Abstract
IntroductionRussia has experienced massive fluctuations in mortality at working ages over the past three decades. Routine data analyses suggest that these are largely driven by fluctuations in heavy alcohol drinking. However, individual-level evidence supporting alcohol having a major role in Russian mortality comes from only two case-control studies, which could be subject to serious biases due to their design.Methods and FindingsA prospective study of mortality (2003–9) of 2000 men aged 25–54 years at recruitment was conducted in the city of Izhevsk, Russia. This cohort was free from key limitations inherent in the design of the two earlier case-control studies. Cox proportional hazards regression was used to estimate hazard ratios of all-cause mortality by alcohol drinking type as reported by a proxy informant. Hazardous drinkers were defined as those who either drank non-beverage alcohols or were reported to regularly have hangovers or other behaviours related to heavy drinking episodes.Over the follow-up period 113 men died. Compared to non-hazardous drinkers and abstainers, men who drank hazardously had appreciably higher mortality (HR = 3.4, 95% CI 2.2, 5.1) adjusted for age, smoking and education. The population attributable risk percent (PAR%) for hazardous drinking was 26% (95% CI 14,37). However, larger effects were seen in the first two years of follow-up, with a HR of 4.6 (2.5, 8.2) and a corresponding PAR% of 37% (17, 51).InterpretationThis prospective cohort study strengthens the evidence that hazardous alcohol consumption has been a major determinant of mortality among working age men in a typical Russian city. As such the similar findings of the previous case-control studies cannot be explained as artefacts of limitations of their design. As Russia struggles to raise life expectancy, which even in 2009 was only 62 years among men, control of hazardous drinking must remain a top public health priority.
Highlights
Russia has experienced massive fluctuations in mortality at working ages over the past three decades
[1] The mortality fluctuations have been due to a wide range of causes including circulatory, respiratory and digestive diseases as well as those directly related to alcohol such as acute alcohol poisoning. Analysis of these routinely collected mortality data alongside information about patterns and levels of alcohol consumption has led to the conclusion that these fluctuations have been largely, if not entirely, driven by parallel fluctuations in heavy alcohol drinking among people of workingage. [2]
In 2007 the Izhevsk Family Study estimated that 43% of deaths among men aged 25–54 years could be attributed to hazardous alcohol drinking [3]; in 2009, a study of a larger number of deaths at working ages in Barnaul, Siberia, concluded that half of all deaths could be attributed to alcohol
Summary
Russia has experienced massive fluctuations in mortality at working ages over the past three decades. Individual-level evidence supporting alcohol having a major role in Russian mortality comes from only two case-control studies, which could be subject to serious biases due to their design. [1] The mortality fluctuations have been due to a wide range of causes including circulatory, respiratory and digestive diseases as well as those directly related to alcohol such as acute alcohol poisoning Analysis of these routinely collected mortality data alongside information about patterns and levels of alcohol consumption has led to the conclusion that these fluctuations have been largely, if not entirely, driven by parallel fluctuations in heavy alcohol drinking among people of workingage. Selection bias may be introduced because the drinking behaviour of the control series may not be representative of that in the population from which the case series comes Both biases could result in either under or overestimation of the strength of effect
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