Alcohol-Related Deaths In Scotland: Do Country-Specific Factors Affecting Cohorts Born in the 1940s and Before Help Explain the Current Trends in Alcohol-Related Trends?

Background: Since the 1970s chronic liver disease (which is largely alcohol-related) has increased in Scotland and many other Western European countries. However, in the last three decades trends in alcohol-related deaths (ARD) in Scotland departed from trends seen in neighbouring countries: in the 1990s ARD rose sharply in Scotland followed by a sustained fall in more recent years. The effects of age, calendar period and birth cohort on the recent ARD trends in Scotland have been compared with England with the aim of exploring what might be driving these differing trends. Methods: Using adult (16yrs+) ARD death data (1990-2010) in England and Scotland separate logistic regression analysis of ARD was performed to identify the adjusted effects of age (15-75yrs+ using five-year age groups), period (1990-2010 in five-year periods) and cohort (1910-1980 in ten-year birth cohorts), using the Office for National Statistics definition of ARD. The sexes were analysed separately. Results: After accounting for the effects of age and period, significant differences in cohort effects on ARD were seen between Scotland and England, particularly for those born in the 1940s and earlier. In England, for each successive cohort the odds of ARD tended to fall (OR [95%CI] for 1910, 1950 and 1980 male birth cohorts respectively: 1.3 [1.2, 1.4], 1.1 [1.0, 1.1], 0.3 [0.2, 0.3]). In contrast, in Scotland for those born in the 1910s to the 1940s the odds of ARD remained static (OR [95%CI] for 1910, 1930 and 1940 male birth cohorts respectively: 0.9 [0.8, 1.0], 1.0 [0.9, 1.0], (1.0 [1.0, 1.0]). As in England, the risk of ARD has fallen in the younger cohorts. The adjusted age effects were similar in both countries. The adjusted period effects reflected national ARD trends. Conclusion: Differences in risk of ARD in the older birth cohorts were seen between England and Scotland: compared with those born in the 1910s, the risk of ARD in subsequent birth cohorts in England tended to fall. In contrast, in Scotland for those born between 1910-1940 the risk of ARD was static. The risk of ARD has fallen in younger birth cohorts in both countries. These data suggest that factors in Scotland primarily affecting those born in the 1940s and before may help explain the current ARD trends in Scotland