Divergent Paths for Adult Mortality in Russia and Central Asia: Evidence from Kyrgyzstan

Michel Guillot,Liudmila Torgasheva,Natalia Gavrilova,Mikhail Denisenko,Tiziana Leone

doi:10.1371/journal.pone.0075314

Michel Guillot, Liudmila Torgasheva + Show 3 more

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https://doi.org/10.1371/journal.pone.0075314

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Abstract

Adult mortality has been lower in Kyrgyzstan vs. Russia among males since at least 1981 and among females since 1999. Also, Kyrgyzstan’s mortality fluctuations have had smaller amplitude. This has occurred in spite of worse macro-economic outcomes in Kyrgyzstan. To understand these surprising patterns, we analyzed cause-specific mortality in Kyrgyzstan vs. Russia for the period 1981-2010, using unpublished official data. We find that, as in Russia, fluctuations in Kyrgyzstan have been primarily due to changes in external causes and circulatory causes, and alcohol appears to play an important role. However, in contrast with Russia, mortality from these causes in Kyrgyzstan has been lower and has increased by a smaller amount. As a result, the mortality gap between the two countries is overwhelmingly attributable to external and cardio-vascular causes, and more generally, to causes that have been shown to be strongly related to alcohol consumption. These cause-specific results, together with the existence of large ethnic differentials in mortality in Kyrgyzstan, highlight the importance of cultural and religious differences, and their impact on patterns of alcohol consumption, in explaining the mortality gap between the two countries. These findings show that explanatory frameworks relying solely on macro-economic factors are not sufficient for understanding differences in mortality levels and trends among former Soviet republics.

Highlights

A puzzling pattern of mortality trends in the former Soviet republics of Central Asia is that declines in life expectancy in the years following the break-up of the Soviet Union have not been as large as in Russia
In Kyrgyzstan – the Central Asian republic that is the focus of this paper, reported life expectancy at birth for both sexes combined declined by 3.3 years between 1990 and 1995, while in Russia during the same period, it declined by 4.6 years
Since mortality fluctuations in Russia and other countries of the former Soviet Union have been primarily attributed to abrupt changes in the economic situation, including drops in gross domestic product (GDP) per capita and increases in unemployment [3,4,5,6,7,8,9], similar – if not greater – mortality increases should be expected in a Central Asian republic like Kyrgyzstan

Summary

Introduction

A puzzling pattern of mortality trends in the former Soviet republics of Central Asia is that declines in life expectancy in the years following the break-up of the Soviet Union have not been as large as in Russia. The most recent estimates show that, in 2009, male life expectancy remains higher in Kyrgyzstan by about 2 years [1] This is puzzling to many observers, because Kyrgyzstan is a much poorer country than Russia, and in many ways has been more severely hit by the economic crisis that followed the collapse of the Soviet Union in 1991. Since mortality fluctuations in Russia and other countries of the former Soviet Union have been primarily attributed to abrupt changes in the economic situation, including drops in GDP per capita and increases in unemployment [3,4,5,6,7,8,9], similar – if not greater – mortality increases should be expected in a Central Asian republic like Kyrgyzstan

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