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Letters
January 27, 1999

The Role of Alcohol and Social Stress in Russia's Mortality Rate—Reply

Author Affiliations
 

Margaret A.Winker, MDIndividualAuthorPhil B.FontanarosaMD, Senior EditorsIndividualAuthor

JAMA. 1999;281(4):321-322. doi:10-1001/pubs.JAMA-ISSN-0098-7484-281-4-jbk0127

In Reply: Our objectives were to describe as fully as possible the dimensions of the catastrophic decline in life expectancy in Russia, to assess the major factors behind the mortality increase, and to discuss data quality issues that could affect the findings. We concluded that no single factor could be identified as the underlying cause of the mortality increase, given the evidence available and the complexity of developments in post-Soviet Russia.

We discussed several factors that we believe worked together to account for the rapid rise in Russian mortality, ie, economic and social instability, consumption of alcohol and tobacco, nutrition, stress and depression, and the health care system. One of those factors was the increase in alcohol consumption, but we felt that other factors played key roles as well, and their interaction was also important. We agree with Dr Vlassov that stress and depression may have played a significant role in both alcohol- and cardiovascular-related causes of death, as we mentioned in our article. We also mentioned the possible positive role of reduced stress and depression in reducing mortality during the early years of the Gorbachev regime.

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