Public health successes and missed opportunities

More documents

Recommendations

Info

Burden of alcohol-attributable mortality in the WHO European Region, 1990–2014 Fig. 72. Comparisons of age-standardized alcohol-attributable mortality for major causes of death, 1990 vs 2014, in the WHO European Region and selected subregions Central-eastern EU 1990 Central-eastern EU 2014 Eastern WHO European Region 1990 Eastern WHO European Region 2014 Central-western EU 1990 Central-western EU 2014 South-eastern WHO European Region 1990 South-eastern WHO European Region 2014 liver cirrhosis cancer CVD unintentional injury intentional injury Mediterranean 1990 Mediterranean 2014 WHO European Region 1990 WHO European Region 2014 0 200 400 600 800 1000 1200 1400 1600 Rate per million In terms of composition of causes of alcohol-attributable death (see Fig. 72), as indicated before, mortality rates due to cancer seem to be relatively stable. This is not surprising, given the considerable and varying lag time of two decades, especially of cancer sites where acetaldehyde plays a key role (165–168). While alcohol consumption plays an important part in cancer mortality, any change in alcohol consumption and thus also the potential effects of alcohol policy measures, will be evident in the long term, as could be seen from the major short-term policy changes such as the Gorbachev-era anti-alcohol campaign, which had no effect on cancer rates (169,170). Mortality due to liver cirrhosis moves predictably and almost instantly with changes in consumption (90), and is a good indicator of harmful drinking in a society (171,172) and thus is relevant for policy (156). However, if liver cirrhosis is to be used for monitoring harm or alcohol use, the impact of hepatitis B and C infections have to be taken into account as well (173), and the indicator should reflect the net impact of alcohol. The main drivers of marked changes in the burden of alcohol-attributable mortality in the WHO European Region are CVD and injuries. As for cardiovascular mortality, alcohol consumption has no marked impact as long as drinking is maintained at moderate levels. The beneficial effects on ischaemic diseases (104,174), described earlier, are almost negated by the detrimental effects on all other CVD (96). As a result, in 2014, the proportion of alcohol-attributable cardiovascular mortality was less than 5% of all alcohol-attributable mortality for the central-western part of the EU, about 12% for the Mediterranean countries, and 14% for the central-eastern part of the EU (for the EU as a whole, it was 10%). This cause-of-death category comprised 54% of all alcohol-attributable mortality in the eastern WHO European Region, and 36% in the WHO European Region as a whole. Cultures with both episodic and chronic heavy drinking will experience mainly detrimental effects, which are obviously most pronounced when very heavy binges are the dominant pattern of drinking for a large part of the population such as in the eastern WHO European Region during the observation period. (For individual large-scale studies, see (5,54,175,176); for discussion, see (110,177); for supporting aggregate-level studies, see (178–181).) Morbidity and mortality rates due to injury have been decreasing globally, including in the European Region (158). The speed of this decline may be halted and even reversed by alcohol consumption (see Fig. 72 and below; for a historical comparison of alcohol poisoning deaths in the Russian Federation, see (182)). It needs to be mentioned that mortality due to alcohol-attributable unintentional injury (i.e. alcohol poisoning) may be underestimated in countries with a high prevalence of heavy binge drinking (e.g. the Russian Federation (183–185); Estonia (186,187)). (For a discussion, see (188,189).) 51
Public health successes and missed opportunities SEX-SPECIFIC TRENDS IN ALCOHOL-ATTRIBUTABLE MORTALITY BETWEEN 1990 AND 2014 BY MAJOR CAUSE-OF-DEATH CATEGORIES Fig. 73 shows the alcohol-attributable cause-of-death rates separately by sex. In all countries, more alcohol is consumed by men compared to women, as men abstain less (see Fig. 13 and 14 for European Region and subregions). As a consequence, alcohol-attributable mortality is higher in men than in women. Overall, the ratio of male-to-female agestandardized rates of alcohol-attributable mortality for the WHO European Region is about 2:1 and has not changed much over the past 25 years (1990: 2.1:1; 2014: 2.0:1). The ratio varies for different causes of death (see Fig. 74–78 below), and by region, however. Whereas in most regions the ratio is around 2:1, countries in the south-eastern part of the European Region and Mediterranean countries have higher ratios. This reflects, in part, the correlation between gender inequality and proportion of alcohol consumed by women, which was –0.65 in 2010 for the WHO European Region (based on 44 countries with available data; 95% CI: –0.79 to 0.44; t = 5.4; P < 0.001); the higher the gender inequality, the lower the proportion of alcohol consumed by women). 19 Fig. 73. Comparisons of age-standardized alcohol-attributable mortality for major causes of death, 1990 vs 2014, by sex in the WHO European Region and selected subregions Central-eastern EU Men Women 1990 2014 1990 2014 liver cirrhosis cancer CVD Eastern WHO European Region Men Women 1990 2014 1990 2014 unintentional injury intentional injury Central-western EU Men Women 1990 2014 1990 2014 South-eastern WHO European Region Men Women 1990 2014 1990 2014 Mediterranean Men Women 1990 2014 1990 2014 WHO European Region Men Women 1990 2014 1990 2014 -100 0 250 500 750 1000 1250 1500 1750 2000 Rate per million 19 Own calculations based on data for the WHO Global status report on alcohol and health (1) and the UN Gender Inequality Index (190). 52
Page 1 and 2:
Public health successes and missed
Page 3 and 4:
Public health successes and missed
Page 5 and 6:
iv
Page 7 and 8:
abbreviations CI CVD EU FAS GDP GIS
Page 9 and 10:
Executive summary This report aims
Page 11 and 12: for voluntary behaviours. 1 Second,
Page 13 and 14: MONITORING ALCOHOL EXPOSURE The key
Page 15 and 16: Public health successes and missed
Page 27 and 28: BURDEN OF ALCOHOL-ATTRIBUTABLE MORT
Page 31 and 32: Table 1. Standardized mortality fro
Page 33 and 34: Table 1 contd Country Liver Liver C
Page 61: Public health successes and missed
Page 71 and 72: CONCLUSION: THE NEED FOR AN ALCOHOL
Page 88: The WHO Regional Office for Europe
show all

Public health successes and missed opportunities

Create successful ePaper yourself

Delete template?

Save as template?