Socioeconomic and behavioral determinants of mortality in posttransition Russia: a prospective population study.

PURPOSE: To study different socioeconomic determinants of mortality in posttransition Russia and propose potential explanations. Previous research has demonstrated a widening educational mortality gradient, widespread deprivation, and harmful health behaviors. METHODS: Data were from seven rounds (1994-2002) of the 38-center Russia Longitudinal Monitoring Survey. We measured associations among education, income, consumer goods, smoking, alcohol consumption, and subsequent death (reported by another household member), using univariate and multivariate Cox proportional hazards analysis. RESULTS: There were 11,482 adults older than 18 years, 782 deaths, and a mean follow-up of 4.2 years. Study and national mortality rates were comparable (standardized mortality ratio of 0.96 in men and 0.78 in women). Education predicted mortality strongly: the fully adjusted hazard ratios for less than secondary compared with higher education were 1.68 (1.26-2.23) in men and 3.08 (2.25-4.21) in women. Income and material measures did not predict mortality strongly. Smoking and weekly drinking independently doubled the mortality risk; however, like income, they did not explain the educational mortality gradient, of which material measures accounted for one-third in men only. CONCLUSIONS: Education, unlike material advantage, protected strongly against mortality. Education may better reflect lifetime health-related exposures, although other explanations (e.g., psychosocial, cardiovascular risk) deserve further research. Health behaviors exhibited strong, separate effects on mortality.