Alcohol, pattern of drinking and all-cause mortality in
Russia, Belarus and Hungary: a retrospective indirect
cohort study based on mortality of relatives
*, Denes Stefler
*, Michael Murphy
, Lawrence King
, Martin McKee
Department of Epidemiology and Public Health, University College London, London, UK,
Department of Social Policy, London School of Economics, London, UK,
Department of Sociology, University of Cambridge, Cambridge, UK
and Department of Health Services Research and Policy, London School of Hygiene and Tropical
Medicine, London, UK
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.
Retrospective cohort study; the cohort consisted of close
relatives of survey participants.
Middle-sized settlements in Russia, Belarus and Hungary.
of 124 150 subjects aged 35–69 years in 1998 and followed-up until 2013.
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)].
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.
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.
Keywords Alcohol, all-cause mortality, binge drinking, cohort study, drinking pattern, Eastern Europe, hazardous
Correspondence to: Martin Bobak, Department of Epidemiology and Public Health, University College London, 1–19 Torrington Place, London WC1E 6BT, UK.
Submitted 29 March 2017; initial review completed 26 June 2017; ﬁnal version accepted 5 February 2018
*Joint ﬁrst authors.
Two decades of mortality research in Eastern Europe
following the collapse of communism precipitated a major
reassessment of the contribution of alcohol to population
health. While the role of alcohol in liver cirrhosis, injuries
and violence has long been recognized, less was known
about its association with other diseases. For example, the
ﬁrst Global Burden of Disease study stated that ‘alcohol is
cardioprotective at all levels of consumption’ . Using
aggregate data, early studies investigating both the high
overall mortality and its large ﬂuctuations in the former
Soviet Union countries in the 1990s revealed close
temporal  and, later, geographical  associations with
deaths from a range of conditions. Subsequent studies,
using a range of methods, identiﬁed mechanisms by which
hazardous drinking might affect these other causes of
A series of individual-level studies in Russia followed,
including case–control [7–9] and cohort studies [10,11],
© 2018 Society for the Study of Addiction Addiction, 113,1252–1263