Alcohol increases circulatory disease mortality in Russia: acute and chronic effects or misattribution of cause?

Abstract

Background There is a consensus that the large fluctuations in mortality seen in Russia in the past two decades can be attributed to trends in alcohol consumption. However, the precise mechanisms linking alcohol to mortality from circulatory disease remain unclear. It has recently been argued that a substantial number of such deaths currently ascribed to cardiovascular disorders are misclassified cases of acute alcohol poisoning.Methods Analysis of routine mortality data and of a case–control study of mortality among working-age (25–54 years) men occurring in the Russian city of Izhevsk, west of the Ural mountains, 2003–05. Interviews were carried out with proxy informants for both the dead cases (N = 1750) and the controls (N = 1750) selected at random from a population register. Mortality was analysed according to indicators of alcohol problems.Results Hazardous drinking was associated with an increased risk of death from circulatory diseases as a whole [odds ratio (OR) = 4.14, 95% confidence interval (CI) 3.23, 5.31] adjusted for age, smoking and education. The association with alcoholic cardiomyopathy was particularly strong (OR = 15.7, 95% CI 9.5, 25.9). Although there was no association with deaths from myocardial infarction (MI; OR = 1.17, 95% CI 0.59, 2.32), there was a strong association with the aggregate of all other ischaemic heart disease (IHD; OR = 4.04, 95% CI 2.79, 5.84). Stronger associations for each of these causes (other than MI) were seen with whether or not the man had drunk very heavily in the previous week. However, associations also remained when analyses were restricted to subjects with no evidence of recent heavy drinking, suggesting that misclassification of acute alcohol poisonings is unlikely to explain these overall associations.Conclusion Taken as a whole, the available evidence suggests that the positive association of alcohol with increased cardiovascular disease mortality may be best explained as being the result of a combination of chronic and acute alcohol consumption resulting in alcohol-related cardiac disorders, especially cardiomyopathy, rather than being due to misclassification of acute alcohol poisoning. Further work is required to understand the mechanisms underlying the link between heavy alcohol consumption and deaths classified as being due to IHD (other than MI).

The relationship between different dimensions of alcohol use and the burden of disease—an update

“…Similar misclassifications were found in other regions of Russia and surrounding countries 49. However, while this means that alcohol poisoning deaths have been under‐reported, this effect is too small to explain the positive association between heavy drinking and cardiovascular mortality in countries with irregular drinking of very large amounts of alcohol, such as the eastern European countries 50, 51. The second reason for the underestimation of alcohol poisoning are the rules applied to classify drug overdose deaths in ICD‐10 or earlier versions of the ICD 52, which give a priority for coding other substances than alcohol in case of involvement of multiple types of substance use in deaths (see also 53, 54).…”

Factors Associated with Blue-collar Workers' Risk Perception of Cardiovascular Disease

“…To the authors' knowledge, no studies have investigated the relationship between risk perception and alcohol consumption. Conversely, many studies have found that alcohol consumption clearly affects the risk of CVD (Leon, Shkolnikov, McKee, Kiryanov, & Andreev, 2010). Thus, an increase in perceived risk accompanying increased alcohol use may reflect an appropriate awareness of this risk of CVD.…”

“…Thus, an increase in perceived risk accompanying increased alcohol use may reflect an appropriate awareness of this risk of CVD. The precise mechanism linking alcohol to the risk of CVD, however, remains unclear (Leon et al, 2010).…”

Components and possible determinants of decrease in Russian mortality in 2004-2010

“…However, the substantial decline in acute alcohol poisoning in 2004-2010 was, unusually, accompanied by a persistently high rate of mortality from liver cirrhosis. While we cannot exclude some change in coding practices, this may indicate a reduction in the frequency of the kind of extreme drinking behavior associated with alcohol poisoning, even as the overall level of alcohol consumption remains high, which may be expected to result in chronic damage affecting not only the liver, but also the pancreas, heart, and other organs (Leon et al 2010).…”