Alcohol, pattern of drinking and all-cause mortality in Russia, Belarus and Hungary: A retrospective indirect cohort study based on mortality of relatives

Abstract

Aims This study investigated the relationship between alcohol consumption and mortality among males and females in three Eastern European countries. Specifically, the study examined the role of drinking frequency, the mortality risk which is posed by the combination of frequent drinking, binge drinking and other hazardous drinking habits, and whether the associations were similar across countries. Methods We conducted an indirect retrospective cohort study, in which the analytical cohort consisted of close relatives of participants in population surveys in selected middle-sized settlements in Russia, Belarus and Hungary. Survey respondents provided information on their mothers, fathers, siblings and partners of female respondents. This information included current vital status and dates of birth and death, alcohol consumption, tobacco smoking and socioeconomic status. Alcohol consumption indices, reported by survey participants, included drinking frequency, binge drinking and hazardous drinking (consuming non-beverage and/or illicitly-produced alcohol and/or heavy drinking over several days [zapoi]). Overall, the analyses included 124,150 men and women were aged 35–69 years in 1998 and followed-up until 2013. The information on vital status and dates of birth and death was used to estimate survival in the cohort of relatives. Findings Drinking frequency was positively associated with mortality in all three countries and both genders. At each drinking frequency level, mortality risk increased among those who also engaged in binge and/or hazardous drinking. Regular male drinkers who were also binge drinkers and hazardous drinkers had the highest risk of death; their hazard ratios (HR), compared to non-binge-non-hazardous occasional drinkers, were 2.56 [95% CI 2.27–2.88], 2.14 [1.84–2.48] and 2.11 [1.90–2.35] in Russia, Belarus and Hungary, respectively. In women, the corresponding HRs (using a lower frequency cut-off) were 2.86 [1.99–4.12] in Russia, 3.44 [2.17–5.44] in Belarus and 3.01 [2.26–4.01] in Hungary. Conclusions Consistently across countries and sexes, the increased mortality risk was concentrated among frequent drinkers who also engaged in binge and hazardous drinking. Binge and hazardous drinking patterns are important for understanding the relationship between alcohol and high mortality in Eastern European populations.