The Russia Retrospective and Prospective Studies

All-cause mortality rates in middle age and early old age in Russia greatly exceed those in the West, and the sharp fluctuations since 1984 are unprecedented for a modern industrialised country. In collaboration with Professor David Zaridze of Moscow, CTSU conducted a retrospective case-control study of adult deaths between 1990 and 2001 in three Siberian cities to assess and the relevance to alcohol consumption to cause-specific mortality.

In this retrospective study:

• Alcohol-related fluctuations in external causes of death and the eight causes above explained most of the large fluctuations in all-cause mortality in Russia.
• Alcohol accounted for more than half of all the male deaths at ages 15-54 and one fifth of those at ages 55-74.
• Alcohol consumption was strongly positively associated with acute ischaemic heart disease other than myocardial infarction, cancers of the liver and the upper aero-digestive tract, other liver disease, tuberculosis, pneumonia, pancreatic disease and ‘ill-specified’ conditions.

The published report (Zaridze, Lancet 2009) prompted the introduction of additional public health measures to limit alcohol consumption. 

A prospective study was also established to confirm the findings of the retrospective study and asked all adult members of the decedent’s family (0.2 million) to complete questionnaires about their own smoking and drinking habits, other lifestyle factors and physical measurements (blood pressure, anthropometry, and peak expiratory airflow) and to provide a pinprick blood sample using dried blood spots. Long-term follow-up is ongoing through mortality records and cancer registries. This is the largest prospective study in Russia.

• As almost all Russians who drink more than one bottle of vodka a week also smoke, any studies of the hazards of drinking have to be largely restricted to its effects among smokers, and any studies of the hazards of smoking will have to be largely restricted to its effects in those drinking less than one bottle of vodka a week.
• Despite significant  variation in drinking habits during follow-up, self-reported baseline alcohol consumption strongly predicted all-cause mortality among male smokers
• The estimated 20-year risks of death in those reporting <1, 1-2.9 and ≥3 bottles of vodka per week were 16%, 20% and 35%, respectively, at ages 35-54; and 50%, 54% and 64% at ages 55-74.
• The previously defined alcohol-associated causes accounted for most of the excess risks.

The published report (Zaridze, Lancet 2014) confirmed that the high number of early deaths in Russia is mainly due to people drinking too much alcohol, particularly vodka.

Data cleaning is complete and mortality follow-up is ongoing with prospective analyses planned of smoking, adiposity, blood pressure and cause-specific mortality

Preliminary analyses of smoking show:

• For all-cause mortality, current smokers at baseline were at 50% higher risk of death than never smokers suggesting that 1/3 of deaths among smokers are due to tobacco.
• These risk estimates together with the Global Adult Tobacco Survey (http://www.who.int/tobacco/surveillance/gats/en/) smoking prevalence estimates suggest that smoking is causing about 20% of male death in middle age.
• If smoking is causing about 20% and alcohol half of the 80% which remains, then about 2/3 of all Russian male deaths in middle age are caused by tobacco and alcohol.

Data access and sharing

The prospective study on mortality in Russia is a collaboration between CTSU and David Zaridze at the Department of Epidemiology and Prevention, NN Blokhin Russian Research Centre, Moscow, Russia. Specific proposals for future collaboration or specific analyses, addressed to the study's Russia-based or Oxford-based investigators, are welcomed. Any requests for the sharing of data will be considered according to the principles set out in NDPH’s data sharing policy.