Darja Irdam’s research while affiliated with University of Cambridge and other places

Hazardous drinking, defined as the consumption of homemade, unofficially made alcohol and non-beverages, is prevalent and accounts for a high proportion of alcohol-related deaths in Russia. Individual-level characteristics are important explanations of hazardous drinking, but they are unlikely to explain spatial variation in this type of alcohol consumption. Areas that attracted insufficient attention in the research of hazardous drinking are the legacy of industrialization and the speed of economic reforms, mainly through the privatization policy of major enterprises in the 1990s. Applying mixed-effects logistic regressions to a unique dataset from 30 industrial towns in the European part of Russia, we find that in addition to individual-level characteristics such as gender, age, marital status, education, social isolation, labor market status, and material deprivation, the types of towns where informants’ relatives resided such as industrial structure and speed of privatization also accounted for the variance in hazardous alcohol consumption among both male and female populations of the analyzed towns.

An unprecedented mortality crisis struck Eastern Europe during the 1990s, causing around seven million excess deaths. We enter the debate about the causes of this crisis by performing the first quantitative analysis of the association between de-industrialisation and mortality in Eastern Europe. We develop a theoretical framework identifying deindustrialisation as a process of social disintegration rooted in the lived experience of shock therapy. We test this theory relying on a novel multi-level dataset, fitting survival and panel models covering 52 towns and 42,800 people in 1989-95 in Hungary and 514 towns in European Russia in 1991-99. The results show that deindustrialisation was directly associated with male mortality and indirectly mediated by hazardous drinking as a stress-coping strategy. The association is not a spurious result of a legacy of dysfunctional working-class health culture aggravated by low alcohol prices during the early years of the transition. Both countries experienced deindustrialisation, but social and economic policies have offset Hungary's more immense industrial employment loss. The results are relevant to health crises in other regions, including the deaths of despair plaguing the American Rust Belt. Policies addressing the underlying causes of stress and despair are vital to save lives during painful economic transformations.

An unprecedented mortality crisis struck Eastern Europe during the transition from socialism to capitalism. Working-class men without a college degree suffered the most. Some argue that economic dislocation caused stress and despair, leading to adverse health behavior and ill health (dislocation-despair approach). Others suggest that hazardous drinking inherited as part of a dysfunctional working-class culture and populist alcohol policy were the key determinants (supply-culture approach). We enter this debate by performing the first quantitative analysis of the association between economic dislocation in the form of industrial employment decline and mortality in postsocialist Eastern Europe. We rely on a novel multilevel dataset, fitting survival and panel models covering 52 towns and 42,800 people in 1989-1995 in Hungary and 514 medium-sized towns in the European part of Russia. The results show that deindustrialization was significantly associated with male mortality in both countries directly and indirectly mediated by adverse health behavior as a dysfunctional coping strategy. Both countries experienced severe deindustrialization, but social and economic policies seem to have offset Hungary’s more immense industrial employment loss. The policy implication is that social and economic policies addressing the underlying causes of stress and despair can improve health.

The ten countries with the fastest shrinking population are all located in Eastern Europe, with low fertility as one of the leading causes. In this article, we analyze the privatization of companies as a potential but so far neglected factor behind the postsocialist fertility decline. We argue that privatization is linked to lower fertility by catalyzing uncertainty, shifting the cost of care work onto families, and reducing the resources available to support social reproduction. We test this hypothesis using a novel database comprising information on the demographic and enterprise trajectories of 52 Hungarian towns between 1989-2006 and a cross-country dataset of 28 countries in Eastern Europe. We fit fixed and random-effects models adjusting for potential confounding factors and control for time-variant factors and common trends. We find that company privatization is significantly associated with the postsocialist fertility decline. The observed level of privatization among Hungarian towns corresponds to 0.37 fewer childbirths per woman on average, i.e., approximately 54.3% of the overall fertility decline. Cross-country fixed effects models covering 28 former socialist-bloc countries for the 1989-2012 period confirm the town-level findings. The observed level of privatization among postsocialist countries might explain approximately 49.75% of the overall fertility decline.

Research on intergenerational social mobility and health-related behaviours yields mixed findings. Depending on the direction of mobility and the type of mechanisms involved, we can expect positive or negative association between intergenerational mobility and health-related behaviours. Using data from a retrospective cohort study, conducted in more than 100 towns across Belarus, Hungary and Russia, we fit multilevel mixed-effects Poisson regressions with two measures of health-related behaviours: binge drinking and smoking. The main explanatory variable, intergenerational educational mobility is operationalised in terms of relative intergenerational educational trajectories based on the prevalence of specified qualifications in parental and offspring generations. In each country the associations between intergenerational educational mobility, binge drinking and smoking was examined with incidence rate ratios and predicted probabilities, using multiply imputed dataset for missing data and controlling for important confounders of health-related behaviours. We find that intergenerational mobility in relative educational attainment has varying association with binge drinking and smoking and the strength and direction of these effects depend on the country of analysis, the mode of mobility, the gender of respondents and the type of health-related behaviour. Along with accumulation and Falling from Grace hypotheses of the consequences of intergenerational mobility, our findings suggest that upward educational mobility in certain instances might be linked to improved health-related behaviours.

An unprecedented mortality crisis befell the former socialist countries between 1989 and 1995, representing one of the greatest demographic shocks of the period after the Second World War. While it is likely that country‐level variation in the post‐socialist mortality crisis in Eastern Europe can be explained by a constellation of political and socio‐economic factors, no comprehensive review of the existing scholarly attempts at explaining these factors exists. We review 39 cross‐national multi‐variable peer reviewed studies of social determinants of mortality in post‐socialist Europe in order to assess the social factors behind the post‐socialist mortality crisis, determine the gaps in the existing literature and to make suggestions for future research. We propose a novel methodology to determine the relative importance of variables based on the ratio of significant to insignificant findings for each variable. The literature identifies inequality, welfare payments, religious composition, democracy, economic performance and unemployment as the leading factors that have a significant influence on mortality outcomes. Existing cross‐country studies fail to establish a definitive connection between mortality and diets, drinking patterns, liberalisation, trust, health expenditure and war. We also point out that the level of analysis is not a neutral methodological choice but might influence the results themselves.

Background: A large proportion of premature deaths in Russia since the early 1990s, following the transition from communism, have been attributed to hazardous drinking. Little is known about the correlates of alcohol consumption. We present new data on the consumption of alcoholic beverages among middle-aged and older Russians and identify socio-demographic, socio-economic, and life-course correlates of frequent drinking. Methods: Within the framework of the PrivMort project, conducted in 30 industrial towns in the European part of Russia, we acquired information on the frequency of drinking among 22,796 respondents and 57,907 of their surviving and deceased relatives. We fit three-level mixed-effects logistic regression models of frequent drinking in which respondents' relatives, aged 40 and over, are nested in their families and towns. Results: Deceased male relatives consumed alcohol significantly more often, while deceased female relatives consumed alcohol significantly less often than the respondents of corresponding gender. In a multivariable analysis, we found that individuals' education, communication with family members, labour market status, history of unemployment, and occupational attainment are all significant correlates of frequent drinking in Russia. These associations are stronger among men rather than among women. Conclusion: There are significant differences between frequency of drinking among surviving and deceased individuals and frequent drinking is associated with a wide array of individual socio-demographic, socio-economic, and life course factors that can partially explain high alcohol consumption in post-communist Russia.

Eastern European men have among the highest cancer mortality rates globally. Prevalence of smoking and alcohol intake in this region is also high. The aim of this study was to calculate population attributable risk fraction (PARF) of cancer deaths from smoking and alcohol in Russia, Belarus and Hungary, and to examine the contribution of these lifestyle factors to differences in male cancer mortality in the three countries. Data was collected as part of the PrivMort retrospective cohort study. Randomly selected participants living in mid‐size towns in Russia, Belarus and Hungary provided information on smoking habits, alcohol consumption, vital status and cause of death (if applicable) of male relatives (fathers, siblings and partners). PARF of cancer deaths (age 35 to 79) due to smoking, alcohol consumption and both combined was estimated between 2001 and 2013. Among 72,190 men, 4,702 died of cancer. Age standardized cancer mortality rates were similar to official data in all three countries. The estimated PARF (95% CI) associated with measures of smoking, alcohol consumption, both combined, and overall smoking or drinking were 25% (19‐30), 2% (0‐4), 29% (19‐39) 43% (32‐53) in Russia, 18% (8‐28), 2% (‐1‐6), 28% (20‐35), 38% (25‐50) in Belarus, and 17% (13‐20), 1% (0‐3), 25% (20‐30) 35% (28‐42) in Hungary, respectively. These results suggest that in Eastern Europe, at least one third of cancer deaths in males may have been attributable to smoking and/or alcohol consumption in recent years. Health policies targeting these lifestyle factors can have a major impact on population health. This article is protected by copyright. All rights reserved.