Alcohol-attributable mortality in Europe: Past trends and their effects on overall mortality variations

Excessive alcohol consumption is a major public health concern in Europe. Differences in alcohol consumption levels and drinking patterns across European populations – and especially risky drinking behaviours among Eastern European men – could contribute to the substantial overall mortality differences observed across European countries, between the sexes, and over time. This thesis examined past trends in alcohol-attributable mortality in Europe and their effects on overall mortality differences. Differences across countries, between the sexes, and across birth generations (cohorts) over long periods of time were analyzed using demographic and epidemiological data and methods. Past trends in alcohol-attributable mortality were found to vary considerably across Europe: the levels were higher and the trends were more irregular among Eastern European men, and recently moderate declines have occurred in countries with high alcohol-attributable mortality. Moreover, differences across countries were found in the birth cohorts at highest risk of alcohol-attributable mortality. These substantial differences in alcohol-attributable mortality across countries, between the sexes, generations and over time can be related to differences in socioeconomic conditions and drinking cultures. Alcohol-attributable mortality had a large impact on overall mortality levels and trends, especially among Eastern European men. In 2012/13, alcohol-attributable mortality contributed around 20% to the life expectancy differences between Eastern and Western Europe, and at least 15% to the gender differences in life expectancy in Eastern Europe. These results suggest that the alcohol problem in Europe deserves further attention from society and policy-makers. Alcohol-related public health interventions can improve overall health while also reducing health inequalities across Europe