Mortality in the former Soviet Union

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Mortality in the former Soviet Union
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Is it the vodka?
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The short answer

• Yes

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The Longer Answer
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Mortality Rates

• Have fluctuated significantly over the last 20
  years
• Decreased between 1984 and 1994, then sharply
  increased
• Have since declined to 1984 levels

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Life expectancy
European Union Whole European
Region Central E. Europe Former Soviet
Union
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Causes of death

• Alcohol direct (e.g., acute alcohol poisoning)
• Alcohol indirect
• Homicide
• Suicide
• Accidents
• Heart disease

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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

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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)

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Of what are they not dying?

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

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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 Gorbachevs reforms
• Even though consumption of substitutes increased
  (perfume)

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Its not just what you drink, its 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 dont like
  Mondays
• Patients with no Hx of CAD likely to die on week
  ends or Mondays

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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

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Crime

• Significantly increased
• Somewhat area dependent
• Accounts for deaths directly and indirectly

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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.

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Health Services

• Age groups affected are those with the least
  contact with health services
• Causes of death relatively insensitive to medical
  care

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Rapid Social Change

• Has affected alcohol consumption
• Is the associated despair also an independent
  factor?