Purpose: To discuss the hypothesis that alcohol, and binge drinking in particular, is a major determinant of the recent mortality fluctuations in Russia.
Methods: Discussion based on published literature.
Results: The hypothesis is based on circumstantial evidence. The changes in mortality coincided with introduction and collapse of the Soviet anti-alcohol campaign. The largest relative changes in mortality were observed for "alcohol-related causes" (a specific diagnostic category used in Russia) as well as violent and accidental deaths, but the largest absolute changes were observed for cardiovascular causes which had the largest impact on all-cause mortality. There is no direct support for the hypothesis. Available estimates of alcohol consumption in Russia are low, and the only published study on alcohol and mortality conducted in Russia produced negative results. Increase in drinking prevalence alone would not explain the mortality rise; increase in relative risk related to alcohol would also be needed. The biological mechanisms which could underlie the presumed strong effects of alcohol on heart disease are not clear. On the other hand, binge drinking has not been addressed adequately by research so far.
Conclusions: Until a well designed study is conducted in Russia, the hypothesis remains debatable.