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

Abstract

Background: Russian adults have extraordinarily high rates of premature death. Retrospective enquiries to the families of about 50,000 deceased Russians had found excess vodka use among those dying from external causes (accident, suicide, violence) and eight particular disease groupings. We now seek prospective evidence of these associations.

Methods: In three Russian cities (Barnaul, Byisk, and Tomsk), we interviewed 200,000 adults during 1999-2008 (with 12,000 re-interviewed some years later) and followed them until 2010 for cause-specific mortality. In 151,000 with no previous disease and some follow-up at ages 35-74 years, Poisson regression (adjusted for age at risk, amount smoked, education, and city) was used to calculate the relative risks associating vodka consumption with mortality. We have combined these relative risks with age-specific death rates to get 20-year absolute risks.

Findings: Among 57,361 male smokers with no previous disease, the estimated 20-year risks of death at ages 35-54 years were 16% (95% CI 15-17) for those who reported consuming less than a bottle of vodka per week at baseline, 20% (18-22) for those consuming 1-2·9 bottles per week, and 35% (31-39) for those consuming three or more bottles per week; trend p<0·0001. The corresponding risks of death at ages 55-74 years were 50% (48-52) for those who reported consuming less than a bottle of vodka per week at baseline, 54% (51-57) for those consuming 1-2·9 bottles per week, and 64% (59-69) for those consuming three or more bottles per week; trend p<0·0001. In both age ranges most of the excess mortality in heavier drinkers was from external causes or the eight disease groupings strongly associated with alcohol in the retrospective enquiries. Self-reported drinking fluctuated; of the men who reported drinking three or more bottles of vodka per week who were reinterviewed a few years later, about half (185 of 321) then reported drinking less than one bottle per week. Such fluctuations must have substantially attenuated the apparent hazards of heavy drinking in this study, yet self-reported vodka use at baseline still strongly predicted risk. Among male non-smokers and among females, self-reported heavy drinking was uncommon, but seemed to involve similar absolute excess risks.

Interpretation: This large prospective study strongly reinforces other evidence that vodka is a major cause of the high risk of premature death in Russian adults.

Funding: UK Medical Research Council, British Heart Foundation, Cancer Research UK, European Union, WHO International Agency for Research on Cancer.

Figure 1

Prevalence of current smoking (%) in 151 811 participants versus mean vodka use self-reported at baseline Excludes people with no follow-up at ages 35–74 years or with evidence at baseline of pre-existing disease (self-reported cancer, myocardial infarction, angina, heart failure, rheumatic heart disease, stroke, diabetes, tuberculosis, liver cirrhosis, or chronic hepatitis) or who had already quit drinking or smoking due to illness. *Current drinkers were subdivided into prespecified categories of vodka consumption (for men <1, 1 to <3, ≥3 bottles per week, for women <0·25, 0·25 to <1, ≥1 bottle per week), but results are plotted against total consumption of alcohol, vodka or other, in units of 200 mL per week, as in table 1.

Figure 2

Mortality rates at ages 35–54 years and 55–74 years for causes prespecified as alcohol-related, other causes, and all causes, by vodka use self-reported at baseline in 57 361 male current smokers without previous disease The mortality rate in each 20-year age range is the mean of the four rates in the four 5-year age groups within that range, and the 20-year risk of death is conditional on reaching the start of the age range. Excludes people with no follow-up at ages 35–74 years or with evidence at baseline of pre-existing disease (self-reported cancer, myocardial infarction, angina, heart failure, rheumatic heart disease, stroke, diabetes, tuberculosis, liver cirrhosis, or chronic hepatitis) or who had already quit drinking or smoking because of illness. Causes prespecified as alcohol-related: external (includes assault, suicide, accident, alcohol poisoning, etc), liver diseases (neoplastic or not), upper aerodigestive cancer, tuberculosis, pneumonia, non-myocardial infarction acute ischaemic heart disease (ICD-10 I24), non-neoplastic pancreatic disease, and ill-defined causes. *Current drinkers were subdivided into prespecified categories of vodka consumption (for men <1, 1 to <3, ≥3 bottles per week), but results are plotted against total consumption of alcohol, vodka or other, in units of 200 mL per week, as in table 1.

Figure 3

All-cause mortality, males aged 15–54 years, in Russia from 1980–2012 and in the UK from 1980–2010 *Mean of male age-specific death rates in the eight component 5-year age groups (15–19 to 50–54 years). †Probability that a 15-year-old male individual would die before age 55 years, if exposed over next 40 years to male age-specific death rates of one particular calendar year.