Alcohol and Russian Mortality a continuing crisis by eot15664

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									International Health Policy Program -Thailand
 International Health Policy Program                     -Thailand




                                    Alcohol and Russian




   Thaksaphon Thamarangsi
                                 Mortality: a continuing crisis
                                                Input
                                                • Alcohol and Russian Mortality: a continuing crisis:
-Thailand




                                                  David Leon, et al. Addiction, 104, 2009
                                                • Alcohol is themain cause of the high rates and rapid
                                                  fluctuations of premature adult mortality in Russia:
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                                                  Richard Peto (proceeding doc) from the Global Expert
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                                                  Meeting on Alcohol Health and Social Develolment,
                                                  Sweden 2009
                                                • Alcohol and Global BODI focussing on infectious
                                                  diseases: Jurgen Rehm (proceeding doc) from the
                                                  Global Expert Meeting on Alcohol Health and Social
                                                  Develolment, Sweden 2009
                                                • WHO alcohol database

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                                                        Russia: Why important?
                                                • High APC
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                                                • Harmful drinking pattern
                                                • High alcohol attributable health burden
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                                                Introduction
                                                • Life Expectance at birth: Low and fluctuated
                                                • remarkable gender difference
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                                                • Early childhood and elderly mortalities: stable/decrease
                                                • Alcohol= most plausible, proximal explanation for the
                                                  fluctuation, while smoking and health care system help
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                                                  explaining the low LE.
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                                                • Trends in alcohol consumption mirror these fluctuation

                                                    The decrease in adult per capita consumption by 25%, from 14.2
                                                    to 10.5 Litre between 1984 and1987, promotes three more life
                                                    expectancy years. After consumption volume rebounded back to its
                                                    former level in five years later, life expectancy also returned to its
                                                    initial figure. When consumption further increased to 15.0 litres per
                                                    capita in 2001, moreover, an additional drop in male life
                                                    expectancy was evident.

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                                                                Negative population growth




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                                                                Life Expectancy at birth




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                                                                 Early childhood and elderly mortality




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                                                                 Mortality rates comparison Russia-Western Europe




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-Thailand
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                                                Does alcohol consumption mirror mortality?




                                                                          All causes mortality 25-54 yo M
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                                                                                      Recorded APC
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                                                  0
                                                       1981 1983 1985 1987 1989 1991 1993 1995 1997 1999 2001 2003
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                                                  Percentage of death and DALYs attributable to
                                                alcohol and tobacco by age group: Thailand 2004
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-Thailand




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                                                                                                    Death alcohol
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                                                                                                    Death tobacco
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                                                                                                    DALYs alcohol
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                                                                                                    DALYs tobacco
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                                                 4
                                                 2
                                                 0
                                                     0-4   5-14 15-29 30-44 45-59 60-69 70-79 80+

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                                                     Alcohol-attributable mortality
                                                • WHO CRA (2002)
-Thailand




                                                  – Alcohol AF= 18% male and 9% female all age
                                                    groups
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                                                  – AAF= 31% male and 20% female 20-44 years
                                                • Izhevsk (2003-5)
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                                                  – AAF= 43% of male 25-54 years



                                                • Thailand (2004)
                                                  – AAF= 9.82% 15-59 years (13.98 M, 1.12 F)


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                                                  Alcohol-attributable mortality: methodology
                                                • Classic cohort studies tend to underestimate
                                                  mortality impact of alcohol
-Thailand




                                                  – Fail to recruit heavy user
                                                  – Late of death onset: cannot capture heavy use
                                                    episode
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                                                  – Conventional underestimation of self report
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                                                • Classic alcohol BOD
                                                • Izhevsk study= case-control
                                                  – Proxy report
                                                  – Innovative indicators
                                                     •   Surrogate alcohol
                                                     •   Zapoi= drinking over 2 days+ escape from normal life
                                                     •   Hangover
                                                     •   Sleep in clothes from drunkenness
                                                     •   Alcohol treatment (compulsory for alcohol problems)
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                                                           Cardiovascular disease
                                                • CVD= largest single component of total mortality
-Thailand




                                                • Most Russian are Caucasoid (subject to gain alcohol
                                                  cardio protective effect)
                                                • Harmful effect of alcohol to CVD: arrhythmia, blood
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                                                  clotting, and blood pressure
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                                                • High acute alcohol poisoning [17% of M&F (35-69)
                                                  forensic autopsies had 400 mg%]
                                                • [+cardio myopathy= chronic effect precipitated by
                                                  final binge drinking]
                                                • AAF for hypertension is 10% (Polikina O, et al 2009)



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                                                                 CVD and non-medical mortality




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                                                Non-beverage alcohols= surrogate alcohols
                                                • Medicinal alcohol, medicine based alcohol, aftershave, lotions,
                                                  perfume, shellac, varnish, antifreeze, de-icing fluids, brake fluid,
-Thailand



                                                  industrial cleaning fluids, solvents, denatured alcohol, glues,
                                                  gasoline, kerosene, tooth powder, vinegar and shoe polish
                                                • Izhevsk: prevalence= 8% of 25-54 years male
                                                • Largely available, esp medicinal tinctures, with higher content
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                                                  but cheaper price to vodka
                                                • Alcohol content for most common (i.e. medicinal tinctures, eau-
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                                                  de-colognes, antiseptic)= 60-95% with no significant amount of
                                                  toxic alcohols
                                                • Surrogate alcohol rose as by complication from Gorbachev’s
                                                  anti-alcohol campaign

                                                • Be clear: what is unrecorded alcohol?




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                                                 Recorded- &unrecorded alcohol
                                                Unrecorded
-Thailand




                                                Legal               Illegal
                                                • Home brewed,      • Smuggling (X-
                                                  where permitted       border)
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                                                                    • Homebrewed,
                                                                        where prohibited
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                                                                    • Counterfeit bev
                                                        Surrogate

                                                Recorded



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                                                        Quantifying consumption
                                                • Survey= underestimation
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                                                • Sale data=production data= cannot capture
                                                  unrecorded
                                                • How to quantify homebrew (Samagon in
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                                                  Russia)
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                                                • Innovative approaches
                                                  – Treml, 1982: retail sales of sugar as a proxy for
                                                    home-brewed
                                                  – Nemstov, 2002: Treml approach plus acute
                                                    alcohol poisoning
                                                • 1/3 (4.9/15.5) to ½ of APC is unrecorded
                                                  alcohol
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                                                              Drinking behaviour
                                                • Vodka and other strong spirits are most common
-Thailand




                                                  drink among men
                                                • Large hazardous amount on single occasions is
                                                  common
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                                                • Challenge to the conventional way to define ‘binge
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                                                  drinking’ (X amount of alcohol in single occasion, or
                                                  public drunkenness) cannot capture or face difficulty
                                                  with heavy drinking episodes/ intensive drinking
                                                  bouts, such as zapoi
                                                • Zapoi prevalence= 12% of male
                                                • Study show many problems relationship with zapoi
                                                  drinkers

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                                                           Who drinks in Russia?
                                                • Men have higher drinker prevalence for any
-Thailand




                                                  beverage type, higher consumption
                                                  volume/episode, and hazardous drinking
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                                                • Social gradients of hazardous drinking
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                                                   – Education: higher< lower
                                                   – Marital status: married<single< divorced/separated
                                                   – Unemployment
                                                • Bidirectional




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                                                        Why do Russians drink?
                                                • Major events
-Thailand




                                                  – Collapse of communism>> convulsion
                                                  – Economic downturn>>Privatization+IMF
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                                                  – Alcohol policy
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 Ukraine
                                      Russia
                                                                 Former USSR




 Turkmenistan
                                    Latvia




 Uzbekistan
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                                                              Lesson learned
                                                • The theory of aggregated consumption
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                                                  volume
                                                • Benefit and (unexpected) complications of
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                                                  alcohol policy
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                                                • Relationship between SD and Alcohol
                                                  consumption and Health
                                                • Innovative methodology




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