ArticlesHazardous alcohol drinking and premature mortality in Russia: a population based case-control study
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)
- et al.
Huge variation in Russian mortality rates 1984-94: artefact, alcohol, or what?
Lancet
(1997) - et al.
Changes in life expectancy in Russia in the mid-1990s
Lancet
(2001) - et al.
Alcohol is implicated in the fluctuations in cardiovascular disease in Russia since the 1980s
Ann Epidemiol
(2001) - et al.
Relation between heavy and binge drinking and all-cause and cardiovascular mortality in Novosibirsk, Russia: a prospective cohort study
Lancet
(2002) - et al.
Towards agreement on ways to measure and report drinking patterns and alcohol-related problems in adult general population surveys: the Skarpo conference overview
J Subst Abuse
(2000) - et al.
Mortality Reversal in Russia: the story so far
Hygiea Internationalis
(2004) Human Mortality Database
Mortality in Central and Eastern Europe: long-term trends and recent upturns
Demogr Res
(2004)Alcohol-related human losses in Russia in the 1980s and 1990s
Addiction
(2002)- et al.
Social stress and the Russian mortality crisis
JAMA
(1998)