Familial Clustering of Adult Mortality Risk in Russia: The Role of Education, Smoking and Alcohol

Michael Murphy, London School of Economics and Political Science (LSE)
Martin Bobak, University College London
Amanda Nicholson, University College London
Richard Rose, University of Aberdeen
Michael Marmot, University College London

Mortality increased substantially since 1991 among Russian working age men. We investigate adult mortality clustering (or ’frailty’) within sibships, and how far high-risk behaviours, such as heavy alcohol and tobacco consumption, explains such mortality clustering. We use information about the vital status, childhood conditions and socio-economic characteristics of the sibs of survey informants, from a 2002 nationally representative survey in the Russian Federation, with a Cox proportional hazard gamma-frailty model. The overall clustering effects were much larger for men than for women but this excess is largely explained by measured socio-economic and behavioural risk factors; once these are accounted for, the magnitude of remaining clustering was similar among male and female sibs. Smoking, drinking and education made a substantial contribution to clustering of mortality in male sibs but unmeasured background familial factors remain important and are of a similar magnitude for men and women.