Alcohol and gender gaps in life expectancy in eight Central and Eastern European countries

Background: Gender differences in life expectancy (LE) have been traditionally large in Central and Eastern Europe (CEE), and alcohol has been hypothesized to be one of its main determinants. We examined the role of alcohol in gender differences in LE in Estonia, Lithuania, Latvia, Moldova, Poland, Romania, Russia and Ukraine, and changes in this role from 1965 until 2012. Methods: We decomposed the gender differences in LE at birth into alcohol- and non-alcohol-related mortality. We examined causes of death wholly attributable to alcohol over the whole period, and estimated from 1990 onwards additional alcohol-attributable mortality by using alcohol-attributable fractions from the Global Burden of Disease study. Results: In the eight CEE countries, women's advantage in LE relative to men increased from 7.3 years on average in 1965 to 10.0 years on average in 2012. All alcohol-attributable mortality contributed 1.9 years on average (uncertainty intervals (UI): 1.2-2.5; 18.8%) to the gender differences from 1990 to 2012. Its relative contribution increased in most countries until around 2005, and declined thereafter, resulting in a contribution of at least 15% in 2012. The absolute contribution of alcohol to the LE gender gap was strongly correlated with the overall LE gender differences (Pearson's r > 0.75), except in Poland and Estonia. Conclusions: Despite recent declines, the contribution of sex differences in excessive alcohol consumption to the LE gender gap is substantial, and should not be neglected. Tackling gender differences in alcohol consumption and alcohol-attributable mortality would contribute to further progress in reducing mortality