Trend in alcohol-related mortality in Sweden 1969–2002: an age-period-cohort analysis

Centre for Epidemiology, National Board of Health and Welfare, Stockholm, Sweden.
Addiction (Impact Factor: 4.74). 07/2006; 101(6):835-40. DOI: 10.1111/j.1360-0443.2006.01421.x
Source: PubMed


To study the effects of age, period and cohorts on alcohol-related mortality trends in Sweden.
The study comprises an age-period-cohort analysis.
The analysis was based on all deaths in the Swedish population between 1969 and 2002.
Data on alcohol-related deaths in Sweden from 1969 to 2002 excluding accidental injury and homicide were used. The analysis covered 43 021 deaths.
Time period and birth cohort both influenced alcohol-related mortality. Male cohorts born in the 1930-40s exhibited the highest alcohol-related mortality, while for females those born in the 1940-50s had the highest alcohol-related mortality. For both men and women, those born in the 1960-70s had the lowest age-adjusted alcohol-related mortality. High-risk cohorts were young or in early adulthood during the periods that alcohol became more available in Sweden. The low-risk cohorts of the 1960-70s were brought up during a period when society was concerned with increasing alcohol problems and more emphasis was placed on issuing alcohol awareness information in schools.
Cohort effects were found suggesting that the link between alcohol consumption and non-accident alcohol-related mortality at the population level is dependent on other factors that may change over time. One such factor may be that restrictive alcohol policies have a greater effect on drinking in those who are younger at the time they are put into effect.

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    • "Previous studies have demonstrated the importance of considering the three time-related effects of age, period and cohort when examining the trends in alcohol consumption [6]–[10]; however, the influence of these effects on the trends of alcohol-related health outcomes have been understudied [11], [12]. Moreover, less is known about the role of these effects in influencing alcohol-related health outcomes in a population that is traditionally not known to have high alcohol consumption levels. "
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    ABSTRACT: To delineate the temporal dynamics between alcohol tax policy changes and related health outcomes, this study examined the age, period and cohort effects on alcohol-related mortality in relation to changes in government alcohol policies. We used the age-period-cohort modeling to analyze retrospective mortality data over 30 years from 1981 to 2010 in a rapidly developed Chinese population, Hong Kong. Alcohol-related mortality from 1) chronic causes, 2) acute causes, 3) all (chronic+acute) causes and 4) causes 100% attributable to alcohol, as defined according to the Alcohol-Related Disease Impact (ARDI) criteria developed by the US Centers for Disease Control and Prevention, were examined. The findings illustrated the possible effects of alcohol policy changes on adult alcohol-related mortality. The age-standardized mortality trends were generally in decline, with fluctuations that coincided with the timing of the alcohol policy changes. The age-period-cohort analyses demonstrated possible temporal dynamics between alcohol policy changes and alcohol-related mortality through the period effects, and also generational impact of alcohol policy changes through the cohort effects. Based on the illustrated association between the dramatic increase of alcohol imports in the mid-1980s and the increased alcohol-related mortality risk of the generations coming of age of majority at that time, attention should be paid to generations coming of drinking age during the 2007-2008 duty reduction.
    PLoS ONE 08/2014; 9(8):e99906. DOI:10.1371/journal.pone.0099906 · 3.23 Impact Factor
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    • "Finally, most studies included in this review are based on self-report of respondents via surveys. Those studies that did not collect data from self-report (Corrao, Ferrari et al. 1997; Kendler, Prescott et al. 1997; Rosen and Haglund 2006; Aristei, Perali et al. 2008; Zhang, Guo et al. 2008) did not consistently document cohort effects, raising questions about the validity of the self-report data. Survey data is an imperfect tool for gauging the total amount of alcohol consumed (Del Boca and Darkes 2003), and the validity of self-reported alcohol consumption is likely subject to some of the same social norms identified above as a potential mechanism driving cohort effects in alcohol consumption. "
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    ABSTRACT: Alcohol consumption has demonstrated substantial temporal trends, with some evidence suggesting strong birth cohort effects. The identification of at-risk birth cohorts can inform the interpretation of alcohol trends across age, time, and demographic characteristics such as gender. The present literature review has 2 objectives. First, we conduct a cross-national review of the literature on birth cohort differences in alcohol consumption, disorder, and mortality. Second, we determine the consistency of evidence for birth cohort effects on gender differences. A search was conducted and key data on population characteristics, presence and direction of cohort effects, and interactions with gender compiled. Thirty-one articles were included. Evidence suggests that younger birth cohorts in North America, especially those born after World War II, are more likely than older cohorts to engage in heavy episodic drinking and develop alcohol disorders, but this cohort effect is not found in Australia and western Europe. Cross-nationally, substantial evidence indicates that women in younger cohorts are at especially high risk for heavy episodic drinking and alcohol disorders. Younger birth cohorts in North America and Europe are engaging in more episodic and problem drinking. The gender gap in alcohol problems is narrowing in many countries, suggesting shifting social norms surrounding gender and alcohol consumption. These trends suggest that public health efforts to specifically target heavy drinking in women are necessary.
    Alcoholism Clinical and Experimental Research 09/2011; 35(12):2101-12. DOI:10.1111/j.1530-0277.2011.01562.x · 3.21 Impact Factor
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    • "Members of Cohort 1 were adolescents during the late 1960s and early 1970s when Sweden had a liberal alcohol policy that included allowing the sale of a new medium-strength beer in supermarkets whereas until then all alcohol was sold only in government owned retail outlets, and a reduction in the minimum age for purchasing alcohol from 21 to 20. By contrast, members of Cohort 2 were adolescents during the early 1980s when access to alcohol was more restricted, only beer with low alcohol content could be sold in supermarkets, government retail outlets selling alcohol were open only 5 days a week, and intensive drug information campaigns were undertaken in schools (Rosén and Haglund, 2006). "
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    ABSTRACT: Little is known about the long-term outcome of substance misuse by teenagers, this is especially true for gender specific consequences. To examine the prevalence of death, physical illnesses related to substance misuse, mental illness, substance misuse, criminality, and poverty in adulthood among two cohorts of individuals who as adolescents had consulted for substance misuse problems, to estimate the effect of sex on adverse outcomes, and to compare cohort effects. Individuals who had consulted a substance misuse clinic as adolescents during 1968-1971 and 1980-1984 were followed until 2002. Adverse outcomes were documented using information from Swedish national registers. In the older cohort followed to age 50, only one-in-five escaped all six adverse outcomes, while over half of subjects experienced at least two or more. Sex and the severity of adolescent substance misuse and delinquency were predictors of adverse outcomes. More women than men experienced physical illness and poverty in the older cohort while more men than women were convicted of criminal offences in both cohorts and presented continued substance misuse in the younger cohort. Men in the younger as compared to the older cohort had higher rates of substance misuse and criminal convictions. Adolescents seeking help for substance misuse problems are at elevated risk for multiple adverse outcomes later in life. Outcomes differ for women and men and by severity of adolescent misuse and delinquency. Few cohort differences in adult outcomes exist.
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