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Alcohol is the main cause of the high rates and rapid fluctuations of premature adult mortality in Russia Richard Peto CTSU, University of Oxford, UK Source: David Zaridze et al in Moscow, with collaborators in Lyon and Oxford.

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  1. Alcohol is the main cause of the high rates and rapid fluctuations of premature adult mortality in Russia Richard Peto CTSU, University of Oxford, UK Source: David Zaridze et al in Moscow, with collaborators in Lyon and Oxford

  2. UK & US (& China): prospective studies find smoking causes far more deaths than drinking doesRussia is different

  3. Accidents, violence & suicide NB. 5/1000 means ~10% die at 35-54 Male Female

  4. “Vascular” (mostly a peculiarly Russian ICD group, I-24: IHD, not MI) Male Female

  5. The large apparent fluctuations in Russian vascular mortality may be due mainly to fluctuations in alcoholic heart damage or poisoning mis-certified as vascular disease

  6. Russia, 1988-94: adverse trends in mortality are NOT seen for - lung cancer mortality - other cancer mortality - childhood mortality (0-4)- mortality in old age (75-9)

  7. Frozen social history: Russian Federation in 1988 and in 2003 Female population by birth year

  8. ↑ Born 1917

  9. ↑ Born 1933-4 ↑ Born 1917

  10. ↑ Born 1933-4 ↑ Born 1943-4 ↑ Born 1917

  11. 1937-8↓ ↑ Born 1933-4 ↑ Born 1943-4 ↑ Born 1917

  12. 1953 Russian secret police report to new Soviet leadership just after Stalin died: numbers each year between 2 world wars they had exiled, imprisoned or executed Great Terror, 1937-8: 700,000 executed

  13. 1937-8↓ ↑ Born 1933-4 ↑ Born 1943-4 ↑ Born 1917

  14. ↓1988 ↑ 1994

  15. Russia, destructive consumption of alcohol and all-cause mortalityat ages 15-34, 35-54 and 55-74Lancet 2009; 373: 2201

  16. Visit, in 2001-5, addresses of 60K deaths at ages 15-74 in 1990-2001 in 3 typical citiesFor 50K deaths (30K men, 20K women), wefound family still there; interview 97% about smoking & drinking habits of deceasedControls: 6K of these deaths that were from diseases we thought unlikely to be much related to smoking or drinking (not perfect, but now confirmed by prospective data)Lancet 2009; 373: 2201

  17. B=0.5 litre bottle of vodka (20 UK shots) Habits of ever-drinkers (few “never”): <0.5 (reference), 0.5-1, 1-3, 3+ B/week Get RR for top vs reference category (NB mean in top category ~1B/day) Lancet 2009; 373: 2201

  18. 8 diseases: Russian male RRs for ~1 bottle of vodka per day 2.1 x liver cancer3.5 x upper aerodigestive cancer3.3 x pneumonia4.1 x respiratory TB6.2 x liver disease6.7 x pancreatic disease3.0 x non-MI acute IHD7.7 x ill-specified diseaseRR=3.8 (3.4-4.1) for all 8 diseasesRR=1.4 (1.3-1.5) for other diseases

  19. Medical & non-medical causes of death: Russian male RRs for ~1 bottle of vodka/day 2 x any medical cause4 x road traffic accident6 x any other accident8 x suicide10 x murder

  20. Male mortality in Russian study regions, 1990-2001 (“strongly alcohol-related” = non-medical causes & 8 selected diseases)

  21. All-cause mortality, Russia 1980-2009 and UK (to 2007): males

  22. All-cause mortality, all Russia 1980-2009 and UK (to 2007): females

  23. Alcohol is the main cause of the high rates and rapid fluctuations of premature adult mortality in Russia What about the rest of the former USSR?

  24. Alcohol is the main cause of the high rates and rapid fluctuations of premature adult mortality in Russia (especially at ages 15-54)

  25. Russian president Dmitry Medvedev spearheads Kremlin offensive against spirit blamed for 500,000 deaths a year: hopes shock ads & price hikes will dampen love for vodka With sensationalist adverts, steep price rises & bombastic rhetoric, Russia is pulling out all the stops. guardian.co.uk 21 June 2010 Ice fishermen sip vodka at a lake in Moscow

  26. With sensationalist adverts, steep price rises and bombastic rhetoric, Russia is pulling out all the stops to curb a national love affair with vodka that is estimated to cause 500,000 deaths a year, especially among men. A series of haunting ads broadcast round the clock on state-run television show in graphic detail the damage that the drink can do. The ads follow on from government plans to double vodka prices to 200 roubles (£4.30) over the next three years, on top of new minimum price stipulations which have already sharply driven up the cost of a bottle. The new offensive is being spearheaded by President Dmitry Medvedev, who has repeatedly warned of the "national calamity" that vodka inflicts on a country with a falling population and low life expectancy. guardian.co.uk Monday 21 June 2010

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