Alcohol and cardiovascular mortality in Moscow; new evidence of a causal association.

BACKGROUND: In explaining recent trends in Russian mortality, alcohol drinking has often been put forward as a major factor. However, cardiovascular disease remains the major cause of death in Russia and alcohol is currently viewed as having a protective effect on heart disease. This study explores this apparent paradox by examining daily trends in deaths from cardiovascular disease in Moscow. SUBJECTS: Those dying in Moscow in the years 1993-1995. METHODS: Analysis of daily variation in deaths based on data from Moscow City death certificates. RESULTS: There is a significant increase in deaths from alcohol poisoning, accidents, and violence and cardiovascular diseases on Saturdays, Sundays, and Mondays. This is especially marked for sudden deaths. This pattern is consistent with the known pattern of drinking in Russia, which is more likely to take place in binges than is the case in other countries. CONCLUSION: A possible causative role for alcohol in sudden cardiovascular death is suggested as there are no other obvious explanations for this pattern, which cannot be accounted for by daily variations in traditional risk factors such as smoking or lipids. Although this is inconsistent with the prevailing view in the West that alcohol is seen as cardioprotective, there is considerable supporting evidence from a necropsy study and from studies in other places with a similar pattern of drinking. In countries such as Russia, where patterns of drinking differ considerably from that in the West, binge drinking can be an important cause of sudden cardiac death. This has important implications for estimates of the amount of mortality worldwide attributable to specific risk factors and thus for national and international policy.

Epidemiological transition of mortality curves in terms of the Brass logit system.

"The purpose of this paper is to examine the long-term trends of life tables in developed countries according to two parameters of the Brass system in order to find the range of variation, consistent with historical life tables (or, in other words, to define 'a field of epidemiological transition')." The author finds that "1) In the past, the mortality curves had U- and J-shapes, the latter being connected with the impact of demographic crises....2) The elimination of the crisis component at the first stage of the transition resulted in the transformation of the mortality curves towards the U-shape....3) At the second stage social control is established over premature mortality. As a result, life expectancy grows, and the shape of the curves moves towards the J-shape....4) In the past the male and female life tables usually did not differ from each other as regards the value of the Brass model parameters. However, in the last 30-40 years considerable sexual differences emerged both in the level and in the shape of the mortality curves." (SUMMARY IN FRE)

Epidemiological transition in the USSR as mirrored by regional differences.

The epidemiological transition in the USSR is examined, with a focus on differences among the constituent republics. "Means of comparative analysis of mortality structure by causes of death are proposed and by these means the lag of [the] Soviet Union behind the U.S. and Sweden as well as some Soviet republics behind others is described. It is shown that the main reason [for] this lag is the lower age of death from the causes characteristic of [the] new type of pathology (circulatory diseases, cancer) though in the more backward regions the causes of death which are characteristic of the old type of pathology keep their importance too." (SUMMARY IN FRE AND ITA)

Deaths from alcohol and violence in Moscow: socio-economic determinants.

PIP: The authors "examine the association between accidental, violent and alcohol related adult mortality in the Russian capital and socio-economic status characteristics such as educational status, occupational group and marital status.... The probability of death from alcohol related diseases increased as education level decreased, with those men failing to complete secondary education over two and a half times as likely to die from these causes than men with higher education. Blue collar workers were also much more likely to die from these causes than white collar workers. Marriage had a marked protective effect for both men and women." (EXCERPT)^ieng

Seasonal variation in mortality in Moscow.

BACKGROUND: Seasonal variation in mortality has been investigated in many countries but not, until recently, in Russia. There are some grounds for suspecting that it may differ in Russia from what is seen in western countries. This paper explores patterns of seasonal variation in mortality in Moscow between 1993 and 1995. METHODS: Analysis was based on individual data on deaths occurring in Moscow between January 1993 and December 1995, grouped by four-week period and by calendar month and on mean monthly temperature in Moscow for the same period. Crude, smoothed and deseasonalized trends were inspected. Auto-correlation functions were estimated and deaths were regressed against temperature. RESULTS: As in other northern hemisphere countries, there is a winter excess of deaths but this is much smaller than in many western countries. It is restricted to some causes of death, such as ischaemic heart disease and cerebrovascular disease, and is associated with low temperature. In contrast, there is a marked summer increase in deaths among young people, especially from accidents and other deaths associated with alcohol consumption. Over the three-year period studied, there was an initial underlying increase in alcohol-related deaths that subsequently fell, coinciding with a previously observed increase in life expectancy. CONCLUSIONS: It is possible that the low level of excess winter mortality reflects warmer indoor environments than in the west. The seasonal variation of deaths among young people reinforces evidence of the important role of alcohol in the Russian mortality crisis.

Huge variation in Russian mortality rates 1984-94: artefact, alcohol, or what?

BACKGROUND: According to published data, between 1984 and 1994 mortality rates in Russia initially underwent a rapid decline followed by an even steeper increase. In 1994, male life expectancy at birth was 57.6 years, having fallen by 6.2 years since 1990. There has been concern that such striking fluctuations in mortality are an artefact, although, among other factors, alcohol consumption has been implicated. METHODS: We analysed the age-specific and cause-specific patterns of mortality decrease and increase by use of data from a newly reconstructed mortality series for Russia so that we could examine the plausibility of various explanations for the mortality trends. FINDINGS: All major causes of death, with the exception of neoplasms, showed declines in mortality between 1984 and 1987 and increases between 1987 and 1994. In relative terms, these tended to be largest for the age-group 40-50 years; surprisingly, they were of the same magnitude among women and men. The largest declines and subsequent increases in proportional terms were observed for alcohol-related deaths and accidents and violence. However, pronounced effects were also seen for deaths from infections, circulatory disease, and respiratory disease. No substantial variations were seen for neoplasms. INTERPRETATION: The stability of mortality from neoplasms in contrast to other causes over the period 1984-94 largely precludes the possibility that the changes in life expectancy are mainly an artefact, particularly one due to underestimation of the population. Although factors such as nutrition and health services may be involved, the evidence is that substantial changes in alcohol consumption over the period could plausibly explain the main features of the mortality fluctuations observed. These results provide a major challenge to public health in Russia and to our understanding of the determinants of alcohol consumption and its role in explaining mortality patterns within and between many other countries.