OBJECTIVES

Previous research investigating association between alcohol affordability(AA)and mortality from various alcohol-attributable causes of death in Russia utilized a measure ofAA defined as the ability of an average monthly salary(AMS)to buy alcohol.In this study we calculatedAA based on the real disposable income(RDI),investigated strengths of associations between RDI-based AA and selected mortality indicators containing large alcohol-attributable fractions,and compared them with associations obtained using AMS-basedAA.

METHODS

RDI-based AA was calculated as the ratio of index of real disposable income to vodka price index divided by consumer price index(a measure of inflation).AMS-basedAA was calculated as the index of number of litres of vodka that an average monthly salary can buy.Kendall’s tau-b andSpearman’s rho correlation coefficients were estimated to assess strengths of bivariate associations betweenAA indices and indices of all-cause mortality,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 and2017.All calculated indices referred to1991 as the base year.All primary data were obtained from theRussianFederal StateStatistics Agency“RosStat”.

RESULTS

Both RDI andAMS-based AAs were fluctuating between1991 and2017,however,fluctuations ofRDI-basedAA were much more pronounced.Between1991 and2005 all-cause andCSD mortality more accurately repeated fluctuations ofRDI-basedAA(tau-b>0.600,p<0.050;rho>0.700,p<0.050)than ofAMS-basedAA(tau-b>0.450,p<0.050;rho>0.550,p<0.050). ECmortality was also stronger associated withRDI-basedAA.For some subpopulations(e.g.urban males and females)associations betweenAMS-basedAA,CSD andEC mortality were weak and not statistically significant.

CONCLUSIONS

Real disposable income-based AA adjusted for inflation is a more accurate measure of alcohol affordability in Russia as it better predicts fluctuations of alcohol-attributable mortality.This is explained by the nature of the real disposable income,which accounts for a wider range of sources of monetary income that individuals can spend on purchasing alcohol,and by taking into consideration influence of inflation,which affects purchasing power of the real disposable income over time.Previous studies in Russia,that utilized measure ofAA based on average monthly salary,have underestimated the role of alcohol affordability in determining both levels of alcohol consumption,and fluctuations of alcohol-attributable mortality.