The role of birth cohorts in long-term trends in liver cirrhosis mortality across eight European countries.

TY - JOUR

T1 - The role of birth cohorts in long-term trends in liver cirrhosis mortality across eight European countries.

AU - Trias Llimós, S.

AU - Bijlsma, M.

AU - Janssen, F.

N1 - E-published ahead of print: 16 September 2016.

PY - 2017

Y1 - 2017

N2 - Background and aimsUnderstanding why inequalities in alcohol-related mortality trends by sex and country exist, is essential for developing health policies. Birth cohort effects, indicative of differences by generation in drinking, have rarely been studied. This study estimated the relative contributions of birth cohorts to liver cirrhosis mortality trends and compared sex- and country-specific cohort patterns across eight European countries.DesignTime-series analysis of population-level mortality data.SettingAustria, Finland, Hungary, Italy, the Netherlands, Poland, Spain and Sweden; 1950-2011.ParticipantsNational populations aged 15-94.MeasurementsWe modelled country- and sex-specific liver cirrhosis mortality (from national vital registers) adjusting for age, period and birth cohort.FindingsBirth cohorts (adjusted for age and period) made statistically significant contributions to liver cirrhosis mortality in all countries and for both sexes (p-values < 0.001), and more so among women (average contribution to deviance reduction of 38.8%) than among men (17.4%). The observed cohort patterns were statistically different between all but two country pairs (p-values < 0.001). Sex differences existed overall (p-value < 0.001), but not in the majority of countries (p-values > 0.999). Visual inspection of birth cohort patterns reveals birth cohorts at higher risk of liver cirrhosis mortality.ConclusionsThe inclusion of the birth cohort dimension improves the understanding of alcohol-attributable mortality trends in Europe. Birth cohorts at higher risk of liver cirrhosis mortality were born around 1935-1949 in Sweden and Finland, around 1950 in Austria and the Netherlands, and around 1960 or later in Hungary, Italy, Poland and Spain.

AB - Background and aimsUnderstanding why inequalities in alcohol-related mortality trends by sex and country exist, is essential for developing health policies. Birth cohort effects, indicative of differences by generation in drinking, have rarely been studied. This study estimated the relative contributions of birth cohorts to liver cirrhosis mortality trends and compared sex- and country-specific cohort patterns across eight European countries.DesignTime-series analysis of population-level mortality data.SettingAustria, Finland, Hungary, Italy, the Netherlands, Poland, Spain and Sweden; 1950-2011.ParticipantsNational populations aged 15-94.MeasurementsWe modelled country- and sex-specific liver cirrhosis mortality (from national vital registers) adjusting for age, period and birth cohort.FindingsBirth cohorts (adjusted for age and period) made statistically significant contributions to liver cirrhosis mortality in all countries and for both sexes (p-values < 0.001), and more so among women (average contribution to deviance reduction of 38.8%) than among men (17.4%). The observed cohort patterns were statistically different between all but two country pairs (p-values < 0.001). Sex differences existed overall (p-value < 0.001), but not in the majority of countries (p-values > 0.999). Visual inspection of birth cohort patterns reveals birth cohorts at higher risk of liver cirrhosis mortality.ConclusionsThe inclusion of the birth cohort dimension improves the understanding of alcohol-attributable mortality trends in Europe. Birth cohorts at higher risk of liver cirrhosis mortality were born around 1935-1949 in Sweden and Finland, around 1950 in Austria and the Netherlands, and around 1960 or later in Hungary, Italy, Poland and Spain.

KW - alcohol

KW - cohort

KW - age-period

KW - cohort analysis

KW - Europe

KW - liver cirrhosis

KW - SSCI

U2 - 10.1111/add.13614

DO - 10.1111/add.13614

M3 - Article

SN - 0965-2140

VL - 112

SP - 250

EP - 258

JO - Addiction

JF - Addiction

IS - 2

ER -