London School of Hygiene & Tropical Medicine

Hazardous alcohol consumption may be responsible for almost half of all deaths among working age men in Russia, significantly more than previously thought, according to a study published in today's Lancet.

The research is the first to identify the major contribution to this toll of premature death made by consumption of alcohol-containing substances that are, officially, not intended to be drunk as beverages. These substances, consumed by almost one in twelve working age men, include eau de cologne, antiseptics and medicinal tinctures.

The study, was carried out by a team led by the London School of Hygiene & Tropical Medicine, in collaboration with researchers in Izhevsk, Russia and at the Max Planck Institute for Demographic Research, Germany and was funded by the Wellcome Trust.

Life expectancy today among Russian men is even lower than in Bangladesh and many other developing countries. In 2004 it was 59 years for men, compared with 77 for men in the UK. Russian men are almost 4 times more likely to die between the ages of 25 and 64 than men of the same age living in England and Wales.

Death rates in Russia have fluctuated greatly over the past 20 years, as in other countries of the former Soviet Union, coinciding with changes in alcohol consumption. President Gorbachev's anti-alcohol campaign in the mid-1980s was associated with an immediate reduction in death rates, but the aftermath of the break-up of the USSR in the early 1990s led to an increase in consumption and the death rate went up again.

Earlier research using conventional methods have estimated the contribution of alcohol to mortality in the European sub-region that contains Russia⁵. This produced a figure of 27% for men aged 15-59 in 2002. The fact that the new research has produced a much higher estimate of deaths attributable to alcohol mortality seems likely to be because it is the first to take account of the consumption of non-beverage alcohols and to comprehensively measure unconventional indicators of problem drinking such as frequent hangovers or periods of continuous drinking lasting two or more days (known in Russia as zapoi ).

For this particular study, the researchers studied men aged 25-54 years, resident in Izhevsk, a typical industrial city in the Urals, and living in households with at least one other person. 1750 men dying from any cause occurring in a 24 month period from October 2003 were compared with the same number of otherwise similar men who were still alive.

Interviewers visited the household where the dead man had lived and obtained information about them from someone who could provide relevant information about them, their habits, and their life experiences. This was typically their widow, partner, or a close relative. The questions were chosen following an extensive study of what information could reliably be obtained in these circumstances, and focused on things that could be directly observed. Where possible, this information was checked with other sources, such as having received treatment for problem drinking.

The most striking contrast between the men who had died and those still alive was their consumption of the alcohol-containing substances not meant to be drunk. The men who had died were five times more likely to drink these substances (41%) than those still alive, although a remarkable 8% of them drank these substances. Surprisingly, although vodka drinking was very common, it was almost equally so among the men who died (81%) and those still alive (79%). However, a much higher percentage of dead men were classified as problem drinkers (45%) compared to those alive (12%), as defined by having frequent hangovers and other problem behaviours.

Professor David Leon of the London School of Hygiene & Tropical Medicine, and lead author of the study, comments: 'This study provides unique and persuasive evidence that mortality among working-age men in a typical city in Russia is strongly associated with hazardous patterns of alcohol consumption, with up to 43% of deaths being attributable to this cause, according to our estimates.

'We have identified drinking of non-beverage alcohols as a potentially major aspect of this phenomenon, that is independent of the consumption of drinks such as vodka, wine and beer. One of the key reasons why people appear to drink non-beverage alcohols is that they are considerably cheaper per unit of ethanol than conventional beverages, in part because they avoid excise duty. This makes them particularly attractive to people who are already relatively poor. The fatal effects of these non-beverage alcohols are most likely to be due to the fact that they are very concentrated sources of alcohol (up to 95% by volume - that is nearly 200% proof) as most of these substances do not appear to contain toxic chemicals other than ethanol itself.

Dr Vladimir Shkolnikov, of the Max Planck Institute for Demographic Research, (Rostock, Germany) a co-author of the paper, and one of the world's leading authorities of mortality trends in Russia, comments 'This unique international collaboration between Russian and British scientists provides new evidence that alcohol has played a crucial role in explaining the sharp fluctuations in mortality observed in Russia over the past 20 years.'

Professor Martin McKee of the London School of Hygiene & Tropical Medicine , a co-author of the paper, comments 'If Russian society is to tackle the appalling toll of premature death among working age men, a tragedy that leaves countless families each year without fathers, there must be a major change in how alcohol is perceived in Russian everyday life. The obvious lesson from our work is that action to restrict the sale of many alcohol containing substances is needed. This is possible and lessons can be learned from elsewhere. These substances were once consumed widely in Finland but this is no longer the case. But if Russian lives are to be saved, then there must also be a broader package of policies and interventions designed to reduce harmful patterns of drinking in general and to educating people about the all-too-often fatal consequences of such hazardous levels of alcohol consumption regardless of where the alcohol comes from'.

• Hazardous alcohol drinking and premature mortality in Russia: a population based case-control study. David A Leon, Lyudmila Saburova, Susannah Tomkins, Evgueny Andreev, Nikolay Kiryanov, Martin McKee, Vladimir M. Shkolnikov.

Interviews were obtained with proxy informants, who lived in the same household as each study subject, for 62% (1750/2835) of all deaths that occurred among male residents of the city aged 25-54 years over 24 months from October 2003. Interviews with proxy informants of live controls, frequency matched by age, were obtained for 57% (1750/3078) of control households approached.

• Rehm J, Taylor B, Patra J. Volume of alcohol consumption, patterns of drinking and burden of disease in the European region 2002. Addiction, 2006; 101 (8): 1086-95.