Socioeconomic inequalities in physiological risk biomarkers and the role of lifestyles among Russians aged 35-69 years.

BACKGROUND: Socioeconomic inequalities in cardiovascular (CVD) health outcomes are well documented. While Russia has one of the highest levels of CVD mortality in the world, the literature on contemporary socio-economic inequalities in biomarker CVD risk factors is sparse. This paper aims to assess the extent and the direction of SEP inequalities in established physiological CVD risk biomarkers, and to explore the role of lifestyle factors in explaining SEP inequalities in physiological CVD risk biomarkers. METHODS: We used cross-sectional data from a general population-based survey of Russians aged 35-69 years living in two cities (n = 4540, Know Your Heart study 2015-18). Logistic models were used to assess the associations between raised physiological risk biomarkers levels (blood pressure levels, cholesterol levels, triglycerides, HbA1C, and C-reactive protein) and socioeconomic position (SEP) (education and household financial constraints) adjusting for age, obesity, smoking, alcohol and health-care seeking behavior. RESULTS: High education was negatively associated with a raised risk of blood pressure (systolic and diastolic) and C-reactive protein for both men and women. High education was positively associated with total cholesterol, with higher HDL levels among women, and with low triglycerides and HbA1c levels among men. For the remaining risk biomarkers, we found little statistical support for SEP inequalities. Adjustment for lifestyle factors, and particularly BMI and waist-hip ratio, led to a reduction in the observed SEP inequalities in raised biomarkers risk levels, especially among women. High financial constraints were weakly associated with high risk biomarkers levels, except for strong evidence for an association with C-reactive protein (men). CONCLUSIONS: Notable differences in risk biomarkers inequalities were observed according to the SEP measure employed. Clear educational inequalities in raised physiological risk biomarkers levels, particularly in blood pressure and C-reactive protein were seen in Russia and are partly explained by lifestyle factors, particularly obesity among women. These findings provide evidence-based information on the need for tackling health inequalities in the Russian population, which may help to further contribute to CVD mortality decline.

Socio-demographic, behavioural and psycho-social factors associated with depression in two Russian cities.

BACKGROUND: Russia has a high burden of suicide and alcohol-attributable mortality. However there have been few studies of the epidemiology of depression. METHODS: The study population was 5077 men and women aged 35-69 years from a cross-sectional population based survey in the cities of Arkhangelsk and Novosibirsk (2015-17). Moderate depression was defined as Patient Health Questionnaire-9 (PHQ-9) score≥10. Risk factors considered were socio-demographic factors (age, sex, marital status, living alone, education, employment status, financial constraints); health behaviours (smoking, alcohol use) and psycho-social factors (life events and social support). RESULTS: After mutual adjustment for all other factors, there was evidence that PHQ-9≥10 was associated with sex (higher in women), financial constraints, employment status, being a non-drinker, problem drinking, smoking, not having enough people to confide in and the number of life events in the past 6 months. Employment status was more strongly associated in men (OR 1.84 (95%CI 1.17, 2.88)) than women (OR 1.15 95% CI 0.86, 1.55). The effect size was particularly striking for financial constraints (odd ratio over 3 times higher in those with not enough money for food and clothes compared to no financial constraints), problem drinking (OR 1.72 (1.12, 2.65) among drinkers with CAGE score of 2 and 2.25 (95% CI 1.42, 3.57) in those with score ≥3 compared to zero) and life events (85% higher odds in those experiencing one life event and over 4 times higher odds in those experiencing 3 or more life events) all of which demonstrated a dose-response with PHQ-9>=10. LIMITATIONS: The study was cross-sectional in nature therefore temporal relationships could not be assessed. CONCLUSIONS: We have identified here a range of risk factors for depression among the Russian general population consistent with findings from other populations. The strikingly strong association with financial constraints indicates the importance of social inequality for the burden of depression.

Chronic Obstructive Pulmonary Disease (COPD) in Population Studies in Russia and Norway: Comparison of Prevalence, Awareness and Management.

BACKGROUND: Chronic obstructive pulmonary disease (COPD) is a major cause of morbidity and mortality worldwide. Despite a high prevalence of smoking and respiratory symptoms, two recent population-based studies in Russia found a relatively low prevalence of obstructive lung function. Here, we investigated the prevalence of both obstructive lung disease and respiratory symptoms in a population-based study conducted in two Russian cities and compared the findings with a similar study from Norway conducted in the same time period. METHODS: The study population was a sub-sample of participants aged 40-69 years participating in the Know Your Heart (KYH) study in Russia in 2015-18 (n=1883) and in the 7th survey of the Tromsø Study (n=5271) carried out in Norway in 2015-16 (Tromsø 7) who participated in spirometry examinations. The main outcome was obstructive lung function (FEV1/FVC ratio< lower limit of normal on pre-bronchodilator spirometry examination) with and without respiratory symptoms (chronic cough and breathlessness). In those with obstructive lung function, awareness (known diagnosis) and management (use of medications, smoking cessation) were compared. RESULTS: The age-standardized prevalence of obstructive lung function was similar among men in both studies (KYH 11.0% vs Tromsø 7 9.8%, p=0.21) and higher in the Norwegian (9.4%) than Russian (6.8%) women (p=0.006). In contrast, the prevalence of obstructive lung function plus respiratory symptoms was higher in Russian men (KYH 8.3% vs Tromsø 7 4.7%, p<0.001) but similar in women (KYH 5.9% vs Tromsø 7 6.4%, p=0.18). There was a much higher prevalence of respiratory symptoms in Russian than Norwegian participants of both sexes regardless of presence of obstructive lung function. CONCLUSION: The prevalence of respiratory symptoms was strikingly high among Russian participants but this was not explained by a higher burden of obstructive lung function on spirometry testing in comparison with Norwegian participants. Further work is needed to understand the reasons and health implications of this high prevalence of cough and breathlessness.

Primary care use and cardiovascular disease risk in Russian 40-69 year olds: a cross-sectional study.

BACKGROUND: The Russian Federation has very high cardiovascular disease (CVD) mortality rates compared with countries of similar economic development. This cross-sectional study compares the characteristics of CVD-free participants with and without recent primary care contact to ascertain their CVD risk and health status. METHODS: A total of 2774 participants aged 40-69 years with no self-reported CVD history were selected from a population-based study conducted in Arkhangelsk and Novosibirsk, Russian Federation, 2015-2018. A range of co-variates related to socio-demographics, health and health behaviours were included. Recent primary care contact was defined as seeing primary care doctor in the past year or having attended a general health check under the 2013 Dispansarisation programme. RESULTS: The proportion with no recent primary care contact was 32.3% (95% CI 29.7% to 35.0%) in males, 16.3% (95% CI 14.6% to 18.2%) in females, and 23.1% (95% CI 21.6% to 24.7%) overall. In gender-specific age-adjusted analyses, no recent contact was also associated with low education, smoking, very good to excellent self-rated health, no chest pain, CVD 10-year SCORE risk 5+%, absence of hypertension control, absence of hypertension awareness and absence of care-intensive conditions. Among those with no contact: 37% current smokers, 34% with 5+% 10-year CVD risk, 32% untreated hypertension, 20% non-anginal chest pain, 18% problem drinkers, 14% uncontrolled hypertension and 9% Grade 1-2 angina. The proportion without general health check attendance was 54.6%. CONCLUSION: Primary care and community interventions would be required to proactively reach sections of 40-69 year olds currently not in contact with primary care services to reduce their CVD risk through diagnosis, treatment, lifestyle recommendations and active follow-up.

Alcohol and suicide in the Nenets Autonomous Okrug and Arkhangelsk Oblast, Russia.

BACKGROUND: High suicide rates in the Russian North are coupled with high alcohol consumption in the described populations. OBJECTIVE: To investigate the potential role of alcohol consumption on suicides in the Nenets Autonomous Okrug (NAO) in 2002-2012 and to compare this information with corresponding data from the neighboring Arkhangelsk Oblast (AO). DESIGN: Retrospective population-based mortality study. METHODS: Data from autopsy reports were used to identify 252 cases of suicide in the NAO and 1,198 cases in the AO in the period 2002-2012. Postmortem blood alcohol content (BAC) was available for 228 cases in the NAO and 1,185 cases in the AO. BAC as well as other selected variables were compared between the NAO and the AO among women and men, different age groups, ethnic groups, and selected variables of suicide. RESULTS: Alcohol was present in the blood of 74.1% of male and 82.9% of female suicide cases in the NAO, which was significantly higher than the proportions found in the AO (59.3% of male and 46.6% female cases). BAC<1.0‰ and between 2.0 and 3.0‰ were more frequently found among suicide cases in the NAO than those in the AO. CONCLUSIONS: Our findings specify that alcohol drinking may be an essential risk factor for suicide in the NAO, and that this factor may be of greater importance in the indigenous population of the NAO than among Russians in the AO.

Variations in suicide method and in suicide occurrence by season and day of the week in Russia and the Nenets Autonomous Okrug, Northwestern Russia: a retrospective population-based mortality study.

BACKGROUND: Suicide is an important world health issue, especially in territories inhabited by indigenous people. This investigated differences in suicide rates, suicide methods, and suicide occurrence by month and day of the week among the indigenous and non-indigenous populations of the Nenets Autonomous Okrug (NAO) and to compare the findings from the NAO with national Russian statistics. METHODS: In this retrospective population-based mortality study we investigated all suicides that occurred in the NAO in 2002-2012 (N = 252). Suicide method and the month and day of the week suicide occurred was taken from autopsy reports and disaggregated by ethnic group (indigenous and non-indigenous) and sex. Data from the NAO were then compared with national data from the Russian Federal Statistics Service (Rosstat). RESULTS: Hanging was the most common suicide method in the NAO in both indigenous and non-indigenous populations. The proportion of suicides by hanging among males was lower in the NAO than in national data (69.3 vs 86.2 %), but the inverse was true for females (86.5 vs 74.9 %). Suicide by firearm and by cutting was significantly higher among the indigenous population in the NAO when compared with national data. Peaks in suicide occurrence were observed in May and September in the NAO, whereas national data showed only one peak in May. Suicide occurrence in the indigenous population of the NAO was highest in April, while the non-indigenous population showed peaks in May and September. Suicide occurrence in the NAO was highest on Fridays; in national data this occurrence was highest on Mondays. CONCLUSIONS: We showed different relative frequencies of suicide by hanging, cutting, and firearm, as well as different suicide occurrence by month and day of the week in the NAO compared with Russia as a whole. These results can be used to plan suicide prevention activities in the Russian Arctic.

Suicides in the indigenous and non-indigenous populations in the Nenets Autonomous Okrug, Northwestern Russia, and associated socio-demographic characteristics.

BACKGROUND: To describe suicide rates in the indigenous and non-indigenous populations of the Nenets Autonomous Okrug (NAO) in 2002-2012, as well as associated socio-demographic characteristics. STUDY DESIGN: Retrospective population-based mortality study. METHODS: Data from autopsy reports were used to identify 252 cases of suicide in the NAO in 2002-2012. Data on socio-demographic characteristics of these cases were obtained from passports and medical records at local primary health care units, and were then linked to total population data from the Censuses in 2002 and 2010. Suicide rates for the indigenous Nenets population and the non-indigenous population were standardized to the European standard population. The rates were also estimated according to different socio-demographic characteristics and compared by calculating relative risks. RESULTS: The crude suicide rates were 79.8 per 100,000 person-years (PYs) in the Nenets population and 49.2 per 100,000 PYs in the non-indigenous population. The corresponding standardized estimates were 72.7 per 100,000 PYs and 50.7 per 100,000 PYs. The highest suicide rates in the Nenets population were observed in the age group 20-29 years (391 per 100,000 PYs), and in females aged 30-39 years (191 per 100,000 PYs). Socio-demographic characteristics associated with high suicide rates in the Nenets population were age 20-39 years, male, urban residence, having secondary school or higher education, being an employee or employer, and being single or divorced. Males aged 20-29 years, and females aged 30-39 and aged 70 years and above had the highest suicide rates in the non-indigenous population (137.5, 21.6 and 29.9 per 100,000 PYs, respectively). The elevated suicide rates observed in the non-indigenous population were associated with male sex, rural residence, secondary school education, being an employee or employer, and being single or divorced. CONCLUSIONS: Suicide rates in the NAO were substantially higher among the indigenous Nenets population than the non-indigenous population, and were associated with different socio-demographic characteristics.

Road traffic fatalities in Arkhangelsk, Russia in 2005-2010: reliability of police and healthcare data.

PURPOSE: To estimate and compare reliability of traffic mortality data of the police and the healthcare sector in Arkhangelsk, Russia. METHODS: The study matched traffic mortality data of the police and the regional healthcare statistics centre for the period from 2005 to 2010. Individual investigations of unmatched cases were performed, and the underlying causes of the non-matches were established. The obtained distribution of non-matches by causes served as basis for estimating the true numbers of traffic fatalities in the two sources, in appliance with corresponding fatality definitions and registration rules. A data accuracy index (DAI) was calculated for each source by using an adapted version of the formula for calculating accuracy of a diagnostic test. This was used as a measure for data reliability. Time trends in annual DAIs were estimated for each source by χ(2)-test for linear trend. RESULTS: During the 6-year period, the police and the healthcare statistics centre registered 217 and 237 traffic fatalities in Arkhangelsk, respectively. Matching of data from the two sources resulted in 162 matched cases, 55 unmatched cases in the police data, and 75 unmatched cases in the healthcare data. More than a half (56%) of the non-matches were attributed to incompatibility of the definitions in the two data registration systems; 39% were attributed to failures in the healthcare data. Other non-matches were due to scarce identifying information (2%) or were not classifiable (2%). None of the non-matches were clearly attributable to failures in the police data. The 6-year DAI was 98% for the police data and 80% for the healthcare data. The DAI for the police data was stable over 2005-2010 (ranging from 96% to 100%). The DAI for the healthcare data increased from 66% in 2005 to 98% in 2010 (Ptrend<0.001). CONCLUSION: The findings suggest that traffic mortality data of the police were more reliable, compared to the healthcare data. However, reliability of the healthcare data was improving during the study period.

Injury prevention and safety promotion course in a Russian Master of Public Health programme.

The Global Burden of Disease Studies describe and emphasise injury as a major and increasing component in the panorama of global ill health. Russia has the one of the highest injury rates in Europe. When a Master in Public Health programme was planned and started in 2007 in Arkhangelsk, Russia, under the auspices of University of Tromsø, Norway, a course on Injury Prevention and Safety Promotion was included. A take-over programme (training-the-trainers) was implemented within the course. The present paper describes the course content, the students and their background, the training-the-trainers programme, the evaluation procedure and its results. So far, 53 students have passed the course, 77% being female. The majority of students were medical doctors (51%), psychologists (11%), pedagogues (9%), dentists (6%) and nurses (6%). The take-over programme has functioned well by gradually using students of excellence as teachers. In 2012, the take-over programme is completed and only Russians teach. Evaluation by students of the course content, organisation and pedagogic approach was useful for improvements.