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RESEARCH ARTICLE
Copyright Kuznetsova PO. This is an open access article distributed under the terms of the Creative Commons Attribu-
tion License (CC-BY 4.0), which permits unrestricted use, distribution, and reproduction in any medium, provided the
original author and source are credited
Alcohol mortality in Russia:
assessmentwithrepresentative survey data
Polina O. Kuznetsova1
1 RANEPA, Moscow, 119571, Russia
Received
2 March 2020 ♦
Accepted
9 September 2020 ♦
Published
7 December 2020
Citation:
Kuznetsova PO (2020) Alcohol mortality in Russia: assessment with representative survey data. Popula-
tion and Economics 4(3): 75-95. https://doi.org/10.3897/popecon.4.e51653
Abstract
According to vast empirical evidence, excessive alcohol consumption is an important factor of prema-
ture mortality in Russia. At the same time, quantifying alcohol-related deaths is not so easy, as gener-
ally the discussion of alcohol mortality only concerns the causes of death attributed solely to alcohol,
which signicantly narrows the range of possible negative consequences. Including data on losses from
myocardial infarction, coronary heart disease and other common cardiovascular and other diseases
in alcohol mortality estimates is enabled by an approach using data on the relative risks of death from
various causes depending on the type of alcohol consumption. Within this study, alcohol consump-
tion, depending on sex and age, was assessed on data from a representative national survey, taking into
account information on the volume of recorded sales of alcoholic beverages.
According to the obtained results, in 2018 the death rate from alcohol-related causes in Russia amount-
ed to 196,000 people, 146,000 men and 50,000 women among them. e peak of alcohol mortality is
observed among people aged over 50. e structure of alcohol mortality is dominated by diseases of
the cardiovascular system and external causes, and for men the contribution of external causes is sig-
nicantly higher. Excessive alcohol consumption reduces life expectancy by 5.9 and 4.7 years for men
and women, and healthy life expectancy by 4.2 and 2.6 years for men and women.
Keywords
alcohol; mortality; causes of death; total life expectancy (TLE); healthy life expectancy (HLE)
JEL codes: J00, J01
Introduction
Excessive alcohol consumption is an important factor of mortality both in Russia (Denisova
2010; Zaridze 2009; Shield and Rehm 2015) and worldwide (WHO 2019). Despite the ob-
vious and undisputed signicance of the topic, it is not so easy to quantify the contribution
Population and Economics 4(3): 75–95
DOI 10.3897/popecon.4.e51653
Kuznetsova PO: Alcohol mortality in Russia: assessment with representative survey data
76
of alcohol to mortality. Oen, analysis of alcohol-related deaths is limited to either causes of
death 100% due to alcohol, or total deaths from all alcohol-related causes. Both ways signi-
cantly distort the real values of alcohol mortality, in the rst case underestimating it, and in
the second— noticeably overestimating it.
In international research literature on hazardous consumption in general, smoking or
alcohol abuse have been widely assessed as factors of mortality and morbidity in general
population, as well as in dierent sex and age groups, through relative mortality risks (Rehm
2011).
Within our study, international methods for assessing the contribution of alcohol-related
diseases to mortality have been adapted to Russian data. e assessment took into account
the prevalence of alcohol consumption and deaths by cause in dierent age groups, as well
as the relative risks of death from alcohol-related diseases, which were borrowed from a
study based on Russian data (Zaridze et al. 2009). An important peculiarity of the obtained
estimates is the use of population survey data on the prevalence of excessive alcohol con-
sumption in calculations. e data on alcohol consumption coming from population sur-
veys are rightly considered to be underestimated (see on this, for example, in (Parish et al.
2017; Nemtsov 2003)); nevertheless, it is a source of valuable information on the nature and
dynamics of consumption of certain types of alcoholic beverages by various socio-economic
groups.
Within this study, in addition to absolute count of alcohol mortality, the author gives
estimates of mortality rates by sex and age for dierent types of alcohol consumption,
which enabled constructing mortality tables for persons with a unsafe and safe type of
alcohol consumption. Total life expectancy at birth (TLE) and healthy life expectancy
at birth (HLE) depending on the type of alcohol consumption were then assessed using
mortality tables and data on population health. In conclusion, the author briey com-
ments on the main ndings of the study and provides recommendations for the state
alcohol policy.
Overview of domestic and foreign studies assessing the contribution
of alcohol consumption to population mortality
Vast empirical evidence proves alcohol to be a direct cause of over 200 types of death
from various diseases and injuries, dened by triple-digit codes in the 10th revision of the
International Statistical Classication of Diseases and Related Health Problems (ICD-10)
(Rehm 2011; Rehm and Shield 2014). According to a WHO global study, the total num-
ber of alcohol-related deaths worldwide exceeded 3 million cases in 2016, accounting for
5.3% of all adult deaths (WHO 2019). Alcohol’s eect on mortality exceeded the negative
eects of tuberculosis (2.3%), HIV (1.8%), diabetes (2.8%), transport incidents (2.5%) and
violence (0.8%).
For the European region, the eects of excessive alcohol consumption are even more
pronounced. e gender and age standardised mortality rate for the world as a whole was
38.8 per 100,000 people, and for the WHO European region it was 62.8. At younger ages,
alcohol’s contribution to mortality is higher than the adult average (Guérin et al. 2013).
ere are also signicant gender dierences in the structure of alcohol mortality, name-
ly, for women, alcohol abuse mainly leads to death from cardiovascular disease (41.6% of
alcohol-related deaths), while for men the main contribution to alcohol-related mortality is
Population and Economics 4(3): 75–95 77
made by unintentional injuries (22.5%), digestive diseases (21.1%) and infectious diseases
(14.6%) (WHO 2019).
Some of the causes of alcohol mortality are attributed solely due to excessive alcohol
consumption. In Russian statistics, these data are collected separately, and there are over 15
dierent causes of death in this domain, including alcoholic cardiomyopathy, accidental al-
cohol poisoning, etc. In 2018, the total number of alcohol-related deaths in Russia mounted
up to 48.8 thousand, and the alcohol-related death rate for men and women was 54 and 16
cases per 100,000 respectively (Demographic Yearbook 2019).
e assessment of alcohol mortality is further hampered by diculties in diagnosing the
causes of death. In their study, D. Zaridze and co-authors (Zaridze et al. 2009b) analysed
over 20,000 deaths among population aged over 15 in Barnaul between 1990 and 2004. A
large proportion of those who died due to other diseases or unclassied cardiovascular dis-
eases had lethal or potentially lethal concentrations of ethanol in their blood. e authors
conclude that excessive alcohol consumption is the leading cause of premature male deaths
in Russia, with many alcohol-related deaths being wrongly attributed to diseases of the cir-
culatory system.
For a long time in Russia there has been observed a signicant inverse relationship be-
tween deaths from alcohol poisonings and TLE, particularly noticeable in the 1990s; howev-
er, in recent times the situation has changed. Comparison of the dynamics of these indica-
tors over three time periods, since 1965, carried out in a study by I. Danilova and co-authors
(Danilova et al. 2020) showed that since 2003 the steady positive dynamics in life expectancy
has been statistically independent of alcohol poisonings— in this period, the driving force
for the increase in life expectancy was the decline in non-alcohol-related mortality in older
ages (65 years and older).
Despite the importance of purely alcohol-related causes of death, the majority of alco-
hol-related deaths are diseases that are not solely caused by alcohol. A study by J. Rehm
and co-authors (Rehm et al. 2017) provides an overview of over 250 papers examining the
strength of the relationship between alcohol consumption and dierent types of diseases
and external causes of death. e negative eects depend heavily on the type of excessive
alcohol consumption. For the regular excess of the daily norm of ethanol consumption,
the most frequent negative consequence is increased risk of death from malformations
and alcohol disorders. In cases when alcohol abuse is mainly reected in the periodic
recurrent episodes of excessive consumption, it has the greatest impact on mortality from
coronary heart disease and other cardiovascular diseases, as well as injuries and infectious
diseases.
External causes of death constitute a signicant part of alcohol mortality. e risk level
of both intentional and unmeasured trauma and injury is clearly linked to alcohol levels in
the blood (Taylor and Rehm 2012) and average alcohol consumption (Corrao et al. 2004).
It is not easy to extract all alcohol-related deaths from mortality statistics by cause, so
researchers oen either consider deaths due solely to alcohol-related causes, or all deaths
due to all causes that might be partly induced by alcohol consumption. However, both of
these methods lead to signicant distortions of alcohol-induced mortality estimates, the rst
towards signicant underestimation, and the second— to notable overestimation.
To better estimate alcohol mortality, we need data on the relative risks of death from vari-
ous causes for people with a excessive type of alcohol consumption compared to non-drink-
ers. e necessary information is gathered through prospective and retrospective mortality
surveys.
Kuznetsova PO: Alcohol mortality in Russia: assessment with representative survey data
78
A global study by J. Rehm and K. D. Shield (Rehm and Shield 2014) provides estimates of
deaths from alcohol-related diseases in 1990 and 2010 in the United States of America. e
calculations take into account data on (1) the amount of alcohol consumed and the nature of
its consumption, (2) the risks of death from various alcohol-related causes, and (3) the mor-
tality from these causes. Within this study, individual types of cancer caused by excessive al-
cohol consumption, cirrhosis of the liver, and external causes were considered as the leading
causes of alcohol-related death. Taking into account the positive eect of moderate alcohol
consumption on the incidence of cardiovascular disease and diabetes, the authors claim that
these three types of deaths stand for 89% of all alcohol-related deaths between the ages of 15
and 64, and without regard to the positive eect— for 79% of alcohol-related deaths.
e paper (Wood et al. 2018) analyzed the results of 83 prospective studies in 19 high-in-
come countries. According to the study, the threshold for safe alcohol consumption was about
100g per week. Excessive alcohol consumption results in a decrease in life expectancy: com-
pared to those whose weekly consumption was 0-100g per week, for those consuming 100-
200g, 200-350g and over 350g per week, life expectancy at the age of 40 was lower by about
6 months, 1-2 years or 4-5 years respectively. Research on the eects of alcohol on mortality
continues, and some of the emerging estimates claim that there is no safe alcohol consumption
in terms of the eect on mortality. Specically, the global study (Griswold et al. 2018) notes that
the level of alcohol consumption that would minimize harm across all health indicators is zero.
Studies on the relationship between mortality and alcohol consumption carried out on
the basis of Russian data are of particular interest for the author. e eect of trends devel-
oped in alcohol consumption back in the Soviet period on mortality is estimated in the work
of S.L. Plavinsky and S.I. Plavinskaya (Plavinsky and Plavinskaya 2009). e empirical basis
of this study is a prospective study of the mortality of 3,907 men born in 1916-1935 and
residing in St. Petersburg in 1974. Along with other things, the authors revealed a U- shaped
dependence between mortality from cardiovascular diseases and alcohol consumption, as
the lowest mortality rate was observed among the moderate consumption group, not among
individuals who had never consumed alcohol.
In the work of M. Bobak and co-authors (Bobak et al. 1999), the nature of alcohol con-
sumption in Russia is studied on the basis of sociological (not epidemiological) database. e
collected data included information on smoking, self-assessment of health, and socio-eco-
nomic characteristics of individuals and households in which they live. e authors revealed
the following factors contributing to higher alcohol consumption among men: smoking,
absence of a marital partner, unemployment and low health self-assessment. e authors
also note the low overall level of alcohol consumption reported by survey participants, and
they suggest underreporting as a possible explanation. At the same time, episodes of one-
time high consumption were quite numerous, and the authors based their estimations of the
excessive alcohol consumption prevalence mainly on this parameter.
e study of M. Neufeld and J. Rehm (Neufeld and Rehm 2013) assesses possible impact
of the state anti-alcohol policy on alcohol consumption and resulting mortality in Russia in
2000-2010 against the background of adoption of the public policy measures aimed at re-
ducing the negative eects of alcohol consumption in 2006. e calculations are based on the
WHO alcohol consumption data supplemented by estimates of illegal consumption provided
by A. Nemtsov. According to the results of this study, there was a signicant variation in both
overall mortality in working age and alcohol-related mortality over the observation period.
e decrease in consumption and mortality was recorded at the end of 2005, when measures
regulating the production and retail of alcoholic beverages were passed at the legislative level.
Population and Economics 4(3): 75–95 79
ere was also a change in consumption patterns. In particular, the overall decline in legal and
illegal alcohol consumption was only partially oset by increases in beer and wine consump-
tion. e authors conclude that anti-alcohol regulation, which came into force in 2006, has had
a positive eect both on the nature of alcohol consumption by the population and on the scale
of its negative consequences. At the same time, the authors note that the strengthening of the
national anti-alcohol policy in Russia still remains highly relevant.
D. Zaridze and co-authors (Zaridze et al. 2009) estimated the relative mortality risks for
individuals aged 15 to 74 demonstrating unsafe alcohol consumption patterns. ese indi-
viduals were divided into three groups, namely: less than one bottle, one to three bottles,
three or more bottles of vodka weekly or during the day episodically. e authors analyzed
data coming from a retrospective survey of over 48,000 deaths that occurred in 1990-2001 in
Russian cities with typical mortality patterns observed back in the 1990s (Tomsk, Biysk and
Barnaul). e survey sample consisted of 50,066 questionnaires lled by relatives of those
who died between the ages of 15 and 74 in 2001-2005.
Using an adjusted logistic regression model, the authors estimated relative mortality risks
for the aforementioned three types of alcohol consumption. Consumption was considered
safe if both of the following conditions were met: (1) alcohol consumption is less than 0.5
bottles of vodka (or equivalent amount of alcohol) per week, and (2) maximum daily con-
sumption of vodka is less than 0.5 bottles. For men, three leading alcohol-related causes of
death were identied as accidents and violence (relative risk RR= 5.94 for the category with
highest alcohol consumption), alcohol poisonings (RR= 21.68) and acute coronary disease
with the exception of myocardial infarction (RR= 3.04). According to the results of the
study, in some years of the observation period, the contribution of alcohol-related mortality
to the overall mortality of men aged 15 to 54 exceeded 50 per cent.
K. D. Shield and J. Rehm (Shield and Rehm 2015) compare relative risks of mortality estimat-
ed by D. Zaridze and co-authors (Zaridze et al. 2009) with similar results for other countries. e
comparison has revealed that the alcohol-related burden of transport injuries is slightly higher
when estimated using non-Russian data on relative risks, while the risk of dying from a heart
attack, by contrast, is noticeably underestimated. Also using Russian estimates of relative risk
increased contribution of deaths from acute and chronic pancreatitis, unintentional injuries (ex-
cluding transport), self-inicted injuries and violence, while mortality from hemorrhagic and
other non-cerebral infarctions and liver cirrhosis appeared to be lower. Alternative relative risk
assessments can be used in performing robustness tests for the achieved results.
A large prospective study by D. Zaridze and co-authors (Zaridze et al. 2014), initiated
as part of an earlier retrospective study, elaborates the analysis of the relationship between
mortality and alcohol consumption (cf. Zaridze et al. 2009). is study bases on the ob-
servations conducted in 1999-2008, with 200,000 people in the original sample. A pecu-
liarity of the male subsample in this survey is that almost all alcohol abusers turned out
to be smokers. Here, alcohol consumption, as well as in the earlier study, was measured in
vodka equivalent. e authors dened tree types of consumption, namely: low consump-
tion (non-drinkers, former drinkers who did not quit smoking due to illness, men drinking
less than 1 bottle per week, or women drinking less than 0.25 bottles per week), average
consumption (men drinking 1 to 3 bottles per week, or women drinking 0.25 to 1 bottle
per week), and high consumption (men drinking more than 3 bottles per week, or women
drinking more than 1 bottle per week). e results of this study show that for smoking men
without prior disease, the estimated 20-year risk of death at the age of 35—54 was 16% with-
in the low alcohol consumption group, 20% within the average consumption group and 35%
Kuznetsova PO: Alcohol mortality in Russia: assessment with representative survey data
80
within the high consumption group. Corresponding estimates for the men aged 55—74 were
50, 54 and 64% respectively. In both age categories, most of the excess mortality among high
consumption respondents was due to external causes or groups of diseases directly related to
alcohol. Additionally, the authors of the study note signicant changes in the self-assessment
of alcohol consumption by respondents during the second round of the survey, which led to
a signicant decrease in the assessment of the risks of alcohol consumption.
Research data and methods
Quantitative assessment of alcohol-related deaths
In order to quantify alcohol-related mortality, it is necessary to calculate the proportion of the
population aected by excessive alcohol consumption— AAF (alcohol attributable fraction).
In order to take into account the eect of alcohol consumption on mortality from all causes,
not just the causes directly related to alcohol, the author of this study uses the methodology
presented in the paper by J. Rehm and co-authors (Rehm et al. 2010). Based on estimates of
relative mortality risks from a number of alcohol-related diseases (Table 1), mortality data by
cause and data on prevalence of excessive alcohol consumption, one can distinguish a compo-
nent, which is due specically to alcohol consumption, in total mortality.
Alcohol consumption corresponding to the equivalent of half a bottle of vodka per week
is considered excessive
in this paper. e author denes three types of excessive alcohol consumption: (1) corre-
sponding to the equivalent of 0.5-1 bottles of vodka (or 11-23 g of ethanol per day); (2)
corresponding to the equivalent of 1-3 bottles of vodka (or 23-67 g ethanol per day) and (3)
corresponding to the equivalent of 3 or more bottles of vodka (or no less than 67 g of ethanol
per day). Relative risks of death from a number of causes from the paper (Zaridze et al. 2009)
have been applied for these three types of consumption.
To assess mortality from diseases caused by excessive alcohol consumption the author
calculated additional risk factor, PAF (population attributable fraction), for various causes of
death and sex and age groups:
where pp p
jj j
() ()
()
,,
123 is the proportion of persons with average alcohol consumption equiv-
alent to 0.5-1 bottles of vodka, 1-3 bottles of vodka and 3 or more bottles of vodka per week
respectively, and pj
()
0
()
() () () ()
pp
pp
jj
jj
01
23
1=− −− is the percentage of the rest of the pop-
ulation in sex and age group j0; RR RR RR
ij ij ij
() ()
()
,,
123are relative risks of death from disease i
in sex and age group j compared to the rest of the adult population, depending on the type
ofalcohol consumption.
e number of excess deaths caused by alcohol (added mortality, AM) for the given
cause of death and the given sex and age group is calculated as , where OM
(overall mortality) is the total number of deaths from the given cause of death, taken from
ocial mortality estimates.
Population and Economics 4(3): 75–95 81
Table 1. Relative risks of death for men aged 15 to 74 from various causes depending on the type of
alcohol consumption (measured as pure alcohol equivalent per week)
Cause of death (ICD-10) Men Wome n
0,5-1 1−3 ≥ 3 0,5-1 1−3 ≥ 3
Upper respiratory tract malignant neoplasm (C00–15,
C32)
1.57 2.32 3.48 1.27 0.99 2.21
Malignant neoplasm of liver and intrahepatic bile ducts 1.01 1.28 2.11 1.52 1.17 1.57
Breast cancer (C50) 0.99 0.54 0.26
Tuberculosis (A15–19, B90) 1.01 1.97 4.14 0.93 4.06 5.32
Bronchitis, emphysema and other chronic obstruc-
tive pulmonary diseases (J40–44)
1.22 1.40 1.79 0.96 1.45 1.60
Other respiratory diseases (acute from J00–98) 0.95 1.92 3.29 2.10 3.21 3.42
Liver disease (K70–77) 0.92 1.77 6.21 2.50 7.07 12.08
Pancreatitis and other pancreatic diseases (K85–86) 1.43 2.07 6.69 1.09 5.01 19.26
Acute myocardial infarction (I20–23) 1.23 1.18 1.20 1.27 1.12 2.04
Acute ASHD without myocardial infarction (I24) 1.06 1.79 3.04 1.79 4.61 9.25
Chronic ASHD (I25) 1.05 1.20 1.49 1.39 1.42 2.58
Cerebrovascular disease (I60–69) 1.06 1.14 1.28 1.38 1.36 1.62
Other cardiovascular diseases (acute from I00–99) 1.02 1.14 1.57 1.23 1.45 2.39
Inconclusive causes of death (R00–99) 1.29 2.84 7.74 2.11 7.16 14.89
Alcohol-related causes of death 1.11 1.91 3.77 1.81 4.52 8.17
Alcohol poisonings (X45, Y15, F10) 1.94 4.06 21.68 3.11 18.04 75.23
Other external causes of death (acute from V00–Y99) 1.44 2.53 5.94 1.90 5.59 9.26
Transport accidents (V00–99) 1.52 2.68 4.20 1.98 4.48 3.17
Other accidents (W00–X44, X46–59, Y37–99) 1.58 2.48 6.07 2.08 5.24 8.56
Suicides (X60–84) 1.21 3.47 8.62 2.82 8.22 14.75
Attacks (X85–Y09) 1.75 3.67 9.47 3.55 10.23 19.11
Damage with uncertain intentions (acute) 1.49 2.36 4.40 1.43 4.54 7.93
Note: Reference category— persons with an average alcohol consumption per week of no higher than
0.5 bottles of vodka and with a maximum daily intake of not more than 0.5 bottles of vodka. Source:
(Zaridze et al. 2009).
Prevalence of excessive alcohol consumption according to the nation-
al representative panel survey
Data on the prevalence of excessive alcohol consumption in various sex and age groups is
needed to assess deaths from all causes related to alcohol. is study uses data from the Rus-
sian Longitudinal Monitoring Survey— HSE (RLMS). e Russian Longitudinal Monito-
ring Survey is conducted by the National Research University Higher School of Economics
and LLC Demoscope with the participation of the Population Centre of the University of
North Carolina at Chapel Hill and the Institute of Sociology of the Federal Research Socio-
Kuznetsova PO: Alcohol mortality in Russia: assessment with representative survey data
82
logy Centre of the Russian Academy of Sciences (RLMS HSE survey websites: http://www.
cpc.unc.edu/projects/rlms and http://www.hse.ru/rlms). Some information on alcohol con-
sumption in the RLMS has been present since 1994, but the full amount of data needed to
calculate the average total consumption of pure alcohol has been collected only since 2006.
e survey regularly gathers detailed information on the population’s consumption of
various alcoholic beverages of both industrial and domestic production. e questionnaire
includes questions for the following beverages: industrial beer; domestic beer; brew (bra-
ga); dry wine or champagne of industrial production; home-made wine; fortied wine (in-
cluding separately fortied home-made wine); hooch; vodka; other strong drinks (whisky,
cognac, liquors); alcoholic cocktails; other alcoholic beverages. For each type of drink, the
same series of questions is asked: 1) “Have you been drinking this drink in the last 30 days?”;
2) “How many grams of this drink did you usually drink a day?”; 3) “How many days a
month did you drink this drink?“.
Estimates of overall alcohol consumption on the basis of population survey data are signif-
icantly underestimated due to, at least, two circumstances. First, respondents tend to under-
estimate alcohol consumption both by the average amount of alcohol consumed per day and
the number of days of alcohol consumption per month. Excessive alcohol consumption and
alcoholism, as one of its eects, are generally disapproved of in society. Second, respondents,
who oen have to answer the interviewer’s questions in the presence of their relatives, may
conceal information on their actual consumption. One of the reasons to do so is that alcohol
consumption oen aects both the nancial situation of the household and the relationship
within the family (see also in the papers by Guérin et al. 2013; Bobak et al. 1999).
Figure 1. Prevalence of alcohol consumption according to RLMS, men and women, 1994-2018, %.
Source: author’s calculations based on the RLMS data.
Population and Economics 4(3): 75–95 83
Figure 1 summarizes the RLMS information on the dynamics of the proportion of alco-
hol consumers in the Russian adult population. In 2010-2015, the share of alcohol consum-
ers decreased, then it stabilized, making 64% for men and 54% for women in 2018. Detailed
information on the volume of consumption is gathered only for respondents who had con-
sumed alcoholic beverages during the 30 days before survey, and in 2018 the proportion of
those was 48 and 32% for men and women respectively.
Figure 2 presents dierences in average annual per capita alcohol consumption estimates
according to WHO statistics on recorded (accounted) and total (including unaccounted)
consumption and according to the author’s calculations on the RLMS data. Additionally, the
author estimated this indicator using the methodology presented in the early study on the
RLMS data (Zohoori et al. 1998). Evidently, the survey data signicantly underestimate the
recorded and especially total alcohol consumption. us, in 2018, consumption according
to RLMS amounted to only 36% of registered sales and 24% of the estimate of total alco-
hol consumption in Russia according to WHO. At the same time, the survey data provide
detailed information on the sex and age pattern of alcohol consumption and are therefore
actively used to assess alcohol mortality in international scientic practice.
Figure 2. Estimates of alcohol consumption in Russia, liters of ethanol per capita, 2006-2018.
Source: author’s calculations based on the WHO data (see http://apps.who.int/gho/data/node.main.
A1022?lang=en; date of reference 27.09.2020).
us, the data on alcohol consumption obtained from the population survey need further
assessment. Based on the assumption of correctness of the information obtained on alco-
hol consumption patterns, estimates can be calibrated according to the data based on retail
Kuznetsova PO: Alcohol mortality in Russia: assessment with representative survey data
84
statistics. For this purpose, the author uses WHO data on per capita consumption of pure
alcohol estimated for population aged 15 years and over (Table 2). Other approaches to cal-
ibrating alcohol consumption statistics might be found in the literature (Rehm et al. 2010b;
Rey et al. 2010; Parish et al. 2017).
Table 2. Per capita alcohol consumption estimated for population aged 15 and over, liters of pure alcohol
Year
Alcohol total
(takingintoaccount
illegal consumption)
Registered alcohol total Including strong spirits
(recorded consumption)
2000 15.7 10.2 7.3
2001 10.5 7.1
2002 10.9 7.2
2003 11.3 7.3
2004 11.5 7.1
2005 17.4 11.6 6.9
2006 11.8 6.7
2007 12.2 6.3
2008 12.1 6.2
2009 11.3 5.8
2010 15.9 11.0 5.6
2011 10.9 5.5
2012 10.9 5.5
2013 10.2 4.8
2014 9.3 4.1
2015 12.5 8.4 3.6
2016 8.2 3.6
2017 7.2 3.1
2018 11.2 7.7 3.2
Source: WHO data (see http://apps.who.int/gho/data/node.main.A1022?lang=en; date of reference
27.09.2020).
Experts have repeatedly claimed that people with very high alcohol consumption are sig-
nicantly underrepresented in the RLMS sample (Nemtsov 2003; Andriyenko and Nemtsov
2006). Taking this into account and considering the fact that this study provides a conserv-
ative (low) estimate of alcohol mortality, the author decided to make a further reassessment
and to harmonize the survey estimates with the level of recorded consumption, that is, re-
corded sales of alcohol (retail statistics).
At the rst step of the assessment, data on the consumption of various alcoholic beverag-
es were aggregated and translated into the amount of pure alcohol consumed per day. e
following translation scale was used for this purpose:
• beer and brew(braga), including industrial beer and domestic beer,— 5% alcohol on
average;
• dry wine, champagne, house wine— 12% alcohol on average;
Population and Economics 4(3): 75–95 85
• fortied wine, including industrial production (martini, vermouth)— 18% alcohol
on average;
• alcoholic cocktails— 7% alcohol on average;
• strong alcoholic beverages including vodka, whisky, cognac, hooch— 40% alcohol on
average;
• other alcoholic beverages— 25% alcohol on average.
In 2018, the consumption of alcohol by the population aged 15 years and over, estimated
on RLMS data, accounted for 36% of recorded alcohol consumption by WHO estimates and
25% of total alcohol consumption (including illegal consumption) as assessed by WHO.
According to estimates on RLMS data, the prevalence of excessive alcohol consumption
for adults was 27% in 2018. Among men, excessive consumption was noticeably more com-
mon (36% of the adult population) than among women (20% of the adult population). e
relatively high values of the indicator for women are partly due to lower threshold meanings.
Figure 1 shows gender and age dierences in the prevalence of excessive alcohol con-
sumption. Between the ages of 20 and 24, alcohol consumption begins to rise rapidly, reach-
ing peak values of about 45% among men and 25 to 30% among women by the age of 30
to 39. en for 15 years alcohol abuse remains high, although slightly decreasing, and only
begins to signicantly fall aer the age of 65.
Figure 3. Prevalence of excessive alcohol consumption and low health estimates depending on age,
males and females, 2018. Source: author’s calculations based on the RLMS and Russian Fertility and
Mortality Database data.
Kuznetsova PO: Alcohol mortality in Russia: assessment with representative survey data
86
Figure 1 also shows the prevalence of low health estimates among dierent sex and age
groups. Information about the state of health was further used to calculate the HLE. e
proportion of people assessing their health as poor or very poor markedly increases with
age, amounting to about 1-2% of the group aged 25-29, 8-10% of those aged 50-54, and over
37-45% of those aged over 75 years. It is particularly noteworthy that in older ages, wom-
en tend to be more pessimistic when assessing their health. is feature will signicantly
change the gender ratios in evaluations with the transition from TLE to HLE.
Results of the study
Applying relative risk assessments from D. Zaridze and co-authors’ paper (Zaridze et al.
2009) to national data on mortality by causes and prevalence of excessive alcohol consump-
tion, the author obtained the following estimates for number of alcohol-related deaths in
2018: 195.5 thousand people overall, including 145.7 thousand men and 49.7 thousand wo-
men. ese data substantially exceeds the numbers on mortality from diseases caused so-
lely by alcohol, which is most commonly used in the discussion of the eect of alcohol on
mortality. In 2018, according to Rosstat data, 48,8 thousand people died from these causes
(Demographic Yearbook 2019). us, employing the information on the relative risks of
mortality enables to rene the data on alcohol mortality in Russia signicantly.
Figure 4. Number of deaths due to excessive alcohol consumption, depending on sex and age, pro-
portion in alcohol mortality (%), men and women, 2018. Source: author’s calculations based on the
RLMS and Russian Fertility and Mortality Database data.
Population and Economics 4(3): 75–95 87
Information on the age structure of alcohol mortality is presented in Figure 4. e peak
of alcohol mortality is observed at the age of 50 and over— 63% of all alcohol deaths among
men and 72% among women are located in this group. A drastic decline in alcohol mortality
is observed aer the age of 80 among men and aer the age of 85 years among women. It’s
likely that this is an age to which people who have abused alcohol over a lifetime simply don’t
live to. Another explanation is that, due to the deterioration of health, alcohol consumers
reduce consumption while ageing or abandon alcohol completely.
Information on the structure of alcohol mortality by cause of death is presented in Fig-
ure5. In Figure 5a the causes of death occurred solely due to alcohol are placed in a separate
group, and therefore are not taken into account with related diseases. In Figure 5b, most
of the causes related to alcohol abuse were attributed to the relevant disease groups, while
the other cause 100% due to alcohol category included mostly alcohol-induced mental and
behavioural disorders.
Causes related solely to alcohol account for 25% of alcohol mortality among men and
women. Most oen, deaths due to excessive alcohol consumption occur because of diseases
of the cardiovascular system and external causes. For men, external causes are the rst to
contribute to alcohol mortality, accounting for 40% of all alcohol-related deaths. e next
important group of causes is cardiovascular disease (31%). e pattern of alcohol mortality
among women is slightly dierent: cardiovascular diseases are the main cause (47%), fol-
lowed by external causes (23%). Liver and pancreatic diseases account for 13% of alcohol
deaths among men and for 20% among women. Neoplasms in the structure of female al-
cohol mortality almost do not occur (0.1%), while for males their proportion is about 5%,
among them, along with others, are malignant neoplasms of the lips, mouth and pharyngeal
cavity (2.0%), esophagus (1.3%), larynx (0.9%) and liver (0.5%).
ese estimates are broadly consistent with the ndings of the WHO Global Study
(WHO 2018), according to which globally the leading cause of alcohol death for women
Figure 5. Number of deaths due to excessive alcohol consumption, depending on causes of death,
proportion in alcohol mortality (%), men and women, 2018. (a) all causes 100% caused by alcohol are
allocated to a separate group; (b) causes 100% caused by alcohol are distributed by the main groups of
causes. Source: author’s calculations based on the RLMS and Russian Fertility and Mortality Database
data.
Kuznetsova PO: Alcohol mortality in Russia: assessment with representative survey data
88
is cardiovascular diseases (41.6% of alcohol-related deaths) and for men— external causes
(31.4%). It should be noted that in Russia the contribution of cardiovascular diseases and
external causes to male alcohol mortality is signicantly higher than in the world as a whole
(in comparison: the share of cardiovascular diseases in Russia is 31%, while in the world it
is estimated at 13%: the share of external causes of death in Russia mounts up to 40% and to
31.4% in the world).
e rst 12 causes of death from ICD-10 in terms of their contribution to alcohol mortal-
ity are given in Table 3. According these data, only one-tenth of the contribution to alcohol
mortality among women is external (accidental alcohol poisoning, 3.1%). For women, the
individual causes of death with the largest contribution to alcohol mortality are cirrhosis,
brosis and hepatitis of the liver, both non-alcoholic (7.1%) and alcoholic (4.8%); diseases of
the cardiovascular system— atherosclerotic heart disease (12.2%), acute myocardial infarc-
tion (7.9%), other forms of chronic coronary heart disease (6.5%), brain infarction (5.1%)
and alcoholic cardiomyopathy (4.9%). Suicide and homicide accounted for 2.4 and 2.1% of
all alcohol deaths among women respectively.
For men, the situation with the contribution of certain causes to alcohol mortality is
slightly dierent. is result is entirely predictable: as it was previously shown in the analysis
of the structure of male mortality due to excessive alcohol consumption, external reasons
prevail in all large demographic groups. Among the three leading causes of alcohol mortal-
ity, two are external causes: suicide (5.6%) and accidental alcohol poisoning (6.0%). Other
key causes of male alcohol mortality are diseases of the cardiovascular system, including al-
cohol cardiomyopathy (8.0%), atherosclerotic disease (4.8%), other forms of acute coronary
heart disease (3.9%), acute myocardial infarction (3.8%), and liver disease of non-alcoholic
(4.6%) and alcoholic origin (4.2%).
Information on the dierences in TLE between people with excessive alcohol consump-
tion compared to the rest of the population is given in Table 4. Excessive alcohol consump-
tion signicantly— by 5.9 years for men and 4.7 years for women— reduces life expectancy;
it goes from 70.7 years for safe alcohol consumption down to 64.8 years in the case of alcohol
abuse for men and from 78.9 years down to 74.2 years for women.
With age, dierences in TLE depending on the type of alcohol consumption are decreas-
ing. Among men, this decrease is faster than among women: if at birth the dierences in
TLE depending on the type of alcohol consumption among men are markedly higher than
among women (5.9 and 4.7 years respectively), by the age of 70 they go down to 2.3 and
2.4 years. is is most likely due to the impact of other factors on male mortality, including
smoking and insucient access to high-quality health care.
Another important result of the study is the assessment of the excessive alcohol consump-
tion contribution to the population’s HLE. Comparative information on the HLE of men and
women, depending on the status of alcohol consumption, is also presented in table 4. HLE in
the case of excessive alcohol consumption is reduced by 4.2 years for men, from 63.2 to 59.0
years, and by 2.6 years for women, from 66.1 to 63.5 years.
It should be noted that gender disparities are noticeably reduced in the transition to HLE
indicators. us, if the dierence between men and women with excessive alcohol consump-
tion in 2018 was more than 9 years (64.8 and 74.2 years respectively), for HLE it was only 4.5
years (59.0 and 63.5 years). Gender dierences for a population with a safe type of alcohol
consumption behave similarly, decreasing markedly with the transition to an assessment of
healthy life expectancy. A clear explanation for this behaviour of life expectancy indicators
is the lower assessment of women’s own health, especially in older ages (see Figure1). us,
Population and Economics 4(3): 75–95 89
a higher proportion of the population with poor health among those living up to older ages
contributes to a decrease in women’s longevity advantage.
Concluding the presentation of the results of the study, let’s note the main limitations of
the obtained estimates. e analysis of deaths from alcohol-related causes has a number of
limitations related to the objective complexity of the object under review, i.e. alcohol con-
sumption and its eects. Let’s try listing at least some of them. Alcohol is a legal commodity,
but at the same time, there is also illegal consumption, the volume of which is dicult to
estimate. Moderate alcohol consumption is not dangerous, and epidemiological studies in-
dicate that for a number of diseases the mortality risks among moderate alcohol consumers
Table 3. Number of deaths due to excessive alcohol consumption, depending on cause of death (ICD-
10 classication), alcohol mortality rate (%), men and women, 2018
Men Wome n
causes of death proportion of
deaths due to
alcohol-related
causes
causes of death proportion of
deaths due to
alcohol-related
causes
Alcoholic cardiomyopathy 8 Atherosclerotic heart disease 12.2
Accidental poisoning (expo-
sure) by alcohol
6 Acute myocardial infarction 7.9
Other intentional self-harm
(including suicide)
5.6 Fibrosis and cirrhosis of the
liver (excl. alcohol)
7.1
Atherosclerotic heart disease 4.8 Other forms of chronic coro-
nary heart disease
6.5
Fibrosis and cirrhosis of the
liver (excl. alcohol)
4.6 Brain infarction 5.1
Alcoholic liver disease (al-
coholic: cirrhosis, hepatitis,
brosis)
4.2 Alcoholic cardiomyopathy 4.9
Other forms of acute coro-
nary heart disease
3.9 Alcoholic liver disease 4.8
Acute myocardial infarction 3.8 Other forms of acute coro-
nary heart disease
4.7
Other forms of chronic coro-
nary heart disease
3.4 Other rened lesions of the
brain vessels
3.7
Contact with sharp and
blunt object with uncertain
intentions
3.1 Accidental poisoning (expo-
sure) by alcohol
3.1
Pneumonia without clari-
cation of the pathogen
2.4 Cerebral atherosclerosis 2.5
Murder 2.4 Pneumonia without clari-
cation of the pathogen)
2.2
Source: author’s calculations based on the RLMS and Russian Fertility and Mortality Database data.
Kuznetsova PO: Alcohol mortality in Russia: assessment with representative survey data
90
are lower than among those who have never consumed it. Alcohol itself comes in diverse
forms and might be consumed both in strong and low degree form, and correct assessment
of its total consumption is not an easy task.
Calculations of alcohol mortality require knowledge of the prevalence of excessive alco-
hol consumption in dierent sex and age groups. Aggregated retail statistics don’t give that
much detail. e necessary data can be obtained from representative population surveys,
however, survey-based estimates are generally signicantly lower when compared to sales
of alcoholic beverages, which raises the question of adequate calibration of the survey data.
is paper presents an attempt of such a calibration. In the future, more complex mathe-
matical and statistical methods can be applied to the assessment of alcohol consumption,
enabling nding a better approximation of real consumption volume.
Recommendations for improving Russia’s policy on mortality
reduction
Recommendation 1. Existing statistics on alcohol consumption and alcohol mortality re-
quire expansion and detailization; the indicators that are currently being collected do not
provide an objective illustration of what is happening.
Excessive alcohol consumption is a signicant factor in premature mortality in Russia.
Alcohol mortality is a complex phenomenon, it cannot be characterized in simple ways.
According to the estimates obtained within this study, alcohol was the direct cause of about
160,000 deaths in 2018. Of these, only about 50 thousand were related solely to alcohol
mortality (including alcoholic cirrhosis of the liver, alcoholic cardiomyopathy, alcoholic
poisonings, etc.). is indicator, widely used in Russian research and administrative prac-
tice for the analysis of alcohol mortality, characterizes the problem only supercially. For a
thorough analysis, it is necessary to assess the contribution of alcohol to mortality from the
most common causes of death, such as coronary heart disease, atherosclerosis, liver disease
of non-alcoholic origin, as well as external cause of death.
Table 4. HLE at various ages depending on alcohol consumption type, 2018
Men Wome n
TLE, years HLE, years TLE, years HLE, years
Age abuse
alcohol
do not
abuse
alcohol
abuse
alcohol
do not
abuse
alcohol
abuse
alcohol
do not
abuse
alcohol
abuse
alcohol
do not
abuse
alcohol
0
(atbirth)
64.8 70.7 59 63.2 74.2 78.9 63.5 66.1
15 50.4 56.4 44.8 49.1 59.8 64.5 49.2 51.8
30 36.7 42.2 31.3 35.1 45.4 49.9 35.1 37.5
45 25.1 29.2 19.7 22.4 32.3 35.8 22.3 24
60 15.3 17.6 10.2 11.5 20.1 22.5 11.3 12.3
75 8.3 9.5 4.1 4.6 9.6 11.2 3.7 4.3
Source: author’s calculations based on the RLMS and Russian Fertility and Mortality Database data.
Population and Economics 4(3): 75–95 91
Gathering complete data on alcohol consumption is possible within population surveys.
Questions about alcohol consumption are asked in many of them, including RMLS—
HSE, Rosstat Comprehensive Survey of Living Conditions (CSLC) and the Population Di-
etary Structure Sample Survey. However, a formal question about the consumption of any
type of alcoholic beverages in the last 30 days is not sucient to calculate estimates of the
prevalence of a dangerous type of alcohol consumption. Alcohol is a complex commodity
the consumption of which is not always dangerous, therefore fundamentally dierent, for
example, from tobacco. Only the RLMS survey provides information sucient to esti-
mate the amount of alcohol consumed per month and the amount of alcohol consumed
on separate days (required to identify episodes of consumption of signicant amounts of
ethanol).
To collect complete information about alcohol consumption the author proposes to add
questions about consumption of the following alcoholic beverages to Rosstat surveys (the
list is compiled on the basis of the RLMS questionnaire):
• beer and brew (braga), including industrial beer and domestic beer;
• dry wine, champagne, homemade wine;
• fortied wine, including industrial production (martini, vermouth);
• alcoholic cocktails;
• strong alcoholic beverages including vodka, whisky, cognac, hooch;
• other alcoholic beverages.
Recommendation 2. An important direction to improve the situation is to reduce the
proportion of strong beverages in the structure of alcohol consumption both by competent
excise policy and by means of limiting physical availability of alcohol.
Modern studies suggest various ways to dene excessive alcohol consumption, but most
experts support the view that alcohol abusers include: (1) individuals consuming on average
high volumes of alcoholic beverages for a certain time period (e.g. within the last 30 days);
and (2) individuals who occasionally consume large volumes of alcohol. Both types of alco-
hol abuse are more common among consumers of strong alcoholic beverages; in Russia, it
is usually vodka.
Shiing alcohol consumption patterns towards less strong beverages (in particular, dry
wine and beer) can reduce the prevalence of excessive alcohol consumption, which, in turn,
will lead to a reduction in alcohol mortality and an increase in TLE. e main instrument of
government inuence on alcohol consumption patterns is the ratio of excise taxes on dier-
ent types of beverages and their binding to the quantitative content of ethanol.
Currently, the excise policy in the sphere of alcohol taxation in Russia is contradictory.
e rule of accounting for the strength of alcoholic beverages in the tax burden of is not
universal: excise taxes on strong beverages in ethanol equivalent are higher only for excise
taxes on wine, but not on beer. In addition, excise duty on vodka and other strong beverages
remains low in comparison with developed countries, where it signicantly impacts con-
sumption and forces the mass consumer to switch to drinks with less alcohol content.
For example, in 2019 excise tax on alcoholic products with a volume share of ethyl alcohol
over 9%, excluding beer, wines, etc. (i.e. the category of vodka and other strong drinks) was
523 rubles per 1 litre of anhydrous ethyl alcohol. For wine the excise was in the range of 5−18
rubles per 1 litre of drink, corresponding to 42−150 rubles in ethyl equivalent, for sparkling
wines— 14−36 rubles per 1 litre of drink or 117−300 rubles in ethyl equivalent. For beer of
a strength from 0.5 to 8.6% the excise duty was 21 rubles per litre of drink, i.e. for beer of
a strength of 4% the value of the excise in ethyl equivalent was 525 rubles. us, the excise
Kuznetsova PO: Alcohol mortality in Russia: assessment with representative survey data
92
duty on vodka is 1.5 to 3.5 times higher than on wine, and no dierent from the excise on
beer of medium strength.
In this regard, it is possible to recommend gradual indexation of excise taxes on strong
alcoholic beverages, with the rate outpacing the ination rate, as well as indexation of excise
taxes on other (less strong) types of beverages.
Recommendation 3. Eective law enforcement practices, including illegal alcohol traf-
cking and sustaining existing age restrictions, might reinforce the success of the state poli-
cy to limit alcohol consumption.
Currently in Russia there are many restrictions on consumption of alcoholic beverages,
and in such a situation the issue of eective enforcement becomes the priority. ere are a
number of dierent areas of alcohol policy, of which illegal consumption as well as obeying
existing age restrictions are the most relevant for the results of this study. However, it is
hardly possible to call Russian policy to reduce alcohol consumption eective (see this in
Grigoriev and Andreev 2015).
According to WHO estimates, Russia is the third country in Europe in terms of consump-
tion of illegal alcohol, which in 2016 amounted to 3.6 litres of ethanol per capita per year.
According to the state national project Demography, legal retail sales in 2016 amounted to
6.6 litres of ethanol per capita, and the proportion of illegal consumption is equal to about
30%, i.e. absolute illegal consumption is slightly lower than WHO estimates. In any case,
these are signicant volumes that are most likely to be located in regions where the popula-
tion is poorer and less likely to shop at large retail chains where the likelihood of encounter-
ing illegal alcohol is lower.
e modern structure of illegal consumption is dominated by products manufactured at
legal enterprises bypassing existing tax rules. e aim of the relevant departments and law
enforcement agencies is to eectively monitor the situation and to identify existing oences
in the retail of alcohol products.
Another task is the consistent enforcement of age restrictions in the alcohol sales. An
important trend in recent years has been the decline in alcohol consumption among young-
er age cohorts. One contributing factor was the change in the retail structure of alcoholic
beverages towards the growth of the share of large retail chains where it is more dicult for
minors to buy alcohol than in small outlets. Obeying the existing age limits will contribute
to increasing the age of drinking and will enable avoiding many of the dangers arising in
situations when children and adolescents prematurely gain access to alcohol.
Conclusion
Alcohol is an important factor in premature mortality in Russia, but it is not easy to estimate
the demographic losses occurring due to its consumption. e main reasons of this dicul-
ty occur to the facts, that moderate alcohol consumption does not necessary have negative
eects on health, and among the causes of alcohol mortality there are those related solely to
alcohol consumption and those only partially related to it. is study presents an attempt to
estimate alcohol-related mortality in its entirety.
According to the obtained estimates, in 2018 the number of alcohol-related deaths in
Russia amounted to 195.5 thousand people, including 145.7 thousand men and 49.7 thou-
sand women. e peak of alcohol mortality is observed among individuals aged 50 and older
(63% of all alcohol deaths among men and 72% among women).
Population and Economics 4(3): 75–95 93
e ocial statistics in Russia estimates the negative impact of alcohol basing on the
number of deaths related solely to alcohol, which leads to a signicant underestimation of
real demographic losses. According to the results of this study, the contribution of these
causes to the overall alcohol-related mortality is only 25% for both sexes.
e structure of alcohol mortality is dominated by diseases of the cardiovascular system
and external causes. ere is a certain gender specicity: for men, external causes dominate
the structure of alcohol mortality (40%), and cardiovascular diseases account for 31% of
all alcohol-related deaths, while for women cardiovascular diseases stand as a main cause
(47%), which is followed by external causes (23%). Liver and pancreatic diseases also con-
tribute signicantly to deaths caused by alcohol abuse— they account for 13 and 20% of
deaths among men and women, respectively. A more detailed study of the structure of al-
cohol mortality enables highlighting the following individual causes with the largest contri-
bution: alcoholic cardiomyopathy, accidental alcohol poisoning and suicides for men, and
atherosclerotic heart disease, acute myocardial infarction and non-alcoholic liver diseases
for women.
Excessive alcohol consumption has been shown to reduce life expectancy by 5.9 years for
men and by 4.7 years for women. Corresponding losses in healthy life expectancy are 4.2 and
2.6 years for men and women, respectively.
It should be noted that gender disparities reduce noticeably with the transition to HLE
indicators. e dierence in TLE between men and women with excessive alcohol consump-
tion in 2018 was over 9 years, while the dierence in HLE was only 4.5 years. Gender dier-
ences for a population with a safe type of alcohol consumption behave similarly. e author
tends to explain these discrepancies by the gender dierences in the health self-assessment:
women tend to state lower estimatesof their own health, which is particularly visible at older
ages.
e mortality tables calculated by the author for persons with excessive alcohol con-
sumption and the rest of the population can be used in insurance and actuarial calculations.
generally, the study has shown that a decrease in the prevalence of alcohol abuse can lead to
a signicant decrease in premature mortality and an increase in TLE and HLE.
Reference list
Andrienko YV, Nemtsov AV (2006) Estimation of individual demand for alcohol. Preprints from the
series “Scientic Proceedings of CEFRD and RES”. №89. (in Russian)
Bobak M, McKee M, Rose R, Marmot M (1999) Alcohol consumption in a national sample of the Rus-
sian population.Addiction94(6): 857–866. https://doi.org/10.1046/j.1360-0443.1999.9468579.x
Corrao G, Bagnardi V, Zambon A and La Vecchia C (2004) A meta-analysis of alcohol consump-
tion and the risk of 15 diseases. Preventive medicine38(5): 613–619. https://doi.org/10.1016/j.
ypmed.2003.11.027
Danilova I, Shkolnikov V, Andreev E and Leon DA (2020) e changing relation between alcohol and
life expectancy in Russia in 1965–2017. Drug Alcohol Rev. doi:10.1111/dar.13034.
Demographic Yearbook of Russia (2019) Stat. Comp. / D 31 Rosstat. (in Russian)
Denisova I (2010) Adult mortality in Russia.Economics of Transition 18(2): 333–363. https://doi.
org/10.1111/j.1468-0351.2009.00384.x
Kuznetsova PO: Alcohol mortality in Russia: assessment with representative survey data
94
Grigoriev P, Andreev E (2015) e huge reduction in adult male mortality in Belarus and Russia: Is it
attributable to anti-alcohol measures?PLoS one10(9): e0138021. https://doi.org/10.1371/journal.
pone.0138021
Griswold, MG, Fullman N, Hawley C et al. (2018) Alcohol use and burden for 195 countries and ter-
ritories, 1990–2016: a systematic analysis for the Global Burden of Disease Study 2016. e Lancet
392(10152), 1015-1035. https://doi.org/10.1016/S0140-6736(18)31310-2
Guérin S, Laplanche A, Dunant A and Hill C (2013) Alcohol-attributable mortality in France.e
European Journal of Public Health23(4): 588–593. https://doi.org/10.1093/eurpub/ckt015
Nemtsov A (2003) Alcohol consumption level in Russia: a viewpoint on monitoring health condi-
tions in the Russian Federation (RLMS). Addiction 98(3), 369. https://doi.org/10.1046/j.1360-
0443.2003.00322.x
Neufeld M, Rehm J (2013) Alcohol consumption and mortality in Russia since 2000: are there any
changes following the alcohol policy changes starting in 2006?Alcohol and Alcoholism48(2): 222–
230. https://doi.org/10.1093/alcalc/ags134
Parish WJ, Aldridge A, Allaire B et al. (2017) A new methodological approach to adjust alcohol expo-
sure distributions to improve the estimation of alcohol‐attributable fractions. Addiction 112(11),
2053-2063. https://doi.org/10.1111/add.13880
Plavinsky SL, Plavinskaya SI (2009) Alcohol consumption and mortality of men in a long prospective
st ud y. Bulletin of I.I. Mechnikov Northwestern State Medical University 1 (1): 69–73. https://doi.
org/10.1136/bmj.318.7200.1725 (in Russian)
Rehm J (2011) e risks associated with alcohol use and alcoholism.Alcohol Research & Health34(2):
135.
Rehm J, Baliunas D, Borges GL et al. (2010) e relation between dierent dimensions of alcohol con-
sumption and burden of disease: an overview.Addiction105(5): 817–843. https://doi.org/10.1111/
j.1360-0443.2010.02899.x
Rehm J, Gmel Sr GE, Gmel G et al. (2017) e relationship between dierent dimensions of alcohol
use and the burden of disease—an update.Addiction112(6): 968–1001. https://doi.org/10.1111/
add.13757
Rehm J, Shield KD (2014) Alcohol and mortality: global alcohol-attributable deaths from cancer, liver
cirrhosis, and injury in 2010.Alcohol research: current reviews35(2): 174.
Rehm J, Kehoe T, Gmel G et al. (2010b) Statistical modeling of volume of alcohol exposure for epide-
miological studies of population health: the US example. Population Health Metrics 8(1), 3. https://
doi.org/10.1186/1478-7954-8-3
Rey G, Boniol M, Jougla E (2010) Estimating the number of alcohol-attributable deaths: methodolog-
ical issues and illustration with French data for 2006. Addiction 105(6), 1018-1029. https://doi.
org/10.1111/j.1360-0443.2010.02910.x
Shield KD, Rehm J (2015) Russia-specic relative risks and their eects on the estimated alcohol-at-
tributable burden of disease.BMC Public Health15(1): 482. https://doi.org/10.1186/s12889-015-
1818-y
Taylor B, Rehm J (2012) e relationship between alcohol consumption and fatal motor vehicle injury:
high risk at low alcohol levels.Alcoholism: clinical and experimental research36(10): 1827–1834.
https://doi.org/10.1111/j.1530-0277.2012.01785.x
Wood AM, Kaptoge S, Butterworth AS et al. (2018) Risk thresholds for alcohol consumption: com-
bined analysis of individual-participant data for 599 912 current drinkers in 83 prospective studies.
e Lancet 391(10129), 1513-1523. https://doi.org/10.1016/S0140-6736(18)30134-X
World Health Organization (2019)Global status report on alcohol and health 2018. World Health
Organization.
Population and Economics 4(3): 75–95 95
Zaridze D, Brennan P, Boreham J et al. (2009) Alcohol and cause-specic mortality in Russia: a retro-
spective case–control study of 48 557 adult deaths.e Lancet373(9682): 2201–2214. https://doi.
org/10.1016/S0140-6736(09)61034-5
Zaridze D, Lewington S, Boroda A et al. (2014) Alcohol and mortality in Russia: prospective observa-
tional study of 151 000 adults.e Lancet383(9927): 1465–1473. https://doi.org/10.1016/S0140-
6736(13)62247-3
Zaridze D, Maximovitch D, Lazarev A et al. (2009b) Alcohol poisoning is a main determinant of re-
cent mortality trends in Russia: evidence from a detailed analysis of mortality statistics and au-
topsies.International journal of epidemiology38(1), 143–153. https://doi.org/10.1093/ije/dyn160
Zohoori N, Mroz TA, Popkin B et al. (1998) Monitoring the economic transition in the Russian Fed-
eration and its implications for the demographic crisis—the Russian Longitudinal Monitoring Sur-
vey. World Development 26(11), 1977-1993. https://doi.org/10.1016/S0305-750X(98)00099-0
Information about the author
Polina Olegovna Kuznetsova, Candidate of Economics, Senior Researcher at the Institute
of Social Analysis and Forecasting of RANEPA. E-mail: polina.kuznetsova29@gmail.com
Available via license: CC BY 4.0
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