Liver cirrhosis mortality in European countries II Working Meeting on Adult Premature Mortality in European Union Warsaw, October 2006

2 Liver cirrhosis mortality, males Mediterranean countries: France, Greece, Italy, Portugal, Spain South-eastern European countries: Bulgaria, Hungary, Romania Former Soviet Union countries: Belarus, Estonia, Latvia, Lithuania, Russia, Ukraine Other countries: Austria, Czech Rep. + Slovakia, Denmark, Finland, Ireland, Netherlands, Norway, Poland, Sweden, Switzerland, UK

3 Liver cirrhosis mortality, females Mediterranean countries: France, Greece, Italy, Portugal, Spain South-eastern European countries: Bulgaria, Hungary, Romania Former Soviet Union countries: Belarus, Estonia, Latvia, Lithuania, Russia, Ukraine Other countries: Austria, Czech Rep. + Slovakia, Denmark, Finland, Ireland, Netherlands, Norway, Poland, Sweden, Switzerland, UK

4 Liver cirrhosis mortality in Mediterranean countries*, * France, Greece, Italy, Portugal, Spain

5 Liver cirrhosis mortality in South-eastern European countries*, * Bulgaria, Hungary, Romania

6 Liver cirrhosis mortality in Hungary, 20-64

7 Liver cirrhosis mortality in Moldova, 20-64

8 Liver cirrhosis mortality in Former Soviet Union countries*, * Belarus, Estonia, Latvia, Lithuania, Russia, Ukraine

9 Liver cirrhosis mortality in Baltic countries*, * Estonia, Latvia, Lithuania

10 Liver cirrhosis mortality in Russia and Baltic countries, 20-64

11 Liver cirrhosis mortality in other European countries*, *Austria, Czech Rep. + Slovakia, Denmark, Finland, Ireland, Netherlands, Norway, Poland, Sweden, Switzerland, UK

12 Liver cirrhosis mortality in Poland and Finland, 20-64

13 Liver cirrhosis mortality in UK, 20-64

14 Liver cirrhosis mortality, males EU(8+2) South-eastern European countries: Bulgaria, Hungary, Romania Baltic countries: Estonia, Latvia, Lithuania Other countries: Czech Rep. + Slovakia, Poland, Slovenia

15 Liver cirrhosis mortality, females EU(8+2) South-eastern European countries: Bulgaria, Hungary, Romania Baltic countries: Estonia, Latvia, Lithuania Other countries: Czech Rep. + Slovakia, Poland, Slovenia

16 Liver cirrhosis mortality rates, males age 20-64, selected countries fruit brandy countryvodka country

17 Liver cirrhosis mortality at ages 20-64, 2002

18 Liver cirrhosis mortality at ages 20-64, 2002

19 Discussion Quality of the data / Complexity of disease Interference of hepatitis B and C Progress in treatment Increase of risk factors

20 Liver cirrhosis mortality and prevalence of drinking at ages 20-64, males, 2002 * Drinking 40 g of pure alcohol per day or more

21 Liver cirrhosis mortality and prevalence of drinking at ages 20-64, females, 2002 * Drinking 40 g of pure alcohol per day or more

22 Liver cirrhosis mortality and prevalence of drinking at ages 20-64, males, 2002 * Drinking 60 g of pure alcohol per day or more

23 Liver cirrhosis mortality and prevalence of drinking at ages 20-64, females, 2002 * Drinking 60 g of pure alcohol per day or more

24 Liver cirrhosis – comments and questions  Decline of liver cirrhosis in Mediterranean countries – how to achieve this in Eastern Europe?  South-Eastern European product / fruit brandy vs. vodka countries  Case of Moldova / vs. AIDS  Former Soviet Union – reservoir effect  Liver cirrhosis – why is it increasing in Baltic States?  Poland – increase among young and middle-aged adults, decreases in population after the age of 65  UK – liver cirrhosis in not a problem only of Eastern Europe

25 Liver cirrhosis – comments and questions Two patterns of alcohol consumption consequences in result of transformation:  In the countries of South-Eastern Europe dramatic constant increase / Hungary  Jumps in former Soviet Union countries – binge drinking - jump changes ( ) Reason the same but the range of consequence is different because of:  Product  Pattern of drinking Different dimension of harm:  Huge in South-Eastern Europe  Very big in former Soviet Union

26 Liver cirrhosis – comments and questions  DATA:  Complexity of the disease  Interference with hepatitis B and C virus  Progress in treatment  Extra correlation with alcohol consumption / consistency between males and females