Russian men, their vodka and early deaths

Currently, 25% of all Russian men die before the age of 55 years, compared with only 7% of UK men. The difference is due mostly to alcohol and cigarettes.

'Russian death rates have fluctuated wildly over the past 30 years as alcohol restrictions and social stability varied under Presidents Gorbachev, Yeltsin, and Putin, and the main thing driving these wild fluctuations in death was vodka,' says Professor Sir Richard Peto of the Clinical Trial Service Unit at the University of Oxford.

Professor Peto is part of the team that has now published two large studies of alcohol and death in Russia. The researchers come from the Russian Cancer Research Centre in Moscow, Oxford University, and the WHO International Agency for Research on Cancer (IARC) in France.

A retrospective study, reported five years ago in The Lancet, asked the families of 49,000 people who had died in three typical Russian cities (Barnaul, Byisk, and Tomsk) how much vodka the deceased person used to drink.

This new study, again published in The Lancet, asked 151,000 people how much vodka they drank, and then followed what happened to them for up to a decade. There were 8000 deaths among this large group of people over this period.

Both studies found much higher risks of death in men who drank three or more half-litre bottles of vodka a week than in men who drank less than one bottle a week.

The 20-year risks of death for smokers between ages 35–54 years were 35% for men who had reported drinking three or more bottles of vodka a week. It was 16% for men who had reported consuming less than one bottle a week.

The extra deaths seen among heavy drinkers were mainly from alcohol poisoning, accidents, violence, suicide, and eight particular categories of disease linked to alcohol (throat cancer, liver cancer, tuberculosis, pneumonia, pancreatitis, liver disease, a particular type of heart disease, and ill-specified medical conditions).

Dr Paul Brennan from IARC says the differences in death rates that the group observed must substantially underestimate the real hazards of persistent heavy drinking because some who said they were light drinkers later became heavy drinkers, and vice versa.

Death rates among adults under 55 in the UK have been declining steadily since 1980, mainly because so many people have stopped smoking. But death rates in Russia have fluctuated sharply, approximately in line with alcohol consumption.

For example, under alcohol restrictions introduced by Mikhail Gorbachev in 1985, alcohol consumption fell rapidly by around 25% and so did the death rates. When communism collapsed, consumption went up steeply and so did the death rates. More recently, since alcohol policy reforms were put in place in 2006, the consumption of spirits in Russia has fallen by about a third, and so has the risk of death before age 55 – although that risk is still substantial.

'The significant decline in Russian mortality rates following the introduction of moderate alcohol controls in 2006 demonstrates the reversibility of the health crisis from hazardous drinking,' says study leader Professor David Zaridze from the Russian Cancer Research Centre in Moscow. 'People who drink spirits in hazardous ways greatly reduce their risk of premature death as soon as they stop.'

Commenting on the study in a separate article in The Lancet, Dr Jürgen Rehm from the Centre for Addiction and Mental Health in Canada writes: 'On its own, the overall volume of alcohol consumed in Russia, albeit high, cannot explain the high alcohol attributable mortality; it is the combination of high overall volume with the specific pattern of episodic binges that is necessary to explain the high level and fluctuating trends of total and alcohol-attributed mortality in Russia.'

He adds: 'Since the average life expectancy from birth for men in Russia is still only 64 years, ranking among the lowest 50 countries in the world, more effective alcohol and tobacco policy measures are urgently needed.'