International Journal of Epidemiology, Vol 26, 100-109, Copyright © 1997 by International Epidemiological Association
G Corrao, P Ferrari, A Zambon, P Torchio, S Arico and A Decarli
BACKGROUND: Since the mid 1970s, a striking reduction in alcohol- related
problems has been observed in many Western countries. Liver cirrhosis
mortality is considered to be a major indicator of alcohol- related
problems in the general population. The aim of the present study is to
describe liver cirrhosis mortality trends in European countries between
1970 and 1989. METHODS: This is a descriptive study on liver cirrhosis
mortality in 25 European countries, and in four grouped European regions. A
Poisson log-linear age-period-cohort model is used to clarify whether the
recent trend in mortality represents a short-term fluctuation or an
emerging long-term trend. In addition, a descriptive comparison between
trends in per capital alcohol consumption and liver cirrhosis mortality is
conducted. RESULTS: In the whole European population and in that of Western
and Southern Europe increasing period effects were observed until the
second half of the 1970s followed by a decline in the next periods. In
Eastern Europe the decline in period effects started in the first half of
the 1980s, whereas in Northern Europe an increasing period effect was
observed until the second half of the 1970s, followed by a stabilization.
Similar trends were observed for per capita alcohol consumption. The age
effect analysis showed a continuously rising effect in Eastern Europe,
whereas an attenuation of the effect at around age 65 years was observed in
Western Europe. Intermediate patterns were observed in Southern and
Northern Europe. The birth cohort effect suggested that in the Western and
Southern populations mortality could continue to decrease over the next
decade, while in Eastern and Northern mortality is still rising and this
will probably continue for the next decade. CONCLUSIONS: The
age-period-cohort analysis allows targeting of health care and prevention
programmes based on future trends. Aetiological and prognostic factors act
differently in Europe. A better understanding of the trends would require
more detailed information on alcoholism treatment rates, alcohol habits,
viral hepatitic infections and other factors involved in the
aetiopathogenesis of the disease.
ARTICLES
Trends of liver cirrhosis mortality in Europe, 1970-1989: age-period- cohort analysis and changing alcohol consumption
Institute of Statistical and Mathematical Sciences, University of Milan, Italy.
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