Estimates of 1932-34 famine direct losses (excess deaths) by age and sex and indirect losses (lost births) are calculated, for the first time, for rural and urban areas of Ukraine. Total losses are estimated at 4.5 million, with 3.9 million excess deaths and 0.6 million lost births. Rural and urban excess deaths are equivalent to 16.5 and 4.0 per cent of respective 1933 populations. We show that urban and rural losses are the result of very different dynamics, as reflected in the respective urban and rural age structures of relative excess deaths.

Yearly estimates of urban and rural direct losses (excess deaths) from the 1932-34 famine are presented for the oblasts of Soviet Ukraine. Contrary to expectations, the highest losses are not found in the grain-producing southern oblasts, but in the north-central Kyiv and Kharkiv oblasts. Several hypotheses are proposed and tested to explain this finding. No single hypothesis provides a comprehensive explanation. Losses in some oblasts are due to specific factors, while losses in other oblasts seem to be explained by a combination of economic and political factors. Quantitative analyses are presented of resistance and Soviet repressions in 1932, and effects of the food assistance program and historical-political factors on direct losses in 1933 are analyzed.Keywords: 1932-33 famine losses by oblast; Holodomor; regional Holodomor losses; Ukrainian famine; urban and rural Holodomor losses. RésuméDes estimations annuelles de pertes (décès excédentaires) directement attribuables à la famine de 1932-34 sont présentées pour les zones urbaines et rurales d'Ukraine sovietique. Contrairement aux attentes, les pertes les plus importantes n'étaient pas dans la région méridionale productrice de grain, mais plutôt dans la région du nord-centre, soit Kiev et Kharkiv. Plusieurs hypothèses sont proposées et mises à l'épreuve pour vérifier cette conclusion. Cependant, aucune hypothèse, à elle seule, ne fournit une explication complète. Dans certaines régions, les pertes sont causées par des facteurs précis, alors que dans d'autres, les pertes sont expliquées par une combinaison de facteurs économiques et politiques. Des analyses quantitatives sont présentées sur la résistance et les répressions sovietiques en 1932. L'effet du programme d'assistance alimentaire et les facteurs politico-historiques attribuables directement aux pertes en 1933 est également analysé.

Deaths due to infectious disease, especially TB, play an important role in the gap in life expectancy between regions in Ukraine. These deaths are entirely preventable--further research is needed to identify what has 'protected' individuals in Western Ukraine from the burden of deaths experienced by their Southern and Eastern counterparts.

Estimates of 1932-1934 famine direct losses (excess deaths) by age and sex and indirect losses (lost births) are calculated, for the first time, for rural and urban areas of Ukraine. Total losses are estimated at 4.5 million, with 3.9 million excess deaths and 0.6 million lost births. Rural and urban excess deaths are equivalent to 16.5 and 4.0 per cent of respective 1933 populations. About 90 % of all direct losses occurred in 1933, with most of them during the first half of that year. We show that urban and rural losses are the result of very different dynamics, as reflected in the respective urban and rural age structures of relative excess deaths, and in yearly losses per 1,000 population. Although 1933 relative direct losses in rural areas were more than five times the number of relative urban direct losses, in 1934 relative losses in both rural and urban areas were of the same magnitude. This means that, although direct losses in 1934 were significantly lower than in 1933, relative to population size urban losses were as high as rural losses.

Ukraine has experienced a long-term decline in life expectancy since the late 1960s. While spectacular improvement in longevity has been observed in Western countries, the trend in Ukraine has been accompanied by increasing or stagnating mortality. Although many studies indicate that alcohol is one of the leading contributors to low life expectancy in Eastern Europe, little is known about its impact on premature mortality in Ukraine. The aim of this study is to estimate alcoholattributable deaths at working ages (20-64) in Ukraine. We investigate the contribution of alcohol to adult mortality between 1980 and 2007 using a new method for estimating alcohol-attributable fractions by causes of death. We also assess the public health burden of alcohol in terms of length of life losses. We find that in 2007 alcohol-related deaths constituted 40% and 22% of all deaths among adult men and women, respectively. The results also indicate that alcohol-related deaths at working ages account for approximately one-third of the male and one-fifth of the female life expectancy difference between Ukraine and western countries. Alcohol is an important public health threat in Ukraine and should be addressed by relevant measures.