1. Liver cirrhosis mortality in European countries II Working Meeting on Adult Premature Mortality in European Union Warsaw, 15-17 October 2006

2. 2 Liver cirrhosis mortality, males 20-64 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. 3 Liver cirrhosis mortality, females 20-64 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. 4 Liver cirrhosis mortality in Mediterranean countries*, 20-64 * France, Greece, Italy, Portugal, Spain

5. 5 Liver cirrhosis mortality in South-eastern European countries*, 20-64 * Bulgaria, Hungary, Romania

6. 6 Liver cirrhosis mortality in Hungary, 20-64

7. 7 Liver cirrhosis mortality in Moldova, 20-64

8. 8 Liver cirrhosis mortality in Former Soviet Union countries*, 20-64 * Belarus, Estonia, Latvia, Lithuania, Russia, Ukraine

9. 9 Liver cirrhosis mortality in Baltic countries*, 20-64 * Estonia, Latvia, Lithuania

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

11. 11 Liver cirrhosis mortality in other European countries*, 20-64 *Austria, Czech Rep. + Slovakia, Denmark, Finland, Ireland, Netherlands, Norway, Poland, Sweden, Switzerland, UK

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

13. 13 Liver cirrhosis mortality in UK, 20-64

14. 14 Liver cirrhosis mortality, males 20-64 EU(8+2) South-eastern European countries: Bulgaria, Hungary, Romania Baltic countries: Estonia, Latvia, Lithuania Other countries: Czech Rep. + Slovakia, Poland, Slovenia

15. 15 Liver cirrhosis mortality, females 20-64 EU(8+2) South-eastern European countries: Bulgaria, Hungary, Romania Baltic countries: Estonia, Latvia, Lithuania Other countries: Czech Rep. + Slovakia, Poland, Slovenia

16. 16 Liver cirrhosis mortality rates, males age 20-64, selected countries - 1989 fruit brandy countryvodka country

17. 17 Liver cirrhosis mortality at ages 20-64, 2002

18. 18 Liver cirrhosis mortality at ages 20-64, 2002

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

20. 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. 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. 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. 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. 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. 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 1990-1996  Jumps in former Soviet Union countries – binge drinking - jump changes (1992-1996) 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. 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