A comparison of the alcohol-attributable mortality in four European countries

Alcohol-Related Mortality in the WHO European Region: Sex-Specific Trends and Predictions

Aims

Alcohol is an important risk factor for morbidity and mortality, especially within the European region. Differences in per capita consumption and drinking patterns are possible reasons for regional differences and diverging trends in alcohol-related health outcomes.

Methods

Twenty-nine countries within the World Health Organization (WHO) European region were evaluated for trends and predictions in alcohol-related deaths within the last four decades using data available from the WHO Health for All database.

Results

Between 1979 and 2015, age-standardised death rates due to selected alcohol-related causes decreased significantly for both sexes in all assessed countries of the WHO European region, but regional differences are still pronounced. Assuming a similar trend in the future, the model predicted a further decrease until the year 2030.

Conclusion

Even though alcohol-related mortality may have decreased within the last decades, the detrimental effects of alcohol consumption and alcohol dependence remain a considerable burden of disease within Europe.

Outpatient Addiction Treatment for Problematic Alcohol Use: What Makes Patients Who Dropped Out Different from Those Who Did Not?

BACKGROUND

A minority of individuals with problematic alcohol use effectively seek help. Moreover, dropouts from care are not uncommon. It remains a major concern for health professionals, as adherence to treatment is significantly associated with better physical and psychological outcomes.

OBJECTIVES

The main aim of this research was to assess what factors could distinguish patients with problematic alcohol use who dropped out from those who did not.

METHODS

The sample included 150 patients followed-up in an outpatient treatment center in France for a problematic alcohol use. Two measurement times were planned: at the first appointment and after six month of treatment. A large set of individual, environmental and institutional variables were considered to compare both subgroups.

RESULTS

Patients who dropped out mostly differ from patients who did not with a higher level of alcohol-related problems, ambivalence, inclinations to use the substance, number of missed appointments. Significant results were also observed regarding a lower time gap between the first contact with the center and the first appointment, as well as the season of the last appointment.

CONCLUSIONS

Tailored motivational interventions could be offered to ambivalent patients, especially during the beginning of the treatment and some significant periods of the year. A particular focus should be brought on patients presenting such profiles in terms of level of alcohol problems, inclinations to drink and motivation to change. Overall, the study provides elements to better understand what may bring one patient to drop out of the treatment, and to improve the continuity of care.

Influence of the degree of adherence to the Mediterranean diet on the cardiometabolic risk in peri and menopausal women. The Flamenco project

BACKGROUND AND AIMS

The Mediterranean diet (MD) has been associated with reduced morbidity from cardiovascular diseases in the general population. The aim of this study was to assess whether different degrees of adherence to the MD were associated with the cardiometabolic risk in peri and menopausal women.

METHODS AND RESULTS

This cross-sectional study included 198 peri and menopausal women participating in the Flamenco project. Validated questionnaires were used to assess menopause health-related quality of life and degree of adherence to the MD (low, medium and high). The following cardiometabolic risk factors were assessed: fat mass percentage, waist circumference, blood pressure and resting heart rate, plasma markers (total cholesterol, high and low-density lipoprotein cholesterol [HDL-C and LDL-C, respectively], total cholesterol/HDL ratio, triglycerides, C-reactive protein and fasting glucose), Physical activity levels and smoking status. The degree of adherence to the MD among the study sample was 27%, 40% and 30% for low, medium and high adherence, respectively. After controlling for potential confounders, women with a high adherence to the MD showed lower plasma total cholesterol (p = 0.025), resting heart rate (p = 0.005), LDL-C (p = 0.019), triglycerides (p = 0.046) and C-reactive protein (p = 0.009) compared to those with a low adherence. Likewise women with high adherence to the MD showed lower total cholesterol/HDL-C ratio (p = 0.020) compared to those with a medium adherence. The high MD adherence group also showed lower clustered cardiometabolic risk (p = 0.004). Moreover, when analysing specific MD components, whole grain cereals, pulses (both p < 0.05) and red wine (p < 0.01) consumption were inversely associated with the clustered cardiometabolic risk.

CONCLUSION

The present findings suggest that a high but not medium adherence to the MD is associated with a cardioprotective effect in peri and menopausal women. As a low percentage of the sample showed a high adherence to the MD, future research aimed at increasing the adherence to this dietary pattern for a better cardiometabolic status during peri and menopause is warranted.

Recommendations on Alcohol Consumption: An International Comparison

Public health policy on alcohol is changing in many countries. This article reviews public health messages with regard to alcohol in Australia, Canada, the United Kingdom (UK) and the United States (US) and highlights the common as well as the different messages delineated. The messages from these four countries are then compared with those of certain other developed and developing countries. Some of the significant differences include definitions of moderate alcohol consumption, the consumption of alcohol by women, underage consumption, and advice to abstainers, which may reflect differences in the characteristics of consumers among countries. Central to the current debate is the concern that incomplete, inconsistent or misleading messages on alcohol consumption could lead to an increase in alcohol abuse, misuse and hence harm, or, conversely, to abstention by particular population groups.

The importance of regional availability of health care for old age survival - Findings from German reunification

Background

This article investigates the importance of regional health care availability for old age survival. Using German reunification as a natural experiment, we show that spatial variation in health care in East Germany considerably influenced the convergence of East German life expectancy toward West German levels.

Method

We apply cause-deleted life tables and continuous mortality decomposition for the years 1982–2007 to show how reductions in circulatory mortality among the elderly affected the East German catch-up in life expectancy.

Results

Improvements in remaining life expectancy at older ages were first seen in towns with university hospitals, where state-of-the-art services became available first.

Conclusion

Our results suggest that the modernization of the health care system had a substantial effect on old-age life expectancy and helped to significantly reduce circulatory diseases as the main cause of death in East Germany.

Quantifying alcohol-related mortality: should alcohol-related contributory causes of death be included?

AIMS

The aim of the study was to assess whether alcohol-related mortality data in the UK should be extended to include contributory as well as underlying cause of death.

METHODS

A total of 101,320 deaths registered in Northern Ireland between 2001 and 2007 were analysed to determine the quantity and characteristics of those with an underlying or contributory alcohol-related cause of death.

RESULTS

Alcohol was found to be an underlying cause of death in 1690 cases (1.7% of deaths) and a contributory cause in a further 1105 cases. Analyses show that the addition of alcohol-related contributory causes of deaths would increase the male-female ratio, result in steeper socio-economic gradients and amplify the apparent rate of increase of alcohol-related deaths. The significant contribution of alcohol to external causes of death, such as accidents and suicide, is also more evident.

CONCLUSIONS

Using only underlying cause of death undoubtedly underestimates the burden of alcohol-related harm and may provide an inaccurate picture of those most likely to suffer from an alcohol-related death, especially among younger men.

Physical Health and Dual Diagnosis

The physical health of people with mental illness may be neglected for a variety of reasons. This paper looks at the common physical health problems experienced by people with a dual diagnosis of substance misuse and serious mental illness, and suggests ways of assessing and managing them.

Intermittent exposure to ethanol vapor affects osteoblast behaviour more severely than estrogen deficiency does in vitro study on rat osteoblasts

With rising rates of alcohol consumption acute and chronic damage from alcohol is expected to increase all over the world. Habitual excessive alcohol consumption is associated with pathological effects on bone. The aim of the present in vitro study was to investigate comparatively the proliferation and synthetic activity of osteoblasts (OB) isolated from the trabecular bone of rats previously exposed to 7-week intermittent exposure to ethanol vapor, sham-aged rats and long-term estrogen deficient rats. Cell proliferation (WST1) and synthesis of alkaline phosphatase (ALP), osteocalcin (OC), collagen I (CICP), transforming growth factor beta1 (TGF-beta1), interleukin-6 (IL-6), tumor necrosis factor alfa (TNFalpha) were measured at 3, 7 and 14 days of culture. Osteoblast proliferation rate and TGF-beta1, IL-6 and TNFalpha syntheses were significantly affected by alcohol exposure. Estrogen deficiency and alcohol consumption share many common pathophysiological mechanisms of damage to bone, but alcohol affects OB proliferation and TNFalpha synthesis significantly more than menopause does. Therefore, these in vitro data suggest that alcohol has even more deleterious effects on bone than estrogen deficiency does.

When risk factors combine: the interaction between alcohol and smoking for aerodigestive cancer, coronary heart disease, and traffic and fire injury

BACKGROUND

Alcohol and tobacco are responsible for a significant amount of burden of disease, but some diseases may be a result of the interaction between these two risk factors.

METHODS

Systematic literature review identified articles on the interaction of alcohol and smoking on a number of outcomes related to both risk behaviours.

RESULTS

The interaction of smoking and alcohol significantly increases risk for aerodigestive cancers, and may increase risk for traffic injury and fire injury, but there were very few quality studies on injury. The indication that the cardioprotective effect of alcohol on coronary heart disease is only valid for smokers, but this result is inconclusive because of small evidence base.

CONCLUSIONS

The interaction between smoking and alcohol consumption seems to be responsible for a significant amount of disease. Unfortunately, little is known on the mechanisms and details of this interaction on disease outcomes. Future studies, especially for coronary heart disease and injury outcomes, are warranted.

Alcohol-attributable mortality and potential years of life lost in Canada 2001: implications for prevention and policy

BACKGROUND

Alcohol is one of the most important risk factors for burden of disease.

OBJECTIVE

To estimate the number of deaths and the years of life lost attributable to alcohol for Canada 2001 using different ways to measure alcohol exposure.

METHODS

Distribution of exposure was taken from a major national survey of Canada, the Canadian Addiction Survey, and corrected for per capita consumption from production and sales. For chronic disease, risk relations were taken from the published literature and combined with exposure to calculate age- and sex-specific alcohol-attributable fractions (AAFs). For injury, AAFs were taken directly from available statistics. Information on mortality, with cause of death coded according to the International Classification of Diseases version 10 (ICD-10) was obtained from Statistics Canada.

RESULTS

For Canada in 2001, 4,010 of all deaths in the group below 70 years of age were attributable to alcohol, 3,132 in men and 877 in women. This constituted 6.0% of all deaths in Canada in this age group, 7.6% for men, and 3.5% for women. The 4,010 deaths are a net figure, already taking into account the deaths prevented by moderate consumption of alcohol. Main causes of alcohol-attributable death were unintentional injuries, malignant neoplasms and digestive diseases. Ischaemic heart disease (IHD) was the biggest cause of death prevented by alcohol, with 78.7% of all alcohol-attributable prevented deaths in the age groups of 70 years and above. A total of 144,143 years of life were lost prematurely in Canada in that year, 113,079 years in men and 31,063 years in women.

DISCUSSION

Regardless of the assumptions made, alcohol is a major contributor to mortality in Canada. The impact of alcohol on social life is not confined to mortality, as other studies indicated that alcohol is linked even more strongly to disability and social harm. Alcohol-attributable harm could be substantially reduced, however, if known effective policies were introduced.