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Thaksaphon Thamarangsi

Alcohol and Russian Mortality: a continuing

crisis

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Input

• Alcohol and Russian Mortality: a continuing crisis: David Leon, et al. Addiction, 104, 2009

• Alcohol is themain cause of the high rates and rapid fluctuations of premature adult mortality in Russia: Richard Peto (proceeding doc) from the Global Expert Meeting on Alcohol Health and Social Develolment, Sweden 2009

• Alcohol and Global BODI focussing on infectious diseases: Jurgen Rehm (proceeding doc) from the Global Expert Meeting on Alcohol Health and Social Develolment, Sweden 2009

• WHO alcohol database

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Russia: Why important?

• High APC• Harmful drinking pattern• High alcohol attributable health burden

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Introduction• Life Expectance at birth: Low and fluctuated• remarkable gender difference• Early childhood and elderly mortalities: stable/decrease• Alcohol= most plausible, proximal explanation for the

fluctuation, while smoking and health care system help explaining the low LE.

• Trends in alcohol consumption mirror these fluctuation

The decrease in adult per capita consumption by 25%, from 14.2 to 10.5 Litre between 1984 and1987, promotes three more life expectancy years. After consumption volume rebounded back to its former level in five years later, life expectancy also returned to its initial figure. When consumption further increased to 15.0 litres per capita in 2001, moreover, an additional drop in male life expectancy was evident.

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Negative population growth

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Life Expectancy at birth

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Early childhood and elderly mortality

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Mortality rates comparison Russia-Western Europe

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Does alcohol consumption mirror mortality?

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1981 1983 1985 1987 1989 1991 1993 1995 1997 1999 2001 2003

Recorded APC

All causes mortality 25-54 yo M

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Percentage of death and DALYs attributable to alcohol and tobacco by age group:

Thailand 2004

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0-4 5-14 15-29 30-44 45-59 60-69 70-79 80+

Death alcohol

Death tobacco

DALYs alcohol

DALYs tobacco

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Alcohol-attributable mortality

• WHO CRA (2002)– Alcohol AF= 18% male and 9% female all

age groups– AAF= 31% male and 20% female 20-44

years

• Izhevsk (2003-5)– AAF= 43% of male 25-54 years

• Thailand (2004) – AAF= 982. % 15-59 years (13.98 M, 1.12

F)

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• Classic cohort studies tend to underestimate mortality impact of alcohol – Fail to recruit heavy user– Late of death onset: cannot capture heavy use

episode– Conventional underestimation of self report

• Classic alcohol BOD• Izhevsk study= case-control

– Proxy report– Innovative indicators

• Surrogate alcohol• Zapoi= drinking over 2 days+ escape from normal life• Hangover• Sleep in clothes from drunkenness• Alcohol treatment (compulsory for alcohol problems)

Alcohol-attributable mortality: methodology

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Cardiovascular disease

• CVD= largest single component of total mortality

• Most Russian are Caucasoid (subject to gain alcohol cardio protective effect)

• Harmful effect of alcohol to CVD: arrhythmia, blood clotting, and blood pressure

• High acute alcohol poisoning [17% of M&F (35-69) forensic autopsies had 400 mg%]

• [+cardio myopathy= chronic effect precipitated by final binge drinking]

• AAF for hypertension is 10% (Polikina O, et al 2009)

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CVD and non-medical mortality

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Non-beverage alcohols= surrogate alcohols

• Medicinal alcohol, medicine based alcohol, aftershave, lotions, perfume, shellac, varnish, antifreeze, de-icing fluids, brake fluid, industrial cleaning fluids, solvents, denatured alcohol, glues, gasoline, kerosene, tooth powder, vinegar and shoe polish

• Izhevsk: prevalence= 8% of 25-54 years male • Largely available, esp medicinal tinctures, with higher

content but cheaper price to vodka• Alcohol content for most common (i.e. medicinal

tinctures, eau-de-colognes, antiseptic)= 60-95% with no significant amount of toxic alcohols

• Surrogate alcohol rose as by complication from Gorbachev’s anti-alcohol campaign

• Be clear: what is unrecorded alcohol?

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Recorded- &unrecorded alcoholUnrecorded

Legal• Home brewed,

where permitted

Illegal• Smuggling (X-

border)• Homebrewed,

where prohibited• Counterfeit bev

Surrogate

Recorded

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Quantifying consumption

• Survey= underestimation• Sale data=production data= cannot

capture unrecorded• How to quantify homebrew (Samagon in

Russia)• Innovative approaches

– Treml, 1982: retail sales of sugar as a proxy for home-brewed

– Nemstov, 2002: Treml approach plus acute alcohol poisoning

• 1/3 (4.9/15.5) to ½ of APC is unrecorded alcohol

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Drinking behaviour

• Vodka and other strong spirits are most common drink among men

• Large hazardous amount on single occasions is common

• Challenge to the conventional way to define ‘binge drinking’ (X amount of alcohol in single occasion, or public drunkenness) cannot capture or face difficulty with heavy drinking episodes/ intensive drinking bouts, such as zapoi

• Zapoi prevalence= 12% of male • Study show many problems relationship with

zapoi drinkers

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Who drinks in Russia?

• Men have higher drinker prevalence for any beverage type, higher consumption volume/episode, and hazardous drinking

• Social gradients of hazardous drinking – Education: higher< lower– Marital status: married<single<

divorced/separated– Unemployment

• Bidirectional

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Why do Russians drink?

• Major events– Collapse of communism>> convulsion– Economic downturn>>Privatization+IMF– Alcohol policy

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ndFormer USSR

Russia Latvia

Ukraine Turkmenistan Uzbekistan

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ndLesson learned

• The theory of aggregated consumption volume

• Benefit and (unexpected) complications of alcohol policy

• Relationship between SD and Alcohol consumption and Health

• Innovative methodology