Public health successes and missed opportunities

Public health successes and missed opportunities
Fig. 79. Trends in alcohol-attributable fractions of mortality in the WHO European Region and selected
subregions, 1990–2014
% of all causes of death for which there is a causal impact of alcohol
30
25
20
15
10
5
EU
Central-western EU
Mediterranean
South-eastern WHO
European Region
Central-eastern EU
Eastern WHO
European Region
WHO
European Region
0
1990
1992
1994
1996
1998
2000
2002
2004
2006
2008
2010
2012
2014
As expected by the formula on attributable risk, the values closely follow the adult per capita alcohol consumption trends
(see Fig. 10), albeit with a slightly higher variation between regions. Given this pattern, it is all the more surprising that in
2014, the Mediterranean countries, after a decade-long decline in consumption (8.0%), had an almost similar proportion
of alcohol-attributable mortality compared to the south-eastern part of the WHO European Region with a high prevalence
of people with Muslim faith (6.8%; see Fig. 79).
REGIONAL TRENDS IN AGE-STANDARDIZED RATES OF MAJOR CAUSE-OF-DEATH CATEGORIES, 1990–2014
Standardized liver cirrhosis rates have been and are the highest in central-eastern EU (see Fig. 80), a region with high
overall consumption. However, consumption alone would not be enough to explain the rates. As indicated earlier, this
is also the region where spirits based on fruits with pits are traditionally consumed (Hungary, Romania, Slovakia and
Slovenia (90,141)). Alternatively, short-chain aliphatic alcohols contained in unrecorded products have been hypothesized
as a possible explanation (192); but see (193,194).
The increase in mortality due to alcohol-attributable liver cirrhosis in the south-eastern part of the WHO European Region
is of concern. While some of this mortality may be overestimated based on global risk functions derived from metaanalyses,
which may not apply to these countries with high rates of mortality due to hepatitis-attributable liver cirrhosis,
it should also be taken into consideration that liver cirrhosis mortality may be impacted by alcohol, irrespective of the
causal factors leading to the liver cirrhosis in the first place (89). Relatively small amounts of alcohol may thus lead to a
high risk of mortality in already damaged livers (87).
Otherwise, the reduction in standardized liver cirrhosis mortality rates in the past few years, even in countries where
consumption has not been going down, should be researched further.
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