title: Alcohol poisoning is a main determinant of recent mortality trends in Russia: evidence from a detailed analysis of mortality statistics and autopsies.
abstract: BACKGROUND
  The changes in Russian mortality rates during the last two decades are unprecedented in a modern industrialized country. Although these fluctuations have attracted much interest, trends for major groups of causes of death have been analysed while trends in specific causes of death might shed light on the underlying determinants.
  
  
  METHODS
  We analysed trends in total and cause-specific mortality in Russia for 1991-2006. The records of 24 836 forensic autopsies carried out during the period 1990-2004 in the city of Barnaul were analysed with respect to blood alcohol level.
  
  
  RESULTS
  Diseases of the circulatory system (in the age group 35-69 years) and external causes (in the age group 15-34 years) were the main contributors to the fluctuations in Russian mortality rates observed in 1991-2006. The largest relative changes were for conditions directly related to alcohol intake. Among cardiovascular diseases, fluctuations were due to 'other forms' of acute and chronic ischaemia, and to atherosclerotic heart disease, while rates of myocardial infarction were low and relatively constant. In the autopsy series a very high proportion of decedents whose death was attributed to 'other' or 'not classified' cardiovascular diseases had lethal or potentially lethal concentrations of ethanol in blood.
  
  
  CONCLUSIONS
  The increases in mortality in 1991-94 and in 1998-2003 coincided with economic and societal crisis, while decreases in 1994-98 and 2003-06 correlate with improvement in the economic situation. Excessive alcohol intake is a major cause of premature male Russian mortality, although many alcohol-related deaths are wrongly attributed to diseases of the circulatory system.
authors.affiliation: Russian N.N. Blokhin Cancer Research Centre, Kashirskoye shosse 24, 115478 Moscow, Russia.
authors.forename: David
authors.initials: D
authors.lastname: Zaridze
authors.forename: Dimitri
authors.initials: D
authors.lastname: Maximovitch
authors.forename: Alexander
authors.initials: A
authors.lastname: Lazarev
authors.forename: Vladimir
authors.initials: V
authors.lastname: Igitov
authors.forename: Alex
authors.initials: A
authors.lastname: Boroda
authors.forename: Jillian
authors.initials: J
authors.lastname: Boreham
authors.forename: Peter
authors.initials: P
authors.lastname: Boyle
authors.forename: Richard
authors.initials: R
authors.lastname: Peto
authors.forename: Paolo
authors.initials: P
authors.lastname: Boffetta
mesh_terms: D000293:Adolescent; D000328:Adult; D000368:Aged; D019973:Alcohol-Related Disorders / Q000097:blood / Q000401:mortality*; D001344:Autopsy; D002318:Cardiovascular Diseases / Q000097:blood / Q000209:etiology / Q000401:mortality; D000431:Ethanol / Q000097:blood / Q000506:poisoning*; D005260:Female; D006801:Humans; D008297:Male; D008875:Middle Aged; D009026:Mortality / Q000639:trends; D009369:Neoplasms / Q000401:mortality; D012426:Russia / Q000453:epidemiology; D012737:Sex Factors; D055815:Young Adult
chemical_list: D000431:Ethanol