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Background Mortality rates from various causes of death significantly fluctuated inRussia after1991,with especially profound amplitude observed in working age populations.This study was aimed to investigate association between affordability of alcohol(AA),pattern of alcohol drinking(PAT),and several selected mortality indicators in which large alcohol-attributable fractions were assumed. Methods Econometric estimation of AA was based on calculation of the ratio of index of real disposable income to vodka price index adjusted for consumer price index.PAT was defined as the index of proportion of strong alcohol beverages sold a year in retail.Spearman’s rho andKendall’s tau-b correlation coefficients were estimated to assess strengths of bivariate associations between AA,PAT and indices of all-cause mortality,of mortality from external causes(EC) and from diseases of circulatory system(CSDs)at working ages(M:16-59;F:16-54yrs)in a time-series analysis between1991 and2016.All indices were calculated with1991 taken as the reference year. All primary data were obtained from the Russian Federal StateStatistics Agency“RosStat”. Results All-cause mortality and mortality from CSDs in both males and females quite precisely repeated fluctuations of AA between 1991 and 2005(tau-b&amp;gt;0.600,p&amp;lt;0.050; rho&amp;gt;0.700,p&amp;lt;0.050). Same moderate to high strength associations were observed between mortality fromEC and AA for 1991-2003.The strongest moderate to high strength associations between PAT and all-cause,CSD and EC mortality were observed during the period after1995, when pattern of drinking began changing towards consumption of low alcohol content beverages, especially beer. PAT repeated fluctuations of AA between 1991 and 1999. Conclusions Our findings further support alcoholic hypothesis of huge mortality fluctuations in Russia during the period after 1991, suggesting that alcohol affordability had played the key role before 2005 and pattern of drinking influenced on mortality decline after 2005. Key messages Fluctuating affordability of alcohol was one of the major determinants of alcohol consumption, and, consequently, of fluctuations of alcohol-attributable mortality in Russia between 1991 and 2005. The ongoing from 1995 change of pattern of alcohol consumption from spirits to low alcohol content drinking likely significantly contributing to mortality decline observed in Russia after 2005.

Huge mortality fluctuations in working ages in Russia after 1991: is alcohol affordability in charge?