Academic journal article Alcoholism and Psychiatry Research

Alcohol Attributable Mortality in Belarus

Academic journal article Alcoholism and Psychiatry Research

Alcohol Attributable Mortality in Belarus

Article excerpt

INTRODUCTION

Alcohol makes a large contribution to the difference in mortality observed between the East and West parts of Europe.1,2 In particular, its effects on health seem to have been especially acute in the countries of the former Soviet Union where it has recently been identified as one of the most important factors underpinning the alarming rise in mortality that has occurred in the post-communist period.3-4-5-6 Like a number of other former Soviet countries, Belarus has experienced a demographic crisis in the post-Soviet period. During recent decades, all-cause mortality in Belarus has risen from 10.7 per 100.000 in 1990 to 14.5 per 100.000 in 2010.7 The combination of a falling birth rate in conjunction with a steeply climbing death rate resulted in a reduction of 707.700 people (i.e. 7%) in the population total between 1990 and 2011.7 Although death rates have risen for nearly all causes of death, the rise has been particularly sharp for cardiovascular and external causes of death, with alcohol being linked strongly to this increase. According to BereauBureau of Forensic Medicine autopsy reports alcohol in blood was found in 62.2% violent mortality victims and in 37.5% cardiovascular deaths victims.8 The level of alcohol consumption in Belarus is one of the highest in the world, with an annual per capita sales rate of 14 litresliters of pure alcohol in people aged 15 and above, while expert's estimates show a figure as high as 18 litresliters.9 The increase in the death rate in Belarus was accompanied by a rapid growth in sales of vodka, while the episodic heavy or binge drinking pattern of consumption strong spirits that is commonplace has also been linked to an increased level of alcohol-related mortality.10 As for indications of harmful drinking patterns it may be mentioned that 60-80% of all alcohol in Belarus is consumed in the form of spirits.8 The consumption of homemade spirits (samogon) and surrogates might also have a particularly negative impact on alcohol-related mortality. The reason that this may be having an impact in terms of mortality is because of the strength and quality of much of this illegal alcohol.11 Arecent survey, undertaken in the city of Grodno found that 31.2% of men and 13.5% of women drank samogon at least occasionally.12

The calculation of alcohol-attributable mortality currently is routinely applied to provide an indication of the public health effect of harmful alcohol consumption for developing strategy to prevent alcohol-related mortality.13 The alcohol-attributable fraction (AAF) is generally defined as the proportion of the disease in the population that would not occur if lifetime exposure to alcohol were hypothetically changed to the counterfactual level of zero.13 A systematic analysis of alcohol-attributable mortality burden undertaken by a group of international experts showed that in the European subrigionsub-region containing Belarus and other countries of the former Soviet Union alcohol was responsible for 18.6% of all premature deaths in men and 5.4% in women.14 However, the authors acknowledge that this figure could be underestimated, as several disease categories were not included because of the different classification system of disease in the former Soviet republics.

Overall, the cause-specific approach may provide greater confidence than the all-cause approach with regard to the relationship between alcohol consumption and mortality. However, AAF estimates based on this methodology have several limitations and require a number of assumptions to be made. In particular, the calculation is a function of relative risk and population drinking estimates, and therefore relies on the accuracy of estimates of alcohol consumption and the relative risk estimates reported in the epidemiological literature. It is acknowledged, however, that self-reported alcohol consumption is usually greatly underestimated.15 Further, alcohol-related risk is associated with two dimensions of alcohol: average volume of alcohol consumption as well as pattern of drinking, although most of epidemiological studies have not examined the impact of drinking pattern. …

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