HUGE VARIATION IN RUSSIAN MORTALITY-RATES 1984-94 - ARTIFACT, ALCOHOL, OR WHAT

Background According to published data, between 1984 and 1994 mortalit y rates in Russia initially underwent a rapid decline followed by an e ven steeper increase. In 1994, male life expectancy at birth was 57.6 years, having fallen by 6.2 years since 1990, There has been concern t hat such striking fluctuations in mortality are an artefact, although, among other factors, alcohol consumption has been implicated. Methods We analysed the age-specific and cause-specific patterns of mortality decrease and increase by use of data from a newly reconstructed morta lity series for Russia so that we could examine the plausibility of va rious ex planations for the mortality trends. Findings All major cause s of death, with the exception of neoplasms, showed declines in mortal ity between 1984 and 1987 and increases between 1987 and 1994, In rela tive terms, these tended to be largest for the age-group 40-50 years; surprisingly, they were of the same magnitude among women and men, The largest declines and subsequent increases in proportional terms were observed for alcohol-related deaths and accidents and violence. Howeve r, pronounced effects were also seen for deaths from infections, circu latory disease, and respiratory disease. No substantial variations wer e seen for neoplasms. Interpretation The stability of mortality from n eoplasms in contrast to other causes over the period 1984-94 largely p recludes the possibility that the changes in life expectancy are mainl y an artefact, particularly one due to underestimation of the populati on. Although factors such as nutrition and health services may be invo lved, the evidence is that substantial changes in alcohol consumption over the period could plausibly explain the main features of the morta lity fluctuations observed, These results provide a major challenge to public health in Russia and to our understanding of the determinants of alcohol consumption and its role in explaining mortality patterns w ithin and between many other countries.