Andreev Evgueni M, Nolte Ellen, Shkolnikov Vladimir M, Varavikova Elena, McKee Martin
Laboratory of Analysis and Prognosis of Population Mortality, Centre of Demography and Human Ecology, Institute of Economic Forecasting, Russian Academy of Sciences, 47 Nakhimovsky Prospect, 117418 Moscow, Russian Federation.
Int J Epidemiol. 2003 Jun;32(3):437-46. doi: 10.1093/ije/dyg085.
Life expectancy at birth in Russia is over 12 years less than in western Europe. This study explores the possible role of medical care in explaining this gap by examining the evolving pattern of mortality amenable to timely and effective medical care in Russia compared with Estonia, Latvia, and Lithuania, and the UK.
Analysis of standardized death rates from causes amenable to health care (treatable) or inter-sectoral health policies (preventable) in all regions and decomposition of differences in life expectancy between Russia and the UK by age, sex, and cause of death for the period 1965-1999/2000.
Death rates from treatable causes remained stable between the mid-1960s and mid-1980s in Russia and the Baltic republics while steadily falling in the UK to less than half the rate in Russia. In the 1990s, rates increased in the former Soviet republics, reaching a peak in 1994 but reversing again in Russia in 1998. Deaths from causes amenable to inter-sectoral health interventions were higher in the UK in 1965 than in the Soviet Union but subsequently fell steadily while they increased in the East. Between 1965 and 1999, the male life expectancy gap between Russia and the UK rose from 3.6 to 15.1 years (women: 1.6 and 7.4 years). Treatable causes became an increasingly important contributor to this gap, accounting for almost 3 years by the end of the 1990s in men and 2 years in women. In Russia, elimination of treatable causes of death would have increased life expectancy by 2.9 years in men in 1995/99 compared with 1.2 years in the UK (women: 3.3 and 1.8 years), suggesting that, were the outcomes of health care achieved in the UK to be obtained in Russia, life expectancy for men might improve by about 1.7 years and for women by about 1.5 years.
Our findings suggest that the Soviet health care system has failed to match the achievements of the West over the past three decades, highlighting the need to establish a system that provides effective and equitable care for the Russian population.
俄罗斯的出生时预期寿命比西欧短12年多。本研究通过考察俄罗斯与爱沙尼亚、拉脱维亚、立陶宛以及英国相比，在可通过及时有效的医疗护理解决的死亡模式演变情况，探讨医疗护理在解释这一差距方面可能发挥的作用。
分析所有地区可通过医疗保健（可治疗）或部门间卫生政策（可预防）解决的死因的标准化死亡率，并按年龄、性别和死因对1965年至1999年/2000年期间俄罗斯和英国的预期寿命差异进行分解。
20世纪60年代中期至80年代中期，俄罗斯和波罗的海共和国可治疗死因的死亡率保持稳定，而英国则稳步下降至俄罗斯的一半以下。20世纪90年代，前苏联各共和国的死亡率上升，1994年达到峰值，但1998年俄罗斯再次下降。1965年，英国可通过部门间卫生干预解决的死因导致的死亡人数高于苏联，但随后稳步下降，而在东方则有所增加。1965年至1999年，俄罗斯和英国之间的男性预期寿命差距从3.6岁上升至15.1岁（女性：从1.6岁升至7.4岁）。可治疗死因在这一差距中所占比例越来越大，到20世纪90年代末，男性占近3年，女性占2年。在俄罗斯，消除可治疗死因可使1995年/99年男性的预期寿命增加2.9岁，而在英国为1.2岁（女性：分别为3.3岁和1.8岁），这表明，如果俄罗斯能取得英国那样的医疗保健成果，男性预期寿命可能提高约1.7岁，女性提高约1.5岁。
我们的研究结果表明，苏联医疗保健系统在过去三十年未能与西方的成就相匹配，凸显了为俄罗斯民众建立一个提供有效且公平护理的系统的必要性。
