Drinking habits and alcohol-related mortality in Moldova, Ukraine and Russia PeninaOlga Centre for Demographic Research, Academy of Sciences of Moldova State University of Medicine and Pharmacy “NicolaeTestemitanu”, Moldova 17 June, Scientific workshop Alcohol and Health: Continuityand Change, INED
Introduction • A long-term health deterioration in the former soviet union countries is explained by a combination of different factors. Excessive alcohol consumption plays a central role. • The majority of studies on alcohol and health in post-soviet countries focus on Russia (Mesléet al. 1996, Shkolnikov & Chervyakov 2000; McKee et al. 2001; Leon et al. 2007; Nemtsov 2008; Razvodovsky 2012), less on other states: Ukraine (Godek, 1998; Mesléet al., 2003; Levchuk, 2010), Georgia and Armenia (Duthé et al., 2013). • A deep analysis of mortality crisis affected the former USSR states from the mid-60s became possible thanks to the reconstruction of continuity of cause-of-death time series by a special method of reconstruction (Meslé &Vallin, INED).
Introduction (cont’n) • Why do we focus on Moldova, Ukraine and Russia? • - the lowest life expectancy at birth among the developed countries (WHO, 2008) • - the world’s heaviest drinking countries (WHO, 2010) with quite different drinking patterns • - availability of the reconstructed death time series from 1965 • Russia: Meslé et al., 1996 • Ukraine: Meslé and Vallin et al., 2003, 2012 • Moldova: Penina, Meslé and Vallin, unpublished
Introduction (cont’n) Our main question: How do changes in trends and patterns of drinking habits influence the alcohol-related mortality in Moldova, Russia and Ukraine?
Data sources on alcohol consumption • Official sales data • WHO data (Global Information System on Alcohol and Health) • Experts’ estimates • Indirect methods for Russia (Treml, 1982; Nemtsov2000, 2008) • Survey data (Pomerleau et al., 2008)
Anti-alcohol measures Soviet period The Soviet Government widely recognized alcohol abuse as a major health problem. Several attempts to reduce alcohol consumption (1917, 1927, 1958, 1972, 1985). The most sizable, but short-lived effect was achieved during the anti-alcohol campaign launched by M. Gorbachev in May 1985 and lasted till October, 1987. However, the anti-alcohol movement started in the early 1980s. Period of Independence Russia: new anti-alcohol measures from 2006 (Nemtsov, 2010) Moldova: anti-alcohol campaign “With sober mind” launched in February 2014 Ukraine: “no specific targets were adopted for the reduction of per capita alcohol consumption” (The World Bank, 2009)
Pure recorded alcohol consumption in litres per person 15+. Sales and WHO data. Source: WHO, Global Information System on Alcohol and Health; National Statistical Offices from Moldova, Ukraine and Russia
Recordedandunrecorded alcohol consumption among adults (15+) in selected European countries. WHO (2010) High share of unrecorded consumption: MDA: 16.8 litres (60%) RUS: 15.1 litres (24%) UKR: 13.9 litres (36%) Source: WHO, Global Information System on Alcohol and Health
Unrecorded alcohol consumption • Moldova: home-made wine (11% of alcohol) • Ukraine: Distilled alcohol, pyvo (hopped beer: 3-6% of alcohol), • braha(unhoped milled beer: 3-6% of alcohol) • Russia: Samogon (vodka: >40% of alcohol) Source: Moldova: Expert Group, 2008; Ukraine and Russia: Popova et al., 2007
Patterns of alcohol sales databetween 1980 and 2012 (in %) Source: National statistical offices from Moldova, Ukraine, Russia
Drinking habits in the three countries • Moldova: closer to Mediterranean type. Economic crisis in 90s led to an overall decline in alcohol sales with a substitution of wine/beer sales by vodka sales. Unrecorded consumption of home-made wine is very high. Recent substitution of vodka sales by beer sales. • Ukraine andRussia: traditional representatives of Nordic type, have similar drinking habits, though “lighter” in Ukraine. A good share of home-distilled alcohol. • In Russia: recent deep decline in vodka sales, an increasing contribution of beer sales. In Ukraine, substitution of vodka sales by beer sales over recent years is less evident.
How do changes in trends and patterns of drinking habits influence alcohol-related mortality?
Alcohol-related mortality: chronic and acute consequences of alcohol use Cronic consequences of alcohol use acute consequences of alcohol use Accidental poisoning, including by alcohol Rest of accidents and violence • Liver cirrhosis • Alcohol use mental disorders • Upper aerodigestive tract cancer
Contribution of chronic and acute consequences of alcohol use to changes in life expectancy at age 15 From 1965
Trends in alcohol-related mortality From 1965
How do changes in trends and patterns of drinking habits influence AR mortality? • In Ukraine and Russia (Nordic type), acute consequences of alcohol use are responsible for long-term mortality decline/stagnation and its fluctuations. Their impact is stronger in Russia than in Ukraine. However, the situation with chronic consequences of alcohol use (liver cirrhosis) is deteriorating very rapidly over the recent years for both sexes, especially in Ukraine. • In Moldova (closer to Mediterranean type), chronic alcoholism, liver cirrhosis in particular, are of much more importance, especially among females. Accidental poisoning by alcohol is by far much lower in Moldova than in Russia and Ukraine.
Conclusions (cont’n) • Recent changes in drinking habits in Russia after 2005 (decline in vodka sales, its substitution by beer) resulted in considerable improvements from acute alcoholism, and much less affected chronic consequences of alcohol abuse. • An increasing contribution of beer sales in total recorded alcohol consumption appears to have a positive effect on mortality trends from violent deaths in three countries, especially at younger ages. This is especially evident in Russia, less in Moldova and Ukraine. • Unlike Russia, recent improvements from violent deaths in Moldova and Ukraine are too short-lived to draw any conclusions about future sustainable improvement.