Background:
Tobacco smoking has been historically high in Russian men, and steadily increased in Russian women following the Soviet Union's collapse. Much has been published about alcohol consumption and alcohol-related mortality in Russia, however, few studies have assessed regional tobacco-related mortality. This study describes regional and gender patterns of lung cancer mortality, as a marker for tobacco-related mortality, in Russia during the period 2000-2015.

Methods:
Age-adjusted lung cancer mortality rates by gender and for eight federal districts and 83 regions were calculated based on mortality and population data extracted from the Russian Fertility and Mortality Database. Annual percentage changes in age-adjusted lung cancer mortality on the national and federal district levels were estimated, and average age-adjusted lung cancer mortality rates were mapped. Two-way ANOVA was applied to assess time-district interaction effects on lung cancer mortality.

Results:
Age-adjusted lung cancer mortality rates were consistently higher in eastern and central regions of Russia. At the national level, a monotonic decline in lung cancer mortality during the 16-year period was noted among men (annual % change = 1.9%), while among women, national lung cancer mortality rates remained unchanged for most years. Differences in age-adjusted lung cancer mortality across federal districts and regions over time, as well as between the sexes, were noted. A strong time-district interaction for age-adjusted lung cancer mortality (F=1.810, p< 0.028), and age-adjusted lung cancer mortality male-to-female ratio (F=3.267, p< 0.001) were found.

Conclusions:
Given the significant increase in tobacco smoking prevalence among Russian women that began the 1990s, female lung cancer mortality will continue to rise in the coming decades, with a disproportionate burden on those regions with insufficient health services and located far from the federal centers. Additional work is needed to identify factors underlying the regional and sex differences.