| 1. |
- Mackenbach, Johan P, et al.
(författare)
-
Inequalities in Alcohol-Related Mortality in 17 European Countries : A Retrospective Analysis of Mortality Registers.
- 2015
-
Ingår i: PLoS Medicine. - : Public Library of Science (PLoS). - 1549-1277 .- 1549-1676. ; 12:12
-
Tidskriftsartikel (refereegranskat)abstract
- BACKGROUND: Socioeconomic inequalities in alcohol-related mortality have been documented in several European countries, but it is unknown whether the magnitude of these inequalities differs between countries and whether these inequalities increase or decrease over time.METHODS AND FINDINGS: We collected and harmonized data on mortality from four alcohol-related causes (alcoholic psychosis, dependence, and abuse; alcoholic cardiomyopathy; alcoholic liver cirrhosis; and accidental poisoning by alcohol) by age, sex, education level, and occupational class in 20 European populations from 17 different countries, both for a recent period and for previous points in time, using data from mortality registers. Mortality was age-standardized using the European Standard Population, and measures for both relative and absolute inequality between low and high socioeconomic groups (as measured by educational level and occupational class) were calculated. Rates of alcohol-related mortality are higher in lower educational and occupational groups in all countries. Both relative and absolute inequalities are largest in Eastern Europe, and Finland and Denmark also have very large absolute inequalities in alcohol-related mortality. For example, for educational inequality among Finnish men, the relative index of inequality is 3.6 (95% CI 3.3-4.0) and the slope index of inequality is 112.5 (95% CI 106.2-118.8) deaths per 100,000 person-years. Over time, the relative inequality in alcohol-related mortality has increased in many countries, but the main change is a strong rise of absolute inequality in several countries in Eastern Europe (Hungary, Lithuania, Estonia) and Northern Europe (Finland, Denmark) because of a rapid rise in alcohol-related mortality in lower socioeconomic groups. In some of these countries, alcohol-related causes now account for 10% or more of the socioeconomic inequality in total mortality. Because our study relies on routinely collected underlying causes of death, it is likely that our results underestimate the true extent of the problem.CONCLUSIONS: Alcohol-related conditions play an important role in generating inequalities in total mortality in many European countries. Countering increases in alcohol-related mortality in lower socioeconomic groups is essential for reducing inequalities in mortality. Studies of why such increases have not occurred in countries like France, Switzerland, Spain, and Italy can help in developing evidence-based policies in other European countries.
|
|
| 2. |
- Norström, Thor, et al.
(författare)
-
The connection between per capita alcohol consumption and alcohol-specific mortality accounting for unrecorded alcohol consumption : The case of Finland 1975-2015
- 2019
-
Ingår i: Drug and Alcohol Review. - : Wiley. - 0959-5236 .- 1465-3362. ; 38:7, s. 731-736
-
Tidskriftsartikel (refereegranskat)abstract
- Introduction and AimsUnrecorded alcohol consumption has increased strongly in Finland after 1995 when the country joined the European Union. This development may have rendered alcohol sales less trustworthy as a proxy for population drinking, and less powerful as predictor of alcohol‐related harm. The study aims to test this contention by analyzing the association between recorded and unrecorded alcohol consumption on the one hand, and alcohol‐specific mortality on the other.Design and MethodsWe analysed age‐standardised rates of alcohol‐specific deaths for the working‐age (15–64 years) population. For alcohol consumption, we used (i) alcohol sales in litres of 100% alcohol per capita, and (ii) estimated unrecorded consumption in litres of 100% alcohol per capita. The data spanned the period 1975–2015. As the data were cointegrated, the relations between mortality and the alcohol indicators were estimated through time‐series analysis of the raw data.ResultsA one litre increase in alcohol sales was associated with an increase in alcohol‐specific deaths of 7.590 deaths per 100 000; the corresponding figure for unrecorded consumption was 9.112 deaths per 100 000. Both estimates were statistically significant (P < 0.001), but the difference between them was not significant (P = 0.293). Although recoded consumption captured the main feature of the trends in alcohol‐specific mortality, it accounted for only half of its marked increase in 1975–2007, while unrecorded consumption explained the remaining part.Discussion and ConclusionsOur study confirms previous findings that recorded alcohol consumption is an important determinant of alcohol‐specific mortality in Finland. A more novel insight is the importance of unrecorded consumption in this context.
|
|
| 3. |
- Paljärvi, Tapio, et al.
(författare)
-
Purchases of prescription drugs before an alcohol-related death : A ten-year follow-up study using linked routine data
- 2018
-
Ingår i: Drug And Alcohol Dependence. - : Elsevier BV. - 0376-8716 .- 1879-0046. ; 186, s. 175-181
-
Tidskriftsartikel (refereegranskat)abstract
- Background: Physician's intention to prescribe drugs could potentially be used to improve targeting of alcohol interventions and enhanced disease management to patients with a high risk of severe alcohol-related harm within outpatient settings. Methods: Comparison of ten-year incidence trajectories of 13.8 million reimbursed purchases of prescription drugs among 303,057 Finnish men and women of whom 7490 ultimately died due to alcohol-related causes (Ale+), 14,954 died without alcohol involvement (Alc-), and 280,613 survived until the end of 2007. Results: 5-10 years before death, 88% of the persons with an Alc+ death had received prescription medication, and over two-thirds (69%) had at least one reimbursed purchase of drugs for the alimentary tract and metabolism, the cardiovascular system, or the nervous system. Among persons with an Alc+ death, the incidence rate (IR) for purchases of hypnotics, and sedatives was L38 times higher (95% confidence interval (C1):1.32,1.44) compared to those with an Alc death, and 4.07 times higher (95%C1:3.92,4.22) compared to survivors; and the IR for purchases of anxiolytics was 1.40 times higher (95%Ck1.34,1.47) compared to those with an Ale death, and 3.61 times higher (95%C1:3.48,3.78) compared to survivors. Conclusions: Using physician's intention to prescribe drugs affecting the alimentary tract and metabolism, cardiovascular system and nervous system could potentially be used to flag patients who might benefit from screening, targeted interventions or enhanced disease management. In particular, patients who are to be prescribed anxiolytics, hypnotics, and sedatives, and antidepressants may benefit from enhanced interventions targeted to problem drinking.
|
|
| 4. |
- Sherk, Adam, et al.
(författare)
-
Alcohol Consumption and the Physical Availability of Take-Away Alcohol : Systematic Reviews and Meta-Analyses of the Days and Hours of Sale and Outlet Density
- 2018
-
Ingår i: Journal of Studies on Alcohol and Drugs. - : Alcohol Research Documentation, Inc.. - 1937-1888 .- 1938-4114. ; 79:1, s. 58-67
-
Forskningsöversikt (refereegranskat)abstract
- Objective: Systematic reviews and meta-analyses were completed studying the effect of changes in the physical availability of take-away alcohol on per capita alcohol consumption. Previous reviews examining this topic have not focused on off-premise outlets where take-away alcohol is sold and have not completed meta-analyses. Method: Systematic reviews were conducted separately for policies affecting the temporal availability (days and hours of sale) and spatial availability (outlet density) of take-away alcohol. Studies were included up to December 2015. Quality criteria were used to select articles that studied the effect of changes in these policies on alcohol consumption with a focus on natural experiments. Random-effects meta-analyses were applied to produce the estimated effect of an additional day of sale on total and beverage-specific consumption. Results: Separate systematic reviews identifi ed seven studies regarding days and hours of sale and four studies regarding density. The majority of articles included in these systematic reviews, for days/hours of sale (7/7) and outlet density (3/4), concluded that restricting the physical availability of take-away alcohol reduces per capita alcohol consumption. Meta-analyses studying the ef-fect of adding one additional day of sale found that this was associated with per capita consumption increases of 3.4% (95% CI [2.7, 4.1]) for total alcohol, 5.3% (95% CI [3.2, 7.4]) for beer, 2.6% (95% CI [1.8, 3.5]) for wine, and 2.6% (95% CI [2.1, 3.2]) for spirits. The small number of included studies regarding hours of sale and density precluded meta-analysis. Conclusions: The results of this study suggest that decreasing the physical availability of take-away alcohol will decrease per capita consumption. As decreasing per capita consumption has been shown to reduce alcohol-related harm, restricting the physical availability of take-away alcohol would be expected to result in improvements to public health.
|
|
| 5. |
- Shield, Kevin D., et al.
(författare)
-
Life-time risk of mortality due to different levels of alcohol consumption in seven European countries : implications for low-risk drinking guidelines
- 2017
-
Ingår i: Addiction. - : Wiley. - 0965-2140 .- 1360-0443. ; 112:9, s. 1535-1544
-
Tidskriftsartikel (refereegranskat)abstract
- Background and AimsLow-risk alcohol drinking guidelines require a scientific basis that extends beyond individual or group judgements of risk. Life-time mortality risks, judged against established thresholds for acceptable risk, may provide such a basis for guidelines. Therefore, the aim of this study was to estimate alcohol mortality risks for seven European countries based on different average daily alcohol consumption amounts.MethodsThe maximum acceptable voluntary premature mortality risk was determined to be one in 1000, with sensitivity analyses of one in 100. Life-time mortality risks for different alcohol consumption levels were estimated by combining disease-specific relative risk and mortality data for seven European countries with different drinking patterns (Estonia, Finland, Germany, Hungary, Ireland, Italy and Poland). Alcohol consumption data were obtained from the Global Information System on Alcohol and Health, relative risk data from meta-analyses and mortality information from the World Health Organization.ResultsThe variation in the life-time mortality risk at drinking levels relevant for setting guidelines was less than that observed at high drinking levels. In Europe, the percentage of adults consuming above a risk threshold of one in 1000 ranged from 20.6 to 32.9% for women and from 35.4 to 54.0% for men. Life-time risk of premature mortality under current guideline maximums ranged from 2.5 to 44.8 deaths per 1000 women in Finland and Estonia, respectively, and from 2.9 to 35.8 deaths per 1000 men in Finland and Estonia, respectively. If based upon an acceptable risk of one in 1000, guideline maximums for Europe should be 8–10 g/day for women and 15–20 g/day for men.ConclusionsIf low-risk alcohol guidelines were based on an acceptable risk of one in 1000 premature deaths, then maximums for Europe should be 8–10 g/day for women and 15–20 g/day for men, and some of the current European guidelines would require downward revision.
|
|
| 6. |
|
|
| 7. |
- Trias-Llimós, Sergi, et al.
(författare)
-
Comparison of different approaches for estimating age-specific alcohol-attributable mortality : The cases of France and Finland
- 2018
-
Ingår i: PLOS ONE. - : Public Library of Science (PLoS). - 1932-6203. ; 13:3
-
Tidskriftsartikel (refereegranskat)abstract
- Background Accurate estimates of the impact of alcohol on overall and age-specific mortality are crucial for formulating health policies. However, different approaches to estimating alcohol-attributable mortality provide different results, and a detailed comparison of age-specific estimates is missing. Methods Using data on cause of death, alcohol consumption, and relative risks of mortality at different consumption levels, we compare eight estimates of sex- and age-specific alcohol-attributable mortality in France (2010) and Finland (2013): five estimates using cause-of-death approaches (with one accounting for contributory causes), and three estimates using attributable fraction (AF) approaches. Results AF-related approaches and the approach based on alcohol-related underlying and contributory causes of death provided estimates of alcohol-attributable mortality that were twice as high as the estimates found using underlying cause-of-death approaches in both countries and sexes. The differences across the methods were greatest among older age groups An inverse U-shape in age-specific alcohol-attributable mortality (peaking at around age 65) was observed for cause-of-death approaches, with this shape being more pronounced in Finland. AF-related approaches resulted in different estimates at older ages: i.e., mortality was found to increase with age in France; whereas in Finland mortality estimates depended on the underlying assumptions regarding the effects of alcohol consumption on cardiovascular mortality. Conclusions While the most detailed approaches (i.e., the AF-related approach and the approach that includes underlying and contributory causes) are theoretically able to provide more accurate estimates of alcohol-attributable mortality, they especially the AF approaches- depend heavily on data availability and quality. To enhance the reliability of alcohol-attributable mortality estimates, data quality for older age groups needs to be improved.
|
|
| 8. |
- Østhus, Ståle, et al.
(författare)
-
Sosial ulikhet i alkoholbruk og alkoholrelatert sykelighet og dødelighet
- 2016
-
Rapport (övrigt vetenskapligt/konstnärligt)abstract
- I Norge er befolkningens helse gjennomgående god og levealderen høy, men tross velstand og høyt velferdsnivå er det i Norge, som i de fleste andre land, sosiale ulikheter i helse og levealder (Dahl, Bergsli, & van der Wel, 2014): Helsen er bedre og levealderen lengre blant dem som har lang utdanning, høy inntekt og høy yrkesstatus, sammenlignet med dem som har kort utdanning, lav inntekt og lav yrkesstatus. Sosial ulikhet i helse har betydelig helsepolitisk interesse, og det er en tverrpolitisk enighet om at sosial ulikhet i helse er en kilde til bekymring. Det er derfor en uttalt målsetting å redusere slik ulikhet (Dahl et al., 2014). I folkehelsemeldingen (Stortingsmelding 16 – Resept for et sunnere Norge) er det gitt flere begrunnelser for å redusere sosial ulikhet i helse. Blant disse er at det ligger muligheter for en forbedring av den samlete folkehelsen dersom alle oppnår en like god helse som den gruppen med best helse og at en bedret helse for alle grupper bidrar til økt økonomisk utvikling (Sund & Krokstad, 2005).
|
|
