Liver cirrhosis mortality trends in Eastern Europe, 1970-1989. Analyses of age, period and cohort effects and of latency with alcohol consumption.

Abstract

There is evidence that in some Eastern European countries alcohol-related deaths have an important impact on mortality. In the whole European population increasing trends in mortality were observed until the second half of the 1970s, followed by a decline in the following decades. By contrast, in Eastern Europe continuously rising trends have been observed. The aim of the present study is to describe cirrhosis mortality trends in Eastern European countries between 1970 and 1989. This is a descriptive study in seven European countries, compared with Europe as a whole. A Poisson's log-linear age-period-cohort model is used to ascertain whether the recent trend in mortality represents a short-term fluctuation or an emerging long-term trend. In addition, changes in cirrhosis death rates were regressed onto changes in per capita alcohol consumption (1961-89) in order to evaluate the latency period between trends. The birth-cohort effects suggested that in Eastern Europe as a whole, and in particular in Hungary, Bulgaria and Romania, the mortality will probably increase in the next decade. Eastern European countries showed a latency period between trends in alcohol consumption and in mortality rates of many years, whereas in Europe as a whole the cirrhosis mortality rates were explained by their relationship with per capita alcohol consumption which lagged by only a few years. Further increases in cirrhosis mortality, and probably in other alcohol-related problems, are expected in several Eastern European countries. Epidemiological studies aimed to estimate the proportion of disease attributable to known risk factors of cirrhosis, and monitoring programmes of viral infections and of alcohol consumption and alcohol-related problems, should be implemented to address the planning of public health programmes.