Introduction and Aims: Eastern Europe is known to suffer from a large burden of alcohol‐related mortality. However, persisting unfavourable conditions at the national level mask variation at the sub‐national level. We aim to explore spatial patterns of cause‐specific mortality across four post‐communist countries: Belarus, Lithuania, Poland and Russia (European part).

Design and Methods: We use official mortality data routinely collected over 1179 districts and cities. The analysis refers to males aged 20–64 years and covers the period 2006–2014. Mortality variation is mainly assessed by means of the standardised mortality ratio. Getis‐Ord Gi* statistic is employed to detect hot and cold spots of alcohol‐related mortality.

Results: Alcohol‐related mortality exhibits a gradient from very high levels in northwestern Russia to low levels in southern Poland. Spatial transitions from higher to lower mortality are not explicitly demarcated by national boundaries. Within these countries, hot spots of alcohol‐related mortality dominate the territories of northwestern and western Russia, eastern and northwestern Belarus, southeastern Lithuania, and eastern and central Poland.

Discussion and Conclusions: The observed mortality gradient is likely associated with the spread of alcohol epidemics from the European part of Russia to the other countries, which appears to have started more than a century ago. Contemporary socioeconomic and demographic factors should be taken into account when developing anti‐alcohol policies. The same is true for the peculiarities of culture, norms, traditions and behavioural patterns observed in specific geographical areas of the four countries. Reducing alcohol‐related harm in the areas identified as hot spots should be prioritised.