Shkolnikov V, McKee M, Leon D A
Max Planck Institute for Demographic Research, Rostock, Germany.
Lancet. 2001 Mar 24;357(9260):917-21. doi: 10.1016/S0140-6736(00)04212-4.
Between 1987 and 1994, life expectancy in Russia declined substantially. Between 1994 and 1998, this trend reversed, and mortality rates returned to those of the early 1980s. Although the decline in life expectancy has been examined previously, much less is known about the subsequent improvement in mortality rates. We used recently published cause-specific mortality data up to 1998 to clarify this issue.
Changes in cause-specific death rates at ages 15-74 years were examined. Rates for 1998 were compared with those for 1994 (the year of lowest life expectancy) and for 1991 (the year the Soviet Union broke up).
Death rates among children fell steadily throughout the 1990s, and those in elderly people changed little. The reduction in mortality since 1994 was mainly due to a decrease in the death rate among middle-aged adults, which had increased until 1994. Deaths among those aged 15-30 years, which rose during 1991-94, remained high. Some causes of death, such as stomach cancer and road-traffic accidents, declined throughout the 1990s, whereas others, such as breast and prostate cancers and tuberculosis, increased. The decline in mortality since 1994 was, however, mainly due to a reduction in the rate of deaths from a group of causes associated with alcohol consumption.
The changing life expectancy in Russia is a consequence of a complex pattern of trends in different causes of death, some of which have their origins long in the past, and others that result from contemporary circumstances. This study provides further support for the view that alcohol has played an important part in the fluctuations in life expectancy in Russia in the 1990s, although there remains a need for a much better understanding of the factors underlying these continuing changes.
1987年至1994年间，俄罗斯的预期寿命大幅下降。1994年至1998年间，这一趋势逆转，死亡率回到了20世纪80年代初的水平。尽管此前已对预期寿命的下降进行过研究，但对于随后死亡率的改善情况却知之甚少。我们利用最近公布的截至1998年的特定病因死亡率数据来阐明这一问题。
研究了15至74岁人群特定病因死亡率的变化。将1998年的死亡率与1994年（预期寿命最低的年份）和1991年（苏联解体的年份）的死亡率进行了比较。
整个20世纪90年代，儿童死亡率稳步下降，老年人死亡率变化不大。1994年以来死亡率的下降主要是由于中年成年人死亡率的下降，该死亡率在1994年之前一直在上升。15至30岁人群的死亡率在1991年至1994年间有所上升，之后仍居高不下。一些死因，如胃癌和道路交通事故，在整个20世纪90年代有所下降，而其他死因，如乳腺癌、前列腺癌和结核病，则有所上升。然而，1994年以来死亡率的下降主要是由于与饮酒相关的一组病因导致的死亡率降低。
俄罗斯预期寿命的变化是不同死因复杂趋势模式的结果，其中一些可追溯到很久以前，另一些则是当代情况导致的。这项研究进一步支持了这样一种观点，即酒精在20世纪90年代俄罗斯预期寿命的波动中起到了重要作用，尽管仍有必要更好地了解这些持续变化背后的因素。
