Mortality In Russia Research Articles

Comparing the efficacy of laparoscopic and open radical prostatectomy: analysis of treatment outcomes in patients with prostate cancer treated in three federal centers

Background. Prostate cancer is currently one of the most challenging problems in urological oncology due to its constantly increasing incidence and mortality in Russia. Surgery remains one of the most radical treatment options for patients with localized and locally advanced prostate cancer of any risk. Multiple studies have compared long-term and functional outcomes of surgeries performed using different surgical approaches. All studies have demonstrated similar long-term and functional outcomes of open, laparoscopic, and robot-assisted surgeries. Objective: to review the existing literature on this problem and analyze outcomes of surgical treatment in patients who had undergone open or laparoscopic prostatectomy in one of three federal centers of the National Medical Research Radiology Center.Materials and methods. This retrospective study included 2,772 patients with localized and locally advanced prostate cancer who had undergone surgery in one of the three federal centers.Results. We evaluated short-term and long-term outcomes of laparoscopic and open radical retropubic prostatectomy (RRP) performed at three federal centers of the National Medical Research Radiology Center. We found that laparoscopic RRP was associated with a longer surgery, lower blood loss, and fewer lymph nodes removed compared to open RRP. Long-term oncological and functional outcomes (prostate-specific antigen relapse-free survival, time to urination recovery) did not significantly differ between patients who had laparoscopic or open RRP.Conclusion. Both open and laparoscopic RRP are equally effective surgical methods for patients with localized and locally advanced prostate cancer.

КАЛИБРОВОЧНЫЕ АЛГОРИТМЫ ОПРЕДЕЛЕНИЯ ЧИСЛА РАДИОГЕННЫХ СМЕРТЕЙ В КОГОРТЕ

Background: Development of algorithms for estimating the number of radiogenic deaths in a cohort that happened or may happen before an arbitrary moment in time. Algorithms should be based on continuous lifelong risk models and minimize the errors of estimates based on deformable non-radiation models ("seed" models) reflecting the general patterns of Russian mortality, but with the possibility of calibrating according to selected data.
 Materials and methods: For the study, the databases of the register of liquidators of the consequences of the Chernobyl accident – employees of the enterprises of the Ministry of Atomic Energy of Russia were used. Persons with a non-zero dose of ionizing radiation received as a result of the accident and who were registered in the register until 2018 were selected from the register. There are 7324 men and 655 women in this sample. The number of deaths from the beginning of the observation period until 1996, 2006, 2016 from all causes, as well as from solid cancers and leukemias, was used as a reference data for the calibration. Radiation risk was calculated using UNSCEAR 2006 models. Calibration was performed using the Levenberg – Marquardt method.
 Results: A general formula was obtained for assessing the excess lifetime risk of death, which is the basis of the developed algorithms. The "seed" models of the risk of death from all causes and from solid cancers and leukemia’s were obtained. In accordance with the purpose of the work, two algorithms have been developed. The first algorithm is intended for direct (without using radiation risk models) estimation of the number of radiation-induced deaths in a cohort. The second uses radiation risk models. The performance of the algorithms was tested using the industry register of liquidators of the consequences of the Chernobyl accident. In particular, a 30 % calculated increase in the estimated number of deaths from radiation-induced solid cancers was recorded using calibrated models.
 Conclusions: The proposed calculation algorithms for calibrated models provide reliable (if the radiation risk models are considered sufficiently adequate) estimates of the number of Chernobyl deaths for points in time preceding the current one and, presumably, more accurate predictive estimates compared to the calculation algorithm for uncalibrated models. The low sensitivity of the lifelong risk model to variations in the parameters of the background models and the total mortality model makes it possible to apply models calibrated according to the liquidator register to other closely related populations (NPP workers, etc.).

The contribution of Kazan scientists to the success of the fight against child mortality

The work aims to analyze and present the contribution of scientists from Kazan medical universities and their pupils to the success of combat child mortality in Russia in the twentieth century using the historical and medical method. The most important results of the works of Kazan scientists can be considered the following: (1) the finding of underestimation of infant mortality; (2) development of methods for its statistical analysis; (3) identification of medical-statistical and social hygienic patterns of child mortality; (4) scientific substantiation of the methodology and strategy for reducing infant mortality in the USSR; (5) a comprehensive study of the problems of child mortality and substantiation of ways to reduce it in the Russian Federation in the late 20th early 21st centuries. Measures are proposed to further reduce child mortality, including a regional approach, reduction of the population's genetic load, priority implementation of antenatal and neonatal prophylaxis, prompt and full provision of treatment by the state for children with rare diseases, further development of specialized and rehabilitation assistance provided to children, intensive development of medical and social assistance.

Abortion and infant mortality change driven by socioeconomic conditions in Russia.

Increasing fertility and decreasing mortality are major response strategies in Russian demographic reform, which has led to significant decreases in both abortion rate (AR) and infant mortality. This study explores mechanisms influencing the socioeconomic conditions leading to abortion and infant mortality. Spatial panel economic analysis using data from the 83 regions of the country covering four time periods was applied. Every 1000 USD increase in per capita gross regional product (GRP) can lead to a decrease of the AR by 0.075, while one year life expectancy increase would lower it by 0.441. For infant mortality rate (IMR), GRP also shows a positive impact, particularly in recent years, while the population size of the region has a negative impact. Every 1000 USD increase in per capita GRP would result in a rate decrease of 0.064 in IMR, and every increase of 1000 added population would lead to an increased IMR by 2.05. The harvest effect between AR and infant mortality that was evident earlier, but not in the recent years, implies that the health care system in Russia is effective. A comprehensive improvement in wellbeing, income, etc. can contribute to mitigation of abortion and infant mortality. Theoretically, this study extends current research by comprehensively displaying the spatio-temporal patterns of abortion and infant mortality in Russia and qualifies the impact of regional socioeconomic disparities with regard to these two issues.

The dynamics of life-span of citizen of the Russian Federation: the sociological aspect

The article considers the results of sociological study that was carried out to determine vector of dynamics of indices regulating duration of life of the Russian population, including the expected one. The method of secondary analysis of statistical and sociological information data was applied. Results. Against the background of decreasing of birth rate, "aging of population", migration inflows and transformation of value systems the reduction of population size in The Russian Federation (natural loss) dominates, though life expectancy itself is slightly increasing. The high value of indicator of «death external causes» is established. The trend of steady decreasing of infant mortality in Russia over the past 27 years is marked. The groups of factors affecting life expectancy of the Russian population is identified. The main characteristics are revealed that are fundamentally important to ensure higher life expectancy of Russians. One of the demographic behavior models in modern Russia is described. The approaches to solve demographic problems in the Russian Federation, proposed by state bodies on the basis of policy documents (Concept of demographic development of the Russian Federation for the period up to 2025, etc.) are considered. The importance of health-preserving projects (such as "Moscow longevity", etc.), is determined.

Distribution pattern of entry holes of the tree-killing bark beetle Polygraphus proximus.

Bark beetles attack their hosts at uniform intervals to avoid intraspecific competition in the phloem. Bark texture and phloem thickness also affect bark beetle attacks, and the bark characteristics are not spatially homogeneous; therefore, the distribution patterns of entry holes can demonstrate an aggregated distribution. Polygraphus proximus Blandford (Coleoptera: Scolytinae) is a non-aggressive phloephagous bark beetle that feeds on Far Eastern firs. They have caused mass mortality in Russia and Japan. However, the distribution pattern of entry holes of P. proximus and spatial relationships with bark characteristics have not been studied. Thus, we investigated the distribution pattern of entry holes of P. proximus. The distribution of entry holes was significantly uniform in most cases. As the attack density increased, an aggregated distribution pattern within a short distance (< 4.0 cm) was observed. The rough bark had a significantly higher number of entry holes than the remaining bark. The distribution pattern of entry holes demonstrated a significantly aggregated spatial association with rough bark. Finally, rough bark around knots had significantly thicker phloem than the remaining barks. These suggest that P. proximus may preferentially attack rough bark to reproduce in the thicker phloem under a rough bark surface.

Effect of Row Spacing and Seeding Rate on Russian Thistle (Salsola tragus) in Spring Barley and Spring Wheat.

Russian thistle (Salsola tragus L.) is a persistent post-harvest issue in the Pacific Northwest (PNW). Farmers need more integrated management strategies to control it. Russian thistle emergence, mortality, plant biomass, seed production, and crop yield were evaluated in spring wheat and spring barley planted in 18- or 36-cm row spacing and seeded at 73 or 140 kg ha−1 in Pendleton and Moro, Oregon, during 2018 and 2019. Russian thistle emergence was lower and mortality was higher in spring barley than in spring wheat. However, little to no effect of row spacing or seeding rate was observed on Russian thistle emergence or mortality. Russian thistle seed production and plant biomass followed crop productivity; higher crop yield produced higher Russian thistle biomass and seed production and lower crop yield produced lower weed biomass and seed production. Crop yield with Russian thistle pressure was improved in 2018 with 18-cm rows or by seeding at 140 kg ha−1 while no effect was observed in 2019. Increasing seeding rates or planting spring crops in narrow rows may be effective at increasing yield in low rainfall years of the PNW, such as in 2018. No effect may be observed in years with higher rainfall than normal, such as in 2019.

СНОВНЫЕ ПРИЧИНЫ ИЗБЫТОЧНОЙ СМЕРТНОСТИ НАСЕЛЕНИЯ В РОССИИ В УСЛОВИЯХ ПАНДЕМИИ COVID-19

Significance. The COVID-19 pandemic has had a significant impact on the mortality rates in Russia. In order to objectively assess mortality, scientists propose to calculate and analyze the scale of excess mortality, which is a more comprehensive indicator of the overall impact of the pandemic on population loss compared to the number of deaths from COVID-19. The purpose of the study is to identify the scale of excess mortality in Russia in the context of the COVID-19 pandemic and its determining factors. Material and methods. The information base of the study was made up of the Rosstat demographic statistics, as well as publications in the periodical press and the Internet. Within the framework of the study, methods of statistical analysis and empirical research (comparison), general logical and analytical methods were used. Results. Using a five-year average method, the scale of excess mortality in Russia was calculated and evaluated, as well its determining factors during the pandemic were analyzed. The distribution of excess mortality by gender, age and place of residence was implemented. The factors of both direct and indirect effects of the coronavirus infection on the excess mortality rate in the country were identified. The pandemic has intensified manifestation of factors that had been determining the mortality dynamics in Russia for several years. Among the latter ones are noncommunicable diseases (primarily, cardiovascular diseases and cancer, which increase the risk of severe COVID-19, as well as those conditions that have deteriorated due to the delayed or postponed care delivery during the pandemic) and external causes of death (depression, alcohol poisoning and drug abuse).

Analysis of Risk Factors in COVID-19 Adult Mortality in Russia.

Background and ObjectiveEpidemiological data obtained during the ongoing SARS-CoV-2 pandemic suggests that COVID-19 mortality has specific age and gender associations. However, limited epidemiological studies explored specific populational risk factors, including comorbidities, and patient clinical characteristics. The main aim of our retrospective cohort study was to analyze associations between age, gender, and comorbidities in deceased COVID-19 patients.Materials and MethodsA retrospective cohort analysis was performed to assess significant risk factors in adult patients deceased from COVID-19 infection by evaluating Electronic Medical Records and post-mortem analysis in COVID-19 patients deceased between April 2020 to October 2020. All patients underwent post-mortem evaluation along with medical history analysis, including data on disease duration, hospitalization, and clinical peculiarities.ResultsMedical records of 1487 COVID-19 patients revealed that the prevalence of males was higher (by 23%) than females; the median age for males was 71 years of age whereas for females it was 78. The most prevalent comorbid pathologies were: hypertension, obesity, diabetes, and cancer. Males are at significantly increased risk of lethal outcome, even in younger age groups, with comorbid conditions.ConclusionThe study concluded that comorbidities, such as hypertension, obesity, diabetes, cancer are the most important risk factors for comorbid mortality in COVID-19 patients. In addition to lung damage, multiple organ dysfunctions may be a crucial reason for COVID-19 induced death. Special precautions, such as early hospitalization, increased monitoring, and preventative tactics should be taken for at-risk patients.

Excess Mortality in Russia in 1868–1912 and Its Historiographic Implications

Excess Mortality in Russia in 1868–1912 and Its Historiographic Implications

ДИНАМИКА ЗАБОЛЕВАЕМОСТИ БОЛЕЗНЯМИ СИСТЕМЫ КРОВООБРАЩЕНИЯ ВЗРОСЛОГО НАСЕЛЕНИЯ РОССИЙСКОЙ ФЕДЕРАЦИИ В 2007-2019 ГГ.

Significance. Diseases of the circulatory system remain one of the leading causes of death and morbidity of the adult population. Over the years, the efforts of the State aimed at controlling diseases of the circulatory system have made the contribution of this disease class to the total mortality in Russia gradually reduce. Nevertheless, diseases of the circulatory system remain the leading ones among diseases, characterized by a steady growth and rapidly increasing prevalence among the population. The purpose of the study is to analyze dynamics in incidence and prevalence of the diseases of the circulatory system among the Russian adult population in 2007-2019. Material and methods. The study used data of the statistical collections of the Ministry of Health of the Russian Federation and the Federal Research Institute for Health Organization and Informatics of the Ministry of Health of Russia: "Morbidity of the adult population of the Russian Federation" for 2007-2019. The study, which is a continuous statistical observation, used the method of direct ranking, calculation of indicators of time series. Results. Diseases of the circulatory system in 2019 ranked fourth in the incidence structure of the adult population (8%), while its prevalence ranked second to none (21%). Over 13 years, the incidence of diseases of the circulatory system in adults increased by 42% (2007-2019) while its prevalence increased by 24%. The highest levels of incidence of diseases of the circulatory system in 2019 are registered in the Krasnodar Territory (9,024.3 per 100 000 population, + 324%), the Kurgan Region (7,404.2, + 103%) and the Karachayevo-Circassian Republic (7 286.2, + 268%), and prevalence - in the Altai Territory (52 557.6, + 2%), the Chuvash Republic (51 814.6, + 38%) and the Voronezh Region (45 339.4, + 59%). The maximum rates of increase in morbidity with diseases of the circulatory system from 2007 to 2019 are registered in the South Federal district (incidence - by 119%, prevalence - by 56%), among the constituent entities of the Russian Federation: incidence - in the Krasnodar Territory (by 324%), prevalence – the Karachayevo-Circassian Republic (by 136%). According to the state statistical reporting, on average, every 7th acute myocardial infarction is complicated by recurrent heart attack in Russia. Conclusions. Throughout the study period of 13 years, the leading nosological forms include: Hypertensive diseases (35%; 45%, respectively), Ischemic heart diseases (22%; 21,6%) and Cerebrovascular diseases (23%; 20%). Over half of the diseases of the circulatory system are registered in the older working ages (55-60 and over). Scope of application. The study results can be useful to regional authorities in public health in planning and implementing regional programs aimed at controlling diseases of the circulatory system.

Спутниковая оценка гибели древостоев от пожаров по данным о сезонном распределении пройденной огнем площади

Спутниковая оценка гибели древостоев от пожаров по данным о сезонном распределении пройденной огнем площади

Динамика смертности российского населения от основных классов болезней экзогенной этиологии

The paper investigates the dynamics of mortality of the Russian population from infectious and parasitic diseases, dis-eases of the respiratory and digestive organs. The relevance of the research is determined by a global pandemic, record-ed for the first time after the completion of the first stage of the epidemiological transition in developed countries. The main provisions of the concept of epidemiological transition and the specifics of the transition in Russia are considered. The situation for the thirty-year period 1990–2019, characterized by multidirectional dynamics of life expectancy of the Russian population, for which annual statistics are available, is analyzed in more detail, in order to identify the situation with exogenous mortality in the run-up to the pandemic. Among the six main classes of causes of death, the most significant increase over the period under review was for diseases of the digestive system and infectious and parasitic diseases. In the conditions of the "reverse epidemiological transition", there was a twofold decrease in the ratio of mortality from infectious diseases and diseases of the circulatory system: from 1:51.8 in 1991 to 1:25.6 in 2019. The share of deaths from infections in the structure of deaths from causes increased to 1.8%. Even more significantly, the ratio of deaths from cardiovascular diseases to deaths from diseases of the digestive system decreased by two and a half times: from 1:21.6 in 1990 to 1:8.6 in 2019. The share of these diseases in the structure of mortality increased to 5.5%. Since 2006 diseases of the digestive system occupy the fourth position in the structure of Russian mortality by causes, pushing respiratory diseases to the fifth place. Mortality from respiratory diseases, which trends over the 30 years under review repeat the vector of the total mortality of the Russian population, and which is characterized by the maximum decrease among the maingroups of causes of death, increased the gap with the level of mortality from diseases of the circulatory system from 1:11.1 to 1: 14.2 in 1991–2019. Its share in the structure of mortality decreased to 3.3%.

Assessment of prevalence and monitoring of outcomes in patients with heart failure in Russia

The increasing prevalence of heart failure (HF) serves as a reverse side of the effective treatment for cardiovascular diseases (CVD) and increasing patient survival. Data on the epidemiology of HF and related mortality in Russia are limited. According to the EPOCHA trial (hospital phase), the prevalence of HF in the Russian Federation is 7%. HF can significantly contribute to cardiovascular mortality. However, its recognition is limited by the peculiarities of the mortality coding system in Russia. The article presents the authors’ view on the registration of HF-related morbidity and mortality cases and perspectives of using left ventricular ejection fraction &lt;50% for statistical reporting.

ANALYSIS OF LETHAL OUTCOME IN ACUTE TRANSMURAL MYOCARDIAL INFARCTION IN OPERATED AND NON- OPERATED PERSONS

The cardiovascular disease are the one of the main causes of hospitalization and mortality in Russia and the other countries. Myocardial infarction, the problem of treatment and timely diagnosis is one of the most actual, socially significant and foreground tasks of world and domestic health care. The coronary stenting is the most widely implemented medical practice which is the main treatment for myocardial infarction. The main indications for it are significant stenosis of the left coronary artery, three-vascular or two-vascular lesion, stable angina pectoris, acute coronary syndrome. The analyze of fatal outcomes in acute transmural myocardial infarction in operated and non-operated individuals is the aim of the study. The unoperated accounted for 87% of cases operated on 13% of cases, while all of patients had absolute indications for stenting immediately. Transmural myocardial infarction was twice as often in men, and five years earlier than in women. This indicate that the female sex is more resistant to diseases of the cardiovascular system. Transmural infarction had a different location, more often than the anterior, anterolateral wall of the left ventricle and septum. The operation was not performed in connection with a serious and extremely serious condition caused by cardiogenic, arrhythmogenic shock, pulmonary artery thromboembolism in most cases of study. The cause of deaths was repeated myocardial infarction due to postresuscitation disease, stent thrombosis and intraoperative asystole in all cases of surgical intervention. It should be noted, that the reason for the late untimely initiation of treatment in the most of the dead was the initial refusal of hospitalization.

Alcohol mortality in Russia: assessment with representative survey data

According to vast empirical evidence, excessive alcohol consumption is an important factor of premature mortality in Russia. At the same time, quantifying alcohol-related deaths is not so easy, as generally the discussion of alcohol mortality only concerns the causes of death attributed solely to alcohol, which significantly narrows the range of possible negative consequences. Including data on losses from myocardial infarction, coronary heart disease and other common cardiovascular and other diseases in alcohol mortality estimates is enabled by an approach using data on the relative risks of death from various causes depending on the type of alcohol consumption. Within this study, alcohol consumption, depending on sex and age, was assessed on data from a representative national survey, taking into account information on the volume of recorded sales of alcoholic beverages. According to the obtained results, in 2018 the death rate from alcohol-related causes in Russia amounted to 196,000 people, 146,000 men and 50,000 women among them. The peak of alcohol mortality is observed among people aged over 50. The structure of alcohol mortality is dominated by diseases of the cardiovascular system and external causes, and for men the contribution of external causes is significantly higher. Excessive alcohol consumption reduces life expectancy by 5.9 and 4.7 years for men and women, and healthy life expectancy by 4.2 and 2.6 years for men and women.

Female mortality in Russia

The aim of this paper was to analyze female mortality in Russia and to elucidate the potential causes of the time lag between gender-specific trends in mortality in the Russian Federation. Methods: We analysed the differences of temporal trends in mortality between residents of urban and rural areas, Moscow and St. Petersburg as well as the main causes of death among women in 1965, 1985, 2003, 2014 and 2018 using the data from the national statistical agency - Rosstat. Results: Our findings suggest that the slowdown in the decrease of female mortality originates from conditions and lifestyle during the period of Perestroika. The main contribution to the lag of changes in female mortality from male rates was made by cohort of women whose childhood and growing up took place in that period. Mortality from diseases of the digestive system increased by 11.9 % and mortality from infectious diseases increased by 170% in 35-44 years old women. Moreover, mortality from alcohol-attributable causes and injecting drug use has been increasing. Contribution of alcohol to female mortality is more pronounced in rural areas whole drug abuse affects urban women to a greater extent. Conclusions: The increased mortality of women aged 35-44 years after 2013 can be at least partly explained by the fact that health-related behaviour of this cohort of women was developed during the times of the social crisis.

Systematization of effective population-based preventive measures under uncertainty: an ontological approach

Effective management decisions in the field of health care and preventive medicine requires a systematic, holistic and scientifically based approach. However, there is a problem of fragmentation and insufficient data. Aim. To develop approaches to modeling population-based preventive measures in Russia, applicable under uncertainty. Material and methods . At the first stage, we selected the central chronic noncommunicable diseases (NCDs) associated with high morbidity and mortality in Russia, for which there are effective preventive measures. At the next stage, based on the literature analysis, we selected risk factors of these NCDs. Further, population-based preventive measures were selected. The following population-based preventive measures were considered: economic measures, taxes, subsidies; information campaigns in the media and public education; changing the environment, infrastructure; labeling, information for the consumer, prohibition, and other legislative measures. Results. An ontological model in the form of a graph was created. Modeling the socio-economic effect of population-based strategies begins with the choice of a preventive measure with a proven effect, which can indirectly, through a decrease in the risk factors’ prevalence, preclude new cases of chronic diseases among the population of Russia and reduce the related costs in the future. Conclusion. Ontological analysis made it possible to identify the functional structure of population-based prevention and its action under uncertainty. The development of ontology provides an additional means of access to the available research data, which is necessary for evidence-based management decision-making.

Road traffic mortality in Russia: definitions, trends and perspectives

In 2016, the crude death rate from road traffic accidents in Russia decreased, according to police data, to a level not observed since 1971, after which it continued to decline. The positive trends apparently served as the basis for the optimistic goals laid down in the Road Safety Strategy for 2018-2024. &#x0D; Based on police data, vital statistics on mortality and international databases on mortality and road safety, the authors try to answer these questions: Are the goals set achievable within the specified timeframe, and how consistent are they with European trends in road traffic mortality, as well as with Russia's present differentiation of road traffic mortality by space, age and category of road users? &#x0D; The study showed that the deadlines for achieving targets in the Road Safety Strategy are very tight. Today, only large and medium-sized cities have the potential to implement a new Road Safety Strategy in which the crude death rate should not exceed 1.5-2 deaths per 100 thousand people by 2024, whereas in small cities and rural settlements - 2.5-3 deaths per 100 thousand people. For many years, the main risk groups have been drivers and passengers aged 15-44 and pedestrians over 60 years old, who do not appear in the Road Safety Strategy as priority categories.&#x0D; In addition, the article shows that in order to eliminate the existing discrepancies between the numbers of deaths published by the two official reporting systems (the police and Rosstat), the very first step might be for Rosstat to stop calculating the number of road traffic deaths based on the current version of the abridged classification of causes of death and transition to one of the two international approaches for aggregating three-digit codes of causes of death used by the WHO.

Evolution of loss due to event of undetermined intent among the Moscow working-age population in the 2000s

Accuracy of statistical registration of mortality in Russia, especially in times of crisis, is a pressing and relevant issue; this problem was challenging Moscow in the 2000s: until recently, the capital was a complete outsider in terms of accuracy of statistical registration of mortality. The purpose of the study was to identify peculiar features of evolution and the structure of mortality from an event of undetermined intent among Moscow working-age population in the 2000s against the background of the processes taking place in Russia. The article analyzes mortality from an event of undetermined intent among Moscow population of young and old working age in the 2000s, as well as its nosological aspects in 2011-2018, when certain events of undetermined intent were separated as individual nosological units. A sharp decline in indicators in 1999-2000 and their growth in 2015-2017 have been identified. It is shown that these shifts were due to all leading events of undetermined intent (falls/jumps from a high place, hanging/strangulation/suffocation, medicament, alcohol and drug poisoning as well as specified and unspecified events). As a result, the structure of mortality after 2015 has significantly changed due to a sharp increase in the significance of alcohol, medicament and especially drug poisoning. It should be emphasized that in the 2010s the significance of latent suicide in all age and gender groups of Moscow working-age population is significantly higher than in Russia.