The contribution of alcohol to the East-West life expectancy gap in Europe from 1990 onward

Putting the exposome into practice: An analysis of the promises, methods and outcomes of the European human exposome network

OBJECTIVES

Contemporary research on the exposome, i.e. the sum of all the exposures an individual encounters throughout life and that may influence human health, bears the promise of an integrative and policy-relevant research on the effect of environment on health. Critical analyses of the first generation of exposome projects have voiced concerns over their actual breadth of inclusion of environmental factors and a related risk of molecularization of public health issues. The emergence of the European Human Exposome Network (EHEN) provides an opportunity to better situate the ambitions and priorities of the exposome approach on the basis of new and ongoing research.

METHODS

We assess the promises, methods, and limitations of the EHEN, as a case study of the second generation of exposome research. A critical textual analysis of profile articles from each of the projects involved in EHEN, published in Environmental Epidemiology, was carried out to derive common priorities, innovations, methodological and conceptual choices across EHEN and to discuss it.

RESULTS

EHEN consolidates its integrative outlook by reinforcing the volume and variety of data, its data analysis infrastructure and by diversifying its strategies to deliver actionable knowledge. Yet data-driven limitations severely restrict the geographical and political scope of this knowledge to health issues primarily related to urban setups, which may aggravate some socio-spatial inequalities in health in Europe.

CONCLUSIONS

The second generation of exposome research doubles down on the initial ambition of an integrative study of the environmental effects of health to fuel better public health interventions. This intensification is, however, accompanied by significant epistemological challenges and doesn't help to overcome severe restrictions in the geographical and political scope of this knowledge. We thus advocate for increased reflexivity over the limitations of this conceptually and methodologically integrative approach to public and environmental health.

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)

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.

Contributions of age groups and causes of death to the sex gap in lifespan variation in Europe

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.

Identification of unhealthy alcohol use by self-report and phosphatidylethanol (PEth) blood concentrations in an acute psychiatric department

BACKGROUND

The use of standard screening methods could improve the detection rate of unhealthy alcohol use in patients admitted to psychiatric acute and emergency departments. The aim of the present study was to investigate the ability of the alcohol biomarker phosphatidylethanol (PEth) to identify patients with high levels of alcohol consumption prior to admission.

METHODS

The data were prospectively collected at admittance to an acute psychiatric department in the period January 2016 to June 2017. A blood sample for the analysis of PEth was available from 177 patients. We compared the PEth concentrations with the Alcohol Use Disorders Identification Test (AUDIT) scores during the hospital stay, and psychiatric diagnoses at discharge.

RESULTS

A total of 45.8% of the patients had a PEth concentration ≥ 0.03 μmol/L, indicating significant alcohol consumption. AUDIT scores consistent with unhealthy alcohol use were present in 51.7%. There was a significant positive correlation between PEth concentrations and AUDIT scores (r = 0.631, p < 0.001). PEth was above the detection limit of 0.03 μmol/L in 19% of those reporting an average daily intake of zero alcohol units per day during the last week before admission. PEth concentrations were significantly higher among those with an alcohol diagnosis than among those without such a diagnosis (0.82 μmol/L vs. 0.09 μmol/L, p = 0.001).

CONCLUSION

PEth provides supplementary information on recent alcohol consumption in a psychiatric population and would be particularly helpful in patients unable or unwilling to give such information at admission.

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

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.

The combined impact of smoking, obesity and alcohol on life-expectancy trends in Europe

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.

Future life expectancy in Europe taking into account the impact of smoking, obesity, and alcohol

Introduction: In Europe, women can expect to live on average 82 years and men 75 years. Forecasting how life expectancy will develop in the future is essential for society. Most forecasts rely on a mechanical extrapolation of past mortality trends, which leads to unreliable outcomes because of temporal fluctuations in the past trends due to lifestyle 'epidemics'. Methods: We project life expectancy for 18 European countries by taking into account the impact of smoking, obesity, and alcohol on mortality, and the mortality experiences of forerunner populations. Results: We project that life expectancy in these 18 countries will increase from, on average, 83.4 years for women and 78.3 years for men in 2014 to 92.8 years for women and 90.5 years for men in 2065. Compared to others (Lee-Carter, Eurostat, United Nations), we project higher future life expectancy values and more realistic differences between countries and sexes. Conclusions: Our results imply longer individual lifespans, and more elderly in society. Funding: Netherlands Organisation for Scientific Research (NWO) (grant no. 452-13-001).

Age, Period and Cohort Effects On Alcohol Consumption In Estonia, 1996-2018

AIMS

To analyse the independent effects of age, period and cohort on estimated daily alcohol consumption in Estonia.

METHODS

This study used data from nationally representative repeated cross-sectional surveys from 1996 to 2018 and included 11,717 men and 16,513 women aged 16-64 years in total. The dependent variables were consumption of total alcohol and consumption by types of beverages (beer, wine and strong liquor) presented as average daily consumption in grams of absolute alcohol. Mixed-effects negative binomial models stratified by sex were used for age-period-cohort analysis.

RESULTS

Alcohol consumption was highest at ages 20-29 years for both men and women and declined in older ages. Significant period effects were found indicating that total alcohol consumption and consumption of different types of beverages had increased significantly since the 1990s for both men and women. Cohort trends differed for men and women. Men born in the 1990-2000s had significantly lower daily consumption compared to earlier cohorts, whereas the opposite was found for women.

CONCLUSION

While age-related patterns of alcohol consumption are aligned with life course stages, alcohol use has increased over the study period. Although the total daily consumption among men is nearly four times higher than among women, the cohort trends suggest convergence of alcohol consumption patterns for men and women.

Future Alcohol-Attributable Mortality in France Using a Novel Generalizable Age-Period-Cohort Projection Methodology

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.

The Role of Smoking in Country Differences in Life Expectancy Across Europe, 1985-2014

INTRODUCTION

Smoking contributes substantially to mortality levels and trends. Its role in country differences in mortality has, however, hardly been quantified. The current study formally assesses the-so far unknown-changing contribution of smoking to country differences in life expectancy at birth (e0) across Europe.

METHODS

Using all-cause mortality data and indirectly estimated smoking-attributable mortality rates by age and sex for 30 European countries from 1985 to 2014, the differences in e0 between each individual European country and the weighted average were decomposed into a smoking- and a nonsmoking-related part.

RESULTS

In 2014, e0 ranged from 70.8 years in Russia to 83.1 years in Switzerland. Men exhibited larger country differences than women (variance of 21.9 and 7.0 years, respectively). Country differences in e0 increased up to 2005 and declined thereafter. Among men, the average contribution of smoking to the country differences in e0 was highest around 1990 (47%) and declined to 35% in 2014. Among women, the average relative contribution of smoking declined from 1991 to 2011, and smoking resulted in smaller differences with the average e0 level in the majority of European countries. For both sexes combined, the contribution of smoking to country differences in e0 was higher than 20% throughout the period.

CONCLUSIONS

Smoking contributed substantially to the country differences in e0 in Europe, their increases up to 1991, and their decreases since 2005, especially among men. Policies that discourage smoking can help to reduce inequalities in mortality levels across Europe in the long run.

IMPLICATIONS

Smoking contributes substantially to country differences in life expectancy at birth (e0) in Europe, particularly among men, for whom the contribution was highest around 1990 (47%) and declined to 35% in 2014. In line with the anticipated progression of the smoking epidemic, the differences between European countries in e0 due to smoking are expected to further decline among men, but to increase among women. The role of smoking in mortality convergence since 2005 illustrates that smoking policies can help to reduce inequalities in life expectancy levels across Europe, particularly when they target smoking in countries with low e0.

Past and Future Alcohol-Attributable Mortality in Europe

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.

Assessing the contribution of alcohol-specific causes to socio-economic inequalities in mortality in England and Wales 2001-16

BACKGROUND AND AIMS

When measuring inequalities in health, public health and addiction research has tended to focus on differences in average life-span between socio-economic groups. This does not account for the extent to which age of death varies between individuals within socio-economic groups or whether this variation differs between groups. This study assesses (1) socio-economic inequalities in both average life-span and variation in age at death, (2) the extent to which these inequalities can be attributed to alcohol-specific causes (i.e. those attributable only to alcohol) and (3) how this contribution has changed over time.

DESIGN

Cause-deleted life table analysis of national mortality records.

SETTING

England and Wales, 2001-16.

CASES

All-cause and alcohol-specific deaths for all adults aged 18+, stratified by sex, age and quintiles of the index of multiple deprivation (IMD).

MEASUREMENTS

Life expectancy at age 18 yearss and standard deviation in age at death within IMD quintiles and the contribution of alcohol to overall differences in both measures between the highest and lowest IMD quintiles by comparing observed and cause-deleted inequality 'gaps'.

FINDINGS

In 2016, alcohol-specific causes reduced life expectancy for men and women by 0.26 and 0.14 years, respectively, and increased the standard deviation in age at death. These causes also increased the inequality gap in life expectancy by 0.33 years for men and 0.17 years for women, and variation in age at death by 0.14 years and 0.13 years, respectively. For both measures, the contribution of alcohol to mortality inequalities rose after 2001 and subsequently fell back. For women, alcohol accounted for 3.6% of inequality in age at death and 6.0% of life-span uncertainty, suggesting that using only the former may underestimate alcohol-induced inequalities. There was no comparable difference for men.

CONCLUSIONS

Deaths from alcohol-specific causes increase inequalities in both life expectancy and variation in age of death between socio-economic groups. Using both measures can provide a fuller picture of overall inequalities in health.

Quantifying the contribution of established risk factors to cardiovascular mortality differences between Russia and Norway

Surprisingly few attempts have been made to quantify the simultaneous contribution of well-established risk factors to CVD mortality differences between countries. We aimed to develop and critically appraise an approach to doing so, applying it to the substantial CVD mortality gap between Russia and Norway using survey data in three cities and mortality risks from the Emerging Risk Factor Collaboration. We estimated the absolute and relative differences in CVD mortality at ages 40-69 years between countries attributable to the risk factors, under the counterfactual that the age- and sex-specific risk factor profile in Russia was as in Norway, and vice-versa. Under the counterfactual that Russia had the Norwegian risk factor profile, the absolute age-standardized CVD mortality gap would decline by 33.3% (95% CI 25.1-40.1) among men and 22.1% (10.4-31.3) among women. In relative terms, the mortality rate ratio (Russia/Norway) would decline from 9-10 to 7-8. Under the counterfactual that Norway had the Russian risk factor profile, the mortality gap reduced less. Well-established CVD risk factors account for a third of the male and around a quarter of the female CVD mortality gap between Russia and Norway. However, these estimates are based on widely held epidemiological assumptions that deserve further scrutiny.

Alcohol control policies in Former Soviet Union countries: A narrative review of three decades of policy changes and their apparent effects

Issues.

The last Soviet anti-alcohol campaign of 1985 resulted in considerably reduced alcohol consumption and saved thousands of lives. But once the campaign’s policies were abandoned and the Soviet alcohol monopoly broken up, a steep rise in mortality was observed in many of the newly formed successor countries, although some kept their monopolies. Almost 30 years after the campaign’s end, the region faces diverse challenges in relation to alcohol.

Approach.

The present narrative review sheds light on recent drinking trends and alcohol policy developments in the 15 Former Soviet Union (FSU) countries, highlighting the most important setbacks, achievements and best practices. Vignettes of alcohol control policies in Belarus, Estonia, Kazakhstan, Lithuania and Uzbekistan are presented to illustrate the recent developments.

Key Findings.

Over the past decade, drinking levels have declined in almost all FSU countries, paralleled by the introduction of various alcohol-control measures. The so-called three ‘best buys’ put forward by the World Health Organization to reduce alcohol-attributable burden (taxation and other measures to increase price, restrictions on alcohol availability and marketing) are relatively well implemented across the countries.

Implications.

In recent years, evidence-based alcohol policies have been actively implemented as a response to the enormous alcohol-attributable burden in many of the countries, although there is big variance across and within different jurisdictions.

Conclusion.

Strong declines in alcohol consumption were observed in the 15 FSU countries, which have introduced various alcohol control measures in recent years, resulting in a reduction of alcohol consumption in the World Health Organization European region overall.

Alcohol and educational inequalities: Hazardous drinking prevalence and all-cause mortality by hazardous drinking group in people aged 50 and older in Europe

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 (PR_medium = 1.09 [95%CI: 0.98-1.21] and PR_high = 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 (PR_medium = 1.28 [95%CI: 1.15-1.42] and PR_high = 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 (RII_hazardous = 1.21 [95%CI: 1.01-1.45]) and women (RII_hazardous = 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.

Spatial patterns of male alcohol-related mortality in Belarus, Lithuania, Poland and Russia

INTRODUCTION AND AIMS

Eastern Europe is known to suffer from a large burden of alcohol-related mortality. However, persisting unfavourable conditions at the national level mask variation at the sub-national level. We aim to explore spatial patterns of cause-specific mortality across four post-communist countries: Belarus, Lithuania, Poland and Russia (European part).

DESIGN AND METHODS

We use official mortality data routinely collected over 1179 districts and cities. The analysis refers to males aged 20-64 years and covers the period 2006-2014. Mortality variation is mainly assessed by means of the standardised mortality ratio. Getis-Ord Gi* statistic is employed to detect hot and cold spots of alcohol-related mortality.

RESULTS

Alcohol-related mortality exhibits a gradient from very high levels in northwestern Russia to low levels in southern Poland. Spatial transitions from higher to lower mortality are not explicitly demarcated by national boundaries. Within these countries, hot spots of alcohol-related mortality dominate the territories of northwestern and western Russia, eastern and northwestern Belarus, southeastern Lithuania, and eastern and central Poland.

DISCUSSION AND CONCLUSIONS

The observed mortality gradient is likely associated with the spread of alcohol epidemics from the European part of Russia to the other countries, which appears to have started more than a century ago. Contemporary socioeconomic and demographic factors should be taken into account when developing anti-alcohol policies. The same is true for the peculiarities of culture, norms, traditions and behavioural patterns observed in specific geographical areas of the four countries. Reducing alcohol-related harm in the areas identified as hot spots should be prioritised.

The changing relation between alcohol and life expectancy in Russia in 1965–2017

Introduction and Aims

Design and Methods

Results

Discussion and Conclusions

Impact of obesity on life expectancy among different European countries: secondary analysis of population-level data over the 1975-2012 period

OBJECTIVE

This study assesses the impact of obesity on life expectancy for 26 European national populations and the USA over the 1975-2012 period.

DESIGN

Secondary analysis of population-level obesity and mortality data.

SETTING

European countries, namely Austria, Belarus, Belgium, the Czech Republic, Denmark, Estonia, Finland, France, Hungary, Iceland, Ireland, Italy, Latvia, Lithuania, Luxembourg, the Netherlands, Norway, Poland, Portugal, the Russian Federation, Slovakia, Spain, Sweden, Switzerland, Ukraine and the UK; and the USA.

PARTICIPANTS

National populations aged 18-100 years, by sex.

MEASUREMENTS

Using data by age and sex, we calculated obesity-attributable mortality by multiplying all-cause mortality (Human Mortality Database) with obesity-attributable mortality fractions (OAMFs). OAMFs were obtained by applying the weighted sum method to obesity prevalence data (non-communicable diseases (NCD) Risk Factor Collaboration) and European relative risks (Dynamic Modeling for Health Impact Assessment (DYNAMO- HIA)). We estimated potential gains in life expectancy (PGLE) at birth by eliminating obesity-attributable mortality from all-cause mortality using associated single-decrement life tables.

RESULTS

In the 26 European countries in 2012, PGLE due to obesity ranged from 0.86 to 1.67 years among men, and from 0.66 to 1.54 years among women. In all countries, PGLE increased over time, with an average annual increase of 2.68% among men and 1.33% among women. Among women in Denmark, Switzerland, and Central and Eastern European countries, the increase in PGLE levelled off after 1995. Without obesity, the average increase in life expectancy between 1975 and 2012 would have been 0.78 years higher among men and 0.30 years higher among women.

CONCLUSIONS

Obesity was proven to have an impact on both life expectancy levels and trends in Europe. The differences found in this impact between countries and the sexes can be linked to contextual factors, as well as to differences in people's ability and capacity to adopt healthier lifestyles.

Lifespan Dispersion in Times of Life Expectancy Fluctuation: The Case of Central and Eastern Europe

Central and Eastern Europe (CEE) have experienced considerable instability in mortality since the 1960s. Long periods of stagnating life expectancy were followed by rapid increases in life expectancy and, in some cases, even more rapid declines, before more recent periods of improvement. These trends have been well documented, but to date, no study has comprehensively explored trends in lifespan variation. We improved such analyses by incorporating life disparity as a health indicator alongside life expectancy, examining trends since the 1960s for 12 countries from the region. Generally, life disparity was high and fluctuated strongly over the period. For nearly 30 of these years, life expectancy and life disparity varied independently of each other, largely because mortality trends ran in opposite directions over different ages. Furthermore, we quantified the impact of large classes of diseases on life disparity trends since 1994 using a newly harmonized cause-of-death time series for eight countries in the region. Mortality patterns in CEE countries were heterogeneous and ran counter to the common patterns observed in most developed countries. They contribute to the discussion about life expectancy disparity by showing that expansion/compression levels do not necessarily mean lower/higher life expectancy or mortality deterioration/improvements.

Mortality and life expectancy forecast for (comparatively) high mortality countries

Background

The Lee–Carter method and its later variants are widely accepted extrapolative methods for forecasting mortality and life expectancy in industrial countries due to their simplicity and availability of high quality long time series data.

Objective

We compared and contrasted mortality forecasting models for higher mortality regimes that lack long time series data of good quality, which is common in several Central and Eastern European (CEE) countries.

Data and methods

We utilized seven different variants of the Lee–Carter method and coherent mortality forecasts of various CEE countries, and the Bayesian Hierarchical Model used by the United Nations to produce probabilistic forecasts. The data of nine CEE countries with comparatively higher mortality have been considered.

Results

The performance of the forecasting models for the nine CEE countries was found to be lower than that observed for low-mortality countries. No model gives uniquely best performance for all the nine CEE countries. Most of the LC variants produced lower forecasts of life expectancies than current life expectancy values for Belarus, Russia, and Ukraine. A coherent mortality forecast could not overcome the limitations of single population forecasting techniques due to increasing mortality differences between these countries over the fitting period (mortality divergence). In the same context, the use of the probabilistic forecasting technique from the Bayesian framework resulted in a better forecast than some of the extrapolative methods but also produced a wider prediction interval for several countries. The more detailed analysis for Hungary indicates that a better fit of certain forecasting methods may occur in the later part of the life span rather than the whole life span.

Conclusion

These findings imply the necessity of inventing a new forecasting technique for high-mortality countries.

Comparison of different approaches for estimating age-specific alcohol-attributable mortality: The cases of France and Finland

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.