Factors Associated with Cause-Specific Death in Russia. Data from Longitudinal Prospective Study 1977-2001

Aim. To evaluate the associations between main risk factors (RF) with cause-specific death in cohorts of Russian men and women.

Material and methods. Data of a number of crossectional studies conducted in different years by unified base protocol had become the subjects for the study. A total of 12,497 men and 5,039 women aged 35-74 years, residents of Moscow and S-Petersburg (former Leningrad) cities at the moment of examination, were enrolled into the study. We analyzed 17 previously selected risk factors and their associations with cause-specific mortalities: coronary heart disease (CHD), stroke, cardiovascular diseases (CVD), non-CVD, all causes. A total of 10,650 deaths were registered: 8,726 in men (for 10 years) and 1,924 – in women (for 20 years).

Results. Men died more often from all the examined causes except for stroke, what was more typical to women. Mortality in men was associated with significantly larger number of RF than in women and correlations were stronger. In particular, smoking (hazard ratio [HR] 2.25; 95% confidence interval [95%CI] 1.75-2.89; р=0.0001), high blood pressure (HR 1.78; 95%CI 1.43-2.22; р=0.0001) and history of CHD (HR 3.23; 95%CI 2.71- 3.84; р=0.0001) significantly increased CHD-related mortality in the men’s cohort but were much less significant for women. The total cholesterol level demonstrated significance in men but was not even selected in the model for women. The main RF for stroke-related mortality were smoking, high blood pressure and atrial fibrillation, while for non-cardiovascular mortality there was only one common factor – smoking. Factors associated with CVD and all-cause mortality were almost the same because CVD cover more than half in the all-cause mortality, however a larger number of predictors were reported in men.

Conclusion. The data obtained indicate: 1) considerably larger number of unfavorable risk factors in the men’s cohort, which significantly increased risk for death from any cause; 2) statistically more pronounced relation between risk factors and mortality rates in men as compared to women, especially note that mortality rates were followed up for 10 years in men and 20 years in women. It is obvious that successful prevention focused on risk factors must be gender-based. 

1. Shkolnikov V., Andreev E., McKee M., Leon D.A. Components and possible determinants of the decrease in Russian mortality in 2004-2010. Demographic Research. 2013;28(32):917-50. [cited by Feb 20] Available from: http://www.demographic-research.org/Volumes/Vol28/32/. doi:10.4054/DemRes.2013.28.32.

2. Yusuf S., Hawken S., Ounpuu S., et al. Effect of potentially modifiable risk factors associated with myocardial infarction in 52 countries (the INTERHEART study): case-control study. Lancet. 2004;364(9438):937-52. doi:10.1016/S0140-6736(04)17018-9.

3. Men T., Brennan P., Boffetta P., Zaridze D. Russian mortality trends for 1991-2001: analysis by cause and region. British Medical Journal. 2003;327(7421):964. doi:10.1136/bmj.327.7421.964.

4. Brainerd E., Cutler D.M. Autopsy on an Empire: Understanding Mortality in Russia and the Former Soviet Union. Journal of Economic Perspectives. 2005;19(1):107-30. doi:10.1257/0895330053147921.

5. Razvodovsky Y.E. Alcohol Consumption and Gender Gap in All-cause Mortality in Russia. J Alcohol Drug Depend. 2017;5:271. doi:10.4172/2329-6488.1000271.

6. Zaridze D., Brennan P., Boreham J., et al. Alcohol and cause-specific mortality in Russia: a retrospective case-control study of 48,557 adult deaths. Lancet. 2009;373(9682):2201-14. doi:10.1016/S0140-6736(09)61034-5.

7. Prineas R.J., Crow R., Blackburn H. The Minnesota code manual of electrocardiographic findings. John Wright-PSG; Littleton MA: 1982. 8. Rose G.A., Blackburn H., Gillum R.F., Prineas R.J. Cardiovascular survey methods. Geneva: World Health Organization; 1982.

8. Lorber J., Moore L.J. Gender and the Social Construction of Illness. Second Edition. Plymouth, United Kingdom: AltaMira Press; 2002.

9. Luy M., Minagava Y. Gender gaps – Life expectancy and proportion of life in poor health. Health Reports Ottawa. 2014;25(12):12-9.

10. Zarulli V., Barthold Jones J.A., Oksuzyan A., et al. Women live longer than men even during severe famines and epidemics. Proc Natl Acad Sci USA. 2018;115(4):E832-E840. doi:10.1073/pnas. 1701535115.

11. Cai J., Pajak A., Li Y., et al. Total cholesterol and mortality in China, Poland, Russia, and the US. Ann Epidemiol. 2004;14:399-408. doi:10.1016/j.annepidem.2003.10.012.

12. Bae J.M., Yang Y.J., Li Z.M., Ahn Y.O. Low Cholesterol is Associated with Mortality from Cardiovascular Diseases: A Dynamic Cohort Study in Korean Adults. Journal of Korean Medical Science. 2012;27(1):58-63. doi:10.3346/jkms.2012.27.1.58.

13. Romero-Corral A., Montori V.M., Somers V.K., et al. Association of bodyweight with total mortality and with cardiovascular events in coronary artery disease: a systematic review of cohort studies. Lancet. 2006;368(9536):666-78. doi:10.1016/S0140-6736(06)69251-9.

14. Pan W.H., Yeh W.T., Chen H.J., et al. The U-shaped relationship between BMI and all-cause mortality contrasts with a progressive increase in medical expenditure: a prospective cohort study. Asia Pac J Clin Nutr. 2012;21(4):577-87.

15. Di Cesare M., Bentham J., Zhou B., et al. Trends in adult body-mass index in 200 countries from 1975 to 2014: a pooled analysis of 1698 population-based measurement studies with 19.2 million participants. Lancet. 2016;387(10026):1377-96. doi:10.1016/S0140-6736(16)30054-X.

16. Flegal K.M., Carroll M.D., Ogden C.L., Curtin L.R. Prevalence and Trends in Obesity Among US Adults, 1999-2008. JAMA. 2010;303(3):235-41. doi:10.1001/jama.2014.6228.

17. The Demographic Yearbook of Russia. 2015: Statistical Handbook. Moscow: Rosstat; 2015 (In Russ.) [Демографический ежегодник России. 2015: Статистический сборник. М.: Росстат; 2015].

18. Meschia J.F., Bushnell C., Boden-Albala B., et al. Guidelines for the Primary Prevention of Stroke. A Statement for Healthcare Professionals from the American Heart Association/American Stroke Association. Stroke. 2014;45(12):3754-832. doi:10.1161/STR.0000000000000046.

19. Piwońska A., Piotrowski W., Broda G., et al. The relationship between resting heart rate and atherosclerosis risk factors. Kardiol Pol. 2008;66(10):1069-75.

20. Papathanasiou G., Georgakopoulos D., Papageorgiou E., et al. Effects of smoking on heart rate at rest and during exercise and on heart rate recovery in young adults. Hellenic J Cardiol. 2013;54(3):168-77.

21. Tolpygina S.N., Polyanskaya Yu.N., Martsevich S.Yu. Treatment of patients with chronic ischemic heart disease in real clinical practice according to the data from PROGNOZ IBS register (part 1). Rational Pharmacotherapy in Cardiology. 2013;9(2):138-42. (In Russ.) [Толпыгина С.Н., Полянская Ю.Н., Марцевич С.Ю. Лечение пациентов с хронической ишемической болезнью сердца в реальной клинической практике по данным регистра «Прогноз ИБС» (часть 1). Рациональная Фармакотерапия в Кардиологии. 2013;9(2):138-42]. doi:10.20996/1819-6446-2013-9-2-138-142.

22. Boytsov S.A., Luk’yanov M.M., Yakushin S.S., et al. Cardiovascular diseases registry (RECVAZA): diagnostics, concomitant cardiovascular pathology, comorbidities and treatment in the real outpatient-polyclinic practice. Cardiovascular Therapy and Prevention. 2014;13(6):3-8. (In Russ.)