Alcohol and mortality in Russia; Is it different than elsewhere?

PURPOSE: To discuss the hypothesis that alcohol, and binge drinking in part icular, is a major determinant of the recent mortality fluctuations in Russ ia. METHODS: Discussion based on published literature. RESULTS: The hypothesis is based on circumstantial evidence. The changes in mortality coincided with introduction and collapse of the Soviet anti alco hol campaign. The largest relative changes in mortality were observed for " alcohol-related causes" (a specific diagnostic category used in Russia) as well as violent and accidental deaths, but the largest absolute changes wer e observed for cardiovascular causes which had the largest impact on all-ca use mortality. There is no direct support for the hypothesis. Available est imates of alcohol consumption in Russia are low, and the only published stu dy on alcohol and mortality conducted in Russia produced negative results. Increase in drinking prevalence alone would not explain the mortality rise; increase in relative risk related to alcohol would also be needed. The bio logical mechanisms which could underlie the presumed strong effects of alco hol on heart disease are not clear. On the other hand, binge drinking has n ot been addressed adequately by research so far. CONCLUSIONS: Until a well designed study is conducted in Russia, the hypoth esis remains debatable. (C) 1999 Elsevier Science Inc. All rights reserved.