Alcohol and mortality in Russia: prospective observational study of 151 000 adults

Abstract

SummaryBackgroundRussian adults have extraordinarily high rates of premature death. Retrospective enquiries to the families of about 50 000 deceased Russians had found excess vodka use among those dying from external causes (accident, suicide, violence) and eight particular disease groupings. We now seek prospective evidence of these associations.MethodsIn three Russian cities (Barnaul, Byisk, and Tomsk), we interviewed 200 000 adults during 1999–2008 (with 12 000 re-interviewed some years later) and followed them until 2010 for cause-specific mortality. In 151 000 with no previous disease and some follow-up at ages 35–74 years, Poisson regression (adjusted for age at risk, amount smoked, education, and city) was used to calculate the relative risks associating vodka consumption with mortality. We have combined these relative risks with age-specific death rates to get 20-year absolute risks.FindingsAmong 57 361 male smokers with no previous disease, the estimated 20-year risks of death at ages 35–54 years were 16% (95% CI 15–17) for those who reported consuming less than a bottle of vodka per week at baseline, 20% (18–22) for those consuming 1–2·9 bottles per week, and 35% (31–39) for those consuming three or more bottles per week; trend p<0·0001. The corresponding risks of death at ages 55–74 years were 50% (48–52) for those who reported consuming less than a bottle of vodka per week at baseline, 54% (51–57) for those consuming 1–2·9 bottles per week, and 64% (59–69) for those consuming three or more bottles per week; trend p<0·0001. In both age ranges most of the excess mortality in heavier drinkers was from external causes or the eight disease groupings strongly associated with alcohol in the retrospective enquiries. Self-reported drinking fluctuated; of the men who reported drinking three or more bottles of vodka per week who were reinterviewed a few years later, about half (185 of 321) then reported drinking less than one bottle per week. Such fluctuations must have substantially attenuated the apparent hazards of heavy drinking in this study, yet self-reported vodka use at baseline still strongly predicted risk. Among male non-smokers and among females, self-reported heavy drinking was uncommon, but seemed to involve similar absolute excess risks.InterpretationThis large prospective study strongly reinforces other evidence that vodka is a major cause of the high risk of premature death in Russian adults.FundingUK Medical Research Council, British Heart Foundation, Cancer Research UK, European Union, WHO International Agency for Research on Cancer.

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

“…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).…”

Alcoholism and mortality in Eastern Europe

“…Excessive alcohol consumption is frequently cited as being the main cause of extremely high rates of male mortality [3], [4], [5], [6], [7], [8], [9], [10], [11]. Country-level data in these studies show a clear correlation between alcohol consumption and male mortality.…”

“…This is due to the fact that while the effect of moderate drinking, both on health and labor productivity, is ambiguous, the effect of heavy drinking is unambiguously negative. This observation is particularly important for former USSR countries, where 50% of all deaths in working-age men are caused by so-called "hazardous" or "binge" drinking [5], [6].…”

“…Public health literature provides several views. Accordingly, some studies argue that the consumption of surrogate alcohol, rather than heavy drinking per se, irrespective of what kind of alcohol is consumed, is the main source of alcohol-related mortality [5], [6].…”

“…Finally, individuals could reduce the amount of their drinking when they become sick and face a high chance of dying. Only one study goes further than others in establishing the causal relationship between heavy drinking and mortality [6]. Similar problems exist in trying to establish the causal effect of alcohol consumption on labor productivity.…”