Relevance of alcohol and tobacco to high premature mortality rate in Russia: Prospective study of 200,000 adults

David ZARIDZE, Russian N.N.Blokhin Cancer Research Centre, Russia
LEWINGTON S. 2 , BORODA A. 1 , SCÉLO G. 3 , XIANGLING KONG X. 2 , BURRETT J. 2 , SHERLIKER P. 2 , BRENNAN P. 3 , PETO R. 2 , KONOBEEVSKAYA I. 4 , LAZAREV A. 5

1 Russian NN Blokhin Cancer Research Centre, Moscow, Russian Federation
2 2CTSU, Nuffield Dept of PopulatiHealth (NDPH), University of Oxford, United Kingdom
3 WHO International Agency for Research on Cancer, Lyon, France.
4 Institute of Cardiology, Tomsk Research Centre, Tomsk, Russia
5 Altai Branch of the Russian Cancer Research Centre, Barnaul, Russia

Purpose: To assess the joint effect of alcohol and tobacco on the high premature mortality in Russia.
Methods: In 3 west Siberian cities, 200,000 healthy adults aged 30-74 were interviewed during 1999-2008 and followed up for cause-specific mortality. Participants completed questionnaires about drinking, smoking and other lifestyle factors and had physical measurements taken. Almost all heavy drinkers smoke, so analyses of alcohol hazards are only in smokers; conversely, analyses of tobacco hazards are only in those who drink <1 bottle of vodka per week. Analyses exclude all with previous disease at entry
Results: Alcohol hazards – Among 57,361 male smokers, estimated 20-year risks of dying at ages 35-54 years were 16% (95% CI 15–17) for those who reported at baseline consuming less than a bottle of vodka per week, 20% (18–22) for those consuming 1-2.9 bottles per week, and 35% (31–39) for those consuming ≥3 bottles per week; trend p<0·0001. The corresponding 20-year risks of death at ages 55-74 years were 50% (48–52), 54% (51–57), and 64% (59–69); trend p<0·0001. Tobacco hazards – Among 59,829 healthy adults who reported drinking <1 bottle of vodka per week, current smoking was associated with elevated all-cause mortality (RR=1.53 vs never smoking, CI 1.43-1.63). Starting young (<14 years) and smoking heavily (≥20 cigarettes/day) were both associated with even higher all-cause mortality (RR=1.97, 1.81-2.15 and RR=1.70, 1.63-1.77 respectively vs never smoking). Ex-smokers who quit before age 45 appeared to avoid most of the excess risk associated with continuing to smoke (RR=1.02 vs never smoking, 0.91-1.15).
Conclusion: These risk ratios, together with retrospective study findings and national mortality trends, suggest that about 2/3 of all Russian male deaths in middle age are caused by tobacco and alcohol.
Funding: UK MRC, British Heart Foundation, Cancer Research UK, WHO IARC