Alcohol Poisoning and Cardiovascular Mortality in Russia 1956-2005

Article excerpt

Summary - High mortality from cardiovascular disease (CVD) in Russia and its profound fluctuations over the past decades have attracted considerable interest. It was emphasized that cardiovascular death played an important role in the Russian mortality crisis during the 1990s. The mounting body of evidence points to binge drinking pattern as a potentially important contributor to high cardiovascular mortality rate in Russia. The purpose was to estimate the aggregate level effect of binge drinking on the CVD mortality rate in Russia. Trends in age-adjusted, sex-specific CVD mortality and fatal alcohol poisoning rate (as a proxy for binge drinking) from 1956 to 2005 were analyzed employing an ARIMA analysis in order to asses bivariate relationship between the two time series. The results of the time series analysis indicate the presence of a statistically significant association between the two time series at zero lag for male (r = 0.79; S.E. = 0.14), and for female (r = 0.58; S.E. = 0.14). The results of the present study suggest a positive relation between alcohol and cardiovascular mortality rate at aggregate level and support the hypothesis that alcohol played a crucial role in cardiovascular mortality fluctuation in Russia over the past decades. The findings of this study contribute to the growing body of evidence that suggests that a substantial proportion of cardiovascular deaths in Russia is due to acute effect of binge drinking. Thus, from a public policy point of view, the outcome of this study suggests that cardiovascular-related mortality prevention programs should focus more on addressing the drinking pattern.

Key words: CVD mortality; fatal alcohol poisoning; ARIMA time series analysis; Russia; 1956-2005

INTRODUCTION

High mortality from cardiovascular disease (CVD) in Russia and its profound fluctuations over the past decades have attracted considerable interest.1-3 After a substantial decline in 1985-1988, coinciding with a major anti-alcohol campaign, CVD mortality rate was rapidly reversed and increased dramatically after the dissolution of the USSR.4 It was repeatedly emphasized that this phenomenon is only partially associated with the traditional CVD risk factors identified in epidemiologic studies.5,6 The results of population studies have shown that such risk factors as total cholesterol and apoprotein profile had little predictive value.7,8 This evidence suggests an influence of other powerful factors that are associated with the increase of the risk of cardiovascular death. Several scholars argue that these mortality fluctuations may be related to alcohol consumption.9,10 This hypothesis is based on a fairly close temporal covariation between trends in overall consumption and CVD mortality during anti-alcohol campaign. This evidence challenged the view on a curvilinear relationship between alcohol and cardiovascular mortality that has been reported repeatedly in the literature.11-14 Several studies point to binge drinking pattern as a potentially important contributor to a higher cardiovascular mortality rate in Russia.15-17 For example, in the Novosibirsk cohort study it was shown that frequent heavy drinking increased the mortality from CVD.16 Similarly, a case-control study of men aged 20-55 in the Republic of Udmurd established that periods of heavy drinking were associated with an increased risk of CVD mortality.17 This study reported that medium or greater level of intoxication occurred in a quarter of Russian men aged 20-55 dying from CVD. The role of excessive drinking pattern as a powerful risk factor for CVD mortality was emphasized in a study based on data from Moscow that reported an increase in deaths from alcohol poisoning and cardiovascular disease on weekends.3 These findings support the argument that binge drinking pattern may strengthen the negative role of alcohol as the major cause of high cardiovascular death rate in Russia.

The change of the paradigm from drinking volume to drinking pattern (heavy episodic drinking or binge drinking versus regular moderate drinking) as the primary determinant of cardiovascular mortality is supported by the mounting body of research evidence from other settings. …