Objective:
During the last three decades dramatic fluctuations of mortality from the diseases of circulatory system (CSD), with major mortality peaks in 1994 and 2005, were observed in Russia. This study was aimed to estimate associations between two major NCD-risk factors - tobacco and alcohol consumption, with CSD mortality in Russia in working age populations (males:16-59;females:16-54 years) in a time-series analysis between 1991 and 2016.

Methods:
Tobacco consumption(TC) was calculated as the index of the annual number of cigarettes sold per capita in Russia. Affordability of vodka(AA) and pattern of alcohol drinking(PAT) were used as the proxy indicators of alcohol consumption. AA index was estimated as the ratio of the index of real disposable income to vodka price index divided by consumer price index. PAT was calculated as the index of proportion of strong alcoholic beverages sold a year in retail. Spearman’s rho and Kendal’s tau-b correlation coefficients were used to assess strength of bivariate associations between indices of CSD mortality, TC, AA and PAT. All indices were calculated with 1991 taken as the base year. Analysis was disaggregated by sex and by urban/rural status of the population. All primary data were obtained from the Russian Federal State Statistics Agency (RosStat).

Results:
Tobacco consumption was moderately to strongly associated with CSD mortality between 1998 and 2016, with the highest strength of association observed among urban males (tau-b=0.534,p=0.002; rho=0.701,p=0.001) and rural females (tau-b=0.582,p=0.001;rho=0.749,p<0.001), with no association seen before 1998 (p>0.05). CSD mortality quite precisely repeated fluctuations of AA between 1991 and 2005, with the strongest association observed among urban males(tau-b=0.714,p<0.001; rho=0.877,p<0.001). PAT was strongly associated with CSD mortality between 2003 and 2016, and especially strongly among urban females (tau-b=0.890,p<0.001; rho=0.969,p<0.001). After 2006 CSD mortality declined in line with the reduction of TC and PAT.

Conclusions:
There is evidence that tobacco consumption in Russia contributed to fluctuations of mortality from circulatory system diseases in working age males and females during the period after 1998. Alcohol, in its turn, influenced on mortality fluctuations during the whole period under analysis (1991-2016). Steady reduction of CSD mortality seen after 2006 is likely facilitated both by reduction of tobacco consumption, and by change of pattern of drinking from spirits to low alcohol content beverage drinking. Restrictive tobacco and alcohol control policies implemented in Russia during the past fifteen years contributed to this reduction.