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Affiliation
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Dalla Lana School of Public Health, University of Toronto, Toronto, Ontario, Canada. |
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Copyright
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(Copyright © 2019, Alcohol Research Documentation, Inc., Rutgers, The State University of New Jersey) |
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Abstract
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We thank our colleagues (Barták, 2019; Pridemore, 2019; Shkolnikov et al., 2019) for their kind comments on our examination of whether trends in alcohol consumption and cause-specific mortality in Russia between 1990 and 2017 were the result of alcohol policy measures (Nemtsov et al., 2019, this issue). We agree with their assessment that factors other than alcohol-policy measures were behind the recent positive changes and would like to offer additional comments.
The trends have been very consistent for different causes of death and by sex, the latter with correlations of .9 and above over the past 30 years. However, given the current distribution in causes of death, cardiovascular mortality is key, as 54.5% of all deaths in the Russian Federation in 2017 were caused by cardiovascular diseases (Global Health Data Exchange [GHDx], 2019). One of the main changes in Russian mortality has been the decline in these deaths, in part fueled by a decrease in alcohol exposure (Shield et al., 2016; Shkolnikov et al., 2019). Alcohol exposure seems to be one of the main risk factors here, and the dimension of alcohol mostly linked to cardiovascular mortality is a pattern of very heavy drinking characterized by frequent excessive drunkenness and/or “zapoi” (i.e., defined as two or more days of continuous drunkenness) (Leon et al., 2010). The same pattern of drinking was also at the root of alcohol poisoning deaths (Zaridze et al., 2009). This pattern of drinking seems to also have been the reason for the almost perfect correlations between poisoning and life expectancy in the period reported.
With the changing patterns of drinking in the Russian Federation—with a lower prevalence of very heavy drinking episodes but still an alcohol consumption level that is globally high (World Health Organization, 2019)—we expect the correlation between poisoning and life expectancy to weaken in the future, yet the overall high level of consumption will still result in a correspondingly high level of attributable deaths from other causes (e.g., liver cirrhosis or cancer; see Rehm et al., 2017). The Russian Federation will likely “normalize” in terms of alcohol consumption. For mortality and life expectancy, it has already been the case with some of the former parts of the Soviet Union, such as the Baltic countries (World Health Organization, 2019).
What does this mean for alcohol policy in the Russian Federation? It suggests that the current implementations, which have supported the recent developments, should persist...
Language: en |