Alcohol and cause-specific mortality in Russia: a retrospective case–control study of 48 557 adult deaths

Abstract

SummaryBackgroundAlcohol is an important determinant of the high and fluctuating adult mortality rates in Russia, but cause-specific detail is lacking. Our case–control study investigated the effects of alcohol consumption on male and female cause-specific mortality.MethodsIn three Russian industrial cities with typical 1990s mortality patterns (Tomsk, Barnaul, Biysk), the addresses of 60 416 residents who had died at ages 15–74 years in 1990–2001 were visited in 2001–05. Family members were present for 50 066 decedents; for 48 557 (97%), the family gave proxy information on the decedents' past alcohol use and on potentially confounding factors. Cases (n=43 082) were those certified as dying from causes we judged beforehand might be substantially affected by alcohol or tobacco; controls were the other 5475 decedents. Case versus control relative risks (RRs; calculated as odds ratios by confounder-adjusted logistic regression) were calculated in ever-drinkers, defining the reference category by two criteria: usual weekly consumption always less than 0·5 half-litre bottles of vodka (or equivalent in total alcohol content) and maximum consumption of spirits in 1 day always less than 0·5 half-litre bottles. Other ever-drinkers were classified by usual weekly consumption into three categories: less than one, one to less than three, and three or more (mean 5·4 [SD 1·4]) bottles of vodka or equivalent.FindingsIn men, the three causes accounting for the most alcohol-associated deaths were accidents and violence (RR 5·94, 95% CI 5·35–6·59, in the highest consumption category), alcohol poisoning (21·68, 17·94–26·20), and acute ischaemic heart disease other than myocardial infarction (3·04, 2·73–3·39), which includes some misclassified alcohol poisoning. There were significant excesses of upper aerodigestive tract cancer (3·48, 2·84–4·27) and liver cancer (2·11, 1·64–2·70). Another five disease groups had RRs of more than 3·00 in the highest alcohol category: tuberculosis (4·14, 3·44–4·98), pneumonia (3·29, 2·83–3·83), liver disease (6·21, 5·16–7·47), pancreatic disease (6·69, 4·98–9·00), and ill-specified conditions (7·74, 6·48–9·25). Although drinking was less common in women, the RRs associated with it were generally more extreme. After correction for reporting errors, alcohol-associated excesses accounted for 52% of all study deaths at ages 15–54 years (men 8182 [59%] of 13968, women 1565 [33%] of 4751) and 18% of those at 55–74 years (men 3944 [22%] of 17 536, women 1493 [12%] of 12 302). Allowance for under-representation of extreme drinkers would further increase alcohol-associated proportions. Large fluctuations in mortality from these ten strongly alcohol-associated causes were the main determinants of recent fluctuations in overall mortality in the study region and in Russia as a whole.InterpretationAlcohol-attributable mortality varies by year; in several recent years, alcohol was a cause of more than half of all Russian deaths at ages 15–54 years. Alcohol accounts for most of the large fluctuations in Russian mo...

The relationship between different dimensions of alcohol use and the burden of disease—an update

“…In the most recent CRAs, this was solved as follows 22, 267:

For hypertensive heart disease, ischaemic heart disease and both stroke types, the risk relations are specified for fatal and non‐fatal outcomes. Moreover, for ischaemic diseases, we used age‐specific risk relations 268.

For countries in eastern Europe (Russia and surrounding countries with similar drinking patterns), different relative risk estimates were used (269, based on 270). In particular, no beneficial effect was modelled because of detrimental drinking patterns and higher relative risk per heavy drinking occasion, as the average quantity per heavy drinking occasion in these countries is higher (see 41, 271, 272, 273 as background).…”

“…For countries in eastern Europe (Russia and surrounding countries with similar drinking patterns), different relative risk estimates were used (269, based on 270). In particular, no beneficial effect was modelled because of detrimental drinking patterns and higher relative risk per heavy drinking occasion, as the average quantity per heavy drinking occasion in these countries is higher (see 41, 271, 272, 273 as background).…”

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