EUROMEDICA  Hanover 6-7  Juni 2008	Advanced methods of diagnosis, treatment and prophylactics
	European Academy of Natural Sciences, Hanover European Scientific Society, Hanover Russian Academy of Natural Sciences, Moscow

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The current serious demographic situation in Russia has been characterized since the early 1990s by the total number of deaths being greater than the total number of births in the majority of geographic regions. This has led to a substantial reduction in the population of the country. Compared to other industrialised countries, over the past 20 years, mortality has been particularly high among working-age men, resulting in a low life expectancy at birth among men. If mortality rates in the future among men remain the same as they are today, only half of young men aged 20 will survive until age 60 years.

Since 2002 we have carried out a series of investigations of the high mortality among working-age men in a typical Russian city to the West of the Ural mountains. This included both analysis of official statistics as well as epidemiological and sociological interview studies of live men and those dying in the period 2003-5.

In interviews with 1750 live men of working age (aged 25-54 years) we have found that strong alcohol drinks (spirits) are the most common alcoholic beverage drunk (consumed by 80% men), with one in 5 men drinking spirits daily or almost daily. Overall, 12% of men drank sufficiently heavily to have frequent hangovers or have some other characteristic of being a problem drinker. Smoking was common, with 63% of men being smokers and 14% former smokers.

The factors associated with problem drinking among men in our study were closely related to socioeconomic circumstances. Low educational level, being divorced and lack of full-time paid employment were particularly strongly linked to heavy drinking.

Men classed as problem drinkers, or who drank non-surrogate alcohols (8% of men), had a risk of mortality that was 6 times greater than men who did not consume alcohol or consumed usual alcohol drinks. From this we have estimated that 43% of deaths among men aged 25-54 years could be attributed to hazardous alcohol consumption. . If these data could be applied to Russian Federation, this amount suggests that up to 175000 excess deaths could be avoided if hazardous alcohol consumption was eliminated.

Based on data from forensic autopsies (which were undertaken on almost all deaths in this age group), medical experts and pathologists established that the most common category of cause of death was injuries, poisoning and violence; cardiovascular diseases was the next most common. Other death causes were rare in occurrence. Alcohol in blood was found in 46% of dead men and diseases connected with alcohol were identified in almost 60% of men.

Thus, our research shows that high mortality in working-age men is associated in many cases with heavy alcohol drinking, and suggests that the adverse effects of alcohol could be diminished with education, availability of permanent job and family. Smoking is also an important contributor to the very high mortality seen among working age men. It is necessary to develop and implement coordinated policies to reduce risk factors for serious ill health and death seen in the working age population in Russia. These would include steps to reduce alcohol consumption as a whole and to reduce smoking. Steps also need to be taken to improve treatments for those with alcohol problems. Most importantly, steps need to be taken to minimise the transmission of these dangerous behaviours to the next generation of Russian citizens.