Where Do People Live Longer in Russia in the 21st Century? Life Expectancy across Urban and Rural areas

The twenty-first century marked the beginning of rapid health improvements in Russia. In the late 2000s and the 2010s, there was already a moderate decrease in inter-oblast mortality disparities, with the exception of the growing life expectancy (LE) advantage of Moscow and Saint Petersburg. We have used newly available data to explore LE changes from 2003-2005 to 2015-2017 and determinants of LE differences across settlements of different types and population sizes. We distinguished between three major segments of the LE distribution: Moscow and Saint Petersburg at the top, large- and medium-sized cities in the middle, and smaller urban and rural areas lagging behind. The LE differences among these three groups increased, but the within-group differences decreased. The gaps between bigger cities and the "periphery" within oblasts grew, and this part of the total dispersion had increased substantially by 2015-2017. Education, together with population size, explained 62 percent (for females) and 67 percent (for males) of LE variation across 292 geographic units in 2015-2017. Our results suggest that slower health progress in small urban and rural areas is an important obstacle to further mortality reduction at the national level and is a matter of public health concern.