International Journal of Epidemiology, Vol 28, 19-29, Copyright © 1999 by International Epidemiological Association
VM Shkolnikov, M McKee, J Vallin, E Aksel, D Leon, L Chenet and F Mesle
BACKGROUND: The dramatic increase in mortality in Russia and Ukraine in the
late 1980s and 1990s has been due to increases in certain causes of death,
particularly cardiovascular disease and accidents and violence. In
contrast, there has been a slight fall in mortality from cancer. METHODS:
This paper presents an analysis of trends and patterns in cancer mortality
and examines four possible explanations for its recent fall: changes in
data collection; cohort effects; competing mortality from other causes of
death; and improvements in health care. RESULTS: All contribute to some
extent to the observed changes, with each affecting predominantly different
age groups. There is evidence of a significant underrecording of cancer
deaths among the elderly especially in rural areas and of significant
changes in coding practices in the early 1990s. Competing mortality from
cardiovascular diseases and accidents can explain some reduction in male
deaths from cancer in middle age. Birth cohort effects can explain some
reduction among males after early middle age and among females at all ages.
The impact of changes in health care are more difficult to identify with
certainty but there is evidence of reduced deaths from childhood leukaemia.
IMPLICATIONS: Recent changes in mortality in Russia are complex and their
understanding will require a multidisciplinary approach embracing
demography, epidemiology and health services research.
ARTICLES
Cancer mortality in Russia and Ukraine: validity, competing risks and cohort effects
Center of Demography and Human Ecology, Institute for Economic Forecasting, Moscow, Russian Federation.
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