Social factors and increase in mortality in Russia in the 1990s: prospective cohort study

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Abstract
Objective To determine the association between social factors and the increase in mortality in Russia in the 1990s. Design Prospective population cohort study. Setting Saint Petersburg, Russia. Participants Two cohorts of men aged 40–59 years randomly selected from district voting list: 3907 screened in 1975–7 and 1467 in 1986-8. Main outcome measures Education, various health related measures, alcohol intake. Mortality in subsequent 10 years. Results There was no recorded increase in mortality in men with university degrees. The relative risk in the second cohort compared with the first was 0.92 (95% confidence interval 0.67 to 1.24). For participants with only high school education it was significantly higher in the second cohort (1.32, 1.02 to 1.71). The most pronounced differences were found among participants with the lowest level of education, in which the relative risk was 1.75 (1.44 to 2.12). The same pattern held for coronary vascular disease and cancer mortality. Conclusion In Russia men in the lower socioeconomic groups were most affected by the sharp increases in mortality in the 1990s.

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