Context.-Russian life expectancy has fallen sharply in the 1990s, but the impact of the major causes of death on that decline has not been measured. Objective.-To assess the contribution of selected causes of death to the dramatic decline in life expectancy in Russia in the years following the breakup of the Soviet Union, Design.-Mortality and natality data from the vital statistics systems of Russia and the United States, Setting.-Russia, 1990-1994, Population.-Entire population of Russia, Main Outcome Variables.-Mortality rates, life expectancy, and contribution to change in life expectancy, Methods.-Application of standard life-table methods to calculate life expectancy by year, and a partitioning method to assess the contribution of specific causes of death and age groups to the overall decline in life expectancy, United States data presented for comparative purposes, Results.-Age-adjusted mortality in Russia rose by almost 33% between 1990 and 1994, During that period, life expectancy for Russian men and women declined dramatically from 63.8 and 74.4 years to 57.7 and 71.2 years, respectively, while in the United States, life expectancy increased for both men and women from 71.8 and 78.8 years to 72.4 and 79.0 years, respectively, More than 75% of the decline in life expectancy was due to increased mortality rates for ages 25 to 64 years. Overall, cardiovascular diseases (heart disease and stroke) and injuries accounted for 65% of the decline in life expectancy while infectious diseases, including pneumonia and influenza, accounted for 5.8%, chronic liver diseases and cirrhosis for 2.4%, other alcohol-related causes for 9.6%, and cancer for 0.7%. Increases in cardiovascular mortality accounted for 41.6% of the decline in life expectancy for women and 33.4% for men, while increases in mortality from injuries leg, falls, occupational injuries, motor vehicle crashes, suicides, and homicides) accounted for 32.8% of the decline in life expectancy for men and 21.8% for women. Conclusion.-The striking rise in Russian mortality is beyond the peacetime experience of industrialized countries, with a 5-year decline in life expectancy in 4 years' time, Many factors appear to be operating simultaneously, including economic and social instability, high rates of tobacco and alcohol consumption, poor nutrition, depression, and deterioration of the health care system, Problems in data quality and reporting appear unable to account for these findings, These results clearly demonstrate that major declines in health and life expectancy can take place rapidly.
