The prevalence of alcohol-related mortality in both sexes: variation between indicators, Stockholm, 1987

Trends in Premature Deaths From Alcoholic Liver Disease in the U.S., 1999-2018

INTRODUCTION

So-called deaths of despair-those involving drug overdoses, alcohol-related liver disease, and suicide-have been rising in the U.S. among middle-aged white, non-Hispanic adults without a college degree. Premature deaths (ages 25-69) from alcoholic liver disease were examined specifically in this study from 1999 to 2018, by sex, race/Hispanic origin, and age group.

METHODS

Data were drawn from the 1999-2018 Multiple Cause of Death database and bridged-race estimates of the U.S. resident population, including 281,243 alcoholic liver disease deaths or an average of 8 deaths per 100,000 population. Analyses examined alcoholic liver disease death rates for sex differences among 3 age groups (25-49, 50-59, and 60-69 years), by race and Hispanic origin, from 1999 to 2018; age-adjusted and age-specific annual percentage changes (accounted for cohorts); years of potential life lost; and age of death for sociodemographic backgrounds, alcoholic liver disease clinical courses, and comortalities.

RESULTS

White non-Hispanics increasingly experienced greater alcoholic liver disease mortality than black non-Hispanics and Hispanics, confirming the racial and ethnic crossover observed in previous studies. Although men consistently had higher rates of mortality, male-to-female ratios decreased in the past 2 decades and were the lowest among ages 25-49 years and especially among ages 25-34 years. Although women generally had longer life expectancies, women died of alcoholic liver disease on average about 2-3 years earlier than men.

CONCLUSIONS

Prevention and intervention efforts are imperative to address the narrowing sex gap and widening racial disparities in alcoholic liver disease premature deaths.

Using Death Certificates to Explore Changes in Alcohol-Related Mortality in the United States, 1999 to 2017

BACKGROUND

Alcohol consumption, alcohol-related emergency department visits, and hospitalizations have all increased in the last 2 decades, particularly among women and people middle-aged and older. The purpose of this study was to explore data from death certificates to assess whether parallel changes in alcohol-related mortality occurred in the United States in recent years.

METHODS

U.S. mortality data from the National Center for Health Statistics were analyzed to estimate the annual number and rate of alcohol-related deaths by age, sex, race, and ethnicity between 1999 and 2017 among people aged 16+. Mortality data contained details from all death certificates filed nationally. For each death, an underlying cause and up to 20 multiple or contributing causes were indicated. Deaths were identified as alcohol-related if an alcohol-induced cause was listed as either an underlying or multiple cause. Joinpoint analyses were performed to assess temporal trends.

RESULTS

The number of alcohol-related deaths per year among people aged 16+ doubled from 35,914 to 72,558, and the rate increased 50.9% from 16.9 to 25.5 per 100,000. Nearly 1 million alcohol-related deaths (944,880) were recorded between 1999 and 2017. In 2017, 2.6% of roughly 2.8 million deaths in the United States involved alcohol. Nearly half of alcohol-related deaths resulted from liver disease (30.7%; 22,245) or overdoses on alcohol alone or with other drugs (17.9%; 12,954). Rates of alcohol-related deaths were highest among males, people in age-groups spanning 45 to 74 years, and among non-Hispanic (NH) American Indians or Alaska Natives. Rates increased for all age-groups except 16 to 20 and 75+ and for all racial and ethnic groups except for initial decreases among Hispanic males and NH Blacks followed by increases. The largest annual increase occurred among NH White females. Rates of acute alcohol-related deaths increased more for people aged 55 to 64, but rates of chronic alcohol-related deaths, which accounted for the majority of alcohol-related deaths, increased more for younger adults aged 25 to 34.

CONCLUSIONS

Death certificates suggest that alcohol-related mortality increased in the United States between 1999 and 2017. Given previous reports that death certificates often fail to indicate the contribution of alcohol, the scope of alcohol-related mortality in the United States is likely higher than suggested from death certificates alone. Findings confirm an increasing burden of alcohol on public health and support the need for improving surveillance of alcohol-involved mortality.

Opportunities to Prevent Alcoholic Liver Cirrhosis in High-Risk Populations: A Systematic Review With Meta-Analysis

BACKGROUND

Alcoholic liver cirrhosis is preventable and caused by heavy drinking. Few in the general population may be at risk and interventions targeting individuals at high risk may be a more feasible opportunity for prevention than interventions targeting the whole population.

METHODS

We conducted a systematic review to identify opportunities to prevent alcoholic liver cirrhosis in high-risk populations. Following MOOSE guidelines, we included observational studies published between 1980 and 2017. Prospective studies of alcohol-problem cohorts were included to investigate whether alcohol-problem cohorts qualify as high-risk populations for alcoholic liver cirrhosis. Studies on the alcohol amount consumed by alcoholic liver cirrhosis patients were included to compare with the amount consumed by the general population. Moreover, studies on alcohol-related healthcare contacts prior to alcoholic liver cirrhosis diagnosis were included to identify opportunities to offer prevention interventions. Of 7198 screened references, 38 studies (N = 120,928) were included.

RESULTS

Alcohol-problem cohorts qualified as high-risk populations with an incidence of alcoholic liver cirrhosis ranging from 7 to 16% after 8-12 years. The alcohol amount consumed by alcoholic liver cirrhosis patients was high compared to the general population. For example, 45% (95%CI 34, 56) of alcoholic liver cirrhosis patients were drinking >110 g alcohol/day. Finally, there were opportunities to reach alcoholic liver cirrhosis patients prior to diagnosis; 40-61% of alcoholic liver cirrhosis patients had a previous alcohol-related healthcare contact.

CONCLUSIONS

We conclude that alcohol-problem cohorts are high-risk populations for alcoholic liver cirrhosis and there seems to be opportunities to reach later alcoholic liver cirrhosis cases with preventive interventions in healthcare settings.

Variations in Alcohol-Related Mortality in the Nordic Countries after 1995—Continuity or Change?

Aims

The main aim of the present paper was to describe and analyse the recent development regarding differences in alcohol-related mortality between the Nordic countries. To what extent do various forms of alcohol-related mortality differ between the Nordic countries, and is a similar cross-national pattern found for men and women? Do differences in mortality rates correspond to variations in levels of alcohol consumption, and have any changes occurred with respect to these variations?

Data

Age-adjusted mortality from alcohol-specific causes, liver cirrhosis, alcohol poisonings and fatal accidents were compared between countries and in relation to recorded per capita consumption for two approximate time periods, 1995–1999 and 2000–2004 R2 was used to evaluate the extent to which differences in per capita consumption accounted for the mortality differences.

Results

Finland and Denmark had typically 2–5 times higher chronic alcohol-related mortality, e.g., cirrhosis, than Sweden, Norway and Iceland, whereas for acute mortality only Finland, and particularly Finnish men, stood out with high mortality rates, e.g., alcohol poisonings. Danish women tended to have higher or more similar mortality in relation to Finnish women in cases when this is not true for men. Differences in per capita consumption accounted for a significant part of variations in chronic alcohol mortality but to a lesser extent for variations in alcohol poisonings and fatal accidents. No marked changes in country differences occurred during the study period.

Conclusion

The results agree with the main prediction of the total consumption model, namely that the level of drinking is an important determinant of alcohol-related harm in society in particular for long-term negative consequences. The findings also suggest that comparisons of alcohol mortality should be gender-specific since the country differences may be different for men and women. The extent to which differences in alcohol policy may influence these national differences is also discussed.

Do Substance Use and Delinquency have Differential Associations with Adolescents’ Peer Relations?

Despite their potentially serious short- and long-term risks, developmental theorists have argued that risk behaviours may play important constructive roles in adolescent development. The present study hypothesised that adolescent substance use, but not delinquency, would be associated with positive peer relations. Subjects were 491 German adolescents participating in the Bielefeld Longitudinal Youth Survey who completed questionnaires during grades 7, 8, 9, and 10. Measures were adolescents’ self-reported substance use (alcohol, tobacco), delinquency (antisocial acts), and peer relations (peer involvement frequency, perceived peer group closeness, perceived position in the peer group, having a boy- or girlfriend). Repeated measures analyses of variance examined gender and school type differences in risk behaviour and peer relations across four occasions. Within-time, peer relations were positively related to substance use and, in a few cases, positively related to delinquency. As hypothesised, substance use predicted increases in the frequency and intensity of peer relations, but delinquency did not do so consistently. The pattern of results did not differ by gender or school type. The discussion focuses on the meaning of risky behaviours and differences between substance use and delinquency, and argues that prevention efforts must take seriously the positive functions served by risk behaviours.

State variation in underreporting of alcohol involvement on death certificates: motor vehicle traffic crash fatalities as an example

OBJECTIVE

We used motor vehicle traffic (MVT) crash fatalities as an example to examine the extent of underreporting of alcohol involvement on death certificates and state variations.

METHOD

We compared MVT-related death certificates identified from national mortality data (Multiple Cause of Death [MCoD] data) with deaths in national traffic census data from the Fatality Analysis Reporting System (FARS). Because MCoD data were not individually linked to FARS data, the comparisons were at the aggregate level. Reporting ratio of alcohol involvement on death certificates was thus computed as the prevalence of any mention of alcohol-related conditions among MVT deaths in MCoD, divided by the prevalence of decedents with blood alcohol concentration (BAC) test results (not imputed) of .08% or greater in FARS. Through bivariate analysis and multiple regression, we explored state characteristics correlated with state reporting ratios.

RESULTS

Both MCoD and FARS identified about 450,000 MVT deaths in 1999-2009. Reporting ratio was only 0.16 for all traffic deaths and 0.18 for driver deaths nationally, reflecting that death certificates captured only a small percentage of MVT deaths involving BAC of .08% or more. Reporting ratio did not improve over time, even though FARS indicated that the prevalence of BAC of at least .08% in MVT deaths increased from 19.9% in 1999 to 24.2% in 2009. State reporting ratios varied widely, from 0.02 (Nevada and New Jersey) to 0.81 (Delaware).

CONCLUSIONS

The comparison of MCoD with FARS revealed a large discrepancy in reporting alcohol involvement in MVT deaths and considerable state variation in the magnitude of underreporting. We suspect similar underreporting and state variations in alcohol involvement in other types of injury deaths.

Mortality in alcohol use disorder in the Lundby Community Cohort--a 50 year follow-up

AIMS

To describe the mortality and causes of death among subjects with alcohol use disorder in comparison with those without alcohol disorder and to study whether mental disorders increase mortality in alcoholics.

DESIGN AND SETTING

Data were analysed from the database of the Lundby Study, comprising 3563 subjects followed from 1947 to 1997.

METHOD

A community-based sample was investigated in 1947 with follow-ups in 1957, 1972 and 1997. Best-estimate consensus diagnoses of mental disorders, including alcohol use disorder, were assessed. In the total cohort, 427 cases of alcohol use disorders were identified. Differences in mortality between subjects with alcohol use disorders and non-alcoholics were studied using Cox regression models and causes of death were compared between alcoholic subjects and other participants. Risk factors for mortality among the 348 individuals with alcohol use disorders and known age-of-onset were analysed by means of Cox regression analyses.

RESULTS

The hazard ratio for mortality was higher for alcoholics compared to other subjects in the cohort. A substantial proportion of the causes of death among the alcoholics was suicide N=27 (6.3%) (26 males, 1 female). In the multivariate models of risk factors in alcohol use disorders, anxiety disorders, psychotic disorders, alcohol induced psychotic disorders and dementia were risk factors for premature death.

CONCLUSION

The mortality risk for subjects with alcohol use disorder was increased, females were especially vulnerable. The risk for suicide was high among males with alcohol problems. Anxiety disorders and severity of alcohol use disorder turned out as risk factors for premature death.

Severity of alcohol-related problems and mortality: results from a 20-year prospective epidemiological community study

There is evidence that high alcohol use is associated with an increase in mortality. Little is known about long-term effects of problematic alcohol consumption in non-clinical (community) populations. The aim of our study was to obtain data on this and related issues in a representative rural community sample assessed longitudinally over a period of 20 years. Assessments focused on a baseline survey from 1980 to 1984 and 20-year follow-up from 2001 to 2004. Based on expert interviews and standardized self-rating scales (e.g. MALT; Munich Alcoholism Test), the following three groups were defined (a) severe alcohol problems, (b) moderate alcohol problems, and (c) no alcohol problems. Mortality and hazard rates were analyzed with logistic and Cox regression adjusted for several health risk factors. From an original community sample of 1,465 individuals, 448 were deceased at 20-year follow-up. Participation rates were high. Baseline prevalence according to the MALT was 1.6% for severe alcohol problems and 4.0% for moderate alcohol problems. Over the 20-year time span, individuals with severe alcohol problems had a significantly elevated risk for dying earlier than the group with no alcohol problems (2.4 times higher). Mortality for those with moderate alcohol problems at baseline had a non-significantly elevated 20-year mortality risk (1.5 times higher) compared to those with no alcohol problems. Cox survival analyses corroborate these findings from multiple sequential logistic regression analyses. In discussing the mortality risk of persons with alcohol problems, the severity of the alcohol problems must be taken into account.

Quantifying alcohol-related mortality: should alcohol-related contributory causes of death be included?

AIMS

The aim of the study was to assess whether alcohol-related mortality data in the UK should be extended to include contributory as well as underlying cause of death.

METHODS

A total of 101,320 deaths registered in Northern Ireland between 2001 and 2007 were analysed to determine the quantity and characteristics of those with an underlying or contributory alcohol-related cause of death.

RESULTS

Alcohol was found to be an underlying cause of death in 1690 cases (1.7% of deaths) and a contributory cause in a further 1105 cases. Analyses show that the addition of alcohol-related contributory causes of deaths would increase the male-female ratio, result in steeper socio-economic gradients and amplify the apparent rate of increase of alcohol-related deaths. The significant contribution of alcohol to external causes of death, such as accidents and suicide, is also more evident.

CONCLUSIONS

Using only underlying cause of death undoubtedly underestimates the burden of alcohol-related harm and may provide an inaccurate picture of those most likely to suffer from an alcohol-related death, especially among younger men.

Mortality risk up to 25 years after initiation of treatment among 420 Swedish women with alcohol addiction

AIMS

Women treated for alcohol addiction have mortality rates three to five times those of women from the general population (GP). However, these figures may be inflated because socially disadvantaged women with advanced drinking careers are over-represented in previous studies. Our aim was to study the long-term mortality of socially relatively well-functioning patients coming to their first treatment, compared to matched GP controls.

DESIGN

The mortality rates and causes of death were compared between patients and their matched GP controls, using data from the Causes of Death Register throughout the follow-up period (0-25 years).

SETTING

A specialized treatment programme for women only, called 'Early treatment for Women with Alcohol Addiction' (EWA) at the Karolinska Hospital, Stockholm, Sweden.

PARTICIPANTS

Subjects (n = 420) receiving their first treatment at the EWA programme, compared to a group of matched GP women (n = 2037).

FINDINGS

The women patients had significantly higher mortality than matched GP controls throughout the whole follow-up period, with a relative risk of 2.4. However, the younger women had four times higher mortality than their matched controls. The peak of deaths occurred during the first 5 years, and alcohol-related causes of death were highly over-represented, as were uncertain suicides and accidents.

CONCLUSIONS

First-time-treated women with alcohol addiction have a substantially lower mortality than reported previously from clinical samples, except for the youngest group. Our figures were corrected for confounding factors such as socio-demographic status. We believe our results could apply to broader groups of heavy drinking women, inside or outside specialized treatment settings.

Gender differences in role of alcohol in fatal injury events

BACKGROUND

The aim was to investigate the differences in alcohol involvement in fatal injury events between females and males.

METHODS

Information was obtained from the Forensic Medicine Database and the Forensic Toxicology Database of the National Board of Forensic Medicine, and from the inpatient register of the National Board of Health and Welfare. Alcohol was regarded to be involved in the injury event: if there was any indication that the deceased was a 'known alcoholic'; if the underlying or contributing causes of death were alcohol-related; if the deceased had alcohol-related inpatient diagnosis during a 3-year period prior to death; or if the deceased tested positive for blood alcohol at autopsy. All injured cases who underwent medico-legal autopsies (1992-1996) in Sweden were analysed (4471 females and 11 156 males).

RESULTS

Compared to males, females died more often (P < 0.05) in intentional injury events (48.0% females, 44.2% males), were less often (P < 0.001) blood alcohol-positive (29% females, 43% males), had lower (P < 0.05) blood alcohol concentrations (0.17% in females, 0.18% in males), and were less likely (P < 0.001) to have an alcohol-related history (18.4% females, 24.4% males). For females, intentional deaths (31.4%) were significantly (P < 0.001) more often alcohol-related than unintentional deaths (22.9%). A significantly (P < 0.001) higher proportion of deaths in males (48.4%) were alcohol-related compared to females (32.9%).

CONCLUSIONS

Almost every third injury event in females and in almost every other event in males is alcohol-related, showing that alcohol plays an important part in fatal injuries in females even though it is mostly a male problem.

[Evolution of the mortality attributable to alcohol consumption in Catalonia, 1988-1997]

OBJECTIVE

To analyse the evolution of mortality attributable to alcohol (MAA) and the potential years of life lost (PYLL) due to alcohol consumption in Catalonia between 1988 and 1997.

DESIGN

Retrospective, descriptive study of mortality.

SETTING

Catalonia 1988-1997.

PARTICIPANTS

Residents in Catalonia. Main measurements. Deaths occurring in Catalonia for the 36 causes of MAA between 1988 and 1997 were studied. The MAA, proportional mortality and the PYLL for each year were calculated on the basis of the population fractions attributable to alcohol (FPAA). Evolution of proportional mortality was studied with the chi2 test for linear trends. Evolution of the MAA and the PYLL were studied through regression straights and Pearson s correlation coefficient.

RESULTS

5.5% of deaths in Catalonia between 1988 and 1997 were attributable to alcohol. Men contributed most deaths (65.8%) and PYLL (80%). Traffic accidents were the most common form of death in men (15.3%), and cerebro-vascular diseases (25.9%) in women. Traffic accidents caused most PYLL (43.3%). Both a steady reduction in proportional mortality, dropping from 6.2% in 1988 to 4.8% in 1997 (chi2=213.4; P<.00001), and a fall in the total MAA (P<.05) and PYLL (P<.05) were found.

CONCLUSIONS

There are gender differences in the numbers and most common causes of MAA. There was a steady drop in the number of MAA and PYLL during the period studied, basically due to the drop in deaths caused by traffic accidents. Similarly, proportional mortality dropped, drawing close to the 4% proposed in the Health Plan for Catalonia.

Prevention of alcohol-related deaths in middle-aged heavy drinkers

BACKGROUND

Alcohol as a cause of death in middle-aged patients is well-known from clinical studies. A similarly important correlation in the general population of urban middle-aged men is highly underestimated. Health screening investigations have shown that mortality related to alcohol is five times more common in nonparticipants than in participants. From the mid-70s, the Malmoe Screening and Intervention Study (MSIS) commenced screening investigations including a large number of residents of Malmoe. One goal was to find intervention programs for individuals in an early development of problem drinking, thereby preventing development of serious complications of endstage alcoholism. Herein, we report on the mortality of heavy drinkers (drinking more than 40 g alcohol/day) who were randomized to an intervention or control procedure and whose median survival was 13 years postentry into the MSIS.

METHODS

Health-screened men, aged 45-49 years at the initial screening examination and displaying serum gamma-glutamyltransferase (GT) in the top decentile of the GT distribution, were included. A total of 978 out of 11,257 participants met this criteria. A randomized intervention and control study was performed for four years and consisted of men (n = 667) who were born between 1927-1937 and who had two consecutive high GT values within 3 weeks along with heavy alcohol consumption. Half the individuals were informed of the test results and invited for further assessment by a senior physician (n = 365). The principles for brief intervention (DiClemente et al.,1991; Miller and Sanchez, 1993; National Institute of Alcohol Abuse and Alcoholism, 1999) were applied. The other half of the men (n = 302) were left with the information that they had a high GT value and were followed up with laboratory checkups every 2nd year. Mortality was followed up until 1991 and information on deaths was obtained from hospital and police records, necropsy reports, and death certificates.

RESULTS

Long-term follow-up of mortality for 10-16 years (median, 13 years) showed that 124 of the 978 men had died (12.7%). Autopsy was performed in 96.5% of the cases. In 59 men (48%), death was alcohol-related. In the intervention group (n = 365), 38 (10.4%) men were dead and in the control group (n = 302), 42 (13.9%) men had died. There was a statistically significant difference (p = 0.026), with advantage for treatment. Less alcohol-related deaths and deaths occurring later during follow-up were found in the intervention group compared with the control group. The difference between the groups in total mortality, coronary heart disease, and cancer death was not statistically significant.

CONCLUSIONS

These findings support previous results from the MSIS study indicating that long-term intervention in urban males with alcohol-induced GT increases may be beneficial in terms of survival.

Excess alcohol consumption and health outcomes: a 6-year follow-up of men over age 50 from the health and retirement study

AIMS

This study examined the association of problem drinking history and alcohol consumption with the onset of several health conditions and death over a 6-year follow-up period.

SETTING

We analyzed two waves of longitudinal data on men over 50 who participated in the Health and Retirement Study, a nationally representative sample of people aged 51-61 and their spouses living in the United States in 1992.

MEASUREMENTS

Five types of health outcomes--mortality, general health, functional status, cognitive status, and mental health--were examined. Drinking categories were based on average drinks per day (0, <1, 1-2, 3-4, 5+), with 5 + defined as 'very heavy drinking'. Problem drinking history was identified as 2+ affirmative responses to the CAGE questionnaire. We controlled for smoking and other factors at baseline.

FINDINGS

Over the 6-year follow-up period, very heavy drinking at baseline quadrupled the risk of developing functional impairments (OR: 4.21 95%, CI: 1.67, 10.61). A problem drinking history increased the onset of depression (OR: 1.67 95% CI: 1.02, 2.74), psychiatric problems (OR: 2.15 95% CI: 1.47, 3.13) and memory problems (OR: 1.71 95% CI: 1.14, 2.56). Heavy drinking among mature adults was not associated with increased incidence of other adverse health events (i.e. angina, cancer, congestive heart failure, diabetes, myocardial infraction, lung disease or stroke).

CONCLUSION

Very heavy drinking and a problem drinking history greatly increased rates of onset of functional impairments, psychiatric problems and memory loss in late middle age for men who had not experienced these impairments at their initial interview.

Alcohol-Related Mortality in Europe: A Tentative Analysis from the EU Project "Alcohol Consumption and Alcohol Problems among Women in European Countries"

Mortality data were collected for eight of the nine study countries in the BIOMED-II concerted action "Alcohol Consumption and Alcohol Problems among Women in European Countries": Finland, France, Germany, Italy, The Netherlands, the United Kingdom (Scotland), Sweden, and Switzerland. An analysis of mortality that is limited to causes of death that are fully attributable to alcohol (DAA) results in a large underestimation of alcohol-related mortality (ARM) rates in all study countries and especially among females. These estimates can be improved by including an analysis of selected causes of death that are indirectly attributable to alcohol. This produces geographic and time-trend variability of ARM rates that are more congruent with alcohol drinking levels and trends. From this study, it is evident that when German data are analyzed separately for the former German Democratic Republic (GDR) and the former Federal Republic of Germany (FRG), two distinct ARM patterns result. The authors underline methodologic limits of this study and recommend procedures for a more reliable calculation of European ARM estimates

Alcohol in a series of medico-legally autopsied deaths in northern Norway 1973-1992

It is well established that use of alcohol increases the risk of fatal injuries. The presence of blood alcohol in autopsied deaths is regularly encountered in medico-legal practices. The aim of this study was to investigate the prevalence and concentration of alcohol in 1539 medico-legal autopsies in two counties in northern Norway in the period 1973-1992, and the reporting of acute alcohol influence among these deaths to the official cause-of-death statistics. Blood alcohol concentration (BAC) >/=0.5 per thousand (50 mg/100 ml) was found in 47.6% (n=456) of violent deaths tested, and in 93% (n=426) of these the BAC was >/=1.0 per thousand. In 17.4% (n=55) of tested natural deaths the BAC was >/=0.5 per thousand. Acute alcohol-influenced violent deaths were under-reported to the cause-of-death statistics. Deaths by motor vehicle traffic accidents did not differ from other violent deaths in this respect. The under-reporting among violent deaths was 41% in cases with BAC >/=0. 5 per thousand and 37% where the BAC was >/=1.0 per thousand during the whole period. It is concluded that post-mortem BAC >/=0.5 per thousand, should be regarded as a possible contributory cause in all violent deaths, and reported accordingly.

Alcohol consumption and disability pension among middle-aged men

PURPOSE

To analyze the relation between alcohol consumption and the risk of disability pension among middle-aged men.

METHODS

In the mid-seventies, complete birth-year cohorts of middle-aged male residents in Malmö, Sweden, were invited to participate in a general health survey. The 3751 men with complete data who constituted the cohort in this study were followed for 11 years. Alcohol consumption was estimated from the scores obtained from a test designed to identify subjects with alcohol related problems.

RESULTS

Of the 498 men granted disability pension during follow-up, 48 stated to be teetotalers. The cumulative incidence of disability pension among teetotalers was 19%, whereas, it was 12% and 16%, respectively, among men with low and high alcohol consumption. The adjusted relative risk (RR) for acquiring a disability pension (using the group with low alcohol consumption as reference) was 1.8 among abstainers and 1.3 among men with high alcohol consumption.

CONCLUSIONS

Alcohol overconsumption, as well as teetotalism, showed a positive relation to disability pension, and a moderate alcohol intake was found to be beneficial with respect to the risk of future disability pension.

High alcohol-related premature mortality in France: concordant estimates from a prospective cohort study and national mortality statistics

This study examines the magnitude of alcohol-related premature death in the French population, which still has the highest average alcohol intake in the world and a relatively low coronary heart disease mortality rate. Two data sources were used: the national mortality data in 1990 and a prospective mortality experience in a cohort of 2,687 middle-aged working men examined in 1980-1985 and followed-up during an average of 9.3 years. In the general population study, alcohol-related premature mortality (35-64 years) was calculated using alcohol-attributable fractions (AAFs) derived from studies of alcohol involvement in deaths from various causes. In the cohort, it was estimated from AAFs and attributable risk using both alcohol exposure prevalence and relative risks of death according to alcohol intake categories. In 1990, estimates of 19.1% and 13.0% of all premature deaths in French men and women were attributed to alcohol. Digestive diseases followed by malignant neoplasms in men and by unintentional injuries in women were major contributors to the total number of alcohol-related premature deaths. In the cohort study, 90 deaths occurred during the follow-up period. The estimation of alcohol-related premature mortality using AAFs was 24.4%. The relative risk of total mortality (adjusted for age, smoking habits, and body mass index) for men who consumed > 60 ml/day of alcohol, compared with those who consumed 0-25 ml/day was 1.9 (95% confidence interval: 1.1-3.5). The consumption of 26-60 ml/day was not associated with reduced risk of mortality, and the adjusted relative risk for this group was 1.3 (95% confidence interval: 0.7-2.5). The estimated attributable risk of premature mortality caused by consumption of > 25 ml/day of alcohol was 29.9%. This study reports the persisting high alcohol-related premature mortality in the French general population, as well as in middle-aged working men. The results suggest that efforts should be paid to reduce further the consumption of alcohol in France.

Ischemic heart disease and epilepsy: two major causes of out-hospital natural death in male alcoholics

The objectives of this research were to study the distribution of in- and out-hospital deaths and causes of death in male alcoholics and in particular to analyze obscure cases. In a population-based sample of 1123 men treated in one detoxification unit during 1986-1989, 97 patients with alcohol dependence (DSM-III-R) died < or = 1 year after in-hospital detoxification. In each case, the cause and the manner of death were assessed by scrutiny of information in hospital and autopsy records, toxicological examinations, and police reports. The results were that 71 of the 97 men died outside hospital. The overall autopsy rate was 89%. Ischemic heart disease accounted for 18 out of 41 evaluable natural out-hospital deaths. Epileptic seizures were judged to be the cause of death in five cases and could also have contributed to seven out of eight obscure out-hospital deaths. Ethanol in blood or urine was detected in 19 of the 23 deaths attributed to trauma or intoxication, whereas only four out of the 18 out-hospital deaths from ischemic heart disease were ethanol-positive. It was concluded that early detection and adequate treatment of ischemic heart disease and epilepsy might improve prognosis in patients with alcohol dependence. The use of clinical information could be of crucial importance in evaluating possible causes of death, especially in obscure cases.