Public health successes and missed opportunities

Public health successes and missed opportunities
Fig. 71. Trends in age-standardized adult mortality due to alcohol-attributable intentional injury for Armenia,
Azerbaijan, Georgia, Kazakhstan, Kyrgyzstan, Tajikistan, Turkey, Turkmenistan and Uzbekistan, 1990–2014
200
Armenia
Azerbaijan
Georgia
Rate per million
150
100
50
Kazakhstan
Kyrgyzstan
Tajikistan
Turkey
Turkmenistan
Uzbekistan
WHO
European Region
0
1990
1992
1994
1996
1998
2000
2002
2004
2006
2008
2010
2012
2014
WHO Euro
Regional differences in alcohol-attributable mortality
Uzbekistan
OVERALL TREND IN ALCOHOL-ATTRIBUTABLE MORTALITY BETWEEN 1990 AND 2014 BY MAJOR
CAUSE-OF-DEATH CATEGORIES
Turkey
Fig. 72 gives an overview of the age-standardized alcohol-attributable mortality rates per million by major categories
of cause of death at the beginning and the end of the observation period, i.e. 1990 and 2014. For the WHO European
Region as a whole, there was higher alcohol-attributable mortality in 2014 than in 1990 (+4%), even though the overall
consumption decreased slightly over this time period (see Fig. 10). The increase in attributable mortality burden was
mainly driven by the mortality trends in the eastern WHO European Region (+22%) and in the south-eastern part of
the WHO European Region (+65%, albeit from a relatively low level in 1990). On the other hand, alcohol consumption
decreased in more affluent countries such as most parts of the EU, more in the Mediterranean (–27%) and the centralwestern
(–25%) than in the central-eastern regions (–15%).
The increase in the burden of alcohol-attributable mortality in the WHO European Region, despite a small decrease in
overall per capita consumption, is due to a number of reasons: first and foremost, the exponential increase in mortality risk
for many cause-of-death categories with increasing levels of average consumption (159–161), which led to a substantial
increase in alcohol-attributable mortality, especially in regions where already high consumption levels per drinker further
increased (see the eastern WHO European Region in Fig. 13 and 14). Second and related to this, heavy drinking occasions
have a specific detrimental effect on cardiovascular and injury mortality, over and above the level of drinking (see also
next paragraph). Finally, the Russian Federation and surrounding countries can be characterized by an overall raised
adult mortality rate and low life expectancy (141,162), which had even led to a separate mortality stratum in the WHO
classification (163,164).
The decrease in alcohol-attributable mortality in the central-eastern EU countries was due to an overall decline in mortality
rates in this region (141,162). Even with stable alcohol-attributable fractions or slightly increasing alcohol-attributable
fractions, such a decline results in lower standardized rates.
50