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According to vast empirical evidence, excessive alcohol consumption is an important factor of premature mortality in Russia. At the same time, quantifying alcohol-related deaths is not so easy, as generally the discussion of alcohol mortality only concerns the causes of death attributed solely to alcohol, which significantly 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 consumption, 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 amounted to 196,000 people, 146,000 men and 50,000 women among them. The peak of alcohol mortality is observed among people aged over 50. The structure of alcohol mortality is dominated by diseases of the cardiovascular system and external causes, and for men the contribution of external causes is significantly 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.
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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:
assessmentwithrepresentative 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 signicantly 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-
nicantly 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 signicance 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. Oen, 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 dierent 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 dierent 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 dierent 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 briey 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, dened by triple-digit codes in the 10th revision of the
International Statistical Classication 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). Alcohols eect on mortality exceeded the negative
eects of tuberculosis (2.3%), HIV (1.8%), diabetes (2.8%), transport incidents (2.5%) and
violence (0.8%).
For the European region, the eects 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 signicant gender dierences 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
dierent 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 diculties 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 unclassied 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 signicant 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 dierent types of diseases
and external causes of death. e negative eects 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 reected 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 signicant 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 oen 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 signicant distortions of alcohol-induced mortality estimates, the rst
towards signicant 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 eect 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 eect— 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 eects of alcohol on mortality
continues, and some of the emerging estimates claim that there is no safe alcohol consumption
in terms of the eect on mortality. Specically, 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 eect 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 eects 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 signicant 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 oset 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 eect 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 identied 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-inicted 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 dened 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 signicant changes in the self-assessment
of alcohol consumption by respondents during the second round of the survey, which led to
a signicant 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 aected by excessive alcohol consumption— AAF (alcohol attributable fraction).
In order to take into account the eect 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 specically 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 denes 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
ofalcohol 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
ocial 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 populations 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; fortied wine (in-
cluding separately fortied 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 eects, are generally disapproved of in society. Second, respondents,
who oen 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 oen aects 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 dierences in average annual per capita alcohol consumption estimates
according to WHO statistics on recorded (accounted) and total (including unaccounted)
consumption and according to the authors 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 signicantly 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 scientic 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
(takingintoaccount
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-
nicantly 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
fortied 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 dierences 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 signicantly fall aer 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 dierent 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 signicantly
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 eect 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 rene the data on alcohol mortality in Russia signicantly.
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 aer the age of 80 among men and aer 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-
ure5. 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 oen, 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 dierent: 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 signicantly 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 dierent. 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 dierences 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 signicantly— 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, dierences 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 dierences 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 insucient 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 dierence 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 dierences 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 womens own health, especially in older ages (see Figure1). 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 womens 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 eects. 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 dicult 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 classication), 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 rened 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 dierent 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 signicantly 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 signicant 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 supercially. 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
(atbirth)
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 sucient 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 dierent, for
example, from tobacco. Only the RLMS survey provides information sucient 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 signicant 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;
fortied 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 dene 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.
Shiing 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 inuence on alcohol consumption patterns is the ratio of excise taxes on dier-
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 signicantly 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 dierent 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 ination rate, as well as indexation of excise
taxes on other (less strong) types of beverages.
Recommendation 3. Eective 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 eective enforcement becomes the priority. ere are a
number of dierent 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 eective (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 signicant 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 eectively monitor the situation and to identify existing oences
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 dicult 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 dicul-
ty occur to the facts, that moderate alcohol consumption does not necessary have negative
eects 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 ocial statistics in Russia estimates the negative impact of alcohol basing on the
number of deaths related solely to alcohol, which leads to a signicant 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 specicity: 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 signicantly 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 dierence in TLE between men and women with excessive alcohol consump-
tion in 2018 was over 9 years, while the dierence in HLE was only 4.5 years. Gender dier-
ences for a population with a safe type of alcohol consumption behave similarly. e author
tends to explain these discrepancies by the gender dierences 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 signicant decrease in premature mortality and an increase in TLE and HLE.
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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
... In 2016, Russian per capita alcohol consumption was estimated to be 11.7 L, surpassing the global average of 6.4 L [3], and caused 21.6% of all deaths in the country, double that of Europe [21]. In 2018, Russia recorded approximately 200,000 alcohol-related deaths [22], a quarter of which were directly attributed to alcohol, encompassing alcoholic cardiomyopathies, poisonings, and liver diseases. At the same time, 75% of these deaths were caused by cardiovascular disease, cancer, and other causes indirectly contributed to alcohol [23,24]. ...
... Targeted interventions have the potential to reduce mortality in such high-risk groups [41,42], but are rare due to limited knowledge about predictors of death among heavy drinkers except for alcohol consumption itself [43][44][45][46]. Recent advances in eHealth systems in Russia offer new opportunities for prospective studies on alcohol-related mortality and its determinants [22,[47][48][49][50], enabling the integration of individual health data with mortality registries [51]. ...
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Background Alcohol-related mortality in Russia exceeds the world average and presents a critical public health concern. This study assesses the impact of alcohol consumption levels on mortality and investigates mortality predictors among Russians, including people treated for alcohol-related diagnoses (narcology patients). Methods We examined 2629 men and women aged 35–69 years who participated in the Know Your Heart study (2015–17), Arkhangelsk, Russia. The participants were categorized into five drinking levels (non-drinking, low-risk, hazardous, harmful, narcology patients) and followed up using a regional mortality database. We used Cox proportional hazards regressions to analyze sociodemographic and cardiovascular biomarkers as mortality predictors among narcology patients and general population and to compare mortality risks across the five drinking levels. Results During a median follow-up of 6.3 years, 223 (8.5%) participants died. Age- and sex-standardized all-cause mortality rates per 100,000 person-years were 1229 (95% CI: 691–1767) in non-drinking participants, 890 (95%CI: 684–1096) and 877 (95%CI: 428–1325) in low-risk and hazardous drinking participants, 2170 (95%CI: 276–4064) in those with harmful drinking, and 4757 (95%CI: 3384–6131) in narcology patients. The largest proportions of deaths were caused by cardiovascular diseases (37.2%), neoplasms (20.2%), and external causes (13.9%). Compared with low-risk drinkers, narcology patients had higher risks of death with hazard ratios of 3.23 (95%CI: 2.02–5.16) for all-cause mortality, 3.25 (95%CI: 1.52–6.92) for cardiovascular diseases, 9.36 (95%CI: 2.63–33.3) for external causes, and 7.79 (95%CI: 3.34–18.1) for other causes. Neoplasm-related mortality did not differ between groups. All-cause mortality in the general population had positive associations with smoking, waist-to-hip ratio, resting heart rate, systolic blood pressure, high-sensitivity C-reactive protein, and negative associations with left ventricular ejection fraction (LVEF) and higher education. These associations were substantially weaker and non-significant in narcology patients. Cardiovascular mortality in narcology patients was increased with higher education, while male sex, LVEF and N-terminal prohormone of brain natriuretic peptide had less impact compared to the general population sample. Conclusion Narcology patients face markedly higher mortality risks—threefold from all causes and cardiovascular diseases, ninefold from external causes, and sevenfold from other causes. Compared with the general population, conventional mortality risk factors were less predictive of deaths in narcology patients.
... Данная проблема имеет важное значение и для России, где 12 % населения страдают расстройствами, связанными с употреблением алкоголя, что почти вдвое выше среднего по Европе [2,3]. При этом показатели обусловленной алкоголем смертности в России остаются одними из самых высоких в мире [1,3,4], унося жизни 200 тысяч россиян в год [5]. ...
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Aim. To assess the association between levels of alcohol consumption and lipid metabolism parameters among adult men. Materials and methods. The study included 881 men aged 35–69 from the general population of Arkhangelsk, who participated in the 2015–17 Know Your Heart study, and 161 men who received inpatient treatment for alcohol-related diagnoses (narcology patients). Participants were divided into five levels of alcohol consumption: non-drinkers, non-problem (infrequent moderate consumption), hazardous (frequent consumption in doses hazardous to health), harmful (prenosological), and narcology patients. Using multivariate linear regressions, we analyzed differences between these groups in atherogenic lipid fractions (total cholesterol [TC], triglycerides [TG], low-density lipoprotein [LDL], apolipoprotein B [ApoB], remnant cholesterol, and non-HDL cholesterol, lipoprotein(a)) (Lp(a)), antiatherogenic lipid fractions (high-density lipoprotein [HDL], apolipoprotein A1 [апо A1]), and in ApoB/апо A1 ratio. Results. Compared with non-problem drinkers, hazardous drinkers had higher mean levels of HDL by 0.22 mmol/L, HDL by 0.07 mmol/L, and ApoB by 0.04 g/L. Among harmful drinkers, mean HDL was higher by 0.15 mmol/L and апо A1 by 0.08 g/L, but the ApoB/апо A1 ratio was lower by 0.06. Among narcology patients, mean TC levels were lower by 0.42 mmol/L, LDL by 0.41 mmol/L, ApoB by 0.09 g/L, ApoB/апо A1 by 0.08, and non-HDL by 0.45 mmol/L, but TG was higher by 0.15 mmol/L. Lp(a) in this group was higher by 0.29 mg/dl only after adjustment for markers of liver function. Non-drinkers had on average lower levels of TC by 0.29 mmol/L, HDL by 0.11 mmol/L, and апо A1 by 0.08 g/L. Conclusions. Compared with non-problem drinkers, hazardous drinkers had elevated levels of both atherogenic and antiatherogenic lipid fractions, hazardous drinkers had only elevated levels of antiatherogenic fractions, and narcology patients had the lowest levels of atherogenic lipid fractions but elevated TG levels. Therefore, lipid profiles may reflect the level of alcohol consumption, which should be taken into account when assessing cardiovascular risk.
... В частности, в России, по мнению экспертов, доля смертей, связанных с табаком, составляла 23% у мужчин и 2% у женщин [4]. Существуют значительные риски алкогольной смертности, пик которой приходится на возраст 50 лет и старше, алкоголь был непосредственной причиной около 160 000 смертей в 2018 г. [5]. Результаты статистического анализа подтвердили негативное воздействие алкоголизма и наркомании на здоровье и, как следствие, на ожидаемую продолжительность (и качество) жизни. ...
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Introduction. Based on the available data, the main practices of self-preservation behavior of the population 15 years and older are studied. An individual’s self-preservation behavior is considered in two main areas: everyday life - behavior for preventing illness and during illness (contacting a medical professional). Materials and methods. State statistics data were used as an empirical basis; results of selective monitoring of the population’s health status for the period from 2019 to 2023; database of the Russian Monitoring of Economics and Health (RLMS-HSE) for the period from 1994 to 2022. The data made it possible to consider the problem of self-preservation behavior in dynamics and in the context of socio-demographic groups. Results. In Russia, there are few people with a high commitment to a healthy life: 7.0% of men and 10.9% of women. Few people eat enough fruits and vegetables every day: 14.2% of the population (2022 - 12.0%), rural population - 15.9%, urban population - 13.6%. There are regional differences in the consumption of fruits and vegetables, which may be related to the availability and eating habits of the population. In some types of behavior, people began to behave more responsibly. The majority of the population (68.8%) do not smoke and have not smoked before; 12.3% have quit smoking. For women, the dynamics have not changed over 26 years, but men began to smoke 18.6% less. Alcohol consumption has decreased significantly; representatives of the 35-54 year old group (every tenth) consume it more often. Positive dynamics in physical activity; currently, more than half of citizens are systematically involved in physical culture and sports - 56.8% (according to the Ministry of Sports). In case of health problems, one third of Russians (37.8% of men and 39.5% of women) went to a polyclinic, to a doctor, the majority treated themselves, the situation worsened with the onset of the pandemic in 2020. Conclusion. In general, the behavior of the population for the purpose of health prevention has a positive trend, but remains at a low level and cannot make a significant contribution to improving the health of the population. At the same time, population activity during the period of illness also remains at a low level, and there is no positive dynamics. Against the backdrop of increasing morbidity, more than half of citizens do not consult a doctor during illness and engage in self-treatment.
... Клинически значимая кардиомиопатия обычно развивается после длительного чрезмерного употребления алкоголя, особенно у генетически предрасположенных пациентов [49,50]. Широко распространено мнение, что умеренное потребление алкоголя безвредно, а некоторые эпидемиологические исследования показывают, что риски ССЗ среди умеренных потребителей алкоголя ниже, чем среди тех, кто никогда его не употреблял [51]. Однако предполагаемые кардиопротективные эффекты низких доз не были подтверждены рядом исследований. ...
... Проблема небезопасного употребления алкоголя является социально значимой во всем мире, поскольку затрагивает наиболее трудоспособную и экономически активную часть населения (Formánek, Krupchanka, Mladá, Winkler & Jones, 2022;Kuznetsova, 2020;Воеводин, Пешковская, Галкин, Белокрылов, 2020). В данной работе впервые показано, что уязвимость исполнительных функций у людей с алкогольной зависимостью ассоциирована с продолжительностью злоупотребления алкоголем и темпом формирования зависимости. ...
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Introduction. Executive functions are multidimensional cognitive processes that provide organization and regulation of behavior. Impairments in executive functions are considered to be a risk factor for addiction, including alcohol dependence. However, it is not clear which domains of executive functions are the most vulnerable and how their changes relate to progression to addiction. Methods. A total of 244 individuals with different alcohol consumption experiences (78 with safe alcohol consumption and 166 with diagnosed alcohol dependence) participated in this study. Executive functions were investigated with the Go/No-Go task, the Simon Test, the Wisconsin Card Sorting Test, and the Corsi Block-Tapping Test, implemented in a computerized version on the Cognitive Symphony platform (Russia). In participants with alcohol dependence, data on dependence duration, remission duration, and treatment courses were also considered. Results of the study showed that participants with alcohol dependence had significantly lower outcomes of executive cognition performance than those who practiced safe alcohol consumption. In particular, alcohol-dependent participants performed worse in cognitive control task (p = 0.0001), attention task (p = 0.026), and cognitive flexibility task (p = 0.006 and p = 0.040). Working memory was also found to be vulnerable, with all alcohol-dependents who performed with lower working memory span compared to participants with safe alcohol consumption (p = 0.044). Subsequent regression analysis showed that cognitive control errors and cognitive flexibility errors in individuals with alcohol dependence were associated with years of alcohol abuse (p < 0.01). In addition, the higher rate of progression to alcohol dependence, the more vulnerable was working memory (p = 0.002559). Discussion. The study showed that executive cognition vulnerability in people with alcohol dependence was associated with alcohol abuse duration and dependence progression rate. The study results may contribute to intervention programs that target executive cognitive functions in alcohol addicts and those at high risk for alcohol dependence.
... Alcohol consumption remains a leading behavioral health risk factor worldwide. It makes a significant contribution to incidence [1,2] and preventable mortality [3,4] as per many nosologies. According to the Global Strategy to Reduce the Harmful Use of Alcohol issued by the World Health Organization (WHO) as far back as in 2010, prevention and reductions of harmful use of alcohol should become a top priority of public healthcare both in developed and developing countries 1 . ...
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In this study, we have estimated alcohol consumption and alcohol-associated incidence in the RF regions in the ‘before crisis’ (2017–2019) and ‘crisis’ (2020–2022) periods. We identified types of the RF regions using hierarchical cluster analysis (Ward’s method) and relying on indirect indicators of alcohol consumption. As a result, we established considerable differences between the macro-regions (the Federal Districts) and RF regions as per alcohol consumption and severity of its outcomes. Poles in this differentiation are represented by ‘favorable’ regions in the Southern Russia where alcohol sales, alcohol-associated crime and incidence are low and ‘unfavorable’ regions located in the Far East and southern Siberia where alcohol-associated crime and incidence are high. We have shown in this study that retail alcohol sales cannot be considered a sufficient indicator to describe alcohol use in a given region. Thus, considerable volumes of alcohol sales involve severe socially significant outcomes in some regions (for example, the Khabarovsk region and Primorye) whereas such outcomes do not occur in other regions with similarly high alcohol sales (Moscow, Saint Petersburg, the Moscow region and the Leningrad region). The level of socioeconomic welfare on a given territory is confirmed as a significant determinant of alcohol consumption. We have also analyzed a correlation between economic vulnerability of RF regions during the ‘pandemic’ and ‘sanction’ crises and levels of alcohol consumption. The analysis revealed that large industrial regions, though expected to be vulnerable, turned out to be quite stable (it is probable due to delayed macroeconomic effects). We have not been able to identify any resources of improving a tense situation with alcohol consumption in economically unfavorable but less vulnerable subsidized agricultural regions. In general, the crisis period of 2020–2022 can be considered a source of additional health risks for the population in the RF regions where the situation with alcohol consumption was rather unfavorable in the ‘before crisis’ period.
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Background: Acute poisoning of chemical etiology is currently a significant socio-economic and medical problem. It is a leading cause of high morbidity and premature mortality among the economically active population. Objectives: This study aimed to analyze the medical and social characteristics of toxicological patients. Methods: The study was conducted on 100 patients with acute chemical poisoning treated at the Specialized Toxicology Centre in Saint Petersburg. Data were collected by copying material from medical records and conducting a survey among patients. The data were then assessed using statistical methods. Results: In the studied group of toxicological patients, the majority (62.0%) were men. Age distribution showed that most patients (62.0%) were between 20 - 40 years old. More than half (55.0%) were unemployed, and only 25.0% were married. Analysis of the patient distribution by diagnosis showed that a large proportion (44.0%) had been poisoned with drugs, 26.0% with medications, 17.0% with ethanol, 11.0% with psychotropic drugs, and 2.0% with other substances. The main causes of poisoning were drug overdose (44.0%), self-medication (26.0%), and intoxication (21.0%). One-third of the patients (33.0%) had a concomitant viral infection. Additionally, 37.0% of patients consumed alcohol more than once a week, and half of the patients (50.0%) associated drinking alcohol with relaxation and pleasure. The largest proportion of patients (56.0%) did not engage in sports or other forms of physical activity at home. Conclusions: Analysis of the medical and social characteristics of toxicological patients indicates a need for public hygiene education measures to promote social competence and cultivate a negative attitude towards harmful factors affecting health.
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Since the mid-nineties of this century, Russia has intensified its state policy of combating excessive alcohol consumption. In particular, a minimum price threshold for vodka was introduced, excise taxes on alcohol in alcoholic beverages were substantially increased, and a mandatory ban on nighttime retail sales was introduced. A number of studies using Russian microdata have confirmed the effectiveness of these measures. From 2007 to 2017, the dynamics of alcohol consumption by the Russian population did show a consistent decline. Many researchers, both Russian and foreign, considered this trend as a success of government policy. Recently, however, official statistics have noted an annual increase in the consumption of alcoholic beverages: from 7.2 liters of pure alcohol per capita adult population in 2017 to 7.7 in 2021. Why has the alcohol policy, designed initially in line with international best practices, not reduced consumption in recent years? This article analyzes the practice of applying price and restrictive measures for the last 10 years on the basis of Rosstat data, federal and regional legislation. Excise duties and minimum vodka prices in real terms are calculated, as well as indices of the ratio of alcoholic beverage prices and average wages. The real excise taxes and prices for alcoholic beverages decreased after 2014, making them more affordable for consumers. After 2017, there is no increase in the number of Russian territories applying stricter temporary restrictions on alcohol trade compared to the norm of the federal law. Today, almost half of the country’s population lives in regions with the mildest possible time limits on alcohol sales that do not constrain its physical availability. We have to admit that the alcohol policy is inconsistent. The formal application of price and restrictive measures in the last decade has not prevented the growth of alcohol consumption.
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Objectives The study seeks to identify the impact of smoking, sports participation, and alcohol consumption on life expectancy of men and women in Russian regions. Study design We use official data for 2014–2020 for 77 Russian regions. We estimate factors related to life expectancy separately for men and women to account for differences in their life expectancy and lifestyles. Methods We run fixed-effect models to estimate regional life expectancy depending on smoking, alcohol consumption, sport participation, healthcare characteristics, and demographical and economic factors. Results Life expectancy was negatively associated with alcohol consumption and smoking and positively with sport participation: a 1-L increase in alcohol consumption was attributed to a 1.6-month decrease in male life expectancy and to a 1.8-month decrease in female life expectancy. If the proportion of smoking women was halved, the increase in woman's life expectancy would be 4.6 months. If sports participation rates were doubled for men and women, the expected increase in their life expectancy would be 1 and 0.9 years, respectively. Other factors attributed to life expectancy were settlement type, income inequality, characteristics of regional healthcare systems, and the COVID-19 pandemic. Conclusion We find significant variation in life expectancy across Russian regions that can be partly explained by unhealthy lifestyles. We suggest that policies aimed at improving national health in diverse countries such as Russia adjust healthy lifestyle measures to the needs of particular region.
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Introduction and aims: In the 1990s, a strong inverse relationship between life expectancy (LE) in Russia and mortality from alcohol poisoning was observed. This association is remarkable as this cause accounts for less than 2% of deaths each year. It can be explained by treating the alcohol poisoning mortality as the best available measure in Russia of the population prevalence of harmful drinking in any year which in turn associated with mortality from a wide range of causes. This study analyses the evolving relationship of LE with this mortality-based measure of harmful drinking since 1965, and places it in a policy context. Design and methods: We examine three periods: 1965-1984, a period of gradual LE decline; 1984-2003, a period of massive LE fluctuations; and 2003-2017, a period of LE improvement. Pearson's correlation coefficients and a linear relationship between annual changes in LE and alcohol poisoning were estimated for each period. Results: The strongest negative correlation between changes in LE and alcohol poisonings was found in 1984-2003. Over the period 2003-2017 a consistent positive LE trend emerged that was statistically independent of alcohol poisoning. Discussion and conclusions: These results suggest that in the period from the mid-2000s a growth of LE in Russia was to a large extent independent of changes in the population prevalence of harmful drinking. While there has been a reduction in mortality at ages 15-64, at older ages mortality reduction unrelated to alcohol has become an increasingly important driver of overall mortality improvements.
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Background: Alcohol use is a leading risk factor for death and disability, but its overall association with health remains complex given the possible protective effects of moderate alcohol consumption on some conditions. With our comprehensive approach to health accounting within the Global Burden of Diseases, Injuries, and Risk Factors Study 2016, we generated improved estimates of alcohol use and alcohol-attributable deaths and disability-adjusted life-years (DALYs) for 195 locations from 1990 to 2016, for both sexes and for 5-year age groups between the ages of 15 years and 95 years and older. Methods: Using 694 data sources of individual and population-level alcohol consumption, along with 592 prospective and retrospective studies on the risk of alcohol use, we produced estimates of the prevalence of current drinking, abstention, the distribution of alcohol consumption among current drinkers in standard drinks daily (defined as 10 g of pure ethyl alcohol), and alcohol-attributable deaths and DALYs. We made several methodological improvements compared with previous estimates: first, we adjusted alcohol sales estimates to take into account tourist and unrecorded consumption; second, we did a new meta-analysis of relative risks for 23 health outcomes associated with alcohol use; and third, we developed a new method to quantify the level of alcohol consumption that minimises the overall risk to individual health. Findings: Globally, alcohol use was the seventh leading risk factor for both deaths and DALYs in 2016, accounting for 2·2% (95% uncertainty interval [UI] 1·5-3·0) of age-standardised female deaths and 6·8% (5·8-8·0) of age-standardised male deaths. Among the population aged 15-49 years, alcohol use was the leading risk factor globally in 2016, with 3·8% (95% UI 3·2-4·3) of female deaths and 12·2% (10·8-13·6) of male deaths attributable to alcohol use. For the population aged 15-49 years, female attributable DALYs were 2·3% (95% UI 2·0-2·6) and male attributable DALYs were 8·9% (7·8-9·9). The three leading causes of attributable deaths in this age group were tuberculosis (1·4% [95% UI 1·0-1·7] of total deaths), road injuries (1·2% [0·7-1·9]), and self-harm (1·1% [0·6-1·5]). For populations aged 50 years and older, cancers accounted for a large proportion of total alcohol-attributable deaths in 2016, constituting 27·1% (95% UI 21·2-33·3) of total alcohol-attributable female deaths and 18·9% (15·3-22·6) of male deaths. The level of alcohol consumption that minimised harm across health outcomes was zero (95% UI 0·0-0·8) standard drinks per week. Interpretation: Alcohol use is a leading risk factor for global disease burden and causes substantial health loss. We found that the risk of all-cause mortality, and of cancers specifically, rises with increasing levels of consumption, and the level of consumption that minimises health loss is zero. These results suggest that alcohol control policies might need to be revised worldwide, refocusing on efforts to lower overall population-level consumption. Funding: Bill & Melinda Gates Foundation.
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Background Low-risk limits recommended for alcohol consumption vary substantially across different national guidelines. To define thresholds associated with lowest risk for all-cause mortality and cardiovascular disease, we studied individual-participant data from 599 912 current drinkers without previous cardiovascular disease. Methods We did a combined analysis of individual-participant data from three large-scale data sources in 19 high-income countries (the Emerging Risk Factors Collaboration, EPIC-CVD, and the UK Biobank). We characterised dose–response associations and calculated hazard ratios (HRs) per 100 g per week of alcohol (12·5 units per week) across 83 prospective studies, adjusting at least for study or centre, age, sex, smoking, and diabetes. To be eligible for the analysis, participants had to have information recorded about their alcohol consumption amount and status (ie, non-drinker vs current drinker), plus age, sex, history of diabetes and smoking status, at least 1 year of follow-up after baseline, and no baseline history of cardiovascular disease. The main analyses focused on current drinkers, whose baseline alcohol consumption was categorised into eight predefined groups according to the amount in grams consumed per week. We assessed alcohol consumption in relation to all-cause mortality, total cardiovascular disease, and several cardiovascular disease subtypes. We corrected HRs for estimated long-term variability in alcohol consumption using 152 640 serial alcohol assessments obtained some years apart (median interval 5·6 years [5th–95th percentile 1·04–13·5]) from 71 011 participants from 37 studies. Findings In the 599 912 current drinkers included in the analysis, we recorded 40 310 deaths and 39 018 incident cardiovascular disease events during 5·4 million person-years of follow-up. For all-cause mortality, we recorded a positive and curvilinear association with the level of alcohol consumption, with the minimum mortality risk around or below 100 g per week. Alcohol consumption was roughly linearly associated with a higher risk of stroke (HR per 100 g per week higher consumption 1·14, 95% CI, 1·10–1·17), coronary disease excluding myocardial infarction (1·06, 1·00–1·11), heart failure (1·09, 1·03–1·15), fatal hypertensive disease (1·24, 1·15–1·33); and fatal aortic aneurysm (1·15, 1·03–1·28). By contrast, increased alcohol consumption was log-linearly associated with a lower risk of myocardial infarction (HR 0·94, 0·91–0·97). In comparison to those who reported drinking >0–≤100 g per week, those who reported drinking >100–≤200 g per week, >200–≤350 g per week, or >350 g per week had lower life expectancy at age 40 years of approximately 6 months, 1–2 years, or 4–5 years, respectively. Interpretation In current drinkers of alcohol in high-income countries, the threshold for lowest risk of all-cause mortality was about 100 g/week. For cardiovascular disease subtypes other than myocardial infarction, there were no clear risk thresholds below which lower alcohol consumption stopped being associated with lower disease risk. These data support limits for alcohol consumption that are lower than those recommended in most current guidelines. Funding UK Medical Research Council, British Heart Foundation, National Institute for Health Research, European Union Framework 7, and European Research Council.
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Alcohol consumption has long been recognized as a risk factor for mortality. By combining data on alcohol per capita consumption, alcohol-drinking status and alcohol-drinking patterns, risk relationships, and mortality, the Comparative Risk Assessment Study estimated alcohol-attributable mortality for 1990 and 2010. Alcohol-attributable cancer, liver cirrhosis, and injury were responsible for the majority of the burden of alcohol-attributable mortality in 1990 and 2010. In 2010, alcohol-attributable cancer, liver cirrhosis, and injury caused 1,500,000 deaths (319,500 deaths among women and 1,180,500 deaths among men) and 51,898,400 potential years of life lost (PYLL) (9,214,300 PYLL among women and 42,684,100 PYLL among men). This represents 2.8 percent (1.3 percent for women and 4.1 percent for men) of all deaths and 3.0 percent (1.3 percent for women and 4.3 percent for men) of all PYLL in 2010. The absolute mortality burden of alcohol-attributable cancer, liver cirrhosis, and injury increased from 1990 to 2010 for both genders. In addition, the rates of deaths and PYLL per 100,000 people from alcohol-attributable cancer, liver cirrhosis, and injury increased from 1990 to 2010 (with the exception of liver cirrhosis rates for women). Results of this paper indicate that alcohol is a significant and increasing risk factor for the global burden of mortality.
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Background and aim: Harmful alcohol consumption has long been recognized as being the major determinant of male premature mortality in the European countries of the former USSR. Our focus here is on Belarus and Russia, two Slavic countries which continue to suffer enormously from the burden of the harmful consumption of alcohol. However, after a long period of deterioration, mortality trends in these countries have been improving over the past decade. We aim to investigate to what extent the recent declines in adult mortality in Belarus and Russia are attributable to the anti-alcohol measures introduced in these two countries in the 2000s. Data and methods: We rely on the detailed cause-specific mortality series for the period 1980-2013. Our analysis focuses on the male population, and considers only a limited number of causes of death which we label as being alcohol-related: accidental poisoning by alcohol, liver cirrhosis, ischemic heart diseases, stroke, transportation accidents, and other external causes. For each of these causes we computed age-standardized death rates. The life table decomposition method was used to determine the age groups and the causes of death responsible for changes in life expectancy over time. Conclusion: Our results do not lead us to conclude that the schedule of anti-alcohol measures corresponds to the schedule of mortality changes. The continuous reduction in adult male mortality seen in Belarus and Russia cannot be fully explained by the anti-alcohol policies implemented in these countries, although these policies likely contributed to the large mortality reductions observed in Belarus and Russia in 2005-2006 and in Belarus in 2012. Thus, the effects of these policies appear to have been modest. We argue that the anti-alcohol measures implemented in Belarus and Russia simply coincided with fluctuations in alcohol-related mortality which originated in the past. If these trends had not been underway already, these huge mortality effects would not have occurred.
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