The transformation of causative structure of epidemiology of mortality in conditions of social economical crises

The article presents analysis of dynamics and structural changes of mortality by main classes of causes in the Russian Federation, the Volga Federal Okrug and the Samara Oblast in 1990–2023. The study covers three key stages: the transitional socioeconomic crisis of the 1990s, the period of relative stabilization and mortality decreasing in 2000–2019 and the pandemic period of 2020–2022. The particular attention is given to identification of regional characteristics, inter-territorial differences and specificity of transformation of causal structure of mortality in conditions of systemic crises. It is demonstrated that the Samara Oblast exhibits unique mortality profile: significant decreasing of mortality due to external causes and diseases of respiratory organs is combined with increasing of mortality because of neoplasms and increased vulnerability to infectious threats during pandemic period. These obtained data substantiate necessity of transition to territorially differentiated model of health care management oriented to local epidemiological characteristics and priority challenges.