Jonas Landberg

Changes in mortality due to major alcohol‐related diseases in four Nordic countries, France and Germany between 1980 and 2009: a comparative age–period–cohort analysis

AIMS To investigate age, period and cohort effects on time trends of alcohol-related mortality in countries with different drinking habits and alcohol policies. DESIGN AND SETTING Age-period-cohort (APC) analyses on alcohol-related mortality were conducted in Denmark, Finland, Norway, Sweden, France and Germany. PARTICIPANTS Cases included alcohol-related deaths in the age range 20-84 years between 1980 and 2009. MEASUREMENTS Mortality data were taken from national causes of death registries and covered the ICD codes alcoholic psychosis, alcohol use disorders, alcoholic liver disease and toxic effect of alcohol. FINDINGS In all countries changes across age, period and cohort were found to be significant for both genders [effect value with confidence interval (CI) shown in Supporting information, Table S1]. Period effects pointed to an increase in alcohol-related mortality in Denmark, Finland and Germany and a slightly decreasing trend in Sweden, while in Norway an inverse U-shaped curve and in France a U-shaped curve was found. Compared with the cohorts born before 1960, the risk of alcohol-related mortality declined substantially in cohorts born in the 1960s and later. Pairwise between-country comparisons revealed more statistically significant differences for period (P < 0.001 for all 15 comparisons by gender) than for age [P < 0.001 in seven (men) and four (women) of 15 comparisons] or cohort [P < 0.01 in two (men) and three (women) of 15 comparisons]. CONCLUSIONS Strong period effects suggest that temporal changes in alcohol-related mortality in Denmark, Finland, Norway, Sweden, France and Germany between 1980 and 2009 were related to secular differences affecting the whole population and that these effects differed across countries.

Changes in mortality due to major alcohol-related diseases in four Nordic countries, France and Germany between 1980 and 2009: a comparative age-period-cohort analysis

AIMS To investigate age, period and cohort effects on time trends of alcohol-related mortality in countries with different drinking habits and alcohol policies. DESIGN AND SETTING Age-period-cohort (APC) analyses on alcohol-related mortality were conducted in Denmark, Finland, Norway, Sweden, France and Germany. PARTICIPANTS Cases included alcohol-related deaths in the age range 20-84 years between 1980 and 2009. MEASUREMENTS Mortality data were taken from national causes of death registries and covered the ICD codes alcoholic psychosis, alcohol use disorders, alcoholic liver disease and toxic effect of alcohol. FINDINGS In all countries changes across age, period and cohort were found to be significant for both genders [effect value with confidence interval (CI) shown in Supporting information, Table S1]. Period effects pointed to an increase in alcohol-related mortality in Denmark, Finland and Germany and a slightly decreasing trend in Sweden, while in Norway an inverse U-shaped curve and in France a U-shaped curve was found. Compared with the cohorts born before 1960, the risk of alcohol-related mortality declined substantially in cohorts born in the 1960s and later. Pairwise between-country comparisons revealed more statistically significant differences for period (P < 0.001 for all 15 comparisons by gender) than for age [P < 0.001 in seven (men) and four (women) of 15 comparisons] or cohort [P < 0.01 in two (men) and three (women) of 15 comparisons]. CONCLUSIONS Strong period effects suggest that temporal changes in alcohol-related mortality in Denmark, Finland, Norway, Sweden, France and Germany between 1980 and 2009 were related to secular differences affecting the whole population and that these effects differed across countries.

More Drinking, More Problems—Stable Association Between Alcohol Consumption and Harm Among Swedish Youth 1995–2012

Aims Alcohol consumption among Swedish youth increased during the 1990s. In the following decade, levels declined coinciding with a reduction in the prevalence of self-reported alcohol-related harm. We examine how the trend in self-reported alcohol-related problems among young Swedish alcohol consumers has followed the trend in alcohol consumption during 1995-2012, and test whether the strength of the association between self-reported alcohol consumption and alcohol-related problems within individuals is inversely proportional to the overall level of consumption among youth. Methods The study was based on a representative survey on alcohol and drug habits among ninth-year students, consisting of current alcohol consumers (n = 68 863), 1995-2012. Negative binominal regression models were used to estimate the relationship between three consumption variables (average volume of consumption, binge drinking and heavy drinking) and self-reported alcohol-related problems. Results The prevalence of binge drinking showed a greater association with self-reported alcohol-related problems than did overall mean consumption. No noticeable variation in the strength of the individual-level alcohol and harm relationship was found over the study period. We found no significant interaction between the individual alcohol use measures and overall mean youth consumption. Conclusion We found no signs of normalization; on the contrary, young alcohol consumers suffer about the same number of self-reported negative consequences from their drinking, regardless of the level of overall youth consumption. The study also suggests that binge drinking rather than overall consumption is the main factor that influences the development of self-reported problems experienced among young alcohol consumers. Short summary Young alcohol consumers suffer about the same number of self-reported negative consequences from their drinking, regardless of the level of overall mean consumption in the youth population. Binge drinking consumption appears to be the main factor influencing the development of self-reported alcohol-related problems among young alcohol consumers.

Socioeconomic Disparities in Alcohol-Related Mortality in Sweden, 1991–2006: A Register-Based Follow-Up Study

AIM To examine whether apparent stability of overall alcohol-related mortality in Sweden during a period when traditionally strict alcohol policies went through a series of liberalizations and overall alcohol mortality remained stable, concealed a heterogeneity across socioeconomic groups (defined by educational level); and whether an increase occurred in the contribution of alcohol-related mortality to overall mortality differentials. METHODS Drawing on cause of death data linked to census records for the period 1991-2006, we computed annual age-standardized and sex-specific rates of alcohol-related mortality for groups with low, intermediate and high education. RESULTS Alcohol-related mortality was considerably higher in lower educational groups for both men and women. For men, the trends in alcohol-related mortality were roughly stable for all education groups, and there were no signs of increasing inequalities by education. For women, alcohol-related mortality increased significantly for the low-education group whereas the two higher education groups showed no significant time trends, thus resulting in a widened educational gap in alcohol mortality for women. Alcohols contribution to the overall mortality differentials declined for men and was basically unchanged for women. CONCLUSIONS The findings provide only partial support to the hypothesis that the liberalizations of Swedish alcohol policy have been followed by a general increase in socioeconomic disparities in alcohol-related mortality.

The contribution of alcohol use and other lifestyle factors to socioeconomic differences in all-cause mortality in a Swedish cohort

INTRODUCTION AND AIMS A relationship between socioeconomic position (SEP) and mortality has been found in high-income countries. One possible explanation is socioeconomic differentials in health behaviours. The aim was to investigate to what degree the association between SEP and all-cause mortality is explained by differences in alcohol use and other lifestyle factors. DESIGN AND METHODS The study was based on data from a large public health survey from Stockholm County in 2002, with 5 year follow-up for all-cause mortality. Proportional hazard models estimated the effect of education, occupational class and income on all-cause mortality, before and after adjusting for alcohol use (both separate and combined effects of levels and patterns of drinking), smoking, physical activity and body mass index. RESULTS The prevalence of lifestyle factors showed a marked social gradient. All three SEP indicators showed higher mortality for the most disadvantaged SEP group than in the least disadvantaged group. Adjusting for a combined measure of alcohol use attenuated the SEP differences in mortality by a fifth, whereas adjusting for volume of consumption resulted in considerably smaller attenuations. Adjusting for smoking resulted in attenuations of 6-18%. In the fully adjusted model, physical activity and body mass index did not account for the socioeconomic differences in mortality beyond that of alcohol and smoking.‬ DISCUSSION AND CONCLUSIONS: Irrespective of whether SEP is defined by education, occupational class or income, the unequal distribution of hazardous alcohol use and smoking contributes to a notable proportion of the socioeconomic differences in mortality in Sweden. [Sydén L, Landberg J. The contribution of alcohol use and other lifestyle factors to socioeconomic differences in all-cause mortality in a Swedish cohort. Drug Alcohol Rev 2016;00:000-000].

Fathers' alcohol consumption and long-term risk for mortality in offspring

We examined the associations between fathers’ alcohol consumption and total and cause-specific mortality in adult offspring. Fathers’ alcohol consumption was associated with increased risk of alcohol-related mortality in offspring. The association appeared to be weaker for causes of death in which alcohol plays a smaller, or less direct, role.