Reserves for Increasing Life Expectancy of Older Population in Russia

Relevance. By 2030, the Russian Federation aims to increase the life expectancy at birth to 78 years as part of its national development plan [1]. This target value cannot be achieved without a reduction in mortality rates among older demographics and an increase in the life expectancy of the aging population.

Aim. To identify reserves for reducing mortality among older population in Russia and the contribution of older age groups to the increase in life expectancy at birth.

Materials and methods. Data from the Federal State Statistics Service (FSSS) on causes of death with population distribution by gender, five-year age groups, and brief nomenclature of death causes for 2022 were used for mortality analysis; data on the average annual population by gender and five-year age groups for 2022; and data from the average forecast variant of FSSS on population size by age groups up to 2030. Data from the Human Mortality Database [2] and agespecific mortality rates by causes of death from the WHO mortality database [3] were also used. The contribution of changes in mortality by age groups and causes of death to the increase in life expectancy was calculated using the decomposition method [4]. The forecast contribution of causes of death to the increase in life expectancy in older population was calculated taking into account the mortality structure by causes of death in 2022 (excluding malignant neoplasms and the Symptoms, signs, and abnormal clinical and laboratory findings, not elsewhere classified class).

Results. Since 2005, Russia has seen a steady increase in life expectancy, interrupted in 2020–2021. COVID-19 pandemic. For the period from 2005 to 2019. Life expectancy for men at birth increased by 9.3 years (from 58.9 to 68.2 years), while the decrease in mortality among men in age groups over 60 years accounted for 21% of this increase. Life expectancy of women at birth for 2005–2019. increased by 5.7 years, the contribution of the reduction in mortality over the age of 60 years was 48%.

Most of the decline in mortality in old age was determined by a reduction in mortality from diseases of the circulatory system. At the same time, there was an increase in mortality from symptoms, signs and abnormalities (ICD-10 class, including the cause of death old age and other codes for undetermined causes), and from other causes of death, incl. diseases of the nervous and endocrine system.

The contribution of the older population to life expectancy at birth increases as this indicator increases. Thus, in the period from 2005 to 2011. The decline in mortality among people aged 60 years and over accounted for 29% of the total increase in life expectancy at birth, from 2011 to 2019. Тhe contribution of reducing mortality in old age increased to 36%. According to the forecast until 2030, when life expectancy at birth reaches 78 years, by 2030 39% of the total growth in the indicator will be provided by age groups over 60 years of age, including almost 30% for men and more than 50% for women.

The forecast for 2030 shows that almost half of the potential increase in life expectancy at age 60 is linked to illnesses of the circulatory system, specifically coronary heart disease and various cerebrovascular events.

According to our estimates, the second most important contribution to life expectancy growth reserves is made by the class Symptoms, Signs and Deviations from the norm (uncertain causes of death, including old age). Age-specific mortality rates from this class of causes increase sharply after age 80 years. Using cause-of-death codes from this class underestimates mortality from other causes of death, including diseases of the circulatory system, neoplasms and other diseases [5] and requires improved quality of coding and selection of the original cause of death when completing medical death certificates.

The next leading causes of death are malignant tumours and COVID-19 (about 9%). Neoplasms are in second place in the structure of mortality in older population after CSD, however, the estimated contribution of changes in cancer mortality to the increase in life expectancy is significantly lower than both diseases of the circulatory system and the class of Symptoms, signs and abnormalities. It was previously shown that in Russia, a decrease in mortality from neoplasms is to a lesser extent a reserve for increasing life expectancy compared to diseases of the circulatory system and external causes [6]. Evidence from other countries between 1970 and 2018 supports a decrease of less than 25% in the standardized mortality rate from neoplasms in the EU-15 countries, while from diseases of the circulatory system it was more than 70% [7].

The remaining reserves aimed at extending the life expectancy in older population are distributed among conditions such as diabetes, nervous system diseases, respiratory and digestive disorders, and external causes leading to mortality.

Conclusion: With increasing life expectancy and aging population, the focus shifts to decreasing mortality rates among older adults, in light of the rising life expectancy at birth. Thus, it is crucial to implement targeted strategies in order to decrease mortality rates among individuals aged 60 and above. In order to increase life expectancy, priority areas in health care planning should be diseases of the circulatory system, which determine about half of the reduction in mortality in older age. Enhancing the quality of statistics on causes of death within this age demographic is crucial, as the common use of vague causes of death prevents a detailed examination of mortality in old age and complicates the creation of targeted approaches to reduce it.

1. Единый план по достижению национальных целей развития Российской Федерации на период до 2024 года и на плановый период до 2030 года/

2. HMD. Human Mortality Database. Max Planck Institute for Demo-graphic Research (Germany), University of California, Berkeley (USA), and French Institute for Demographic Studies (France). Available at www.mortality.org

3. WHO Mortality Database. Available at https://www.who.int/data/data-collection-tools/who-mortality-database/

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5. Данилова И.А. Проблемы качества российской статистики причин смерти в старческом возрасте // Успехи геронтологии, 2015 г., Т. 28, №3. С. 409–414

6. Пьянкова А.И., Фаттахов Т.А. Резервы роста ожидаемой продолжи-тельности жизни в северных регионах России. Профилактическая медицина. 2020;23(2):89-96.

7. Расчеты по данным World Health Organization Mortality Database, базе данных "Здоровье для всех" (HFA-DB).