Mortality in Transition: Study Protocol of the PrivMort Project, a multilevel convenience cohort study

Abstract

BackgroundPrevious research using routine data identified rapid mass privatisation as an important driver of mortality crisis following the collapse of Communism in Central and Eastern Europe. However, existing studies on the mortality crisis relying on individual level or routine data cannot assess both distal (societal) and proximal (individual) causes of mortality simultaneously. The aim of the PrivMort Project is to overcome these limitations and to investigate the role of societal factors (particularly rapid mass privatisation) and individual-level factors (e.g. alcohol consumption) in the mortality changes in post-communist countries.MethodsThe PrivMort conducts large-sample surveys in Russia, Belarus and Hungary. The approach is unique in comparing towns that have undergone rapid privatisation of their key industrial enterprises with those that experienced more gradual forms of privatisation, employing a multi-level retrospective cohort design that combines data on the industrial characteristics of the towns, socio-economic descriptions of the communities, settlement-level data, individual socio-economic characteristics, and individuals’ health behaviour. It then incorporates data on mortality of different types of relatives of survey respondents, employing a retrospective demographic approach, which enables linkage of historical patterns of mortality to exposures, based on experiences of family members. By May 2016, 63,073 respondents provided information on themselves and 205,607 relatives, of whom 102,971 had died. The settlement-level dataset contains information on 539 settlements and 12,082 enterprises in these settlements in Russia, 96 settlements and 271 enterprises in Belarus, and 52 settlement and 148 enterprises in Hungary.DiscussionIn addition to reinforcing existing evidence linking smoking, hazardous drinking and unemployment to mortality, the PrivMort dataset will investigate the variation in transition experiences for individual respondents and their families across settlements characterized by differing contextual factors, including industrial characteristics, simultaneously providing information about how excess mortality is distributed across settlements with various privatization strategies.Electronic supplementary materialThe online version of this article (doi:10.1186/s12889-016-3249-9) contains supplementary material, which is available to authorized users.

Smoking, alcohol and cancer mortality in Eastern European men: Findings from the PrivMort retrospective cohort study

“…Survey participants were recruited from selected settings, mid‐size towns, because the primary purpose was to test hypotheses about the health effects of large‐scale changes related to the local economies. There was only a moderate response rate, and by design individuals who did not get married or had no children had lower probability to be included in the analytical sample, comprised of close relatives of survey respondents . Nevertheless, age‐standardized cancer death rates, as well as the prevalence of male smoking and alcohol consumption was similar to previous studies which estimated these values on more representative samples …”

“…General limitations of the PrivMort project related to study design and other aspects of the data collection procedures have been described earlier . However, there are several particular issues which need to be emphasized here too.…”

“…PrivMort study is a multi‐center retrospective cohort created to explore the impact of societal and individual‐level factors on mortality in Eastern Europe during a period of extensive socio‐political change. Sample selection and data collection procedures have been described in detail previously . In brief, individual‐level data were collected between January 2014 and December 2015 in Russia, Belarus and Hungary.…”

Alcohol, pattern of drinking and all‐cause mortality in Russia, Belarus and Hungary: a retrospective indirect cohort study based on mortality of relatives

“…We used data from the PrivMort retrospective convenience cohort study . As the primary aim of this study was to test the hypothesis that rapid privatization in the 1990s was associated with increased mortality, it was undertaken in a sample of settlements (towns and cities) selected based on whether the local economy was dominated by a single enterprise or multiple enterprises and whether post‐communist privatization was slow or fast.…”

Parental transmission of smoking among middle-aged and older populations in Russia and Belarus

“…Response rate was higher in Russia (48%) than in Belarus (39%). Full details concerning the selection of towns and other aspects of the PrivMort methodology are given elsewhere (Irdam et al 2016 ; Azarova et al 2017 ; Gugushvili et al 2018 ).…”