More than Half of All Deaths in Russia among People Aged 15–54 Years Are Attributable to Alcohol

Both mortality rates and overall alcohol consumption have fluctuated sharply in Russia over the past 2 decades. In this case-control study, researchers analyzed death records of 48,557 men and women from 3 Russian cities who died between 1990–2001 to determine the effect of alcohol consumption on cause-specific mortality. Family members provided information on each subject’s alcohol consumption. Drinking categories were defined as <250 ml vodka per week, 250 to <500 ml per week, 500 ml to <1500 ml per week, and ≥1500 ml per week. Cases were defined a priori as those subjects who died from causes substantially related to alcohol or tobacco use. Controls were those who died from other causes.

• Alcohol was associated with 52% of deaths at ages 15– 54 and 18% of deaths at ages 55–74.

• Compared with men who drank <250 ml of vodka or its equivalent per week, the relative risks (RRs)* of death in men who drank ≥1500 ml per week were as follows:

       –  accidents, 5.9;
       –  alcohol poisoning, 21.7;
       –  acute ischemic heart disease other than myocardial infarction, 3.0;
       –  upper aerodigestive tract cancer, 3.5;
       –  liver cancer, 2.1;
       –  tuberculosis, 4.1;
       –  pneumonia, 3.3;
       –  liver disease, 6.2;
        –  pancreatic disease, 6.7; and
        –  ill-specified conditions, 7.7.

• Trends in risks were significant for these causes across drinking categories.

• Except for liver cancer, relative risks were even higher among women, with significant trends for all these causes except upper aerodigestive tract and liver cancer.

• These causes were the main source of recent fluctuations in overall mortality in Russia.

Comments:

Assuming a causal relationship and generalizability of these results, this study demonstrates how damaging alcohol can be in a heavy-drinking population, notably for young adults and by increasing the risk of violent death. Although researchers applied adequate methodology (i.e., blinding families to the study objectives and embedding questions about the subjects within questions about other family members), differential bias in exposure classification could be present. Nevertheless, these results indicate a large association between alcohol and mortality in Russia.

Nicolas Bertholet, MD, MPH

Reference:

Zaridze D, Brennan P, Boreham J, et al. Alcohol and cause-specific mortality in Russia: a retrospective case-control study of 48,557 adult deaths. Lancet. 2009;373 (9682):2201–2214.