,992 1,382,477 1,311,498

Percent beginning care in first trimester .......... 72.7 68.8 68.5 70.0 71.2 72.0 71.8

Percent beginning care after first trimester ......... 27.3 31.2 31.5 30.0 28.2 28.0 28.2

United States

Number of live births ...................... 3,760,561 4,158,212 4,110,907 4,065,014 4,000,240 3,952,767 3,899,589

Percent beginning care in first trimester .......... 76.2 75.8 76.2 77.7 78.9 80.2 81.3

Percent late or no care . . . . . . . . . . . . . . . . . . . . . 5.7 6.1 5.8 5.2 4.8 4.4 4.2

SOURCES: Russian Federation: Ministry of Health. Maternal and Child Health Services. Moscow, 1997; United States: Centers for Disease Control and Prevention, National Center for Health

Statistics, Division of Vital Statistics.

Table 3. Rates of live birth with selected medical risk factors: Russian Federation and United States, selected years, 1985–95

Country and risk factor1 1985 1990 1991 1992 1993 1994 1995

Russian Federation Rate per 1,000 pregnant women

Data from polyclinic registration:

Anemia .......................................... 648.2 54.0 128.0 166.0 217.0 255.0 292.0 344.0

Cardiovascular disease ............................ 648.5–648.6 43.0 51.0 55.0 61.0 67.0 75.0 77.0

Diabetes ......................................... 648.0 1.0 - - - 1.0 1.0 2.0 1.2 1.1

Toxemia, eclampsia, and preeclampsia ............. 642.4–642.7, 646.1 89.0 112.0 111.0 126.0 138.0 151.0 157.0

Hypertension and renal disease .............. 642.0–642.3, 642.9, 646.2 35.0 59.0 80.0 94.0 108.0 123.0 129.0

Rate per 1,000 deliveries

Data from maternity hospitals:

Anemia .......................................... 648.2 27.2 65.1 90.2 122.6 146.1 180.0 209.5

Cardiovascular disease ............................ 648.5–648.6 25.7 32.6 34.4 38.5 43.5 49.4 53.2

Diabetes ......................................... 648.0 1.0 - - - 1.3 1.2 1.2 1.0 1.0

Toxemia, eclampsia, and preeclampsia ............. 642.4–642.7, 646.1 57.9 89.6 100.0 114.0 131.8 148.8 156.8

Hypertension and renal disease .............. 642.0–642.3, 642.9, 646.2 25.4 43.5 49.4 58.2 70.7 82.4 87.0

United States Rate per 1,000 live births

Anemia ........................................... 648.2 - - - 17.7 18.0 17.7 18.4 19.8 20.2

Cardiac disease .................. 648.5–648.6, 390–398, 404, 410–429 - - - 3.3 3.5 3.8 4.2 4.5 4.7

Acute or chronic lung disease . . 110–119, 162–163, 480–487, 490–496, 500–519 - - - 2.9 3.5 4.1 4.7 5.6 6.8

Diabetes ............................... 250, 648.0, 468.8, 790.2 - - - 20.6 22.5 25.2 25.6 25.2 24.9

Genital herpes ........................................ 54.1 - - - 7.6 7.8 8.0 8.3 8.1 8.4

Hydramnios/oligohydramnios ........................... 657, 658.0 - - - 5.7 6.5 7.6 9.0 10.1 11.2

Hemoglobinopathy . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 282 - - - 0.4 0.5 0.6 0.6 0.6 0.7

Hypertension, chronic ....................... 642.0–642.3, 401–405 - - - 6.3 6.3 6.4 6.6 6.7 6.7

Hypertension, pregnancy-associated ............ 642.4–642.5, 642.7–642.9 - - - 26.4 26.2 27.7 29.2 31.8 33.7

Eclampsia .......................................... 642.6 - - - 3.8 3.4 3.5 3.3 3.4 3.6

Incompetent cervix .................................... 654.5 - - - 3.3 2.3 2.2 2.2 2.3 2.3

Previous infant 4,000 grams or more . . . . . . . . . . . . . . . . . . . . . . . . . . . . . --- 10.1 9.7 9.9 10.2 10.2 10.3

Previous preterm or small-for-gestational-age infant . . . . . . . . . . . . . . . . . . . . - - - 11.6 11.2 11.5 1.4 11.3 11.2

Renal disease ............ 580–589, 590–593.2, 646.2, 753.0–753.1, 753.3 - - - 2.1 2.1 2.2 2.2 2.6 2.6

Rh sensitization ...................................... 656.1 - - - 5.9 5.8 6.2 6.0 6.5 6.3

Uterine bleeding ........................... 640,641.1, 641.3–641.9 - - - 8.1 7.7 7.8 7.7 7.8 7.6

- - - Data not available.

1Codes are from the International Classification of Diseases, Ninth Revision.

SOURCES: Russian Federation: Ministry of Health. Maternal and Child Health Services. Moscow, 1997; United States: Centers for Disease Control and Prevention, National Center for Health

Statistics, Division of Vital Statistics.

Series 5, No. 10 [ Page 29
Table 4. Number and percent distribution of abortions, according to age of woman: Russian Federation and United States, selected years

1985–95

Country and age 1985 1990 1991 1992 1993 1994 1995

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

All women 15–49 years of age ......... 116.1 108.8 98.0 90.3 81.9 75.1 67.6

Abortions per 100 live births and stillbirths

All ages ....................... 184.2 195.3 199.4 203.7 208.4 200.5 190.1

Percent distribution of abortions by age of woman

All ages ....................... 100.0 100.0 100.0 100.0 100.0 100.0 100.0

Under 15 years . . . . . . . . . . . . . . . . . . - - - - - - 0.2 0.1 0.2 0.1 0.1

15–19 years . . . . . . . . . . . . . . . . . . . . - - - - - - 9.9 10.0 10.8 10.9 10.9

20–34 years . . . . . . . . . . . . . . . . . . . . --- --- 71.6 70.8 70.3 68.9 68.4

35 years and over . . . . . . . . . . . . . . . . . --- --- 18.3 19.1 18.8 20.1 20.5

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

All women 15–49 years of age ......... 21.2 21.8 21.0 20.3 19.8 18.7 17.7

Abortions per 100 live births

All ages ....................... 35.4 34.5 33.9 33.5 33.4 32.1 31.1

Under 15 years .................. 137.6 84.4 76.7 79.0 74.4 70.4 - - -

15–19 years .................... 68.8 51.5 46.2 44.0 44.0 41.5 - - -

20–24 years .................... 38.6 37.7 37.8 37.6 38.4 36.4 - - -

25–29 years .................... 21.7 22.0 22.1 22.2 22.7 22.2 - - -

30–34 years .................... 19.9 19.1 18.7 18.3 18.0 17.2 - - -

35–39 years .................... 33.6 27.3 26.2 25.6 24.8 23.4 - - -

40 years and over ................. 62.3 50.1 46.9 45.4 43.0 41.2 - - -

Percent distribution of abortions by age of woman

All ages ....................... 100.0 100.0 100.0 100.0 100.0 100.0 100.0

Under 20 years .................. 26.3 22.4 21.0 20.1 20.0 20.2 20.1

20–24 years .................... 34.7 33.2 34.4 34.5 34.4 33.5 32.5

25 years and over ................. 39.0 44.4 44.6 45.4 45.6 46.3 47.4

- - - Data not available.

NOTE: Columns may not add to 100.0 because of rounding.

SOURCES: Russian Federation: Ministry of Health. Maternal and Child Health Services. Moscow, 1997; United States: Centers for Disease Control and Prevention, National Center for Health

Statistics: Health United States, selected years; Centers for Disease Control and Prevention, CDC Surveillance Summaries, August 8, 1997. MMWR 46:SS-4. 1997.

Page 30 [ Series 5, No. 10
Table 5. Number and percent distribution of abortions, according to period of gestation: Russian Federation and United States, selected

years 1985–95

Country and period of gestation 1985 1990 1991 1992 1993 1994 1995

Russian Federation Number of abortions

Ministry of Health ................... 4,257,581 3,920,287 3,525,904 3,265,718 2,977,935 2,808,103 2,574,834

Combined reports ................... 4,454,000 4,103,000 3,608,000 3,530,800 3,476,000 3,006,000 2,753,000

Period of gestation: Percent distribution

Less than 6 weeks . . . . . . . . . . . . . . . . . --- 24.3 24.0 26.2 26.8 26.1 25.4

6 weeks or more . . . . . . . . . . . . . . . . . . --- 75.7 76.0 73.8 73.2 73.9 74.6

United States Number of abortions

Centers for Disease Control and Prevention . . . 1,328,570 1,429,577 1,388,937 1,359,145 1,330,414 1,267,415 1,210,883

Alan Guttmacher Institute .............. 1,589,000 1,609,000 1,557,000 1,529,000 - - - 1,400,000 - - -

Period of gestation: Percent distribution

Total .......................... 100.0 100.0 100.0 100.0 100.0 100.0 100.0

Less than 9 weeks ............... 50.3 51.6 52.3 52.1 52.3 53.7 54.0

Less than 7 weeks . . . . . . . . . . . . . . --- --- --- 13.7 14.7 15.7 15.7

7 weeks . . . . . . . . . . . . . . . . . . . . . --- --- --- 15.0 16.2 16.5 17.1

8 weeks . . . . . . . . . . . . . . . . . . . . . --- --- --- 21.4 21.6 21.6 21.2

9–10 weeks .................... 26.6 25.3 25.1 24.2 24.4 23.5 23.1

11–12 weeks ................... 12.5 11.7 11.5 12.0 11.6 10.9 10.9

13–15 weeks . . . . . . . . . . . . . . . . . . . 5.9 6.4 6.1 6.0 6.3 6.3 6.3

16–20 weeks . . . . . . . . . . . . . . . . . . . 3.9 4.0 3.9 4.2 4.1 4.3 4.3

21 weeks or more . . . . . . . . . . . . . . . . 0.8 1.0 1.1 1.5 1.3 1.3 1.4

- - - Data not available.

NOTE: Columns may not add to 100.0 because of rounding.

SOURCES: Russian Federation: Ministry of Health. Maternal and Child Health Services. Moscow, 1997; United States: Centers for Disease Control and Prevention, National Center for Health

Statistics: Health United States, selected years.

Table 6. Number and rate of births, by method of delivery: Russian Federation and United States, selected years 1985–95

Country and method of delivery 1985 1990 1991 1992 1993 1994 1995

Russian Federation Percent

Percent of all deliveries in hospital . . . . . . . --- 99.7 99.2 99.1 99.1 99.1 99.1

Number of deliveries

Deliveries in hospital ............... 2,341,952 1,937,036 1,740,919 1,547,114 1,379,089 1,378,456 1,333,441

Method of delivery: Rate per 100 deliveries

Forceps . . . . . . . . . . . . . . . . . . . . . . 0.6 0.6 0.5 0.5 0.4 0.4 0.4

Vacuum . . . . . . . . . . . . . . . . . . . . . . 0.4 0.2 0.3 0.2 0.2 0.1 0.1

Cesarean . . . . . . . . . . . . . . . . . . . . . 3.3 6.9 7.4 8.3 9.0 9.6 10.1

Other . . . . . . . . . . . . . . . . . . . . . . . 0.1 0.1 0.1 0.1 0.1 0.1 0.1

United States Number of live births

Live births ...................... 3,760,561 4,158,212 4,110,563 4,065,014 4,000,240 3,952,767 3,899,589

Method of delivery: Rate per 100 live births

Cesarean, total ................. 22.7 22.7 22.6 22.3 21.8 21.2 20.8

Cesarean, primary1 .............. 16.3 16.0 15.9 15.6 15.3 14.9 14.7

Vacuum . . . . . . . . . . . . . . . . . . . . . . - - - 3.9 4.4 4.8 5.3 5.7 5.9

Forceps . . . . . . . . . . . . . . . . . . . . . . - - - 5.1 4.6 4.3 4.1 3.8 3.5

VBAC2 . . . . . . . . . . . . . . . . . . . . . . 6.6 19.9 21.3 22.6 24.3 26.3 27.5

- - - Data not available.

1Number of primary cesarean deliveries per 100 live births to women who have not had a previous cesarean delivery.

2Number of vaginal births after previous cesarean delivery per 100 live births to women with a previous cesarean delivery.

SOURCES: Russian Federation: Ministry of Health. Maternal and Child Health Services. Moscow, 1997; United States, 1985: Centers for Disease Control and Prevention, National Center for Health

Statistics, Division of Health Care Statistics; United States, 1990–95: Centers for Disease Control and Prevention, National Center for Health Statistics, Division of Vital Statistics.

Series 5, No. 10 [ Page 31
Table 7. Rate of live births, by complication of labor and delivery: Russian Federation and United States, selected years 1985–95

Country and complication1 1985 1990 1991 1992 1993 1994 1995

Russian Federation Rate per 1,000 deliveries

Uterine bleeding associated with placenta ........ 641.1–641.2 6.5 8.9 9.1 9.4 9.8 10.2 10.3

Anomalies of process of delivery ................ 661–662 - - - 93.1 96.5 102.9 110.7 118.5 124.7

Rupture of perineum ..................... 664.0–664.4 0.3 0.4 0.8 0.5 0.5 0.6 0.4

Rupture of uterus ....................... 665.0–665.1 0.2 0.2 0.3 0.2 0.2 0.2 0.2

Postdelivery sepsis and generalized postdelivery

infection ............................. 659.3, 670 0.9 0.3 1.0 1.2 1.4 1.2 1.8

Including peritonitis after cesarean section . . . . . . . . . . . . 670 - - - 0.2 0.3 0.2 0.3 0.2 0.2

United States Rate per 1,000 live births

Febrile .................................. 659.2 - - - 12.0 13.0 13.6 14.9 15.5 16.0

Meconium . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . --- 60.4 60.8 60.9 57.8 57.3 57.1

Premature rupture of membranes ................. 658.1 - - - 33.4 32.6 32.0 31.1 31.1 30.6

Abruptio placentae .......................... 641.2 - - - 6.2 6.0 5.8 5.8 5.8 5.7

Placenta previa ........................ 641.0–641.1 - - - 3.6 3.5 3.5 3.5 3.4 3.4

Other excessive bleeding .................. 641.3–641.9 - - - 5.3 5.4 5.4 5.4 5.5 5.8

Seizures during labor ......................... 669.1 - - - 0.4 0.4 0.4 0.4 0.4 0.4

Precipitous labor ............................ 661.3 - - - 18.1 18.7 19.3 19.0 19.0 19.1

Prolonged labor . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 662 - - - 10.7 10.3 10.0 9.3 9.0 8.8

Dysfunctional labor .............. 661.0–661.2,661.4–661.9 - - - 29.6 29.5 29.6 29.9 29.8 28.0

Breech/malpresentation .......... 652.1–652.9, 660.4, 669.6 - - - 38.3 38.1 37.7 37.8 37.4 37.4

Cephalopelvic disproportion . . . . . . . . . . . . . . . . . . . . . . . 653 - - - 37.2 35.2 33.3 30.4 25.5 25.4

Cord prolapse ............................. 663.0 - - - 3.0 2.7 2.5 2.3 2.4 2.3

Anesthetic complication . . . . . . . . . . . . . . . . . . . . . . . . . 668 - - - 0.6 0.4 0.4 0.6 0.6 0.6

Fetal distress .............................. 656.3 - - - 42.8 42.9 41.9 41.7 41.2 41.5

- - - Data not available.

1Codes are from the International Classification of Diseases, Ninth Revision.

SOURCES: Russian Federation: Ministry of Health. Maternal and Child Health Services. Moscow, 1997; United States: Centers for Disease Control and Prevention, National Center for Health

Statistics, Division of Vital Statistics.

Table 8. Number and percent distribution of live births, according to birthweight: Russian Federation and United States, selected years

1985–95

Country and birthweight 1985 1990 1991 1992 1993 1994 1995

Russian Federation Number

Number of live births in Ministry of Health hospitals .......... 2,340,405 1,953,469 1,756,433 1,562,379 1,394,771 1,393,759 1,348,137

Birthweight: Percent of live births

Less than 2,500 grams . . . . . . . . . . . . . . . . . . . . . . . . . . . . 5.6 5.7 5.7 5.9 6.1 6.2 6.2

500–999 grams . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 0.3 0.2 0.2 0.2 0.3 0.3 0.3

1,000–2,499 grams . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 5.3 5.5 5.5 5.7 5.8 5.9 5.9

2,500–3,499 grams ............................. 49.1 50.8 53.4 54.7 55.1 55.1 56.0

3,500 grams or more ........................... 45.3 43.5 40.9 39.4 38.8 38.7 37.8

United States Number

Number of live births ............................. 3,760,561 4,158,212 4,110,907 4,065,014 4,000,240 3,952,767 3,899,589

Birthweight: Percent of live births

Less than 2,500 grams . . . . . . . . . . . . . . . . . . . . . . . . . . . . 6.8 7.0 7.1 7.1 7.2 7.3 7.3

Less than 500 grams . . . . . . . . . . . . . . . . . . . . . . . . . . . 0.1 0.1 0.1 0.1 0.1 0.1 0.1

500–999 grams . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 0.5 0.5 0.5 0.5 0.5 0.5 0.5

1,000–1,499 grams . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 0.6 0.6 0.7 0.7 0.7 0.7 0.7

1,500–1,999 grams . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 1.3 1.3 1.4 1.4 1.4 1.4 1.4

2,000–2,499 grams . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 4.2 4.4 4.5 4.4 4.5 4.6 4.6

2,500–2,999 grams ............................. 15.9 16.0 16.3 16.1 16.4 16.4 16.4

3,000–3,499 grams ............................. 36.7 36.7 36.8 36.7 36.9 36.8 36.9

3,500–3,999 grams ............................. 29.6 29.4 29.2 29.4 29.1 29.1 29.0

4,000–4,499 grams . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 9.2 9.1 8.9 9.0 8.8 8.8 8.7

4,500 grams or more . . . . . . . . . . . . . . . . . . . . . . . . . . . 1.9 1.8 1.7 1.7 1.7 1.7 1.4

NOTE: Columns may not add to 100.0 because of rounding.

SOURCES: Russian Federation: Ministry of Health. Maternal and Child Health Services. Moscow, 1997; United States: Centers for Disease Control and Prevention, National Center for Health

Statistics, Division of Vital Statistics.

Page 32 [ Series 5, No. 10
Table 9. Number and percent distribution of live births, according to urban-rural region, race, and birth order: Russian Federation and

United States, selected years 1985–95

Country and live birth order 1985 1990 1991 1992 1993 1994 1995

Russian Federation Number

All births ................................. 2,375,147 1,988,858 1,794,626 1,587,644 1,378,983 1,408,159 1,363,806

Urban births ............................. 1,666,673 1,386,247 1,230,516 1,068,304 930,530 960,413 933,460

Rural births ............................. 708,474 602,611 564,110 519,340 448,453 447,746 430,346

Percent distribution

All regions:

First child ............................... 45.1 49.5 52.5 55.7 58.6 59.7 59.7

Second child ............................. 38.7 34.2 32.0 29.9 28.9 28.5 28.6

Third child .............................. 10.8 10.5 9.8 8.9 7.9 7.6 7.6

Fourth child . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 2.9 3.1 3.0 2.9 2.5 2.3 2.3

Fifth child and over . . . . . . . . . . . . . . . . . . . . . . . . . 2.5 2.7 2.7 2.5 2.1 1.9 1.8

Urban:

First child ............................... 48.8 54.1 57.7 61.3 64.3 65.3 65.5

Second child ............................. 39.8 34.6 31.7 29.0 27.4 27.0 26.9

Third child . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 8.6 8.0 7.4 6.6 5.7 5.5 5.4

Fourth child . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 1.7 1.8 1.9 1.7 1.5 1.3 1.3

Fifth child and over . . . . . . . . . . . . . . . . . . . . . . . . . 1.1 1.4 1.4 1.4 1.1 1.0 0.9

Rural:

First child ............................... 36.4 39.0 41.2 44.3 46.8 47.5 47.1

Second child ............................. 36.1 33.3 32.5 32.0 32.1 31.9 32.2

Third child .............................. 15.9 16.0 15.2 13.6 12.4 12.3 12.4

Fourth child . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 5.8 6.0 5.6 5.3 4.6 4.5 4.5

Fifth child and over . . . . . . . . . . . . . . . . . . . . . . . . . 5.7 5.7 5.4 4.9 4.1 3.8 3.8

United States Number

All races ................................. 3,760,561 4,158,212 4,110,907 4,065,014 4,000,240 3,952,767 3,899,589

White ................................. 2,991,373 3,290,273 3,241,273 3,201,678 3,149,833 3,121,004 3,098,885

Black ................................. 608,193 684,336 682,602 673,633 658,875 636,391 603,139

Percent distribution

All races:

First child ............................... 41.6 40.9 40.7 40.3 40.7 41.2 41.6

Second child ............................. 33.2 32.2 32.1 32.4 32.4 32.2 32.1

Third child .............................. 15.6 16.4 16.4 16.4 16.2 16.1 16.0

Fourth child . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 5.7 6.3 6.4 6.4 6.4 6.3 6.1

Fifth child and over . . . . . . . . . . . . . . . . . . . . . . . . . 3.8 4.2 4.3 4.4 4.4 4.3 4.2

White:

First child ............................... 42.1 41.6 41.5 41.0 41.3 41.6 41.8

Second child ............................. 34.0 32.9 32.8 33.1 33.1 32.9 32.8

Third child .............................. 15.4 16.2 16.2 16.2 16.1 16.0 16.0

Fourth child . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 5.3 5.9 5.9 6.0 5.9 5.9 5.8

Fifth child and over . . . . . . . . . . . . . . . . . . . . . . . . . 3.2 3.5 3.6 3.6 3.6 3.6 3.6

Black:

First child ............................... 39.4 37.3 37.0 36.8 37.5 38.8 39.7

Second child ............................. 29.8 29.5 29.3 29.3 29.0 28.9 28.7

Third child .............................. 17.0 18.0 18.0 18.0 17.6 17.0 16.7

Fourth child . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 7.7 8.5 8.7 8.7 8.5 8.2 8.0

Fifth child and over . . . . . . . . . . . . . . . . . . . . . . . . . 6.1 6.7 7.0 7.3 7.4 7.1 7.0

NOTE: Columns may not add to 100.0 because of rounding.

SOURCES: Russian Federation: Goskomstat. The Demographic Yearbook of Russia, 1995. Moscow, 1995; The Demographic Yearbook of Russia, 1996. Moscow, 1996. United States: Centers for

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

Series 5, No. 10 [ Page 33
Table 10. Number and percent of live births to unmarried mothers, by urban-rural region or race: Russian Federation and United States,

selected years 1985–95

Country and marital status 1985 1990 1991 1992 1993 1994 1995

Russian Federation Number of live births

Live births to unmarried mothers .................. 285,016 290,601 287,944 272,255 250,714 275,765 288,291

Percent of live births to unmarried mothers

All regions ............................... 12.0 14.6 16.0 17.1 18.2 19.6 21.1

Urban . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 11.3 13.8 15.5 16.7 18.1 19.5 21.1

Rural ................................. 13.6 16.5 17.3 18.0 18.4 19.8 21.3

United States Number of live births

Live births to unmarried mothers .................. 828,174 1,165,384 1,213,769 1,224,876 1,240,172 1,289,592 1,253,976

Percent of live births to unmarried mothers

All races ................................. 22.0 28.0 29.5 30.1 31.0 32.6 32.2

White ................................. 14.5 20.4 21.8 22.6 23.6 25.4 25.3

Black ................................. 60.1 66.5 67.9 68.1 68.7 70.4 69.9

SOURCES: Russian Federation: Goskomstat. The Demographic Yearbook of Russia, 1995. Moscow, 1995; The Demographic Yearbook of Russia, 1996. Moscow, 1996. United States: Centers for

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

Page 34 [ Series 5, No. 10
Table 11. Rate of live births, by age of mother: Russian Federation and United States, selected years 1985–95

Country and age of mother 1985 1990 1991 1992 1993 1994 1995

Russian Federation Live births per 1,000 women

All regions:

15–49 years .............................. 65.0 55.3 49.9 43.9 38.4 38.0 36.0

Under 20 years ........................... 46.9 55.6 54.9 51.4 47.9 49.9 45.6

20–24 years ............................. 164.2 156.8 146.6 134.0 120.4 120.3 113.5

25–29 years ............................. 113.3 93.2 83.0 72.7 65.0 67.2 67.2

30–34 years ............................. 60.0 48.2 41.6 35.0 29.6 29.6 29.7

35–39 years ............................. 23.2 19.4 16.5 13.9 11.4 10.6 10.7

40–44 years . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 3.7 4.2 3.7 3.2 2.6 2.3 2.2

45–49 years . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 0.3 0.2 0.2 0.2 0.2 0.1 0.1

Urban:

15–49 years .............................. 58.9 49.3 43.9 38.1 33.3 33.6 32.1

Under 20 years ........................... 42.3 48.1 47.4 43.7 41.1 43.5 39.8

20–24 years ............................. 141.5 141.5 130.4 117.5 105.3 106.9 101.7

25–29 years ............................. 102.7 86.0 75.2 65.0 58.0 61.2 61.5

30–34 years ............................. 55.4 44.2 37.7 31.5 26.6 26.9 27.1

35–39 years ............................. 20.5 17.0 14.4 12.1 9.8 9.4 9.4

40–44 years . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 2.7 3.4 3.0 2.6 2.0 1.8 1.8

45–49 years . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 0.1 0.1 0.1 0.1 0.1 0.1 0.1

Rural:

15–49 years .............................. 85.8 76.5 71.3 63.9 55.5 52.8 49.3

Under 20 years ........................... 59.3 83.2 81.1 75.9 68.1 66.6 62.4

20–24 years ............................. 256.8 207.5 201.5 189.9 172.2 167.7 154.5

25–29 years ............................. 152.5 116.3 107.7 96.2 85.9 85.2 84.3

30–34 years ............................. 77.3 62.0 54.8 46.5 39.2 37.8 37.9

35–39 years ............................. 33.9 28.3 24.5 20.6 16.8 15.0 14.7

40–44 years . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 6.7 7.6 6.7 5.7 4.5 3.9 3.6

45–49 years . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 0.6 0.3 0.4 0.4 0.4 0.3 0.3

United States Live births per 1,000 women

All races:

15–49 years .............................. 60.1 63.4 62.0 60.8 59.5 58.3 57.1

15–19 years ............................. 51.0 59.9 62.1 60.7 59.6 58.9 56.8

20–24 years ............................. 108.3 116.5 115.7 114.6 112.6 111.1 109.8

25–29 years . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 111.0 120.2 118.2 117.4 115.5 113.9 112.2

30–34 years ............................. 69.1 80.8 79.5 80.2 80.8 81.5 82.5

35–39 years ............................. 24.0 31.7 32.0 32.5 32.9 33.7 34.3

40–44 years . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 4.0 5.5 5.5 5.9 6.1 6.4 6.6

45–49 years . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 0.2 0.2 0.2 0.3 0.3 0.3 0.3

White:

15–49 years .............................. 57.7 60.7 59.4 58.4 57.2 56.4 55.7

15–19 years ............................. 43.3 50.8 52.8 51.8 51.1 51.1 50.1

20–24 years ............................. 104.1 109.8 109.0 108.2 106.9 106.2 106.3

25–29 years ............................. 112.3 120.7 118.8 118.4 116.6 115.5 114.8

30–34 years ............................. 69.9 81.7 80.5 81.4 82.1 83.2 84.6

35–39 years ............................. 23.3 31.5 31.8 32.2 32.7 33.7 34.5

40–44 years . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 3.7 5.2 5.2 5.7 5.9 6.2 6.4

45–49 years . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 0.2 0.2 0.2 0.2 0.3 0.3 0.3

Black:

15–49 years .............................. 71.9 78.8 77.5 75.3 72.6 69.0 64.5

15–19 years ............................. 95.4 112.8 115.5 112.4 108.6 104.5 96.1

20–24 years ............................. 135.0 160.2 160.9 158.0 152.6 146.0 137.1

25–29 years ............................. 100.2 115.5 113.1 111.2 108.4 104.0 98.6

30–34 years ............................. 57.9 68.7 67.7 67.5 67.3 65.8 64.0

35–39 years ............................. 23.9 28.1 28.3 28.8 29.2 28.9 28.7

40–44 years . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 4.6 5.5 5.5 5.6 5.9 5.9 6.0

45 years and over . . . . . . . . . . . . . . . . . . . . . . . . . 0.3 0.3 0.2 0.2 0.3 0.3 0.3

SOURCES: Russian Federation: Goskomstat. The Demographic Yearbook of Russia, 1995. Moscow, 1995; The Demographic Yearbook of Russia, 1996. Moscow, 1996. United States: Centers for

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

Series 5, No. 10 [ Page 35
Table 12. Childhood death rates from all causes, by age, sex, urban-rural region, or race: Russian Federation and United States, selected

years 1985–95

Country, sex, and age 1985 1990 1991 1992 1993 1994 1995

Russian Federation, both sexes Deaths per 1,000 population

All regions:

Under 1 year1 .............................. 20.7 17.4 17.8 18.0 19.9 18.6 18.1

1–4 years . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 1.4 1.0 1.0 1.0 1.1 1.0 1.1

5–9 years . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 0.5 0.5 0.6 0.6 0.6 0.5 0.6

10–14 years . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 0.4 0.4 0.5 0.5 0.5 0.5 0.5

15–19 years . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 0.9 1.1 1.2 1.3 1.5 1.5 1.6

Urban:

Under 1 year1 .............................. 19.8 17.0 17.2 17.6 19.2 17.9 17.4

1–4 years . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 1.0 0.8 0.8 0.8 0.9 0.9 0.9

5–9 years . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . - - - 0.5 0.5 0.5 0.5 0.5 0.5

10–14 years . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . - - - 0.4 0.5 0.5 0.5 0.5 0.5

15–19 years . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . - - - 1.0 1.1 1.2 1.4 1.4 1.6

Rural:

Under 1 year1 .............................. 22.8 18.3 19.1 19.1 21.4 20.1 19.8

1–4 years . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 2.1 1.5 1.5 1.4 1.6 1.5 1.5

5–9 years . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . - - - 0.7 0.8 0.7 0.7 0.7 0.7

10–14 years . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . - - - 0.5 0.6 0.6 0.6 0.6 0.6

15–19 years . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . - - - 1.5 1.5 1.5 1.7 1.7 1.9

United States, both sexes

All races:

Under 1 year1 .............................. 10.6 9.2 8.9 8.5 8.4 8.0 7.6

1–4 years . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 0.5 0.5 0.5 0.4 0.4 0.4 0.4

5–9 years . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 0.2 0.2 0.2 0.2 0.2 0.2 0.2

10–14 years . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 0.3 0.3 0.3 0.2 0.3 0.3 0.3

15–19 years . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 0.8 0.9 0.9 0.8 0.9 0.9 0.8

White:

Under 1 year1 . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 9.2 7.6 7.3 6.9 6.8 6.6 6.3

1–4 years . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 0.5 0.4 0.4 0.4 0.4 0.4 0.4

5–9 years . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 0.2 0.2 0.2 0.2 0.2 0.2 0.2

10–14 years . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 0.3 0.2 0.2 0.2 0.2 0.2 0.2

15–19 years . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 0.8 0.8 0.8 0.8 0.8 0.8 0.8

Black:

Under 1 year1 .............................. 19.0 18.0 17.6 16.8 16.5 15.8 15.1

1–4 years . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 0.8 0.7 0.7 0.7 0.8 0.8 0.7

5–9 years . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 0.4 0.3 0.3 0.3 0.3 0.3 0.3

10–14 years . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 0.3 0.3 0.3 0.4 0.4 0.4 0.4

15–19 years . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 0.9 1.1 1.2 1.4 1.4 1.5 1.3

Russian Federation, male

All regions:

Under 1 year1 .............................. 23.8 20.2 20.7 21.1 22.4 21.3 20.5

1–4 years . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 1.5 1.1 1.1 1.1 1.2 1.2 1.2

5–9 years . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 0.6 0.7 0.8 0.7 0.7 0.7 0.7

10–14 years . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 0.5 0.6 0.7 0.7 0.7 0.7 0.7

15–19 years . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 1.3 1.6 1.7 1.8 2.1 2.1 2.4

Urban:

Under 1 year1 .............................. 22.8 19.5 20.0 20.5 21.5 20.5 19.6

1–4 years . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 1.2 0.9 0.9 0.9 1.0 1.0 1.0

5–9 years . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . - - - 0.6 0.7 0.6 0.7 0.6 0.6

10–14 years . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . - - - 0.6 0.6 0.6 0.7 0.6 0.6

15–19 years . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . - - - 1.5 1.5 1.7 2.0 2.0 2.3

Rural:

Under 1 year1 .............................. 26.1 21.1 22.3 22.3 24.2 23.0 22.3

1–4 years . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 2.4 1.7 1.7 1.7 1.7 1.7 1.7

5–9 years . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . - - - 0.9 1.0 0.9 0.9 0.8 0.9

10–14 years . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . - - - 0.7 0.8 0.8 0.8 0.8 0.8

15–19 years . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . - - - 2.0 2.0 2.0 2.3 2.4 2.7

Page 36 [ Series 5, No. 10

See footnotes at end of table.
Table 12. Childhood death rates from all causes, by age, sex, urban-rural region, or race: Russian Federation and United States, selected

years 1985–95—Con.

Country, sex, and age 1985 1990 1991 1992 1993 1994 1995

United States, male Deaths per 1,000 population

All races:

Under 1 year1 . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 11.9 10.3 10.0 9.4 9.3 8.8 8.3

1–4 years . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 0.6 0.5 0.5 0.5 0.5 0.4 0.4

5–9 years . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 0.3 0.3 0.2 0.2 0.2 0.2 0.2

10–14 years . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 0.3 0.3 0.3 0.3 0.3 0.3 0.3

15–19 years . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 1.1 1.3 1.3 1.2 1.3 1.3 1.2

White:

Under 1 year1 .............................. 10.4 8.5 8.3 7.7 7.6 7.2 7.0

1–4 years . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 0.5 0.5 0.5 0.4 0.4 0.4 0.4

5–9 years . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 0.3 0.2 0.2 0.2 0.2 0.2 0.2

10–14 years . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 0.3 0.3 0.3 0.3 0.3 0.3 0.3

15–19 years . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 1.1 1.2 1.1 1.1 1.1 1.1 1.1

Black:

Under 1 year1 .............................. 20.8 19.6 19.4 18.4 18.3 17.5 16.3

1–4 years . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 0.9 0.9 0.9 0.8 0.9 0.8 0.8

5–9 years . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 0.4 0.4 0.4 0.4 0.4 0.4 0.3

10–14 years . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 0.4 0.5 0.5 0.4 0.5 0.5 0.5

15–19 years . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 1.2 2.0 2.3 2.2 2.3 2.3 2.0

Russian Federation, female

All regions:

Under 1 year1 .............................. 17.6 14.7 15.3 15.5 17.1 15.7 15.5

1–4 years . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 1.2 0.9 0.9 0.8 1.0 0.9 1.0

5–9 years . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 0.4 0.4 0.4 0.4 0.4 0.4 0.4

10–14 years . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 0.3 0.3 0.3 0.3 0.4 0.4 0.4

15–19 years . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 0.5 0.6 0.7 0.7 0.8 0.8 0.9

Urban:

Under 1 year1 .............................. 16.8 14.4 14.9 15.1 16.6 15.2 14.8

1–4 years . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 0.9 0.7 0.7 0.7 0.8 0.8 0.8

5–9 years . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . - - - 0.3 0.4 0.4 0.4 0.4 0.4

10–14 years . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . - - - 0.3 0.3 0.3 0.3 0.3 0.4

15–19 years . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . - - - 0.6 0.6 0.6 0.7 0.8 0.8

Rural:

Under 1 year1 .............................. 19.6 15.4 16.3 16.4 18.3 17.0 16.9

1–4 years . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 1.8 1.3 1.2 1.2 1.4 1.4 1.3

5–9 years . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . - - - 0.5 0.5 0.5 0.5 0.5 0.5

10–14 years . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . - - - 0.3 0.4 0.4 0.4 0.4 0.4

15–19 years . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . - - - 0.9 0.9 0.9 1.0 0.9 1.0

United States, female

All races:

Under 1 year1 . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 9.3 8.1 7.8 7.6 7.4 7.2 6.8

1–4 years . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 0.4 0.4 0.4 0.4 0.4 0.4 0.4

5–9 years . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 0.2 0.2 0.2 0.2 0.2 0.2 0.2

10–14 years . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 0.2 0.2 0.2 0.2 0.2 0.2 0.2

15–19 years . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 0.5 0.5 0.5 0.4 0.5 0.4 0.5

White:

Under 1 year1 . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 7.9 6.6 6.3 6.1 6.0 5.9 5.6

1–4 years . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 0.4 0.4 0.4 0.3 0.3 0.3 0.3

5–9 years . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 0.2 0.2 0.2 0.2 0.2 0.2 0.2

10–14 years . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 0.2 0.2 0.2 0.2 0.2 0.2 0.2

15–19 years . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 0.5 0.5 0.5 0.4 0.4 0.4 0.4

Black:

Under 1 year1 .............................. 17.2 16.2 15.7 15.3 14.7 14.1 13.9

1–4 years . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 0.7 0.7 0.7 0.7 0.7 0.7 0.6

5–9 years . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 0.3 0.3 0.3 0.3 0.3 0.3 0.3

10–14 years . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 0.3 0.3 0.2 0.3 0.3 0.3 0.3

15–19 years . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 0.4 0.5 0.5 0.5 0.5 0.6 0.6

- - - Data not available.

1Under 1 year death rate is per 1,000 live births.

SOURCES: Russian Federation: Goskomstat. The Demographic Yearbook of Russia, 1995. Moscow, 1995; The Demographic Yearbook of Russia, 1996. Moscow, 1996. United States: Centers for

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

Series 5, No. 10 [ Page 37
Table 13. Infant mortality rates, by age at death: Russian Federation and United States, selected years 1985–95

Country and year

Infant mortality rate

Perinatal

mortality rate

Late fetal

Total Neonatal Postneonatal death rate

Russian Federation Deaths per 1,000 live births

Deaths per 1,000 live births

and late fetal deaths

1985 ......................... 20.7 11.1 9.6 17.8 9.3

1990 ......................... 17.4 10.8 6.6 17.9 9.1

1991 ......................... 17.8 11.0 6.8 17.5 8.7

1992 ......................... 18.0 11.3 6.7 17.2 8.3

1993 ......................... 19.9 12.1 7.8 17.4 7.8

1994 ......................... 18.6 11.8 6.8 16.7 7.8

1995 ......................... 18.1 11.0 7.0 15.8 7.4

United States

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

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

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

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

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

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

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

SOURCES: Russian Federation: Goskomstat. The Demographic Yearbook of Russia, 1995. Moscow, 1995; The Demographic Yearbook of Russia, 1996. Moscow, 1996. Ministry of Health. Maternal

and Child Health Services in 1996. Moscow, 1997. United States: Centers for Disease Control and Prevention, National Center for Health Statistics, Division of Vital Statistics.

Page 38 [ Series 5, No. 10
Table 14. Infant mortality rates per 100,000 live births, by sex and selected causes: Russian Federation and United States, 1990–95

Country, sex, and cause of death1 1990 1991 1992 1993 1994 1995

Russian Federation, both sexes Deaths per 100,000 live births

All causes ........................................ 001–999 1,764.2 1,810.5 1,839.7 2,026.6 1,856.4 1,821.4

Infectious and parasitic diseases .......................... 001–139 135.4 126.3 118.9 144.2 122.1 127.7

Pneumonia and influenza ........................ 480–483, 485–486 172.2 189.0 190.1 220.0 177.9 170.4

Congenital anomalies ................................. 740–759 375.5 394.0 393.7 414.9 404.6 419.8

Conditions originating in perinatal period ..................... 760–779 812.4 810.8 820.0 897.0 849.0 789.5

Birth trauma . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 767 137.2 136.5 129.2 133.6 117.7 106.2

Intrauterine hypoxia and birth asphyxia . . . . . . . . . . . . . . . . . . . . . . . 768 121.2 118.3 136.4 141.6 134.4 112.8

Respiratory distress syndrome .................... 769, 770.2–770.9 301.5 296.9 282.9 312.8 290.5 246.0

Congenital and aspirated pneumonia .................... 770.0–770.1 79.8 79.0 85.5 93.3 90.9 85.1

Accidents and adverse effects ................. E800–E949, E990–E999 62.1 66.9 71.7 82.5 76.1 77.9

United States, both sexes

All causes ........................................ 001–999 922.3 894.4 851.9 836.6 802.2 758.6

Infectious and parasitic diseases .......................... 001–139 20.2 21.1 19.2 19.2 21.2 19.8

Pneumonia and influenza .............................. 480–487 15.2 14.8 14.8 13.2 14.1 12.6

Congenital anomalies ................................. 740–759 198.1 186.9 183.2 178.2 173.4 168.1

Conditions originating in perinatal period ..................... 760–779 420.4 403.6 382.8 373.6 362.2 341.8

Maternal complications of pregnancy . . . . . . . . . . . . . . . . . . . . . . . . . 761 39.8 37.4 35.9 33.6 32.8 33.6

Complications of placenta, cord, and membranes . . . . . . . . . . . . . . . . . 762 23.4 23.4 24.4 24.8 24.0 24.7

Short gestation and low birthweight . . . . . . . . . . . . . . . . . . . . . . . . . . 765 96.5 100.7 99.3 107.7 107.6 100.9

Birth trauma . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 767 5.0 5.0 5.1 5.4 5.8 5.2

Intrauterine hypoxia and birth asphyxia . . . . . . . . . . . . . . . . . . . . . . . 768 18.3 14.6 15.1 13.7 13.6 12.2

Respiratory distress syndrome . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 769 68.5 62.5 50.8 45.4 39.6 37.3

Congenital and aspirated pneumonia .................... 770.0–770.1 4.2 4.0 3.9 2.9 3.4 2.0

Infections of the perinatal period . . . . . . . . . . . . . . . . . . . . . . . . . . . 771 21.0 21.4 22.2 19.3 20.9 20.2

Sudden infant death syndrome ............................. 798.0 130.3 130.1 120.3 116.7 103.0 87.1

Accidents and adverse effects ......................... E800–E949 22.4 23.4 20.1 22.4 22.5 20.2

Russian Federation, male

All causes ........................................ 001–999 2,026.1 2,072.0 2,110.5 2,287.7 2,123.8 2,066.9

Infectious and parasitic diseases .......................... 001–139 144.9 139.8 135.0 167.8 134.5 147.5

Pneumonia and influenza ........................ 480–483, 485–486 194.5 212.4 215.4 240.0 201.3 186.2

Congenital anomalies ................................. 740–759 417.5 425.2 425.2 450.8 432.1 465.9

Conditions originating in perinatal period ..................... 760–779 970.6 973.1 977.8 1,040.8 1,012.0 924.0

Birth trauma . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 767 171.8 170.8 160.1 162.0 148.0 129.7

Intrauterine hypoxia and birth asphyxia . . . . . . . . . . . . . . . . . . . . . . . 768 140.6 142.1 160.1 163.7 156.5 126.7

Respiratory distress syndrome .................... 769, 770.2–770.9 363.5 357.0 344.5 363.8 350.6 287.6

Congenital and aspirated pneumonia .................... 770.0–770.1 92.6 87.4 96.1 102.0 104.9 98.3

Accidents and adverse effects ................. E800–E949, E990–E999 68.7 69.0 78.5 88.5 87.7 86.4

United States, male

All causes ........................................ 001–999 1,026.3 999.7 938.7 925.3 880.8 832.6

Infectious and parasitic diseases .......................... 001–139 21.4 22.5 20.6 20.0 22.9 22.0

Pneumonia and influenza .............................. 480–487 17.1 15.6 17.1 15.1 16.8 14.0

Congenital anomalies ................................. 740–759 212.3 200.0 193.7 189.7 177.5 179.6

Conditions originating in perinatal period ..................... 760–779 466.6 449.7 419.1 408.7 398.4 376.5

Maternal complications of pregnancy . . . . . . . . . . . . . . . . . . . . . . . . . 761 41.6 40.0 37.0 35.7 35.6 34.9

Complications of placenta, cord, and membranes . . . . . . . . . . . . . . . . . 762 26.2 26.2 26.2 25.7 25.3 26.4

Short gestation and low birthweight . . . . . . . . . . . . . . . . . . . . . . . . . . 765 105.7 107.5 105.7 116.0 114.8 110.6

Birth trauma . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 767 6.1 5.7 5.7 5.9 7.3 6.1

Intrauterine hypoxia and birth asphyxia . . . . . . . . . . . . . . . . . . . . . . . 768 19.5 17.0 15.8 13.9 14.0 13.5

Respiratory distress syndrome . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 769 81.5 74.2 58.9 53.4 47.0 43.4

Congenital and aspirated pneumonia .................... 770.0–770.1 4.4 4.2 3.8 3.3 3.1 2.0

Infections of the perinatal period . . . . . . . . . . . . . . . . . . . . . . . . . . . 771 22.3 24.4 24.9 21.3 23.7 22.4

Sudden infant death syndrome ............................. 798.0 155.9 157.4 142.4 139.3 122.1 100.0

Accidents and adverse effects ......................... E800–E949 23.9 26.4 22.2 24.6 25.0 21.1

Series 5, No. 10 [ Page 39

See footnotes at end of table.
Table 14. Infant mortality rates per 100,000 live births, by sex and selected causes: Russian Federation and United States, 1990–95—Con.

Country, sex, and cause of death1 1990 1991 1992 1993 1994 1995

Russian Federation, female Deaths per 100,000 live births

All causes ........................................ 001–999 1,487.9 1,533.4 1,552.8 1,750.4 1,572.7 1,562.4

Infectious and parasitic diseases .......................... 001–139 125.3 112.0 101.7 119.4 108.9 106.7

Pneumonia and influenza ........................ 480–483, 485–486 148.7 164.1 163.3 198.9 153.1 153.7

Congenital anomalies ................................. 740–759 331.1 360.8 360.2 377.0 375.4 371.1

Conditions originating in perinatal period ..................... 760–779 645.4 638.7 652.9 744.9 676.1 647.5

Birth trauma . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 767 100.7 100.1 96.5 103.5 85.6 81.5

Intrauterine hypoxia and birth asphyxia . . . . . . . . . . . . . . . . . . . . . . . 768 100.8 93.1 111.2 118.2 111.1 98.1

Respiratory distress syndrome .................... 769, 770.2–770.9 236.0 233.3 217.5 258.8 226.7 202.1

Congenital and aspirated pneumonia .................... 770.0–770.1 66.3 70.1 74.3 84.1 76.1 71.3

Accidents and adverse effects ................. E800–E949, E990–E999 55.1 64.6 64.5 76.1 63.7 68.9

United States, female

All causes ........................................ 001–999 813.1 784.2 760.6 743.4 719.9 681.0

Infectious and parasitic diseases .......................... 001–139 18.9 19.7 17.8 18.4 19.3 17.5

Pneumonia and influenza .............................. 480–487 13.3 13.9 12.3 11.3 11.4 11.1

Congenital anomalies ................................. 740–759 183.3 173.3 172.2 166.2 169.1 156.0

Conditions originating in perinatal period ..................... 760–779 372.0 355.4 344.7 336.8 324.2 305.4

Maternal complications of pregnancy . . . . . . . . . . . . . . . . . . . . . . . . . 761 38.0 34.6 34.8 31.4 29.8 32.2

Complications of placenta, cord, and membranes . . . . . . . . . . . . . . . . . 762 20.6 20.5 22.5 23.9 22.6 22.8

Short gestation and low birthweight . . . . . . . . . . . . . . . . . . . . . . . . . . 765 86.9 93.5 92.5 99.1 100.1 90.7

Birth trauma . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 767 3.8 4.2 4.4 4.9 4.1 4.2

Intrauterine hypoxia and birth asphyxia . . . . . . . . . . . . . . . . . . . . . . . 768 17.1 12.0 14.4 13.5 13.1 10.8

Respiratory distress syndrome . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 769 54.9 50.3 42.2 36.9 31.9 30.8

Congenital and aspirated pneumonia .................... 770.0–770.1 4.1 3.8 4.0 2.6 3.7 2.0

Infections of the perinatal period . . . . . . . . . . . . . . . . . . . . . . . . . . . 771 19.8 18.4 19.3 17.2 18.0 17.9

Sudden infant death syndrome ............................. 798.0 103.4 101.6 97.1 93.0 83.0 73.6

Accidents and adverse effects ......................... E800–E949 20.8 20.2 18.0 20.2 19.9 19.2

1Codes are from the International Classification of Diseases, Ninth Revision.

SOURCES: Russian Federation: Rates computed by MedSocEconomInform from data provided by Goskomstat; United States: Centers for Disease Control and Prevention, National Center for Health

Statistics, Division of Vital Statistics.

Table 15. Maternal mortality rates, by cause of death: Russian Federation and United States, selected years 1985–95

Country and cause of death1 1985 1990 1991 1992 1993 1994 1995

Russian Federation Number per 100,000 live births

Total ...................................... 630–676 54.0 47.4 52.4 50.8 51.6 52.3 53.3

Ectopic pregnancy . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 633 3.2 3.2 4.4 4.7 3.8 4.1 3.9

Legally induced abortion . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 635 1.8 0.9 1.1 1.4 1.7 1.5 1.5

Other abortion ....................... 630–632, 634, 636–639 19.7 12.8 11.9 10.9 13.1 11.7 10.8

Hemorrhage of pregnancy and childbirth ....... 640, 641.1–641.9, 666 5.3 6.4 7.1 7.2 7.1 6.2 6.7

Toxemia of pregnancy ...................... 642.4–642.9, 643 5.6 5.7 7.8 5.8 6.2 6.4 5.3

Sepsis .................................... 659.3, 670 1.8 1.7 1.6 2.3 1.7 2.3 2.4

Other . . 642.0–642.3, 641.0, 644–648, 652–659.2, 659.4–659.9, 660–665,

667–669, 671–676 16.6 16.7 18.7 18.5 17.9 20.2 22.7

United States

Total ...................................... 630–676 7.8 8.2 7.9 7.8 7.5 8.3 7.1

Ectopic pregnancy . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 633 0.9 1.0 0.8 0.7 0.8 0.6 0.5

Legally induced abortion . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 635 0.1 ******

Other abortion ....................... 630–632, 634, 636–638 0.3 0.4 0.5 ****

Hemorrhage of pregnancy and childbirth ....... 640, 641.1–641.9, 666 1.1 1.1 0.9 1.0 1.0 1.2 0.9

Toxemia of pregnancy ...................... 642.4–642.9, 643 0.9 1.5 1.6 1.3 1.3 1.7 1.2

Complications of puerperium ....................... 670–676 2.4 2.4 2.4 2.3 2.5 2.6 2.4

Other ................. 642.0–642.3, 644–648, 651–665, 667–669 2.2 1.9 1.3 1.9 1.5 1.8 1.9

* Figures do not meet standards of reliability or precision.

1Codes are from the International Classification of Diseases, Ninth Revision.

SOURCES: Russian Federation: Rates computed by MedSocEconomInform from data supplied by Goskomstat; United States: Centers for Disease Control and Prevention, National Center for Health

Statistics, Vital Statistics of the United States, volume II, Mortality, Part A, for the years shown.

Page 40 [ Series 5, No. 10
Table 16. Percent of children breastfed, by selected characteristics: Russian Federation and United States, selected years 1985–95

Country and age 1985 1990 1991 1992 1993 1994 1995

Russian Federation Percent of children breastfed

3 months . . . . . . . . . . . . . . . . . . . . . . . . . . . --- --- 47.9 49.3 45.6 45.2 41.6

4 months ........................... 68.9 62.5 - - - - - - - - - - - - - - -

6 months . . . . . . . . . . . . . . . . . . . . . . . . . . . --- --- 33.3 33.5 32.7 31.6 30.0

United States

Ever breastfed ........................ 58.0 51.5 53.3 54.2 55.9 57.4 59.7

Breastfed at 6 months ................... 22.1 17.6 18.2 18.9 19.0 19.7 21.6

- - - Data not available.

SOURCES: Russian Federation: Ministry of Health. Maternal and Child Health Services. Moscow, 1997; United States: Ross Products Division, Abbott Laboratories. (1996). Ross Mother’s Survey.

Series 5, No. 10 [ Page 41
Table 17. Mortality rates per 100,000 population 1–4 years of age, by cause and sex: Russian Federation and United States, 1990–95

Country, sex, and cause of death1 1990 1991 1992 1993 1994 1995

Russian Federation, both sexes Deaths per 100,000 population

All causes ........................................ 001–999 98.5 100.6 99.4 108.4 104.8 108.3

Infectious and parasitic diseases .......................... 001–139 7.9 7.4 6.8 8.0 8.7 9.1

Neoplasms ....................................... 140–239 9.2 9.4 9.1 8.7 8.2 8.6

Diseases of nervous system ............................ 320–389 7.5 7.6 6.9 7.8 8.5 8.4

Cardiovascular diseases ............................... 390–459 0.9 1.1 1.2 1.1 1.3 1.2

Pneumonia and influenza ........................ 480–483, 485–486 9.8 8.5 7.4 9.5 8.5 9.5

Congenital anomalies ................................. 740–759 13.5 13.8 13.1 15.4 13.7 14.9

Accidents and adverse effects ................. E800–E949, E990–E999 36.8 39.3 41.9 41.7 39.9 39.5

Transport accidents, excluding automobile crashes . . . E800–E807, E826–E848 0.7 0.6 0.8 0.5 0.6 0.4

Motor vehicle accidents ............................ E810–E825 6.3 6.2 6.4 6.1 5.7 5.2

Accidental poisoning, excluding alcohol .......... E850–E858, E861–E869 7.3 8.1 8.0 10.0 8.1 7.7

Accident caused by fire ............................ E890–E899 4.9 5.1 5.6 6.4 6.1 5.5

Drowning ......................................... E910 7.6 8.1 8.6 7.4 7.6 6.9

Homicide and legal intervention ........................ E960–E978 0.7 0.8 1.1 1.4 1.6 1.5

United States, both sexes

All causes ........................................ 001–999 46.8 47.4 43.6 44.8 42.9 40.6

Infectious and parasitic diseases .......................... 001–139 2.8 2.7 2.5 3.0 3.1 2.9

HIV infection .................................... *042–*044 0.8 1.0 1.0 1.3 1.3 1.3

Neoplasms ....................................... 140–239 4.0 4.0 3.5 3.8 3.8 3.4

Diseases of nervous system ............................ 320–389 3.3 3.0 2.8 3.2 2.8 2.9

Cardiovascular diseases ............................... 390–459 2.3 2.7 2.3 2.3 2.3 2.1

Pneumonia and influenza .............................. 480–487 1.2 1.4 1.2 1.2 1.1 1.0

Congenital anomalies ................................. 740–759 6.0 5.7 5.5 5.1 4.5 4.4

Accidents and adverse effects ......................... E800–E949 17.3 17.5 15.9 16.4 15.9 14.5

Transport accidents, excluding automobile crashes . . . E800–E807, E826–E848 0.1 0.2 0.2 0.2 0.2 0.1

Motor vehicle accidents ............................ E810–E825 6.3 5.9 5.5 5.6 6.0 5.2

Accidental poisoning, excluding alcohol .......... E850–E858, E861–E869 0.4 0.4 0.3 0.4 0.2 0.2

Accident caused by fire ............................ E890–E899 3.7 4.0 3.7 3.7 3.8 2.8

Drowning ......................................... E910 3.8 3.8 3.3 3.5 3.0 3.4

Homicide and legal intervention ........................ E960–E978 2.6 2.8 2.8 2.9 3.0 2.9

Russian Federation, male

All causes ........................................ 001–999 110.9 114.1 113.5 119.4 116.0 120.9

Infectious and parasitic diseases .......................... 001–139 8.6 7.5 7.6 8.4 9.4 10.0

Neoplasms ....................................... 140–239 10.3 10.0 10.2 9.5 9.0 9.6

Diseases of nervous system ............................ 320–389 8.5 8.7 7.5 9.0 9.7 9.3

Cardiovascular diseases ............................... 390–459 0.9 1.0 1.3 1.2 1.3 1.1

Pneumonia and influenza ........................ 480–483, 485–486 10.7 8.8 7.8 10.1 9.4 10.1

Congenital anomalies ................................. 740–759 13.4 15.4 13.4 15.4 14.1 15.5

Accidents and adverse effects ................. E800–E949, E990–E999 46.2 49.8 54.7 51.8 49.3 51.0

Transport accidents, excluding automobile crashes . . . E800–E807, E826–E848 0.8 0.7 1.1 0.6 0.6 0.6

Motor vehicle accidents ............................ E810–E825 7.2 7.3 7.6 7.1 6.6 5.6

Accidental poisoning, excluding alcohol .......... E850–E858, E861–E869 8.2 9.4 9.0 10.5 9.1 8.3

Accident caused by fire ............................ E890–E899 5.5 5.3 6.8 7.0 6.3 6.6

Drowning ......................................... E910 10.5 11.2 11.8 9.7 9.9 9.4

Homicide and legal intervention ........................ E960–E978 0.8 0.8 1.1 1.3 1.6 1.9

United States, male

All causes ........................................ 001–999 52.4 52.0 48.0 49.5 47.3 44.8

Infectious and parasitic diseases .......................... 001–139 3.0 2.8 2.6 3.0 3.2 2.8

HIV infection .................................... *042–*044 0.8 1.0 1.1 1.3 1.2 1.2

Neoplasms ....................................... 140–239 4.2 4.2 3.5 4.3 4.0 4.0

Diseases of nervous system ............................ 320–389 3.9 3.2 2.8 3.3 2.8 3.1

Cardiovascular diseases ............................... 390–459 2.2 2.8 2.3 2.5 2.4 2.3

Pneumonia and influenza .............................. 480–487 1.2 1.6 1.2 1.2 1.2 0.9

Congenital anomalies ................................. 740–759 6.2 6.0 5.8 4.8 4.4 4.6

Accidents and adverse effects ......................... E800–E949 20.8 20.1 19.1 19.1 18.7 16.8

Transport accidents, excluding automobile crashes . . . E800–E807, E826–E848 0.1 0.3 0.3 0.2 0.1 0.1

Motor vehicle accidents ............................ E810–E825 6.9 6.3 6.1 6.1 6.6 5.6

Accidental poisoning, excluding alcohol .......... E850–E858, E861–E869 0.4 0.5 0.3 0.4 0.2 0.3

Accident caused by fire ............................ E890–E899 4.4 4.6 4.7 4.4 4.7 3.3

Drowning ......................................... E910 5.0 4.9 4.1 4.5 3.7 4.3

Homicide and legal intervention ........................ E960–E978 2.7 3.0 3.0 3.4 3.3 3.1

Page 42 [ Series 5, No. 10

See footnotes at end of table.
Table 17. Mortality rates per 100,000 population 1–4 years of age, by cause and sex: Russian Federation and United States, 1990–95—Con.

Country, sex, and cause of death1 1990 1991 1992 1993 1994 1995

Russian Federation, female Deaths per 100,000 population

All causes ........................................ 001–999 85.6 86.5 84.6 96.8 93.0 95.0

Infectious and parasitic diseases .......................... 001–139 7.2 7.3 5.9 7.6 7.9 8.1

Neoplasms ....................................... 140–239 8.1 8.8 7.9 7.9 7.5 7.6

Diseases of nervous system ............................ 320–389 6.4 6.4 6.3 6.7 7.3 7.4

Cardiovascular diseases ............................... 390–459 0.9 1.1 1.1 0.9 1.4 1.2

Pneumonia and influenza ........................ 480–483, 485–486 8.8 8.3 7.0 8.9 7.7 8.8

Congenital anomalies ................................. 740–759 13.7 12.2 12.8 15.5 13.3 14.2

Accidents and adverse effects ................. E800–E949, E990–E999 29.1 30.6 31.8 34.5 33.6 31.9

Transport accidents, excluding automobile crashes . . . E800–E807, E826–E848 0.6 0.6 0.5 0.4 0.5 0.2

Motor vehicle accidents ............................ E810–E825 5.3 4.9 5.2 5.1 4.7 4.8

Accidental poisoning, excluding alcohol .......... E850–E858, E861–E869 6.4 6.8 7.0 9.6 7.1 7.1

Accident caused by fire ............................ E890–E899 4.2 4.9 4.3 5.7 5.9 4.4

Drowning ......................................... E910 4.5 4.8 5.4 4.9 5.1 4.3

Homicide and legal intervention ........................ E960–E978 0.7 0.8 1.1 1.6 1.6 1.1

United States, female

All causes ........................................ 001–999 41.0 42.7 39.0 39.9 38.2 36.2

Infectious and parasitic diseases .......................... 001–139 2.7 2.6 2.3 2.9 3.1 3.0

HIV infection .................................... *042–*044 0.8 1.1 1.0 1.3 1.3 1.5

Neoplasms ....................................... 140–239 3.8 3.7 3.4 3.3 3.5 2.8

Diseases of nervous system ............................ 320–389 2.7 2.8 2.7 3.0 2.7 2.6

Cardiovascular diseases ............................... 390–459 2.4 2.6 2.3 2.1 2.1 1.9

Pneumonia and influenza .............................. 480–487 1.1 1.1 1.2 1.2 1.0 1.1

Congenital anomalies ................................. 740–759 5.8 5.4 5.2 5.4 4.6 4.2

Accidents and adverse effects ......................... E800–E949 13.7 14.8 12.6 13.6 12.9 12.0

Transport accidents, excluding automobile crashes . . . E800–E807, E826–E848 0.2 0.1 0.2 0.1 0.2 0.1

Motor vehicle accidents ............................ E810–E825 5.6 5.5 4.9 5.2 5.4 4.8

Accidental poisoning, excluding alcohol .......... E850–E858, E861–E869 0.3 0.3 0.2 0.4 0.3 0.1

Accident caused by fire ............................ E890–E899 2.9 3.4 2.6 3.0 2.8 2.3

Drowning ......................................... E910 2.5 2.6 2.6 2.3 2.2 2.4

Homicide and legal intervention ........................ E960–E978 2.4 2.6 2.5 2.5 2.7 2.6

1Codes are from the International Classification of Diseases, Ninth Revision.

NOTE: HIV is human immunodeficiency virus.

SOURCES: Russian Federation: Rates computed by MedSocEconomInform from data provided by Goskomstat; United States: Centers for Disease Control and Prevention, National Center for Health

Statistics; rates computed by Office of International Statistics from data supplied by the Division of Vital Statistics.

Series 5, No. 10 [ Page 43
Table 18. Mortality rates per 100,000 population 5–9 years of age, by cause and sex: Russian Federation and United States, 1990–95

Country and cause of death1 1990 1991 1992 1993 1994 1995

Russian Federation, both sexes Deaths per 100,000 population

All causes ........................................ 001–999 53.3 58.9 56.4 57.0 52.9 55.8

Infectious and parasitic diseases .......................... 001–139 1.0 1.1 1.1 1.2 1.8 2.0

Neoplasms ....................................... 140–239 7.3 7.1 7.3 6.5 6.2 6.1

Diseases of nervous system ............................ 320–389 4.5 4.8 4.5 4.9 4.8 4.7

Pneumonia and influenza ........................ 480–483, 485–486 1.3 1.1 1.0 1.3 1.3 1.7

Congenital anomalies ................................. 740–759 3.7 3.5 4.1 3.6 3.6 3.6

Accidents and adverse effects ................. E800–E949, E990–E999 29.3 34.7 31.4 31.3 27.9 30.2

Transport accidents, excluding automobile crashes . . . E800–E807, E826–E848 0.8 1.0 0.9 1.0 0.8 0.5

Motor vehicle accidents ............................ E810–E825 10.0 10.1 9.6 9.7 8.8 8.1

Accidental poisoning, excluding alcohol .......... E850–E858, E861–E869 1.5 1.7 1.7 1.8 1.6 1.9

Drowning ......................................... E910 10.0 13.9 11.4 10.7 9.3 11.0

Homicide and legal intervention ........................ E960–E978 0.8 0.7 1.0 1.2 1.3 1.1

United States, both sexes

All causes ........................................ 001–999 22.2 21.5 20.4 21.1 19.9 19.7

Infectious and parasitic diseases .......................... 001–139 1.0 0.9 1.0 1.2 1.1 1.2

HIV infection .................................... *042–*044 0.4 0.4 0.4 0.5 0.6 0.6

Neoplasms ....................................... 140–239 3.5 3.4 3.3 3.3 3.2 3.0

Diseases of nervous system ............................ 320–389 1.6 1.6 1.5 1.6 1.5 1.5

Pneumonia and influenza .............................. 480–487 0.4 0.4 0.3 0.4 0.3 0.4

Congenital anomalies ................................. 740–759 1.6 1.5 1.3 1.5 1.3 1.3

Accidents and adverse effects ......................... E800–E949 9.8 9.5 8.9 8.6 8.5 8.4

Transport accidents, excluding automobile crashes . . . E800–E807, E826–E848 0.2 0.2 0.2 0.2 0.2 0.2

Motor vehicle accidents ............................ E810–E825 5.4 5.1 4.9 4.7 4.7 4.7

Accidental poisoning, excluding alcohol .......... E850–E858, E861–E869 0.1 0.1 0.1 0.1 0.1 0.1

Drowning ......................................... E910 1.3 1.2 1.0 0.9 0.9 1.1

Homicide and legal intervention ........................ E960–E978 0.9 0.8 0.8 1.0 0.8 0.8

Russian Federation, male

All causes ........................................ 001–999 69.1 77.2 73.0 71.5 64.9 69.7

Infectious and parasitic diseases .......................... 001–139 1.2 1.2 1.1 1.2 2.0 2.4

Neoplasms ....................................... 140–239 8.1 8.0 8.6 7.1 6.9 6.8

Diseases of nervous system ............................ 320–389 5.2 5.6 5.4 5.2 5.0 5.6

Pneumonia and influenza ........................ 480–483, 485–486 1.6 1.2 1.0 1.4 1.4 1.7

Congenital anomalies ................................. 740–759 4.0 3.6 4.4 3.9 3.8 3.8

Accidents and adverse effects ................. E800–E949, E990–E999 42.1 50.6 44.8 43.2 37.3 40.6

Transport accidents, excluding automobile crashes . . . E800–E807, E826–E848 1.2 1.4 1.2 1.4 1.1 0.7

Motor vehicle accidents ............................ E810–E825 13.2 13.4 12.8 12.7 10.9 10.4

Accidental poisoning, excluding alcohol .......... E850–E858, E861–E869 1.6 2.1 1.9 1.8 1.8 1.9

Drowning ......................................... E910 16.1 21.9 17.9 16.5 14.2 16.4

Homicide and legal intervention ........................ E960–E978 0.7 0.6 0.8 1.1 1.3 1.3

United States, male

All causes ........................................ 001–999 25.6 24.5 23.7 23.2 22.6 22.5

Infectious and parasitic diseases .......................... 001–139 1.0 0.9 1.0 1.0 1.0 1.2

HIV infection .................................... *042–*044 0.3 0.4 0.5 0.5 0.5 0.6

Neoplasms ....................................... 140–239 3.7 3.7 3.7 3.6 3.4 3.2

Diseases of nervous system ............................ 320–389 1.8 1.6 1.7 1.9 1.8 1.5

Pneumonia and influenza .............................. 480–487 0.4 0.4 0.3 0.4 0.4 0.3

Congenital anomalies ................................. 740–759 1.7 1.6 1.3 1.5 1.2 1.3

Accidents and adverse effects ......................... E800–E949 12.2 12.0 11.3 10.3 10.4 10.3

Transport accidents, excluding automobile crashes . . . E800–E807, E826–E848 0.4 0.3 0.3 0.3 0.3 0.3

Motor vehicle accidents ............................ E810–E825 6.4 6.3 6.1 5.4 5.8 5.6

Accidental poisoning, excluding alcohol .......... E850–E858, E861–E869 0.1 0.1 0.1 0.1 0.1 0.1

Drowning ......................................... E910 1.8 1.8 1.5 1.3 1.4 1.7

Homicide and legal intervention ........................ E960–E978 0.8 0.8 0.8 1.1 0.8 0.9

Page 44 [ Series 5, No. 10

See footnotes at end of table.
Table 18. Mortality rates per 100,000 population 5–9 years of age, by cause and sex: Russian Federation and United States, 1990–95—Con.

Country and cause of death1 1990 1991 1992 1993 1994 1995

Russian Federation, female Deaths per 100,000 population

All causes ........................................ 001–999 36.9 40.0 39.2 41.9 40.4 41.4

Infectious and parasitic diseases .......................... 001–139 0.8 1.0 1.2 1.1 1.7 1.7

Neoplasms ....................................... 140–239 6.5 6.1 5.9 5.8 5.5 5.4

Diseases of nervous system ............................ 320–389 3.8 4.0 3.7 4.6 4.6 3.6

Pneumonia and influenza ........................ 480–483, 485–486 1.1 1.1 1.0 1.2 1.1 1.6

Congenital anomalies ................................. 740–759 3.5 3.4 3.8 3.2 3.4 3.4

Accidents and adverse effects ................. E800–E949, E990–E999 16.1 18.4 17.6 18.9 18.1 19.3

Transport accidents, excluding automobile crashes . . . E800–E807, E826–E848 0.4 0.5 0.5 0.6 0.6 0.4

Motor vehicle accidents ............................ E810–E825 6.6 6.8 6.3 6.6 6.7 5.8

Accidental poisoning, excluding alcohol .......... E850–E858, E861–E869 1.4 1.2 1.4 1.8 1.4 1.8

Drowning ......................................... E910 3.6 5.5 4.6 4.7 4.1 5.4

Homicide and legal intervention ........................ E960–E978 0.9 0.9 1.1 1.2 1.3 1.0

United States, female

All causes ........................................ 001–999 18.5 18.4 16.8 19.0 17.0 16.7

Infectious and parasitic diseases .......................... 001–139 0.9 0.9 0.9 1.3 1.2 1.3

HIV infection .................................... *042–*044 0.4 0.4 0.3 0.6 0.6 0.6

Neoplasms ....................................... 140–239 3.1 3.0 3.0 3.0 2.8 2.7

Diseases of nervous system ............................ 320–389 1.3 1.6 1.4 1.3 1.1 1.4

Pneumonia and influenza .............................. 480–487 0.4 0.3 0.2 0.4 0.2 0.4

Congenital anomalies ................................. 740–759 1.5 1.5 1.3 1.5 1.3 1.2

Accidents and adverse effects ......................... E800–E949 7.3 6.9 6.4 6.8 6.4 6.4

Transport accidents, excluding automobile crashes . . . E800–E807, E826–E848 0.1 0.2 0.2 0.2 0.2 0.1

Motor vehicle accidents ............................ E810–E825 4.3 3.9 3.7 4.0 3.6 3.8

Accidental poisoning, excluding alcohol .......... E850–E858, E861–E869 0.1 0.1 0.0 0.1 0.1 0.1

Drowning ......................................... E910 0.8 0.6 0.5 0.5 0.5 0.5

Homicide and legal intervention ........................ E960–E978 1.0 0.8 0.8 1.0 0.9 0.7

0.0 Quantity more than zero but less than 0.05.

1Codes are from the International Classification of Diseases, Ninth Revision.

NOTE: HIV is human immunodeficiency virus.

SOURCES: Russian Federation: Rates computed by MedSocEconomInform from data provided by Goskomstat; United States: Centers for Disease Control and Prevention, National Center for Health

Statistics; rates computed by Office of International Statistics from data supplied by the Division of Vital Statistics.

Series 5, No. 10 [ Page 45
Table 19. Mortality rates per 100,000 population 10–14 years of age, by cause and sex: Russian Federation and United States,

1990–95

Country, sex, and cause of death1 1990 1991 1992 1993 1994 1995

Russian Federation, both sexes Deaths per 100,000 population

All causes ........................................ 001–999 44.2 51.2 49.9 52.5 49.5 52.0

Neoplasms ....................................... 140–239 5.7 6.3 6.4 6.0 5.4 5.2

Diseases of nervous system ............................ 320–389 3.2 3.8 4.0 4.0 3.7 4.3

Cardiovascular diseases ............................... 390–459 0.9 1.0 1.0 1.2 1.2 1.1

Congenital anomalies ................................. 740–759 1.9 2.0 2.1 2.2 1.8 1.8

Accidents and adverse effects ................. E800–E949, E990–E999 22.0 26.3 23.9 24.8 23.9 25.8

Transport accidents, excluding automobile crashes . . . E800–E807, E826–E848 1.2 1.1 1.3 1.2 1.0 0.8

Motor vehicle accidents ............................ E810–E825 7.6 8.2 7.4 7.1 6.6 6.0

Accidental poisoning, excluding alcohol .......... E850–E858, E861–E869 1.3 1.5 1.4 1.6 1.7 1.5

Drowning ......................................... E910 4.9 7.4 5.5 6.3 6.4 8.1

Suicide ....................................... E950–E959 2.8 3.1 3.3 3.6 3.7 3.5

Homicide and legal intervention ........................ E960–E978 1.3 1.2 1.6 2.5 1.8 1.7

United States, both sexes

All causes ........................................ 001–999 26.0 25.8 24.6 25.6 25.2 25.5

Neoplasms ....................................... 140–239 3.4 3.2 3.2 2.9 3.0 3.0

Diseases of nervous system ............................ 320–389 1.6 1.6 1.5 1.7 1.5 1.6

Cardiovascular diseases ............................... 390–459 1.4 1.2 1.1 1.3 1.4 1.2

Congenital anomalies ................................. 740–759 1.1 1.2 1.1 1.1 1.0 1.1

Accidents and adverse effects ......................... E800–E949 11.0 10.9 9.7 10.1 10.2 10.2

Transport accidents, excluding automobile crashes . . . E800–E807, E826–E848 0.4 0.5 0.4 0.4 0.4 0.4

Motor vehicle accidents ............................ E810–E825 6.4 6.1 5.5 5.9 6.0 6.1

Accidental poisoning, excluding alcohol .......... E850–E858, E861–E869 0.2 0.2 0.1 0.1 0.2 0.1

Drowning ......................................... E910 1.4 1.2 1.1 1.2 1.1 1.2

Suicide ....................................... E950–E959 1.5 1.5 1.7 1.7 1.7 1.7

Homicide and legal intervention ........................ E960–E978 2.1 2.2 2.4 2.5 2.2 2.1

Russian Federation, male

All causes ........................................ 001–999 58.9 68.6 65.8 68.4 64.1 66.7

Neoplasms ....................................... 140–239 6.1 7.6 7.4 6.5 5.8 5.7

Diseases of nervous system ............................ 320–389 3.5 4.5 4.6 4.2 4.1 4.7

Cardiovascular diseases ............................... 390–459 1.0 1.1 1.1 1.3 1.0 1.2

Congenital anomalies ................................. 740–759 2.0 2.2 2.1 2.3 1.9 1.8

Accidents and adverse effects ................. E800–E949, E990–E999 32.7 38.1 34.9 35.7 33.6 35.9

Transport accidents, excluding automobile crashes . . . E800–E807, E826–E848 2.0 1.4 2.0 1.8 1.5 1.0

Motor vehicle accidents ............................ E810–E825 10.3 11.7 10.1 9.5 8.8 7.8

Accidental poisoning, excluding alcohol .......... E850–E858, E861–E869 1.7 1.9 1.8 1.8 2.2 1.8

Drowning ......................................... E910 7.2 9.9 7.6 8.5 8.3 11.0

Suicide ....................................... E950–E959 4.5 5.0 5.3 5.6 5.9 5.7

Homicide and legal intervention ........................ E960–E978 1.5 1.3 1.9 3.3 2.3 2.0

United States, male

All causes ........................................ 001–999 31.6 32.9 30.7 31.7 31.2 31.0

Neoplasms ....................................... 140–239 3.7 3.8 3.7 3.3 3.3 3.3

Diseases of nervous system ............................ 320–389 1.7 1.9 1.7 2.0 1.8 1.8

Cardiovascular diseases ............................... 390–459 1.5 1.3 1.3 1.4 1.6 1.3

Congenital anomalies ................................. 740–759 1.0 1.3 1.2 1.3 1.2 1.1

Accidents and adverse effects ......................... E800–E949 14.8 15.1 13.2 13.3 13.5 13.2

Transport accidents, excluding automobile crashes . . . E800–E807, E826–E848 0.7 0.7 0.6 0.5 0.6 0.5

Motor vehicle accidents ............................ E810–E825 7.6 7.9 7.1 7.2 7.3 7.2

Accidental poisoning, excluding alcohol .......... E850–E858, E861–E869 0.3 0.3 0.2 0.1 0.2 0.2

Drowning ......................................... E910 2.2 1.8 1.6 1.9 1.8 1.7

Suicide ....................................... E950–E959 2.2 2.3 2.4 2.4 2.4 2.6

Homicide and legal intervention ........................ E960–E978 2.6 2.9 3.2 3.2 2.9 3.0

Page 46 [ Series 5, No. 10

See footnotes at end of table.
Table 19. Mortality rates per 100,000 population 10–14 years of age, by cause and sex: Russian Federation and United States,

1990–95—Con.

Country, sex, and cause of death1 1990 1991 1992 1993 1994 1995

Russian Federation, female Deaths per 100,000 population

All causes ........................................ 001–999 29.0 33.3 33.4 36.2 34.5 36.9

Neoplasms ....................................... 140–239 5.3 5.0 5.4 5.6 5.0 4.7

Diseases of nervous system ............................ 320–389 3.0 3.0 3.4 3.7 3.3 3.9

Cardiovascular diseases ............................... 390–459 0.8 0.9 0.9 1.1 1.3 1.0

Congenital anomalies ................................. 740–759 1.8 1.9 2.1 2.0 1.8 1.8

Accidents and adverse effects ................. E800–E949, E990–E999 10.9 14.0 12.6 13.6 14.0 15.4

Transport accidents, excluding automobile crashes . . . E800–E807, E826–E848 0.4 0.7 0.6 0.6 0.4 0.4

Motor vehicle accidents ............................ E810–E825 4.9 4.6 4.6 4.6 4.4 4.1

Accidental poisoning, excluding alcohol .......... E850–E858, E861–E869 0.8 1.1 0.9 1.4 1.1 1.2

Drowning ......................................... E910 2.6 4.8 3.4 4.1 4.4 5.0

Suicide ....................................... E950–E959 0.9 1.1 1.4 1.6 1.3 1.2

Homicide and legal intervention ........................ E960–E978 1.1 1.1 1.2 1.6 1.2 1.4

United States, female

All causes ........................................ 001–999 20.2 18.2 18.2 19.2 18.8 19.6

Neoplasms ....................................... 140–239 3.0 2.6 2.8 2.5 2.6 2.6

Diseases of nervous system ............................ 320–389 1.4 1.4 1.3 1.4 1.2 1.5

Cardiovascular diseases ............................... 390–459 1.4 1.2 1.0 1.1 1.2 1.1

Congenital anomalies ................................. 740–759 1.1 1.1 1.0 1.0 0.9 1.1

Accidents and adverse effects ......................... E800–E949 7.1 6.4 6.1 6.7 6.7 7.1

Transport accidents, excluding automobile crashes . . . E800–E807, E826–E848 0.2 0.3 0.3 0.4 0.3 0.3

Motor vehicle accidents ............................ E810–E825 5.1 4.2 3.9 4.4 4.7 4.9

Accidental poisoning, excluding alcohol .......... E850–E858, E861–E869 0.1 0.2 0.1 0.2 0.1 0.1

Drowning ......................................... E910 0.6 0.5 0.6 0.5 0.4 0.6

Suicide ....................................... E950–E959 0.8 0.7 0.9 0.9 1.0 0.8

Homicide and legal intervention ........................ E960–E978 1.5 1.3 1.6 1.8 1.5 1.3

1Codes are from the International Classification of Diseases, Ninth Revision.

SOURCES: Russian Federation: Rates computed by MedSocEconomInform from data provided by Goskomstat; United States: Centers for Disease Control and Prevention, National Center for Health

Statistics; rates computed by Office of International Statistics from data supplied by the Division of Vital Statistics.

Series 5, No. 10 [ Page 47
Table 20. Mortality rates per 100,000 population 15–19 years of age, by cause and sex: Russian Federation and United States,

1990–95

Country and cause of death1 1990 1991 1992 1993 1994 1995

Russian Federation, both sexes Deaths per 100,000 population

All causes ........................................ 001–999 113.2 117.0 126.9 145.0 147.3 163.2

Neoplasms ....................................... 140–239 8.4 8.7 8.6 8.2 8.1 8.1

Diseases of nervous system ............................ 320–389 3.8 4.5 5.4 5.0 4.7 5.2

Cardiovascular diseases ............................... 390–459 4.7 4.7 4.8 5.0 5.8 5.5

Pneumonia and influenza ........................ 480–483, 485–486 1.3 1.3 1.5 1.5 1.5 1.9

Congenital anomalies ................................. 740–759 1.6 1.5 1.8 1.7 1.7 1.5

Accidents and adverse effects ................. E800–E949, E990–E999 52.0 51.9 52.4 60.2 59.4 72.7

Transport accidents, excluding automobile crashes . . . E800–E807, E826–E848 3.0 3.0 3.0 3.3 3.0 2.5

Motor vehicle accidents ............................ E810–E825 25.6 23.4 22.5 23.4 22.2 21.4

Accidental poisoning, excluding alcohol .......... E850–E858, E861–E869 3.8 4.0 4.3 5.8 6.3 7.0

Alcohol poisoning .................................... E860 0.8 0.8 1.4 2.3 2.4 1.9

Drowning ......................................... E910 5.3 6.1 6.0 7.5 7.8 10.2

Suicide ....................................... E950–E959 15.1 15.5 16.2 19.9 22.2 23.1

Homicide and legal intervention ........................ E960–E978 8.7 10.2 14.1 17.5 16.9 16.2

United States, both sexes

All causes ........................................ 001–999 87.9 89.0 84.3 86.9 86.8 83.5

Neoplasms ....................................... 140–239 4.5 4.6 4.5 4.4 4.4 4.1

Diseases of nervous system ............................ 320–389 2.1 2.0 2.0 2.1 2.1 2.1

Cardiovascular diseases ............................... 390–459 2.5 2.8 2.5 2.8 2.6 2.7

Pneumonia and influenza .............................. 480–487 0.5 0.5 0.5 0.6 0.5 0.5

Congenital anomalies ................................. 740–759 1.3 1.3 1.3 1.3 1.2 1.4

Accidents and adverse effects ......................... E800–E949 42.3 40.3 36.5 37.3 37.3 36.7

Transport accidents, excluding automobile crashes . . . E800–E807, E826–E848 0.9 1.0 0.9 0.9 0.8 0.8

Motor vehicle accidents ............................ E810–E825 33.1 31.2 28.2 28.6 29.3 28.6

Accidental poisoning, excluding alcohol .......... E850–E858, E861–E869 1.0 1.0 0.8 0.8 0.8 0.9

Alcohol poisoning .................................... E860 0.1 0.0 0.1 0.0 0.0 0.1

Drowning ......................................... E910 2.4 2.4 2.0 2.2 1.8 2.2

Suicide ....................................... E950–E959 11.1 11.0 10.8 10.9 11.1 10.5

Homicide and legal intervention ........................ E960–E978 17.0 19.6 19.3 20.7 20.3 18.2

Russian Federation, male

All causes ........................................ 001–999 161.9 166.4 180.4 209.7 212.0 239.6

Neoplasms ....................................... 140–239 10.0 10.2 10.0 9.4 9.7 9.0

Diseases of nervous system ............................ 320–389 4.6 5.4 6.7 6.1 5.6 6.6

Cardiovascular diseases ............................... 390–459 6.0 6.1 6.3 6.9 7.6 7.8

Pneumonia and influenza ........................ 480–483, 485–486 1.6 1.5 1.9 2.0 1.8 2.6

Congenital anomalies ................................. 740–759 1.7 1.9 2.1 2.0 2.0 1.8

Accidents and adverse effects ................. E800–E949, E990–E999 79.9 78.9 78.8 90.0 87.7 112.0

Transport accidents, excluding automobile crashes . . . E800–E807, E826–E848 4.5 4.9 4.4 5.2 4.6 4.0

Motor vehicle accidents ............................ E810–E825 38.5 33.8 32.0 32.2 29.9 28.9

Accidental poisoning, excluding alcohol .......... E850–E858, E861–E869 4.9 5.4 5.8 7.8 8.5 9.9

Alcohol poisoning .................................... E860 1.3 1.4 2.3 3.9 4.0 3.2

Drowning ......................................... E910 8.6 9.6 9.4 12.3 12.6 15.9

Suicide ....................................... E950–E959 23.4 24.2 25.3 31.8 34.9 36.2

Homicide and legal intervention ........................ E960–E978 13.4 15.8 22.1 27.6 26.3 24.8

United States, male

All causes ........................................ 001–999 127.2 128.6 122.4 126.0 126.6 119.5

Neoplasms ....................................... 140–239 5.1 5.3 5.4 5.0 5.1 4.9

Diseases of nervous system ............................ 320–389 2.9 2.7 2.8 2.8 2.8 2.7

Cardiovascular diseases ............................... 390–459 3.2 3.4 3.3 3.5 3.2 3.3

Pneumonia and influenza .............................. 480–487 0.4 0.6 0.5 0.5 0.5 0.6

Congenital anomalies ................................. 740–759 1.6 1.5 1.7 1.5 1.4 1.5

Accidents and adverse effects ......................... E800–E949 60.6 56.5 50.7 52.6 52.2 50.1

Transport accidents, excluding automobile crashes . . . E800–E807, E826–E848 1.4 1.4 1.5 1.4 1.4 1.2

Motor vehicle accidents ............................ E810–E825 45.5 41.4 37.0 38.7 38.9 36.8

Accidental poisoning, excluding alcohol .......... E850–E858, E861–E869 1.4 1.5 1.2 1.2 1.2 1.4

Alcohol poisoning .................................... E860 0.1 0.1 0.1 0.0 0.1 0.1

Drowning ......................................... E910 4.4 4.2 3.7 4.0 3.2 3.9

Suicide ....................................... E950–E959 18.1 18.0 17.8 17.6 18.2 17.4

Homicide and legal intervention ........................ E960–E978 28.0 32.8 32.6 34.8 34.5 30.0

Page 48 [ Series 5, No. 10

See footnotes at end of table.
Table 20. Mortality rates per 100,000 population 15–19 years of age, by cause and sex: Russian Federation and United States,

1990–95—Con.

Country and cause of death1 1990 1991 1992 1993 1994 1995

Russian Federation, female Deaths per 100,000 population

All causes ........................................ 001–999 62.8 66.2 72.0 78.5 80.8 84.5

Neoplasms ....................................... 140–239 6.9 7.2 7.3 6.9 6.4 7.2

Diseases of nervous system ............................ 320–389 3.1 3.6 4.1 3.9 3.7 3.7

Cardiovascular diseases ............................... 390–459 3.3 3.2 3.2 3.0 4.0 3.2

Pneumonia and influenza ........................ 480–483, 485–486 1.0 1.0 1.1 0.9 1.1 1.1

Congenital anomalies ................................. 740–759 1.5 1.2 1.6 1.4 1.5 1.3

Accidents and adverse effects ................. E800–E949, E990–E999 23.3 24.1 25.2 29.7 30.2 32.2

Transport accidents, excluding automobile crashes . . . E800–E807, E826–E848 1.5 1.1 1.6 1.4 1.2 1.0

Motor vehicle accidents ............................ E810–E825 12.2 12.6 12.8 14.4 14.2 13.6

Accidental poisoning, excluding alcohol .......... E850–E858, E861–E869 2.7 2.5 2.7 3.8 4.0 4.0

Alcohol poisoning .................................... E860 0.3 0.3 0.4 0.6 0.7 0.7

Drowning ......................................... E910 1.9 2.4 2.5 2.7 2.9 4.3

Suicide ....................................... E950–E959 6.4 6.6 6.9 7.7 9.1 9.5

Homicide and legal intervention ........................ E960–E978 3.8 4.5 6.0 7.2 7.2 7.3

United States, female

All causes ........................................ 001–999 46.4 47.2 44.0 45.6 44.8 45.7

Neoplasms ....................................... 140–239 3.9 3.8 3.7 3.8 3.7 3.2

Diseases of nervous system ............................ 320–389 1.3 1.3 1.2 1.4 1.2 1.4

Cardiovascular diseases ............................... 390–459 1.8 2.1 1.8 2.0 2.0 2.1

Pneumonia and influenza .............................. 480–487 0.5 0.4 0.5 0.6 0.5 0.3

Congenital anomalies ................................. 740–759 0.9 1.2 0.9 1.1 1.0 1.2

Accidents and adverse effects ......................... E800–E949 23.0 23.2 21.4 21.1 21.5 22.5

Transport accidents, excluding automobile crashes . . . E800–E807, E826–E848 0.4 0.5 0.3 0.4 0.3 0.3

Motor vehicle accidents ............................ E810–E825 20.0 20.5 18.8 18.0 19.1 20.0

Accidental poisoning, excluding alcohol .......... E850–E858, E861–E869 0.5 0.4 0.5 0.5 0.4 0.4

Alcohol poisoning .................................... E860 0.0 - - - 0.0 0.0 - - - 0.1

Drowning ......................................... E910 0.4 0.4 0.3 0.4 0.4 0.4

Suicide ....................................... E950–E959 3.7 3.7 3.4 3.8 3.5 3.1

Homicide and legal intervention ........................ E960–E978 5.4 5.5 5.2 5.9 5.3 5.9

0.0 Quantity is more than zero but less than 0.05.

- - - Data not available.

1Codes are from the International Classification of Diseases, Ninth Revision.

SOURCES: Russian Federation: Rates computed by MedSocEconomInform from data provided by Goskomstat; United States: Centers for Disease Control and Prevention, National Center for Health

Statistics; rates computed by Office of International Statistics from data supplied by the Division of Vital Statistics.

Table 21. Immunization coverage: Russian Federation and United States, selected years 1987–95

Country and type of immunization 1987 1990 1991 1992 1993 1994 1995

Russian Federation Percent of children1

Diphtheria/Tetanus (1 year) ..................... 79.9 68.5 68.8 72.6 79.2 88.1 92.7

Oral polio vaccine (1 year) ..................... 49.8 69.3 71.5 69.0 82.2 87.5 91.6

Measles (2 years) ........................... 91.9 81.1 78.7 82.6 88.2 91.3 94.1

Mumps (2 years) ........................... 58.6 58.5 56.8 61.7 66.9 71.3 77.1

Pertussis (1 year) ........................... 57.8 60.2 58.8 62.0 65.2 71.7 81.0

Tuberculosis (newborn) ....................... 92.1 91.4 88.3 86.2 86.7 95.5 96.2

United States

Diphtheria/Tetanus . . . . . . . . . . . . . . . . . . . . . . . . . . --- --- --- 83.0 88.0 93.0 95.0

Oral polio vaccine . . . . . . . . . . . . . . . . . . . . . . . . . . . --- --- --- 72.0 79.0 83.0 88.0

Measles . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . --- --- --- 83.0 84.0 89.0 90.0

Pertussis . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . --- --- --- 83.0 88.0 93.0 95.0

Hepatitis B . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . - - - - - - - - - 8.0 16.0 36.0 68.0

Haemophilus influenzae B . . . . . . . . . . . . . . . . . . . . . . --- --- --- 28.0 55.0 86.0 92.0

- - - Data not available.

1Percent of children for United States includes those 19–35 months of age.

SOURCES: Russia: States Committee for Sanitary Epidemiology and Surveillance, Ministry of Health. United States: Centers for Disease Control and Prevention (1992–93) Health Interview Survey,

National Center for Health Statistics; (1994–95) National Immunization Survey, National Immunization Program; (1992) unpublished Hepatitis B data.

Series 5, No. 10 [ Page 49
Table 22. Childhood morbidity rates per 100,000 population: Russian Federation, 1990–95

Age and disease category1 1990 1991 1992 1993 1994 1995

0–14 years of age Rate per 100,000 population 0–14 years of age

All causes ........................................ 001–999 113,620.1 117,551.6 105,134.9 114,177.0 113,042.3 118,498.3

Infectious diseases .................................. 001–139 8,841.6 8,267.2 8,592.4 9,002.2 10,223.3 10,485.5

Neoplasms ....................................... 140–239 104.4 113.6 132.8 139.3 156.1 159.4

Endocrine, nutritional, and metabolic ....................... 240–279 540.6 597.0 689.2 797.0 923.9 956.0

Blood and blood-forming organs .......................... 280–289 411.1 462.9 555.6 646.0 710.2 758.1

Nervous system and sense organs ........................ 320–389 6,215.2 6,311.8 6,827.2 7,310.9 7,710.0 8,053.6

Circulatory system .................................. 390–459 191.6 205.1 277.9 352.8 395.0 430.4

Respiratory system .................................. 460–519 78,359.7 82,200.3 67,235.2 73,475.9 68,308.9 71,526.7

Digestive system ................................... 520–579 3,876.2 4,070.5 4,686.1 5,111.0 5,183.1 5,754.6

Genitourinary system ................................. 580–629 770.5 810.0 979.1 1,105.2 1,303.2 1,397.7

Skin and subcutaneous tissue ........................... 680–709 4,847.8 4,843.0 5,063.9 5,749.2 6,847.9 7,240.0

Musculoskeletal system and connective tissue ................. 710–739 843.7 915.0 1,130.9 1,345.1 1,580.6 1,707.6

Congenital anomalies ................................. 740–759 270.0 311.8 335.5 347.3 383.7 407.0

Injury ........................................... 800–999 7,034.3 6,796.8 6,739.1 6,695.9 6,982.5 7,214.5

15–17 years of age Rate per 100,000 population 15–17 years of age

All causes ........................................ 001–999 - - - 57,770.9 60,864.5 67,037.3 66,842.8 71,753.6

Infectious diseases .................................. 001–139 - - - 2,124.7 2,338.5 3,074.8 3,735.8 4,135.6

Neoplasms ....................................... 140–239 - - - 67.3 87.0 104.1 119.2 131.4

Endocrine, nutritional, and metabolic ....................... 240–279 - - - 523.0 759.2 840.3 1,098.6 1,161.8

Blood and blood-forming organs .......................... 280–289 - - - 111.0 148.2 183.9 242.8 287.3

Nervous system and sense organs ........................ 320–389 - - - 3,320.9 4,079.7 4,549.5 4,944.0 5,309.3

Circulatory system .................................. 390–459 - - - 389.3 496.1 535.2 614.5 649.9

Respiratory system .................................. 460–519 - - - 33,175.0 32,396.3 35,389.7 32,031.9 35,304.3

Digestive system ................................... 520–579 - - - 2,918.7 3,643.8 3,854.4 4,316.0 4,308.1

Genitourinary system ................................. 580–629 - - - 1,061.7 1,465.3 1,776.2 2,163.8 2,495.5

Skin and subcutaneous tissue ........................... 680–709 - - - 3,175.4 3,689.3 4,278.9 5,087.1 5,238.5

Musculoskeletal system and connective tissue ................. 710–739 - - - 1,098.6 1,502.5 1,655.3 1,850.4 2,094.7

Congenital anomalies ................................. 740–759 - - - 79.4 101.3 108.5 128.6 138.7

Injury ........................................... 800–999 - - - 8,568.8 8,989.1 9,446.9 9,191.0 9,078.1

- - - Data not available.

1Codes are from the International Classification of Diseases, Ninth Revision.

SOURCE: Ministry of Health. Maternal and Child Health Services. Moscow, 1997.

Page 50 [ Series 5, No. 10
Table 23. Hospital discharge rates per 100,000 population, by diagnosis and age: United States, 1990–95

Age and disease category1 1990 1991 1992 1993 1994 1995

1–4 years of age Discharge rates per 100,000 population

All causes ............................................. 001–999 4,852.4 4,834.8 5,193.6 4,143.4 4,310.2 4,724.4

Infectious diseases ....................................... 001–139 388.7 421.0 414.6 326.3 335.3 381.9

Neoplasms ............................................ 140–239 103.0 105.0 137.1 88.8 79.2 89.1

Endocrine, nutritional, and metabolic ............................ 240–279 236.9 183.4 275.6 207.2 327.3 400.4

Blood and blood-forming organs ............................... 280–289 104.3 111.4 120.5 95.9 94.8 124.7

Nervous system and sense organs ............................. 320–389 401.2 353.0 372.5 248.6 248.2 270.2

Circulatory system ....................................... 390–459 38.2 44.3 63.9 52.0 62.6 38.7

Respiratory system ....................................... 460–519 1,849.4 1,939.4 1,936.5 1,635.6 1,676.6 1,939.6

Digestive system ........................................ 520–579 425.0 350.7 477.5 388.4 391.8 351.4

Genitourinary system ...................................... 580–629 117.8 124.4 135.8 135.5 107.9 116.0

Skin and subcutaneous tissue ................................ 680–709 122.8 113.1 116.8 76.2 77.8 96.2

Musculoskeletal system and connective tissue ...................... 710–739 47.2 71.2 59.2 * 34.5 52.6

Congenital anomalies ...................................... 740–759 258.9 228.6 250.4 172.2 168.0 197.4

Injury ................................................ 800–999 549.9 592.5 603.7 517.3 516.6 459.3

5–9 years of age

All causes ............................................. 001–999 2,486.9 2,543.0 2,369.3 1,920.4 2,090.5 2,233.3

Infectious diseases ....................................... 001–139 143.1 166.1 157.7 139.4 123.2 136.3

Neoplasms ............................................ 140–239 48.7 82.2 87.0 26.9 103.1 61.7

Endocrine, nutritional, and metabolic ............................ 240–279 117.4 97.8 97.4 95.0 90.4 120.9

Blood and blood-forming organs ............................... 280–289 88.0 63.3 58.5 65.0 79.8 100.1

Nervous system and sense organs ............................. 320–389 177.6 154.8 117.5 84.4 109.2 94.4

Circulatory system ....................................... 390–459 ******

Respiratory system ....................................... 460–519 751.3 753.0 604.7 546.8 531.9 670.3

Digestive system ........................................ 520–579 272.9 272.2 259.1 212.9 242.5 279.9

Genitourinary system ...................................... 580–629 104.3 77.6 104.2 67.4 74.9 62.3

Skin and subcutaneous tissue ................................ 680–709 62.6 68.7 63.1 65.3 54.6 46.0

Musculoskeletal system and connective tissue ...................... 710–739 64.0 82.8 59.1 64.0 69.2 54.1

Congenital anomalies ...................................... 740–759 78.4 109.3 93.0 62.4 78.9 69.2

Injury ................................................ 800–999 386.6 440.1 450.1 320.8 336.8 345.9

10–14 years of age

All causes ............................................. 001–999 2,654.5 2,795.6 2,591.2 2,274.7 2,354.7 2,339.0

Infectious diseases ....................................... 001–139 106.1 93.4 93.3 112.1 77.9 85.2

Neoplasms ............................................ 140–239 69.4 84.6 87.9 74.3 60.9 36.8

Endocrine, nutritional, and metabolic ............................ 240–279 133.7 159.0 133.5 97.5 125.8 123.7

Blood and blood-forming organs ............................... 280–289 134.7 114.3 88.7 96.8 63.5 72.5

Nervous system and sense organs ............................. 320–389 121.0 103.6 108.4 78.2 93.6 80.3

Circulatory system ....................................... 390–459 * 33.2 31.8 39.8 39.0 *

Respiratory system ....................................... 460–519 432.9 470.0 389.7 332.7 307.2 386.5

Digestive system ........................................ 520–579 371.3 348.2 324.0 275.7 292.3 270.2

Genitourinary system ...................................... 580–629 102.1 116.6 83.0 81.5 88.1 95.7

Skin and subcutaneous tissue ................................ 680–709 39.7 62.9 41.4 34.2 47.3 40.8

Musculoskeletal system and connective tissue ...................... 710–739 98.0 123.6 90.4 100.6 91.8 90.1

Congenital anomalies ...................................... 740–759 72.0 57.9 63.1 55.9 54.5 64.0

Injury ................................................ 800–999 511.7 521.6 545.2 422.1 423.2 420.6

Complications of pregnancy, childbirth, and the puerperium; delivery .... 630–676, V27 101.1 100.6 68.4 72.6 106.5 73.5

Series 5, No. 10 [ Page 51

See footnotes at end of table.
Table 23. Hospital discharge rates per 100,000 population, by diagnosis and age: United States, 1990–95—Con.

Age and disease category1 1990 1991 1992 1993 1994 1995

15–19 years of age Discharge rates per 100,000 population

All causes ............................................. 001–999 7,816.0 7,950.7 7,450.7 7,005.2 7,448.3 6,739.4

Infectious diseases ....................................... 001–139 160.7 111.8 131.7 135.0 128.3 113.2

Neoplasms ............................................ 140–239 65.6 89.5 95.1 58.8 76.7 62.8

Endocrine, nutritional, and metabolic ............................ 240–279 132.1 143.6 146.7 121.7 148.4 155.5

Blood and blood-forming organs ............................... 280–289 91.3 122.6 76.2 148.6 161.0 114.4

Nervous system and sense organs ............................. 320–389 115.9 132.3 119.5 69.0 69.2 63.9

Circulatory system ....................................... 390–459 83.4 62.3 60.6 60.9 48.5 66.3

Respiratory system ....................................... 460–519 416.2 389.9 375.0 335.2 344.0 298.4

Digestive system ........................................ 520–579 551.9 500.6 532.7 407.9 487.3 422.4

Genitourinary system ...................................... 580–629 394.7 406.5 353.9 285.6 279.6 262.3

Skin and subcutaneous tissue ................................ 680–709 69.3 80.9 84.2 55.8 40.4 59.4

Musculoskeletal system and connective tissue ...................... 710–739 193.2 241.6 227.5 173.0 142.2 175.9

Congenital anomalies ...................................... 740–759 52.7 63.3 36.5 * 34.3 27.5

Injury ................................................ 800–999 1,083.6 1,042.4 1,004.6 935.6 975.0 855.2

Complications of pregnancy, childbirth, and the puerperium; delivery .... 630–676, V27 3,542.1 3,727.9 3,395.6 3,369.2 3,420.5 3,075.9

* Figures do not meet standards of reliability or precision.

1Codes are from the International Classification of Diseases, Ninth Revision.

SOURCE: Centers for Disease Control and Prevention, National Center for Health Statistics; rates computed by the Office of International Statistics from data supplied by the Division of Health Care

Statistics.

Page 52 [ Series 5, No. 10
Table 24. Rates of selected notifiable diseases, by type of disease and age group: Russian Federation and United States, 1990–95

Country and disease category 1990 1991 1992 1993 1994 1995

Russia, 0–14 years of age Cases per 100,000 population

AIDS . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 0.0 0.0 0.0 0.0 0.0 0.0

Diphtheria . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 1.0 1.8 3.2 13.6 42.8 38.2

Hepatitis, all types ......................................... 551.0 443.9 286.8 251.2 248.9 251.2

Salmonellosis, excluding typhoid fever ............................ 119.9 121.1 138.0 117.2 121.5 118.4

Syphilis, primary and secondary . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 0.1 0.2 0.4 0.8 2.4 4.8

Gonorrhea . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 4.0 4.1 5.4 8.0 8.5 7.4

Tuberculosis . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 7.8 8.4 9.1 10.5 12.0 13.0

Poliomyelitis . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 0.0 0.0 0.0 0.0 0.0 0.5

Russia, 15–17 years of age

AIDS . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . --- --- --- --- --- ---

Diphtheria . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . --- --- --- --- --- ---

Hepatitis, all types . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . --- --- --- --- --- ---

Salmonellosis, excluding typhoid fever . . . . . . . . . . . . . . . . . . . . . . . . . . . . --- --- --- --- --- ---

Syphilis, primary and secondary . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 5.7 9.4 20.2 57.2 139.5 278.0

Gonorrhea ............................................. 255.6 261.1 317.8 421.4 350.5 292.1

Tuberculosis ............................................ 16.1 16.6 16.5 18.6 19.1 20.7

Poliomyelitis . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 0.0 0.0 0.0 0.0 0.0 0.0

United States, 0–4 years of age

AIDS . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 3.2 3.2 3.6 3.4 3.0 2.3

Diphtheria . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 0.0 0.0 0.0 0.0 0.0 0.0

Hepatitis A . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 11.2 8.7 8.3 8.0 10.4 10.5

Hepatitis B . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 1.6 1.1 1.1 0.7 0.6 0.4

Hepatitis C, non-A, non-B . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 0.1 0.2 0.4 0.3 0.2 0.2

Salmonellosis, excluding typhoid fever ............................ 69.1 67.3 65.8 55.4 59.3 62.2

Syphilis, primary and secondary . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 0.0 0.0 0.0 0.0 0.0 0.0

Gonorrhea . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 0.0 0.0 0.0 0.0 0.0 0.0

Tuberculosis . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 5.0 5.3 5.5 5.5 5.2 4.7

Poliomyelitis . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 0.0 0.0 0.0 0.0 0.0 0.0

United States, 5–9 years of age

AIDS . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 0.7 0.6 0.8 0.7 0.6 0.7

Diphtheria . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 0.0 0.0 0.0 0.0 0.0 0.0

Hepatitis A ............................................. 26.9 20.2 18.5 16.6 21.6 21.1

Hepatitis B . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 0.7 0.7 0.5 0.5 0.4 0.4

Hepatitis C, non-A, non-B . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 0.2 0.1 0.1 0.1 0.1 0.0

Salmonellosis, excluding typhoid fever ............................ 15.6 15.3 14.4 12.7 14.9 14.8

Syphilis, primary and secondary . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 0.0 0.0 0.0 0.0 0.0 0.0

Gonorrhea . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 0.0 0.0 0.0 0.0 0.0 0.0

Tuberculosis . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 2.0 2.2 2.1 1.9 2.1 2.0

Poliomyelitis . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 0.0 0.0 0.0 0.0 0.0 0.0

United States, 10–14 years of age

AIDS . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 0.3 0.5 0.5 0.6 0.6 0.6

Diphtheria . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 0.0 0.0 0.0 0.0 0.0 0.0

Hepatitis A ............................................. 17.7 14.4 13.2 11.4 13.3 13.9

Hepatitis B . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 1.2 1.2 1.2 1.1 0.9 0.7

Hepatitis C, non-A, non-B . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 0.2 0.1 0.2 0.2 0.1 0.1

Salmonellosis, excluding typhoid fever ............................ 10.1 9.3 8.8 7.9 8.5 8.6

Syphilis, primary and secondary . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 1.1 0.4 0.4 0.9 0.6 0.6

Gonorrhea ............................................. 68.9 64.6 57.8 48.5 48.3 41.3

Tuberculosis . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 1.8 1.4 1.4 1.6 1.5 1.3

Poliomyelitis . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 0.0 0.0 0.0 0.0 0.0 0.0

United States, 15–19 years of age

AIDS . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 1.0 1.0 1.1 1.3 1.3 1.3

Diphtheria . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 0.0 0.0 0.0 0.0 0.0 0.0

Hepatitis A ............................................. 13.4 10.3 10.4 10.7 11.6 14.8

Hepatitis B . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 8.6 7.9 6.5 5.3 4.6 3.9

Hepatitis C, non-A, non-B . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 0.6 0.5 0.6 0.4 0.4 0.2

Salmonellosis, excluding typhoid fever . . . . . . . . . . . . . . . . . . . . . . . . . . . . 11.4 9.6 10.0 9.2 8.7 9.4

Syphilis, primary and secondary ................................ 15.2 12.5 8.5 17.0 12.7 10.1

Gonorrhea . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 1,114.4 1,031.4 889.6 728.3 733.7 870.7

Tuberculosis . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 3.2 3.5 3.4 3.4 3.2 3.0

Poliomyelitis . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 0.0 0.0 0.0 0.0 0.0 0.0

0.0 Quantity more than zero but less than 0.05. - - - Data not available.

NOTE: AIDS is acquired immunodeficiency syndrome.

SOURCES: Russia: 0–14 years: States Committee for Sanitary Epidemiology and Surveillance of Russia Information Yearbook. Moscow, 1997; 15–17 years: Ministry of Health. United States: Centers

for Disease Control and Prevention, National Center for Health Statistics.

Series 5, No. 10 [ Page 53
Glossary

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.

In Russia a reporting form is

completed when each AIDS case is

reported. Monthly reports on confirmed

AIDS cases are published. The monthly

results can be corrected during the year

as necessary. All confirmed AIDS cases

are included in the annual statistical

report.

Alan Guttmacher Institute— The Alan

Guttmacher Institute (AGI) conducts an

annual survey of abortion providers.

Data are collected from hospitals,

nonhospital clinics, and physicians

identified as providers of abortion

services. A universal survey of 3,092

hospitals, nonhospital clinics, and

individual physicians was compiled. To

assess the completeness of the provider

and abortion counts, supplemental

surveys were conducted of a sample of

obstetrician-gynecologists and a sample

of hospitals (not in original universe)

that were identified as providing

abortion services through the American

Hospital Association Survey.

The number of abortions estimated

by AGI through the mid to late 1980’s

was about 20 percent more than the

number reported to the Centers for

Disease Control and Prevention (CDC).

Since 1989 the AGI estimates have been

about 12 percent higher than those

reported by CDC.

For more information, write: The

Alan Guttmacher Institute, 120 Wall

Street, New York, NY 10005; or visit

AGI’s home page at http://www.agiusa.org.

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.

Since 1979 the International

Classification of Diseases, Ninth

Revision (ICD–9) has been used for

coding cause of death.

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

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.

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

Page 54 [ Series 5, No. 10
first recorded final diagnosis on the

medical record face sheet (summary

sheet).

Gestation—For the National Vital

Statistics System and the Centers for

Disease Control and Prevention’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.

Health maintenance organization

(HMO)—An HMO is a prepaid health

plan delivering comprehensive care to

members through designated providers,

having a fixed monthly payment for

health care services, and requiring

members to be in a plan for a specified

period of time (usually 1 year). Pure

HMO enrollees use only the prepaid

capitated health services of the HMO’s

panel of medical care providers.

Open-ended HMO enrollees use the

prepaid HMO health services but in

addition may receive medical care from

providers who are not part of the

HMO’s panel. There is usually a

substantial deductible, copayment, or

coinsurance associated with the use of

nonpanel providers. These open-ended

products are governed by State HMO

regulations.

HIV—See Human immunodeficiency

virus infection.

Hospital—Hospitals are licensed

institutions with at least 6 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. (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, Ninth

Revision; 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 5–15 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,

Ninth Revision (ICD–9)—The

International Classification of Diseases

(ICD) classifies mortality information

for statistical purposes. The ICD was

first used in 1900 and has been revised

about every 10 years since then. The

ICD–9, published in 1977, is used to

code U.S. mortality data beginning with

data year 1979. 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

Series 5, No. 10 [ Page 55
poisoning. See related International

Classification of Diseases, Ninth

Revision.

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 World Health

Organization 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

1992.

However, 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—In the National Vital

Statistics System 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.

MedSocEconomInform—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 the

Public Health Institute.

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.

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.

Offıce-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. 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

Page 56 [ Series 5, No. 10
time. It is often expressed as a rate (for

example, the prevalence of diabetes per

1,000 persons during a year). See

related Incidence.

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, 15–49

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 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. 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. WHO also recommends

calculating this rate per 100,000

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.

Resident population—See Population.

Ross ‘‘Mother’s Survey’’—The Ross

Products Division of Abbott

Laboratories conducts an annual sample

survey of mothers of infants. The survey

questionnaire is mailed to mothers when

their infant is 6 months of age. In the

questionnaire, mothers are asked to

recall the type of milk their baby was

fed in the hospital and in the last 30

days.

For more information, write:

Mr. Booker Smith

Ross Mother’s Survey

625 Cleveland Ave

Columbus, Ohio 43215-1724

Stillbirth—See Rate: Death and related

rates.

Series 5, No. 10 [ Page 57
Vital and Health Statistics

series descriptions

SERIES 1. Programs and Collection Procedures—These reports

describe the data collection programs of the National Center

for Health Statistics. They include descriptions of the methods

used to collect and process the data, definitions, and other

material necessary for understanding the data.

SERIES 2. Data Evaluation and Methods Research—These reports

are studies of new statistical methods and include analytical

techniques, objective evaluations of reliability of collected

data, and contributions to statistical theory. These studies also

include experimental tests of new survey methods and

comparisons of U.S. methodology with those of other

countries.

SERIES 3. Analytical and Epidemiological Studies—These reports

present analytical or interpretive studies based on vital and

health statistics. These reports carry the analyses further than

the expository types of reports in the other series.

SERIES 4. Documents and Committee Reports—These are final

reports of major committees concerned with vital and health

statistics and documents such as recommended model vital

registration laws and revised birth and death certificates.

SERIES 5. International Vital and Health Statistics Reports—These

reports are analytical or descriptive reports that compare U.S.

vital and health statistics with those of other countries or

present other international data of relevance to the health

statistics system of the United States.

SERIES 6. Cognition and Survey Measurement—These reports are

from the National Laboratory for Collaborative Research in

Cognition and Survey Measurement. They use methods of

cognitive science to design, evaluate, and test survey

instruments.

SERIES 10. Data From the National Health Interview Survey—These

reports contain statistics on illness; unintentional injuries;

disability; use of hospital, medical, and other health services;

and a wide range of special current health topics covering

many aspects of health behaviors, health status, and health

care utilization. They are based on data collected in a

continuing national household interview survey.

SERIES 11. Data From the National Health Examination Survey, the

National Health and Nutrition Examination Surveys, and

the Hispanic Health and Nutrition Examination Survey—

Data from direct examination, testing, and measurement on

representative samples of the civilian noninstitutionalized

population provide the basis for (1) medically defined total

prevalence of specific diseases or conditions in the United

States and the distributions of the population with respect to

physical, physiological, and psychological characteristics, and

(2) analyses of trends and relationships among various

measurements and between survey periods.

SERIES 12. Data From the Institutionalized Population Surveys—

Discontinued in 1975. Reports from these surveys are

included in Series 13.

SERIES 13. Data From the National Health Care Survey—These

reports contain statistics on health resources and the public’s

use of health care resources including ambulatory, hospital,

and long-term care services based on data collected directly

from health care providers and provider records.

SERIES 14. Data on Health Resources: Manpower and Facilities—

Discontinued in 1990. Reports on the numbers, geographic

distribution, and characteristics of health resources are now

included in Series 13.

SERIES 15. Data From Special Surveys—These reports contain

statistics on health and health-related topics collected in

special surveys that are not part of the continuing data

systems of the National Center for Health Statistics.

SERIES 16. Compilations of Advance Data From Vital and Health

Statistics—Advance Data Reports provide early release of

information from the National Center for Health Statistics’

health and demographic surveys. They are compiled in the

order in which they are published. Some of these releases

may be followed by detailed reports in Series 10–13.

SERIES 20. Data on Mortality—These reports contain statistics on

mortality that are not included in regular, annual, or monthly

reports. Special analyses by cause of death, age, other

demographic variables, and geographic and trend analyses

are included.

SERIES 21. Data on Natality, Marriage, and Divorce—These reports

contain statistics on natality, marriage, and divorce that are

not included in regular, annual, or monthly reports. Special

analyses by health and demographic variables and

geographic and trend analyses are included.

SERIES 22. Data From the National Mortality and Natality Surveys—

Discontinued in 1975. Reports from these sample surveys,

based on vital records, are now published in Series 20 or 21.

SERIES 23. Data From the National Survey of Family Growth—

These reports contain statistics on factors that affect birth

rates, including contraception, infertility, cohabitation,

marriage, divorce, and remarriage; adoption; use of medical

care for family planning and infertility; and related maternal

and infant health topics. These statistics are based on

national surveys of women of childbearing age.

SERIES 24. Compilations of Data on Natality, Mortality, Marriage,

Divorce, and Induced Terminations of Pregnancy—

These include advance reports of births, deaths, marriages,

and divorces based on final data from the National Vital

Statistics System that were published as supplements to the

Monthly Vital Statistics Report (MVSR). These reports provide

highlights and summaries of detailed data subsequently

published in Vital Statistics of the United States. Other

supplements to the MVSR published here provide selected

findings based on final data from the National Vital Statistics

System and may be followed by detailed reports in Series 20

or 21.

For answers to questions about this report or for a list of reports published

in these series, contact:

Data Dissemination Branch

National Center for Health Statistics

Centers for Disease Control and Prevention

6525 Belcrest Road, Room 1064

Hyattsville, MD 20782-2003

(301) 436–8500

E-mail: nchsquery@cdc.gov

Internet: www.cdc.gov/nchswww