Analyzing the Health Impact of Economic Change: Insights From a Multi-Level Retrospective Cohort Study


An unprecedented mortality crisis befell the former socialist countries between 1989 and 1995, representing one of the most significant demographic shocks of the post-Second World War period. Academic research has identified economic transitions as a crucial factor behind the post-socialist mortality crisis. However, most previous studies relied on either country-level or individual-level data, which leaves the potential for modeling error, as they cannot assess both distal (economic) and proximal (individual) causes of mortality simultaneously. We aimed to overcome these limitations and investigate the role of economic transitions (rapid mass privatization, deindustrialization, and foreign investment liberalization) and individual-level factors (e.g., alcohol consumption) in the mortality crises in post-socialist countries. We identified towns with different privatization strategies and collected administrative data on 539 towns in Russia, 96 towns in Belarus, and 52 towns in Hungary. In these towns, we identified the largest companies and collected data on their ownership structure. We also conducted large-scale surveys using a retrospective cohort study approach. Respondents provided information on themselves and their relatives, including socio-economic characteristics, health behavior, as well as the vital status of their relatives. In total, we collected data on 268,600 subjects in the three countries. Using this information, we created a complex multi-level database linking towns’ industrial characteristics and individual health outcomes covering three decades from 1980 to 2010. We investigated how excess mortality of individuals is distributed across settlements with different privatization strategies. The results confirmed that economic change and alcohol were crucial determinants of mortality during the post-socialist transition.

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