Background: Since 2005, Russia has made substantial progress, experiencing an almost doubling of per-capita gross domestic product by purchasing power parity (GDP [PPP]) to US$24 800 and witnessing a 6-year increase in life expectancy, reaching 71·4 years by 2015. Even greater gains in GDP (PPP) were seen for Moscow, the Russian capital, reaching $43 000 in 2015 and with a life expectancy of 75·5 years. We aimed to investigate whether mortality levels now seen in Russia are consistent with what would be expected given this new level of per-capita wealth.
Methods: We used per-capita GDP (PPP) and life expectancy from 61 countries in 2014–15, plus those of Russia as a whole and its capital Moscow, to construct a Preston curve expressing the relationship between mortality and national wealth and to examine the positions of Russia and other populations relative to this curve. We adjusted life expectancy values for Moscow for underestimation of mortality at older ages. For comparison, we constructed another Preston curve based on the same set of countries for the year 2005. We used the stepwise replacement algorithm to decompose mortality differences between Russia or Moscow and comparator countries with similar incomes into age and cause-of-death components.
Findings: Life expectancy in 2015 for both Russia and Moscow lay below the Preston-curve-based expectations by 6·5 years and 4·9 years, respectively. In 2015, Russia had a lower per-capita income than 36 of the comparator countries but lower life expectancy than 60 comparator countries. However, the gaps between the observed and the Preston-expected life expectancy values for Russia have diminished by about 25% since 2005, when the life expectancy gap was 8·9 years for Russia and 6·6 years for Moscow. When compared with countries with similar level of income, the largest part of the life expectancy deficit was produced by working-age mortality from external causes for Russia and cardiovascular disease at older ages for Moscow.
Interpretation: Given the economic wealth of Russia, its life expectancy could be substantially higher. Sustaining the progress seen over the past decade depends on the ability of the Russian Government and society to devote adequate resources to people’s health.
In studies of massive changes in social life, researchers often have to rely on low-quality retrospective data such as memoirs and manipulated government reports as opposed to reliable data such as vital registration. The dissolution of the Soviet Union in 1991 was an unpredictable event with large-scale consequences for the lives of millions of Russians. Beginning in the 1960s, the Soviet Union started to fall into a deep demographic crisis.1 The end of Communism was accompanied by a further increase in total mortality, with unprecedented fluctuations during the next two decades. Several studies were done in a bid to explain this.2
In the middle of last century, life expectancy at birth in Russia was similar to that of other European countries. However, from 1964, it slowly declined, with male life expectancy falling by 7·5 years to the nadir of 57·4 years in 1994 after the collapse of the Soviet Union (with an equivalent decrease of 2·3 years in women to 71·1 years). After a slow restoration to the year 2005, life expectancy is increasing at an unprecedented pace of 0·82 years per year, reaching 67·5 years for men and 77·6 years for women in 2017. Pessimists might say that this is just a rebound effect, restoring previous loss rather than indicating continued growth. This question was addressed in a study
in 2014, where the authors cautiously concluded that the increase in Russian life expectancy is a result of the national project to address health care and other state measures. Some of the same authors are now asking whether the current life expectancy in Russia is consistent with the country's wealth.
Since 2010, the rate of improvement in life expectancy in the UK has slowed. We aimed to put this trend in the context of changes over the long term and in relation to a group of other high-income countries.
We compared sex-specific trends in life expectancy since 1970 and age-specific mortality in England and Wales with median values for 22 high-income countries (in western Europe, Australia, Canada, New Zealand, Japan, and the USA). We used annual mortality data (1970–2016) from the Human Mortality Database.
Until 2011–16, male life expectancy in England and Wales followed the median life expectancy of the comparator group. By contrast, female life expectancy was below the median and is among the lowest of the countries considered. In 2011–16, the rate of improvement in life expectancy slowed sharply for both sexes in England and Wales, and slowed more moderately in the comparator group because of negative trends in all adult age groups. This deceleration resulted in a widening gap between England and Wales and the comparators from 2011 onwards. Since the mid-2000s, for the first time, mortality rates in England and Wales among people aged 25–50 years were appreciably higher than in the comparator group.
Although many countries have seen slower increases in life expectancy since 2011, trends in England and Wales are among the worst. The poor performance of female life expectancy over the long-term is in part driven by the relative timing of the smoking epidemic across countries. The previously overlooked higher mortality among young working-age adults in England and Wales relative to other countries deserves urgent attention.