Spatial patterns of male alcohol‐related mortality in Belarus, Lithuania, Poland and Russia*
Research article
Summary
In some former Soviet bloc countries, men often die early due to alcohol. Alcohol-related mortality varies considerably from one region to another, according to a study in the European part of Russia, Belarus, Lithuania and Poland. The most problematic regions in these terms are north-western and western Russia, eastern and north-western Belarus, south-eastern Lithuania, and eastern and central Poland.
Heavy alcohol use often turns out to be fatal and largely explains early mortality of men in European Russia, Belarus, Lithuania and Poland. These regions share a common past, as well as similar cultural practices and consumption patterns. The researchers believe that this largely determines mortality due to alcohol consumption, which is similar in the four countries.
Nevertheless, generalizing can be problematic. The situation with alcohol-related early mortality varies considerably not only by country, but by region inside a given country, with identifiable hot spots with epidemic levels of alcohol harm.
All these countries face a problem of heavy alcohol consumption, due to their common history. This includes both the socialist past (Poland was long influenced by the Soviet Union, while Belarus and Lithuania were Soviet republics) and history more than a century ago under the Russian Empire, which included a considerable part of Poland along with Belarus and Lithuania.
Pervasive and heavy alcohol consumption practices formed over a century ago and have persisted up to the present.
For instance, in central parts of Poland and in the east (in areas bordering Belarus), mortality data show that heavy alcohol consumption is more widespread than in the other parts of the country.
On the contrary, in regions that have not been impacted by a shared past, such as in southern Poland, which used to be part of Austria-Hungary, alcohol-related mortality is lower. The alcohol norm is obviously less pervasive and harmful there.
The alcohol norm is obviously ‘barrier-free’ and crosses national borders. Patterns of heavy alcohol use in border regions are almost identical. This is true, for example, for border regions of Russia and Belarus, or Belarus and Lithuania.
In Lithuania, almost all regions close to the border with Belarus have higher alcohol-related mortality.
In addition to shared history, other factors impact alcohol-related mortality. These include a region’s socio-economic situation: real household earnings and unemployment levels, as well as migration from the country’s remote rural regions to its centre and urban settlements, and the illegal alcohol trade.
For example, the relative safety of Moscow and St. Petersburg may be explained by higher living standards and cultural habits of the population. Other ‘sober’ territories are university towns and some closed administrative territories, such as related to defence industry (Zhukovsky, Korolev, Obninsk, Dubna, Protvino, etc).
Socio-economic factors largely determine the situation with alcohol-related lethality in the north-western economic region.
When alcohol-related mortality is analysed by the type of settlement, rural areas perform worse than urban ones. This is due to worse access to medical care, weak leisure infrastructure, and uncertainty regarding the future. Rural areas lack attractive jobs. Younger, healthier and ambitious people leave for the cities.
The study further found:
- There are more alcohol-related mortality hot spots in Russia and Belarus, and fewer in Lithuania and Poland.
- The most troubled territories are north-western Russia, eastern and north-western Belarus, south-eastern Lithuania, and eastern and central Poland.
- Within Russia, the lowest alcohol-related mortality rates are in Moscow, St. Petersburg and the Central Black Earth regions (Lipetsk, Kursk, and Voronezh oblasts), while the highest rates are in north-west and west (Leningrad, Novgorod, Smolensk, and Bryansk oblasts).
- Alcohol-related male mortality rates largely explain early mortality among men in general.
Previous studies have also found that peaks in mortality coincide with alcohol consumption peaks – illustrating that the contribution of alcohol use in mortality is high.
Abstract
Introduction and Aims
Eastern Europe is known to suffer from a large burden of alcohol‐related mortality. However, persisting unfavourable conditions at the national level mask variation at the sub‐national level.
The researchers aim to explore spatial patterns of cause‐specific mortality across four post‐communist countries: Belarus, Lithuania, Poland and Russia (European part).
Design and Methods
The researchers use official mortality data routinely collected over 1179 districts and cities.
The analysis refers to males aged 20–64 years and covers the period 2006–2014.
Mortality variation is mainly assessed by means of the standardised mortality ratio. Getis‐Ord Gi* statistic is employed to detect hot and cold spots of alcohol‐related mortality.
Results
Alcohol‐related mortality exhibits a gradient from very high levels in northwestern Russia to low levels in southern Poland. Spatial transitions from higher to lower mortality are not explicitly demarcated by national boundaries. Within these countries, hot spots of alcohol‐related mortality dominate the territories of northwestern and western Russia, eastern and northwestern Belarus, southeastern Lithuania, and eastern and central Poland.
Discussion and Conclusions
The observed mortality gradient is likely associated with the spread of alcohol epidemics from the European part of Russia to the other countries, which appears to have started more than a century ago.
Contemporary socioeconomic and demographic factors should be taken into account when developing alcohol policies. The same is true for the peculiarities of culture, norms, traditions and behavioural patterns observed in specific geographical areas of the four countries.
Reducing alcohol‐related harm in the areas identified as hot spots should be prioritised.
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* PHOTO CREDIT: S. Timonin, E. Andreev et al.
