Elsevier

The Lancet

Volume 369, Issue 9578, 16–22 June 2007, Pages 2001-2009
The Lancet

Articles
Hazardous alcohol drinking and premature mortality in Russia: a population based case-control study

https://doi.org/10.1016/S0140-6736(07)60941-6Get rights and content

Summary

Background

The reason for the low life expectancy in Russian men and large fluctuations in mortality are unknown. We investigated the contribution of alcohol, and hazardous drinking in particular, to male mortality in a typical Russian city.

Methods

Cases were all deaths in men aged 25–54 years living in Izhevsk occurring between Oct 20, 2003, to Oct 3, 2005. Controls were selected at random from the city population and were frequency matched to deaths by age. Interviews with proxy informants living in the same household as cases were done between Dec 11, 2003, and Nov, 16 2005, and were obtained for 62% (1750/2835) of cases and 57% (1750/3078) of controls. We ascertained frequency and usual amount of beer, wine, and spirits consumed and frequency of consumption of manufactured ethanol-based liquids not intended to be drunk (non-beverage alcohol), and markers of problem drinking. Complete information on markers of problem drinking, frequency of alcohol consumption, education, and smoking was available for 1468 cases and 1496 controls.

Findings

751 (51%) cases were classed as problem drinkers or drank non-beverage alcohol, compared with 192 (13%) controls. The mortality odds ratio (OR) for these men, compared with those who either abstained or were non-problematic beverage drinkers, was 6·0 (95% CI 5·0–7·3) after adjustment for smoking and education. The mortality ORs for drinking non-beverage alcohol in the past year (yes vs no) was 9·2 (7·2–11·7) after adjustment for age. Adjustment for volume of ethanol consumed from beverages lowered the OR to 8·3 (6·5–10·7), and further adjustment for education and smoking reduced it to 7·0 (5·5–9·0). A strong direct gradient with mortality was seen for frequency of non-beverage alcohol drinking independent of volume of beverage ethanol consumed. 43% of mortality was attributable to hazardous drinking (problem drinking or non-beverage alcohol consumption, or both) adjusted for smoking and education.

Interpretation

Almost half of all deaths in working age men in a typical Russian city may be accounted for by hazardous drinking. Our analyses provide indirect support for the contention that the sharp fluctuations seen in Russian mortality in the early 1990s could be related to hazardous drinking as indicated by consumption of non-beverage alcohol.

Introduction

Russia has exceptionally low life expectancy for an industrialised country. In 2004, life expectancy was 59 years for males and 72 years for females, mainly because of very high mortality at working ages.1 Russian men have a probability of dying between 25 and 65 years of 0·55 compared with 0·15 for men in England and Wales.2 This low life expectancy, coupled with a low birthrate, means that the Russian population is falling by 700 000 people per year.

Mortality rates in Russia have greatly fluctuated over the past 20 years,2 as in other countries of the former Soviet Union.3 Although these fluctuations have been greatest for men, much the same trends are seen for women of working age.4, 5 Previous studies suggest that alcohol has had an important role.4, 6 President Gorbachev's anti-alcohol campaign in the mid 1980s was associated with an immediate rise in life expectancy,7 whereas increased alcohol consumption has been linked to rising mortality in the early 1990s during the transition from communism.8, 9 Deaths obviously related to alcohol, such as acute alcohol poisoning and liver cirrhosis, showed the greatest fluctuations, with similar trends for other causes plausibly linked to alcohol consumption.

A worldwide assessment of drinking patterns in 2000, showed that the European subregion containing Russia and other parts of the former Soviet Union had the most hazardous pattern of (binge) drinking and the highest consumption of alcohol per head (13·9 L of pure ethanol per year in people aged ≥15 years).10 2001–03 estimates from the same source show a figure of 15·2 L per head,11 which is consistent with indirect Russian estimates for the 1990s of 14–15 L per person every year.12 Although population surveys generally underestimate alcohol consumption,13 cross sectional studies in Russia in the 1990s show frequent consumption of large quantities of ethanol (mainly vodka) on single occasions.14, 15, 16, 17, 18 A study in Arkhangelsk, Russia, (1999–2000) classified 75% of male industrial workers as harmful or hazardous drinkers using AUDIT criteria.19

In 2002, in the European subregion containing Russia, 19% of male mortality was attributable to alcohol compared with 3% in western Europe,20 with almost identical attributable fractions estimated for Russia alone.11

Manufactured ethanol-based liquids not intended for consumption (from now on referred to as non-beverage alcohols), including eau de colognes, medicinal tinctures, and cleaning agents, are not classed as alcoholic drinks. They therefore avoid excise duty and are up to six times cheaper per unit of ethanol than vodka. Toxicological analyses of non-beverage alcohols bought in Izhevsk (Russia) showed no traces of methanol and only very low concentrations of long-chain alcohols.21 However, many non-beverage alcohols have very high concentrations of ethanol. Russian vodka contains on average 43% ethanol by volume, whereas the tinctures and eau de colognes bought for drinking varied between 60% and 97% ethanol.21

The need for more rigorous assessment of the association of mortality in Russia with alcohol, and hazardous alcohol consumption in particular, overcoming the limitations of previous work, led to the Izhevsk Family Study, which focused on working age men. We investigated the contribution of alcohol, particularly hazardous drinking, to male mortality in a typical Russian city.

Section snippets

Population and study design

We used a population-based case-control design. Our study was undertaken in Izhevsk, an industrial city on the western side of the Ural mountains in Russia. Our earlier work22 in the region showed the feasibility of undertaking such a complex investigation in this location. It is a typical Russian city of its size (population 632 000 at the 2002 all Russia Census) with average life expectancy for Russia and a distribution of deaths by cause in working age men that is much the same as that for

Results

The proportion of interviews obtained from case proxies and control proxies was much the same (table 1). More cases than controls lived alone so no proxy was available, although refusals by proxies were more common for controls than for cases (table 1). Table 2 shows that success in obtaining a proxy interview for cases varied by education and marital status (as derived from the death certificate). Equivalent information about number of years in education and marital status of non-responding

Discussion

We have shown that mortality in working-age men in a typical city in Russia is strongly associated with hazardous patterns of alcohol consumption. In particular, we have identified drinking of non-beverage alcohols as a potentially major contributor to mortality. Frequency of consumption of such beverages was strongly associated with all cause mortality in a graded fashion, and was statistically independent of volume of consumption of beverage alcohols. Mortality was also associated with a

References (36)

  • P Walberg et al.

    Economic change, crime, and mortality crisis in Russia : regional analysis

    BMJ

    (1998)
  • J Rehm et al.

    The global distribution of average volume of alcohol consumption and patterns of drinking

    Eur Addict Res

    (2003)
  • J Rehm et al.

    Russian Federation

    (2006)
  • V Treml

    Soviet and Russian statistics on alcohol consumption and abuse

  • G Gmel et al.

    Measuring alcohol consumption

    Contemp Drug Probl

    (2004)
  • M Bobak et al.

    Contribution of drinking patterns to differences in rates of alcohol related problems between three urban populations

    J Epidemiol Community Health

    (2004)
  • P Carlson

    Risk behaviours and self rated health in Russia 1998

    J Epidemiol Community Health

    (2001)
  • M Bobak et al.

    Alcohol consumption in a national sample of the Russian population

    Addiction

    (1999)
  • Cited by (0)

    View full text