Alcohol and Alcoholism Vol. 35, No. 6, pp. 601-611, 2000
© 2000 Medical Council on Alcoholism
QUANTIFICATION OF ALCOHOL-RELATED MORTALITY IN SWEDEN
Department of Community Medicine and Rehabilitation, Forensic Medicine, Umeå University, P.O. Box 7642, SE-907 12 Umeå and
1 Department of Statistics, SE-901 87 Umeå University, Sweden
Received 10 September 1999; first review notified 30 May 2000; accepted 13 June 2000
The main aim of the present study was to estimate total alcohol-related mortality in Sweden. For natural deaths, a meta-analysis carried out in Australia was updated to the end of March 1998, and pooled estimates of the relative risks were calculated for different diseases based on data from scientific studies that have been published in the international literature. The proportion of current alcohol drinkers from recent Swedish surveys, and the pooled relative risk estimates were used to estimate disease-specific alcohol-attributable fractions. Natural deaths ‘caused’ or ‘prevented’ by alcohol were estimated for the period 1992–1996. For unnatural deaths, all cases from 1992 through 1996 in Sweden were analysed (n = 23 132). Alcohol was regarded to attribute to the death: if the deceased was a ‘known alcoholic’; if the underlying or contributing cause of death was alcohol-related; if the deceased had an alcohol-related in-patient diagnosis during a 3-year period prior to death; if the case tested positive for blood alcohol. Person years of life lost/gained (<70 years) due to alcohol were also assessed. The assumptions underlying the attributable risk methods used to analyse alcohol-related mortality due to natural causes need to be borne in mind when interpreting the results on natural deaths. Moreover, the preventive effect of alcohol on coronary heart disease and stroke is still controversial. The findings of alcohol-related mortality due to unnatural causes were much more reliable. About 3.5% of deaths were attributed to alcohol; alcohol involvement was more than twice as common in deaths of males (4.8%) than in those of females (2.0%). About one-quarter of the deaths in those aged below 50 years were attributed to alcohol. In those (
69 years, alcohol had a net harmful effect in that it ‘caused’ more deaths than it ‘prevented’; 7% of deaths were in net ‘caused’. More person years of life were in net lost than were saved by alcohol, suggesting that alcohol has a negative effect on premature mortality. We conclude that alcohol accounted for about 3.5% of deaths in all ages, and 25% of deaths in those aged below 50 years, and about 10% of person years of life lost in Sweden. The balance of harm and benefit does not weigh in favour of making a recommendation to the public to drink in order to prevent death.
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