Past and Future Alcohol-Attributable Mortality in Europe.

Fanny Janssen,Shady El Gewily,Sergi Trias-Llimós,Anastasios Bardoutsos

doi:10.3390/ijerph17239024

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.

Highlights

Alcohol consumption is an important public health challenge in Europe, as it substantially increases the risk of contracting many different diseases, including liver cirrhosis, alcohol use disorders, specific cancers, cardiovascular diseases, and infectious diseases, and the risk of sustaining injuries [1,2]
These 26 European countries represent all of the European countries for which there are both Global Burden of Disease (GBD) study data on alcohol-attributable mortality (1975–2016) and high-quality all-cause mortality data from the Human Mortality Database (HMD) since at least 1990 and up to at least 2013, except Estonia, Latvia and Slovakia, which we excluded from our analysis, because of their unrealistic alcohol-attributable mortality rates at the old ages
We avoided unrealistically large future differences between countries in age-standardised attributable mortality fractions (AAMF) levels by assuming that the current increases in AAMF observed for selected countries will eventually turn into declines. This assumption was motivated by the observation of a wave-shaped pattern of an increase followed by a decline in AAMF in a number of European countries; by the large reductions in alcohol consumption that have recently occurred, in Eastern Europe [27], by the decrease in alcohol use among the youth [14]; by the recent implementation of strong alcohol prevention policies in European countries [27]; and by evidence that prevention policies have the power to bend increases into declines [27]

Summary

Introduction

Alcohol consumption is an important public health challenge in Europe, as it substantially increases the risk of contracting many different diseases, including liver cirrhosis, alcohol use disorders, specific cancers, cardiovascular diseases, and infectious diseases, and the risk of sustaining (road/transport) injuries [1,2]. Alcohol use has a large impact on (healthy) life expectancy [5,6]. Europe is the region with the highest levels of alcohol consumption: in 2016, an estimated 9.8 litres of pure alcohol were consumed per capita in Europe, compared to 6.4 litres worldwide [7]. Without alcohol-attributable mortality, national life expectancy levels in Europe would be, on average, 1.8 years higher among men and 0.5 years higher among women [8]. Having a clear overview of past trends in alcohol-attributable mortality, and understanding how alcohol-attributable mortality is likely to further develop in the future, is highly relevant for society, and for health policy-makers in particular

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