1
|
Van Hemelrijck WMJ, Martikainen P, Zengarini N, Costa G, Janssen F. The impact of estimation methods for alcohol-attributable mortality on long-term trends for the general population and by educational level in Finland and Italy (Turin). PLoS One 2023; 18:e0295760. [PMID: 38096271 PMCID: PMC10721192 DOI: 10.1371/journal.pone.0295760] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/25/2023] [Accepted: 11/28/2023] [Indexed: 12/18/2023] Open
Abstract
BACKGROUND AND AIMS This paper assesses the impact of estimation methods for general and education-specific trends in alcohol-attributable mortality (AAM), and develops an alternative method that can be used when the data available for study is limited. METHODS We calculated yearly adult (30+) age-standardised and age-specific AAM rates by sex for the general population and by educational level (low, middle, high) in Finland and Turin (Italy) from 1972 to 2017. Furthermore the slope index of inequality and relative inequality index were computed by country and sex. We compared trends, levels, age distributions, and educational inequalities in AAM according to three existing estimation methods: (1) Underlying COD (UCOD), (2) Multiple COD (MCOD) method, and (3) the population attributable fractions (PAF)-method. An alternative method is developed based on the pros and cons of these methods and the outcomes of the comparison. RESULTS The UCOD and MCOD approaches revealed mainly increasing trends in AAM compared to the declining trends according to the PAF approach. These differences are more pronounced when examining AAM trends by educational groups, particularly for Finnish men. Until age 65, age patterns are similar for all methods, and levels nearly identical for MCOD and PAF in Finland. Our novel method assumes a similar trend and age pattern as observed in UCOD, but adjusts its level upwards so that it matches the level of the PAF approach for ages 30-64. Our new method yields levels in-between UCOD and PAF for Turin (Italy), and resembles the MCOD rates in Finland for females. Relative inequalities deviate for the PAF-method (lower levels) compared to other methods, whereas absolute inequalities are generally lower for UCOD than all three methods that combine wholly and partly AAM. CONCLUSIONS The choice of method to estimate AAM affects not only levels, but also general and education-specific trends and inequalities. Our newly developed method constitutes a better alternative for multiple-country studies by educational level than the currently used UCOD-method when the data available for study is limited to underlying causes of death.
Collapse
Affiliation(s)
| | - Pekka Martikainen
- Population Research Unit, Faculty of Social Sciences, University of Helsinki, Helsinki, Finland
- Max Planck Institute for Demographic Research, Rostock, Germany
| | | | - Giuseppe Costa
- Department of Public Health and Microbiology, University of Turin, Turin, Italy
| | - Fanny Janssen
- Netherlands Interdisciplinary Demographic Institute(NIDI)-KNAW/University of Groningen, The Hague, The Netherlands
- Population Research Centre, Faculty of Spatial Sciences, University of Groningen, Groningen, The Netherlands
| |
Collapse
|
2
|
Zazueta-Borboa JD, Aburto JM, Permanyer I, Zarulli V, Janssen F. Contributions of age groups and causes of death to the sex gap in lifespan variation in Europe. POPULATION STUDIES 2023; 77:475-496. [PMID: 37366162 DOI: 10.1080/00324728.2023.2222723] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/31/2022] [Accepted: 04/17/2023] [Indexed: 06/28/2023]
Abstract
Much less is known about the sex gap in lifespan variation, which reflects inequalities in the length of life, than about the sex gap in life expectancy (average length of life). We examined the contributions of age groups and causes of death to the sex gap in lifespan variation for 28 European countries, grouped into five European regions. In 2010-15, males in Europe displayed a 6.8-year-lower life expectancy and a 2.3-year-higher standard deviation in lifespan than females, with clear regional differences. Sex differences in lifespan variation are attributable largely to higher external mortality among males aged 30-39, whereas sex differences in life expectancy are due predominantly to higher smoking-related and cardiovascular disease mortality among males aged 60-69. The distinct findings for the sex gap in lifespan variation and the sex gap in life expectancy provide additional insights into the survival differences between the sexes.
Collapse
Affiliation(s)
| | - José Manuel Aburto
- London School of Hygiene and Tropical Medicine
- University of Oxford
- University of Southern Denmark
| | - Iñaki Permanyer
- ICREA
- Centre for Demographic Studies (CED-CERCA), Autonomous University of Barcelona
| | | | - Fanny Janssen
- Netherlands Interdisciplinary Demographic Institute-KNAW
- University of Groningen
| |
Collapse
|
3
|
Moustgaard H, Tarkiainen L, Östergren O, Korhonen K, Zengarini N, Costa G, Martikainen P. The contribution of alcohol-related deaths to the life-expectancy gap between people with and without depression - a cross-country comparison. Drug Alcohol Depend 2022; 238:109547. [PMID: 35810620 DOI: 10.1016/j.drugalcdep.2022.109547] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 03/15/2021] [Revised: 06/20/2022] [Accepted: 06/27/2022] [Indexed: 11/03/2022]
Abstract
BACKGROUND Alcohol-related deaths may be among the most important reasons for the shorter life expectancy of people with depression, yet no study has quantified their contribution. We quantify the contribution of alcohol-related deaths to the life-expectancy gap in depression in four European countries with differing levels of alcohol-related mortality. METHODS We used cohort data linking population registers with health-care and death records from Denmark, Finland, Sweden and Turin, Italy, in 1993-2007 (210,412,097 person years, 3046,754 deaths). We identified psychiatric inpatients with depression from hospital discharge registers in Denmark, Finland, and Sweden and outpatients with antidepressant prescriptions from prescription registers in Finland and Turin. We assessed alcohol-related and non-alcohol-related deaths using both underlying and contributory causes of death, stratified by sex, age and depression status. We quantified the contribution of alcohol-related deaths by cause-of-death decomposition of the life-expectancy gap at age 25 between people with and without depression. RESULTS The gap in life expectancy was 13.1-18.6 years between people with and without inpatient treatment for depression and 6.7-9.1 years between those with and without antidepressant treatment. The contribution of alcohol-related deaths to the life-expectancy gap was larger in Denmark (33.6%) and Finland (18.1-30.5%) - i.e., countries with high overall alcohol-related mortality - than in Sweden (11.9%) and Turin (3.2%), and larger among men in all countries. The life-expectancy gap due to other than alcohol-related deaths varied little across countries. CONCLUSIONS Alcohol contributes heavily to the lower life expectancy in depression particularly among men and in countries with high overall alcohol-related mortality.
Collapse
Affiliation(s)
- Heta Moustgaard
- Helsinki Institute for Social Sciences and Humanities, University of Helsinki, Vuorikatu 3, 00014, Finland; Population Research Unit, Faculty of Social Sciences, University of Helsinki, Helsinki, P.O. Box 18, 00014, Finland.
| | - Lasse Tarkiainen
- Population Research Unit, Faculty of Social Sciences, University of Helsinki, Helsinki, P.O. Box 18, 00014, Finland; Helsinki Institute for Urban and Regional Studies (URBARIA), University of Helsinki, Yliopistonkatu 3, 00100 Helsinki, Finland.
| | - Olof Östergren
- Department of Public Health Sciences, Stockholm University, SE - 106 91 Stockholm, Sweden; Aging Research Center, Karolinska Institutet, Tomtebodavägen 18a, SE-171 65 Solna, Sweden.
| | - Kaarina Korhonen
- Population Research Unit, Faculty of Social Sciences, University of Helsinki, Helsinki, P.O. Box 18, 00014, Finland.
| | - Nicolás Zengarini
- Epidemiology Unit, Regional Health Service ASL TO3, Via Sabaudia 164, Turin, Grugliasco (TO), Italy.
| | - Giuseppe Costa
- Epidemiology Unit, Regional Health Service ASL TO3, Via Sabaudia 164, Turin, Grugliasco (TO), Italy.
| | - Pekka Martikainen
- Population Research Unit, Faculty of Social Sciences, University of Helsinki, Helsinki, P.O. Box 18, 00014, Finland; Department of Public Health Sciences, Stockholm University, SE - 106 91 Stockholm, Sweden; Laboratory of Population Health, Max Planck Institute for Demographic Research, Konrad-Zuse-Str. 1, 18057 Rostock, Germany.
| |
Collapse
|
4
|
Pérez-Ríos M, Rey-Brandariz J, Galán I, Fernández E, Montes A, Santiago-Pérez MI, Giraldo-Osorio A, Ruano-Raviña A. Methodological guidelines for the estimation of attributable mortality using a prevalence-based method: The STREAMS-P tool. J Clin Epidemiol 2022; 147:101-110. [PMID: 35341948 DOI: 10.1016/j.jclinepi.2022.03.016] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/03/2021] [Revised: 03/04/2022] [Accepted: 03/21/2022] [Indexed: 10/18/2022]
Abstract
BACKGROUND There is evidence of strong links between exposure to different risk factors and life-threatening diseases. Assessing the burden of a risk factor on the population's mortality due to a given disease provides a clear picture of these links. The estimation of attributable mortality to a risk factor is the most widely used procedure for doing this. Although different methods are available to estimate attributable mortality, the prevalence-based methodology is the most frequent. The main objective of this paper is to develop guidelines and checklists to STrengthen the design and REporting of Attributable-Mortality Studies using a Prevalence-based method (STREAMS-P) and also to assess the quality of an already published study which uses this methodology. METHODS The design of the guideline and checklists has been done in two phases. A development phase, where we set recommendations based on the review of the literature; and a validation phase, where we validated our recommendations against other published studies that have estimated attributable mortality using a prevalence-based method. RESULTS We have developed and tested a guideline that includes the information required to perform a prevalence-based attributable mortality study to a given risk factor; a checklist of aspects that should be present when a report or a paper on attributable mortality is written or interpreted and a checklist of quality control criteria for reports or papers estimating attributable mortality. CONCLUSION To our knowledge, the STREAMS-P is the first set of criteria specifically created to assess the quality of such studies and it could be valuable for authors and readers interested in performing attributable mortality studies or interpreting their reliability.
Collapse
Affiliation(s)
- Mónica Pérez-Ríos
- Department of Preventive Medicine and Public Health, University of Santiago de Compostela, Santiago de Compostela, Spain; CIBER Epidemiology and Public Health, CIBERESP; Health Research Institute of Santiago de Compostela (IDIS), Santiago de Compostela, Spain.
| | - Julia Rey-Brandariz
- Department of Preventive Medicine and Public Health, University of Santiago de Compostela, Santiago de Compostela, Spain
| | - Iñaki Galán
- National Centre for Epidemiology, Instituto de Salud Carlos III, Madrid, Spain; Department of Preventive Medicine and Public Health, School of Medicine, Universidad Autónoma de Madrid/Instituto de Investigaciones Sanitarias Hospital Universitario La Paz, Madrid, Spain
| | - Esteve Fernández
- Tobacco Control Unit, WHO Collaborating Center for Tobacco Control, Institut Català d'Oncologia (ICO), Spain; Tobacco Control Research Group, Institut d'Investigació Biomèdica de Bellvitge (IDIBELL), Spain; School of Medicine and Health Sciences, Universitat de Barcelona; CIBER of Respiratory Diseases (CIBERES), Spain
| | - Agustín Montes
- Department of Preventive Medicine and Public Health, University of Santiago de Compostela, Santiago de Compostela, Spain; CIBER Epidemiology and Public Health, CIBERESP; Health Research Institute of Santiago de Compostela (IDIS), Santiago de Compostela, Spain
| | | | - Alexandra Giraldo-Osorio
- Department of Preventive Medicine and Public Health, University of Santiago de Compostela, Santiago de Compostela, Spain; Departamento de Salud Pública, Grupo de investigación Promoción de la Salud y Prevención de la Enfermedad (GIPSPE), Universidad de Caldas, Manizales, Colombia; Fundación Carolina, Madrid, Spain
| | - Alberto Ruano-Raviña
- Department of Preventive Medicine and Public Health, University of Santiago de Compostela, Santiago de Compostela, Spain; CIBER Epidemiology and Public Health, CIBERESP; Health Research Institute of Santiago de Compostela (IDIS), Santiago de Compostela, Spain
| |
Collapse
|
5
|
Acosta E, Mehta N, Myrskylä M, Ebeling M. Cardiovascular mortality gap between the US and other high life expectancy countries in 2000-2016. J Gerontol B Psychol Sci Soc Sci 2022; 77:S148-S157. [PMID: 35195702 PMCID: PMC9154236 DOI: 10.1093/geronb/gbac032] [Citation(s) in RCA: 2] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/10/2021] [Indexed: 11/24/2022] Open
Abstract
Objectives Reductions in U.S. cardiovascular disease (CVD) mortality have stagnated. While other high life expectancy countries (HLCs) have also recently experienced a stall, the stagnation in CVD mortality in the United States appeared earlier and has been more pronounced. The reasons for the stall are unknown. We analyze cross-national variations in mortality trends to quantify the U.S. exceptionality and provide insight into its underlying causes. Methods Data are from the World Health Organization (2000–2016). We quantified differences in levels and trends of CVD mortality between the United States and 17 other HLCs. We decomposed differences to identify the individual contributions of major CVD subclassifications (ischemic heart disease [IHD], stroke, other heart diseases). To identify potential behavioral explanations, we compared trends in CVD mortality with trends in other causes of death related to obesity, smoking, alcohol, and drugs. Results Our study has four central findings: (a) U.S. CVD mortality is consistently higher than the average of other HLCs; (b) the U.S.–HLC gap declined until around 2008 and increased thereafter; (c) the shift from convergence to divergence was mainly driven by slowing IHD and stroke mortality reductions and increasing mortality from other CVD causes; (d) among the potential risk factors, only obesity- and alcohol-related mortality showed age-specific temporal changes that are similar to those observed for cardiovascular mortality. Discussion The exceptional changes in U.S. CVD mortality are driven by a distinct pattern of slowing reductions in IHD and stroke mortality and deteriorating mortality from other CVD causes. Obesity and alcohol abuse appear to be interrelated factors.
Collapse
Affiliation(s)
- Enrique Acosta
- Max Planck Institute for Demographic Research, Rostock, Germany.,Max Planck Institute for Demographic Research, Konrad-Zuse-Straße 1, 18057 Rostock, Germany
| | - Neil Mehta
- The University of Texas Medical Branch, Galveston, USA
| | - Mikko Myrskylä
- Max Planck Institute for Demographic Research, Rostock, Germany.,University of Helsinki, Helsinki, Finland
| | - Marcus Ebeling
- Max Planck Institute for Demographic Research, Rostock, Germany.,Karolinska Institutet, Stockholm, Sweden
| |
Collapse
|
6
|
Trias-Llimós S, Spijker JJA. Educational differences in alcohol-related mortality and their impact on life expectancy and lifespan variation in Spain (2016-2018): a cross-sectional analysis using multiple causes of death. BMJ Open 2022; 12:e053205. [PMID: 35074816 PMCID: PMC8788229 DOI: 10.1136/bmjopen-2021-053205] [Citation(s) in RCA: 5] [Impact Index Per Article: 2.5] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 12/20/2022] Open
Abstract
BACKGROUND Socioeconomic inequalities in alcohol-related mortality in Spain exists, and are postulated to contribute to inequalities in all-cause mortality. We aim to assess absolute and relative educational inequalities in alcohol-related mortality, and to estimate the role of alcohol in educational inequalities in both life expectancy and lifespan variation in Spain. METHODS We used multiple cause-of-death (MCOD) mortality data for individuals aged 30 and over for Spain (2016-2018) by educational attainment. We estimated by sex and educational attainment age-standardised alcohol-attributable mortality rates, relative and absolute indices of educational inequalities; and total life expectancy and lifespan variation at age 30 for all-cause mortality and after eliminating alcohol-attributable mortality. RESULTS The use of MCOD resulted in an additional 2543 annual alcohol-related deaths (+75% among men and +50% among women) compared with estimates derived from underlying causes of death. In absolute terms, educational inequalities were the highest among men aged 45-84 and among women aged 45-64. In relative terms, higher inequalities raised in working ages, whereas at older ages inequalities tended to be lower, although still important among men. Alcohol contributed to educational inequalities in life expectancy (men: 0.13 years (3.2%); women 0.02 years (0.7%)) and lifespan variation (2.1% and 1.4% for men and women, respectively). CONCLUSION Alcohol consumption remains an important lifestyle habit to be tackled in order to reduce socioeconomic inequalities in mortality in Spain, particularly among men.
Collapse
Affiliation(s)
- Sergi Trias-Llimós
- Centre d'Estudis Demografics, Centres de Recerca de Catalunya (CERCA), Universitat Autònoma de Barcelona, Bellaterra, Spain
| | - Jeroen J A Spijker
- Centre d'Estudis Demografics, Centres de Recerca de Catalunya (CERCA), Universitat Autònoma de Barcelona, Bellaterra, Spain
| |
Collapse
|
7
|
Janssen F, Trias-Llimós S, Kunst AE. The combined impact of smoking, obesity and alcohol on life-expectancy trends in Europe. Int J Epidemiol 2021; 50:931-941. [PMID: 33432332 PMCID: PMC8271206 DOI: 10.1093/ije/dyaa273] [Citation(s) in RCA: 16] [Impact Index Per Article: 5.3] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 12/10/2020] [Indexed: 01/09/2023] Open
Abstract
BACKGROUND Smoking, obesity and alcohol abuse greatly affect mortality and exhibit a distinct time dynamic, with their prevalence and associated mortality rates increasing and (eventually) declining over time. Their combined impact on secular trends in life expectancy is unknown but is relevant for understanding these trends. We therefore estimate the combined impact of smoking, obesity and alcohol on life-expectancy trends in Europe. METHODS We used estimated national age-specific smoking-, obesity- and alcohol-attributable mortality fractions for 30 European countries by sex, 1990-2014, which we aggregated multiplicatively to obtain lifestyle-attributable mortality. We estimated potential gains in life expectancy by eliminating lifestyle-attributable mortality and compared past trends in life expectancy at birth (e0) with and without lifestyle-attributable mortality. We examined all countries combined, by region and individually. RESULTS Among men, the combined impact of smoking, obesity and alcohol on e0 declined from 6.6 years in 1990 to 5.8 years in 2014, mainly due to declining smoking-attributable mortality. Among women, the combined impact increased from 1.9 to 2.3 years due to mortality increases in all three lifestyle-related factors. The observed increase in e0 over the 1990-2014 period was 5.0 years for men and 4.0 years for women. After excluding lifestyle-attributable mortality, this increase would have been 4.2-4.3 years for both men and women. CONCLUSION Without the combined impact of smoking, obesity and alcohol, the increase over time in life expectancy at birth would have been smaller among men but larger among women, resulting in a stable increase in e0, parallel for men and women.
Collapse
Affiliation(s)
- Fanny Janssen
- Netherlands Interdisciplinary Demographic Institute—KNAW/University of Groningen, The Hague, The Netherlands
- Population Research Centre, Faculty of Spatial Sciences, University of Groningen, The Netherlands
| | - Sergi Trias-Llimós
- Department of Non-communicable Disease Epidemiology, Faculty of Epidemiology and Population Health, London School of Hygiene & Tropical Medicine, London, UK
- Center for Demographic Studies, Centres de Recerca de Catalunya (CERCA), Bellaterra, Spain
| | - Anton E Kunst
- Department of Public and Occupational Health, Amsterdam UMC, University of Amsterdam, Amsterdam, The Netherlands
| |
Collapse
|
8
|
Trias-Llimós S, Bardoutsos A, Janssen F. Future Alcohol-Attributable Mortality in France Using a Novel Generalizable Age-Period-Cohort Projection Methodology. Alcohol Alcohol 2021; 56:325-333. [PMID: 33089307 PMCID: PMC8085365 DOI: 10.1093/alcalc/agaa107] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/11/2020] [Revised: 09/22/2020] [Accepted: 09/22/2020] [Indexed: 02/06/2023] Open
Abstract
AIM To forecast age- and sex-specific alcohol-attributable mortality in France for the period 2015-2050 using a novel generalizable methodology that includes different scenarios regarding period and cohort change. METHODS For the French national population aged 25-90 years (1979-2014), we estimated alcohol-attributable mortality by mortality from the main causes of death wholly attributable to alcohol, plus liver cirrhosis mortality. We modelled sex-specific alcohol-attributable mortality by adjusting for age, period and birth cohort. We forecasted the model parameters to obtain future age- and sex-specific alcohol-attributable mortality up until 2050 using a conventional baseline, scenario I (favourable period change) and scenario II (unfavourable cohort change). RESULTS Alcohol-attributable mortality is clearly declining in France, with the decline decelerating from 1992 onwards. In 2014, the age-standardized alcohol-attributable mortality rates, in deaths per 100,000, were 34.7 among men and 9.9 among women. In 2050, the estimated rates are between 10.5 (prediction interval: 7.6-14.4; scenario I) and 17.6 (13.1-23.7; scenario II) among men, and between 1.1 (0.7-1.7; scenario I) and 1.8 (1.2-2.9; scenario II) among women; which implies declines of 58% for men and 84% for women (baseline). CONCLUSION Alcohol-attributable mortality in France is expected to further decline in the coming decades, accompanied by age pattern changes. However, France's levels are not expected to reach the current lower levels in Italy and Spain for 15 years or more. Our results point to the value of implementing preventive policy measures that discourage alcohol consumption among people of all ages, but especially among adolescents.
Collapse
Affiliation(s)
- Sergi Trias-Llimós
- Population Research Centre, Faculty of Spatial Sciences, University of Groningen, Landleven 1, 9747 Groningen, The Netherlands
- Center for Demographic Studes, Centres de Recerca de Catalunya (CERCA), Carrer de Ca n’Altayó, Edifici E2, 08193 Bellaterra, Spain
| | - Anastasios Bardoutsos
- Population Research Centre, Faculty of Spatial Sciences, University of Groningen, Landleven 1, 9747 Groningen, The Netherlands
| | - Fanny Janssen
- Population Research Centre, Faculty of Spatial Sciences, University of Groningen, Landleven 1, 9747 Groningen, The Netherlands
- Netherlands Interdisciplinary Demographic Institute, KNAW/University of Groningen, Lange Houtstraat 19, 2511 The Hague, The Netherlands
| |
Collapse
|
9
|
Janssen F, El Gewily S, Bardoutsos A, Trias-Llimós S. Past and Future Alcohol-Attributable Mortality in Europe. INTERNATIONAL JOURNAL OF ENVIRONMENTAL RESEARCH AND PUBLIC HEALTH 2020; 17:E9024. [PMID: 33287385 PMCID: PMC7730378 DOI: 10.3390/ijerph17239024] [Citation(s) in RCA: 5] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Subscribe] [Scholar Register] [Received: 10/15/2020] [Revised: 11/10/2020] [Accepted: 11/29/2020] [Indexed: 12/11/2022]
Abstract
Although alcohol consumption is an important public health issue in Europe, estimates of future alcohol-attributable mortality for European countries are rare, and only apply to the short-term future. We project (age-specific) alcohol-attributable mortality up to 2060 in 26 European countries, after a careful assessment of past trends. For this purpose we used population-level country-, sex-, age- (20-84) and year-specific (1990-2016) alcohol-attributable mortality fractions (AAMF) from the Global Burden of Disease (GBD) study, which we adjusted at older ages. To these data we apply an advanced age-period-cohort projection methodology, that avoids unrealistic future differences and crossovers between sexes and countries. We project that in the future, AAMF levels will decline in all countries, and will converge across countries and sexes. For 2060, projected AAMF are, on average, 5.1% among men and 1.4% among women, whereas in 2016 these levels were 10.1% and 3.3%, respectively. For men, AAMF is projected to be higher in Eastern and South-western Europe than in North-western Europe. All in all, the share of mortality due to alcohol is projected to eventually decline in all 26 European countries. Achieving these projected declines will, however, require strong ongoing public health action, particularly for selected Eastern and North-western European countries.
Collapse
Affiliation(s)
- Fanny Janssen
- Netherlands Interdisciplinary Demographic Institute, KNAW/University of Groningen, Lange Houtstraat 19, 2511 CV The Hague, The Netherlands
- Population Research Centre, Faculty of Spatial Sciences, University of Groningen, P.O. Box 800, 9700 AV Groningen, The Netherlands; (S.E.G.); (A.B.)
| | - Shady El Gewily
- Population Research Centre, Faculty of Spatial Sciences, University of Groningen, P.O. Box 800, 9700 AV Groningen, The Netherlands; (S.E.G.); (A.B.)
| | - Anastasios Bardoutsos
- Population Research Centre, Faculty of Spatial Sciences, University of Groningen, P.O. Box 800, 9700 AV Groningen, The Netherlands; (S.E.G.); (A.B.)
| | - Sergi Trias-Llimós
- Centre d’Estudis Demogràfics, Centres de Recerca de Catalunya (CERCA), Carrer de Ca n’Altayó, Buildings E2, Autonomous University of Barcelona, 08193 Bellaterra, Spain;
- Department of Non-Communicable Disease Epidemiology, Faculty of Epidemiology and Population Health, London School of Hygiene & Tropical Medicine, Keppel St, London WC1E 7HT, UK
| |
Collapse
|
10
|
Junna LM, Tarkiainen L, Östergren O, Jasilionis D, Martikainen P. Exploring the longevity advantage of doctorates in Finland and Sweden: The role of smoking- and alcohol-related causes of death. Scand J Public Health 2020; 49:419-422. [PMID: 33176584 PMCID: PMC8135231 DOI: 10.1177/1403494820969541] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/15/2022]
Abstract
Aims: Tobacco smoking and alcohol use contribute to differences in life expectancy between individuals with primary, secondary and tertiary education. Less is known about the contribution of these risk factors to differences at higher levels of education. We estimate the contribution of smoking and alcohol use to the life-expectancy differences between the doctorates and the other tertiary-educated groups in Finland and in Sweden. Methods: We used total population data from Finland and Sweden from 2011 to 2015 to calculate period life expectancies at 40 years of age. We present the results by sex and educational attainment, the latter categorised as doctorate or licentiate degrees, or other tertiary. We also present an age and cause of death decomposition to assess the contribution of deaths related to smoking and alcohol. Results: In Finland, deaths related to smoking and alcohol constituted 48.6% of the 2.1-year difference in life expectancy between men with doctorate degrees and the other tertiary-educated men, and 22.9% of the 2.1-year difference between women, respectively. In Sweden, these causes account for 22.2% of the 1.9-year difference among men, and 55.7% of the 1.6-year difference among women, which in the latter case is mainly due to smoking. Conclusions: Individuals with doctorates tend to live longer than other tertiary-educated individuals. This difference can be partly attributed to alcohol consumption and smoking.
Collapse
Affiliation(s)
- Liina M Junna
- Population Research Unit, Faculty of Social Sciences, University of Helsinki, Finland.,The Max Planck Institute for Demographic Research, Germany
| | - Lasse Tarkiainen
- Population Research Unit, Faculty of Social Sciences, University of Helsinki, Finland.,Helsinki Institute of Urban and Regional Studies, University of Helsinki, Finland
| | - Olof Östergren
- Department of Public Health Sciences, Stockholm University, Sweden.,Aging Research Centre (ARC), Karolinska Institutet, Sweden
| | - Domantas Jasilionis
- The Max Planck Institute for Demographic Research, Germany.,Demographic Research Centre, Vytautas Magnus University, Lithuania
| | - Pekka Martikainen
- Population Research Unit, Faculty of Social Sciences, University of Helsinki, Finland.,The Max Planck Institute for Demographic Research, Germany.,Department of Public Health Sciences, Stockholm University, Sweden
| |
Collapse
|
11
|
Trias-Llimós S, Bosque-Prous M, Obradors-Rial N, Teixidó-Compañó E, Belza MJ, Janssen F, Espelt A. Alcohol and educational inequalities: Hazardous drinking prevalence and all-cause mortality by hazardous drinking group in people aged 50 and older in Europe. Subst Abus 2020; 43:152-160. [PMID: 32543303 DOI: 10.1080/08897077.2020.1773597] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/24/2023]
Abstract
Background: We examined educational inequalities in hazardous drinking prevalence among individuals aged 50 or more in 14 European countries, and explored educational inequalities in mortality in hazardous drinkers in European regions. Methods: We analyzed data from waves 4, 5 and 6 of the Survey of Health Ageing and Retirement in Europe (SHARE). We estimated age-standardized hazardous drinking prevalence, and prevalence ratios (PR) of hazardous drinking by country and educational level using Poisson regression models with robust variance. We estimated the relative index of inequality (RII) for all-cause mortality among hazardous drinkers and non-hazardous drinkers using Cox proportional hazards regression models and for each region (North, South, East and West). Results: In men, educational inequalities in hazardous drinking were not observed (PRmedium = 1.09 [95%CI: 0.98-1.21] and PRhigh = 0.99 [95%CI: 0.88-1.10], ref. low), while in they were observed in women, having the highest hazardous drinking prevalence in the highest educational levels (PRmedium = 1.28 [95%CI: 1.15-1.42] and PRhigh = 1.53 [95%CI: 1.36-1.72]). Overall, the Relative Index of Inequality (RII) in all-cause mortality among hazardous drinkers was 1.12 [95%CI: 1.03-1.22] among men and 1.10 [95%CI: 0.97-1.25] among women. Educational inequalities among hazardous drinkers were observed in Eastern Europe for both men (RIIhazardous = 1.21 [95%CI: 1.01-1.45]) and women (RIIhazardous = 1.46 [95%CI: 1.13-1.87]). Educational inequalities in mortality among non-hazardous drinkers were observed in Southern, Western and Eastern Europe among men, and in Eastern Europe among women. Conclusions: Higher educational attainment is positively associated with hazardous drinking prevalence among women, but not among men in most of the analyzed European countries. Clear educational inequalities in mortality among hazardous drinkers were only observed in Eastern Europe. Further research on the associations between alcohol use and inequalities in all-cause mortality in different regions is needed.
Collapse
Affiliation(s)
- Sergi Trias-Llimós
- Department of Non-communicable Disease Epidemiology, London School of Hygiene and Tropical Medicine, London, United Kingdom
| | - Marina Bosque-Prous
- Faculty of Health Sciences, Universitat Oberta de Catalunya, Barcelona, Spain
| | - Nuria Obradors-Rial
- Facultat de Ciències de la Salut de Manresa, Universitat de Vic-Universitat Central de Catalunya (UVicUCC), Manresa, Spain
| | - Ester Teixidó-Compañó
- Facultat de Ciències de la Salut de Manresa, Universitat de Vic-Universitat Central de Catalunya (UVicUCC), Manresa, Spain
| | - Maria José Belza
- Escuela Nacional de Sanidad, Instituto de Salud Carlos III, Madrid, Spain.,Centro de Investigación Biomédica en Red de Epidemiología y Salud Pública (CIBERESP), Madrid, Spain
| | - Fanny Janssen
- Netherlands Interdisciplinary Demographic Institute - KNAW/University of Groningen, The Hague, The Netherlands.,Netherlands Interdisciplinary Demographic Institute, The Hague, The Netherlands
| | - Albert Espelt
- Facultat de Ciències de la Salut de Manresa, Universitat de Vic-Universitat Central de Catalunya (UVicUCC), Manresa, Spain.,Centro de Investigación Biomédica en Red de Epidemiología y Salud Pública (CIBERESP), Madrid, Spain.,Departament de Psicobiologia i Metodologia en Ciències de la Salut, Universitat Autònoma de Barcelona (UAB), Bellaterra, Spain
| |
Collapse
|
12
|
Trias-Llimós S. Reply to Montes-Santiago and Roseiro-Sordo: “The importance of alcohol-related mortality estimates in Spain”. Rev Clin Esp 2020. [DOI: 10.1016/j.rceng.2019.09.006] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/25/2022]
|
13
|
Trias-Llimós S. Respuesta a Montes-Santiago y Roseiro-Sordo: «La importancia de las estimaciones de mortalidad relacionadas con el alcohol en España». Rev Clin Esp 2020; 220:144. [DOI: 10.1016/j.rce.2019.09.010] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/28/2019] [Accepted: 09/05/2019] [Indexed: 12/01/2022]
|
14
|
Norström T, Mäkelä P. The connection between per capita alcohol consumption and alcohol‐specific mortality accounting for unrecorded alcohol consumption: The case of Finland 1975–2015. Drug Alcohol Rev 2019; 38:731-736. [DOI: 10.1111/dar.12983] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/13/2019] [Revised: 07/27/2019] [Accepted: 08/07/2019] [Indexed: 11/29/2022]
Affiliation(s)
- Thor Norström
- Swedish Institute for Social Research (SOFI)Stockholm University Stockholm Sweden
| | - Pia Mäkelä
- National Institute for Health and Welfare (THL) Helsinki Finland
| |
Collapse
|
15
|
Östergren O, Martikainen P, Tarkiainen L, Elstad JI, Brønnum-Hansen H. Contribution of smoking and alcohol consumption to income differences in life expectancy: evidence using Danish, Finnish, Norwegian and Swedish register data. J Epidemiol Community Health 2019; 73:334-339. [PMID: 30674585 PMCID: PMC6581103 DOI: 10.1136/jech-2018-211640] [Citation(s) in RCA: 38] [Impact Index Per Article: 7.6] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/20/2018] [Revised: 12/06/2018] [Accepted: 01/05/2019] [Indexed: 02/06/2023]
Abstract
Background Despite being comparatively egalitarian welfare states, the Nordic countries have not been successful in reducing health inequalities. Previous studies have suggested that smoking and alcohol contribute to this pattern. Few studies have focused on variations in alcohol-related and smoking-related mortality within the Nordic countries. We assess the contribution of smoking and alcohol to differences in life expectancy between countries and between income quintiles within countries. Methods We collected data from registers in Denmark, Finland, Norway and Sweden comprising men and women aged 25–79 years during 1995–2007. Estimations of alcohol-related mortality were based on underlying and contributory causes of death on individual death certificates, and smoking-related mortality was based on an indirect method that used lung cancer mortality as an indicator for the population-level impact of smoking on mortality. Results About 40%–70% of the between-country differences in life expectancy in the Nordic countries can be attributed to smoking and alcohol. Alcohol-related and smoking-related mortality also made substantial contributions to income differences in life expectancy within countries. The magnitude of the contributions were about 30% in Norway, Sweden and among Finnish women to around 50% among Finnish men and in Denmark. Conclusions Smoking and alcohol consumption make substantial contributions to both between-country differences in mortality among the Nordic countries and within-country differences in mortality by income. The size of these contributions vary by country and sex.
Collapse
Affiliation(s)
- Olof Östergren
- Department of Public Health Sciences, Stockholm University, Stockholm, Sweden, Europe
| | - Pekka Martikainen
- Department of Public Health Sciences, Stockholm University, Stockholm, Sweden, Europe.,Population Research Unit, Department of Social Research, University of Helsinki, Helsinki, Finland, Europe.,The Max Planck Institute for Demographic Research, Germany
| | - Lasse Tarkiainen
- Population Research Unit, Department of Social Research, University of Helsinki, Helsinki, Finland, Europe
| | - Jon Ivar Elstad
- NOVA, Centre for Welfare and Labour Research, Oslo Metropolitan University, Oslo, Norway
| | | |
Collapse
|