Trends 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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    • "The major impact of the observed changes in the period between 1968 and 2002 came from birth cohorts, while the effect of age and period were marginal and not statistically significant. In another study, trends of alcohol-related mortality were found to be influenced by period and cohort (Rosén and Haglund, 2006). Building on these analyses, the present paper aims at explaining changes in total alcohol consumption by modelling the independent effects of age, period and cohort. "
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    ABSTRACT: In Sweden, alcohol abstention has increased over the last 20 years and consumption has recently decreased after a peak in 2004. To understand the dynamics of these trends the present study aims at estimating age, period and cohort (APC) effects on trends in alcohol use prevalence as well as overall and beverage-specific volume of drinking over the last three decades. APC analysis of seven cross-sectional surveys from 1979 to 2011 was conducted using cross-classified random effects models (CCREMs) by gender. The nationally representative samples comprised 77,598 respondents aged 16-80 years. Outcome measures were 30-day prevalence of alcohol use and overall as well as beverage-specific alcohol volume. Trends in prevalence, overall and beverage-specific volume were significantly affected by APC. The period effects of prevalence and overall volume show a small decline after an increase up to the year 2005. Mean beer and wine volume levelled off after a peak in 2005 and volume of spirits drinking decreased constantly. Predicted alcohol prevalence rates in male cohorts (1945-1985) remained generally at the same level, while they declined in post-World War II female generations. Results point to high overall and beverage-specific consumption among cohorts born in the 1940s, 1950s and 1980s. High consuming cohorts of the 1940-1950s were key in rising consumption up to 2005. Progression through the life course of these cohorts, a decrease in prevalence and drinking volume in successive cohorts seem to have contributed to the recent downward trend in alcohol use in Sweden. © The Author 2015. Medical Council on Alcohol and Oxford University Press. All rights reserved.
    No preview · Article · Mar 2015 · Alcohol and Alcoholism
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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.
    Full-text · Article · Aug 2014 · PLoS ONE
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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.
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