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Cited by 106Alcohol Consumption and Health EffectsHealthcare Systems and Public HealthSubstance Abuse Treatment and Outcomes

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

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Leon, D. A., Shkolnikov, V. M., McKee, M., Kiryanov, N., Andreev, E.·2010·International Journal of Epidemiology
DOI 10.1093/ije/dyq102PMC PMC2972439
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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).

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  • The under-reporting of alcohol poisoning deaths 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.

    “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.”

    From The relationship between different dimensions of alcohol use and the burden of disease—an update (2017) · cites this paper as [50]

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  1. [23]Poikolainen K Alcohol Poisoning Mortality in Four Nordic Countries Vol. 28 Helsinki, Finland The Finnish Foundation for Alcohol Studies. Alcohol Research in the Northern Countries, 1977

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Authors
Leon, D. A., Shkolnikov, V. M., McKee, M., Kiryanov, N., & Andreev, E.
Affiliations
London School of Hygiene & Tropical Medicine (GB)
Corresponding author
Leon, D. A.
ORCID
Venue
International Journal of Epidemiology
Publisher
Oxford University Press (OUP)
Published
2010-06-30
Volume
39
Issue
5
Pages
1279-1290
ISSN
  • 0300-5771 (ISSN-L)
  • 1464-3685
DOI
10.1093/ije/dyq102
PMC
PMC2972439
OpenAlex
W2129362401
Cited by
106
References
32
Citations by year
2026: 2 · 2025: 2 · 2024: 3 · 2023: 5 · 2022: 4 · 2021: 8 · 2020: 9 · 2019: 6 · 2018: 6 · 2017: 9 · 2016: 6 · 2015: 6 · 2014: 11 · 2013: 10 · 2012: 8
FWCI
6.28
Type
journal article
Language
en
Open access
Licence
cc-by-nc
Locations
  • International Journal of Epidemiology (publishedVersion, cc-by-nc)
  • PubMed Central (publishedVersion, cc-by-nc)
  • PubMed (publishedVersion)
  • LSHTM Research Online (London School of Hygiene and Tropical Medicine) (acceptedVersion)
Funders
Wellcome Trust
Topics
  • Health Sciences › Medicine › Pathology and Forensic Medicine › Alcohol Consumption and Health Effects
  • Health Sciences › Medicine › Epidemiology › Healthcare Systems and Public Health
  • Health Sciences › Medicine › Epidemiology › Substance Abuse Treatment and Outcomes
Keywords
alcohol consumption, circulatory disease mortality, cardiovascular mortality, alcoholic cardiomyopathy, ischemic heart disease, myocardial infarction, acute alcohol poisoning, heavy drinking, working-age men, Russia, Izhevsk
MeSH terms
Acute Disease, Adult, Alcoholism, Cardiomyopathy, Alcoholic, Cardiovascular Diseases, Chronic Disease, Humans, Male, Middle Aged, Risk Factors, Russia, Causality, Case-Control Studies

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