Age-adjusted disability rates and regional effects in Russia.

Abstract We provide three measures of age-standardized disability rates for each Russian region and show that most, though not all, of the regional patterns in disability prevalence disappear with standardization. Disability prevalence remains unusually high for women in St Petersburg and Belgorod but the "remote but healthy" pattern is nearly gone. We conclude that differences in age structure largely account for the differences in disability prevalence across regions of Russia. (ProQuest: ... denotes formulae omitted.) 1. Introduction The prevalence of disability in transition nations is high, reflecting a combination of high prevalence of chronic disease, poor work-place safety practices, and relatively generous social safety net provisions (Andreev, 2008; Seitenova and Becker, 2008; Becker and Urzhumova, 1998). This high prevalence has attracted considerable discussion, and the presence of detailed data has made it possible to explore the characteristics of those receiving disability payments in far more detail than is practical for most other middle-income countries. One of the superficially surprising characteristics concerns regional patterns of disability. Previous research has found that disability prevalence is lowest in Russia's Far East and far north while highest in St Petersburg, Moscow, and the Central federal district. This is a counterintuitive finding, since the high prevalence regions are more prosperous and have better health care and social services. Based on anecdotal evidence, the discrepancies in disability prevalence across regions have been attributed to differences in the generosity of benefits, ease of access to the disability screening process or the prevalence of corruption or fraud. However, by incorporating the age structure of Russian regions, we conclude that almost all of the differences in disability prevalence can be attributed to differences in age structure, and that non-medical explanations are likely to be fairly unimportant. Due to recent migration out of the Russian north and Far East, the population distribution in these regions is undoubtedly a product of self-selection on the basis of health and employment opportunity, which heavily correlate with age. Crude comparisons of disability prevalence rates across the regions of Russia may therefore be biased. A more appropriate method of comparison of disability rates would adjust for age. Such ageadjusted rates are already used in a number of applications, including mortality rates, incidence of cancer, and the like. This paper estimates age-adjusted disability rates on the basis of survey data of Russian households. In addition, the paper explores two other methods of capturing regional effects on disability prevalence using regression analysis. With standardization, the "remote but healthy" advantage that appears to characterize Siberia, the Far East, and the northernmost regions almost disappears. A few significant gender differences in disability prevalence in some regions do remain. Even after standardization, for example, disability rates for women in St Petersburg and Belgorod Oblast remain unusually high. The remainder of this paper proceeds as follows: the next section summarizes the structure of the Russian disability system as well as some of the recent literature on this subject. Section 3 provides the methodology for estimating age-adjusted disability rates from survey data and for capturing regional effects using regression models. Section 4 presents the results of the age-adjustment computations and regional effect regression analysis. A final section offers conclusions and ideas for further study. 2. The Russian disability system Disability in Russia is governed by the 24 November 1995 Federal law "On the Social Protection of Disabled Individuals in the Russian Federation." The law defines as disabled an individual "who has a health impairment with a continued disruption of bodily functions caused by illness, the results of trauma, or [anatomical] defects, leading to limited capacity for life and requiring social protection" (Russian Federation, 1995). …