Chernyavskiy V, Wenzel H, Mikhailova J, Ivanova A, Zemlyanova E, Bjegovic-Mikanovic V, Mikhailov A, Laaser U. Successful reduction of premature mortality in the Russian Federation and the countries around the Baltic Sea working together on Health and Social Well-being (Original research). SEEJPH 2019, posted: 25 October 2019. DOI 10.4119/seejph-3129 P a g e 1 | 20 ORIGINAL RESEARCH Successful reduction of premature mortality in the Russian Federation and the countries around the Baltic Sea working together on Health and Social Well-being Valery Chernyavskiy1, Helmut Wenzel2, Julia Mikhailova1, Alla Ivanova1,3, Elena Zemlyanova1,3, Vesna Bjegovic-Mikanovic4, Alexander Mikhailov1, Ulrich Laaser5 1 Federal Research Institute for Health Organization and Informatics of the Russian Ministry of Health, Moscow, Russian Federation; 2 Independent consultant, Konstanz, Germany; 3 Institute of Socio-Political Research of the Russian Academy of Sciences, Moscow, Russian Federation 4 University of Belgrade, Faculty of Medicine, Institute of Social Medicine, Belgrade, Serbia; 5 University of Bielefeld, Bielefeld School of Public Health, Bielefeld, Germany. Corresponding author: Prof. Dr. med. Ulrich Laaser; Address: Bielefeld School of Public Health, University of Bielefeld, Germany; E-mail: Ulrich.laaser@uni-bielefeld.de Chernyavskiy V, Wenzel H, Mikhailova J, Ivanova A, Zemlyanova E, Bjegovic-Mikanovic V, Mikhailov A, Laaser U. Successful reduction of premature mortality in the Russian Federation and the countries around the Baltic Sea working together on Health and Social Well-being (Original research). SEEJPH 2019, posted: 25 October 2019. DOI 10.4119/seejph-3129 P a g e 2 | 20 Abstract Context: The ‘Northern Dimension on Public Health and Social Well-being’ is a platform for dialogue and cooperation of countries around the Baltic Sea, established in 2003, guided by the Sustainable Development Goal 3 on Health and Social Well-being and the Strategy for the Baltic Sea Region of the European Union adopted in 2009. In this paper we determine the overall progress of the Russian Federation and its North West Federal Okrugin in particular, with regard to the reduction of mortality. Methods: For the purpose of inter-country comparison and progress over time we make use of age-standardised Potential Years of Life Lost (PYLL) applied to quantifiable strategic targets, the Sustainable Development Goal 3 on Health and Social Well-being and the European Union Strategy of the Baltic Sea Region. A gap analysis is performed to determine whether the target achievement is in delay or on track. Results: With reference to the baseline of 2009 – corresponding to the most relevant recent period 2009-2020 respectively 2009-2030 – the Russian Federation as a whole is on track achieving the two strategic targets in advance by 2.7 years. For the North West Federal Okrug around St. Petersburg and Kaliningrad bordering the Baltic Sea the target achievement is estimated to be 4.8 and 10.8 years in advance of the deadlines 2020 and 2030. In comparison to the Baltic Sea states the Russian Federation takes a middle position after Estonia, Latvia and Finland. The early target achievement is confirmed if the period 2003-2020 respectively 2003- 2030 is considered. Conclusion: Although the region is progressing there may be a slowdown towards 2030. A careful analysis is required to determine to which degree the activities of the Partnership for Health and Social Well-being have contributed to the success and what should be proposed to increase the impact on premature mortality. Keywords: gap analysis, northern dimension, North West Federal Okrug, premature mortality, public health, Russian Federation. Chernyavskiy V, Wenzel H, Mikhailova J, Ivanova A, Zemlyanova E, Bjegovic-Mikanovic V, Mikhailov A, Laaser U. Successful reduction of premature mortality in the Russian Federation and the countries around the Baltic Sea working together on Health and Social Well-being (Original research). SEEJPH 2019, posted: 25 October 2019. DOI 10.4119/seejph-3129 P a g e 3 | 20 Introduction Since 1999 the countries around the Baltic Sea (figure 1) initiated in several steps a platform for cooperation the ‘Northern Dimension’(ND) (1,2) with meanwhile four Partnerships on Culture, Environment, Health and Social Well-being, and Transport. The ‘Northern Dimension Partnership on Public Health and Social Well-being’ (NDPHS) (2) was formally established at a ministerial-level meeting on 27 October 2003, in Oslo, Norway. Today the membership comprises ten countries characterised by very diverse population size, history, health status and culture: Estonia, Finland, Germany, Iceland, Latvia, Lithuania, Norway, Poland, the Russian Federation, and Sweden (Denmark is not included) as well as related international organisations, the European Union (EU), the Baltic Sea States Sub-regional Cooperation (BSSSR), the Northern Dimension Institute (NDI), the World Health Organisation (WHO-EURO) and several more. Coordinated by a secretariat in Stockholm the NDPHS promotes dialogue, practical cooperation and development (3) in two priority fields: I. To reduce the spread of major communicable diseases, and II. To prevent life-style related non- communicable diseases. Emphasis is placed on encouraging proper nutrition, physical exercise, safe sexual behaviour, ensuring good social and work environments, as well as supporting alcohol, drug and smoke-free leisure activities. During the decade 2010-2020 two strategies for development of the Baltic Sea region have been most relevant: I. The Sustainable Development Goals (SDG), especially SDG 3 on Health and Social Well-being (4): SDG target 3.4, by 2030: Reduce by one third premature mortality from Non-Communicable Diseases (NCDs) through prevention and treatment and promote mental health and well-being. II. The EU Strategy for the Baltic Sea Region (EU-SBSR) adopted by the European Council October 2009 (5): EU-SBSR action target, by 2020 1) Reduce by at least 10% premature preventable mortality determined as Potential Years of Life Lost (PYLL) in the countries of the Baltic Sea region. 2) Reduce by at least 10% the difference between the lowest (best) and the highest (worst) PYLL rates for women and men in the countries of the Baltic Sea region. In this framework, the Russian Federation (RUF) is fully engaged as an entire member state and especially regarding its North- West Federal Okrug (NWO) including St. Petersburg and Kaliningrad and stretching from the Baltic to the Barents Sea with a territory of 1,686,970 km2. Chernyavskiy V, Wenzel H, Mikhailova J, Ivanova A, Zemlyanova E, Bjegovic-Mikanovic V, Mikhailov A, Laaser U. Successful reduction of premature mortality in the Russian Federation and the countries around the Baltic Sea working together on Health and Social Well-being (Original research). SEEJPH 2019, posted: 25 October 2019. DOI 10.4119/seejph-3129 P a g e 4 | 20 Figure 1. The geographical area of the Northern Dimension Partnership on Health and Social Well-being Figure 2. The geographical area of the North West Federal Okrug of the Russian Federation Chernyavskiy V, Wenzel H, Mikhailova J, Ivanova A, Zemlyanova E, Bjegovic-Mikanovic V, Mikhailov A, Laaser U. Successful reduction of premature mortality in the Russian Federation and the countries around the Baltic Sea working together on Health and Social Well-being (Original research). SEEJPH 2019, posted: 25 October 2019. DOI 10.4119/seejph-3129 P a g e 5 | 20 With our analysis, we attempt to determine to which extent it is possible for the RUF and the NWO to achieve the targets of the EU-SBSR and SDG. In addition, we try to identify the Russian Federation’s rank of target achievement in comparison with the other Baltic Sea states. For the NWO a specific Strategy and Action Plan of Social and Economic Development has been developed. It lists 109 activities together with the responsible institutions and timelines ending at the 4th quarter 2020: 12 activities relate to the health of the population, of which 3 are linked to maternal and child health (activities 63, 68, and 74). Activity 71 refers to primary health care, and activity 77 to HIV. Health related activities can also be found in other sections, e.g. activities 79 and 80 aiming at elderly services and 81 to rehabilitation. Of interest is also activity 40 on the implementation of cross-border cooperation programmes. Methods Losses of years of life up to the age of 69 years inclusive are predominantly preventable. It is in this sense that we will use the terms “premature” and “preventable” losses as synonyms. The Preventable Years of Life Lost (PYLL) were calculated by Vienonen et al. (6) for all countries except the Russian Federation up to the age of 69, based on the method of Haenszel (7) i.e. calculating the “...number of deaths in a theoretical standard population obtained by multiplying the specific death rates by the standard population”. To standardize the rates the OECD 1980 Standard Population (8) was applied. For age standardisation the direct method was used as recommended e.g. by Armitage (9). The likelihood of achieving the SDG targets (4) and EU-SBSR (5) is determined by the indicators’ time gap (G), i.e. the time needed to achieve an agreed target deadline related to the time remaining between the year of observation and the target year. To this end we use the mathematical model of the United Nations Development Program (UNDP) originally employed to assess advancement towards the target year of the Millennium Development Goals (MDG) (10), based on linear progress between the value of an earlier ‘baseline year’ and the year of observation; for details of the calculation see Bjegovic-Mikanovic et al. (11,12). We applied the EU-SBSR targets for 2020 with an intended reduction of 10% (4) and for 2030 of 33% (5). As non- communicable conditions make up for more than 2/3 of premature mortality, it seems to be justified for the purpose of intercountry comparison to apply the SDG-3 target to the calculated PYLL rates. A positive time gap G indicates that the respective country is “On Track” to achieve the target on time or even earlier; a negative value indicates that it may still be “Likely” or even “Unlikely” to achieve the target within the targeted timeframe i.e. here in 2020 respectively 2030. A country is still considered likely to achieve the target as long as a negative value does not make up for more than 25% of the remaining time (gap ratio). The gap ratio multiplied by the remaining time since the year of observation i.e. 2020-2013 = 7 or 2030-2013 = 17 indicates the number of years in advance or delay given the target year. Table 1 provides details of the calculation using the year of observation 2013 and the Russian Federation as an example. The demographic data have been provided by the Federal Research Institute for Health Organization and Informatics of the Russian Ministry of Health (Annex 1). Chernyavskiy V, Wenzel H, Mikhailova J, Ivanova A, Zemlyanova E, Bjegovic-Mikanovic V, Mikhailov A, Laaser U. Successful reduction of premature mortality in the Russian Federation and the countries around the Baltic Sea working together on Health and Social Well-being (Original research). SEEJPH 2019, posted: 25 October 2019. DOI 10.4119/seejph-3129 P a g e 6 | 20 Table 1. Calculation of Premature Years of Life Lost before age 70 (PYLL) in 2013 for the Russian Federation (RUF) Standardized death rates 2013 Direct standardization Study Population (Russian Federation) Standard Population Deaths Population (OECD 1980) Crude Rate Expected deaths (study pop.) PYLL Age Groups di pi STD Pi ri = di/pi Di = ri * STD Pi Di * (Remaining Years to Upper Age Limit) 0-4 18,549 8,793,034 80,269,483 0.00211 169,329 11,429,730 5-9 1,878 7,551,502 84,285,393 0.00025 20,961 1,310,070 10-14 1,930 6,755,920 85,828,597 0.00029 24,519 1,409,849 15-19 5,479 7,053,780 87,597,591 0.00078 68,041 3,572,160 20-24 15,314 10,409,826 82,619,776 0.00147 121,543 5,773,282 25-29 29,730 12,539,043 77,252,661 0.00237 183,166 7,784,539 30-34 44,424 11,503,329 73,604,119 0.00386 284,247 10,659,271 35-39 51,039 10,536,321 61,676,142 0.00484 298,765 9,709,877 40-44 53,882 9,656,787 57,394,499 0.00558 320,244 8,806,717 45-49 68,120 9,365,912 54,245,506 0.00727 394,538 8,877,095 50-54 111,658 11,310,281 52,537,987 0.00987 518,669 9,076,699 55-59 146,852 10,508,048 48,323,994 0.01398 675,337 8,441,714 60-64 177,781 8,819,230 36,727,063 0.02016 740,356 5,552,674 65-69 126,245 4,861,125 36,887,734 0.02597 957,986 2,394,966 Sum 852,881 129,664,138 919,250,545 0.00706 4,777,702 94,798,643 Standardized rate (per 100 000) 520 10,313 Results Table 2 presents the Premature Years of Life Lost (PYLL) for the Russian Federation (RUF). The data are used below for the calculation of the gap status for the target years 2020 and 2030 (for further details see Annex 2). Chernyavskiy V, Wenzel H, Mikhailova J, Ivanova A, Zemlyanova E, Bjegovic-Mikanovic V, Mikhailov A, Laaser U. Successful reduction of premature mortality in the Russian Federation and the countries around the Baltic Sea working together on Health and Social Well-being (Original research). SEEJPH 2019, posted: 25 October 2019. DOI 10.4119/seejph-3129 P a g e 7 | 20 Table 2. Overview of age standardized PYLL rates of the Russian Federation, based on the OECD 1980 Standard Population Age groups PYLL 2003 PYLL 2009 PYLL 2013 0-4 18,229,269 12,183,235 11,429,730 5-9 2,215,671 1,612,951 1,310,070 10-14 2,146,975 1,681,090 1,409,849 15-19 5,589,625 4,317,138 3,572,160 20-24 9,726,159 6,893,909 5,773,282 25-29 12,106,799 9,949,936 7,784,539 30-34 13,094,532 11,961,014 10,659,271 35-39 12,824,630 9,977,662 9,709,877 40-44 14,212,643 10,036,011 8,806,717 45-49 15,208,226 10,587,880 8,877,095 50-54 16,014,381 11,134,913 9,076,699 55-59 13,353,138 10,139,068 8,441,714 60-64 8,350,403 6,339,159 5,552,674 65-69 3,546,838 2,902,400 2,394,966 Sum of PYLL 146,619,290 109,716,365 94,798,643 Age standardised rate/100,000 15,950 11,935 10,313 We see in table 2 an impressive reduction of Premature Years of Life lost from 15,950 in 2003 to 10,313 in 2013, which translates if continued at the same speed into a positive Gap ratio for 2020 and 2030 standing for an early target achievement ranking 4th among the member states of NDPHS (table 3). The Gap ratios for the RUF based on 2009 of 0.39 for the target year 2020 and 0.16 for 2030 correspond to 2.7 years in advance of either target (calculated from 0.39 * 7 years and 0.16 * 17 years up to the corresponding target year). If 2003 is used as the baseline year the gap analysis shows the following results: PYLL 2003 / 100,000 15,950 PYLL 2013 / 100,000 10,313 Target 2020 (-10%) = 9,282 Target 2030 (-33%) = 6,875 Gap value 2020 = 0.62 (4.4 years in advance) Gap value 2030 = 0.40 (6.8 years in advance) Table 4 presents the corresponding data for the NOW (for details see Annex 3). Progress between 2003 and 2009 is very slow but accelerates considerably between 2009 and 2013. Chernyavskiy V, Wenzel H, Mikhailova J, Ivanova A, Zemlyanova E, Bjegovic-Mikanovic V, Mikhailov A, Laaser U. Successful reduction of premature mortality in the Russian Federation and the countries around the Baltic Sea working together on Health and Social Well-being (Original research). SEEJPH 2019, posted: 25 October 2019. DOI 10.4119/seejph-3129 P a g e 8 | 20 Table 3. Gap Analysis of the mortality in the Russian Federation and NDPHS member states (ESTonia, LATvia, FINland, POLand, GERmany, RUssian Federation, SWEden, LIThuania, Ru) Countries ranked according to achievement 2009-2013 -2020 Change of country ranks 2009-2030 Baseline value 2009 All Death: PYLL/ 100,000 Observed value 2013 All Death: PYLL/ 100,000 Target value 2020 (-10% as of 2013) All death: PYLL/ 100,000 Target value 2030 (-33% as of 2013) All death: PYLL/ 100,000 Gap ratio 2020 according to baseline 2009 Gap ratio 2030 according to baseline 2009 1) EST EST1 6247 4979 4481 3319 0.557 0.299 2) LAT LAT2 8247 6837 6153 4558 0.487 0.237 3) FIN FIN3 3741 3115 2803 2077 0.477 0.229 4) RUF RUF4 11935 10313 9282 6875 0.390 0.160 5) POL POL5 5649 4901 4411 3267 0.379 0.152 6) GER GER7 3219 3008 2707 2005 0.076 -0.021 7) SWE SWE8 2670 2511 2260 1674 0.039 -0.038 8) LIT LIT6 8351 7369 6632 4913 0.033 0.118 LIT - SWE 5681 4858 4372 3239 0.420 0.181 Table 4. Overview of age standardized PYLL rates of the North West Federal Okrug, based on the OECD 1980 Standard Population Age groups PYLL 2003 PYLL 2009 PYLL 2013 0-4 15,994,997 9,627,834 8,660,105 5-9 2,279,635 2,512,981 1,189,746 10-14 2,066,224 2,939,012 1,180,353 15-19 5,248,957 5,051,446 2,998,759 20-24 9,630,348 7,584,853 4,984,555 25-29 13,542,067 12,095,659 6,912,712 30-34 15,222,446 16,309,283 10,162,831 35-39 15,455,366 16,274,079 9,581,213 40-44 17,978,711 17,318,045 8,800,723 45-49 18,879,238 16,853,065 9,053,049 50-54 19,914,378 18,018,859 9,311,518 55-59 15,444,599 17,242,066 8,640,291 60-64 9,238,993 12,450,710 5,528,433 65-69 3,712,069 6,661,087 2,323,054 Sum of PYLL 164,608,028 160,938,978 89,399,156 Age standardised rate/100,000 17,907 17,508 9,725 Chernyavskiy V, Wenzel H, Mikhailova J, Ivanova A, Zemlyanova E, Bjegovic-Mikanovic V, Mikhailov A, Laaser U. Successful reduction of premature mortality in the Russian Federation and the countries around the Baltic Sea working together on Health and Social Well-being (Original research). SEEJPH 2019, posted: 25 October 2019. DOI 10.4119/seejph-3129 P a g e 9 | 20 The demographic and mortality data in table 4 provided for the NWO allow for the following calculation of the PYLL target achievement for 2020 and 2030 (reduction of PYLL, 0-69 years of age, direct age- standardisation, population base 2003, 2009 and 2013): Baseline value 2009 (PYLL NWO) 17,508 Observed value 2013 (PYLL NWO) 9,725 Target value 2020 (-10% of 2013) 8,753 Target value 2030 (-33% of 2013) 6,483 GAP 2020 0.69 (4.8 years in advance) GAP 2030 0.64 (10.8 years in advance) If 2003 is used as the baseline year the gap analysis shows the following results: PYLL 2003 / 100,000 17,907 PYLL 2013 / 100,000 9,725 Target 2020 (-10%) = 8,753 Target 2030 (-33%) = 6,483 GAP 2020 = 0.31 (2.2 years in advance) GAP 2030 = 0.55 (9.3 years in advance) Discussion With reference to the baseline of 2009 - corresponding to the most relevant recent period 2009-2020 respectively 2009-2030 - the Northern Dimension and all its member states including the RUF and the NOW are on track or are likely to achieve the targets in time (Sweden and Germany with slight delays regarding the SDG targets [The borderline for “not likely” is a gap status <- 0.25. The status “likely” is indicated by a gap status <0 and >= -0.25]). This can be considered a success to which the NDPHS contributed. However for all countries the positive gap (indicating achievement before the targeted time) is smaller for the SDG targets of 2030 than for 2020. This may indicate a slowing down of the dynamics in reducing mortality. The analysis is confirmed if the period 2003-2020 respectively 2003-2030 is considered. The Russian Federation keeps throughout the years a middle position among the NDPHS member states included in table 3 whereas the NWO would even take a top position for its more than 12 million inhabitants in front of the neighbouring Estonia. This relative good positioning is unlikely to be due to data inconsistencies as figure 3 shows an impressive homogeneity of mortality development throughout age groups in 2003, 2009 and 2013. Nevertheless the NWO shows accelerated progress. Chernyavskiy V, Wenzel H, Mikhailova J, Ivanova A, Zemlyanova E, Bjegovic-Mikanovic V, Mikhailov A, Laaser U. Successful reduction of premature mortality in the Russian Federation and the countries around the Baltic Sea working together on Health and Social Well-being (Original research). SEEJPH 2019, posted: 25 October 2019. DOI 10.4119/seejph-3129 P a g e 10 | 20 Figure 3. Percentage of deaths by age-groups in the Russian Federation 2003, 2009 and 2013 Limitations The straight projection of past progress into the future may be modified by the realities of historical development with its unpredictable interference in positive as well as negative direction. However, advanced achievement of targets may encourage to continue along the path of success whereas delays should stimulate to add up efforts. For the target year 2020 most ND member states have already achieved the target one or two years ago, so did the Russian Federation. Also in this paper we applied the targeted SDG-3 reduction by one third for non-communicable diseases to the PYLL rates which include to a minor degree communicable diseases too. The Russian Government’s activities during the last decade were marked by big investments in healthcare (around 10bln US dollars per year) with main focus to reconstruction of old health facilities including purchasing of modern medical equipment for diagnostics and treatment. A model of avoidable mortality was used to analyze causes of death related to insufficient diagnostics and treatment (healthcare factor), and causes associated with behavioural risks (lifestyle factor) (13). A comparison of regions of North-Western Russia and neighbouring European countries confirmed that the higher the mortality levels the stronger the contribution of avoidable causes i.e. up to 50% in average in 0.00 5.00 10.00 15.00 20.00 25.00 0-4 5-9 10-14 15-19 20-24 25-29 30-34 35-39 40-44 45-49 50-54 55-59 60-64 65-69 Age Groups % of Age groups 2003 % of Age groups 2009 % of Age groups 2013 Chernyavskiy V, Wenzel H, Mikhailova J, Ivanova A, Zemlyanova E, Bjegovic-Mikanovic V, Mikhailov A, Laaser U. Successful reduction of premature mortality in the Russian Federation and the countries around the Baltic Sea working together on Health and Social Well-being (Original research). SEEJPH 2019, posted: 25 October 2019. DOI 10.4119/seejph-3129 P a g e 11 | 20 North-Western Russia, varying between 45% in St. Petersburg and 67% in Pskov and Novgorod. Healthcare does substantially contribute to mortality reduction, however its role is not the leading one. For this moment our analysis could include only one Federal Okrug but it would be a fascinating task to analyse target achievement for all Okrugs of the huge territory of the Russian Federation. As the Russian Federation borders the Near and Far East this may induce dynamic exchange and a more global than national perspective (14), especially if combined with a more precise sub-grouping according to gender and to specific disease groups. The very good ranking of the Russian Federation and its NWO are encouraging although it will be difficult to keep the pace of improvement as it started from very high levels of premature mortality in 2009 and even worse in 2003. A national strategy may be considered in this regard. Also for the European Union (15) a technical cooperation in this area may be of mutual interest. Conflicts of interest: None declared. References 1. The European External Action Service (EEAS). The Northern Dimension. 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Successful reduction of premature mortality in the Russian Federation and the countries around the Baltic Sea working together on Health and Social Well-being (Original research). SEEJPH 2019, posted: 25 October 2019. DOI 10.4119/seejph-3129 P a g e 12 | 20 11. Bjegovic-Mikanovic V, Broniatowski R, Byepu S, Laaser U. A Gap Analysis of Mother, New-born, and Child Health in West Africa with Reference to the Sustainable Development Goals 2030. Afr J Reprod Health 2018;22:123-34. DOI: 10.29063/ajrh2018/v22i4.13. 12. Bjegovic-Mikanovic V, Salem ZA, Wenzel H, Broniatowski R, Nelson C, Vukovic D, et al. A gap analysis of SDG 3 and MDG 4/5 mortality health targets in the six Arabic countries of North Africa: Egypt, Libya, Tunisia, Algeria, Morocco, and Mauritania. Libyan J Med 2019:14;1607698. Available at: https://doi.org/10.1080/19932820.2019. 1607698 (accessed: 10 August, 2019). 13. Ivanova A, Zemlianova E. 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Available at: https://eeas.europa.eu/headquarters/hea dquarters-homepage/35939/european- union-and-russian-federation_en (accessed: 10 August, 2019). https://doi.org/10.1080/19932820.2019.1607698 https://doi.org/10.1080/19932820.2019.1607698 http://journal.frontiersin.org/article/10.3389/fpubh.2016.00241/full?&utm_source=Email_to_authors_&utm_medium=Email&utm_content=T1_11.5e1_author&utm_campaign=Email_publication&field=&journalName=Frontiers_in_Public_Health&id=209500 http://journal.frontiersin.org/article/10.3389/fpubh.2016.00241/full?&utm_source=Email_to_authors_&utm_medium=Email&utm_content=T1_11.5e1_author&utm_campaign=Email_publication&field=&journalName=Frontiers_in_Public_Health&id=209500 http://journal.frontiersin.org/article/10.3389/fpubh.2016.00241/full?&utm_source=Email_to_authors_&utm_medium=Email&utm_content=T1_11.5e1_author&utm_campaign=Email_publication&field=&journalName=Frontiers_in_Public_Health&id=209500 http://journal.frontiersin.org/article/10.3389/fpubh.2016.00241/full?&utm_source=Email_to_authors_&utm_medium=Email&utm_content=T1_11.5e1_author&utm_campaign=Email_publication&field=&journalName=Frontiers_in_Public_Health&id=209500 http://journal.frontiersin.org/article/10.3389/fpubh.2016.00241/full?&utm_source=Email_to_authors_&utm_medium=Email&utm_content=T1_11.5e1_author&utm_campaign=Email_publication&field=&journalName=Frontiers_in_Public_Health&id=209500 http://journal.frontiersin.org/article/10.3389/fpubh.2016.00241/full?&utm_source=Email_to_authors_&utm_medium=Email&utm_content=T1_11.5e1_author&utm_campaign=Email_publication&field=&journalName=Frontiers_in_Public_Health&id=209500 http://journal.frontiersin.org/article/10.3389/fpubh.2016.00241/full?&utm_source=Email_to_authors_&utm_medium=Email&utm_content=T1_11.5e1_author&utm_campaign=Email_publication&field=&journalName=Frontiers_in_Public_Health&id=209500 https://eeas.europa.eu/headquarters/headquarters-homepage/35939/european-union-and-russian-federation_en https://eeas.europa.eu/headquarters/headquarters-homepage/35939/european-union-and-russian-federation_en https://eeas.europa.eu/headquarters/headquarters-homepage/35939/european-union-and-russian-federation_en Chernyavskiy V, Wenzel H, Mikhailova J, Ivanova A, Zemlyanova E, Bjegovic-Mikanovic V, Mikhailov A, Laaser U. Successful reduction of premature mortality in the Russian Federation and the countries around the Baltic Sea working together on Health and Social Well-being (Original research). SEEJPH 2019, posted: 25 October 2019. DOI 10.4119/seejph-3129 P a g e 13 | 20 ANNEX 1: Population and mortality data of the Russian Federation for 2003, 2009, and 2013 Annex 1a: Population and mortality in the Russian Federation 2003 Age-group Total population Males Females Total mortality Males Females 00-04 6,565,695 3,364,592 3,201,103 22,090 12,754 9,336 05-09 6,818,772 3,486,662 3,332,110 2,868 1,791 1,077 10-14 9,760,069 4,985,362 4,774,707 4,246 2,778 1,468 15-19 12,669,554 6,432,752 6,236,802 15,399 11,128 4,271 20-24 11,713,409 5,913,034 5,800,375 29,030 23,001 6,029 25-29 10,717,142 5,360,243 5,356,899 39,519 31,466 8,053 30-34 9,963,892 4,973,305 4,990,587 47,270 37,095 10,175 35-39 9,888,714 4,863,197 5,025,517 63,268 49,281 13,987 40-44 12,324,267 5,972,742 6,351,525 110,977 85,938 25,039 45-49 11,777,383 5,564,681 6,212,702 146,751 111,219 35,532 50-54 10,316,215 4,737,479 5,578,736 179,688 131,720 47,968 55-59 5,976,065 2,638,995 3,337,070 132,107 91,857 40,250 60-64 7,045,054 2,854,945 4,190,109 213,572 141,469 72,103 65-69 6,718,590 2,573,559 4,145,031 258,403 155,124 103,279 00-69 132,254,821 63,721,548 68,533,273 1,265,188 886,621 378,567 Annex 1b: Population and mortality in the Russian Federation 2009 Age-group Total population Males Females Total mortality Males Females 00-04 7,793,807 3,994,295 3,799,512 17,525 10,064 7,461 05-09 6,887,915 3,530,220 3,357,695 2,109 1,273 836 10-14 6,784,360 3,470,481 3,313,879 2,311 1,416 895 15-19 9,274,152 4,699,081 4,575,071 8,706 6,073 2,633 20-24 12,354,120 6,242,785 6,111,335 21,702 16,795 4,907 25-29 11,788,055 5,916,062 5,871,993 35,724 27,844 7,880 30-34 10,751,459 5,306,042 5,445,417 46,591 36,183 10,408 35-39 9,997,601 4,903,848 5,093,753 49,765 37,620 12,145 40-44 9,307,938 4,493,889 4,814,049 59,185 44,056 15,129 45-49 11,415,509 5,393,625 6,021,884 99,028 73,183 25,845 50-54 11,292,748 5,136,151 6,156,597 136,765 98,957 37,808 55-59 9,821,361 4,274,188 5,547,173 164,853 113,724 51,129 60-64 6,497,033 2,694,911 3,802,122 149,520 100,238 49,282 65-69 5,059,895 1,869,565 3,190,330 159,249 94,717 64,532 00-69 129,025,953 61,925,143 67,100,810 953,033 662,143 290,890 Chernyavskiy V, Wenzel H, Mikhailova J, Ivanova A, Zemlyanova E, Bjegovic-Mikanovic V, Mikhailov A, Laaser U. Successful reduction of premature mortality in the Russian Federation and the countries around the Baltic Sea working together on Health and Social Well-being (Original research). SEEJPH 2019, posted: 25 October 2019. DOI 10.4119/seejph-3129 P a g e 14 | 20 Annex 1c: Population and mortality in the Russian Federation 2013 Age-group Total population Males Females Total mortality Males Females 00-04 8,793,034 4,513,291 4,279,743 18,549 10,567 7,982 05-09 7,551,502 3,865,465 3,686,037 1,878 1,120 758 10-14 6,755,920 3,462,420 3,293,500 1,930 1,234 696 15-19 7,053,780 3,608,295 3,445,485 5,479 3,930 1,549 20-24 10,409,826 5,300,627 5,109,199 15,314 12,034 3,280 25-29 12,539,043 6,323,822 6,215,221 29,730 22,980 6,750 30-34 11,503,329 5,734,090 5,769,239 44,424 33,885 10,539 35-39 10,536,321 5,145,842 5,390,479 51,039 38,699 12,340 40-44 9,656,787 4,689,062 4,967,725 53,882 39,702 14,180 45-49 9,365,912 4,444,475 4,921,437 68,120 49,808 18,312 50-54 11,310,281 5,204,736 6,105,545 111,658 80,673 30,985 55-59 10,508,048 4,587,151 5,920,897 146,852 101,408 45,444 60-64 8,819,230 3,635,352 5,183,878 177,781 118,451 59,330 65-69 4,861,125 1,877,877 2,983,248 126,245 76,787 49,458 00-69 129,664,138 62,392,505 67,271,633 852,881 591,278 261,603 Chernyavskiy V, Wenzel H, Mikhailova J, Ivanova A, Zemlyanova E, Bjegovic-Mikanovic V, Mikhailov A, Laaser U. Successful reduction of premature mortality in the Russian Federation and the countries around the Baltic Sea working together on Health and Social Well-being (Original research). SEEJPH 2019, posted: 25 October 2019. DOI 10.4119/seejph-3129 P a g e 15 | 20 ANNEX 2: Complete Gap Analysis based on the demographic data of the Russian Federation for 2003, 2009, and 2013 Annex 2a: Standardized death rates 2003, direct standardization Study Population (Russian Federation) Standard Population Deaths Population (OECD 1980) Crude Rate Expected deaths (Standard Pop.) PYLL Age Groups di pi STD Pi ri = di/pi Di = ri * STD Pi Di * (Remaining Years to Upper Age Limit) 0-4 22,090 6,565,695 80,269,483 0.00336 270,063 18,229,269 5-9 2,868 6,818,772 84,285,393 0.00042 35,451 2,215,671 10-14 4,246 9,760,069 85,828,597 0.00044 37,339 2,146,975 15-19 15,399 12,669,554 87,597,591 0.00122 106,469 5,589,625 20-24 29,030 11,713,409 82,619,776 0.00248 204,761 9,726,159 25-29 39,519 10,717,142 77,252,661 0.00369 284,866 12,106,799 30-34 47,270 9,963,892 73,604,119 0.00474 349,188 13,094,532 35-39 63,268 9,888,714 61,676,142 0.00640 394,604 12,824,630 40-44 110,977 12,324,267 57,394,499 0.00900 516,823 14,212,643 45-49 146,751 11,777,383 54,245,506 0.01246 675,921 15,208,226 50-54 179,688 10,316,215 52,537,987 0.01742 915,108 16,014,381 55-59 132,107 5,976,065 48,323,994 0.02211 1,068,251 13,353,138 60-64 213,572 7,045,054 36,727,063 0.03032 1,113,387 8,350,403 65-69 258,403 6,718,590 36,887,734 0.03846 1,418,735 3,546,838 Sum 1,265,188 132,254,821 919,250,545 0.01089 7,390,966 146,619,290 Standardized rate (per 100,000) 804 15,950 Chernyavskiy V, Wenzel H, Mikhailova J, Ivanova A, Zemlyanova E, Bjegovic-Mikanovic V, Mikhailov A, Laaser U. Successful reduction of premature mortality in the Russian Federation and the countries around the Baltic Sea working together on Health and Social Well-being (Original research). SEEJPH 2019, posted: 25 October 2019. DOI 10.4119/seejph-3129 P a g e 16 | 20 Annex 2b: Standardized death rates 2003, direct standardization Study Population (Russian Federation) Standard Population Deaths Population (OECD 1980) Crude Rate Expected deaths (Standard Pop.) PYLL Age Groups di pi STD Pi ri = di/pi Di = ri * STD Pi Di * (Remaining Years to Upper Age Limit) 0-4 17,525 7,793,807 80,269,483 0.00225 180,492 12,183,235 5-9 2,109 6,887,915 84,285,393 0.00031 25,807 1,612,951 10-14 2,311 6,784,360 85,828,597 0.00034 29,236 1,681,090 15-19 8,706 9,274,152 87,597,591 0.00094 82,231 4,317,138 20-24 21,702 12,354,120 82,619,776 0.00176 145,135 6,893,909 25-29 35,724 11,788,055 77,252,661 0.00303 234,116 9,949,936 30-34 46,591 10,751,459 73,604,119 0.00433 318,960 11,961,014 35-39 49,765 9,997,601 61,676,142 0.00498 307,005 9,977,662 40-44 59,185 9,307,938 57,394,499 0.00636 364,946 10,036,011 45-49 99,028 11,415,509 54,245,506 0.00867 470,572 10,587,880 50-54 136,765 11,292,748 52,537,987 0.01211 636,281 11,134,913 55-59 164,853 9,821,361 48,323,994 0.01679 811,125 10,139,068 60-64 149,520 6,497,033 36,727,063 0.02301 845,221 6,339,159 65-69 159,249 5,059,895 36,887,734 0.03147 1,160,960 2,902,400 Sum 953,033 129,025,953 919,250,545 0.00831 5,612,089 109,716,365 Standardized rate (per 100,000) 611 11,935 Chernyavskiy V, Wenzel H, Mikhailova J, Ivanova A, Zemlyanova E, Bjegovic-Mikanovic V, Mikhailov A, Laaser U. Successful reduction of premature mortality in the Russian Federation and the countries around the Baltic Sea working together on Health and Social Well-being (Original research). SEEJPH 2019, posted: 25 October 2019. DOI 10.4119/seejph-3129 P a g e 17 | 20 Annex 2c: Standardized death rates 2013, direct standardization Study Population (Russian Federation) Standard Population Deaths Population (OECD 1980) Crude Rate Expected deaths (Study Pop.) PYLL Age Groups di pi STD Pi ri = di/pi Di = ri * STD Pi Di * (Remaining Years to Upper Age Limit) 0-4 18,549 8,793,034 80,269,483 0.00211 169,329 11,429,730 5-9 1,878 7,551,502 84,285,393 0.00025 20,961 1,310,070 10-14 1,930 6,755,920 85,828,597 0.00029 24,519 1,409,849 15-19 5,479 7,053,780 87,597,591 0.00078 68,041 3,572,160 20-24 15,314 10,409,826 82,619,776 0.00147 121,543 5,773,282 25-29 29,730 12,539,043 77,252,661 0.00237 183,166 7,784,539 30-34 44,424 11,503,329 73,604,119 0.00386 284,247 10,659,271 35-39 51,039 10,536,321 61,676,142 0.00484 298,765 9,709,877 40-44 53,882 9,656,787 57,394,499 0.00558 320,244 8,806,717 45-49 68,120 9,365,912 54,245,506 0.00727 394,538 8,877,095 50-54 111,658 11,310,281 52,537,987 0.00987 518,669 9,076,699 55-59 146,852 10,508,048 48,323,994 0.01398 675,337 8,441,714 60-64 177,781 8,819,230 36,727,063 0.02016 740,356 5,552,674 65-69 126,245 4,861,125 36,887,734 0.02597 957,986 2,394,966 Sum 852,881 129,664,138 919,250,545 0.00706 4,777,702 94,798,643 Standardized rate (per 100,000) 520 10,313 Chernyavskiy V, Wenzel H, Mikhailova J, Ivanova A, Zemlyanova E, Bjegovic-Mikanovic V, Mikhailov A, Laaser U. Successful reduction of premature mortality in the Russian Federation and the countries around the Baltic Sea working together on Health and Social Well-being (Original research). SEEJPH 2019, posted: 25 October 2019. DOI 10.4119/seejph-3129 P a g e 18 | 20 ANNEX 3. Demographic and mortality data and the resulting PYLL rates of the North West Federal Okrug (NWO) of the Russian Federation for 2003, 2009 and 2013 Study Population (NWO District) Standard Population Annex 3a Deaths Population (OECD 1980) Crude Rate Expected deaths (Standard Pop.) PYLL Age Groups di pi STD Pi ri = di/pi Di = ri * STD Pi Di* (Remaining Years to Upper Age Limit) 0-4 1,666 564,500 80,269,483 0.00295 236,963 15,994,997 5-9 244 564,321 84,285,393 0.00043 36,474 2,279,635 10-14 357 852,259 85,828,597 0.00042 35,934 2,066,224 15-19 1,362 1,193,690 87,597,591 0.00114 99,980 5,248,957 20-24 2,787 1,135,751 82,619,776 0.00245 202,744 9,630,348 25-29 4,238 1,027,373 77,252,661 0.00412 318,637 13,542,067 30-34 5,264 954,497 73,604,119 0.00552 405,932 15,222,446 35-39 7,347 952,804 61,676,142 0.00771 475,550 15,455,366 40-44 13,686 1,201,468 57,394,499 0.01139 653,771 17,978,711 45-49 18,436 1,191,875 54,245,506 0.01547 839,077 18,879,238 50-54 23,048 1,064,075 52,537,987 0.02166 1,137,964 19,914,378 55-59 16,456 643,591 48,323,994 0.02557 1,235,568 15,444,599 60-64 21,782 649,414 36,727,063 0.03354 1,231,866 9,238,993 65-69 26,624 661,425 36,887,734 0.04025 1,484,828 3,712,069 Sum 143,296 12,657,040 919,250,545 0.01233 8,395,289 164,608,028.34 Standardized rate (per 100,000) 913.28 17,906.76 Chernyavskiy V, Wenzel H, Mikhailova J, Ivanova A, Zemlyanova E, Bjegovic-Mikanovic V, Mikhailov A, Laaser U. Successful reduction of premature mortality in the Russian Federation and the countries around the Baltic Sea working together on Health and Social Well-being (Original research). SEEJPH 2019, posted: 25 October 2019. DOI 10.4119/seejph-3129 P a g e 19 | 20 2009 Study Population (NWO District) Standard Population Annex 3b Deaths Population (OECD 1980) Crude Rate Expected deaths (Standard Pop.) PYLL Age Groups di pi STD Pi ri = di/pi Di = ri * STD Pi Di* (Remaining Years to Upper Age Limit) 0-4 1,178 662,703 80,269,483 0.00178 142,635 9,627,834 5-9 281 590,035 84,285,393 0.00048 40,208 2,512,981 10-14 335 561,830 85,828,597 0.00060 51,113 2,939,012 15-19 880 801,242 87,597,591 0.00110 96,218 5,051,446 20-24 2,238 1,157,868 82,619,776 0.00193 159,681 7,584,853 25-29 4,207 1,141,931 77,252,661 0.00368 284,604 12,095,659 30-34 6,185 1,046,782 73,604,119 0.00591 434,914 16,309,283 35-39 7,872 969,565 61,676,142 0.00812 500,741 16,274,079 40-44 9,872 899,724 57,394,499 0.01097 629,747 17,318,045 45-49 15,352 1,111,823 54,245,506 0.01381 749,025 16,853,065 50-54 22,146 1,129,981 52,537,987 0.01960 1,029,649 18,018,859 55-59 28,516 999,024 48,323,994 0.02854 1,379,365 17,242,066 60-64 31,156 689,278 36,727,063 0.04520 1,660,095 12,450,710 65-69 33,458 463,209 36,887,734 0.07223 2,664,435 6,661,087 Sum 163,675 12,224,992 919,250,545 0.01528 9,822,430 160,938,978.09 Standardized rate (per 100,000) 1,068.53 17,507.63 Chernyavskiy V, Wenzel H, Mikhailova J, Ivanova A, Zemlyanova E, Bjegovic-Mikanovic V, Mikhailov A, Laaser U. Successful reduction of premature mortality in the Russian Federation and the countries around the Baltic Sea working together on Health and Social Well-being (Original research). SEEJPH 2019, posted: 25 October 2019. DOI 10.4119/seejph-3129 P a g e 20 | 20 2013 Study Population (NWO District) Standard Population Annex 3c Deaths Population (OECD 1980) Crude Rate Expected deaths (Standard Pop.) PYLL Age Groups di pi STD Pi ri = di/pi Di = ri * STD Pi Di* (Remaining Years to Upper Age Limit) 0-4 1,220 757,156 80,269,483 0.00161 129,362 8,731,919 5-9 145 642,852 84,285,393 0.00023 19,036 1,189,746 10-14 137 573,546 85,828,597 0.00024 20,528 1,180,353 15-19 394 603,558 87,597,591 0.00065 57,119 2,998,759 20-24 1,252 985,677 82,619,776 0.00127 104,938 4,984,555 25-29 2,587 1,228,690 77,252,661 0.00211 162,652 6,912,712 30-34 4,193 1,138,908 73,604,119 0.00368 271,009 10,162,831 35-39 4,956 1,036,737 61,676,142 0.00478 294,807 9,581,213 40-44 5,259 943,130 57,394,499 0.00558 320,026 8,800,723 45-49 6,779 913,922 54,245,506 0.00742 402,358 9,053,049 50-54 11,182 1,104,138 52,537,987 0.01013 532,087 9,311,518 55-59 15,070 1,053,570 48,323,994 0.01430 691,223 8,640,291 60-64 17,942 893,981 36,727,063 0.02007 737,124 5,528,433 65-69 13,078 519,162 36,887,734 0.02519 929,222 2,323,054 Sum 84,195 12,395,023 919,250,545 0.00695 4,671,490 89,399,155.82 Standardized rate (per 100,000) 508.18 9,725.22 ___________________________________________________________________________ © 2019 Chernyavskiy et al; This is an Open Access article distributed under the terms of the Creative Commons Attribution License (http://creativecommons.org/licenses/by/3.0), which permits unrestricted use, distribution, and reproduction in any medium, provided the original work is properly cited.