The Huge Reduction in Adult Male Mortality in Belarus and Russia: Is It Attributable to Anti-Alcohol Measures?

<div><p>Background and Aim</p><p>Harmful alcohol consumption has long been recognized as being the major determinant of male premature mortality in the European countries of the former USSR. Our focus here is on Belarus and Russia, two Slavic countries which continue to suffer enormously from the burden of the harmful consumption of alcohol. However, after a long period of deterioration, mortality trends in these countries have been improving over the past decade. We aim to investigate to what extent the recent declines in adult mortality in Belarus and Russia are attributable to the anti-alcohol measures introduced in these two countries in the 2000s.</p><p>Data and Methods</p><p>We rely on the detailed cause-specific mortality series for the period 1980–2013. Our analysis focuses on the male population, and considers only a limited number of causes of death which we label as being alcohol-related: accidental poisoning by alcohol, liver cirrhosis, ischemic heart diseases, stroke, transportation accidents, and other external causes. For each of these causes we computed age-standardized death rates. The life table decomposition method was used to determine the age groups and the causes of death responsible for changes in life expectancy over time.</p><p>Conclusion</p><p>Our results do not lead us to conclude that the schedule of anti-alcohol measures corresponds to the schedule of mortality changes. The continuous reduction in adult male mortality seen in Belarus and Russia cannot be fully explained by the anti-alcohol policies implemented in these countries, although these policies likely contributed to the large mortality reductions observed in Belarus and Russia in 2005–2006 and in Belarus in 2012. Thus, the effects of these policies appear to have been modest. We argue that the anti-alcohol measures implemented in Belarus and Russia simply coincided with fluctuations in alcohol-related mortality which originated in the past. If these trends had not been underway already, these huge mortality effects would not have occurred.</p></div

The trends in overall mortality among adult males and recorded adult per capita consumption of pure alcohol; Belarus and Russia, 1980–2013.

<p>Source: Panel A: Belarus—until 2010 [<a href="http://www.plosone.org/article/info:doi/10.1371/journal.pone.0138021#pone.0138021.ref034" target="_blank">34</a>], since 2011, official statistics (unpublished tables); Russia [<a href="http://www.plosone.org/article/info:doi/10.1371/journal.pone.0138021#pone.0138021.ref036" target="_blank">36</a>]. Panel B: [<a href="http://www.plosone.org/article/info:doi/10.1371/journal.pone.0138021#pone.0138021.ref042" target="_blank">42</a>].</p

First-order differences in the SDRs from selected alcohol-related causes in Belarus and Russia; males 20–64, 1980–2013.

<p>Source: As for <a href="http://www.plosone.org/article/info:doi/10.1371/journal.pone.0138021#pone.0138021.g002" target="_blank">Fig 2</a>.</p

Mortality trends from selected alcohol-related causes of death in Belarus and Russia; males 20–64, 1980–2013.

<p>Source: As for <a href="http://www.plosone.org/article/info:doi/10.1371/journal.pone.0138021#pone.0138021.g001" target="_blank">Fig 1</a> (Panel A). Note: Vertical dashed lines represent the major turning points of mortality trends.</p

Mortality rate for men in the 2000 Ontario prison cohort* and general population† of Ontario by age group.

<p>*Men admitted to provincial correctional facilities for adults in Ontario in 2000 with follow up for death to 2012. 95% confidence intervals are indicated. †Death rate for men in Ontario population in 2006.</p

Life expectancy for men in the 2000 Ontario prison cohort* and general population† of Ontario, by age interval.

<p>*Men admitted to provincial correctional facilities for adults in Ontario in 2000 with follow up for death to 2012. 95% confidence intervals are indicated. †Life expectancy for men in the Ontario population in 2006.</p

Age distribution by sex of persons in the 2000 Ontario prison cohort^* at the time of initial admission to provincial correctional facilities in Ontario in 2000.

<p>Age distribution by sex of persons in the 2000 Ontario prison cohort^{<a href="http://www.plosone.org/article/info:doi/10.1371/journal.pone.0175837#t001fn001" target="_blank">*</a>} at the time of initial admission to provincial correctional facilities in Ontario in 2000.</p