Vodka is a major cause of early death in Russia and partly to blame for the high mortality rates among men in the country, research has revealed.
Vodka, or "little water" as it is sometimes called, has become more available over the last 30 years, which is reflected in premature death statistics, say scientists.
A new forward-looking study has now found that Russian men who drink three or more bottles of vodka a week are far more likely to go to an early grave than those who consume less than one.
Researchers spoke to 57,361 men in three different Russian cities and found more of a third of male smokers drinking three half-litre bottles every week could expect to make it to the ages of 35 and 54.
Study co-author Professor Sir Richard Peto, from Oxford University, explained:
– Professor Sir Richard Peto
Russian death rates have fluctuated wildly over the past 30 years as alcohol restrictions and social stability varied under Presidents Gorbachev, Yeltsin and Putin, and the main thing driving these wild fluctuations in death was vodka.
The premature death rate in men who consumed less than a bottle of vodka a week was 16%.
Excess deaths among heavy drinkers were caused by alcohol poisoning, accidents, violence and suicide.
Deaths from throat and liver cancer, tuberculosis, pneumonia and pancreatitis were also thought to be caused by Russia's systemic drinking problem.
Co-author Dr Paul Brennan, from the World Health Organisation International Agency for Research on Cancer in Lyon, France, said:
– Dr Paul Brennan
Because some who said they were light drinkers later became heavy drinkers, and vice versa, the differences in mortality that we observed must substantially under-estimate the real hazards of persistent heavy drinking.
The findings are published in the latest edition of The Lancet medical journal.