Alcohol abuse - particularly vodka - is largely to blame for a quarter of all Russian men dying before they reach their mid-50s, according to research.
A study of more than 150,000 people, published on Friday, found extraordinarily high premature death rates among Russian men, some of whom reported drinking three or more bottles of vodka a week.
Deaths among heavy drinkers were mainly due to alcohol poisoning, accidents, violence and suicide, as well as diseases such as throat and liver cancer, tuberculosis, pneumonia, pancreatitis and liver disease.
"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 ... was vodka," said Richard Peto of Oxford University, who worked on the study.
The researchers, including David Zaridze from the Russian Cancer Research Centre in Moscow, noted that whereas British death rates between age 15 and 54 have been falling steadily since 1980, mainly because so many people there have stopped smoking, Russian death rates in this age range have fluctuated sharply - often approximately in line with alcohol consumption.
Under Mikhail Gorbachev's 1985 alcohol restrictions, alcohol consumption fell by around 25 percent - and so did the death rates, they said. And when communism in Russia collapsed, alcohol consumption went up steeply, as did death rates.
More recently, since Russian alcohol policy reforms were introduced in 2006, consumption of spirits has fallen by about a third and so has the risk of death before age 55, the researchers said - although that risk is "still substantial".
For this study, published in the Lancet medical journal, researchers asked 151,000 people how much vodka they drank, and whether they smoked, then monitored them for up to a decade.
About 8,000 of them died during that time, and the results showed much higher risks of death in men who smoked and who also drank three or more half-litre bottles of vodka a week than in men who smoked and drank less than one bottle a week.
Zaridze described the relationship between vodka and deaths as a "health crisis" for Russia, but stressed it could also be turned around if people were to drink more moderately.
"The significant decline in Russian mortality rates following the introduction of moderate alcohol controls in 2006 demonstrates the reversibility," he said.
"People who drink spirits in hazardous ways greatly reduce their risk of premature death as soon as they stop."
Source: Al Jazeera and agencies