Mortality in the former Soviet Union

Is it the vodka?

The short answer:

Yes

The Longer Answer:

Mortality Rates

Have fluctuated significantly over the last 20 years

Decreased between 1984 and 1994, then sharply increased

Have since declined to 1984 levels.

Life expectancyEuropean Union

Whole European Region

Central & E. Europe

Former Soviet Union

Causes of death

Alcohol directly (e.g., acute alcohol poisoning)

Alcohol indirectly:– Homicide– Suicide– Accidents– Heart disease

Who is dying?

Somewhat surprisingly, mortality rates for the most vulnerable portions of the population, the elderly and children, have remained stable

The deaths are occurring in 20 -45 year old men and women.

Of what are they dying?

Pneumonias (alcohol related) Sudden cardiac death (alcohol related) Infectious diseases Alcohol related diseases (cirrhosis and

alcohol poisoning) Accidents and violence (alcohol related) Cancer of the female breast (alcohol

related).

CCEE =Countries of Central & Eastern EuropeEU=European Union NIS = newly independent states

Of what are they not dying?

Neoplasms

Lung cancer deaths have actually declined, in spite of heavy tobacco use

Vodka

Tends to be drunk in binges Responsible for the deaths from acute

alcohol poisoning Mortality declined as consumption

decreased in the mid 1980s as a result of Gorbachev’s reforms

Even though consumption of substitutes increased (perfume).

It’s not just what you drink, it’s how you drink it Conventional wisdom held that alcohol had a

cardioprotective effect, regardless of the level of consumption

Data from Russia shows that binge drinking is associated with sudden cardiac death

Supported by data from Scotland “I don’t like Mondays”

Patients with no Hx of CAD likely to die on week ends or Mondays.

Social problems

Interact with alcohol

For example, failure of regulatory bodies

Standards not enforced for building codes, so public safety is compromised

Significant deaths from drowning and fires (e.g., sprinklers do not work)

Enforcement of drunk driving laws lessened.

Crime

Significantly increased

Somewhat area dependent

Accounts for deaths directly and indirectly.

Poverty

Surprisingly, wealthier areas more affected I.e., “the greatest declines in life expectancy

are in those regions that were the wealthiest in 1990 and have subsequently experienced the smallest declines in household income”

Why? Perhaps due to previously high wages for hard manual labour jobs; in Russia the link between income and education was less than elsewhere.

Health Services

Age groups affected are those with the least contact with health services

Causes of death relatively insensitive to medical care.

Rapid Social Change

Has affected alcohol consumption

Is the associated despair also an independent factor?