Alcohol-related mortality in European countries II Working Meeting on Adult Premature Mortality in European Union Warsaw, October 2006

Methodology Relative Risks (RRs) were taken from published meta-analyses and from the WHO Comparative Risk Assessment project and combined with exposure to calculate age- and sex-specific alcohol-attributable fractions (AAFs) according formula: Following categories for average alcohol consumption were used: Abstainer or very light drinker 0 -< 0.25 g/day Drinking Category I < 20 g/day Drinking Category II20 -< 40 g/day Drinking Category III40 -< 60 g/day Drinking Category IV 60+ g/day

Prevalence data To determine the distribution of consumption levels across these strata World Health Surveys, National Health Surveys and prevalence data from different publications were identified with the help of the Global Alcohol Database and adjusted by adult per capita consumption including unrecorded consumption.

Alcohol related disease and injury Chronic disease: –Cancer: Mouth & Oropharyngeal cancer, oesophageal cancer, liver cancer, colorectal cancer, female breast cancer –Neuropsychiatric diseases: Alcohol use disorders, epilepsy –Diabetes –Cardiovascular diseases: Hypertensive diseases, coronary heart disease, stroke by subtypes –Gastrointestinal diseases: Liver cirrhosis Injury: –Unintentional injury: Motor vehicle accidents, drownings, falls, poisonings, other unintentional injuries –Intentional injury: Self-inflicted injuries, homicide, other intentional injuries Not included for lack of reliable estimation techniques : Depression FAS and other alcohol-attributable disease from drinking of the mother during pregnancy Infectious disease

Alcohol-attributable death rates per 100,000 population, 2002

Alcohol-attributable death rates at ages per 100,000 population, 2002

* ICD-9 BTL1

Alcohol-attributable death rates at ages per 100,000 population, males, 2002 * ICD-9 BTL1

Alcohol-attributable death rates at ages per 100,000 population, females, 2002 * ICD-9 BTL1

Alcohol-attributable deaths at ages 20-64, 2002 MalesMalignant neoplasm CVDLiver cirrhosis Unintentional injuries Intentional injuries Other diseases All alcohol- attributable deaths* EU15 No. deaths Rate/100,000 population Percent 21.9%-29.7%25.0%9.0%14.4%100.0% EU(8+2) No. deaths Rate/100,000 population Percent 15.5%-27.7%34.6%12.1%10.2%100.0% Russia No. deaths Rate/100,000 population Percent 5.3%-7.6%60.8%23.7%2.6%100.0% * Excluded CVD

Alcohol-attributable deaths at ages 20-64, 2002 Females Malignant neoplasm CVD Liver cirrhosis Unintentional injuries Intentional injuries Other diseases All alcohol- attributable deaths* EU15 No. deaths Rate/100,000 population Percent 26.9%-40.0%14.1%7.9%11.2%100.0% EU(8+2) No. deaths Rate/100,000 population Percent 15.3%-40.6%27.7%10.6%5.8%100.0% Russia No. deaths Rate/100,000 population Percent 7.9%-18.3%50.8%19.8%3.2%100.0% * Excluded CVD

Premature alcohol-related deaths (including CVD) % of overall deaths EU(8+2)EU15Russia Males Ages Ages Ages Females Ages Ages Ages

Conclusions, discussion and questions Huge variation between countries, especially between eastern and western European countries Most of the variation is confined to men Within EU(8+2), relatively low alcohol burden in Bulgaria CVD, positive effect of alcohol use was modelled based on cohorts of western countries only. Thus protective effect is overestimated and alcohol-related harm is very conservatively estimated. Part of the differences between countries can be explained by volume, patterns of drinking and differences between revisions of ICD