Risk factor policies, morbidity, and mortality in Russia
Authors: Jürgen Rehm, Carina Ferreira-Borges
Journal: The Lancet (2018)

Mortality rates in Russia decreased for non-communicable diseases and all other major causes of death between 1980 and 2016 according to the Global Burden of Disease (GBD) 2016 Study by the GBD 2016 Russian Collaborators,1GBD 2016 Russia CollaboratorsThe burden of disease in Russia from 1980 to 2016: a systematic analysis for the Global Burden of Disease Study 2016.Lancet. 2018; (published online Aug 30.)http://dx.doi.org/10.1016/S0140-6736(18)31485-5Google Scholar published in The Lancet. As the prevalence of the most important risk factor according to this study—high blood pressure—increased over the past decades,2Forouzanfar MH Liu P Roth GA et al.Global Burden of hypertension and systolic blood pressure of at least 110 to 115 mm Hg, 1990–2015.JAMA. 2017; 317: 165-182Crossref PubMed Scopus (1153) Google Scholar these achievements seem to be primarily due to substance control policies, specifically WHO's so-called best buys,3WHOTackling NCDs: “best buys” and other recommended interventions for the prevention and control of noncommunicable diseases.http://www.who.int/ncds/management/best-buys/en/Date: 2017Date accessed: August 15, 2018Google Scholar which resulted in marked declines in tobacco4WHO Regional Office Office for EuropeGlobal Adult Tobacco Survey (GATS): executive summary 2016.http://www.euro.who.int/__data/assets/pdf_file/0012/347979/GATS-2016-rus-ES-FINAL-170906.pdfDate: 2016Date accessed: August 15, 2018Google Scholar and—more importantly for Russia—alcohol use.5WHOGlobal status report on alcohol and health 2018. World Health Organization, Geneva2018Google Scholar For tobacco, recent trends have been measured via the Global Adult Tobacco Survey (GATS), a nationally representative household survey of individuals aged 15 years or older, with standard tobacco monitoring indicators. As part of the Global Tobacco Surveillance System, this survey was first implemented in Russia in 2009 (n=11 406), and was repeated in 2016 (n=11 458), with response rates of 98%.4WHO Regional Office Office for EuropeGlobal Adult Tobacco Survey (GATS): executive summary 2016.http://www.euro.who.int/__data/assets/pdf_file/0012/347979/GATS-2016-rus-ES-FINAL-170906.pdfDate: 2016Date accessed: August 15, 2018Google Scholar GATS found a significant 21·5% reduction in the prevalence of smoking, from 39·4% (95% CI 38·0–40·8) in 2009 to 30·9% (29·4–32·4) in 2016, and this reduction was proportionally lower among men (16%) than among women (34%). Relatedly, exposure to second-hand smoke also decreased.4WHO Regional Office Office for EuropeGlobal Adult Tobacco Survey (GATS): executive summary 2016.http://www.euro.who.int/__data/assets/pdf_file/0012/347979/GATS-2016-rus-ES-FINAL-170906.pdfDate: 2016Date accessed: August 15, 2018Google Scholar These reductions in tobacco exposure are associated with Russia's Federal Law (No. 15-FZ), passed in 2013,6Government of RussiaFederal Law No 15-FZ “On protection the health of citizens from the effects of second hand tobacco smoke and the consequences of tobacco consumption.http://data.euro.who.int/tobacco/Sites/Legislation.aspx?legislatureID=174Date: Feb 20, 2013Date accessed: August 15, 2018Google Scholar which included a smoke-free policy for public places, increased taxes on tobacco products, enacted advertising, promotion, and sponsorship bans, and strengthened prohibitions on selling tobacco to minors. Additionally, in 2012, by decree of the Ministry of Health, graphic health warnings were introduced on cigarette packages. Alcohol use indicators also decreased substantially. The most important indicator, adult per capita consumption, decreased from 2010 to 2016 by 26·1%, from 15·8 L (95% CI 15·2–16·5) to 11·7 L (11·2–12·2) of pure alcohol (both figures are based on 3-year moving averages). Heavy episodic drinking (defined as consuming 60 g or more of pure alcohol on at least one drinking occasion in the past 30 days) decreased by 14·3%, from 49·4% (95% CI 26·2–61·0) in 2010 to 42·3% (20·8–54·6) in 2016.5WHOGlobal status report on alcohol and health 2018. World Health Organization, Geneva2018Google Scholar The decrease in heavy episodic drinking was proportionally larger for men (−16·9%) than for women (−10·4%). All alcohol exposure data were obtained and processed as part of the 2018 Global Status Report on Alcohol and Health.5WHOGlobal status report on alcohol and health 2018. World Health Organization, Geneva2018Google Scholar Alcohol exposure data have been validated at the country level and were consistent between sales figures and survey results. The reductions in alcohol use described above are likely to have resulted from policy measures7Neufeld M Rehm J Effectiveness of policy changes to reduce harm from unrecorded alcohol in Russia between 2005 and now.Int J Drug Policy. 2018; 51: 1-9Crossref PubMed Scopus (28) Google Scholar (including all best buys) instituted over the past decade, such as the gradual raising of the minimum price on spirits since 2010. Although the noted comparisons are for 2010 and 2016 (to align with the tobacco statistics), changes in alcohol legislation and declines in alcohol use and attributable mortality started before 2010.1GBD 2016 Russia CollaboratorsThe burden of disease in Russia from 1980 to 2016: a systematic analysis for the Global Burden of Disease Study 2016.Lancet. 2018; (published online Aug 30.)http://dx.doi.org/10.1016/S0140-6736(18)31485-5Google Scholar, 8Neufeld M Rehm J Alcohol consumption and mortality in Russia since 2000 – are there any changes following the alcohol policy changes starting in 2006.Alcohol Alcohol. 2013; 48: 222-230Crossref PubMed Scopus (86) Google Scholar For Russia and eastern Europe, alcohol use is a major determinant of life expectancy9Nemtsov AV Rossijskaja smertnost' v svete potreblenija alkogolja. [Russian mortality in light of alcohol consumption].Demograficheskoe obozrenie. 2015; 2: 113-135Google Scholar and burden of disease.5WHOGlobal status report on alcohol and health 2018. World Health Organization, Geneva2018Google Scholar Unlike tobacco, alcohol-related deaths occur early in the life course. The GBD study reported that among people aged 15–49 years, 34·4% (95% CI 29·5–38·6) of male deaths and 20·1% (17·1–23·4) of female deaths were due to alcohol.1GBD 2016 Russia CollaboratorsThe burden of disease in Russia from 1980 to 2016: a systematic analysis for the Global Burden of Disease Study 2016.Lancet. 2018; (published online Aug 30.)http://dx.doi.org/10.1016/S0140-6736(18)31485-5Google Scholar WHO estimates are higher, indicating that among people aged 15–49 years old, 38·6% (95% CI 35·3–40·7) of male deaths and 30·3% (95% CI 27·6–32·5) of female deaths were due to alcohol.5WHOGlobal status report on alcohol and health 2018. World Health Organization, Geneva2018Google Scholar Overall, differences between studies reflect different methodologies; however, both studies indicate a high proportion of premature mortality in Russia due to alcohol. In addition, as unrecorded alcohol use is an important part of overall use, and is difficult to estimate for Russia in any study,10Rehm J Kailasapillai S Larsen E et al.A systematic review of the epidemiology of unrecorded alcohol consumption and the chemical composition of unrecorded alcohol.Addiction. 2014; 109: 880-893Crossref PubMed Scopus (132) Google Scholar alcohol exposure and attributable burden statistics might be underestimated by both studies. WHO estimates are closer to, but lower than, earlier estimates based on the retrospective case-control study of Zaridze and colleagues,11Zaridze D Brennan P Boreham J et al.Alcohol and cause-specific mortality in Russia: a retrospective case–control study of 48 557 adult deaths.Lancet. 2009; 373: 2201-2214Summary Full Text Full Text PDF PubMed Scopus (261) Google Scholar which showed that in the 1990s, among people aged 15–54 years, 59% of all male deaths and 33% of all female deaths were attributable to alcohol. The higher estimates of Zaridze and colleagues are likely to be primarily due to considerably higher drinking levels in the 1990s12Shield KD Rylett M Rehm J Public health successes and missed opportunities. Trends in alcohol consumption and attributable mortality in the WHO European Region, 1990–2014. WHO European Region, Copenhagen2016Google Scholar and the fact that the study involved only three cities. Despite reductions in alcohol and tobacco use, the fact that alcohol contributes to more than every third death in early and middle adulthood in Russia, and that mortality in this age category remains high, suggests there is still substantial room for improvement. Given Russia's proportion of alcohol-attributable deaths relatively early in life, and that over half of Russian men use tobacco, the potential to further increase life expectancy for Russia through effective control policies is enormous. We declare no competing interests. Part of the work of CF-B was financially supported by the WHO European Office for Prevention and Control of Non communicable diseases, which is in part supported by the Government of Russia. The burden of disease in Russia from 1980 to 2016: a systematic analysis for the Global Burden of Disease Study 2016Trends in mortality in Russia from 1980 to 2016 might be related to complicated patterns of behavioural risk factors associated with economic and social change, to shifts in disease burden, and to changes in the capacity of and access to health care. Ongoing mortality and disability from causes and risks amenable to health-care interventions and behaviour modifications present opportunities to continue to improve the wellbeing of Russian citizens. Full-Text PDF Open Access