Vladimir M. Shkolnikov

There is mounting evidence in Germany of significant mortality inequalities associated with socioeconomic status (SES). This issue holds considerable relevance for social policy debates. However, there is a paucity of research regarding how SES-mortality inequalities differ across German regions and between urban and rural areas. This is surprising, given that existing studies suggest that SES-mortality disparities can vary systematically based on place characteristics. This paper aims to address this research gap by analysing subnational variation in the association between SES and mortality among retired men in Germany. Specifically, we investigate whether the observed SES-mortality gradients differ across subnational macro-regions and by settlement type (large cities, (other) urban, rural). For this purpose, we analyse a large administrative dataset from the German Pension Insurance (DRV), comprising 17.03 million person-years of exposure and 0.59 million recorded deaths over the period 2012–2017 among men aged 65–84 at baseline (2011). Employing a Cox proportional hazards model, we estimate relative mortality risks. To quantify the steepness of the gradients across the subregions, we use the Slope Index of Inequality and the Relative Index of Inequality. Our findings indicate that the SES-mortality association is nearly linear across a large part of the SES range in all macro-regions and settlement types, with mortality risks decreasing as SES increases. Furthermore, we observe substantial regional variation in the steepness of the mortality gradients, with large cities exhibiting the steepest gradients. Another important finding is that among individuals with high SES, regional variation in mortality risks is smallest.

Background: The poor performance of the UK in reducing mortality compared to many other high-income countries following the 2008 financial crisis have been extensively studied, with particular attention to deaths of despair at working ages. However, longer-term trends in the differences in working-age mortality between the UK and peer countries have not been systematically investigated. Methods: We compared trends (1990–2019) in age-standardised mortality rates at age 25–49 years in the UK and its constituent parts (England and its 9 standard regions, Wales, Scotland, Northern Ireland) with those of 21 peer countries. Findings: Between 1990 and 2019 the UK went from having relatively low mortality rates at age 25–49 years compared to its peers to having one of the highest. This reflects both the better progress made by many other countries in reducing mortality rates as well as an absolute increase in the UK from 2013. Against the counter-factual that rates in the UK followed the median of the comparator countries (2001–2019) this resulted in 3.1 million excess years of life lost. The divergence in mortality of the UK with its peers was apparent from 1990 and was observed for all constituent parts of the UK and English regions. External cause mortality accounted for much of the divergence in rates between 2001 and 2019 (69% women; 78% men), as did the overlapping categories of drug-related deaths (42%; 28%) and suicides (17%; 20%). Alcohol-related deaths made only a small contribution. Interpretation: The divergence in mortality rates at ages 25–49 years in the UK from peer countries was already apparent from 1990, pre-dating the austerity policies two decades later. Nevertheless, austerity may well have exacerbated this longer-term deterioration in the UKs position. The fact that all areas of the UK showed deterioration relative to peer countries indicates that this is a national problem.

Seasonal mortality fluctuations significantly affect national life expectancy, yet their role in regional inequalities remains underexplored. Understanding this is crucial for targeted health policies aimed at reducing spatial mortality differences. We quantify the impact of seasonal excess mortality on regional life expectancy levels (e ₀ ) and inequalities in Italy. Using monthly mortality data from the Italian National Statistical Institute by region (N = 20), sex and age between 2005 and 2019, we assessed e ₀ losses due to seasonality by using the general approach of comparing observed e ₀ with minimum achievable levels. Seasonal effects on inequalities in e ₀ were quantified by comparing standard deviations with and without excess seasonal mortality. We then analysed regional contributions using decomposition analysis. Seasonal excess mortality led to an average loss in e ₀ of 1.4 years (1.36–1.70) across Italian regions. This effect was most pronounced in southern and insular regions (Campania and Sicilia), especially for winter-related excess mortality. Our analysis showed that spatial inequality in e ₀ would have been reduced on average by 11.2% by eliminating excess seasonal mortality, mostly due to excess winter mortality (−7.5%). However, during the years with high mortality burdens (2005 and 2015), seasonality contributed to spatial mortality inequality by 10% and 5.2%, respectively. The regional contributions to e ₀ inequality revealed that Campania and Sicilia also had the strongest role in increasing spatial mortality variation throughout the period. The pronounced regional inequalities in e ₀ losses due to seasonal excess mortality contributed significantly to shaping regional e ₀ variation in Italy, mostly due to different impacts of winter mortality within the country

Background The poor performance of the UK in reducing mortality compared to many other high-income countries following the 2008 financial crisis have been extensively studied, with particular attention to deaths of despair at working ages. However, longer-term trends in the differences in working-age mortality between the UK and peer countries have not been systematically investigated. Methods We compared trends (1990-2019) in age-standardised mortality rates at age 25-49 years in the UK and its constituent parts (England and its 9 standard regions, Wales, Scotland, Northern Ireland) with those of 21 peer countries. Findings Between 1990 and 2019 the UK went from having relatively low mortality rates at age 25-49 years compared to its peers to having one of the highest. This reflects both the better progress made by many other countries in reducing mortality rates as well as an absolute increase in the UK from 2013. Against the counter-factual that rates in the UK followed the median of the comparator countries (2001-2019) this resulted in 3.1 million excess years of life lost. The divergence in mortality of the UK with its peers was apparent from 1990 and was observed for all constituent parts of the UK and English regions. External cause mortality accounted for much of the divergence in rates between 2001 and 2019 (69% women; 78% men), as did the overlapping categories of drug-related deaths (42%; 28%) and suicides (17%; 20%). Alcohol-related deaths made only a small contribution. Interpretation The divergence in mortality rates at ages 25-49 years in the UK from peer countries was already apparent from 1990, pre-dating the austerity policies two decades later. Nevertheless, austerity may well have exacerbated this longer-term deterioration in the UKs position. The fact that all areas of the UK showed deterioration relative to peer countries indicates that this is a national problem.

Volume 50 - Article 41 | Pages 1223–1246

Objective. To evaluate gender differences in the profile of a wide range of risk factors (RF) among men and women aged 65 years and older and its associations with cardiovascular and all-cause mortality. Design and methods. The present study was the part of the Survey on Stress, Aging, and Health in Russia. The sample size was 1,243 participants aged 65 years and older. Thirty RF were included in the analysis, including social, cardiometabolic, behavioural, physical and cognitive functioning, inflammation, and neuroendocrine biomarkers, as well as coronary heart disease (CHD), myocardial infarction, arterial hypertension, and acute stroke. The mean follow-up was 12 years, during which 534 participants died from various causes, including 324 from cardiovascular diseases (CVD). Results. Multivariate analysis showe that elevated heart rate, smoking, excessive alcohol consumption, elevated interleukin‑6, elevated leukocyte levels, reduced cognitive function (for CVD mortality), CHD and history of acute stroke contributed to allcause and CVD mortality among men 65 years and older. Elevated blood pressure and elevated high-sensitive C-reactive protein, impaired cognitive function, reduced muscle strength, reduced dehydroepiandrosterone sulfate levels, absence of children, and a history of acute stroke were associated with all-cause and CVD mortality among women 65 years and older. Conclusions. The present study identified gender difference in survival and RF profile for both total and CVD mortality in population of men and women aged 65 years and older. Aamong more than 30 RF and several CVD, 8 indicators were found to affect mortality in men and 7 RF affected mortality in women.

The COVID-19 pandemic has revealed significant gaps in the coverage and quality of the existing international and national statistical surveillance systems. The most reliable approach to estimating mortality associated with short-term risk factors or factors fluctuating within calendar years is based on estimating weekly excess mortality. Although this approach is obvious, its application turned out to be problematic due to the lack of reliable data. In response to this challenge, a new Short-Term Mortality Fluctuations (STMF) data series was created in 2020. The Russian Short-Term Mortality Fluctuations Data Series (RuSTMF) is a further development of the STMF idea at the regional level. It contains weekly crude and standardized death rates for the Russian regions and Russia as a whole. The main source for calculating death rates is depersonalized individual data on the deceased provided by the Rosstat. This database provides for the analysis of short- and medium-term changes in mortality in males, females and total population in Russia as a whole and its regions, as well as the estimation of «excess» deaths during short-term sharp increases in mortality due to, for example, heat or cold waves, seasonal influenza epidemics, the Covid-19 pandemic or technogenic catastrophes.

Introduction: For over half a century, life expectancy in the former communist countries of Eastern Europe has been noticeably lower than in Western Europe. Since 2000 this gap has narrowed. We examined the impact of the COVID-19 pandemic on these long-term mortality trends and differences. Methods: Nationally reported mortality data were used to estimate East-West differences in excess mortality and life expectancy losses. Regression and decomposition methods were employed to examine the contribution of vaccination, trust in government, regulatory enforcement, and air connectivity between populations to these differences. Results: During the pandemic, the East-West life expectancy gap widened to its highest level in more than two decades. Moreover, the trajectory of excess mortality during the pandemic differed between East and West, with levels of excess mortality in the East being minimal until autumn 2020. Cumulative excess mortality in weeks 10-18 of 2020 was correlated with an index of air connectivity, which was appreciably lower in Eastern compared to Western European countries in the immediate pre-pandemic period. From October 2020 onwards, the East suffered greater losses in life expectancy, especially in 2021. This could not be explained by greater frailty of the Eastern European populations, as indicated by higher pre-pandemic mortality levels. Half of the difference between East and West in 2021 was jointly explained by COVID-19 vaccination levels and trust in government. Conclusions: East-West contrasts in the timing and magnitude of life expectancy losses during the COVID-19 pandemic appear to have their ultimate origins in differences between societies that were established during the Cold War. These include differences in the connectivity of populations, levels of trust in science and authorities and the related capacity of Eastern countries to mount effective vaccination campaigns.