Jacques Vallin

Mortality and causes of death in 20th-century Ukraine

General introduction.- Part one: Long-term trends in life expectancy and the consequences of major historical disasters.- Chapter 1: The crisis of the 1930s: Jacques Vallin, France Mesle, Sergei Adamets and Serhii Pyroshkov.- Chapter 2: The consequences of the second world war and the Stalinist repression: Jacques Vallin, France Mesle, Sergei Adamets and Serhii Pyroshkov.- Part two: Eighty years of trends in sex-specific and age-specific mortality.- Chapter 3 : Is mortality under-estimated?: France Mesl e, Jacques Vallin and Vladimir Shkolnikov.- Chapter 4: Eight years of sex-specific and age-specific mortality trends: France Mesle, Jacqyes Vallin and Vladimir Shkolnikov.- Chapter 5: Ukrainians and Russians in Ukraine and in Russia: Vladimir Shkolnikov.- Chapter 6: Health crises and cohort mortality: Vladimir Shkolnikov.- Part Three: Cause-specific mortality trends from 1965.- Chapter 7: Data Collection, data quality and the history of cause-of-death classification: Vladimir Shkolnikov, France Mesle and Jacques Vallin.- Chapter 8: Reconstructing series of deaths by cause with constant definitions: France Mesle and Jacques Vallin.- Chapter 9: General trends in mortality by cause: France Mesle and Jacques Vallin.- Chapter 10: Impact of major groups of causes on life expectancy trends: France Mesle, Jacques Vallin and Serhii Pyroshkov.- Chapter 11: Mortality trends by age group and detailed causes of death: France Mesle and Jacques Vallin.- Conclusion.

A new estimate of Ukrainian population losses during the crises of the 1930s and 1940s.

Ukraine experienced two very acute demographic crises during the Soviet era: the 1933 famine and the Second World War. While different estimates of total losses have been produced previously, we have tried here to distinguish the specific impact of the crises on mortality from their impact on fertility and migration. Taking into account all existing sources of registered data and estimates, a painstaking reconstruction of annual demographic changes has been produced and complete annual life tables have been computed for the years 1926–59. Life expectancy at birth fell to a level as low as 10 years for females and 7 for males in 1933 and plateaued around 25 for females and 15 for males in the period 1941–44.

Reconstructing Series of Deaths by Cause with Constant Definitions

In all countries, the study of long-term cause-specific mortality trends is hampered by discontinuities that distort statistical series as a result of periodic revisions to the classification of causes of death. In very rare cases, when an office responsible for cause-of-death statistics has produced classifications for one or two transition years under two different revisions (as in England and Wales when the Eighth Revision of the International Classification of Diseases (ICD-8) was replaced by the Ninth Revision (ICD-9); see Mesle and Vallin 1993), observed transition coefficients can be used to reassign deaths classified under the old revision to the various items of the new revision. Unfortunately, in most cases, no such double classification is available, and a way has to be found to estimate the transition coefficients ex post.

Data Collection, Data Quality and the History of Cause-of-Death Classification

Until 1996, when INED published its work on trends in causes of death in Russia (Mesle et al. 1996), there had been no overall study of cause-specific mortality for the Soviet Union as a whole or for any of its constituent republics. Yet at least since the 1920s, all the republics had had a modern system for registering causes of death, and the information gathered had been subject to routine statistical use at least since the 1950s. The first reason for the gap in the literature was of course that, before perestroika, these data were not published systematically and, from 1974, had even been kept secret. A second reason was probably that researchers were often questioning the data quality; however, no serious study has ever proved this. On the contrary, it seems to us that all these data offer a very rich resource for anyone attempting to track and understand cause-specific mortality trends in the countries of the former USSR – in our case, in Ukraine. Even so, a great deal of effort was required to trace, collect and computerize the various archived data deposits.

Eighty Years of Sex-Specific and Age-Specific Mortality Trends

In Chaps. 2 and 3, we reconstructed annual sex-specific and age-specific mortality trends from the second quarter of the twentieth century, which had been seriously disrupted by the crises of the 1930s and 1940s; in Chap. 4, we were able to correct the standard estimates for the second half of the century, taking into account under-registration of deaths. From now on, therefore, we can work with a continuous series of life tables for each of the years 1927–2006 (see the complete time series in Annex II on the CD-ROM for the main functions of these life tables). Figure 5.1 provides an overview, tracing annual trends in life expectancy at birth for each sex over the course of the past 80 years.

Impact of Major Groups of Causes on Life Expectancy Trends

Here we shall start by assessing the impact of each major group of causes on the overall change in life expectancy observed between 1965 and 2006. However, this overview conceals trends that contrast somewhat over time because of fluctuations in life expectancy. Therefore we should go on to examine the sequential cumulation of annual gains and losses that lead to this overall result. Finally, mortality trends do not carry the same weight in life expectancy in all age groups, though in different ways for different causes. The chapter will conclude with a general survey of this issue.

Mortality Trends by Age Group and Detailed Causes of Death

Reconstructing cause-of-death series at the most detailed level of the Soviet Classification will enable us to make a more in-depth analysis of the diseases involved in trends across the major groups of causes that we have been studying.

The Consequences of the Second World War and the Stalinist Repression

In 20 years, from one census to the next, the population of Ukraine went from 30.9 million inhabitants in 1939 (RAN 1992) to 41.9 million in 1959 (TsSU 1962). However, this steep population growth is merely apparent, since it resulted essentially from major changes to the borders of the Republic of Ukraine.

The Crisis of the 1930s

From 1935, in a way that now seems almost surreal, Ukraine’s UNKhU (Directorate for National Economy and Account) challenged the figures on births and deaths registered between 1930 and 1935. In a note addressed to the leadership of the Republic’s Communist Party, presenting them with some figures on annual change in the Ukrainian population between 1926 and 1934 (Table 2.1), Aleksandr Asatkin, Director of the UNKhU of Ukraine, expressed his amazement at the peak in mortality observed in 1933, and attempted to explain it through errors in the registration system (ZAGS), without, of course, ever mentioning the famine that had reached its highest level in that year. However, checks made in 1934-1935 on the way ZAGS functioned showed that deaths in the regions most affected by the disaster had in fact been under-registered. Moreover, ZAGS’ final results for 1933 were much higher than this 1935 document showed (see N.B. in Table 2.1; Annex I, Tables 1 and 2 on the CD-ROM). In reality, the presence of famine was clear, but everything was done to conceal it. Monitors from the TsUNKhU (Central Directorate for National Economy and Account), covering the whole USSR, systematically reclassified deaths initially classified as “from starvation” under either “cause of death unknown” or “from exhaustion”.

Is Mortality Under-Estimated?

Before assessing changes in age- and sex-specific patterns of mortality in Ukraine, we have to decide what line to take towards shortcomings, often mentioned in the literature, in recording deaths. In order to judge the quality of registration of deaths, reference is generally made to age-specific model life tables. Just as for Russia (Shkolnikov et al. 1995a), the specific nature of mortality in Ukraine in the adult age groups makes the use of these models tricky, if not futile. However, we must take into consideration the criticisms often made of the quality of mortality data for the very young as well as for the old.