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To the Editor: Drs Leon and Shkolnikov,1 in their Editorial regarding the article by Dr Notzon and colleagues,2 discussed the increase in mortality in Russia in relation to the drinking habits of Russians: "Initially, there was an increase in life expectancy at birth, a result of Gorbachev's antialcohol campaign . . . followed by a steady decrease in life expectancy." Later in the Editorial, they state that "alcohol appears to be a proximal risk factor and plays a central role."
Proposing alcohol as a cause of reduced life expectancy is a weak hypothesis. While an increased life expectancy was noted between 1986 and 1988 in almost all "socialist" countries, the Soviet Union was the only country where there was an antialcohol campaign. The subsequent increase in mortality took place in all postsocialist countries, irrespective of alcohol consumption.3
In their study, Notzon et al2 used the group of deaths due to "other alcohol-related causes" for the analysis, but they did not present the deaths due to alcohol intoxication. Their use of the percent change reveals another inconsistency: the increase in percent change in age-adjusted mortality for "other alcohol-related causes" for women is 308.5% vs 249.5% for men, while the all-cause mortality rate for women in Russia has increased less than that for men. Trends of alcohol consumption and mortality demonstrate some parallelism, but it is not enough for causation.
Leon and Shkolnikov1 did not cite a book published in Moscow in 19973 devoted to health of Russians during reforms up to 1996. The main sources of the negative trends in Russia and other former socialist countries it identifies are poverty, stress, and disillusionment under the pressure of the new ideological oligarchic state. Leon and Shkolnikov1 wrote that "social stresses . . . appear to have played such a central part in the recent crisis," and earlier, "the increase in alcohol consumption in the 1990s was driven by the stress of economic and political transformation." While stress is a reasonable general starting point for a discussion of alcohol consumption in Russia, the explanation of the increased mortality by increased alcohol consumption is not supported by data.
Country-Specific Mortality and Growth Failure in Infancy and Yound Children and Association With Material Stature
Use interactive graphics and maps to view and sort country-specific infant and early dhildhood mortality and growth failure data and their association with maternal
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