Why do Russian women outlive Russian men? Even with the substantial improvements in mortality that Russia has seen over the past decade or so, it has one of the largest gaps ever seen in life expectancy by sex – about 11.3 years in 2013, when women’s life expectancy was just over 76 years, and men’s was about 65.*
Human women generally have longer average lifespans than human men, but the size of the difference in Russia is remarkable. From what we know of the Russian pattern of mortality, we might guess that this is because of high mortality from external causes (that is, causes originating outside the body – accidents, violence, poisoning, etc.), and especially alcohol-related death among working-age men. Those who have spent time in Russia might think of a ruddy-faced man getting on their tramvai or marshrutka, reeking of alcohol and having trouble standing up at 9 a.m.; or a party where they were poured and pressured to take shot after shot of vodka; or a news story about a tragic alcohol-related car crash, pedestrian accident, or murder. These images play into stereotypes of life in Russia, and do indeed reflect certain aspects of Russian reality. However, in terms of demographic rates, they’re only part of the story.
The chart below shows how many years of that 11.3-year life expectancy gap are caused by excess male deaths at each age and for each cause of death. It features data from the Russian Fertility and Mortality Database and is constructed using an incredibly nifty algorithm for comparing demographic rates devised by Andreev, Shkolnikov, and Begun in 2002.
This is based on age-specific death rates, so the differing number of women and men in the population doesn’t matter. (Also, I left off the childhood ages for better readability – the sex differences in death rates there are very small.) It shows, for example, that a higher male death rate at ages 50-54 accounts for a full year of the Russian sex difference in life expectancy, and about a third of that excess death is from accidents, while another third is from cardiovascular diseases. The cause-of-death categories are deliberately broad here – “other internal causes” includes anything internal that’s not cancer or cardiovascular disease – emphysema, kidney failure, cirrhosis, ALS, etc. – and “all other causes” includes external causes that are not accidents (suicide and homicide, infectious disease), maternal and infant mortality, death of undetermined causes, and senility.
What’s surprising about this chart (at least to the layperson – folks who work on Russian mortality already know this) is that the most excess male death occurs not at working ages, but in early older ages. What’s more, the largest part of the sex difference is not from accidents and external causes, but from cardiovascular diseases, which account for over four years of the life expectancy difference. Accidents and external causes are still quite important, contributing about 2.8 years of lost male life expectancy, and playing an especially important role for younger adult men. It’s also worth noting that much of this excess cardiovascular mortality may also be alcohol-related; the ebb and flow of heart attacks, strokes, and other cardiovascular deaths in Russia is intimately tied to alcohol consumption. But the sex difference is not just due to an epidemic of violent deaths and accidents. This is good news, because it means that both alcohol policy and other measures – such as improved health care, better prevention and monitoring of cardiovascular disease, and lifestyle changes such as better diet and more exercise – can go a long way toward improving Russian men’s demographic profile.
* A quick note about the nuances of life expectancy – despite the name, it doesn’t actually tell us how long a real person can expect to live. It tells us how long a hypothetical person born today and then exposed to today’s age-specific death rates at each age throughout her life could expect to live. Of course, this doesn’t really happen; when a person born today is five, she’ll be exposed to the year 2020’s age-specific rates for five-year-olds, which may differ from 2015’s. When she’s twenty, she’ll be exposed to 2035’s age-specific death rates for 20-year-olds. Et cetera. Despite its confusing nature and uselessness as, say, a retirement planning tool, life expectancy still gives us a good summary picture of current mortality conditions.