, Volume 48, Issue 3, pp 1081–1104 | Cite as

Understanding the “Russian Mortality Paradox” in Central Asia: Evidence from Kyrgyzstan

  • Michel GuillotEmail author
  • Natalia Gavrilova
  • Tetyana Pudrovska


In the former Soviet republics of central Asia, ethnic Russians have exhibited higher adult mortality than native ethnic groups (e.g., Kazakh, Kyrgyz, Uzbek) in spite of the higher socioeconomic status of ethnic Russians. The mortality disadvantage of ethnic Russians at adult ages appears to have even increased since the breakup of the Soviet Union. The most common explanation for this “Russian mortality paradox,” is that deaths are better reported among ethnic Russians. In this study, we use detailed mortality data from Kyrgyzstan between 1959 and 1999 to evaluate various explanations for the Russian mortality paradox: data artifacts, migration effects, and cultural effects. We find that the most plausible explanation is the cultural hypothesis because the personal behaviors that appear to generate a large part of the observed mortality differences (alcohol consumption, in particular) seem to be closely tied to cultural practices. We examine the implications of this finding for understanding the health crisis in post-Soviet states.


Adult mortality Central Asia Kyrgyzstan Alcohol Former Soviet Union 



This research was supported by grants from the National Institute of Child Health and Human Development (R03-HD38752 and R01-HD045531). The authors thank Zarylbek Kudabaev, former chairman of the National Statistical Committee of the Kyrgyz Republic, and Orozmat Abdykalykov, its current chairman, for giving us access to much of the data used in this article; and Liudmila Torgashova, Larissa Mimbaeva, and Elena Komandirova for supervising the data collection in Kyrgyzstan. Anonymous reviewers provided helpful comments on earlier versions of this article.


  1. Abraido-Lanza, A. F., Dohrenwend, B. P., Ng-Mak, D. S., & Turner, J. B. (1999). The Latino mortality paradox: A test of the “salmon bias” and healthy migrant hypotheses. American Journal of Public Health, 89, 1543–1548.CrossRefGoogle Scholar
  2. Ackland, R., & Falkingham J. (1997). A profile of poverty in Kygyzstan. In J. Falkingham, J. Klugman, S. Marnie and J. Micklewright (Eds.), Household welfare in central Asia (pp. 81–99). Houndmills, Basingstoke [England]: Macmillan Press; New York: St. Martin’s Press.Google Scholar
  3. Anderson, B. A., & Silver, B. D. (1986). Sex differentials in mortality in the Soviet Union: Regional differences in length of working life in comparative perspective. Population Studies, 40, 191–214.CrossRefGoogle Scholar
  4. Anderson, B. A., & Silver, B. D. (1990). Trends in mortality of the Soviet population. Soviet Economy, 6, 191–251.Google Scholar
  5. Anderson, B. A., & Silver, B. D. (1994). Mortality trends in the working ages: Soviet regions in comparative perspective. In W. Lutz, S. Scherbov, & A. Volkov (Eds.), Demographic trends and patterns in the Soviet Union before 1991 (pp. 295–338). London, UK: Routledge.Google Scholar
  6. Anderson, B. A., & Silver, B. D. (1997). Issues of data quality in assessing mortality trends and levels in the new independent states. In J. L. Bobadilla, C. A. Costello, & F. Mitchell (Eds.), Premature death in the new independent state (pp. 120–155). Washington, DC: National Academy Press.Google Scholar
  7. Andreev, E. M., Dobrovolskaya, V. M., & Shaburov, K. Y. (1992). Etnicheskaya differentsiatsiya smertnosti [Ethnic mortality differentials]. Sotsiologicheskie Issledovaniya, 1992(7), 43–49.Google Scholar
  8. Becker, C. M., Bibosunova, D. I., Holmes, G. E., & Ibragimova, M. M. (1998). Maternal care vs. economic wealth and the health of newborns: Bishkek, Kyrgyz Republic and Kansas City, USA. World Development, 11, 2057–2072.CrossRefGoogle Scholar
  9. Bobrik, A., Danishevski, K., Eroshina, K., & McKee, M. (2005). Prison health in Russia: The larger picture. Journal of Public Health Policy, 26, 30–59.CrossRefGoogle Scholar
  10. Brainerd, R. (1998). Market reform and mortality in transitions economics. World Development, 26, 2013–2027.CrossRefGoogle Scholar
  11. Brainerd, E., & Cutler, D. M. (2005). Autopsy on an empire: Understanding mortality in Russia and the former Soviet Union. The Journal of Economic Perspectives, 19, 107–130.CrossRefGoogle Scholar
  12. Coale, A. J., Anderson, B. A., & Härm, E. (1979). Human fertility in Russia since the nineteenth century. Princeton, NJ: Princeton University Press.Google Scholar
  13. Cockerham, W. C. (1999). Health and social change in Russia and Eastern Europe. London, UK: Routledge.Google Scholar
  14. Cockerham, W. C. (2000). Health lifestyles in Russia. Social Science & Medicine, 51, 1313–1324.CrossRefGoogle Scholar
  15. Cockerham, W. C., Hinote, B. P., & Abbott, P. (2006). Psychological distress, gender, and health lifestyles in Belarus, Kazakhstan, Russia, and Ukraine. Social Science & Medicine, 63, 2381–2394.CrossRefGoogle Scholar
  16. Cockerham, W. C., Hinote, B. P., Abbott, P., & Haerpfer, C. (2004). Health lifestyles in central Asia: The case of Kazakhstan and Kyrgyzstan. Social Science & Medicine, 59, 1409–1421.CrossRefGoogle Scholar
  17. Coninx, R., Maher, D., Reyes, H., & Grzemska, M. (2000). Tuberculosis in prisons in countries with high prevalence. British Medical Journal, 320, 440–442.CrossRefGoogle Scholar
  18. Cornia, A. G., & Paniccia, R. (1995). The demographic impact of sudden impoverishment: Eastern Europe during the 1989–1994 transition (Innocenti Occasional Papers—Economic Policy Studies No. 49). Florence, Italy: UNICEF.Google Scholar
  19. Darsky, L., & Andreev, E. (1991). Vosproizvodstvo naseleniya otdel’nykh natsional’nostei v SSSR [Population growth among different nationalities in the USSR]. Vestnik Statistiki, 6, 3–10.Google Scholar
  20. Dobrovolskaya, V. M. (1990). Etnicheskaya differentsiatsiya smertnosti [Ethnic differentials in mortality]. In A. G. Volkov (Ed.), Demograficheskie protsessy v SSSR [Demographic processes in the USSR] (pp. 150–166). Moscow, Russia: Nauka.Google Scholar
  21. Franzini, L., Ribble, J. C., & Keddie, A. M. (2001). Understanding the Hispanic paradox. Ethnicity and Disease, 11, 496–518.Google Scholar
  22. Gavrilova, N. S., Gavrilov, L. A., Semyonova, V. G., Evdokushkina, G. N., & Ivanova, A. E. (2005). Patterns of violent crime in Russia. In W. A. Pridemore (Ed.), Ruling Russia: Law, crime, and justice in a changing society (pp. 117–145). Boulder, CO: Rowman & Littlefield Publishers, Inc.Google Scholar
  23. Gorenburg, D. (2006). Rethinking interethnic marriage in the Soviet Union. Post-Soviet Affairs, 22, 145–165.CrossRefGoogle Scholar
  24. Guillot, M. (2004). Kachestvo Demograficheskikh Dannykh v Kyrgyzstane c 1958 g [The quality of demographic data in Kyrgyzstan since 1958]. In Z. I. Kudabaev, M. Guillot, & M. Denisenko (Eds.), Naselenie Kyrgyzstana [The population of Kyrgyzstan] (pp. 53–76). Bishkek, Kyrgyz Republic: Natsional’ny Statistichesky Komitet Kyrgyzkoy Respubliki.Google Scholar
  25. Guillot, M. (2007). Mortality in Kyrgyzstan since 1959: Real patterns and data artifacts. Espace-Populations-Sociétés, 1, 113–126.Google Scholar
  26. Guillot, M. & Lim S. (2009, May). Infant mortality in Kyrgyzstan before and after the break-up of the Soviet Union. Paper presented at the annual meetings of the Population Association of America, Detroit, MI.Google Scholar
  27. Heath, D. B. (Ed.). (1995). International handbook on alcohol and culture. Westport, CT: Greenwood Press.Google Scholar
  28. Hummer, R. A., Powers, D. A., Pullum, S. G., Gossman, G. L., & Frisbie, W. P. (2007). Paradox found (again): Infant mortality among the Mexican-origin population in the United States. Demography, 44, 441–457.CrossRefGoogle Scholar
  29. Jones, E., & Grupp, F. W. (1983). Infant mortality trends in the Soviet Union. Population and Development Review, 9, 213–246.CrossRefGoogle Scholar
  30. Kahn, M. (1993). Les Russes Dans les ex-Républiques Soviétiques. Le Courrier des Pays de l’Est, 376, 3–20.Google Scholar
  31. Leon, D. A., Chenet, L., Shkolnikov, V. M., Zakharov, S., Shapiro, J., Rakhmanova, G.,…McKee, M. (1997). Huge variation in Russian mortality rates 1984–94: Artefact, alcohol, or what? Lancet, 350, 383–388.Google Scholar
  32. Leon, D. A., Saburova, L., Tomkins, S., Andreev, E., Kiryanov, N., McKee, M., & Shkolnikov, V. M. (2007). Hazardous alcohol drinking and premature mortality in Russia: A population based case-control study. Lancet, 369, 2001–2009.Google Scholar
  33. Leon, D. A., & Shkolnikov, V. M. (1998). Social stress and the Russian mortality crisis. Journal of the American Medical Association, 11, 790–791.CrossRefGoogle Scholar
  34. Leon, D. A., Shkolnikov, V. M., & McKee, M. (2009). Alcohol and Russian mortality: A continuing crisis. Addiction, 104, 1630–1636.CrossRefGoogle Scholar
  35. Lönnroth, K., Williams, B. G., Stadlin, S., Jaramillo, E., & Dye, C. (2008). Alcohol use as a risk factor for tuberculosis—A systematic review. BMC Public Health, 8, 289.CrossRefGoogle Scholar
  36. Markides, K. S., & Eschbach, K. (2005). Aging, migration and mortality: Current status of research on the Hispanic paradox. Journals of Gerontology: Series B, 60B(Special Issue II), 68–75.CrossRefGoogle Scholar
  37. McKee, M., Shkolnikov, V. M., & Leon, D. A. (2001). Alcohol is implicated in the fluctuations in cardiovascular disease in Russia since the 1980s. Annals of Epidemiology, 11, 1–6.CrossRefGoogle Scholar
  38. Mendes de Leon, C. F., & Glass, T. A. (2004). The role of social and personal resources in ethnic disparities in late life health. In N. B. Anderson, R. A. Bulatao, & B. Cohen (Eds.), Critical perspectives on racial and ethnic differences in health in late life (pp. 353–405). Washington, DC: National Academies Press.Google Scholar
  39. Olcott, M. B. (1995). Islam and fundamentalism in independent central Asia. In Y. Ro’i (Ed.), Muslim Eurasia: Conflicting legacies (pp. 21–40). Portland, OR: F. Cass.Google Scholar
  40. Palloni, A., & Arias, E. (2004). Paradox lost: Explaining the Hispanic adult mortality advantage. Demography, 41, 385–416.CrossRefGoogle Scholar
  41. Palloni, A., & Morenoff, J. (2001). Interpreting the paradoxical in the “Hispanic Paradox”: Demographic and epidemiological approaches. In M. Weinstein, A. Hermalin, & M. Stoto (Eds.), Population health and aging (pp. 140–174). New York: New York Academy of Sciences.Google Scholar
  42. Poujol, C. (1995). Minorites exogènes ou Russes de l’intérieur en Asie Centrale [Exogenous minorities or indigenous Russians in Central Asia]. Revue d’Etudes Comparatives Est-Ouest, 26(4), 125–142.CrossRefGoogle Scholar
  43. Pridemore, W. A. (2002). Vodka and violence: Alcohol consumption and homicide rates in Russia. American Journal of Public Health, 92, 1921–1930.CrossRefGoogle Scholar
  44. Pridemore, W. A. (2004). Weekend effects on binge drinking and homicide: The social connection between alcohol and violence in Russia. Addiction, 99, 1034–1041.CrossRefGoogle Scholar
  45. Ramstedt, M. (2009). Fluctuations in male ischaemic heart disease mortality in Russia 1959–1998: Assessing the importance of alcohol. Drug and Alcohol Review, 28, 390–395.CrossRefGoogle Scholar
  46. Rose, R. (2002). How Muslims view democracy: Evidence from central Asia. Journal of Democracy, 13(4), 102–111.CrossRefGoogle Scholar
  47. Roy, O. (1997). La nouvelle Asie centrale ou la fabrication des nations [The new central Asia or the making of nations]. Paris, France: Editions du Seuil.Google Scholar
  48. Shapiro, J. (1995). The Russian mortality crisis and its causes. In A. Aslund (Ed.), Russian economic reforms at risk (pp. 149–178). London, UK: Pinter.Google Scholar
  49. Shkolnikov, V. M., Cornia, G. A., Leon, D. A., & Meslé, F. (1998). Causes of the Russian mortality crisis. World Development, 26, 1995–2011.CrossRefGoogle Scholar
  50. Shkolnikov, V. M., McKee, M., & Leon, D. A. (2001). Changes in life expectancy in Russia in the mid-1990s. Lancet, 357, 917–921.CrossRefGoogle Scholar
  51. Sinelnikov, A. B. (1988). Dinamika urovnia smernosti v SSSR [The dynamics of the level of mortality in the USSR]. In L. L. Rybakovskii (Ed.), Naselenie SSSR za 70 let [The population of the USSR in the last 70 years] (pp. 115–133). Moscow, Russia: Nauka.Google Scholar
  52. Smith-Warner, S. A., Spiegelman, D., Yaun, S. S., van den Brandt, P. A., Folsom, A. R., Goldbohm, R. A.… Hunter, D. J. (1998). Alcohol and breast cancer in women: A pooled analysis of cohort studies. Journal of the American Medical Association, 279, 535–540.Google Scholar
  53. Stern, V. (Ed.). (1999). Sentenced to die? The problem of TB in prisons in eastern Europe and central Asia. London, UK: Kings College.Google Scholar
  54. Stuckler, D., King, L., & McKee, M. (2009). Mass privatization and the post-communist mortality crisis: A cross-national analysis. Lancet, 373, 399–407.CrossRefGoogle Scholar
  55. Vallin, J., & Meslé, F. (2001). Trends in mortality in Europe since 1950: Age-, sex-, and cause-specific mortality. Trends in mortality and differential mortality (pp. 31–186). Strasbourg, France: Council of Europe Publishing.Google Scholar
  56. World Bank. (1999). Kyrgyz republic: Update on poverty in the Kyrgyz Republic (Report No. 19425-KG). Washington, DC: World Bank.Google Scholar
  57. World Bank. (2007). Kyrgyz Republic poverty assessment (Report No. 40864-KG). Washington, DC: World Bank.Google Scholar
  58. World Bank. (2009). World development indicators 2008. Washington, DC: World Bank.Google Scholar
  59. Zaridze, D., Brennan, P., Boreham, J., Boroda, A., Karpov, R., Lazarev, A.,…Peto, R. (2009a). Alcohol and cause-specific mortality in Russia: A retrospective case-control study of 48,557 adult deaths. Lancet, 373, 2201–2214.Google Scholar
  60. Zaridze, D., Maximovitch, D., Lazarev, A., Igitov, V., Boroda, A., Boreham, J.,…Boffetta, P. (2009b). Alcohol poisoning is a main determinant of recent mortality trends in Russia: Evidence from a detailed analysis of mortality statistics and autopsies. International Journal of Epidemiology, 38, 143–153.Google Scholar

Copyright information

© Population Association of America 2011

Authors and Affiliations

  • Michel Guillot
    • 1
    Email author
  • Natalia Gavrilova
    • 2
  • Tetyana Pudrovska
    • 3
  1. 1.Population Studies CenterUniversity of PennsylvaniaPhiladelphiaUSA
  2. 2.Center on AgingNORC/University of ChicagoChicagoUSA
  3. 3.Population Research CenterUniversity of TexasAustinUSA

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