title: Hazardous alcohol consumption is a major factor in male premature mortality in a typical Russian city: prospective cohort study 2003-2009.
abstract: BACKGROUND
  Russia has experienced massive fluctuations in mortality at working ages over the past three decades. Routine data analyses suggest that these are largely driven by fluctuations in heavy alcohol drinking. However, individual-level evidence supporting alcohol having a major role in Russian mortality comes from only two case-control studies, which could be subject to serious biases due to their design.
  
  
  RESULTS
  A prospective study of mortality (2003-9) of 2000 men aged 25-54 years at recruitment was conducted in the city of Izhevsk, Russia. This cohort was free from key limitations inherent in the design of the two earlier case-control studies. Cox proportional hazards regression was used to estimate hazard ratios of all-cause mortality by alcohol drinking type as reported by a proxy informant. Hazardous drinkers were defined as those who either drank non-beverage alcohols or were reported to regularly have hangovers or other behaviours related to heavy drinking episodes. Over the follow-up period 113 men died. Compared to non-hazardous drinkers and abstainers, men who drank hazardously had appreciably higher mortality (HR = 3.4, 95% CI 2.2, 5.1) adjusted for age, smoking and education. The population attributable risk percent (PAR%) for hazardous drinking was 26% (95% CI 14,37). However, larger effects were seen in the first two years of follow-up, with a HR of 4.6 (2.5, 8.2) and a corresponding PAR% of 37% (17, 51).
  
  
  CONCLUSIONS
  This prospective cohort study strengthens the evidence that hazardous alcohol consumption has been a major determinant of mortality among working age men in a typical Russian city. As such the similar findings of the previous case-control studies cannot be explained as artefacts of limitations of their design. As Russia struggles to raise life expectancy, which even in 2009 was only 62 years among men, control of hazardous drinking must remain a top public health priority.
authors.affiliation: London School of Hygiene and Tropical Medicine, London, United Kingdom.
authors.forename: Susannah
authors.initials: S
authors.lastname: Tomkins
authors.forename: Tim
authors.initials: T
authors.lastname: Collier
authors.forename: Alexey
authors.initials: A
authors.lastname: Oralov
authors.forename: Lyudmila
authors.initials: L
authors.lastname: Saburova
authors.forename: Martin
authors.initials: M
authors.lastname: McKee
authors.forename: Vladimir
authors.initials: V
authors.lastname: Shkolnikov
authors.forename: Nikolay
authors.initials: N
authors.lastname: Kiryanov
authors.forename: David A
authors.initials: DA
authors.lastname: Leon
mesh_terms: D000328:Adult; D000428:Alcohol Drinking / Q000009:adverse effects / Q000453:epidemiology / Q000401:mortality*; D015331:Cohort Studies; D005500:Follow-Up Studies; D006801:Humans; D008017:Life Expectancy; D008297:Male; D061213:Mortality, Premature; D011446:Prospective Studies; D012426:Russia / Q000453:epidemiology; D012737:Sex Factors