Objective:
Much has been published about tobacco smoking consumption in Russia, though tobacco-related mortality remains unexplored. This study aims to describe national and regional sex patterns of lung cancer (LC) mortality (as a marker for tobacco-related mortality) in Russia in 2000-2015.

Methods:
Age-adjusted LC mortality (AALCM) 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 AALCM on the national and federal district levels were estimated; average AALCM rates were mapped. Two-way ANOVA was applied to assess time-district interaction effects on LC mortality.

Results:
At the national level, a monotonic decline in LC mortality during the 16-year period was noted among men (annual % change=1.9%), while among women, national LC mortality rates remained unchanged for most years. Sex differences in AALCM rates across federal districts and regions were noted. Among men, AALCM rates were consistently higher in northern, central and Far Eastern regions of Russia, while among women, AALCM rates increased moving from west to east over Russia. A strong time-district interaction for age-adjusted LC mortality male-to-female ratio (F=3.267,p<0.001) was found.

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

Funding:
Invariable LC mortality among Russian women follows the observation of increasing tobacco smoking consumption in the past and predicts growing challenges to the national healthcare system in coming decades.