WITHDRAWN: Extremely high sex disparities in adult premature mortality in Estonia 1995–2014: Is a stricter alcohol and tobacco policy needed?

Abstract

To quantify relative sex disparities in cause-specific adult premature mortality in Estonia and to determine for which causes of death the inequalities are the highest; subsequently, to provide some guidance to public health policy-makers, considering the relatively liberal national alcohol policy. The analyses were based on individual death records of 1995–2014 and ages of 20–69 years, and involved the calculation of overall and cause-specific age-standardized mortality rates, average annual percentage changes of mortality, and cause-specific men to women mortality rate ratios. Overall adult premature mortality has decreased considerably during 1995–2014, but no reduction was observed with respect to the high relative sex disparities. In circulatory disease mortality the disparities widened significantly with time. Extremely high mortality rate ratios were observed for cancer of the upper aero-digestive tract and lung cancer. There was a stable, more than five-fold male excess mortality from external causes. A four-fold male disadvantage was evident for alcohol poisoning and mental disorders due to alcohol. Even though adult premature mortality has markedly decreased over time, there has been no success in diminishing high sex differences in mortality patterns, many of which were related to smoking and excessive drinking of alcohol, both more prevalent among men. Estonia needs a comprehensive and consistent alcohol policy while maintaining and further developing anti-tobacco measures.