Past and future alcohol-attributable mortality in Europe

We project (age-specific) alcohol-attributable mortality up to 2060 in 26 European countries by carefully assessing past trends and applying advanced projecting techniques. We used estimated sex and age-specific alcohol-attributable mortality fractions (AAMF) among the national populations aged 20-84, for 1990 up to 2016, from the Global Burden of Disease Study, whichwe adjusted at older ages. We applied age-period-cohort modelling and projection, and avoided unrealistic future crossovers and differences in age-standardised AAMF between sexes and country groups, by implementing different lower bounds and by enabling that current (stagnating) increases areturned into declines. We find that in 2016, age-standardised AAMF were substantially higher among men (10.1%) than women (3.3%), and were much higher in Eastern Europe (14.3%) than in Western Europe (8.2%) amongmen. From 1990 to 2016, age-standardised AAMF mostly increased in Eastern and North-western Europe, and then declined or stagnated; whereas in South-western Europe, AAMF mostly declined, albeit with decelerations, particularly among men. We project that in the future, AAMF levels will decline in all countries, and will converge across countries, but that for men, levels will be higher in Eastern and South-western Europe than in North-western Europe. For 2060, projected AAMF are, on average, 5.1% among men and 1.4% among women. In sum, the share of mortality due to alcohol is projected to eventually decline in all 26 European countries, and to converge across countries and sexes. Particularly for Eastern and North-western European countries, achieving these projected declines will require strong, ongoing public health action