Parallels between decline in alcohol use and mortality rates in Russia

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Since the early 2000s, Russia has seen significant declines in overall alcohol consumption, and a review published in the Journal of Studies on Alcohol and Drugs shows that there also has been a parallel, steep decline in the country's mortality rates.

Much of the decline in drinking has been the result of economic factors, evolving patterns of alcohol consumption, and alcohol policies enacted by the government, according to the review.

In Russia today, life expectancy for men and women is 6.1 and 4.7 years longer, respectively, than it was in 1980, with alcohol consumption patterns playing a disproportionate role.

"(A)lcohol use has been established as one of the main contributors, if not the main contributor, to Russian mortality," write the authors, led by Maria Neufeld of the Moscow Research Institute of Psychiatry. She is also with the Institute of Clinical Psychology and Psychotherapy, Dresden Technical University in Dresden, Germany.

To study the relationship between mortality, alcohol consumption, government policies, and social trends, the researchers analysed a number of sources. These included the Russian Fertility and Mortality Database to obtain data on death rates and cause of death, including deaths specifically due to alcohol consumption (alcohol poisoning, liver disease, and cardiomyopathy) as well as deaths frequently related to drinking (suicide and homicide). They obtained data on life expectancy broken down by sex and beer sales from the Russian Statistical Service.

Alcohol consumption rates were determined using a technique developed by the study's first author, Alexander Nemtsov, of the Moscow Research Institute of Psychiatry. Neufeld and colleagues observed three waves over time in which drinking and mortality dropped together.

The first was 1985 to 1987, a time that corresponded with Mikhail Gorbachev's anti-alcohol campaign of the 1980s. Shortly after repeal of these measures in 1990, life expectancy again dropped while alcohol consumption, particularly of illegal vodka, increased.

In the second wave from 1995 to 1998, life expectancy again grew as the economy faltered and alcohol consumption declined. But beginning in 1998, purchasing power increased in Russia, followed by increased drinking and decreased life expectancy. The third wave, beginning around 2003 and continuing through the present, saw the enactment of a number of government policies aimed at alcohol consumption. These included greater restrictions on hours of sale and the locations in which alcohol can be sold, increases in minimum pricing and alcohol taxes, stricter licensing, and prohibitions on public drinking.

At the same time, the authors note that Russian drinking patterns changed, shifting somewhat away from vodka and toward beer.

Although the study can't prove that the decrease in alcohol consumption directly led to improved life expectancy, the link is strong, waxing and waning in tandem over time. "Trends in estimated total alcohol consumption and official alcohol sales strongly correspond with the observed shifts of mortality," the authors write.

In a related editorial, William A Pridemore, of the School of Criminal Justice at SUNY Albany, concurs that regulations are effective but that the narrative is often complex. "Alcohol policies also may be rooted in culture or a zeitgeist that affects health outcomes independent of regulations," he writes. "For example, a developing nation with high consumption enacts alcohol regulations, but also enacts other health-related policies, and goes through demographic transition, and experiences economic growth."

"The amount and type of regulations are driven by social forces, some of which might also influence health via other mechanisms," he writes.

"(A)lcohol policy is effective in reducing harm," according to Pridemore, "but is embedded in a complex network of social, political, and economic forces that make it difficult to discern its precise effects."

Are trends in alcohol consumption and cause-specific mortality in Russia between 1990 and 2017 the result of alcohol policy measures?

Journal of Studies on Alcohol and Drugs

Abstract
Objective: The purpose of this study was to analyze trends in alcohol consumption and mortality and their association with alcohol control measures in Russia between 1990 and 2017.
Method: Analysis of trends for all-cause mortality and alcohol-related mortality, life expectancy, and total adult per capita alcohol consumption and their relationship were conducted. A narrative literature review of alcohol control policies since 1990 was done.

Results: Corresponding trends of alcohol consumption and all-cause mortality and cause-specific mortality were observed for the analyzed period. Steep increases in consumption and mortality occurred in 1991–1994 and in 1998–2002, and a continuous decline was observed since 2003. Trends in alcohol consumption were also closely mirrored by trends in life expectancy. These dynamics seem to be affected by economic trends and alcohol control policies, which were increasingly implemented over the observation period, even though some measures remained vague.
Conclusions: A combination of several factors seems to be at play to explain alcohol consumption and mortality trends: the general economic situation, the availability and affordability of alcohol, and the changing patterns of alcohol consumption. Alcohol control measures seem to have had a positive impact on decreasing alcohol consumption and mortality insofar as they have reinforced the existing economic trends.

Authors
Alexander Nemtsov, Maria Neufeld, Jürgen Rehm

Journal of Studies on Alcohol and Drugs material Journal of Studies on Alcohol and Drugs abstract

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