Health care and life expectancy: A letter from Russia

摘要

As discussed by Zatoriski and Bhala, the trends for life expectancy at birth have improved in many areas around the world. However, those in Russia and some other former Soviet Union countries 'have not shown signs of growth since the middle of the 20th century.' 'In 2008, the difference in life expectancy between men in some West-European countries and Russia was 20 years.' Estimates from 2008 on the probability of death before 65 years of age for men are approximately 16% in Western Europe, compared with 31% in Eastern Europe and 54% in Russia. As a pathologist, I can comment on the relatively high mortality rates from cardiovascular disease in Russia compared with West Europe, illustrated by Zatoriski and Bhala's graphs. Since the Soviet time, autopsy has remained obligatory for all patients dying in hospitals; however, the attitude towards post-mortem examinations has become less serious. Autopsies have often been performed incompletely and without much insight. If a cause of death is not entirely clear, it is common practice to write on the death certificate: 'ischaemic heart disease with cardiac insufficiency' or a similar formulation.