Reducing geographic inequalities in access times for acute treatment of myocardial infarction in a large country: the example of Russia.

Background: Russia has the largest area of any country in the world and has one of the highest cardiovascular mortality rates. Over the past decade, the number of facilities able to perform percutaneous coronary interventions (PCIs) has increased substantially. We quantify the extent to which the constraints of geography make equitable access to this effective technology difficult to achieve. Methods: Hospitals performing PCIs in 2010 and 2015 were identified and combined with data on the population of districts throughout the country. A network analysis tool was used to calculate road-travel times to the nearest PCI facility for those aged 40+ years. Results: The number of PCI facilities increased from 144 to 260 between 2010 and 2015. Overall, the median travel time to the closest PCI facility was 48 minutes in 2015, down from 73 minutes in 2010. Two-thirds of the urban population were within 60 minutes' travel time to a PCI facility in 2015, but only one-fifth of the rural population. Creating 67 new PCI facilities in currently underserved urban districts would increase the population share within 60 minutes' travel to 62% of the population, benefiting an additional 5.7 million people currently lacking adequate access. Conclusions: There have been considerable but uneven improvements in timely access to PCI facilities in Russia between 2010 and 2015. Russia has not achieved the level of access seen in other large countries with dispersed populations, such as Australian and Canada. However, creating a relatively small number of further PCI facilities could improve access substantially, thereby reducing inequality

Mortality from cardiovascular diseases and life expectancy in Russia

High premature mortality from cardiovascular disease (CVD) and its long-term negative trends are one of the main reasons for Russia's lag behind the developed countries in life expectancy, especially of its female population. Despite the decline in mortality since 2003, CVD mortality rates at particular ages (30-74 years for males and 30-49 for females) are still higher than in 1970. Decomposition of long-term changes in life expectancy in Russia shows a negative contribution of changes in CVD mortality for men (-1.0 years in 1972-2010) and a small positive contribution for women (+0.7 years from 1972 to 2010). The mortality structure within the full class of cardiovascular diseases in Russia is significantly different from that observed in the countries with the lowest level of CVD mortality. Ischemic heart disease constitutes more than half of all deaths, and this share, in contrast to Western countries, is tending to rise. Second place belongs to deaths from cerebrovascular diseases, the share of which is declining, but remains significantly higher than in Western countries. The share of deaths from other cardiovascular diseases accounts for about 50% of all CVD mortality in Western countries, while in Russia it is only about 15%, but these are characterized by a very low age at death. Regional patterns of CVD mortality in Russia are discussed, as well as the quality of statistics on causes of death and changes in the coding practices in the Russian Federation

Disparities in length of life across developed countries: Measuring and decomposing changes over time within and between country groups

Published version. Source at http://doi.org/10.1186/s12963-016-0094-0. License CC BY 4.0.Background. Over the past half century the global tendency for improvements in longevity has been uneven across countries. This has resulted in widening of inter-country disparities in life expectancy. Moreover, the pattern of divergence appears to be driven in part by processes at the level of country groupings defined in geopolitical terms. A systematic quantitative analysis of this phenomenon has not been possible using demographic decomposition approaches as these have not been suitably adapted for this purpose. In this paper we present an elaboration of conventional decomposition techniques to provide a toolkit for analysis of the inter-country variance, and illustrate its use by analyzing trends in life expectancy in developed countries over a 40-year period. Methods. We analyze trends in the population-weighted variance of life expectancy at birth across 36 developed countries and three country groups over the period 1970–2010. We have modified existing decomposition approaches using the stepwise replacement algorithm to compute age components of changes in the total variance as well as variance between and within groups of Established Market Economies (EME), Central and Eastern Europe (CEE), and the Former Soviet Union (FSU). The method is generally applicable to the decomposition of temporal changes in any aggregate index based on a set of populations. Results. The divergence in life expectancy between developed countries has generally increased over the study period. This tendency dominated from the beginning of 1970s to the early 2000s, and reversed only after 2005. From 1970 to 2010, the total standard deviation of life expectancy increased from 2.0 to 5.6 years among men and from 1.0 to 3.6 years among women. This was determined by the between-group effects due to polarization between the EME and the FSU. The latter contrast was largely fueled by the long-term health crisis in Russia. With respect to age, the increase in the overall divergence was attributable to between-country differences in mortality changes at ages 15–64 years compared to those aged 65 and older. The within-group variance increased, especially among women. This change was mostly produced by growing mortality differences at ages 65 and older. Conclusions. From the early 1970s to the mid-2000s, the strong divergence in life expectancy across developed countries was largely determined by the between-group variance and mortality polarization linked to the East–West geopolitical division

Evidence of large systematic differences between countries in assigning ischaemic heart disease deaths to myocardial infarction: the contrasting examples of Russia and Norway

Background There is considerable variation in mortality rates from myocardial infarction (MI) across high-income countries, some of which may be artefactual. Methods Time trends in mortality rates from ischaemic heart disease (IHD) and MI were analysed for a set of high-income countries from the end of the 1970s. Using individual-level mortality data from Russia (2005-2017) and Norway (2005-2016), we investigated factors associated with the proportion of total IHD deaths certified as due to MI. Results In most countries, MI mortality rates have dramatically declined from the 1970s. However, the share of MI in total IHD deaths varies substantially across countries. In Russia, only 12% of IHD deaths had MI assigned as the underlying cause vs 63% in Norway. IHD deaths occurring outside of hospital without autopsy were far less likely to be assigned as MI in Russia (2%) than in Norway (59%). Conclusions Although established international criteria for MI require specific clinical or post-mortem evidence, it appears that certifying specialists in different countries may interpret these criteria differently. At one extreme, Russian doctors may only assign MI as a cause of death when there is specific pathophysiological evidence. At the other extreme, their counterparts in Norway may be willing to specify MI as the cause even when this evidence is not available. Internationally established criteria for MI diagnosis are challenging to apply for out-of-hospital deaths. Differences between countries in how certifiers interpret these criteria may account for at least some of the international variation in MI mortality rates

Diffuse neutron scattering in relaxor ferroelectric PbMg1/3Nb2/3O3

High energy resolution neutron spin-echo spectroscopy has been used to measure intrinsic width of diffuse scattering discovered earlier in relaxor ferroelectric crystals. The anisotropic and transverse components of the scattering have been observed in different Brillouin zones. Both components are found to be elastic within experimental accuracy of 1 eV. Possible physical origin of the static-like behavior is discussed for each diffuse scattering contribution.Comment: Submitted to the "Physical Chemistry and Chemical Physics" (Proceedings of the QENA2004

Excess mortality in Russia and its regions compared to high income countries: An analysis of monthly series of 2020.

BACKGROUND: Russia has been portrayed in media as having one of the highest death tolls due to the COVID-19 pandemic in the world. However, the precise scale of excess mortality is still unclear. We provide the first estimates of excess mortality in Russia as a whole and its regions in 2020, placing this in an international context. METHODS: We used monthly death rates for Russia and 83 regions plus the equivalent for 36 comparator countries. Expected mortality was derived in two ways using averages in the same months in preceding years and the same averages adjusted for secular trends. Excess death rates were estimated for the whole year and the last 3 quarters. We also estimated the relationships between excess mortality and reported COVID-19 cases and deaths across countries and Russian regions. RESULTS: Estimating excess deaths rates based on the trend-adjusted average, Russia had the highest excess mortality of any of the 37 countries considered. Using the simple average, Russia had the third highest. Most of the excess deaths were recorded in the 4th quarter of 2020 and the level and trajectory of excess mortality in Russia and most of Eastern European countries differed from that in Western countries. While both the cumulative number of COVID-19 cases and deaths showed positive correlations with excess mortality across countries (r=0.65 and r=0.75, p<0.001), the association across the Russian regions was, surprisingly, negative for cases (r=-0.34, p<0.01) and deaths (r=-0.09, p=0.42). When we replaced reported deaths with final data from death certificates the correlation was positive (r=0.38, p<0.001). CONCLUSION: Russia has one of the largest absolute burden of excess mortality in 2020 but there is a counter-intuitive negative association between excess mortality and cumulative incidence at the regional level. Under-recording of COVID-19 cases seems to be a problem in some regions

Spatial patterns of male alcohol‐related mortality in Belarus, Lithuania, Poland and Russia

Introduction and Aims Eastern Europe is known to suffer from a large burden of alcohol‐related mortality. However, persisting unfavourable conditions at the national level mask variation at the sub‐national level. We aim to explore spatial patterns of cause‐specific mortality across four post‐communist countries: Belarus, Lithuania, Poland and Russia (European part). Design and Methods We use official mortality data routinely collected over 1179 districts and cities. The analysis refers to males aged 20–64 years and covers the period 2006–2014. Mortality variation is mainly assessed by means of the standardised mortality ratio. Getis‐Ord Gi* statistic is employed to detect hot and cold spots of alcohol‐related mortality. Results Alcohol‐related mortality exhibits a gradient from very high levels in northwestern Russia to low levels in southern Poland. Spatial transitions from higher to lower mortality are not explicitly demarcated by national boundaries. Within these countries, hot spots of alcohol‐related mortality dominate the territories of northwestern and western Russia, eastern and northwestern Belarus, southeastern Lithuania, and eastern and central Poland. Discussion and Conclusions The observed mortality gradient is likely associated with the spread of alcohol epidemics from the European part of Russia to the other countries, which appears to have started more than a century ago. Contemporary socioeconomic and demographic factors should be taken into account when developing anti‐alcohol policies. The same is true for the peculiarities of culture, norms, traditions and behavioural patterns observed in specific geographical areas of the four countries. Reducing alcohol‐related harm in the areas identified as hot spots should be prioritised