Huge variation in Russian mortality rates 1984-94: artefact, alcohol, or what?

Spatial disparities in cause-specific mortality in Ukraine: A district-level analysis, 2006-19

Turbulent socio-economic development, recent political challenges, and remarkable regional diversity with deep historical roots make Ukraine an important case study for understanding mortality trends in Eastern Europe. In this paper, we provide the first comprehensive, spatially detailed analysis of cause-specific mortality trends and patterns in Ukraine, focusing on the period 2006-19. We rely on official mortality data and use various demographic and spatial analysis techniques. Our results suggest a notable attenuation of the long-standing West-East and West-South-East mortality gradients. Cardiovascular mortality at older ages largely explains the gap between the vanguard (lowest mortality) and laggard (highest mortality) areas, especially for females and in the most recent period. By contrast, the impact of mortality from external causes has greatly diminished over time. Hotspot analyses reveal strong and persistent clustering of mortality from suicide, HIV, and lung cancer. Further research should focus on in-depth assessment of the mechanisms causing the observed patterns.

Hazardous alcohol consumption in slow- and fast-privatized Russian industrial towns

Hazardous drinking, defined as the consumption of homemade, unofficially made alcohol and non-beverages, is prevalent and accounts for a high proportion of alcohol-related deaths in Russia. Individual-level characteristics are important explanations of hazardous drinking, but they are unlikely to explain spatial variation in this type of alcohol consumption. Areas that attracted insufficient attention in the research of hazardous drinking are the legacy of industrialization and the speed of economic reforms, mainly through the privatization policy of major enterprises in the 1990s. Applying mixed-effects logistic regressions to a unique dataset from 30 industrial towns in the European part of Russia, we find that in addition to individual-level characteristics such as gender, age, marital status, education, social isolation, labor market status, and material deprivation, the types of towns where informants' relatives resided such as industrial structure and speed of privatization also accounted for the variance in hazardous alcohol consumption among both male and female populations of the analyzed towns.

COVID-19-Related Shifts in Polysubstance Use

Background: Big Events, such as economic crises and natural disasters, affect drug use patterns (e.g. Friedman & Rossi, 2015). The COVID-19 pandemic is a Big Event that led to lockdowns, travel restrictions, protocols on businesses, and rules for social engagements across the globe. Studies primarily in Europe and Oceania show that the pandemic impacted the type and amount of substances used (e.g. Winstock et al., 2020). Objectives: This study examines the impact of COVID-19 on substance use using a sample of 257 individuals across 36 states, who engage in polysubstance use. Results: The sample was recruited via DanceSafe, Inc.'s social media to complete an online survey (April-October 2020) about drug use during the pandemic. The mostly White, heterosexual sample used an average of seven different substances in the past 12 months. Slightly less than half reported increasing use since the onset of the COVID-19 pandemic, with young adults and lesbian, gay, bisexual, pansexual, or queer (LGBPQ) identifying individuals significantly more likely to do so. Relative to other substances, benzodiazepine use increased, and 3,4- methylenedioxymethamphetamine (MDMA) and psychedelic use decreased, while alcohol use stayed the same. Conclusions: The COVID-19 pandemic disproportionately affected those who are young adults, LGBPQ, and use drugs. Their unique needs during the pandemic warrant attention. The swap from leisure (e.g. MDMA) to anti-anxiety (e.g. Xanax) drugs is not surprising. Yet, the rise in novel benzodiazepines (Laing et al., 2021) is a point of concern that suggests drug checking and educational efforts can best reduce potential risks.

Alcohol control policies reduce all-cause mortality in Baltic Countries and Poland between 2001 and 2020

Alcohol consumption in the Baltic countries and Poland is among the highest globally, causing high all-cause mortality rates. Contrary to Poland, the Baltic countries have adopted many alcohol control policies, including the World Health Organization (WHO) "best buys". The aim of this study was to evaluate the impact of these policies, which were implemented between 2001 and 2020, on all-cause mortality. Monthly mortality data for men and women aged 20+ years of age in Estonia, Latvia, Lithuania, and Poland were analysed for 2001 to 2020. A total of 19 alcohol control policies, fulfilling an a-priori defined definition, were implemented between 2001 and 2020 in the countries of interest, and 18 of them could be tested. Interrupted time-series analyses were conducted by employing a generalized additive mixed model (GAMM) for men and women separately. The age-standardized all-cause mortality rate was lowest in Poland and highest in Latvia and had decreased in all countries over the time period. Taxation increases and availability restrictions had short-term effects in all countries, on average reducing the age-standardized all-cause mortality rate among men significantly (a reduction of 2.31% (95% CI 0.71%, 3.93%; p = 0.0045)). All-cause mortality rates among women were not significantly reduced (a reduction of 1.09% (95% CI - 0.02%, 2.20%; p = 0.0554)). In conclusion, the alcohol control policies implemented between 2001 and 2020 reduced all-cause mortality among men 20+ years of age in Baltic countries and Poland, and thus, the practice should be continued.

The association between beverage-specific alcohol consumption and mortality among road users in Russia, 1965-2019

A vast body of literature suggests a relationship between alcohol consumption and road traffic fatalities. Despite an impressive downward trend in road traffic fatalities in Russia, the death rate is still unacceptably high. Far fewer studies have differentiated the association by road users and types of alcoholic beverages. This population-based study aims to estimate the associations of total and beverage-specific alcohol per capita (15+) consumption (APC) based on official alcohol sales statistics and road traffic mortality using police data on the number of deaths by road users. The study covers the period 1965-2019. We employed a first-order difference linear regression model with robust and autocorrelation consistent standard errors, controlling for a level of motorisation. To examine the possible evolution of the phenomenon, we repeated models separately for three consecutive periods (1965-1984, 1985-2002, 2003-2019). The findings suggest that an annual 1-litre increase in APC (in litres of pure alcohol) associated with a corresponding increase in the death rates (per 100,000 inhabitants) of both unprotected road users and motor vehicle occupants by about 0.3 (p < 0.01) and 0.4 (p < 0.05), respectively. A beverage-specific analysis for 1965-2019 revealed a positive and significant association between mortality of pedestrians and cyclists and the consumption of strong alcoholic beverages (p < 0.05) as well as mortality of drivers and passengers and the consumption of weaker alcoholic beverages, primarily beer (p < 0.01). Various road safety strategies should be applied to prevent road traffic fatalities of road users.

The Developmental Origins of Health and Disease: Adolescence as a Critical Lifecourse Period to Break the Transgenerational Cycle of NCDs-A Narrative Review

Noncommunicable diseases (NCDs), including type 2 diabetes and cardiovascular disease, represent a significant and growing global health burden. To date, a primary focus has been on treatment approaches to NCDs once manifested rather than strategies aimed at prevention. In this context, there is clear evidence that a range of adverse early life exposures can predispose individuals towards a greater risk of developing NCDs across the lifecourse. These risk factors can be passed to future generations, thus perpetuating a cycle of disease. This concept, preferentially termed "developmental programming", forms the basis of the Developmental Origins of Health and Disease (DOHaD) framework. To date, DOHaD has focused on preconception, pregnancy, lactation and, more recently, paternal health at the time of conception. However, it is becoming increasingly clear that investment in the window of adolescence is perhaps the most critical developmental window. Adolescence is a period where lifestyle behaviours become entrained. Therefore, a focus on adolescent behaviours, health literacy and emotional development may afford the best opportunity to break the cycle of NCDs. As the next generation of parents, adolescents should therefore be considered a priority group in advancing appropriate and informed actions aimed at reducing NCD risk factors across the lifecourse. This advancement requires a more comprehensive community understanding and uptake of DOHaD knowledge and concepts. NCD prevention strategies have typically entailed siloed (and often disease-specific) approaches with limited efficacy in curbing NCD prevalence and breaking the transgenerational transmission of disease traits. Recent findings across various disciplines have highlighted that a lifecourse systems approach is required to establish a comprehensive and sustainable framework for NCD intervention. A whole community approach with a particular focus on adolescents as potential agents of change is necessary to break the disease cycle.

Can alcohol control policies reduce cirrhosis mortality? An interrupted time-series analysis in Lithuania

BACKGROUND AND AIMS

The relationship between alcohol consumption and cirrhosis is well established. Policies that can influence population-level use of alcohol should, in turn, impact cirrhosis. We examined the effect of population-level alcohol control policies on cirrhosis mortality rates in Lithuania - a high-income European Union country with high levels of alcohol consumption.

METHODS

Age-standardized, monthly liver mortality data (deaths per 100,000 adults, aged 15+) from Lithuania were analysed from 2001 to 2018 (n = 216 months) while controlling for economic confounders (gross domestic product and inflation). An interrupted time-series analysis was conducted to estimate the effect of three alcohol control policies implemented in 2008, 2017 and 2018 and the number of cirrhosis deaths averted.

RESULTS

There was a significant effect of the 2008 (P < .0001) and 2017 (P = .0003) alcohol control policies but a null effect of the 2018 policy (P = .40). Following the 2008 policy, the cirrhosis mortality rate dropped from 4.93 to 3.41 (95% CI: 3.02-3.80) deaths per 100,000 adults, which equated to 493 deaths averted. Further, we found that following the 2017 policy, the mortality rate dropped from 2.85 to 2.01 (95% CI: 1.50-2.52) deaths per 100,000 adults, corresponding to 245 deaths averted.

CONCLUSIONS

Our findings support the hypothesis that alcohol control policies can have a significant, immediate effect on cirrhosis mortality. These policy measures are cost-effective and aid in reducing the burden of liver disease.

Alcohol taxation, alcohol consumption and cancers in Lithuania: A case study

Aims

The aim of this contribution was to estimate the impact of the last significant alcohol taxation increase in Lithuania in 2017 on alcohol consumption, incident cancer cases, and cancer mortality, as well as the number of cancer outcomes that could have potentially been averted in 2018 had larger increases in alcohol excise taxation been applied.

Design

Statistical modelling was used to estimate the change in alcohol per capita consumption following the tax increase, and alcohol-attributable fraction methodology was then used to estimate the associated cancer incidence and mortality. Potential increases of current excise duties were modelled in two steps. First, beverage-specific price elasticities of demand were used to predict the associated decreases in consumption and cancer outcomes, and second, the outcomes arising from the actual numbers and the modelled numbers were compared.

Method

Data were taken from the following sources: alcohol consumption data from Statistics Lithuania and the WHO, cancer data from the International Agency of Research on Cancer, and risk relations and elasticities of demand from published meta-analyses.

Results

A total of 15,857 new cancer cases (8,031 in women and 7,826 in men) and 8,534 cancer deaths (3,757 in women and 4,777 in men) were recorded in Lithuania in 2018. Using the attributable fraction methodology, we estimate that 4.8% of 761 of these new cancer cases were attributable to alcohol use (284 in women; 477 in men), as well as 5.5% or 466 cancer deaths (115 in women; 351 in men). With the taxation increase of 2017, 45 new cases and 24 deaths will be averted over the next 10 years. Further taxation increases of 100% could double the number of new cancer cases averted or saved.

Conclusion

In a high-consumption European country like Lithuania, alcohol use is an important and avoidable risk factor for cancer. Taxation is an important measure to reduce the alcohol-attributable cancer burden.

What have we learned about mortality patterns over the past 25 years?

In this paper, I examine progress in the field of mortality over the past 25 years. I argue that we have been most successful in taking advantage of an increasingly data-rich environment to improve aggregate mortality models and test pre-existing theories. Less progress has been made in relating our estimates of mortality risk at the individual level to broader mortality patterns at the population level while appropriately accounting for contextual differences and compositional change. Overall, I find that the field of mortality continues to be highly visible in demographic journals, including Population Studies. However much of what is published today in field journals could just as easily appear in neighbouring disciplinary journals, as disciplinary boundaries are shrinking.

Alcohol control policy measures and all-cause mortality in Lithuania: an interrupted time-series analysis

BACKGROUND AND AIMS

Alcohol use has been identified as a major risk factor for burden of mortality and disease, particularly for countries in eastern Europe. During the past two decades, several countries in this region have implemented effective alcohol policy measures to combat this burden. The aim of the current study was to measure the association between Lithuania's alcohol control policies and adult all-cause mortality.

DESIGN

Interrupted time-series methodology by means of general additive models.

SETTING

Lithuania.

PARTICIPANTS

Adult population of Lithuania, aged 20 years and older.

MEASUREMENTS

Alcohol control policies were ascertained via a document review of relevant legislation materials. Policy effects were evaluated as follows: (1) slope changes in periods of legislative (non-)activity with regard to alcohol control policy (analysis 1); (2) level changes of three interventions following recommendations of the World Health Organization (analysis 2); and (3) level changes of seven interventions judged a priori by an international panel of experts (analysis 3). Mortality was measured by sex-stratified and total monthly age-standardized rates of all-cause mortality for the adult population.

FINDINGS

During the period 2001-18, effective alcohol control policy measures were implemented on several occasions, and in those years the all-cause mortality rate declined by approximately 3.2% more than in years without such policies. In particular, the implementation of increased taxation in 2017 was associated with reduced mortality over and above the general trend for men and in total for all analyses, which amounted to 1452 deaths avoided (95% confidence interval = -166 to -2739) in the year following the implementation of the policy.

CONCLUSIONS

Alcohol control policies in Lithuania appear to have reduced the overall adult all-cause mortality over and above secular trends.

Years of life lost due to alcohol-related mortality: A nationwide population study in Poland, 1999-2017

BACKGROUND

The aim of this study was to assess alcohol-related mortality and years of life lost (YLL) in Poland between 1999 and 2017.

METHODS

A database of 7,168,765 death certificates of Polish residents who died in 1999-2017 was reviewed. This number included 112,512 people who had died due to alcohol consumption. YLL was calculated with the use of the Standard Expected Years of Life Lost (SEYLL) measure; its value was related to the size of the study population and calculated per 100,000 people (SEYLLp). Time trends were determined by joinpoint regression analysis.

RESULTS

In 1999, the SEYLLp value was 653.99 years among males and 71.20 years among females; in 2017, these numbers rose to 1,263.76 and 293.10 years, respectively. Time trend analysis revealed that SEYLLp increased more quickly in females (by 8.69 % per year) than in males (by 3.68 %). The ratio of male to female SEYLLp values decreased from 9.18 to 4.31 over the study period.

CONCLUSIONS

In Poland, both males and females are experiencing adverse changes in the number of alcohol-induced YLLs. However, the disparity in YLLs between males and females is gradually decreasing, primarily due to the value increasing more quickly in females.

Outcomes of Young Patients With Alcoholic Cirrhosis After First Hospitalization for Cirrhosis: A Carilion Clinic Experience

Background 

Alcoholic cirrhosis though uncommon in young patients is being reported more frequently and related mortality is also increasing. 

Study aim 

To evaluate risk factors associated with mortality among young patients (<40 years) with alcoholic cirrhosis and older patients (> 40 years old) after their first hospitalization in a tertiary referral academic center. 

Methods

Carilion clinic’s electronic medical record (EPIC) was queried to identify all alcoholic patients hospitalized for the first time with either a new diagnosis of alcoholic cirrhosis or a prior diagnosis of this from 2008 to 2016 with follow-up through June 2018. Information on demographics, comorbidities, lab values, procedures, and mortality was extracted. The cumulative risks of long-term mortality after the first hospitalization were estimated using Kaplan-Meier curves and compared between the two groups; those < 40 years of age and those > 40 years of age. Demographic data, lab values, and comorbidities associated with cirrhosis were assessed using multivariable Cox proportional hazard analysis to determine risk factors associated with long-term mortality. 

Results

We identified 65 young patients out of a total of 325 patients admitted for the first time for alcoholic cirrhosis (mean age: 34.6 ± 4.7 yrs, 72.3% males, 74.4% current alcohol users, 52.3% current smokers, 12.6% current illicit drugs users). The one, three, and five-year cumulative mortality after the first hospitalization was 21.1 %, 31.1%, and 49.7% respectively. The median survival for young patients was longer as compared to the older patients (p<0.001); likely related to high early mortality in older patients who had many other comorbidities. On multivariate Cox proportional hazard analysis, increased age [hazard ratio (HR) 1.03; 95% confidence interval (CI), 1.01-1.05], neutrophils-to-lymphocytes ratio (NLR) at first hospital discharge (HR 1.02; 95% CI, 1.01-1.04), the presence of encephalopathy (HR, 1.93; 95% CI, 1.06-3.55), and initial MELD (model for end-stage liver disease) score (HR, 1.13; 95% CI, 1.08-1.19) were associated with increased risk of mortality. Though the majority of patients endorsed current alcohol and tobacco use before the admission, it was not significantly associated with mortality. 

Conclusions 

Five-year cumulative mortality for patients < 40 years of age with alcoholic cirrhosis after their first hospitalization is 49.7%. Old age, most recent NLR, hepatic encephalopathy, and MELD score on admission were associated with increased late mortality. 

Singapore First Aid Guidelines 2021

The Singapore Resuscitation and First Aid Council is updating the guidelines for first aid based on the latest evidence-based review from the International First Aid Taskforce Consensus on Science with Treatment Recommendations published in 2020. This is part of the regular updating of standards of care and training for first aid. This article presents some of the updated evidence-based approaches to first aid treatments in common emergencies such as asthma, chronic bronchitis, anaphylaxis, shock, unresponsiveness, seizure, heat disorders, ingested poisons, bleeding, head and spinal injury, bites and dental injuries. These updated treatments will be incorporated into the Standard and Child First Aid course syllabus in Singapore.

Non-Beverage Alcohol Consumption In Izhevsk: 15 Years Later

AIMS

Non-beverage alcohol was a major cause of preventable mortality of working-age males in Izhevsk (Russia) in 2003-2004. The Russian government has since taken measures to reduce availability of non-beverage alcohol. Yet, some types of non-beverage alcohol still remain available for consumers. The aim of this study was to assess the availability and sources of non-beverage alcohol in Udmurtia.

METHODS

A survey of adults on the streets of Izhevsk and its environs was performed on workdays to assess non-beverage drinking patterns in 2018. The questionnaire included questions about socio-demographic status and alcohol use, including non-beverage alcohol consumption and drinking patterns.

RESULTS

One hundred and sixty-eight people were questioned, of whom, 28% reported consuming non-beverage alcohol. Non-beverage alcohol consumers were more likely to be single, unemployed or retired, younger or older than 19-29 years, have lower educational status and income, have hangovers and drink moonshine.

CONCLUSION

Non-beverage alcohol consumption still took place at Izhevsk, a typical Russian city, in 2018, and its availability was still high. Untaxed and cheap medicinal non-beverage alcohol consumption seems to have become the major source of non-beverage alcohol consumption. Further regulation of non-beverage alcohol may be required in Russia.

The role of alcohol use in the aetiology and progression of liver disease: A narrative review and a quantification

Issues.

Alcohol use has been shown to impact on various forms of liver disease, not restricted to alcoholic liver disease.

Approach.

We developed a conceptual framework based on a narrative review of the literature to identify causal associations between alcohol use and various forms of liver disease including the complex interactions of alcohol with other major risk factors. Based on this framework, we estimate the identified relations for 2017 for the USA.

Key Findings.

The following pathways were identified and modelled for the USA for the year 2017. Alcohol use caused 35 200 (95% uncertainty interval 32 800–37 800) incident cases of alcoholic liver cirrhosis. There were 1700 (uncertainty interval 1100–2500) acute hepatitis B and C virus (HBV and HCV) infections attributable to heavy-drinking occasions, and 14 000 (uncertainty interval 5900–19 500) chronic HBV and 1700 (uncertainty interval 700–2400) chronic HCV infections due to heavy alcohol use interfering with spontaneous clearance. Alcohol use and its interactions with other risk factors (HBV, HCV, obesity) led to 54 500 (uncertainty interval 50 900–58 400) new cases of liver cirrhosis. In addition, alcohol use caused 6600 (uncertainty interval 4200–9300) liver cancer deaths and 40 700 (uncertainty interval 36 600–44 600) liver cirrhosis deaths.

Implications.

Alcohol use causes a substantial number of incident cases and deaths from chronic liver disease, often in interaction with other risk factors.

Conclusion.

This additional disease burden is not reflected in the current alcoholic liver disease categories. Clinical work and prevention policies need to take this into consideration.

COVID-19 in Russia: Should we expect a novel response to the novel coronavirus?

Russia provides an important case study in its COVID-19 response by a country that has one of the largest epidemics, increasingly authoritarian government policies, and important domestic and international political influence. In this article, we describe and explain Russia's public health and social policy responses to COVID-19 - earlier in the pandemic when the concern was the border with China, to later when there were confirmed cases in all regions in the country. In the past, Russia has served as an interesting case for exploring global health politics and infectious diseases. Thus, we position our analysis of the COVID-19 response through a reflection on infectious disease control in the Soviet Union and contemporary Russia. We explore the following: government control, contention with official statistics, (dis-)information, (mis-)trust, and vulnerabilities of medical care workers. We also discuss how Russia is reinforcing its role in global health during the pandemic, for example through vaccine development and foreign humanitarian aid. We situate our analysis in the historical, political, and social contexts to help explain Russia's response to the novel coronavirus pandemic.

Surveillance Metrics of SARS-CoV-2 Transmission in Central Asia: Longitudinal Trend Analysis

BACKGROUND

SARS-CoV-2, the virus that caused the global COVID-19 pandemic, has severely impacted Central Asia; in spring 2020, high numbers of cases and deaths were reported in this region. The second wave of the COVID-19 pandemic is currently breaching the borders of Central Asia. Public health surveillance is necessary to inform policy and guide leaders; however, existing surveillance explains past transmissions while obscuring shifts in the pandemic, increases in infection rates, and the persistence of the transmission of COVID-19.

OBJECTIVE

The goal of this study is to provide enhanced surveillance metrics for SARS-CoV-2 transmission that account for weekly shifts in the pandemic, including speed, acceleration, jerk, and persistence, to better understand the risk of explosive growth in each country and which countries are managing the pandemic successfully.

METHODS

Using a longitudinal trend analysis study design, we extracted 60 days of COVID-19-related data from public health registries. We used an empirical difference equation to measure the daily number of cases in the Central Asia region as a function of the prior number of cases, level of testing, and weekly shift variables based on a dynamic panel model that was estimated using the generalized method of moments approach by implementing the Arellano-Bond estimator in R.

RESULTS

COVID-19 transmission rates were tracked for the weeks of September 30 to October 6 and October 7-13, 2020, in Central Asia. The region averaged 11,730 new cases per day for the first week and 14,514 for the second week. Infection rates increased across the region from 4.74 per 100,000 persons to 5.66. Russia and Turkey had the highest 7-day moving averages in the region, with 9836 and 1469, respectively, for the week of October 6 and 12,501 and 1603, respectively, for the week of October 13. Russia has the fourth highest speed in the region and continues to have positive acceleration, driving the negative trend for the entire region as the largest country by population. Armenia is experiencing explosive growth of COVID-19; its infection rate of 13.73 for the week of October 6 quickly jumped to 25.19, the highest in the region, the following week. The region overall is experiencing increases in its 7-day moving average of new cases, infection, rate, and speed, with continued positive acceleration and no sign of a reversal in sight.

CONCLUSIONS

The rapidly evolving COVID-19 pandemic requires novel dynamic surveillance metrics in addition to static metrics to effectively analyze the pandemic trajectory and control spread. Policy makers need to know the magnitude of transmission rates, how quickly they are accelerating, and how previous cases are impacting current caseload due to a lag effect. These metrics applied to Central Asia suggest that the region is trending negatively, primarily due to minimal restrictions in Russia.

Multimorbidity from Chronic Conditions among Adults in Urban Slums: The AWI-Gen Nairobi Site Study Findings

Background:

In the era of double burden of infectious and non-communicable diseases in sub-Saharan Africa, the burden of multimorbidity is likely to be common. However, there is limited evidence on the burden and its associated factors in the sub-Saharan African context.

Objective:

The aim of this study was to determine the levels and identify determinants of multimorbidity from chronic conditions in two urban slums in Nairobi.

Methods:

Data collected from 2003 study participants aged 40–60 years in two urban slums of the Nairobi Urban Health and Demographic Surveillance System in 2015 were used. Using self-report, anthropometry and key biomarkers, data on 16 conditions including chronic diseases, behavioral disorders and metabolic abnormalities were gathered. Lifetime multimorbidity defined by the occurrence of at least two chronic conditions in an individual at any time during their life course was computed. Factors associated with lifetime multimorbidity were identified using multiple logistic regression.

Findings:

A total of 2,081 chronic conditions were identified among 1,302 individuals. While 701 (35.0%) had no chronic condition, single morbidity was reported in 726 (36.2%) of the study population. The overall prevalence of lifetime multimorbidity was 28.7%. The prevalence of dyads and triads of simultaneous occurrences of conditions (episodic multimorbidity) was 20.8% and 6.1%, respectively. Single morbidity was positively associated with gender and alcohol consumption; and negatively associated with employment. Women, older people, the unemployed, current smokers and current alcohol consumers had higher levels of lifetime multimorbidity in the study population.

Interpretation:

The findings of this study indicate that a considerable proportion of adults living in urban slums experience multimorbidity from chronic conditions. Further studies with a better rigor to establish temporal associations between socio-demographic factors and the occurrence of chronic conditions are needed to explore the impacts and implications on health status and health system.

Quantifying the contribution of established risk factors to cardiovascular mortality differences between Russia and Norway

Surprisingly few attempts have been made to quantify the simultaneous contribution of well-established risk factors to CVD mortality differences between countries. We aimed to develop and critically appraise an approach to doing so, applying it to the substantial CVD mortality gap between Russia and Norway using survey data in three cities and mortality risks from the Emerging Risk Factor Collaboration. We estimated the absolute and relative differences in CVD mortality at ages 40-69 years between countries attributable to the risk factors, under the counterfactual that the age- and sex-specific risk factor profile in Russia was as in Norway, and vice-versa. Under the counterfactual that Russia had the Norwegian risk factor profile, the absolute age-standardized CVD mortality gap would decline by 33.3% (95% CI 25.1-40.1) among men and 22.1% (10.4-31.3) among women. In relative terms, the mortality rate ratio (Russia/Norway) would decline from 9-10 to 7-8. Under the counterfactual that Norway had the Russian risk factor profile, the mortality gap reduced less. Well-established CVD risk factors account for a third of the male and around a quarter of the female CVD mortality gap between Russia and Norway. However, these estimates are based on widely held epidemiological assumptions that deserve further scrutiny.

Impact of alcohol on mortality in Eastern Europe: Trends and policy responses

Within the global context, Eastern Europe has been repeatedly identified as the area with the highest levels of alcohol-related health harms. Although the Berlin Wall fell in 1989, and the Soviet Union collapsed soon afterwards, alcohol-related mortality in Eastern Europe remains far higher than in Western Europe. However, despite the high burden of alcohol harm and mortality in Eastern Europe, with the partial exception of Russia, relatively little is known about the country-specific impact of alcohol on health and mortality and the various policy responses to it. In response to this, an international symposium was held in Vilnius, Lithuania in June 2017 entitled Persisting burden of alcohol in Central and Eastern Europe: recent evidence and measurement issues. This special section of Drug and Alcohol Review is based on a selection of the papers presented at this symposium, providing for the first time a broad overview of the problem of alcohol-related mortality in a diverse range of Eastern European countries linked to a description and analysis of alcohol control initiatives that have been developed. While there is strong evidence of the influence of history, culture and education across European countries having a profound and persistent effect on differences in drinking patterns and preferences, there is, nevertheless, evidence that effective policy responses have been mounted in a range of countries.

Russia's National Concept to Reduce Alcohol Abuse and Alcohol-Dependence in the Population 2010-2020: Which Policy Targets Have Been Achieved?

In the 2000s, Russia was globally one of the top 5 countries with the highest levels of alcohol per capita consumption and prevailing risky patterns of drinking, i.e., high intake per occasion, high proportion of people drinking to intoxication, and high frequency of situations where alcohol is consumed and tolerated. In 2009, in response to these challenges, the Russian government formed the Federal Service for Alcohol Market Regulation and published a national strategy concept to reduce alcohol abuse and alcohol-dependence at the population level for the period 2010-2020. The objectives of the present contribution are to analyze the evidence base of the core components of the concept and to provide a comprehensive evaluation framework of measures implemented (process evaluation) and the achievement of the formulated targets (effect evaluation). Most of the concept's measures were found to be evidence-based and aligned with eight out of 10 areas of the World Health Organization (WHO) policy portfolio. Out of the 14 tasks, 7 were rated as achieved, and 7 as partly achieved. Ten years after the concept's adoption, alcohol consumption seems to have declined by about a third and alcohol is conceptualized as a broad risk factor for the population's health in Russia.

Alcohol control policies in Former Soviet Union countries: A narrative review of three decades of policy changes and their apparent effects

Issues.

The last Soviet anti-alcohol campaign of 1985 resulted in considerably reduced alcohol consumption and saved thousands of lives. But once the campaign’s policies were abandoned and the Soviet alcohol monopoly broken up, a steep rise in mortality was observed in many of the newly formed successor countries, although some kept their monopolies. Almost 30 years after the campaign’s end, the region faces diverse challenges in relation to alcohol.

Approach.

The present narrative review sheds light on recent drinking trends and alcohol policy developments in the 15 Former Soviet Union (FSU) countries, highlighting the most important setbacks, achievements and best practices. Vignettes of alcohol control policies in Belarus, Estonia, Kazakhstan, Lithuania and Uzbekistan are presented to illustrate the recent developments.

Key Findings.

Over the past decade, drinking levels have declined in almost all FSU countries, paralleled by the introduction of various alcohol-control measures. The so-called three ‘best buys’ put forward by the World Health Organization to reduce alcohol-attributable burden (taxation and other measures to increase price, restrictions on alcohol availability and marketing) are relatively well implemented across the countries.

Implications.

In recent years, evidence-based alcohol policies have been actively implemented as a response to the enormous alcohol-attributable burden in many of the countries, although there is big variance across and within different jurisdictions.

Conclusion.

Strong declines in alcohol consumption were observed in the 15 FSU countries, which have introduced various alcohol control measures in recent years, resulting in a reduction of alcohol consumption in the World Health Organization European region overall.

Being unneeded in post-Soviet Russia: Lessons for an anthropology of loneliness

The problem of loneliness is receiving increasing attention in the popular media and among social scientists. Despite anthropology's rich engagement with emotions and experience, the anthropology of loneliness is still scant. In psychology, loneliness has been defined as relational lack. In this article, I reconsider one culturally specific form of relational lack-being unneeded among post-Soviet Muscovites. I draw on the anthropological literature on emotion, exchange, and morality to suggest that being unneeded is an ethical commentary on a lack of recognition. During Soviet times, recognition was secured through informal social exchange practices. Being unneeded among middle-aged and elderly post-Soviet Muscovites is therefore connected to a constricted ability to give and experience recognition. One avenue of analysis for an anthropology of loneliness is to consider social exchange practices and how these connect with societal and moral dimensions of loneliness.

The link between per capita alcohol consumption and alcohol-related harm in educational groups

INTRODUCTION AND AIMS

Research based on individual-level data suggests that the same amount of alcohol yields more harm in low-socioeconomic status (SES) groups than in high-SES groups. Little is known whether the effect of changes in population-level alcohol consumption on harm rates differs by SES-groups. The aim of this study was to elucidate this issue by estimating the association between per capita alcohol consumption and SES-specific rates of alcohol-related mortality.

DESIGN AND METHODS

Per capita alcohol consumption was proxied by Systembolaget's alcohol sales (litres 100% alcohol per capita 15+). Quarterly data on mortality and alcohol consumption spanned the period 1991Q1-2017Q4. We used two outcomes: (i) alcohol-specific mortality (deaths with an explicit alcohol diagnosis); and (ii) violent deaths. SES was measured by education. We used three educational groups: (i) low (<10 years); (ii): intermediate (10-12 years); and (iii) high (13+ years). We applied error correction modelling to estimate the association between alcohol and alcohol-specific mortality, and seasonal autoregressive integrated moving average-modelling to estimate the association between alcohol and violent deaths.

RESULTS

The estimated associations between per capita consumption and the two outcomes were positive and statistically significant in the two groups with low and intermediate education, but not in the high education group. There was a significant gradient in the level of association between alcohol consumption and alcohol-related harm by educational group; the association was stronger the lower the educational group.

DISCUSSION AND CONCLUSIONS

Our findings suggest that the association between per capita consumption and alcohol-related harm was stronger the lower the educational group.

Effect of alcohol prohibition on liver cirrhosis mortality rates in Canada from 1901 to 1956: A time-series analysis

INTRODUCTION AND AIMS

The extent to which alcohol consumption in Canada was affected by alcohol prohibition in the early 20th century remains unclear. Since there is a dearth of data on consumption during this time, we estimated the effect of alcohol prohibition on alcohol consumption, as measured by changes in liver cirrhosis mortality rates in Canada.

DESIGN AND METHODS

Annual liver cirrhosis mortality data were obtained for 1901 to 1956 for the provinces of Alberta, British Columbia, Manitoba, New Brunswick, Nova Scotia, Ontario and Saskatchewan. Changes in death rates were assessed, by province, using autoregressive integrated moving average models. Results were pooled across provinces using a fixed effects meta-analysis. A secondary fixed effects meta-analysis was performed which only included provinces with data for before, during and after prohibition, and excluded provinces with data only beginning during prohibition.

RESULTS

Prohibition was associated with a statistically significant decrease in liver cirrhosis death rates only in Nova Scotia (P = 0.01). Pooling of provincial results indicated that prohibition resulted in 0.39 (95% confidence interval 0.06, 0.72; P = 0.02) fewer liver cirrhosis deaths per 100 000 people. In the restricted meta-analysis, prohibition resulted in 0.65 (95% confidence interval 0.18, 1.12; P < 0.01) fewer liver cirrhosis deaths per 100 000 people.

DISCUSSION AND CONCLUSIONS

Although alcohol prohibition in Canada did not eliminate alcohol consumption, our findings suggest that prohibition was associated with reduced consumption, as evidenced by a reduction in liver cirrhosis mortality rates. Further, it's important to reflect on alcohol's history in Canada and use those policy lessons to guide the construction of effective cannabis legislation.

Spatial patterns of male alcohol-related mortality in Belarus, Lithuania, Poland and Russia

INTRODUCTION AND AIMS

Eastern Europe is known to suffer from a large burden of alcohol-related mortality. However, persisting unfavourable conditions at the national level mask variation at the sub-national level. We aim to explore spatial patterns of cause-specific mortality across four post-communist countries: Belarus, Lithuania, Poland and Russia (European part).

DESIGN AND METHODS

We use official mortality data routinely collected over 1179 districts and cities. The analysis refers to males aged 20-64 years and covers the period 2006-2014. Mortality variation is mainly assessed by means of the standardised mortality ratio. Getis-Ord Gi* statistic is employed to detect hot and cold spots of alcohol-related mortality.

RESULTS

Alcohol-related mortality exhibits a gradient from very high levels in northwestern Russia to low levels in southern Poland. Spatial transitions from higher to lower mortality are not explicitly demarcated by national boundaries. Within these countries, hot spots of alcohol-related mortality dominate the territories of northwestern and western Russia, eastern and northwestern Belarus, southeastern Lithuania, and eastern and central Poland.

DISCUSSION AND CONCLUSIONS

The observed mortality gradient is likely associated with the spread of alcohol epidemics from the European part of Russia to the other countries, which appears to have started more than a century ago. Contemporary socioeconomic and demographic factors should be taken into account when developing anti-alcohol policies. The same is true for the peculiarities of culture, norms, traditions and behavioural patterns observed in specific geographical areas of the four countries. Reducing alcohol-related harm in the areas identified as hot spots should be prioritised.

Alcohol control policies and mortality trends in Belarus

BACKGROUND AND AIM

Belarus is among the countries that have very high alcohol consumption levels, and that suffer from a huge burden of excessive drinking. This paper aims to explore the peculiarities of the alcohol control policies implemented in Belarus, and to link these policies to the trends in alcohol consumption and mortality.

DATA AND METHODS

Our narrative review of alcohol policies and anti-alcohol measures is based on the laws, directives and other official documents issued by Belarusian authorities since the early 1990s. The data on alcohol consumption and other relevant variables originate from official statistical books. Our analysis of mortality trends is based upon official statistical tables by causes of death.

RESULTS

Despite the large number of government policy initiatives that authorities claimed were controlling the problem, alcohol consumption in Belarus grew rapidly up to 2010, when it reached the highest level in the world. This negative trend can be largely attributed to inconsistent alcohol control policies. In particular, the implementation of excise taxes encouraged the manufacturing of inexpensive fortified fruit wines. Additionally, measures designed to raise the price of alcohol were inadequate, resulting in strong alcoholic drinks (e.g. vodka) becoming more affordable. However, the third anti-alcohol campaign, which was launched in 2011, led to declines in both alcohol consumption and alcohol-related mortality.

CONCLUSIONS

Belarus has acquired the experience and the legislative foundation needed to implement effective alcohol control polices. To further reduce alcohol-related harm in Belarus, a steady and consistent long-term policy perspective is required.

The changing relation between alcohol and life expectancy in Russia in 1965–2017

Introduction and Aims

Design and Methods

Results

Discussion and Conclusions

Alcohol consumption and alcohol policy in Estonia 2000-2017 in the context of Baltic and Nordic countries

Introduction and Aims

Alcohol consumption has become a global health threat and there is need for an evidence‐based global alcohol policy. This study aimed to describe alcohol consumption in parallel with alcohol policy in 2000–2017 in Estonia in the context of Baltic and Nordic countries.

Design and Methods

A review of routine statistics concerning alcohol consumption and the pertinent legislation in Estonia was performed. The measures used to assess the effects of alcohol policy were adult (15 and older) pure alcohol per capita consumption (APC) in litres, alcohol outlet densities and opening hours, taxes and the price of alcoholic beverages.

Results

Adult domestic APC in Estonia increased from 9.3 to 14.8 in 2000–2007 and thereafter decreased to 10.2 in 2016 (10.3 in 2017). Adult APC in Estonia was lower than that in Latvia and Lithuania but higher than that in Nordic countries. Since 2010, beer has been the most prevalent alcoholic beverage in Estonia. The density and opening hours of alcohol retail shops were much higher in Estonia and other Baltic countries than in Nordic countries. The alcohol retail price increased twice from 2006 to 2017 in Estonia, resulting in a double price difference with Latvia.

Discussion and Conclusions

Evidence‐based comprehensive alcohol policy should continue in Estonia. Based on the example of Nordic countries, more attention should be paid to the physical availability of alcohol in Estonia. In terms of economic availability, it is important to focus on the cross‐border alcohol trade to achieve improvements in public health.

The life expectancy gap between North and South Korea from 1993 to 2008

Background

Comparative research on health outcomes in North and South Korea offers a unique opportunity to explore political and social determinants of health. We examined the age- and cause-specific contributions to the life expectancy (LE) gap between the two Koreas.

Methods

We calculated the LE at birth in 1993 and 2008 among North and South Koreans, and cause-specific contributions to the LE discrepancy between the two Koreas in 2008. The cause-specific mortality data from South Korea were used as proxies for the cause-specific mortality data in North Korea in 2008.

Results

The LE gap between the two Koreas was approximately 1 year in 1993, but grew to approximately 10 years in 2008. This discrepancy was attributable to increased gaps in mortality among children younger than 1 year and adults 55 years of age or older. The major causes of the increased LE gap were circulatory diseases, digestive diseases, infant mortality, external causes, cancers and infectious diseases.

Conclusions

This study underscores the urgency of South Korean and international humanitarian aid programs to reduce the mortality rate of the North Korean people.

Cross-country evidence on the social determinants of the post-socialist mortality crisis in Europe: a review and performance-based hierarchy of variables

An unprecedented mortality crisis befell the former socialist countries between 1989 and 1995, representing one of the greatest demographic shocks of the period after the Second World War. While it is likely that country-level variation in the post-socialist mortality crisis in Eastern Europe can be explained by a constellation of political and socio-economic factors, no comprehensive review of the existing scholarly attempts at explaining these factors exists. We review 39 cross-national multi-variable peer reviewed studies of social determinants of mortality in post-socialist Europe in order to assess the social factors behind the post-socialist mortality crisis, determine the gaps in the existing literature and to make suggestions for future research. We propose a novel methodology to determine the relative importance of variables based on the ratio of significant to insignificant findings for each variable. The literature identifies inequality, welfare payments, religious composition, democracy, economic performance and unemployment as the leading factors that have a significant influence on mortality outcomes. Existing cross-country studies fail to establish a definitive connection between mortality and diets, drinking patterns, liberalisation, trust, health expenditure and war. We also point out that the level of analysis is not a neutral methodological choice but might influence the results themselves.

A Future for Observational Epidemiology: Clarity, Credibility, Transparency

Observational studies are ambiguous, difficult, and necessary for epidemiology. Presently, there are concerns that the evidence produced by most observational studies in epidemiology is not credible and contributes to research waste. I argue that observational epidemiology could be improved by focusing greater attention on 1) defining questions that make clear whether the inferential goal is descriptive or causal; 2) greater utilization of quantitative bias analysis and alternative research designs that aim to decrease the strength of assumptions needed to estimate causal effects; and 3) promoting, experimenting with, and perhaps institutionalizing both reproducible research standards and replication studies to evaluate the fragility of study findings in epidemiology. Greater clarity, credibility, and transparency in observational epidemiology will help to provide reliable evidence that can serve as a basis for making decisions about clinical or population-health interventions.

Distilled Spirits Overconsumption as the Most Important Factor of Excessive Adult Male Mortality in Europe

Aims

To explain comprehensively variations in adult male mortality rate in Europe, and in particular, high mortality in some East European countries with particular focus on specific patterns of alcohol consumption.

Short summary

Per capita distilled spirits consumption is found to be the strongest determinant of the adult male mortality rate in Europe as soon as the unrecorded alcohol consumption is taken into account. It turns out to be much stronger than the other tested significant determinants such as per capita health expenditures, smoking prevalence, consumption of hard drugs and per capita consumption of vegetables and fruit.

Methods

Ordinary least squares (OLS) multiple regression with adult male mortality rate as a dependent variable, and various indicators of alcohol and drug consumption as well as logarithm of gross domestic product (GDP) per capita, logarithm of total per capita health expenditures, latitude (climatic factors), per capita fruit and vegetable consumption, smoking prevalence as independent factors.

Results

Per capita distilled spirits consumption turns out to be the strongest determinant of the adult male mortality rate in Europe as soon as the unrecorded alcohol consumption is taken into account. It turns out to be much stronger than the other tested significant determinants of the adult male mortality rate such as per capita health expenditures, smoking prevalence, consumption of hard drugs and per capita consumption of vegetables and fruit. Still, higher per capita wine consumption has turned out to be a marginally significant determinant of the higher adult male mortality rate in some tests. Latitude, beer and soft drug consumption have turned out insignificant in this study.

Conclusions

Spirits consumption is a major risk factor of adult male mortality, with significantly greater impact compared to beer and wine. Therefore, reduction in distilled spirits consumption in hard liquor drinking areas should be a major target in health policy.

Lifespan Dispersion in Times of Life Expectancy Fluctuation: The Case of Central and Eastern Europe

Central and Eastern Europe (CEE) have experienced considerable instability in mortality since the 1960s. Long periods of stagnating life expectancy were followed by rapid increases in life expectancy and, in some cases, even more rapid declines, before more recent periods of improvement. These trends have been well documented, but to date, no study has comprehensively explored trends in lifespan variation. We improved such analyses by incorporating life disparity as a health indicator alongside life expectancy, examining trends since the 1960s for 12 countries from the region. Generally, life disparity was high and fluctuated strongly over the period. For nearly 30 of these years, life expectancy and life disparity varied independently of each other, largely because mortality trends ran in opposite directions over different ages. Furthermore, we quantified the impact of large classes of diseases on life disparity trends since 1994 using a newly harmonized cause-of-death time series for eight countries in the region. Mortality patterns in CEE countries were heterogeneous and ran counter to the common patterns observed in most developed countries. They contribute to the discussion about life expectancy disparity by showing that expansion/compression levels do not necessarily mean lower/higher life expectancy or mortality deterioration/improvements.

Cancer Incidence and Mortality Among Ethnic German Migrants From the Former Soviet Union

Germany is a country known for immigration. In 2015, 21% of the general population in Germany consisted of individuals with a migration background. This article focuses on cancer-specific incidence and mortality among one of the biggest migrant groups in Germany: the resettlers. Resettlers are ethnic Germans who mainly immigrated from the Russian federation and other countries of the former Soviet Union after its collapse in 1989. We investigated differences between resettlers and the general German population, regarding (i) incidence and mortality of malignant neoplasms, (ii) time trends of the corresponding incidence and mortality, and (iii) cancer stage at diagnosis. We provide data from two resettler cohorts covering an observation time of 20 years: one cohort on cancer incidence (N = 32,972), and another cohort on mortality (N = 59,390). Cancer-specific standardized incidence ratios (SIR) and standardized mortality ratios (SMR) for all malignant neoplasms combined and the most common cancer-sites were calculated between resettlers and the general German population. Time trend analyses using Poisson regression were performed to investigate the developments of SIRs and SMRs. To investigate differences in stage at diagnosis, logistic regression was performed, calculating Odds Ratios for condensed cancer stages. We observed higher incidence and mortality of stomach cancer [SIR (men) 1.62, 95%CI 1.17-2.19; SMR (men) 1.62, 95%CI 1.31-2.01; SIR (women) 1.32, 95%CI 0.86-1.94; SMR (women) 1.52, 95%CI 1.19-1.93] and higher mortality of lung cancer [SMR (men) 1.34, 95%CI 1.20-1.50] among resettlers compared to the general German population, but lower incidence and mortality of colorectal (both sexes), lung (women), prostate and female breast cancer. However, time trend analyses showed converging incidence risks of cause-specific incidence over time, whereas differences of mortality did not show changes over time. Results from logistic regression suggest that resettler men were more often diagnosed with advanced cancer stages compared to the Münster population. Our findings suggest that risk factor patterns of the most common cancer-sites among resettlers are similar to those observed within the Russian population. Such increases in prostate, colorectal and breast cancer incidence may be the consequence of improved detection measures, and/or the adaptation of resettlers to the German lifestyle.

Alcohol, pattern of drinking and all-cause mortality in Russia, Belarus and Hungary: a retrospective indirect cohort study based on mortality of relatives

AIMS

To assess the relationship between alcohol intake frequency and mortality among males and females in three Eastern European populations, and to estimate the additional mortality risk posed by a combination of frequent drinking, binge drinking and other hazardous drinking habits.

DESIGN

Retrospective cohort study; the cohort consisted of close relatives of survey participants.

SETTING

Middle-sized settlements in Russia, Belarus and Hungary.

PARTICIPANTS

A total of 124 150 subjects aged 35-69 years in 1998 and followed-up until 2013.

MEASUREMENTS

Survey respondents provided information on their mothers, fathers, siblings and partners of female respondents. This information, including current vital status and dates of birth and death, was used to construct the cohort of relatives. Alcohol consumption indices, reported by survey participants, included drinking frequency, binge drinking and hazardous drinking [consuming non-beverage and/or illicitly-produced alcohol and/or heavy drinking over several days (zapoi in Russian)].

FINDINGS

Drinking frequency was associated positively with mortality in all three countries and both genders. At each drinking frequency level, mortality risk increased among those who also engaged in binge and/or hazardous drinking. Regular male drinkers who were also binge drinkers and hazardous drinkers had the highest risk of death; their hazard ratios (HR), compared with non-binge-non-hazardous occasional drinkers, were 2.56 [95% confidence interval (CI) = 2.27-2.88], 2.14 (95% CI = 1.84-2.48) and 2.11 (95% CI = 1.90-2.35) in Russia, Belarus and Hungary, respectively. In women, the corresponding HRs (using a lower frequency cut-off) were 2.86 (95% CI = 1.99-4.12) in Russia, 3.44 (95% CI = 2.17-5.44) in Belarus and 3.01 (95% CI = 2.26-4.01) in Hungary.

CONCLUSIONS

Drinking frequency is associated positively with mortality among men and women in Russia, Belarus and Hungary. The mortality risk is higher among frequent drinkers who exhibit binge and hazardous drinking patterns.

Alcohol and Homicide in Early 20th-century Russia

This article extends the existing research on the relationship between alcohol and homicide in the Soviet and post-Soviet periods by examining this relationship in the latter years of the tsarist regime. A cross-sectional study of the 50 provinces of “European” Russia in the years 1909–1911 was undertaken using regional data on homicide, alcohol consumption, population, and structural factors gathered from official state statistical publications. There was a positive and significant association between alcohol consumption and homicide, indicating higher homicide rates in regions with higher alcohol consumption. When this association was examined while controlling for other structural variables, it was still positive and significant. The findings from this study, when taken together with evidence from other studies, suggest that alcohol consumption was an important factor in regional variation in homicide rates in Russia across the course of the 20th century. This was despite the huge social, political and economic changes the country underwent, as well as the changing trends and regional variations in alcohol consumption that were observed at the aggregate level across the period. When trying to explain this association, it is necessary to focus on what did not change across the course of the 20th century and may therefore have been important in this context: the Russian drinking “culture.”

Child injury deaths linked with adult alcohol consumption: A time series analysis

OBJECTIVE

This paper aims to quantify the population-level associations between child injury deaths and adult (aged 15+ years) per capita alcohol consumption (PCC) and between child injury deaths and the impact of major alcohol and safety policy changes in Australia.

METHODS

All child deaths due to external causes during 1910-2013, and child deaths due specifically to road crashes, assaults, suicide and other external causes, were obtained from the Australian Institute of Health and Welfare. Child (0-14 year) mortality rates were analysed in relation to PCC using an Autoregressive Integrated Moving Average model.

RESULTS

A positive association between PCC and overall child external mortality was identified. The estimated coefficient was 0.326 (p = .002), indicating that a 10% decrease in PCC was associated with a 3.3% reduction in child injury mortality. A positive association was identified for road traffic and other child injury mortality, but not assault injuries. The introduction of compulsory seatbelt legislation in combination with random breath testing was associated with a reduction in overall injury and road traffic child mortality. Decreasing the legal drinking age was associated with an increase in the rate of other external-cause child mortality.

CONCLUSION

Reducing PCC in Australia is likely to result in a small but significant reduction in the injury mortality rate of children aged 0-14 years.

The contribution of alcohol to the East-West life expectancy gap in Europe from 1990 onward

BACKGROUND

Central and Eastern European (CEE) countries have lower life expectancies and higher alcohol-attributable mortality than Western European countries. We examine the contribution of alcohol consumption to mortality across Europe, and specifically to the East-West life expectancy gap from 1990 onward.

METHODS

We retrieved alcohol-attributable mortality rates (GBD Study 2013) and all-cause mortality rates (Human Mortality Database) by age and sex for nine CEE countries and for the EU-15 countries. We assessed country-specific potential gains in life expectancy (PGLE) by eliminating alcohol-attributable mortality using associated single decrement life tables. We decomposed the life expectancy differences between each CEE country and the EU-15 population-weighted average for 1990-2012/13 into alcohol-attributable and non-alcohol-attributable mortality.

RESULTS

In 2012/13, the PGLE for men and women were, respectively, 2.15 and 1.00 years in the CEE region and 0.90 and 0.44 years in the EU-15 region. The contribution of alcohol to the East-West gap in life expectancy was largest among men in Russia {2.88 years [uncertainty interval (UI): 1.57-4.06]}, Belarus [3.70 years (UI: 1.75-5.45)] and Ukraine [2.47 years (UI: 0.90-3.88)]. The relative contributions increased in most of the countries between 1990 and 2005 (on average, from 17.0% to 25.4% for men, and from 14.7% to 22.5% for women), and declined thereafter (20.2% for men and 20.5% for women in 2012/13).

CONCLUSIONS

Alcohol contributed substantially to the East-West life expectancy gap in Europe, and to its increase (1990-2005) and decline (2005 onward). Diminishing alcohol consumption in CEE countries to Western European levels can contribute to mortality convergence across Europe.

Alcohol-Related Causes of Death and Drinking Patterns in Moldova as Compared to Russia and Ukraine

Most studies dedicated to alcohol-related mortality in the former USSR countries explore the situation primarily in Russia and Belarus, while somewhat less so in Ukraine. In these countries, the consumption of spirits is one of the main contributors to a huge decline in adult health since the mid-60s, especially among males. Moldova, also an ex-Soviet country, is quite different in that their drinking habits are much closer to those of the Mediterranean drinking culture, although they are still like Russia and Ukraine in that their level of alcohol consumption is among the highest in the world while life expectancy at birth is one of the lowest among developed countries. This study provides a descriptive analysis of the changes in alcohol-related mortality trends and drinking patterns in Moldova as compared to Ukraine and Russia, both during the Soviet period and after Independence. We found that accidental poisoning by alcohol in Moldova is of minor importance in contrast to Russia and Ukraine, whereas very high liver cirrhosis mortality without a traditional sex gap is a peculiar feature of the Moldovan mortality pattern. Furthermore, the burden of liver cirrhosis accounts for much lower Moldovan female life expectancy compared to their Russian or Ukrainian counterparts. We attempt to explain this phenomenon by hypothesizing the existence of harmful drinking habits of homemade wine consumption in Moldova, which seems to affect males and females equally. In Moldova, the anti-alcohol policies must include the measures aimed at reducing the consumption of homemade wine.

Convergence or Divergence? Life Expectancy Patterns in Post-communist Countries, 1959-2010

In the 1960s and 1970s, the countries of Central and Eastern Europe and the Soviet Union experienced an unanticipated stagnation in the process of mortality reduction that was accelerating in the west. This was followed by even starker fluctuations and overall declines in life expectancy during the 1980s and 1990s. We identify statistically the extent to which, since the 1990s, the countries of the post-communist region have converged as a group towards other regional or cross-regional geopolitical blocks, or whether there are now multiple steady-states ('convergence clubs') emerging among these countries. We apply a complex convergence club methodology, including a recursive analysis, to data on 30 OECD countries (including 11 post-communist countries) drawn from the Human Mortality Database and spanning the period 1959-2010. We find that, rather than converging uniformly on western life expectancy levels, the post-communist countries have diverged into multiple clubs, with the lowest seemingly stuck in low-level equilibria, while the best performers (e.g. Czech Republic) show signs of catching-up with the leading OECD countries. As the post-communist period has progressed, the group of transition countries themselves has become more heterogeneous and it is noticeable that distinctive gender and age patterns have emerged. We are the first to employ an empirical convergence club methodology to help understand the complex long-run patterns of life expectancy within the post-communist region, one of very few papers to situate such an analysis in the context of the OECD countries, and one of relatively few to interpret the dynamics over the long-term.