Impact of alcohol on mortality in Eastern Europe: Trends and policy responses

Global, regional and national burden of pancreatitis in children and adolescents, 1990-2021: a systematic analysis for the global burden of disease study 2021

BACKGROUND

Pancreatitis poses a significant global health burden, disproportionately affecting children and adolescents. This study uses the global burden of disease (GBD) 2021 dataset to evaluate pancreatitis epidemiology in this demographic, focusing on disparities by age, sex, and region.

OBJECTIVE

To assess global trends in pediatric pancreatitis, identify risk factors, and forecast disease burden to 2035.

METHODS

We analysed GBD 2021 data on deaths and disability-adjusted life years (DALYs) for pancreatitis in individuals under 20. The socio-demographic index (SDI) assessed the link between societal development and health outcomes. Bayesian age-period-cohort (BAPC) modelling and Poisson's linear models were applied to project future burdens and estimate annual percentage changes (EAPCs) in age-standardized rates.

RESULTS

In 2021, pancreatitis caused 1120.09 deaths in children and adolescents, comprising 2% of all pancreatitis-related deaths. Age-standardized death rate (ASDR) and DALYs rate declined from 1990 to 2021 (EAPC -0.92 and -0.86, respectively). Low-middle SDI regions, notably Andean and Central Latin America and Eastern Europe, faced the highest burden. Alcohol was a leading risk factor, accounting for 3.51% of related deaths, and males had higher death and DALYs rate.

CONCLUSIONS

Despite declining pancreatitis-related mortality and DALYs, the disease remains a challenge, particularly in low-middle SDI regions. Alcohol consumption is a key risk factor, underscoring the need for targeted public health interventions. Gender-, age-, and region-specific strategies are essential to mitigate pancreatitis impact in children and adolescents.

Global, regional and national burdens of alcoholic cardiomyopathy among the working-age population, 1990-2021: a systematic analysis

OBJECTIVES

Alcoholic cardiomyopathy (ACM) results from chronic alcohol misuse and primarily affects the working-age population (15-64 years). The global age-standardized rates (ASRs) of ACM disease burden declined slightly from 1990 to 2021, but the absolute cases increased, especially in high‒medium sociodemographic index (SDI) regions such as Eastern Europe. The aim of this study was to inform strategies to combat this preventable yet escalating health issue.

METHODS

We calculated estimated annual percentage changes (EAPCs) to quantify the dynamics of prevalence, deaths, and disability-adjusted life years (DALYs) for ACM. Decomposition analysis quantifies the contributor of disease burden in ACM. Additionally, we employed a health inequality analysis with two core indicators, the slope index (SI) and the concentration index (CIN), to assess national differences in the burden of ACM in relation to the SDI. Frontier analysis was used to identify preventable burdens with respect to optimized alcohol policies, particularly in high-middle SDI countries. Finally, we applied a Bayesian age‒cohort (BAPC) model to project the ACM burden to 2035.

RESULTS

This study revealed that the ASRs of prevalence, deaths, and DALYs decreased slightly from 1990 to 2021, whereas absolute cases of ACM continued to increase globally. Global income-based health disparities in ACM have intensified over the past 32 years, with high SDI populations disproportionately favoured. Population growth was the main driver of the increased ACM burden. The global burden of ACM is expected to increase in the future according to the BAPC model.

CONCLUSIONS

The global burden of ACM continues to rise, primarily due to population ageing and insufficient prevention policies. This burden disproportionately impacts working-age populations, who face heightened vulnerability due to alcohol accessibility, premature mortality, and reduced workforce productivity. Moreover, economic growth paradoxically coincides with increased alcohol-related harm in regions with high-middle socioeconomic development-the alcohol control paradox. Projections highlight an urgent need for tailored alcohol control strategies, including stricter regulation and early cardiac screening in high-risk groups, to mitigate workforce productivity loss and align public health priorities with sustainable development goals.

Global burden of hypertensive heart disease and attributable risk factors, 1990-2021: insights from the global burden of disease study 2021

Hypertensive heart disease (HHD) significantly contributes to global morbidity and mortality, worsened by rising hypertension rates. This study aims to assess the burden of HHD from 1990 to 2021, analyzing prevalence, mortality, and disability-adjusted life years (DALYs) stratified by age, sex, and Sociodemographic Index (SDI). Utilizing data from the Global Burden of Disease 2021 project across 204 countries and 21 regions, the study calculated age-standardized rates and evaluated risk factors for prevention priorities. In 2021, there were 12.5 million HHD cases globally, resulting in 1.332 million deaths and 25.4622 million DALYs. Age-standardized rates were 148.3 for prevalence, 16.3 for deaths, and 301.6 for DALYs per 100,000 people, reflecting increases of 18.2% for prevalence but decreases for deaths (- 22%) and DALYs (- 25.8%) since 1990. Eastern Sub-Saharan Africa recorded the highest prevalence (291.8), while Bulgaria had the highest mortality (103.4) and DALY rates (1739.3). Age-specific trends showed that prevalence, deaths, and DALYs increased with age across genders, and at regional levels, DALYs decreased with higher SDI. Major contributing factors included high systolic blood pressure, metabolic risks, high body-mass index, unhealthy diet, alcohol use, and low fruit and vegetable intake. Despite advances in management, HHD remains a global health concern, especially in low-SDI areas. Efforts focused on modifiable risks, like hypertension control and dietary improvements, are essential to mitigate the burden of HHD.

Global burden of diseases attributable to childhood sexual abuse and bullying: findings from 1990 to 2019 and predictions to 2035

PURPOSE

Childhood sexual abuse (CSA) and bullying are serious public health concerns that influence child, adolescent, and adult health. This study aims to provide updated estimate of age- and sex- specific deaths and disability-adjusted life years (DALYs) associated with CSA and bullying from 1990 to 2019 at the global, regional, and national levels, and to forecast the global burden of disease attributed to it from 2020 to 2035.

METHODS

We used the data for the number of deaths, DALYs, age-standardized rate (per 100,000 population), percentage change, and population attributable fraction (PAF) from the Global Burden of Disease Study 2019 (GBD 2019) to assess the disease burden attributable to CSA and bullying. We further applied an autoregressive integrated moving average (ARIMA) model to predict the disease burden for the period 2020 to 2035.

RESULTS

In 2019, CSA and bullying accounted for 0.02% and 0.28% of global all-cause deaths and DALYs, respectively. The highest deaths rates were observed in men aged 45-49, and women aged 50-54. The highest DALYs rates were observed in men aged 20-24 and women aged 15-19. The highest age-standardized deaths and DALYs rates were observed in the Eastern Europe region (1.222 [95% UI 0.161, 3.013]) and in High-Income North America region (176.613 [95% UI 79.02, 312.064]) per 100,000 people respectively. El Salvador (1.523 [95% UI 0.209, 3.589]) and Greenland (298.014 [95% UI 138.745, 518.086]) per 100,000 people had the highest age-standardized- deaths and DALYs rates, respectively. The highest age-standardized rates of CSA and bullying related deaths and DALYs were observed in high-socio-demographic Index (SDI) quintile. The age-standardized deaths rate attributable to CSA and bullying is projected to decrease in both sexes between 2019 and 2035, whereas the age-standardized DALYs rate is projected to decrease in male and increase in female between 2019 and 2035.

CONCLUSIONS

CSA and bullying contributed to the global disease burden. Action is needed to develop effective policies. Our study provides policymakers with up-to-date and comprehensive information.

A systematic review of the reasons for quitting and/or reducing alcohol among those who have received alcohol use disorder treatment

Research has primarily studied reasons for quitting and/or reducing alcohol use in non-treatment samples. This systematic review aimed to characterize the reasons for quitting and/or reducing alcohol use among those who have received treatment for AUD and examine how reasons endorsed differ across measurement methods used. Articles were identified through PsycINFO, Web of Science, PubMed, and CINAHL. Twenty-one articles met inclusion criteria. Thematic coding revealed 21 unique themes in reasons for quitting and/or reducing. Common reasons included physical health issues, misalignment with personal goals, family influence, and social factors-also noted in non-treatment populations. Unique themes like hitting rock bottom and avoiding disapproval were identified, potentially linked to treatment initiation or development. The measurement approach influenced the reasons reported, highlighting the need for standardized methods. Common reasons are fundamental and are not a result of treatment, while others are unique to individuals who have received AUD treatment, which may suggest that they are critical in leading one to seek treatment or may be developed during treatment. Assessing and tailoring treatment based on these reasons may enhance outcomes. Standardizing how we measure reasons for quitting or reducing alcohol is crucial for comparing studies and improving treatment. Future research should evaluate reasons over time, assess their importance at different treatment stages, and use varied assessment strategies for comprehensive insights.

Alcohol and cause-specific mortality in Russia: the Know Your Heart Study 2015-23

BACKGROUND

Alcohol-related mortality in Russia exceeds the world average and presents a critical public health concern. This study assesses the impact of alcohol consumption levels on mortality and investigates mortality predictors among Russians, including people treated for alcohol-related diagnoses (narcology patients).

METHODS

We examined 2629 men and women aged 35-69 years who participated in the Know Your Heart study (2015-17), Arkhangelsk, Russia. The participants were categorized into five drinking levels (non-drinking, low-risk, hazardous, harmful, narcology patients) and followed up using a regional mortality database. We used Cox proportional hazards regressions to analyze sociodemographic and cardiovascular biomarkers as mortality predictors among narcology patients and general population and to compare mortality risks across the five drinking levels.

RESULTS

During a median follow-up of 6.3 years, 223 (8.5%) participants died. Age- and sex-standardized all-cause mortality rates per 100,000 person-years were 1229 (95% CI: 691-1767) in non-drinking participants, 890 (95%CI: 684-1096) and 877 (95%CI: 428-1325) in low-risk and hazardous drinking participants, 2170 (95%CI: 276-4064) in those with harmful drinking, and 4757 (95%CI: 3384-6131) in narcology patients. The largest proportions of deaths were caused by cardiovascular diseases (37.2%), neoplasms (20.2%), and external causes (13.9%). Compared with low-risk drinkers, narcology patients had higher risks of death with hazard ratios of 3.23 (95%CI: 2.02-5.16) for all-cause mortality, 3.25 (95%CI: 1.52-6.92) for cardiovascular diseases, 9.36 (95%CI: 2.63-33.3) for external causes, and 7.79 (95%CI: 3.34-18.1) for other causes. Neoplasm-related mortality did not differ between groups. All-cause mortality in the general population had positive associations with smoking, waist-to-hip ratio, resting heart rate, systolic blood pressure, high-sensitivity C-reactive protein, and negative associations with left ventricular ejection fraction (LVEF) and higher education. These associations were substantially weaker and non-significant in narcology patients. Cardiovascular mortality in narcology patients was increased with higher education, while male sex, LVEF and N-terminal prohormone of brain natriuretic peptide had less impact compared to the general population sample.

CONCLUSION

Narcology patients face markedly higher mortality risks-threefold from all causes and cardiovascular diseases, ninefold from external causes, and sevenfold from other causes. Compared with the general population, conventional mortality risk factors were less predictive of deaths in narcology patients.

Global, regional, and national burden of pancreatitis in older adults, 1990-2019: A systematic analysis for the global burden of disease study 2019

Background

To describe the past, present and future burden of pancreatitis in older adults, and to explore cross-national inequalities across socio-demographic index (SDI).

Methods

Data on pancreatitis in older adults, including mortality and disability-adjusted life years (DALYs) rates, were collected from the Global Burden of Disease (GBD) 2019 study. Temporal trends were measured using joinpoint analyses and predicted using a Bayesian age-period-cohort model. Additionally, the unequal distribution of the burden of pancreatitis in older adults was quantified.

Results

From 1990 to 2019, the number of deaths and DALYs due to pancreatitis in older adults has been increasing annually. However, in most regions of the world, age-standardized death rates (ASDR) and age-standardized DALYs rates have been declining. The burden of pancreatitis in older adults was highest in low SDI region, primarily affecting the population aged 65-74, with a greater burden on males than females. Furthermore, from 1990 to 2019, absolute and relative cross-national inequalities in pancreatitis among older adults have remained largely unchanged. It is projected that in the next 11 years, the number of deaths in older adults due to pancreatitis will continue to increase, but the ASDR is expected to decline.

Conclusion

Over the past 30 years, the ASDR and age-standardized DALYs rate of pancreatitis in older adults have shown a decline globally, but the absolute burden continues to increase. Cross-national health inequalities persist. Therefore, it is necessary to develop targeted intervention measures and enhance awareness among this vulnerable population regarding the risk factors associated with pancreatitis.

Age-period-cohort analysis of pancreatitis epidemiological trends from 1990 to 2019 and forecasts for 2044: a systematic analysis from the Global Burden of Disease Study 2019

Objective

Pancreatitis poses a serious medical problem worldwide. This study aims to explore the epidemiological trends of pancreatitis from 1990 to 2019, analyze the association between disease burden and age, period and birth cohort, and subsequently present a forecast of pancreatitis incidence and deaths.

Methods

Epidemiologic data were gathered from the Global Health Data Exchange query tool. Joinpoint regression model was used to calculate the average annual percentage changes (AAPCs). Age-period-cohort analysis was utilized to estimate the independent effects of age, period and birth cohort. We also predicted the global epidemiological trends to 2044.

Results

Globally, the incident cases and deaths of pancreatitis increased 1.63-and 1.65-fold from 1990 to 2019, respectively. Joinpoint regression analysis showed that the age-standardized incidence rate (ASIR) and age-standardized death rate (ASDR) decreased over the past three decades. The age effect indicates that older people have higher age-specific incidence and death rates. The period effect on incidence and deaths showed downward trends from 1990 to 2019. The cohort effect demonstrated that incidence and death risk peaked in the earlier birth cohort and were lower in the latest birth cohort. Incident cases and deaths of pancreatitis may significantly increase in the next 25 years. The ASIRs were predicted to slightly increase, while the ASDRs were predicted to decrease.

Conclusion

Epidemiologic patterns and trends of pancreatitis across age, period and birth cohort may provide novel insight into public health. Limitations of alcohol use and prevention strategies for pancreatitis are necessary to reduce future burden.

Are restrictions in sales hours of alcohol associated with fewer emergency room visits in Lithuania? An interrupted time-series analysis

INTRODUCTION

On 1 January 2018, an amendment to the alcohol control law was introduced in Lithuania which, among other changes, reduced trading hours for alcoholic beverages by 4 h for weekdays and Saturdays, and by 9 h for Sundays. The objective of the current study was to quantify the potential association of this law with the numbers and types of emergency room (ER) visits in Lithuania, in general and specifically for Sundays, for all ER visits, for injury-related ER visits and specifically for alcohol poisoning as a 100% alcohol-attributable cause.

METHODS

Sex-stratified time-series analysis-based models for the period 2016-2019 were used to test for associations and for potential alternative explanations (e.g., the increase in minimum legal drinking age, which occurred at the same time).

RESULTS

Overall, while the reduction in sales hours for both sexes was associated with slight increases in all types and in injury-related ER visits on a weekly basis, the association with ER visits for alcohol poisoning was in the opposite direction for men in all models. Specifically, among men, it was associated with an approximate decrease of 20% of alcohol poisoning-related ER visits on Sundays and an approximate decrease of 12% of alcohol poisoning-related ER visits for all seven weekdays.

DISCUSSION AND CONCLUSIONS

As predicted, restrictions on availability were associated with marked reductions in ER visits for alcohol poisoning in men. However, contrary to expectations, there were no overall reductions in overall ER visits, nor reductions in injury-related ER visits.

2022 Prevention of chronic non-communicable diseases in Of the Russian Federation. National guidelines

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