Premature Death in the New Independent States (1997) / Chapter Skim
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The Anti-Alcohol Campaign and Variations in Russian Mortality
The Anti-Alcohol Campaign and Variations in Russian Mortality
Pages 239-261
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From page 239... ...
The rapid mortality decrease observed for the years 1984 to 1987 can be assumed to reflect largely a pure effect of reduced alcohol abuse on mortality, because there were no other significant changes in public health conditions that could have resulted in such an abrupt change in so short a period of time. The increase in life expectancy during the period was more than 3 years for males and a little less than 1.5 years for females.
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From page 240... ...
Moreover, trends in age-adjusted and age-specific death rates for many leading causes of death are closely associated with the trend in real alcohol consumption (Shkolnikov et al., 1994a)
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From page 241... ...
Alcohol abuse became a serious social problem, and in the period 1885-1890, the sober movement arose in Russian society. In 1913, the officially reported alcohol consumption in Russia was 3.4 liters of pure alcohol per capita (4.7 liters according to some other sources)
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From page 242... ...
involving the presence of alcohol in the blood (see Annex 81~. For the period 1981-1987, the resulting estimated levels of annual alcohol consumption in Russia are only a little higher than the sum of the Goskomstat estimates of samogon consumption and the official values of state alcohol sales for the same period (Table 8-1~.
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From page 243... ...
. state alcohol sales became completely unrealistic in the late 1980s because of the increase in illegal samogon distillation, and were even more unrealistic in the early l990s because of the growth of underrecorded private alcohol sales (Table 8-1~.
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From page 244... ...
The main directions of the campaign were a reduction in state alcohol production, a reduction in state alcohol sales, efforts against the distillation of samogon, increases in the state prices of alcohol (in August 1985 and August 1986) , and further development of the special health care system for compulsory treatment of alcoholism (the so-called LTP, first organized in 1976~.
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From page 245... ...
scenario, we suppose that the death rates in 1985-1992 are equal to the average level of the period 1980-1984 (in the period 1981-1983, the level of mortality was significantly lower than in 1980~; for the second (medium-mortality) scenario, we continue the long-term linear trends of the period 1970-1983; and for the third (high-mortality)
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From page 246... ...
We know that the maximum gains in expectation of life at birth and in the age-standardized death rate concern younger ages and the years 1986 and 1987. These differences
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From page 247... ...
This is not the case for ages above 55. Death rates for these ages grow rather slowly until 1992, when they rise substantially, though they remain slightly below the previous extreme point of 1984.
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From page 248... ...
and older adult ages. To clarify this matter, let us consider the trends in agespecific death rates by classes of causes of death (Figure 8-4~.
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From page 249... ...
rates for external causes over each age group are relatively larger than those in the trends for other causes of death. The corresponding standardized death rates start increasing immediately after 1987, when alcohol consumption began to grow, whereas the trends in circulatory diseases and in respiratory and digestive diseases are more inert, showing a rather moderate increase in the period 1988-1991.
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From page 250... ...
~ 100 1Q 1 OOOC 1 000 External eoplasms Respiratory Digestive 1975 1976 1977 1978 1979 1980 1981 1482 1983 1984 1685 1686 1987 1988 1989 1990 1991 1992 1993 AGE 45-49 All causes combined External Circulatory hIQ^mIsomc~ Respiratory ~Digestive 1C 1975 1976 1977 1978 1979 1980 1981 1682 1683 1984 1685 1 86 1 ~ 1988 1989 1990 1991 1992 1993 AGE 65-69 1 01w All causes combined CirAyiatory Neoplagms 1 000 10~ Respiratory External Digestive it_ 1975 1976 1977 1978 1979 1980 1981 1482 1583 1984 1685 1686 1987 1488 1989 1990 1991 1992 1993 FIGURE 8-4 Death rates at selected adult ages by principal classes of cause of death in Russia, males, 1975-1993 (per 100,000)
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From page 251... ...
At young adult ages, external causes, directly related to alcohol abuse, predominate and control the trend of the total age-specific death rate; at older ages, mortality from circulatory diseases predominates. ALCOHOL ABUSE AND THE LARGE INCREASE IN MORTALITY IN 1993 A sharp increase in death rates occurs at almost all ages in 1993, as shown in Figure 8-6.
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From page 252... ...
. Death rates among children from exogenous causes are a good indicator of a society's general state of health and sanitary conditions.
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From page 253... ...
observed from model death rates increases very substantially in 1993 as compared with the preceding years. The approximate nature of the simple model applied here does not allow us 30 25 20 8 a' 15 cat 1 = O- I 1 1 1 1 1 1 1 1 1 1 1 1 1 1980 1981 1982 1983 1984 1985 1986 1987 1988 1989 1990 1991 1992 1993 FIGURE 8-7 Standardized death rates for respiratory, infectious, and digestive diseases combined in Russia, males, 1980-1993.
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From page 254... ...
Obviously, these factors could be related to the great socioeconomic shocks that occurred in Russia in the 1990s. Finally, we can examine Russian male mortality in terms of standardized death rates by 25 principal causes of death.
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From page 255... ...
255 l ~ ~ Cal a I O I LL Cal o co TIC _ ~i O O O O ~O Or, Or, 4} ' t1, ' a, Hi.
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From page 256... ...
. The very impressive increase in the standardized death rate for accidental poisoning in 1993 can be explained not only by rising alcohol consumption, but also serious deterioration in the quality of alcohol consumed (see also Treml in this volume)
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From page 257... ...
This allows us to calculate illegal samogon production in 1984 and 1986 in Moscow as 0.61 and 1.49 liters per capita, respectively. Finally, we can add these estimates for samogon production to the official figures for alcohol sales per capita and derive estimates of true alcohol consumption in Moscow in 1984 and 1986 of 11.89 and 8.48 liters, respectively.
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From page 258... ...
ANNEX 8-2 COMPARISON OF ACTUAL AND PREDICTED CAUSE-SPECIFIC DEATH RATES FOR 1993 We fit linear models to the age-specific death rates for each year 1980 through 1992 (13 data points for each cause) , relating the dependent variables (annual age-specific death rates for each cause and for all causes combined)
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From page 260... ...
At ages 30-34, the linear trends are statistically insignificant for all causes except neoplasm. At ages 60-64, by contrast, the linear trend is significantly associated with age-specific death rates for most causes For both age groups, the death rates for all causes combined in 1993 are much larger than would be predicted from these models estimated on the 19801992 data: 136 excess deaths per 100,000 for ages 30-34 and 670 excess deaths per 100,000 for ages 60-64.
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From page 261... ...
4. Recorded state alcohol sales per capita is equivalent to annual alcohol consumption officially reported by Goskomstat.
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